Prisons Are Built With Bricks Of Law And Brothels With Bricks Of Religion, But That Doesn’t Prove A Causal Relationship

Research Suggests Psychiatric Interventions Like Admission To A Mental Hospital Could Increase Suicide Risk says an Alternet article about a study that specifically mentions that it should not be used to conclude that psychiatric interventions like admission to a mental hospital could increase suicide risk.

But I wouldn’t be so worried if it wasn’t based on a very similar editorial written by field experts and published in the Journal of Social Psychiatry and Psychiatric Epidemiology.

The study involved is Rygaard-Hjorthøj, Madsen, Agerbo, and Nordentoft (2013), hereafter just “Hjorthøj” because I like saying that word. Hjorthøj finds that people who receive psychiatric treatment are much more likely to commit suicide than people who don’t. For example, someone who gets psychiatric medication is six times more likely to commit suicide than someone who doesn’t; someone who gets admitted to a psychiatric hospital is a whopping 44 times more likely to commit suicide than someone who doesn’t. The authors observe a “dose-response relationship”, which means that the more psychiatric treatment you get, the more likely you are to kill yourself.

Now, you’re probably asking yourself at this point “Wait, were they just using perfectly healthy people with no psychiatric problems as a control group?” and the answer is yes. Yes they were. So this study is basically finding that people who get committed to psychiatric hospitals are more likely to be the sort of people who are going to commit suicide than people who do not get committed to psychiatric hospitals. I for one find this result rather reassuring.

The authors of the study are absolutely on board with this, saying that “observational studies such as the present one cannot establish causality, but merely associations”, and their conclusion is that “not only people with a history of of psychiatric hospitalization, but also those receiving only psychiatric medication, outpatient treatment, or emergency room treatment should be monitored more closely”. Sure. If you absolutely must have a snappier conclusion than “psych patients often mentally ill, more at eleven,” I guess that fits the bill.

But according to an editorial published in the same journal by two people who are not the original authors, it says something much more sinister:

The results of a study in this issue of the Journal…raise the disturbing possibility that psychiatric care might, at least in part, cause suicide.

A…bold hypothesis. Why should we privilege this hypothesis over the alternative possibility that suicidal people are more likely to seek (or get forced into) psychiatric treatment?

The authors understandably caution that ‘the association is likely one of selection rather than causation, in that people with increasing levels of psychiatric contract are also more severely at risk of dying from suicide.’ This is undoubtedly part of the reason for the association, but it is not possible to be sure that an element of causation may not also be contributing. Associations that are strong, demonstrate a dose-effect relationship, and have a plausible mechanism are more likely to indicate a causal relationship than associations that lack these characteristics.

And then the Alternet article picks this up and adds a different argument:

The Danish researchers argued that we were seeing the results of something like a cancer treatment study. Sicker people were appropriately getting into more intensive treatments, but unfortunately the sicker they were the more likely it was that they would still die, despite even the best of medicines. They also suggested that we may have therefore discovered the most accurate predictor of suicide we’ve ever found: The more someone seeks or is forced into psychiatric care, the closer they probably are on the trajectory towards suicide.

The only problem with this line of reasoning is that there’s no evidence to support it. Suicide is not a progressive illness like cancer; that is, there’s no evidence that people with suicidal feelings travel on a trajectory of ever-intensifying, ever-more-constant suicidal feelings while getting into ever more intensive psychiatric care until they die at steadily increasing rates along the way. If suicidality was in fact progressive in that way, we’d be much better at identifying where people are along that path and intervening at the right time to prevent suicides. Instead, completed suicides tend to be impulsive, related to a myriad of cascading, confounding, unpredictable factors, not much more common overall in people diagnosed with mental disorders than in the general population, and most often surprising to even those closest to the victims.

Okay, let’s stop talking about psychiatric disease and shift to murder.

Probably the best risk factor for murder that you will ever find, better than being abused as a child or doing drugs or having the MAOA warrior gene or whatever, is “previous contact with the police”.

Murder is not “progressive” (shut up, neoreactionaries). Much like suicide, there’s no evidence that murderers “travel on a trajectory of ever-intensifying, ever-more-constant murderous feelings while getting into more intensive police custody until they kill at steadily increasing rates along the way.” Instead it seems to be “impulsive, related to a myriad of cascading, confounding, unpredictable factors, and surprising even to those closest to the perpetrators.”

The link between murder and previous contact with the police will be strong. For example, previous murderers released from prison have a 1.2% chance of getting arrested for another murder within three years, compared to about a 0.0001% murder rate per three years among the general population. That’s a relative risk of 10,000x, which blows Hjorthøj’s relative risk of 44x out of the water.

The link will be dose-dependent. People who have previously only gotten warnings from the police will be less likely to murder than people who have gotten small fines, who are less likely to murder than people who have gotten probation, who are less likely to murder than people who have gotten short jail sentences, who are less likely to murder than people who have gotten long jail sentences.

The link even has a plausible causal mechanism. Contact with the police can seriously disrupt people’s lives, making them stressed and anxious and angry and hopeless, all of which are the sort of emotions that predispose someone towards violence.

Therefore, the police cause murder?

Here are some other links that are non-progressive, strong, dose-dependent, and have plausible causal mechanisms.

The link between getting detention and dropping out of school. Therefore, detentions cause students to become demoralized and drop out from school.

The link between ice cream sales in a city and heatstroke cases in that city. Therefore, ice cream contains toxic chemicals that cause heatstroke.

The link between having lots of bruises and being in an abusive relationship. Therefore, abusers only abuse their victims because they’re angry about how many bruises they have.

The editorial authors seem to have gotten the “strong, dose-dependent, plausible” criteria from an article on epidemiology (God only knows where the journalist got the non-progressive criterion from). I would bet that the epidemiology article either did not intend for it to be used in this way, or that it meant that these criteria provide only the most tenuous of possible links.

This is why the saying is “correlation doesn’t imply causation” and not “correlation does not imply causation, unless it’s really strong correlation, in which case knock yourself out.”

And this is why the article finds that even going to a psychiatric emergency room and being turned down for treatment increases your risk of suicide almost twenty times. I mean, in my ER patients only even see a psychiatrist for like half an hour. You’re saying a half an hour with a psychiatrist leads to a vigintupling of suicide rates months down the road? We might be bad. But we’re not that bad.

The sad thing is, I think there might be a point buried underneath all this.

You can’t conclude from an increased murder rate among people with criminal histories that the police cause murder. But the justice system does contribute to murder in its way by sticking hardened criminals together, traumatizing them, and failing to give them enough resources to rebuild their lives. The contribution of the criminal justice system to crime isn’t exactly a secret, it’s just not accessible with that methodology.

Likewise, I don’t disagree that contact with the psychiatric system can sometimes be harmful. Forced commitment can sometimes make people lose their jobs, or cause them stigma, or stick them in an unpleasant psychiatric hospital where they don’t want to be. While there are no doubt potential benefits as well, the weighing of the costs and benefits is something that hasn’t been investigated nearly as much as it deserves. I think forced commitment is an overused tool and would be glad to get some evidence backing me up.

But this paper contributes nothing to the discussion. All we know is there’s an association between psychiatric care and suicide, which was entirely obvious already. We don’t know how much of that association is causal, how much of it is selection, and how much of it is “it would be even worse without psychiatric care but psychiatric care can’t do everything.

The exact effect of psychiatric care on suicide is a topic worthy of further high-quality research and discussion. But this isn’t it.

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80 Responses to Prisons Are Built With Bricks Of Law And Brothels With Bricks Of Religion, But That Doesn’t Prove A Causal Relationship

  1. Did the post titled “Petty Internet Drama (Part 1 of ∞)” just disappear? What happened?

    • Scott Alexander says:

      Decided I agreed with the people who said it was unproductive, and got rid of it.

      • I respect your decision, but I think there was at least some worthwhile content in that post which I hope finds a home somewhere else. If you say nice things about a movement that says the kinds of things neoreactionaries say, that’s generally going to be treated as evidence that you’re a horrible person who shouldn’t be listened to—and not entirely without justification, the marketplace of ideas notwithstanding. Those of us who’ve read much of your writing know that you are not a horrible person who shouldn’t be listened to, but it might be nice to lay the case out explicitly somewhere, perhaps for the benefit of those who aren’t as familiar with your beliefs.

        Also there was at least one pretty good comment about being afraid to criticize leftists on Tumblr that didn’t even survive long enough to be preserved in Google’s cache, poor thing.

        • Scott Alexander says:

          All right, I’ve posted some of it in the relevant LW thread.

          • othercriteria says:

            There’s probably some allegory in how the negative karma to David Gerard’s comment induced by your comment causes the entire conversational subtree including both of your comments to go invisible.

      • drethelin says:

        I liked parts of it and am hoping you bring some of it back

        • blacktrance says:

          Seconded. It’s not quite SSC-quality, but it could have a place on Slate Star Stratchpad.

          • Sniffnoy says:

            Too long for SSS, I think. Post it on the LJ? 🙂

          • Rash92 says:

            Ok, can someone tell me what all the yvain sites are and what the differences are? I knew this site and he occasionally posts on less wrong, and he used to have another blog from ages ago he links sometimes, which all seem to have fairly similar content. Now I hear there’s a slatestar scratchpad, and a livejournal.

          • Anonymous says:

            No, they’re secret.

          • Matthew says:


          • jaimeastorga2000 says:

            @Rash92: He’s got this blog, his old blog/livejournal (squid314), his website (raikoth), his tumblr (slatestarscratchpad), and his lesswrong posts (yvain). Unfortunately, he does not yet have an account on getstungbymillionsofwasps.

      • Matt says:

        I enjoyed it, for whatever that’s worth. I thought it was a well-deserved smackdown of some nasty elements on the right and the left, as well as a decent piece of self-defence. I guess we all already knew how you feel about leftists who give up on intellectual integrity, but I think you did yourself a favour by clearly demonstrating your contempt for (some elements of) the neoreactionary movement.

      • Anonymous says:

        🙁 I thought it was brilliant.

      • Anonymous says:

        That’s a shame, it was interesting. Good thing the internet archive has a copy.

      • Jai says:

        I liked it, but I sympathize with not wanting combative language lying around where it could incite yelling.

        For what it’s worth – I don’t know what mistake was made by the fallen bloggers of the lost post that led them to think what they think, but I think you’re fantastic and have a pretty fantastic filter or content-worth-engaging-with.

        Maybe write another Utopia post, but just go absolutely nuts with it, break the world building, break the laws of physics, just write about what a very, very good world would be like. This seems like a good way to credibly communicate your caluesto anyone who isn’t completely hellbent on viewing you evil/degernate/untrustworthy.

        (just remembered that I took sleepy medicine right before writing this, may not be representative of sober Jai, reserve right to retract and/or laugh at later. Also I probably won’t remember posting this.)

        • Doug S. says:

          I find it somewhat ironic that the Communists and the Libertarians have basically the same utopia…

      • Qiaochu Yuan says:

        For what it’s worth, I think getting rid of it was reasonable, however satisfying it might have been to write and/or read (indulging in that kind of thing is a cognitive algorithm I distrust at all times and in all people).

        • I didn’t see the comments, but I agree the post wasn’t SSC-level. I feel like ‘war’-ish posts that make people’s blood boil need to meet an extra high level of quality. (… Though that may have the unfortunate consequence of making the best posts disproportionately too-inflammatory-to-share.)

        • I feel the same way. I found the post in my RSS feed, and read it from there once I found that the original had been deleted. It wasn’t bad, but I support Scott’s decision to eliminate it.

      • ckp says:

        My RSS reader gave me a cached version so I was able to read it after you had deleted it.

      • Liskantope says:

        I too see the reasons behind this decision, but at the same time thought the post contained some great points and was hopeful that some productive things would come out of the comments thread as well. It’s good to have some sort of meta-post now and then that displays to the wider online world what SSC stands for, while also giving the group of SSC-followers a chance to discuss how we feel about SSC and how the wider online world sees it.

        (Incidentally, I tried and couldn’t find the “relevant LW thread”, which goes to show how unfamiliar with LW I still am, I guess.)

        • Vaniver says:

          You can go to Yvain’s user account and look at his recent comments; this is the comment.

          The bits about Jim are sadly lost, but maybe Jim will let them be posted on his blog. 😉

          • Jaskologist says:

            Amusingly, the fact that Scott disappeared his original post would count as evidence supporting Jim’s claim that he’s now afraid to talk about politics.

            On the other hand, the fact that the newer version contains only the parts attacking leftwards undercuts that.

      • Vaniver says:

        Hmm. I thought it was productive–mostly because I agreed with you that you had tried the polite response and it hadn’t worked–and was unsure whether or not to post that. Now I see that I’ve fallen prey to the cooperator’s hesitancy.

        I think it would have been better to post it as a response to David_Gerard’s comment, as it is now, or to send it to him and say “I’m going to post this, would you like to comment?” (which has obvious drawbacks but gets some respect points). I know that time I was more critical than I endorse now of one of your LJ posts on LW I got flak for switching sites (which I had done for technical reasons), but when the thing you’re resentful of is posted in at least four places it’s harder to interpret ‘switching sites.’

        I think you did a good (almost great) job of keeping the mockery on the claims, where it belongs, and off the people. The primary hole I saw was the parts where you directly attributed intentions to David_Gerard, as he may not consciously endorse them, or made predictions about his future behaviors, as he may change them. That paragraph could have been worded as a cynical prediction that you hope he will do better than; either he shapes up and you can hope some part of that was your admonishment, or he doesn’t and you can be right all along. It’s not clear to me that branding someone as a radical is the best move, as opposed to saying “they’re at risk of being a radical; watch them closely.” I suspect it leads to more “hmm, would X make me a radical? Should I do it?” and less “yeah, I guess I am a radical. Time to ditch the few ethical compunctions I had that don’t serve me as a radical.”

      • roystgnr says:

        Probably not unproductive, but definitely not SSC style. Usually when you’re digging into someone you’re also making more effort at trying to find the pony.

      • Patri Friedman says:

        I think fisking of a popular nrx blogger who makes random false sweeping generalizations is useful. Usually his statements are about global cultural trends that are not so instantly disprovable by data. I feel like your post could get some people who care about truth, but never bothered to look into Jim’s accuracy, to realize that he just makes stuff up.

    • AR+ says:

      On a completely unrelated note, does anybody know how to view entities in the Firefox browser cache?

      Not that I’m actually trying to un-memory-hole this particular post! (There wouldn’t be a point if I was because it’s on the Wayback Machine anyway.) But this HAS brought to my attention that it feels like I should be able to, given how much tremendous and consistent effort is required to ensure that data I want deleted stays deleted, yet despite having something on my screen I may lose it forever because I refreshed without knowing it would be gone!

      (Funny thing about the Wayback Machine, it’s terms of use say users are not “…to copy offsite any part of the Collections without written permission.” If taken seriously this would mean you can’t view it’s webpages at all because the data has to be copied to your computer in any distribution system short of an encrypted server-to-monitor channel, so I should be able to save it just by stopping it from being deleted, if I knew how.)

      • Paul says:

        I have a copy in my RSS feed reader app, although I’ll refrain from posting it without Scott’s approval. (For the record, I think it should have stayed up. It IS petty internet drama, but it debunks a few nasty slurs using our favorite thing, facts & figures)

  2. Izaak Weiss says:

    I don’t understand how the title of this post relates to the body of the post. Anyone care to enlighten me how the two are correlated? (You don’t have to prove a causal relationship.)

    • Toggle says:

      The ‘Prisons are built with bricks of law…” bit is an old saying that refers to the ways in which some of our less savory institutions are a natural byproduct of people trying to create artificial distinctions between good and evil, or law and vice, or what have you, in the name of helping people be more virtuous. Scott was comparing that to the argument-from-correlation about psychiatric hospitals, I think.

      • DavidS says:

        Well, it’s a quote from William Blake (proverbs of heaven and hell). Not sure if the prisons bit was a preceding proverb on, yknow, earth.

        Incidentally, as usual not that clear what Blake means! But in the context of his other stuff I’d guess that what he’s saying is that trying to control human energy with law and religion leads to it coming out in distorted forms (crime and prostitution). So the equivalent in this area would be less ‘meeting a psychiatrist makes you commit suicide’ and more ‘the labelling of people as ‘mentally ill’ forces them into a distorted role and ultimately to their suicide’. Which I’m sure is at least a risk – the question is just how much risk exists already because of actual mental illness.

  3. Matthew says:

    and surpising even to those closest to the perpetrators.”

    Typo. Interesting, in that one sees “suprising” all the time for surprising, but I’m not sure I’ve ever seen “surpising” before.

  4. Anonymous says:

    I am sad to see Jaime’s comment disappear.

    • He probably just deleted it. It would be highly uncharacteristic of Scott to remove such a comment.

      • Anonymous says:

        Assigning blame does not assuage my sorrow.

      • lmm says:

        Scott does remove comments silently and without notice. I was surprised and confused when it happened to one of mine.

        • Scott Alexander says:

          Can’t remember the incident you’re talking about. Was it race or gender in the open thread?

          In any case, I didn’t delete Jaime’s.

          • lmm says:

            Yes it was (though one where you’d omitted the usual prohibition, and y’know, exception, rule and all that. More to the point, the first (visible) time this happened, you let the post stand). I was prepared to be banned but the silent disappearing was a real surprise, and annoying as I’d got halfway through reading a very interesting reply during my lunch break and then the rest wasn’t there.

  5. Alex Godofsky says:

    What is the point in responding to stuff posted on alternet? Isn’t it exclusively full of crazies?

    • Anonymous says:

      Does the War Nerd count as a crazy?

      • Paul says:

        In the best way. TWN has a solid record of correct predictions regarding asymmetric warfare, insight into the nasty ethnic-group-slugfest nature of insurgencies, and is a genuinely good if acerbic writer.

        He’s at Pando now, and I consider him the sole redeeming facet of that website.

      • Ilya Shpitser says:

        +1 to War Nerd, he’s a cool dude.

    • Scott Alexander says:

      I’m a little less worried about Alternet believing this stuff and a little more worried about it being in an editorial by two researchers in the field published in the Journal of Social Psychiatry and Psychiatric Epidemiology.

      I’ve edited to make that clear.

  6. Anonymous says:

    Wrong pop-science interpretation is wrong, obviously, but you’d have just as much trouble showing the absence of a vaguely blaming causation: If you show that psychiatrists *don’t* cause suicide, you could still say that the stigmatization of mental illness causes both psychiatrists to exist AND suicide among people who are mentally ill.

    This gets slightly more persuasive when you apply it to things like brothels, but I’m told that certain types of mental illnesses are less debilitating in cultures where they are not considered treatment-worthy – like cultures with schizophrenic shamans, for instance…but then, they also might be legitimately less ill in some environment-biological sense, which causes those cultures to not stigmatize it.

    It’s always hard to tell if the stigma or the negative correlation came first.

    • Anthony says:

      So both the original study and most of your examples are not counterexamples of “correlation implies causation”. In some cases, they directly imply causation, you’re just (deliberately) reversing the causation. In others, there’s a very good case that there’s an underlying causal factor.

      It may even be worth reporting that suicidal people actually do seek psychiatric help, in rough proportion to how suicidal they are. It would be distressing but believable that there was no correlation between seeking psychiatric help and being suicidal.

  7. dst says:

    dat snark tho

  8. Roman says:

    Yeah. The post (the one that you deleted) wasn’t constructive, but it was well written, and true, and may have given people a better understanding of you.

    It would have been better if you had made single posts in response to iindividual acts of stupidity on SSS, rather than than make a giant one with as many related grievances as you did. I don’t think much was gained in the synthesis.

  9. I’m a newbie here, so go easy on me, y’all. I’m very glad I found this blog. I love the content, the comments, everything.

    I wanted to comment on the psychiatry issue. Being a mental health clinician- I’m a psychotherapist- I see this problem on a weekly, if not almost daily, basis. Some people assume that just contacting a therapist will inevitably trigger that slippery slope into mental health hell. I see people misuse the exact data you mention, that taking a psychotropic drug or being diagnosed with some type of disorder will cause them to become even worse. But yes, as you say, there is a certain “guilty by association” factor. I think a lot of it depends on the quality of care.

    There has been a trend among mental health professional in the last 20 years or so to seek hospitalization for anyone who just casually mentions thoughts of suicide or even just thinking about death. This has definitely led to a ridiculous number of patients being hospitalized who never should have been. Their symptoms could have been managed at home and with outpatient staff. In many cases, psychiatric hospitalization is emotionally and physically traumatic. So some people emerge at discharge feeling worse than when admitted. Even truly suicidal patients will feign feeling better just to get the hell out of there.

    I work hard to prevent hospitalization and continued dependency on mental health clinicians. And to help those who have been hospitalized establish a sense of normalcy so they can avoid the “frequent flyer” points. I develop a strong bond with them in order to get them up and moving again in order to eventually find their own strength so as to not need me on a continued basis.

    I read with interest both of the topics you mentioned and the subject matter certainly rings true with my experience and knowledge. I look forward to lively debate and shared information on a variety of subjects. Think I’m going to like it here.

    • MugaSofer says:

      > I see this problem on a weekly, if not almost daily, basis. Some people assume that just contacting a therapist will inevitably trigger that slippery slope into mental health hell. I see people misuse the exact data you mention, that taking a psychotropic drug or being diagnosed with some type of disorder will cause them to become even worse.

      Well, that’s worrying.

      Do you think this is a widespread misconception creeping into almost-science, or a piece of easily-misinterpreted science negatively effecting the public?

  10. Ilya Shpitser says:

    I think one reason people might think a really _strong_ association might imply causation is because in order for that not to be the case, there has to be a very strong confounder explaining all of the relationship away. These are not _impossible_ to find (so there is still no implication), but not very common either.

    To be a bit more precise, there has to be a set of non-causal things that explain the strong relationship, some of it might be things like hidden common causes (non-causal marginal d-connected paths in the relevant causal diagram), some of it might be Berkson’s bias/explaining away due to selection (non-causal d-connected paths conditional on a descendant of two associated variables).

  11. Anonymous says:

    There is a causal link between people committing suicide and people talking about suicide. Therefore, people talking about suicide causes people to commit suicide. That’s even somewhat true according to Cialdini’s Influence. Goodness knows how many people Alternet killed by talking about such things!

  12. veronica d says:

    I think we’ve mentioned this before here (or maybe it was on Ozy’s blog), but there was a Swedish study a few years back that showed that people who have received gender reassignment surgery are more likely to commit suicide. Which, wow. But who was the control group? Against whom did they compare the trans people?

    Like you needed to ask. They compared post-surgical trans folks to ordinary cis people who are not remotely trans.

    So basically the same situation as you describe above.

    How is this study used? Do people read it responsibly and get its real message?

    Of course not. They take it out of context and weaponize it against transgender people. It now comes up in every stupid conversation about why trans folks should not be respected and should not get medical care.

    Arguments are weapons, even terrible arguments.

    • Liskantope says:

      This reminds me of terrible arguments used against gay people about why their “choice” to be gay is unhealthy: look at their higher suicide rate!

      • MugaSofer says:

        Has anyone tried doing a study on closeted vs. out gay people? Perhaps using those (admittedly rather awkward) pornography-arousal tests?

        • Susebron says:

          There are bound to be confounders, though. If someone is gay but is too afraid to come out, or hates homosexuality, there would probably be a higher rate of suicide as well.

          • RCF says:

            But that’s precisely the point: if it’s the fear and internalized homophobia that causes suicide, rather than homosexuality itself, then that an argument for trying to reduce homophobia.

  13. Liskantope says:

    I get the impression that in many disciplines, sometimes really obvious findings are published not necessarily because the researchers think they will surprise anybody, but because it’s necessary to lay a framework for more investigation into their underlying mechanics. I’m reminded of the “wug test”, which proved to the linguistic world that children naturally acquire an understanding of morphological rules rather than simply memorizing pairs of nouns and their plurals. I’m sure almost everybody with experience speaking a language with any inflection at all finds this completely obvious, but apparently it was pretty foundational in the study of how humans process language. I don’t know much about the state of psychological studies linking psychiatric care to rates of suicide apart from what I learned from this post, but I would like to believe that perhaps some similar benefits will come from the Hjorthøj article: now that it’s been scientifically established that this painfully obvious correlation exists, scientists in the area can start to pick apart the underlying mechanics of the correlation.

  14. roystgnr says:

    I like the suicide example and the murder counter-example. My past favorites:

    “…people with a history of using parachutes are more likely to die in skydiving accidents even when controlling for present altitude, people with a history of chemotherapy treatment are more likely to die of new cancer outbreaks even when controlling for current state of health, and scientists with a history of me mocking them on the internet are more likely to produce subsequent studies which fail to distinguish between obvious alternative hypotheses even when controlling for pass-rate of peer review.”

  15. Nornagest says:

    I’ve occasionally heard various sources alleging that there exists a particular species of very very stupid accessible only to people writing science editorials or popular science articles.

    At the time, I thought the idea was anti-intellectual, but now I’m not so sure.

    • Scott Alexander says:

      The weird part is that the editorial writers are doctors and university lecturers and seem to have a lot of pretty good publications. Part of the reason I wrote this was to see if I was missing something.

  16. “Proximity to other murders/murderers” might also be a risk factor:

    Of course, I’d like more evidence for this than a Slate article. But interesting if true.

  17. Thasvaddef says:

    Why did they do this study? Why was it funded? What could it possibly have proved? Why is anyone at all surprised it is being misinterpreted?

  18. Lambert says:

    Have any randomised, controlled, as-double-blind-as-possible studies been done?
    (randomly assign a group of new patients entering a programme of treatment from none to intensive and measure outcomes.)
    Navigating ethical issues seems like the biggest obstacle.

  19. Nikias The Random Blog Commenter says:

    The authors of the study are absolutely on board with this, saying that “observational studies such as the present one cannot establish causality, but merely associations”, and their conclusion is that “not only people with a history of of psychiatric hospitalization, but also those receiving only psychiatric medication, outpatient treatment, or emergency room treatment should be monitored more closely”.

    That’s not even a conclusion. It ignores the cost of additional monitoring both to society and the monitored person.

  20. RCF says:

    It seems to me that the phrase “A increases the risk of B” is problematic. The literal meaning of it is merely that A and B are correlated, but the apparent meaning is that A causes B.

    • Anonymous says:

      Yes, it is problematic, but what do you mean by “literal”? Do you mean “conventional”? I think that the literal meaning is cause: A is the subject of the verb; A is acting.

      Most of the examples of “increase” in this article, whether Scott’s words or quotes, are of the form “patients with increased A.” These examples have less ambiguity, but I think it is still worth the simple change of “patients with higher A.” There are a few cases with the more ambiguous but harder to correct “A increases B.” The proper form is “Conditioning on A increases B.” That is still active, but the technical word “condition” comes with the caveat that it is not about cause. But I don’t expect anyone to adopt this simply because it is more words.

  21. Paul Torek says:

    OK now I feel stupid for reading this post after the open thread post, but, my wife’s set of references contains two that are weakly related to your question:

    I think forced committment is an overused tool and would be glad to get some evidence backing me up.

    “Community treatment orders” aren’t the same thing, or as drastic, as commitment, but one plausible hypothesis that gets a boost from those studies would be that forced treatment tends not to work.

  22. Zanzard says:

    Maybe I’m not the first to say this, but this particular post sounds a lot like the posts of the blog The Last Psychiatrist.

    This is a compliment, by the way. I really like that blog (even though there’s very rarely any new posts there).