Contra Contra Contra Caplan On Psych

I.

In 2006, Bryan Caplan wrote a critique of psychiatry. In 2015, I responded. Now it’s 2020, and Bryan has a counterargument. I’m going to break the cycle of delay and respond now, and maybe we’ll finish this argument before we’re both too old and demented to operate computers.

Bryan writes:

1. With a few exceptions, Scott fairly and accurately explains my original (and current) position.

2. Scott correctly identifies several gray areas in my position, but by my count I explicitly acknowledged all of them in my original article.

3. Scott then uses those gray areas to reject my whole position in favor of the conventional view.

4. The range of the gray areas isn’t actually that big, so he should have accepted most of my heterodoxies.

5. If the gray areas were as big as Scott says, he should reject the conventional view too and just be agnostic.

I think the gray areas are overwhelming and provide proof that Bryan’s strict dichotomies don’t match the real world.

I also think, as a general philosophical point, that we ought to be suspicious of arguments of the form “the gray areas are small”. Even if this is true, and your model only fails in a few places, controversial questions are likely to be controversial questions precisely because they’re located where your model fails. Nobody challenges a model on an exactly typical case where everything makes sense. So if a point is under debate, let’s say in a fifteen year back-and-forth argument between two bloggers that’s attracted hundreds of total comments, the a priori size of the gray areas doesn’t matter. Even if your model is good at most things, you have strong evidence this isn’t one of them.

In this case, the model we’re debating is Bryan’s idea of constraints vs. preferences. My previous summary of this (which Bryan endorses) goes like this:

Consumer theory distinguishes between two different reasons why someone might not buy a Ferrari – budget constraints (they can’t afford one) and preferences (they don’t want one, or they want other things more). Physical diseases seem much like budget constraints – the reason a paralyzed person can’t run a marathon is because it’s beyond her abilities, simply impossible. Psychiatric diseases seem more like preferences. There’s nothing obvious stopping an alcoholic from quitting booze and there’s nothing obvious preventing someone with ADHD from sitting still and paying attention. Therefore they are best modeled as people with unusual preferences – the one with a preference for booze over normal activities like holding down a job, the other with a high dispreference for sitting still and attending classes. But lots of people have weird preferences. Therefore, psychiatric diseases should be thought of as within the broad spectrum of normal variation, rather than as analogous to physical diseases.

I countered by pointing out that this was in fact very analogous to physical diseases:

Alice has always had problems concentrating in school. Now she’s older and she hops between a couple of different part-time jobs. She frequently calls in sick because she feels like she doesn’t have enough energy to go into work that day, and when she does work her mind isn’t really on her projects. When she gets home, she mostly just lies in bed and sleeps. She goes to a psychiatrist who diagnoses her with ADHD and depression.

Bob is a high-powered corporate executive who rose to become Vice-President of his big Fortune 500 company. When he gets home after working 14 hour days, he trains toward his dream of running the Boston Marathon. Alas, this week Bob has the flu. He finds that he’s really tired all the time, and he usually feels exhausted at work and goes home after lunch; when he stays, he finds that his mind just can’t concentrate on what he’s doing. Yesterday he stayed home from work entirely because he didn’t feel like he had the energy. And when he gets home, instead of doing his customary 16 mile run he just lies in bed all day. His doctor tells him that he has the flu and is expected to recover soon.

At least for this week Alice and Bob are pretty similar. They’d both like to be able to work long hours, concentrate hard, and stay active after work. Instead they’re both working short hours, calling in sick, failing to concentrate, and lying in bed all day.

But for some reason, Bryan calls Alice’s problem “different preferences” and Bob’s problem “budgetary constraints”, even though they’re presenting exactly the same way! It doesn’t look like he’s “diagnosing” which side of the consumer theory dichotomy they’re on by their symptoms, but rather by his assumptions about the causes.

But Bryan doesn’t budge:

I’m unimpressed, because I not only anticipated such objections in my original paper, but even proposed a test to help clarify the fuzziness…can we change a person’s behavior purely by changing his incentives? If we can, it follows that the person was able to act differently all along, but preferred not to; his condition is a matter of preference, not constraint. I will refer to this as the ‘Gun-to-the-Head Test’. If suddenly pointing a gun at alcoholics induces them to stop drinking, then evidently sober behavior was in their choice set all along. Conversely, if a gun-to-the-head fails to change a person’s behavior, it is highly likely (though not necessarily true) that you are literally asking the impossible.

I then presented multiple forms of evidence that a wide range of alleged mental illnesses are responsive to incentives. Scott barely mentions said evidence.

Still, does this mean that the flu isn’t “really” an illness either? No. Rather it means that physical illness often constrains behavioral and changes preferences. When sick, the maximum amount of weight I can bench press falls. (Yes, I’ve actually tried this). Yet in addition, I don’t feel like lifting weights at all when I’m sick. Anyone who has worked while ill should be able to appreciate these dual effects. If you literally get sick, your ability and desire to work both go down. When you metaphorically get “sick of your job,” in contrast, only your desire goes down.

I reject the heck out of this answer. I agree the “gun to the head” test is a good summary of Bryan’s position, but we already agreed what Bryan’s position is. The only thing he’s adding here is a claim that the flu still qualifies as a real disease because it sometimes constrains behavior (the amount of weight Bryan can lift). But nobody cares how much weight they can lift during a flu! When we talk about having the flu being bad, we’re talking 0% about how much weight we can lift, and 100% about the sorts of problems Bob has – feeling too ill to go to work, not wanting to do things, etc. If Bryan searches hard enough, he can find a way the flu results in slightly weaker muscle strength. But if I search hard enough, I can find a way depression results in slightly weaker muscle strength. Neither of these things are what the average person thinks about when they think of “flu symptoms” or “depression symptoms”, and I consider them both equally irrelevant.

But if a change in weight-lifting ability really disqualifies the flu for Bryan, we can talk about other diseases.

What about shingles? It’s a viral infection that causes a very itchy rash. But sometimes (herpes sine zoster) the rash isn’t visible, and you just get really itchy for a few days. Like, really itchy. I had this condition once and it was just embarrassing how much I was scratching myself. But if you had put a gun to my head and said “Don’t scratch yourself, or I’ll kill you”, I would have sat on my hands and suffered quietly. For Bryan, an itch is just a newfound preference for scratching yourself. Shingles, like depression or ADHD, is just a preference shift, and so doesn’t qualify as a real disease.

Or what about respiratory tract infections that cause coughing? My impression is that, put a gun to my head, and I could keep myself from coughing, even when I really really felt like it. Coughing is a preference, not a constraint, and Bryan, to be consistent, would have to think of respiratory infections as just a preference for coughing.

Or what about migraines? Sure, people with migraines say they feel pain, but that’s no better grounded than someone with depression saying they feel sad. If Bryan is allowed to bring in concepts like “pain”, I’m allowed to bring in concepts like “sadness”, “anxiety”, etc. And since an anxious person feels anxiety and cannot stop feeling it even if threatened with a gunshot, the anxiety counts as a constraint, and so mental disorders are constraining. For Bryan’s constraints-vs-preferences dichotomy to work at all, he has to endorse a sort of behaviorism, where we need not believe anything that doesn’t express itself as behavior. And the only behavior we see in a migraine is somebody lying in bed, turning off all the lights, and occasionally clutching their head and saying “auggggh”. But put a gun to their head and demand they be in a bright room with lots of loud music, and they’ll go to the bright room with lots of loud music. Threaten to shoot them unless they stop clutching their head and moaning, and they’ll stop clutching their head and moaning. In Bryan’s model, migraines are just a newfound preference for saying “auggggh” a lot. Why medicalize this? Some people like saying “auggggh” and that’s valid!

Bryan’s preference vs. constraint model doesn’t just invalidate mental illness. It invalidates many (maybe most) physical illnesses! Even the ones it doesn’t invalidate may only get saved by some triviality we don’t care about – like how maybe you can lift less weight when you have the flu – and not by the symptoms that actually bother us.

II.

We need a model that lets us describe shingles as something more than “this person has a preference for scratching themselves frantically, and that preference is valid, nothing to worry about here”. I don’t have a beautiful elegant version of a model like this yet, but I think Bryan himself has gone most of the way to an at-least-adequate one.

In his post The Depression Preference, Bryan admits that most depressed people don’t want to be depressed. But he terms this a meta-preference – a preference over preferences. They have depressive preferences – for example, a preference for sitting around crying rather than doing work. They would meta-prefer not to have those preferences. But they do have them.

I agree this is a fruitful way to look at things, but I think we have to be really careful here, and that using the same term for endorsed meta-preferences and unendorsed object-level preferences is preventing this level of care. Let’s call endorsed preferences which people meta-prefer to have “goals”, and unendorsed preferences which people would meta-prefer not to have “urges”. I think this closely matches our intuitive understanding of these terms.

Suppose I created a sinister machine that beamed mind control rays into Bryan’s head and gave him an urge to constantly slap himself in the face. This urge could theoretically be resisted, but it’s so strong that in practice he never managed to resist it. It didn’t make him enjoy slapping himself in the face, or think this was a reasonable thing to do. It just made him compulsively want to keep doing it. He loses his job, his friends, and his dignity, because nobody wants to be around someone who’s slapping himself in the face all the time. I hope we can common-sensically agree on the following:

1. This is bad
2. Bryan would want to find and destroy the sinister machine
3. That would be a pretty reasonable goal for Bryan to have, and society should support him in this

This seems a lot like the shingles case. A sinister outside imposition (the viral infection) gives its victim an urge to constantly scratch themselves. It doesn’t make them enjoy scratching themselves, or think this is a reasonable thing to do. These people want to cure their shingles infection, and everyone agrees this desire is reasonable.

But this also seems a lot like some cases of OCD. Did you know that a subset of childhood OCD is caused by a streptococcal infection? So again, you get a sinister outside imposition (an infection) that gives its victim an urge to, let’s say, wash their hands fifty times a day. It doesn’t make them enjoy washing their hands, or think this is a reasonable thing to do (some OCD patients do believe their rituals are necessary, others don’t). These people want to cure their OCD, and I at least agree this desire is reasonable.

If you would support the sinister machine victim and the shingles victim, it’s hard for me to see a case for putting the OCD victim in a different category. I agree I’m using as clear a case as possible (most mental disorders aren’t obviously due to infections), but both Bryan and I are trying to avoid bringing specific facts about biology into this mostly-philosophical debate. The distinction between goals and urges turns what looked like an acceptable situation (these people are following their preferences, which is good) into an unacceptable situation (these people’s goals are being thwarted by unwelcome urges which they can’t resist).

I expect most of Bryan’s skepticism to focus on those last two words – “can’t resist”. He will no doubt bring up his gun-to-the-head test again. If we put a gun to the head of a shingles patient, they could stop scratching. So although we can be sympathetic to the trouble their unwanted new preference causes them, how can we recommend anything other than “just suck it up and resist the preference”?

The best model of decision-making I know of comes from research on lampreys. Various areas of the lamprey brain come up with various plans – hunt for food, hide under a rock, wriggle around – and calculate the “strength” of the “case” for each one, which they convert into an amount of dopamine. They send this dopamine to a part of the brain called the pallium, and then the pallium executes whichever plan has the most dopamine associated with it.

Suppose I have shingles. I’m giving a speech to a group of distinguished people whom I desperately want to impress. Then I get a very strong itch. Part of my brain calculates the expected value of continuing to speak in a dignified way, and converts that into dopamine. Another part calculates the importance of scratching myself vigorously, and converts that into dopamine. The pallium compares these two amounts of dopamine, one is larger than the other, and the decision gets made. If the itch is bad enough, and if whatever lizard-brain nucleus makes me want to scratch itches has enough dopamine to spare, then I never had a chance.

“But,” Bryan objects, “if I put a gun to your head, and threatened to shoot you if you scratched the itch, you wouldn’t do it, would you?”

In that case, a part of my brain calculates the expected value of continuing to speak in a dignified way plus not getting shot. This is a very high expected value! It sends lots and lots of dopamine to my pallium. The part of my brain calculating the expected value of scratching the itch and getting shot calculates this as a very low-expected-value course, and sends some a very low (maybe negative?) signal. The pallium decisively selects the plan to keep speaking and not get shot.

To summarize: the brain compares the strength of various preferences and executes the strongest. Anything that strengthens your urges at the expense of your goals makes you more likely to do things you don’t endorse, and makes you worse off. In a counterfactual world where a threatened gunshot is also weighing down the scale, maybe the calculus would come out different. But in the non-counterfactual world where there is no gunshot, the calculus comes out the way it does.

(also, if Bryan uses his gunshot analogy one more time, I am going to tell him about all of the mentally ill people I know about who did, in fact, non-metaphorically, non-hypothetically, choose a gunshot to the head over continuing to do the things their illness made it hard for them to do. Are you sure this is the easily-falsified hill you want to die on?)

This model doesn’t use the word or the concept of “choice” anywhere. There are various algorithms mechanically evaluating the expected reward of different actions, and a more central algorithm comparing all of those evaluations. Those algorithms could have resolved differently in different situations, and you can be uncertain how they will resolve in the same situation, but there’s no point at which they actually could resolve differently in the same situation. If this makes you want to start debating free will – in either direction – I cannot recommend this Less Wrong post highly enough.

A few examples to hammer this in:

1. Most weekends, Alice stays in and reads a book (preference strength 20). But today is her firstborn child’s wedding, which she has been looking forward to for years (preference strength 100). Just before she leaves for the chapel, she gets a terrible migraine, and she feels like it would be unbearable to go out of her room (preference strength 200). Since 200 is greater than 100, Alice misses the wedding and feel miserable, since she would have meta-preferred to go to the wedding. If you had threatened to shoot her unless she went to the wedding, she would have gone to the wedding and been miserable the whole time, because she is terrified of death (preference strength 9999) and 9999 is greater than 200.

2. Bryan is a responsible member of society and wants to work hard and take care of his family (preference strength 100). He drinks some alcohol, but because he has no genetic or environmental risk factors for alcoholism, it doesn’t make him feel any urge to drink himself to death (preference strength 0), so he doesn’t. If we CRISPRed him to give him every single alcoholism risk gene plus crippling anxiety, then drinking the alcohol would make him feel a very strong urge to drink himself to death (preference strength 200), and he would drink himself to death instead of caring for his family.

3. CRISPRed alcoholic Bryan goes to an addiction doctor. The doctor advises him to take the anti-alcoholism drug naltrexone (-20 preference strength for alcoholism). Then the doctor advises him to go to Alcoholics Anonymous and get a whole new friend group in which his status depends entirely on his ability to remain sober (+20 for staying sober). Now his preferences are “stay sober and take care of my family” (strength 120) vs. “drink myself to death (strength 180), but the preference to drink is still stronger, so he does.

4. Bryan goes to a therapist who asks him to visualize the things he loves about his family and why he thinks it’s important to take care of them, which makes this more vivid in his mind (preference +10 for sobriety). Bryan’s boss threatens to fire him if he misses one more day of work because of drunkenness (preference +20 for sobriety). Now he’s at 150 for sobriety vs. 180 for drinking. He gives $20,000 to Beeminder, which they will only give him back if he stays sober for the next year (+20 for sobriety), and he reads George Ainslie’s Picoeconomics which describes ways to reconceptualize choices across time to better account for all of their implications (+20 for sobriety). Now he’s at 190 for sobriety vs. 180 for drinking, so he stays sober.

5. A few months later, Bryan’s friend dies in an accident. He feels angry, depressed, and anxious. This makes alcohol seems more attractive, since it would temporarily help him forget these feelings (+20 for drinking). At the same time, he stops going to AA because it’s annoying and far away (-20 for staying sober). Now he’s at 170 for sobriety vs. 200 for drinking, so he falls off the wagon.

I’m not claiming this lamprey model is exactly literally true for humans. And I’m not claiming there’s a perfect binary distinction between endorsed goals and unendorsed urges. This model is full of complications and gray areas. I’m just saying it’s a better model, with fewer gray areas, than trying to separate everything into just “preference” or “constraint”, and shooting yourself in the foot again and again like some kind of tipped-over Gatling gun.

And it goes a lot of the way to modeling mental illness: the mentally ill have conditions that give them strong unendorsed urges. For any given strength of goal, having strong urges will make people less able to pursue that goal, in favor of pursuing the urges instead, and that will make them worse off, for a definition of “well off” that involves being happy and achieving goals. These people very reasonably want to stop having these weird urges so they can pursue their goals in peace.

Bryan will correctly point out that there are awkward implications in identifying “unexpected generator of strong unendorsed urges” with “disease”. For example, gay people in a traditional religious community will have strong urges to have homosexual relationships, and they won’t endorse those urges – they would probably rather be straight instead.

Or: obese people feel an urge to eat which they don’t endorse. Should we call obesity a disease, and describe them as having a disease which produces urges contrary to their preferences? Some people say yes (and keep in mind that both genetics and viral infections can induce obesity). But suppose some normal-weight person would rather be supermodel-thin, and their perfectly normal urge to eat a normal amount prevents them from looking like a broomstick. Is their normal level of hunger a disease? A naive equation of “biological generator of unendorsed urges” and “disease” would say yes!

We want some criteria that let us call shingles a disease, but don’t let us call “being thin but wanting to be even thinner” a disease. Unfortunately, there is no perfect solution to this problem. People have wanted perfect solutions to definitional questions ever since Plato defined man as “a featherless biped”, and it’s never worked. Luckily, there are kludgy, good-enough solutions, which I describe in Dissolving Questions About Disease, the fourth most popular Less Wrong post of all time. If you still think this is confusing, please read it. If it’s still confusing even after that, try The Categories Were Made For Man, Not Man For The Categories.

I think Bryan should be happy with this solution. It’s very libertarian. It says that it’s up to every individual to decide how to satisfy their own preferences (including meta-preferences). If your problem is constraints (you want to go to Hawaii, but you don’t have enough money), you can work to resolve those constraints (eg go to work and earn more money). If your problem is urges (you want to go to Hawaii, but you’re too anxious to leave your room), you can work to resolve those urges (eg go to a psychiatrist and get medication). The job of a good liberal society is to support people in achieving their own goals as they understand them, and this includes supporting their decision to get the job they want and their decision to get the psychiatric treatment they want.

As I write this essay, I’m a little bit caffeinated. I looked at my preference set – which included an urge to get back in bed instead of writing blog posts – decided it didn’t achieve my goals, and took a psychotropic drug to shift my preference set to one I liked better. And if we’re willing to accept this in relatively trivial cases, the argument for accepting it is even stronger for people whose preference sets have been deranged by obvious bizarre causes – infections, hormone imbalances, brain injuries, addictive substances, genetic defects – and for people whose irresistible urges are ruining their lives in preventable ways.

458 thoughts on “Contra Contra Contra Caplan On Psych

  1. Wizek

    I take some issue with this part:

    What about shingles? It’s a viral infection that causes a very itchy rash. But sometimes (herpes sine zoster) the rash isn’t visible, and you just get really itchy for a few days. Like, really itchy. I had this condition once and it was just embarrassing how much I was scratching myself. But if you had put a gun to my head and said “Don’t scratch yourself, or I’ll kill you”, I would have sat on my hands and suffered quietly. For Bryan, an itch is just a newfound preference for scratching yourself. Shingles, like depression or ADHD, is just a preference shift, and so doesn’t qualify as a real disease.

    It makes more sense to me — perhaps in accordance with how much I understand Bryan Caplan’s model — that there is no change of preference of yours here much at all. You always had the preference not to itch. It just wasn’t very visible to you by virtue of it always being trivially satisfied by itching-attacks rarely happening by themselves.

    Other times, e.g. when an ant crawls on you, it’s still almost trivially satisfied by you automatically scratching yourself once, which pushes the ant off your skin. You might not even fully register what happened and why your body had that sudden urge, you just keep on doing what you originally wanted to do in the first place.

    And in rare circumstances, your preference not to itch is almost impossible to satisfy. No matter how much you scratch yourself that virus makes sure to keep you from satisfaction until the infection lasts.

    So, in a sense, that’s actually a constraint! While previously you were not constrained from meeting your non-itching preference much at all, suddenly you are very constrained! Everything you do is constrained from working at relieving you.

    And all these constraints can be thought of as the part where the concept of illness still makes sense and empathy still has a place: Most can imagine how awful it is to have the preference not to itch, while having the constraint of no relief. This could be the pattern for illness in this model.

    Or more generally: the pattern for any kind of suffering. Because why are we clutching to the concept of illness in contrast to other kinds of suffering? Surely it is rather easy to think of illness that is merely inconvenient, while thinking of other kinds of ill that are devastating? For instance, I’d much rather have the itchy virus infection for a few days, which demonstrably intrudes from outside of me, infecting me biologically; than have my closest friends and loved ones die, which is demonstrably not an illness, yet more devastating and for longer. Since I also have the constant preference of wanting my closest connections to live, which is satisfied until the constraint of them not living anymore would intrude into my life.

    In conclusion, I propose the following as truce between the two warring conceptualizations: The framework of preferences+constraints seems hard to dismiss for me as a potentially valid and maybe even useful model. Not the only one, but definitely one of them. While we should acknowledge that even that model has space for the concept of illness and suffering within itself, which specifically happens when preferences collide with constraints. The bigger the collision, I think most of us should agree, the more tragic and worthy of help the situation should be considered.

    Am I making myself clear here?

  2. chridd

    (Expanding on Dacyn’s comment above.)

    I’ve been thinking more about the idea of budget constraints, and I think many budget constraints can be thought of as people having tradeoffs where people with less constrained budgets don’t, or that are more severe than people with less constrained budgets. E.g., someone who’s super rich can afford both an expensive house and an expensive car; someone who’s less rich might be able to afford either an expensive house or an expensive car, and has a tradeoff (the better the house the worse their car) that the super rich person doesn’t have. Someone even less rich would be trading off having an expensive car vs. having any house at all, or they might be trading off having an expensive car vs. not having a huge debt they’ll never pay off, or having an expensive car vs. not being wanted by the police for stealing a car.

    This would mean that the gun-to-the-head test doesn’t really work; a poor person faced with a strong negative incentive against not having a Ferrari may still be able to get a Ferrari… at some possibly-huge cost like being homeless and/or on the run for the police. And something similar could apply to at least some mental health issues, where they could put a lot of effort into sitting still and paying attention but it might come at the cost of losing sleep or risking burnout or not being able to do anything other than their job or something.

    (Also, the spoons thing is explicitly a metaphor for mental health in terms of budget constraints…)

  3. googolplexbyte

    I feel like something that modified your meta-preferences so that symptomatic urges became goals, would be considered a disease, and a terrifying one at that.

    Changing meta-preference can be a good thing of course. Convincing a gay person that their preferences are goals not urges seems like a positive thing to me. But if there was a virus that did the same thing that would not seem benign.

  4. philosophistry

    I wonder if instead of seeking to win an argument, we instead try to figure out what makes some debates endless. I see some hints at that in the comments where Scott mentioned that he is trying to honor the behaviorism framework set by Bryan. In which case, the source of the endless debate seems to be the mixing of morality and behaviorism.

    Psychiatry is only rent-seeking if it doesn’t work. In the 1970s, if you could visit a psychiatrist or take a pill that would cure homosexuality, based on the norms of that time, that would have been a good thing, and most people would have done it.

    So then really the question is what Scott mentioned as liberalism, which is, should we be okay with a profession that gives us the choice to keep trying to cure the incurable? For example, I could spend hundreds of thousands of dollars trying to cure my taste for a rap music and it would not succeed. Are all the psychiatrists that help me along the way rent-seeking?

    Another example would be cancer treatment in the 1970s, which has all the appearances of rent-seeking, simply because it didn’t work. But now that we’re gradually reducing the cancer death rate, it’s starting to seem less and less like rent-seeking. Likewise, it seems like psychiatry is slowly nibbling at more and more edge cases. And so depending on which time period in which you judge psychiatry, it will determine how much rent-seeking the profession seems like.

    Degrees of futility getting collapsed into the black-and-white of morality.

    1. Rana Dexsin

      (Oops, accidentally hit Report on this while trying to hit the spam below it. Disregard please.)

  5. MrSquid

    Having read through the arguments and counterarguments, I remain utterly baffled by Caplan’s position. A model in economics would be judged primarily on three criteria: does it match empirical observations, does it match theoretical expectations, and does it provide correct conclusions re: policy. Caplan’s attempt at modeling various mental illnesses as merely “extreme preferences” and not constraints fails on all three and thus is a bad model. I’m going to use ADHD as an example case, both because Caplan used it and because it’s well studied enough that there’s a general understanding of what causes ADHD and methods of treating it. Caplan views “Attention Deficit Hyperactivity Disorder (ADHD) as an exceptionally high disutility of labor, combined with a strong taste for variety.” It’s pretty trivial here to falsify this understanding empirically, as anyone who has experienced hyperfocus or been around a person with ADHD who is in hyperfocus state would find the idea that they are, at that moment, experiencing “exceptionally high disutility of labor, combined with a strong taste for variety,” to be pretty laughable. I wrote fifteen pages of my thesis during a particularly strong bout of hyperfocus and end up not eating for eleven hours as a consequence. Under Caplan’s theory, hyperfocus is a bizarre aberration. Preferences flip into something that would on its face be the opposite of a person’s natural state? But it makes perfect sense under the standard interpretation of ADHD as issues with regulation of attention. It also further does poorly in matching observations that persons with ADHD often have issues switching tasks and take longer to move from one activity to the next – what “preferences” are to explain this? So on empirical grounds, it looks like there’s two commonly observed ADHD traits that are pretty incongruous with thinking of ADHD solely as a set of extreme preferences (or attempts to model it as such).

    It’s also a terrible attempt theoretically. ADHD is very well studied, as far as mental illnesses go, and explanations of it are all pretty certain that dopamine is a key factor. Caplan’s model on theoretical grounds would have to contend with the scores of observations that persons with ADHD tend to have dopamine deficiencies and that these dopamine deficiencies make regulating attention and focus more difficult. Thus, theoretically, eliminating these deficiencies should treat ADHD. This matches empirical observations that medications which deliver additional dopamine do treat ADHD – perhaps not fully or completely, but at a non-zero level. But if additional dopamine is a treatment, and there’s no studies to suggest persons with ADHD could simply will additional dopamine into their body, that seems theoretically as more of a physical constraint than a preference. After all, medication is one of the leading ways to treat ADHD and generally is the most favorably rated by those getting treatment of any option. If it were physically capable to do so, it seems a likely bet that a majority of persons with ADHD would opt to simply create more dopamine as a treatment. Caplan’s preference model reveals the precise opposite of his conclusion, as it is revealed that most people with ADHD actually have a preference to be getting treatment and prefer the set of preferences under higher dopamine than under lower dopamine. This is pretty obviously suggesting a physical constraint and Caplan’s claims to the contrary strike as pretty naive.

    But the biggest issue, in my opinion, is the policy conclusions one would derive. If viewing merely as preferences, then the conclusion to “ADHD = disutility of labor” is “ADHD = unemployed”. And if he’s deriving this purely from economic standpoints, that seems desirable. After all, if they as employees are going to be harder to keep incentivised to work, why not simply hire people without these extreme preferences? It’s pretty obvious that this is a horrifically bad approach from an ethical standpoint, but it’s also one that doesn’t even work economically. Almost every recommendation from experts on ADHD notes numerous ways a boss can accommodate employees with ADHD that begin with the premise of treating it as a constraint rather than a preference. His model fails in the place it absolutely must work to be valid! The conclusions it would draw about persons with ADHD missing medications or deadlines are that they preferred not to meet them when the far more likely reality is that they simply could not remember without external reminders. As a simple thought experiment, what proportion of missed Adderall (or any other prescription) doses would have been taken if the person with ADHD was prompted by someone else saying they forgot their Adderall? If that proportion is higher than zero, it speaks pretty poorly of Caplan’s model.

    All of this is to further note that his model fails at key points when dealing with a relatively easy case to model. A model of ADHD as extreme preferences makes some sense intuitively and is what Caplan goes to as his representative illustration. But it still breaks down wildly and ends up purporting the worst myths and flawed assumptions about mental illnesses. And I must note that it is particularly galling that Caplan attacks in the original paper advances in diagnosing mental illnesses and claims “the progress of brain science and behavioral genetics sheds little light on deeper questions about the nature of mental illness.” He brings up the hypothetical of a discovery that a certain chemical causes love of chocolate and states this “would show that a preference had a biological basis – which presumably we thought all along.” But Caplan’s theoretical here shows the lack of serious thought. We have a discovery of a certain chemical which can treat ADHD symptoms – dopamine (and possibly norepinephrine) – and evidence that most people with ADHD would prefer the treatment. To hold that they nonetheless have preferences as described by ADHD symptoms assumes preferences they demonstrably do not prefer. It’s meaningless at best, actively damaging to those with mental illnesses at worst. Caplan is beyond intellectually wrong, he is morally wrong in his misguided attempt to claw back a domain that economists rightly abandoned long ago.

    1. Orion

      Caplan views “Attention Deficit Hyperactivity Disorder (ADHD) as an exceptionally high disutility of labor, combined with a strong taste for variety.” It’s pretty trivial here to falsify this understanding empirically, as anyone who has experienced hyperfocus or been around a person with ADHD who is in hyperfocus state would find the idea that they are, at that moment, experiencing “exceptionally high disutility of labor, combined with a strong taste for variety,” to be pretty laughable.

      This strikes me as a fruitful line of argument. Thank you for contributing it.

      …empirical observations that medications which deliver additional dopamine do treat ADHD – perhaps not fully or completely, but at a non-zero level. But if additional dopamine is a treatment, and there’s no studies to suggest persons with ADHD could simply will additional dopamine into their body, that seems theoretically as more of a physical constraint than a preference.

      This, on the other hand, seems to me to be missing the point. Caplan isn’t saying that people choose to have ADHD or that they would prefer to have ADHD. He’s saying that when we say someone “has ADHD,” we mean “they have an unusual and maladaptive set of behavioral preferences, for some reason.” It doesn’t damage his theory at all to say that certain chemical levels correlate with certain preferences, or that administering a drug to change someone’s brain chemistry can change those preferences.

      1. MrSquid

        Caplan isn’t saying that people choose to have ADHD or that they would prefer to have ADHD.

        A cleaner summary might be: people with ADHD can partially treat ADHD with stimulants, like Adderall, that provide additional dopamine. They cannot, without this medication, produce additional dopamine. It is clear that there is both a reported and revealed preference among many people with ADHD for treatment via medication than non-medication (both from the large number of people with ADHD who regularly take medication and from the self-reports of quite high satisfaction among those who take medication with the medication treatment). As such, if characterising the symptoms caused by dopamine deficiency, it is silly to count them a preference rather than a physical constraint: people physically cannot resolve those symptoms through changes in incentives alone. Thus even if the symptoms of dopamine deficiencies / dopamine mis-regulation are strictly in the realm of preferences, and none are considered physical constraints, the source of them is a physical constraint and treatment is most effective when considering the broader symptoms as such. This I think is a major flaw of Caplan’s dichotomy, as there are many components to mental illnesses that are in treatment functional as physical constraints (manic depression, for example, may be functionally modeled as alternations between two extreme sets of preferences. A regular course of treatment, however, is lithium.) and by classifying them as extreme preferences it implies that the treatments are mostly managing incentives. This conclusion is questionable at best.

        1. Orion

          I think the part of “physical constraint” that Caplan takes issue with is “cosntraint,” not “physical.” He isn’t saying that you shouldn’t look for physical interventions to correct the physical causes of your preferences. He’s saying that people are not in fact constrained by those preferences. (Incidentally, there are plenty of cases where “treatment as incentive management” works fairly smoothly. For instance, when my feet are sore, I have a strong incentive not to stand up. I can manage my incentives by using ibuprofen to alleviate the pain)

          I part ways with Caplan because I think psychiatric disorders are a lot more constraining than he does, but I don’t think conceding that they are physical would require him to abandon his current position on constraint.

          1. MrSquid

            He’s saying that people are not in fact constrained by those preferences.

            I don’t think conceding that they are physical would require him to abandon his current position on constraint.

            I think my distinction here is that Caplan is attempting to create a dichotomy where one should not exist. He is attempting to create a distinction between a physical constraint and extreme preferences which is fine within the confines of economics in which budgets are clearly distinct from preferences. But there are aspects of ADHD which are genuinely constraints and preferences! A much better way of thinking about hyperfocus, for example, is as a preference so extreme that alternatives do not even enter the choice set. There is no weighing during hyperfocus whether one should play video games for another eight hours or eat and workout like they had planned on – the focus is so extreme on video games that the alternative is not even weighed against it. And as my view about models, particularly economics models, is that they are only valuable in so far as they lead us to correct predictions, it seems quite clear to me that viewing hyperfocus as a preference so strong it artificially restricts the choice set is a better model. Why? Because the treatment “remind someone hyperfocusing of thing X they need/want to do instead” typically works better than “create harsh penalties for not doing thing X or strong incentives to do thing X”. This is kind of the objection I had in the third part of the initial post, but I think deserves to be stated explicitly that even if Caplan’s model is 100% correct, which I don’t think to be the case, that some alternatives which also appear to be correct and also have generally more accurate predictions about what treatments will work and why makes Caplan’s model inferior at best.

  6. Manx

    I really loved the image of Bryan Caplan irresistably slapping himself in the face. Thank you for that.

  7. TJ2001

    Let’s remember that there was a time that American Society at Large more or less believed that mental conditions were largely hereditary and incurable.. And what happened – we got lots of Asylums…. And I think many people here can agree that on the whole – this model made mental healthcare worse on average than better…

    My big concern here is to look at the reality of how things end up – not dream about how they would in some utopia that is not the one we live in…. The trouble is when we start talking about “These people are broken” and “Hereditary” and “We really can’t cure this” – it pushes society back towards institutionalization instead of coping again. That’s bad in my book.

    So lets be honest – the funding and staffing of an asylum is determined based on how many patients are enrolled… If you cure people or at least get them coping such that they can enjoy a more or less “normal” life in public – they don’t stay in asylums… Your beds empty out… Your funding drops. And with less prestige – you have more trouble attracting high quality administrators, doctors and therapists. Thus an evil self winding clock…

    No – lets structure our self-winding clocks to do good instead of evil…..

    The big change that happened in the 70’s and 80’s was to change the model to one where we WANT to have as many people as possible living more or less normal lives out in public and only use asylums for people who absolutely cannot cope in society.. This has pushed treatment strategies in this direction. AND it has driven development of medications and treatments to deal with “more difficult” conditions because the default position is “By law – they have to go home in a few days, but you can’t send them home like that…”

    In my book – it’s WAY better now than it was then. In that day – any hint of a “mental condition” got you institutionalized more or less forever. People would NOT admit to any sort of “mental issue” much less get treated because they feared losing their jobs, families, and being permanently institutionalized…. So they “Self medicated” with drugs and alcohol. They frequently ended up in and out of jail dealing or drifting with all these conditions more or less in secret….

    Now at least people Can get treatment with the end goal of getting them back into their life and family as quickly as possible….

    1. Aapje

      They kicked many people out of institutions in my country. Those didn’t suddenly learn to cope or to function in society, but end up getting the police called on them for dangerous or antisocial behavior (or they blow up their house, stab people, etc), whereupon the police typically throws them in a cell, which is not a kind environment.

      Ultimately, it seems to me that a balance needs to be found between institutionalizing people too easily vs not soon enough.

      Note that an institution doesn’t have to be like the one in One Flew Over the Cuckoo’s Nest.

      1. TJ2001

        Absolutely the change in society has taken a LONG time. I think in part because both “The System” and “The People” are more or less invested in keeping things as they are….

        Actual meaningful change is painful, expensive, and time consuming. In this case – the “change” had to be forced upon society kicking and screaming.

        The entire Mental Health field has spent untold millions of man hours and billions of dollars getting to where we are now 35-40 years later. Stuff that was basically a life sentence into an asylum 50 years ago can be pretty well controlled today. Many who would have been considered hopeless basket cases can now cope in society and have a more or less normal life.

        That’s progress in my book – even if it didn’t really seem like we were getting anywhere in any given year….

      2. cuke

        I don’t know if this was the case in your country as well — here in the U.S., the deinstitutionalization of a lot of people with severe mental illness coincided with dismantling networks of community-based mental health agencies that were publicly supported. Those community agencies provided an intermediate institution for people at risk of hospitalization if they didn’t get treatment and would have provided a buffer for people who were deinstitutionalized en masse as a result of policy changes.

        The movement of people from institutions to homelessness in many cities may have been significantly prevented by supporting rather than dismantling those community mental health agencies.

        1. Aapje

          Well, in my country these people did not usually become homeless, as they seem to get enough care to be able to live on their own. It’s more that some of these people have episodes of crazy behavior (or they stop taking their medicine), which is noticed if they live with others, who notice them acting weird. If these people live on their own, the weird behavior is often noticed much later, when it has escalated a lot, and by bystanders with no ability to help beyond calling the police, who in turn have little alternative but to toss the person in a cell.

          And that is the best case, where they don’t stab people or blow up their house.

    1. Andrew Cady

      lots of people have weird preferences. Therefore, psychiatric diseases should be thought of as within the broad spectrum of normal variation, rather than as analogous to physical diseases.

      There are distinct notions of the abnormal and the pathological. That’s why we can’t say:

      “Lots of people have weird physical attributes. Therefore all physical attributes should be thought of as within the broad spectrum of normal variation, rather than as physical diseases.”

      Modelling everything as preferences doesn’t justify rejecting the possibility of pathological preferences as distinct from abnormal preferences.

      (I imagine a 21st century psychiatrist would ask: “does the preference cause clinically significant distress or clinically significant impairment in social or occupational functioning?”)

  8. Majuscule

    Did you know that a subset of childhood OCD is caused by a streptococcal infection?

    This blew my mind, because when I was 8-9 years old I had 6 strep infections in about a year, which coincided with transient symptoms of OCD. I never had a diagnosis of childhood OCD, but descriptions I’ve read are exactly what I experienced. Both the recurring strep and the OCD behaviors vanished by age 10. I had never considered they might have been related, which would be just wild.

  9. thedude

    Amazingly, in his post, Caplan implicated himself with his own words in needing to resist an urge which was not alligned with his preferences:

    I didn’t read his critique because I knew that if I read it, I could easily spend a week reflecting – and composing a reply.  I knew, moreover, that until I wrote my reply, I would think of little else.

  10. Deej

    Caplan is a clever idiot. Clever in that he can do logic with assumptions and definitions, and write well. Idiot in that he can’t see his own bias. Constantly there’s a little voice in his head telling him that the difference between them and him is that he’s right.

  11. wonderer

    Bryan will correctly point out that there are awkward implications in identifying “unexpected generator of strong unendorsed urges” with “disease”. For example, gay people in a traditional religious community will have strong urges to have homosexual relationships, and they won’t endorse those urges – they would probably rather be straight instead.

    You haven’t answered Caplan’s question: why should homosexuality not be considered an illness?

    It isn’t because calling it an illness is mean and would automatically feed into millennia of Christian homophobia, even though that’s what a lot of people believe. The mainstream Christian view is not that homosexuality is a mental illness; in fact, that wasn’t even a meaningful category in people’s lexicon in Biblical times. Homosexuality is wrong (according to the Christian view) because it is a sin, just like adultery, theft, or greed. The conservative position in the US has long been that homosexuality is a choice; the liberal position is that it’s innate. Few people choose to be ill, whereas many illnesses are innate. Since people tend to have more sympathy for the ill than for the immoral, calling homosexuality an illness is not necessarily anti-gay.

    Furthermore, homosexuality is similar to other mental illnesses in its detrimental impact on quality of life. Gay people in very religious communities are not happy about their orientation, especially if they can’t get out of the community easily (i.e. if the community was Saudi Arabia). If there was a cure, most of the world’s gays would take it, and their quality of life would noticeably improve. How is this different from the alcoholic who prefers not to have an urge to drink, or an ADHD patient who prefer to resist the urge to get distracted? If cheap and effective gay conversion therapy was invented, I’m guessing psychiatrists would not offer it because homosexuality is not classified as a illness. Yet gay conversion therapy would drastically increase the quality of life of gay people in Saudi Arabia, to take one example. For one thing, they won’t be beheaded! Even if the therapy had side effects, surely a mentally competent adult can weigh the costs vs. benefits as they do for other treatments.

    Of course, many gay people are perfectly happy with their orientation and deeply value the friends they made in the gay community as well as their own identity as a member of that community. More power to them. That doesn’t mean homosexuality is not an illness. After all, a lot of autistics don’t want a normal brain because their condition is part of their identity, and in cases of mild autism, their condition might even benefit their career. That doesn’t mean autism is not a mental illness. There are blind and deaf support networks that their members strongly identify with and see tremendous value in. That doesn’t mean blindness and deafness are not physical illnesses.

    Clearly, the designation of conditions as illnesses has some political component. When we say a condition is an illness, we mean that the condition is bad for the patient, AND that society should work to reduce the incidence of the condition. These aren’t sufficient criteria for illness, but they seem to be necessary criteria. It is not politically feasible to say that society should work to reduce the incidence of homosexuality when LGBT activism is an important component of the political identity of half the population. Left-wing LGBT activism triggers right-wing hostility while solidifying the LGBT identity; the hostility induces more left-wing activists to advocate for LGBT issues, and on and on the cycle goes. This is very similar to the process of ethnogenesis, the formation of a nation.

    With a solid core of self-identifying LGBT people that half the population has staked their political identity on defending and the other half has staked their political identity on opposing, anybody advocating “treating” gayness would be immediately (and probably rightly) be seen as homophobic. The person advocating treatment would be accused of something akin to genocide. The left wing would quickly rally to defeat the genocidal maniac, while the right wing wouldn’t be particularly kin on defending him because they don’t agree homosexuality is an illness and have never thought that. The political and religious salience of homosexuality is what makes it politically impossible to classify as an illness. From a purely medical perspective, it ticks all the common boxes for an illness:

    1. Is it rare (not normal) in the population? Yes, it has a prevalence of at most a few percent.
    2. Is it detrimental to oneself? Definitely. Being gay makes dating much harder, to say nothing of the guilt and persecution that’s still ubiquitous in most of the world.
    3. Is it detrimental to others? Minimally, but yes. Aside from the risks inherent in gay sex (i.e. HIV/AIDS), homosexuality hurts parents who want grandchildren, and relatives who fear for the gay person’s soul.
    4. Do most patients want it treated? Yes. Most gay people today live in intolerant societies and share the society’s values.

    1. rahien.din

      “Detrimental to oneself” does not include “other people will persecute you” because symptoms are not exogenous.

      IE, if persecution is a symptom, it is a symptom of the persecutor, not the persecuted.

      1. wonderer

        Why does it matter if the symptoms are exogenous? If I murder someone and get sentenced to death, that murder was clearly detrimental to my health. The fact that the detriment was externally opposed doesn’t change the fact that I’m about to die. Similarly, if I’m schizophrenic and nobody wants to be anywhere near me, or I’m bipolar and no employer wants to hire me, those effects are clearly detrimental to my well-being. The fact that the detriments are imposed by others doesn’t change the fact that my quality of life is now in the dumps.

        1. rahien.din

          Symptoms originate from the patient’s state.

          It is nonsense to claim that Alex has the disease when the primary symptom is Bob’s actions.

        2. Simon_Jester

          Because me living in a society where people punch me in the face every time I sneeze, severe facial bruising still isn’t a symptom of hay fever. It’s a symptom of being punched in the face.

          The correct prescription is “people, stop punching each other in the face,” not “people, learn to stop sneezing when you have hay fever.”

          There is a fundamental difference here between symptoms that present real problems for other people, and problems that present imagined or self-selected problems for others.

          Now, these kinds of problems (real versus imagined) may exist on a sliding scale. I could decide to ignore the problems your bipolarity causes me as your employer if I really try and don’t care about losing money, but I could very easily decide to ignore the fact that my people’s customs require me to punch you in the nose for sneezing.

          But the scale exists. Bad consequences you decide to impose on other people to punish them for actions you disapprove of do not have the same moral weight as bad consequences that occur as an effect of the actions no matter how anyone chooses to feel about them.

    2. MrSquid

      1. Is it rare (not normal) in the population? Yes, it has a prevalence of at most a few percent.
      2. Is it detrimental to oneself? Definitely. Being gay makes dating much harder, to say nothing of the guilt and persecution that’s still ubiquitous in most of the world.
      3. Is it detrimental to others? Minimally, but yes. Aside from the risks inherent in gay sex (i.e. HIV/AIDS), homosexuality hurts parents who want grandchildren, and relatives who fear for the gay person’s soul.
      4. Do most patients want it treated? Yes. Most gay people today live in intolerant societies and share the society’s values.

      I find none of these all that convincing and think there’s more than a little here that is kind of offensive mischaracterisations. Prevalence is hard to strike down exactly, as there are many reasons to doubt self-reporting on this metric more than normal, but studies on the subject regularly find that heterosexuality is overstated – most people are not strictly heterosexual nor strictly homosexual, and lie somewhere in between. The degree might not practically matter, but to conclude “at most a few percent” is very at odds with sex studies.
      The “detrimental” aspect is not just wrong, it is offensively so. The “risks inherent in gay sex (i.e. HIV/AIDS)” is not only a homophobic trope that has a long history of being used to excuse both anti-gay policies and to excuse inaction on studying and treating HIV/AIDs, it’s also not accurate. There’s no inherent risk that is not present with anal sex in heterosexual couples and the common risk is rather the lack of condom use (in part due to, especially in the United States, sex education that focuses solely on the risk of pregnancy and makes little note that there are risks in unprotected homosexual sex). Beyond that, the incidence rate among homosexual women is lower than that of heterosexual women or heterosexual men. Are we to conclude that heterosexuality is more inherently risky than lesbianism? As for guilt and dating, it is inherently absurd to say it is detrimental when the sole detriment is a societal reaction. Otherwise, one could by this metric very well claim that blackness is an illness: it carries a higher risk of sickle-cell anemia, blacks in the United States tend to have lower incomes and worse employment rates, racists are “minimally” harmed by it.
      And the treatment is a giant citation needed. It is a pretty extraordinary claim in all regards and without actual proof that “most” homosexuals want “treatment”, despite widespread activism against conversion therapy by homosexuals, my prior is that this conclusion is false.

  12. Purple Tortoise

    The strongest argument on Caplan’s side is that psychiatrists themselves treat mental disorders as a matter of preference rather than biology.

    Case in point: in her middle age, my mother developed paranoid delusions. There were no hallucinations, no voices in the head, no psychosis, no fantastical stories — all was very prosaic, and it was only possible to determine she was deluded by having independent knowledge of the facts. As time went on, it became impossible for her to get along in society, and she became homeless. Nonetheless, she continued to insist nothing was wrong with her mentally, and absolutely refused to cooperate with anyone trying to help her. Due to her paranoia, she would not comply with rules and bureaucratic procedure.

    My mother lived on the street for decades, largely out of contact with her family, and her delusions and her health worsened. She was brought to the hospital with severe gangrene in her feet, but she insisted that the black, dead flesh falling off her feet was black tape, and if it were removed, healthy toes would appear underneath, and then set about to picking bits off while one watched in horror. I asked that my mother be given a psychiatric evaluation but unfortunately was not there when the psychiatrist stopped by. The psychiatrist talked with her for a couple minutes and ruled that she was mentally competent. I called the psychiatrist afterward, and the psychiatrist explained to me that my mother was suffering from Delusional Disorder, which so far as I can tell is nothing more than a label for a particular behavior. But suffering from Delusional Disorder is not a cause for involuntary confinement, even if one thinks that one’s gangrenous toes are only covered by black tape, so my mother was free to leave the hospital and hobble back on the street, which she did as soon as she could.

    Several months later my mother was brought back to the hospital, and the orthopedist wanted to amputate her feet to save her life. My mother refused, so a psychiatrist was called in. The psychiatrist talked with my mother for a couple minutes and decided what needed to be done was for the orthopedist to better explain the situation to my mother. The orthopedist had already done that, of course, and talking it over a second time accomplished nothing. An elderly, old-school doctor thought the whole business of calling in psychiatrists was stupid when a family member was there to give consent to a procedure, and eventually the amputation was carried out against my mother’s will and with my consent. My reasoning was that since my mother prized her own life above everything else, by consenting to the amputation I was doing what she wanted in the big picture.

    In my opinion, psychiatry isn’t science or medicine; it is voodoo. Every society needs a way to determine whether someone is competent to make decisions, and some societies have priests and others have witch doctors — our society has psychiatrists. And psychiatrists are wise beyond the common man — an ordinary person might view someone who insisted gangrenous toes were nothing more than black tape as unable to make mentally sane decisions for oneself, but psychiatrists know better. Psychiatrists can even make such wise decisions after only talking with someone for a couple of minutes. Clearly the psychiatrists viewed my mother’s mental condition as a case of preference because they refused to do anything against her will.

  13. cando19

    Bipolar economist here. I think both of your arguments have merits of truth—yours more so than his, although I’m still not sure what the takeaway is supposed to be (besides “Bryan is wrong”). Admittedly, Bryan is wrong to think that mental diseases can be boiled down to extreme preferences. My condition is very much inherited, and my extreme preference is that I wasn’t a manic depressive. But I agree with him in one regard: the preferences-versus-constraints breakdown is different when it comes to mental disease.

    But by trying to “model” this, you’re both set up to fail. Models are supposed to explain the unknown, with the goal of prediction. Models also rest on some pre-existing knowledge, which guides the assumptions we make. So I’m not sure there will be a satisfactory model of mental disease until we gain a rudimentary knowledge of what the hell it is. If there’s one thing to learn from the decades-long wild goose chase in depression research, we still have a long way to go. (Becker and Murphy’s theory of rational addiction feels like an exception to this because it’s awesome, but their model targets a specific behavior—self-medication—which is correlated with both mental and physical disease.)

    You rightfully stress the gray areas then use them to dismiss Bryan’s point altogether, which feels dichotomous and ironic. From what I can tell, there are two tenets in both of your arguments: 1) all humans face preferences and constraints; and 2) physical and mental health is associated with said preferences and constraints. Since the current science shows that physical disease is more likely to follow a predictable treatment path (on average), and that mental disease is more misunderstood in terms of both diagnosis and treatment (on average), the logical conclusion is that mental and physical health affect preferences and constraints similarly sometimes, differently more times, and the casual pathway may go in both directions. In other words, it’s an endogenous mess. Thus, a model may do more harm than good.

    Economists don’t take the Hippocratic oath and compulsively model everything, so Bryan’s approach doesn’t surprise me. But yours does. I don’t understand why psychiatrists insist that mental disease is “analogous to physical disease.” I unfortunately have both and they’re decidedly not analogous, although there is some overlap. I do think you’re doing it with good intentions, to validate mental diseases at large, to destigmatize. But I’m starting to think that the certainty you express when dismissing Bryan’s points, which is widespread in your field, isn’t helping us. It’s the type of certainty that got me involuntarily committed—a full-fledged constitutional crisis that few want to acknowledge, so I appreciate the libertarians’ attention to this. It breeds confirmation bias and dismisses too many folks’ lived experiences. It leads to mismanaged medication regimens based on weak evidence, which caused my hair to fall out (I’d take another involuntary commitment to get it back). And it ultimately takes away our agency, with the best of intentions.

    To be clear, mental health is just as important as physical health. I just think that ignoring or dismissing their fundamental differences is suboptimal. Most measures of “success” in the mental health space—diagnostic prevalence, suicides, drug and alcohol overdoses, self-reported mental health—suggest that we’re more miserable than ever. Maybe it’s because we’re insisting that mental health is something it’s not.

  14. kalimac

    I’m going to strengthen Scott’s point by opining that the “gun to the head test” doesn’t always work. Scott says that if he’s coughing, and someone put a gun to his head and told him to stop coughing or get shot, he’d stop coughing.

    I don’t think I could do that.

    I attend a lot of chamber music concerts. When I’m there, I have a very, very strong motivation to not cough. Yet if I have a cough, and it’s too strong to be suppressed entirely by medication, I can’t prevent it. So in those cases I just don’t go to the concert.

    It’s weird, because, unlike sneezing, coughing is a voluntary action. I don’t cough unless I decide to. Yet, if I need to, the need is so overwhelming that I have to decide to do it.

    I’m trying to parse this against things like smoking, or compulsive hand-washing. Does the need get so overwhelming like that? Yet, what if you feel this need, but you don’t have a cigarette, or there’s no wash basin nearby. What do you do then?

  15. Kamil Przespolewski

    ‘Gun-to-the-Head Test’ reminds me about similar argumentation from one court case (emphasis added):

    The prosecutor argued that the patient’s hyper-sexual behavior in some situations but not others was evidence for volitionally controlled criminal behavior; that it was incompatible with a neurological cause. For example, he downloaded and viewed child pornography at home but not at work. We responded that patients with neurological disorders may restrain their urges when in socially inappropriate places and only give vent to them in selected settings. For example, a Parkinson’s patient in a hyperdopaminergic state may compulsively masturbate in his bedroom but not in public. Neurological disease often changes the threshold for abnormal behavior, but does not make behavior indiscriminate.

    Julie Devinsky, Oliver Sacks & Orrin Devinsky (2010) Klüver–Bucy syndrome, hypersexuality, and the law, Neurocase, 16:2, 140-145, DOI: 10.1080/13554790903329182

    There is episode of Radiolab based on this story.

    1. cuke

      This is a good one: “Neurological disease often changes the threshold for abnormal behavior, but does not make behavior indiscriminate.”

      This is the case for a ton of what we call “mental illness.” A person is coping okay but along comes a new stressor and it tips them into not functioning so well. People usually show up in doctors’, psychiatrists’, therapists’ offices at those moments, where one more stressor has been added. And then the goal is often to lower the threshold by helping the person expand their coping repertoire (and/or medication that lowers the level of nervous system reactivity to the stressor).

      The way behavior is so complexly determined by inside and outside factors that are constantly changing over time makes the “preference” model too simplistic to have much explanatory power (IMO).

      1. cuke

        The back and forth here about whether someone can resist coughing belongs here in the same sense. We all vary as individuals in our sensitivity to what we might call cough impulse; we experience cough differently; we have different histories around cough. Sometimes a cough is really strong and sometimes not. If we’re tired or run down or dealing with other things, we may not be able to resist the same cough we could yesterday.

        In the face of all that variety and change, how do we make a fixed conclusion about whether cough is optional? Just because a behavior was changeable or resistable or optional in one person or at one time, does not make it so for another person or for the same person in other circumstances.

        See also: gag reflex

  16. chridd

    > Dissolving Questions About Disease

    I think the beginning of that post might be helpful in explaining a thing that feels weird to me in debates about this topic…

    My position is something closeish to her sister’s view (not absolutely, more that I think society is too far in the other direction), and my starting assumption is that the debate is between her doctor and her sister; her husband’s view seems weird to even consider in most cases (at least as a serious policy position rather than just being a jerk). However, some people (in this comment section and elsewhere) seem to be assuming that the debate is between her husband and her doctor, and aren’t even acknowledging her sister’s position (including people who I’d expect to be on my side strongly supporting “it’s a disease” and claiming it’s the more compassionate/less jerkish position).

    Furthermore, I associate claims of “it’s a disease” with people who seem actually maybe more towards her husband’s side, vs. other people seem to assume “it’s a disease” is the opposite of her husband’s side. Possible explanation is that the people I most strongly disagree with are somewhere between her husband and her doctor, whereas I’m somewhere between her doctor and her sister… even though her husband and her sister are both anti–it’s-a-disease and therefore could easily be confused with each other. (…and it looks like different people in this comment section are making different assumptions about which view Caplan has.)

    I guess my conclusion is that maybe we should be more explicitly acknowledging the difference between her husband’s view and her sister’s view? (…also wondering if this distinction, and the existence of confusion about this distinction, generalizes to more general political positions…)

  17. caryatis

    I’d like to respond generically to two weak arguments that I’ve seen repeatedly made in these comments.

    1) >Caplan only thinks this because he has zero experience with mental illness.

    This is a remarkably weak and uncharitable argument, and I’m disappointed to see it made here. It’s the equivalent of saying “Check your privilege—you don’t have a mental illness, so you must be wrong”—except it’s even weaker than that, because no one has presented any evidence that Caplan lacks experience with mental illness. (I would be surprised if someone could reach the age of forty-something without ever even knowing a person with a mental illness, but that’s beside the point.)

    Even if it were true that Caplan had zero experience with mental illness, there are demonstrably people who do have such experience who agree with him. Szasz himself was a practicing psychiatrist/psychoanalyst, and if you look up the Mad Pride movement, there are many people who question ideas of “mental illness” who have extensive experience in the system as patients, doctors, or both.

    This is fundamentally not a debate about facts—it’s about values and philosophy, and it should surprise no one that reasonable people with the same information or experience about mental illness can disagree.

    2) >I’ve been mentally ill and it didn’t feel like expressing a preference.

    This argument is less weak, but still of limited value. Don’t overgeneralize from your own experience. It may be that different people experience mental illness differently, or it may be that different types of mental illness are…different. I find it more plausible, for instance, to categorize depression and anxiety as “illnesses” because they are experienced as aversive by the person with them. But it’s a lot less clear that this applies to things like the personality disorders, mania, or psychosis, where the person having that experience (or that personality) often does not seek to end the experience. Sometimes people diagnosed with a personality disorder will think, “What do you mean, disorder? This is just my personality and it’s just fine.” That experience of mental illness is just as real as that of the severely depressed person who would do anything to stop feeling that way.

    It’s also possible, by the way, that the way mental illness feels to you is not a reliable guide to what the reality is. See Freud, concept of the unconscious, etc.

    Other point: this isn’t just an academic debate. Szasz/Caplan are NOT trying to “shame” people diagnosed with mental illnesses, and I have no idea why anyone would imagine they are. Thoughtful people *should* be interrogating the line between normal and “illness,” both because it’s inherently interesting and because it stops us from taking our society’s dogmas so seriously that we enable human rights violations.

    People are still forced to take psychiatric drugs and still forced into institutions. Yes, I know Scott has made the point that this does not happen as much as it did 50 years ago, but it still happens, especially with children and teenagers, elderly people, and people in prison. *Any* forced treatment is an unacceptable abuse of human rights, and accepting that some people labeled as “mentally ill” do not want treatment and do not think anything is wrong with them is an important step towards stopping this abuse.

    1. notpeerreviewed

      But it’s a lot less clear that this applies to things like the personality disorders, mania, or psychosis, where the person having that experience (or that personality) often does not seek to end the experience.

      I agree with that but to my mind that puts me on Scott’s side, not Caplan’s. My impression is that Caplan claims that *all* mental illness can be explained as extreme preferences. I don’t have a problem with the idea that *some* of the things that we label mental illnesses have been mislabeled.

    2. rahien.din

      You seem (Caplan seems, Szasz seems) to be concerned with not discounting the patient’s lived experiences and not forcing upon the patient a treatment plan despite their metapreferences. This is a genuine problem, and it is very valid to feel – as we all here do – the impulse to help persons who are so in extremis, and to do so ethically.

      But you haven’t exactly fixed the problem. You are still relying on being able to discount the patient’s lived experiences. And you haven’t suggested any real alternative, you’ve just turned the dial to “Do nothing.” And it must be pointed out that you lack a very basic understanding of certain kinds of mental illness.

      So it is very fair of people to accuse you (and Caplan, and Szasz) of overgeneralization, condescension, and ignorance. Particularly if those people are the ones whose experiences you would like to discount.

      You haven’t evaded the problem. You are just congratulating yourself for indulging in your preferred version of the problem.

  18. notpeerreviewed

    Generally I hate to make an argument from “lived experience” but it’s really hard for me to imagine that if Bryan Caplan had any direct experience with addicts or addiction, he would still believe that addiction can be modeled as an extreme preference. Yes, just reading the DSM diagnostic criteria make it sound like alcohol use disorder could be just an extreme preference, but…addicts aren’t *like* that. They don’t behave as though they had stable, well-ordered preferences when it comes to alcohol.

    1. NoRandomWalk

      Frankly, sometimes I find ‘lived experience’ to be the most-useful arguments to hear from strangers. I’m smart enough to have already figured out most of what is a reasonable conclusion from ‘common knowledge’. So, help us expand the pool of common knowledge by adding your lived experience.

    2. caryatis

      This is a debate about values and philosophy, not about “lived experience,” so you need not assume that the only possible reason Caplan might disagree is lack of experience. It’s not difficult to find people who have experience with addiction who are on the Szasz/Caplan side of this debate (including me FWIW).

      1. notpeerreviewed

        Rational choice models are based on a well-defined set of assumptions that could be shown to hold, or not, for addicts. That doesn’t seem to me like a debate about values and philosophy.

  19. Doctor Mist

    Scott, I’d be very interested in your take on how Sapolsky’s Behave: The Biology of Humans at Our Best and Worst plays into this. I just finished reading it on the recommendation of somebody here and found it fascinating. It’s all about how very multifactored and complex are the mechanisms that produce human (or animal, for that matter) behavior, starting with things that happen one second before the behavior (things like neurotransmitters) and moving progressively backward through hours and days (things like hormones) and years (development in childhood and adolescence) and millennia (evolution). Nothing “causes” a particular behavior because all these levels of mechanism mostly just have effects on the other levels. Among the interesting things I learned is that oxytocin isn’t the popular image of the lovey-huggy hormone — it encourages affection toward somebody you already tend to like but encourages suspicion of somebody you already are suspicious of; testosterone has an analogously bimodal effect.

    Toward the end he gets into criminal justice reforms and makes a case that “punishment” is a necessary part of it, and will be seen as barbaric a few hundred years from now. The analogy is epilepsy, once thought of as a clear manifestation of witchhood and treated accordingly even by good, well-meaning people whose only concern was for the well-being of the community. We now know better. We do impose restrictions on the freedoms of epileptics — if it is not controlled by medication, we don’t let them drive, for instance — but we have no model of that as “punishment”.

    This is not a namby-pamby “To understand all is to forgive all”: somebody who is prone to murder must clearly be prevented from murdering, by incarceration if there is no better method. But to attach a moral valence to it, to say, “He chose to murder, fuck him,” may be seen by our descendants as something not much different from burning witches.

    In the context of the book, this analysis was uncomfortable enough to me that I think it might have revealed to me that I am in fact a deontologist (because it made me wonder if I ought not to be). Sapolsky is not denying free will, by any means, but the symphony of things that go into how and why we do the things we do of our own free will certainly make it a much fuzzier idea than it seems to a philosopher.

  20. Seth B

    Loved the back and forth.

    One issue I wish both Scott and Bryan had focused on more is what keeps meta-preferences from ‘collapsing’ into preferences. I.e. If I have the meta-preference to not be an alcoholic (i.e. I have the preference to not prefer to drink alcohol to excess), yet find it hard to resist the impulse/regular preference to drink alcohol right now.

    In this framing, it seems like either:
    >My meta-preference always overrides my impulse — i.e. it doesn’t make sense to talk about meta-preferences being different than preferences for me (my understanding is that classical economic theory gives this result — that any meta-preference should just immediately realize itself as a preference)
    >My meta-preference doesn’t really exist (I’m lying to myself or others about it)
    >”Changing” my preferences to match my meta-preferences requires some sort of resource I have in short supply (willpower?) — this sounds like a constraint to me, but not a binary one. In other words, I might have enough willpower resources to resist drinking 3/4 of the month, but fall off the wagon at the end of the month.

    1. notpeerreviewed

      I think Caplan is treating “meta-preferences” as purely subjective; i.e. I experience a desire for my preferences to be different from what they actually are, but that has no effect on my behavior. Once meta-preferences start having an actual effect on the world, you’re no longer in the realm of rational choice theory.

  21. gkai

    I think Bryan should be happy with this solution. It’s very libertarian. It says that it’s up to every individual to decide how to satisfy their own preferences (including meta-preferences).

    I agree that physical and mental illnesses have a lot of characteristics in common, and given that the brain is an organ interracting with others, and can be affected by chemicals, it seems logical to be so.

    What you said cover many aspect of mental illness, and I think (appart from cost and state subsidies for treatment) its not where you can find controverse. Patient express a will to be changed because they feel they could be better, and doctor help them giving chemicals, doing surgery, designing technological or biological (in the future?) prothesis, or doing some talking. Physical or mental illness the same, appart maybe the talking being more used for mental and prothesis /surgery more for physical…

    The scary issue with mental illness is forced treatment, when the decision is not taken by the patient but by society. This is scary, and not only for libertarian. This is, I think, more common for mental illness, even if we can find something similar for physical illnesses (vaccination, quarantine, something else? circumcison? 😉 ). No wonder those are sensitive subjects with differing opinions….

    The other issue is subsidies/work absence/quotas. This is huge ethical issue, something I may have a much more fringe approach to (see later), but again not specially linked to mental diseases (appart it may be easier to fake).
    Special advantage for dissabilities is always an issue, it become tempting to fake consciously or unconsciously any condition that would advantage you. In the past, I think this was offset by a devalorisation of weakness/victim… Now it is less and less accepted practice, which is good….but without that you have only incentives to play the victim.
    I think there is still a strong devalorisation (but not official, it’s more or less hidden)…If society progress so much as to remove it, I fear there will be no check against playing victim and compensations will progressively dissapear…
    Regarding the faking, many physical diseases can be faked well enough (especially as deep medical check is costly), but usually they are expected to go away quickly. Mental illness is probably harder to fake, but there is a lot or border cases and it is often long to solve, unsolvable or chronic….

  22. EGI

    Maybe the core of the disagreement is the problem that the mental vs. physical distinction as well as the healthy vs. diseased definition are both rather artificial, since there is no “mental” distinct from “physical” and no clear boundary between healthy and diseased.

    Mental vs. Physical
    I think a good definition of mental disease is “poorly understood disease of the brain with symptoms manifesting on higher behavioral abstraction levels”. A brain disease which makes your hands shake is not thought of as “mental”, while one that makes you sad or anxious is. Also I am pretty sure that as soon as we can point to the exact physical problem that produces the “mental” disease the mental tag will go away. You won’t have the “mental disease” depression anymore but the “genetic disease” of mutation a in promotor b which leads to underexpression of gene xyz.

    Healthy vs. diseased
    Disease is typically defined as something like “function impairment that causes suffering” but this definition is not really rigorously applied, since otherwise things like ageing 1, forgetting your keys 2, beating your spouse 3 or failing to work when you should 4 would all be seen of diseases (I think they are in most cases). To be seen as disease a condition needs to have additional properties like not being too common 1,2, not being seen as a moral failure 3,4, being amenable to medical intervention 1, 2, 3, 4, and having causes in your body that can be identified by current medical technology 2,3,4. Falure to concentrate for example was historically not seen as a disease but as a moral failure and thus “treated” with a vigorous beating. Now it is less seen as a moral failure and somewhat amenable to medical intervention and thus became the disease ADHD and is treated with Modafinil. As soon as the exact causes are identified and treatment becomes possible I am sure 1, 2, 3, and 4 will all be seen as (physical) diseases.

  23. EGI

    Or what about respiratory tract infections that cause coughing? My impression is that, put a gun to my head, and I could keep myself from coughing, even when I really really felt like it.

    Huh, thats wired. I could not for sure. Dampen the sound, sometimes delaying a bit, coughing through the nose, yes. Preventing the contraction in the chest, no way.

  24. hnau

    Separate comment to make a separate point, sorry.

    On the whole Scott’s model is better, but Caplan’s model does a lot better at explaining certain (not-necessarily-mental-illness) situations. I worry that Scott’s attacks on Caplan’s model might obscure that fact, so I want to balance them with a counterexample.

    I have trouble with procrastination. To use Scott’s language: My goal is to get X done. My urge is to do Y instead of working on X. I give into my urge and spend the next 4 hours doing Y. Then I say to myself: “Wow, that was bad. I wish I had worked on X instead.”

    Scott might interpret this as an endorsed preference for X, but it isn’t. Maybe I would prefer to have worked on X, but I sure don’t prefer to be working on X. It’s easy enough for Later Me, having just enjoyed 4 hours of Y, to say that I “should have” worked on X– it makes Later Me feel better, without suffering any consequences like actually having to do X. The revealed in-the-moment preference of Earlier Me for doing Y over doing X is a more trustworthy signal. In this situation it’s much more sensible to model Earlier Me’s revealed preferences as rational responding-to-incentives, and Later Me’s endorsed preferences as defensive self-deception.

    Besides, if I really preferred X over Y, then even Later Me would put more effort into working out systems– training, reminders, incentives, getting friends to hold me accountable– that caused me to be doing X rather than Y. I wish Scott’s argument here left more room for people (including myself) to challenge my self-deception and tell me that.

  25. hnau

    Reading this and Caplan’s previous post, I noticed a weird sub-disagreement.

    Caplan says:

    “I have a disease” is a convenient excuse for bad behavior; indeed, it’s so convenient that heavy drinkers offer it so casually that they don’t experience it as deception.

    Scott says:

    We need a model that lets us describe shingles as something more than “this person has a preference for scratching themselves frantically, and that preference is valid, nothing to worry about here”.

    It looks like in the gray-area / marginal cases Caplan sees the label “disease” as harmful because it prevents society from addressing harmful behavior with incentives. And in the same cases Scott sees the label “not-a-disease” as harmful because it prevents society from addressing harmful behavior with psychiatric treatment. And who’s right mostly depends on whether incentives or drugs are more effective in those cases.

    So is the real disagreement here just that on the margin– compared to where society draws the line today– Caplan, the economist, sees the incentives as more powerful, and Scott, the psychiatrist, sees the drugs as more powerful? That wouldn’t exactly be a shocker.

    1. rui

      I think you are right about Caplan, but not about Scott. He may be focusing on being a counterweight to Caplan. If you read the [post he links where he describes his view on ” the line”](https://www.lesswrong.com/posts/895quRDaK6gR2rM82/diseased-thinking-dissolving-questions-about-disease) he basically concludes what you just said.

      We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition, and we should allow patients to seek treatment whenever it is available and effective.

  26. JimmysPotatoSalad

    I. My Problems are like a Constraint.

    I’d like to chime in and say that ADHD, at least for me, feels much more like a budget constraint than a preference or even what you term an urge.

    Caplan proposes the following test to distinguish between preference and constraint:

    can we change a person’s behavior purely by changing his incentives? If we can, it follows that the person was able to act differently all along, but preferred not to; his condition is a matter of preference, not constraint.

    Setting aside the unfortunate naming of the Gun-to-head Test, it was exactly my inability to change my behavior in response to incentives that has caused me so much trouble. In particular, I have trouble filling out paperwork. Anything more than half a page, and I just can’t get the whole thing done in one sitting.
    Given the amount of paperwork a modern adult is subjected to, you can certainly imagine the amount of trouble this causes me.

    There was one incident in particular that stands out. I needed to fill out some online form before a deadline or lose 1000 dollars due to late fees. My total savings at the time was less than 2000 dollars, so this wasn’t an insignificant cost. I procrastinated until the last day, as is typical for me. But no big deal; it only takes a few minutes to complete. So that last day, I sat down, pulled up the form, and then… ? I don’t remember, and I didn’t remember even immediately after. But I didn’t submit the form.

    I wasn’t lacking any of the skills needed to complete the task. I had all the necessary information pulled up in front of me. I lost the majority of my financial assets in exchange for nothing, not even a fond memory, because I wasn’t distracted by doing something fun and exciting. I was just plain distracted.

    II. What Doesn’t work

    Here is an incomplete list of things I have tried to help me accomplish tasks in a timely manner:

    * Pomorodo Timers
    * A timer that just goes off every 3 minutes to remind me to return to task.
    * Time Constraints
    * Self-imposed Financial Incentives
    * Self-imposed Financial Rewards
    * Verbal Encouragement from a loved one
    * Food-based Rewards
    * Having accountability meetings with a friend
    * Coworking in the same room as a that friend
    * Setting things up so that my father will be very ashamed of me if I don’t complete my task.
    * Unplugging the internet
    * Unplugging the internet and clearing the room of anything that could possibly be distracting.
    * Completely empyting a room of everything except the bare minimum needed to complete the task, and sitting on the floor looking directly at what I was trying to accomplish.
    * Working myself into a rage hoping that the adrenaline could somehow be channeled into productivity.
    * Having my spouse just sit next to me and slap me every time I get distracted.

    That last one almost worked. It didn’t stop me from getting distracted, but it did put me back on task when I was visibly distracted. Even this though only marginally boosted my productivity because there are plenty of ways a person can get distracted that look indistinguishable from thinking hard about a task. So via a sort of selection effect, I spent most of my time lost in imaginationland.

    If someone put a gun to my head, and threatened to shoot me unless I filled out 20 pages of paperwork without getting distracted, I would die. That’s not a hyperbole. It’s a confident prediction, with sound empirical evidence backing it up.

    III. What did finally help me:

    There are three things that allow me to get tasks done:
    1. Having the spare time to spend multiple days on a single task which should take less than an hour.
    2. Having someone else do it for me.
    3. Stimulant Medication.

    (By the Way, I only reached out to a psychiatrist after reading one of your posts. Not the one you’re thinking of. It was a tumblr post talking about about your desire to shout “CONSIDER THE POSSIBILITY THAT YOU MIGHT HAVE ADHD” at a speaker sharing their troubles with procrastination. I immediately resolved to call a local pysch clinic to see if that might be my problem. And I made that call a mere 2 months after that. So thanks for the initial kick.)

    IV. Caplan’s Unscientific Attitude

    Bryan Caplan’s posts on this subject are especially frustrating to me because I like his arguments at the meta level. I do think the budget-constraint/preference distinction is an appealing and fruitful way to think about a range of both mental and physical disorders. And I’m sympathetic to his end goal of being more tolerant and forgiving of people with unusual minds.

    But he is grossly ignorant of the object-level details of the conditions he’s using as examples. Worse than that, in his original post, he finds evidence discomfirming his theory, acknowledges it, and then just sticks his head in the sand.

    In the original article from 2006, Caplan presents a set of DSM-IV-TR diagnostic criteria for ADHD, and points out that a majority of these symptoms would also be present in someone who just has a high disutility for work or a strong taste for variety. And if his article were merely arguing that ADHD is an overbroad and fuzzt category, and that the diagnostic criteria likely include a large chunk of people who really shouldn’t be conceptualized as having something disease-like, then I’d probably agree. You’ve made similar points before, I believe. But he goes on to say:

    A few of the symptoms of inattention – especially (2), (5) and (9), are worded to sound more like constraints. However, each of these is still probably best interpreted as descriptions of preferences. As the DSM uses the term, a person who ‘has difficulty’ ‘sustaining attention in tasks or play activities’ could just as easily be described as ‘disliking’ sustaining attention. Similarly, while ‘is often forgetful in daily activities’ could be interpreted literally as impaired memory, in context it refers primarily to conveniently forgetting to do things you would rather avoid. No one accuses a boy diagnosed with ADHD of forgetting to play videogames.[13]

    No Bryan! I literally actually really do have impaired memory. Yesterday, my spouse came home and asked me why there was a bag of frozen pork sitting on our bed. I think it was there because I couldn’t find a bag of ice, so grabbed a suitable substitute. But then when I went into the bedroom, I forgot why I needed ice, set the pork down for a second, and then wandered away. Is Caplan seriously going to contend that this happened because I simply would have recieved too much disutility from using the pork for its intended purpose or from returning it to the fridge?

    And that last sentence is baffling. I have forgotten to play videogames. I mean, it says right there in the part he directly quotes that many people with ADHD have “difficulty sustaining attention in… play activity.” His footnote 13 refers to a profile of a specific hyperactive child named Andy in a book titled Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New Psychiatry”.

    So his argument is essentially that

    The diagnostic criteria of ADHD can be most easily formalized as a set of unusual preferences if we ignore some of the diagnostic criteria and deliberately misinterpret some of the others to mean nearly the opposite of their literal interpretation. But the literal interpretation is invalid because it doesn’t match an anecdote from a book about the power of love.

    He’s not just being a bit ignorant or confused here. He’s playing word-games so that he can ignore the evidence in front of him. It’s like if he had a theory that migraines are caused by eating too much beef. A patient comes in with horrible migraines, and tells him that they’re a vegan and that most of their diet consists of lentils. Aha! What are lentils if not the beef of the seed world? Theory confirmed.

    End

    This post was originally intended to be a bit more supportive of some of Caplan’s points. I agree with him that the utility theory is applicable to nearly all aspects of life and not just “which brand of shampoo to buy”. There was originally going to be a section at the end here about other simple economic formalizations which better match the symptoms of ADHD, like the game theoretic concept of a trembling hand. But when I wrote everything else up to this point, it was only 7:30, and now it’s 10:30 and I do not remember what I did in the intervening time. So that’s all for now.

  27. echidna

    You are talking past each other. Economists have the strong preference (not constraint!) to limit their models to preferences and constraints. Given this self-imposed constraint, mental illness and much physical illness are indeed better modelled as preferences. Bryan Caplan is right. You point out that, in so far as we are interested in models that help us understand people and help them, the economics straigtjacket is absurd. You are right.

  28. Charlie Lima

    My question is: has Caplan ever actually had a gun to his head?

    I mean that literally. As someone who has, I can assure you that the cocktail of stimuli that hits the blood enabled me to do things that are not physically possible for me. For instance, your blood pressure spikes. Mine went up enough to discolor my urine later that day with with blood. It also made me faster, as in the fastest “combat run” I ever did happened during combat. It also caused my heart to hit rates I cannot manage at exhaustion level workouts and started to muck up my hearts conduction system (per BuMed).

    Physically, the same muscles did things well above and beyond what I have ever been able to manage before or since. When I was a high school athlete, I wanted to be fast. When I wanted to not get shot I also wanted to be fast. Yet one of the circumstances resulted in superior performance.

    Funny thing, of course, is that I now sometimes wake up with my heart pounding, my blood pressure spiking and it is just is a nightmare. But I suppose I just have some bizarre preference for having intrusive dreams, which just so happened to typically go away with Minipress.

    I find it very hard to believe that my brain can dump a bunch of responses out of the HPA axis only in response to physical stimuli. I certainly feel much the same whether the stimuli provoking everything was actual gunfire or just a terrifying dream. Frankly, I am trying awfully hard to understand why a mild pheochromocytoma would be considered a “constraint” while PTSD would merely be a “preference”. From what I understand, both make your heart race, your blood pressure rise, and make sleep difficult because they use the same blood biochemical pathway. Why exactly, would mine be a preference and the poor schmuck with the tumor have a constraint?

    1. hnau

      Yep. One way to model this is that most “constraints” are actually preferences so strong that the body hard-codes them.

  29. boog

    What’s a prediction about actual behavior in the world that these two models would disagree on?

    Absent such, it’s like a debate on the merits of programming in Python vs Java. Although you may find certain concepts easier to deal with in one vs the other (and if I have to deal with your code I probably also have an opinion on which one to use), we can correctly compute the solution to a problem in either.

    1. hnau

      It seems like, on the margin, Caplan believes that incentives (e.g. law, social pressure) are a more appropriate response to certain conditions, while Scott believes that psychiatric treatments (e.g. drugs, therapy) are a more appropriate response. If they can agree on how to measure outcomes, then this is a testable prediction.

  30. NoRandomWalk

    Does it matter if meta-level preferences are stable before/after treatment?
    For example, someone with the flu would prefer to not have the flu both before and after they have it.
    On the other hand, someone with anorexia would genuinely claim to believe that a state of being ‘normal weight’ is highly undesireable, and that they want to be anorexic because having this preference increases the likelihood they will achieve the desired state.

    People seem to object to ‘society’ deciding what a ‘disease’ is, but if preferences are unstable as a function of treatment, surely society should administer the treatment if it will change preferences towards the better? Or do we default to status quo preferences, which seems arbitrary.

    1. cuke

      This is a central problem for me in this preferences frame — which is that we have many competing preferences operating at different levels and they change all the time, not just in response to “treatment.”

      And “preferences” doesn’t really capture the sense of what we’re talking about. We’re talking about the stuff that shapes behavior and mind states. Impulses, goals, urges, fears, longings. They are thoughts, feelings, and schemas — some operating in consciousness and some outside of consciousness. “Preference” seems an impoverished concept in this context.

      Someone very depressed may want to die but hopefully as a result of treatment no longer wants to die. Someone with a fear of flying may really want to visit their cousin in Toledo but also may really want to avoid feeling terrified.

      Someone with an eating disorder may want multiple things — a sense of control, a feeling of okayness through achieving a particular body shape, or a need to avoid foods or body states that feel repellent, for instance. They may also want to be free from worry about food, to stop having it take up so much space in their head, to feel strong and healthy, and so on. But also, the act of calorie restriction messes with a person’s appetite in a way that can become its own dynamic. So a lot’s going on at once and it’s not all pulling in the same direction.

      I guess I really don’t see what “preferences” illuminates here as a model for understanding what we currently put under the heading of mental illness. We do have preferences as people, but our preferences, even our “revealed” ones, don’t explain all of our behavior or our experience.

      I guess I can appreciate that part of what the “preference” language is trying to highlight is our capacity as humans to make choices. In treating mental health issues, we often try to help people identify where they have choices that they didn’t recognize before. In trying to solve one form of mental suffering, we often build other forms of mental suffering — like how the default reaction to anxiety may be to avoid the thing that triggers the anxiety, but then the avoidance tends to feed the experience of anxiety. So rather than saying that anxiety is a “preference,” we might say that avoidance becomes an unconscious problem-solving strategy for anxiety. In therapy, a person might get to identify other choices besides avoidance and to test them out.

      But the choice part doesn’t really come into play until the person can see and feel that they have choices. In a funny way, we don’t really have choice until we are aware that we have choice. A “revealed preference” isn’t really a choice.

      To me this whole preference language is a little bit like, “well, that mess you’re in, I guess that’s what you wanted or you wouldn’t be in it.” When instead it’s more like “let’s look at the factors keeping you in this predicament and see what other choices you have and which options seem most appealing to try next.”

    2. Orion

      Does it matter if meta-level preferences are stable before/after treatment?
      For example, someone with the flu would prefer to not have the flu both before and after they have it.
      On the other hand, someone with anorexia would genuinely claim to believe that a state of being ‘normal weight’ is highly undesireable, and that they want to be anorexic because having this preference increases the likelihood they will achieve the desired state.

      There are probably some people with anorexia who consistently express a stable preference toward losing weight, but people I’ve known who had eating disorders have generally had unstable, chaotic, and self-contradictory goals and urges about food and weight. For many of them, behaviors-aimed-at-reducing-weight (fasting, purging, etc.,) were not driven by a “goal to be thin” they would endorse on reflection, but rather by an “urge not to be fat” which tended to manifest as a sudden burst of fear, shame, or disgust.

  31. journcy

    It was very satisfying to read this whole correspondence from start to finish as my first interaction with it, because I started out feeling like Caplan had something to say but was also subtly wrong, and then you didn’t quite make out what the wrong thing was, I thought, in your first rebuttal, which was clarified somewhat in his response to you, and then this post finally got down to the meat of my problem with his argument, which is the whole meta-preferences thing. Or rather, the meta-preferences framing makes clear what I think is right about his argument, which is that at some level a preferences framing of mental illness makes sense, but that level is not the object level. And using an object level framing results in all the bad properties discussed, those being what I disliked about his original article.

  32. teageegeepea

    We want some criteria that let us call shingles a disease, but don’t let us call “being thin but wanting to be even thinner” a disease. Unfortunately, there is no perfect solution to this problem.

    As I pointed out recently, Greg Cochran does have a relatively “objective” solution: look to Darwinian fitness. If something significantly reduces it, occurs at a frequency higher than one percent, and has been around for a while, it’s probably caused by a pathogen. Genetic “diseases” can exist and reduce fitness, but they will typically have low frequencies. Cochran concludes that obligate homosexuality definitely looks more like a pathogen than an adaptation, which is something this blog has discussed before.

    1. Scott Alexander Post author

      I’m not sure that’s right. Being ugly, being annoying, and being so religious that you become a monk all reduce fitness, but any system that classified them as diseases would end up pretty awkward.

      1. teageegeepea

        There are doctors offering cures for ugliness, so perhaps it’s not that far fetched. Do therapists treat patients who ask how to be less annoying?

  33. rahien.din

    Having read the original paper, Caplan seems confused.

    His criticisms of psychiatry do not cohere. On one hand, he rebukes psychiatrists as mere enforcers of unjust morality – the patient’s claim of normality must be categorically accepted because (mumble mumble) normative judgments cannot withstand human heterogeneity. He denounces psychiatry because no person’s experiences can be discounted (even, as stated elsewhere in the paper, on basis of the effects of their behavior.) On the other hand, he says that while true hallucinations are constraints-not-preferences, the claim of a hallucination is probably just attention-seeking and therefore only a preference. Even the paranoid schizophrenic is not truly deluded but is simply a self-indulgent fantasist. He denounces psychiatry because any person’s experiences can be discounted. These two claims can not withstand each other.

    At the most charitable, one could permit that we might gradually discover which experiences can be discounted and which cannot. But then we must accept that psychiatrists are permitted and even required to engage in such progressive discovery – EG as they have done regarding homosexuality and transsexuality. Otherwise, this is just an isolated demand for rigor.

    In a third attempt, he discounts the experience of irrationality altogether, because John Nash claims to have rationally chosen to no longer be irrational. But this is simple confusion. If irrationality does not actually exist, then it is impossible to have chosen (or to have abandoned) a non-existent mental state, rendering the experience of (even the experience of abandoning) irrationality itself irrational. Moreover: therein Caplan assents that one can rationally choose to abandon rationality, and also rely upon rationality in order to achieve rationality. This is also confusion. A mental function cannot, independently, causally precede its own cessation – one cannot move in order to be still. Likewise, an abandoned mental function cannot causally precede its own restoration – being in London cannot be the method of going to London.

    These ideas could be resolved if consciousness was causally preceded by a divisible system of competing components. One might presume that Caplan is not eager to rely on such a concept.

    Pragmatically, his arguments would absolve the psychiatrist. After all, if morality is simply another mental behavior, and if we are not permitted to disqualify a behavior on the mere basis of its effects, the imposition of morality receives the same categorical validation as any other behavior. He cannot call psychiatry (even involuntary commitment) a sick/harmful mental behavior if the category of sick/harmful mental behavior does not exist.

    Caplan exempts mental disorders from any neurobiologic correlation, carefully reasoning that while we are limited by the current state of the art, physical testing would be sufficient only to explain disease, not to create disease categories. He permits only the resort to behavioral observations, and finds this basis to be invalid. Thus, he rejects the category of “constraint-based mental disease that is evident from behavior but not from testing.” However, he unknowingly he creates the category that he is trying to reject, as he has no problem with intellectual disability* falling in the category of constraint. However, in most cases of intellectual disability, we are unable to identify the cause or demonstrate a neurologic lesion, and must rely upon behavioral observations. Presumably, intellectual disability would be subject to the same reasoning as mental disorders vis-a-vis testing. Therefore, in permitting that there is such a thing as intellectual disability, he is implicitly assenting to the category “constraint-based mental disease that is evident from behavior but not from testing” and providing an example thereof. Some justification is required if he wishes to exempt mental disorders from that extant category.

    * He uses the term “mental retardation,” likely due to era and unfamiliarity with medical nomenclature. No foul.

  34. Matt M

    In the words of the great Mitch Hedberg, “Alcoholism is a disease, but it’s the only disease you can get yelled at for having.”

    1. Andrew Cady

      I don’t get it. Seems to me it’s at least half of mental diseases that you can get yelled at for having.

  35. Lawrence D'Anna

    I think it’s worth looking closer at two of the examples you raise: anorexia and homosexuality. I don’t think they prove Bryan right, but I do think they prove something else. They prove that judgements about mental illness depend on contestable questions of value in a way that judgments about physical illness do not.

    Decades ago, homosexuality was considered a mental illness. Now it is not. What accounts for this change? Is it of a scientific or medical character? Or a moral one? To me it seems self evident that it is a change in moral attitudes about sexuality. There have been no medical or scientific discoveries that in and of themselves could have justified the change. There have been huge changes in how we think about the morality of sex, and that is why psychiatry’s attitude has changed.

    You might respond by saying “Sure, back then psychiatry was improperly influenced by the culture’s moralistic attitudes towards sex, but that has been corrected. Now we’re just neutrally helping people attain goals and overcome urges”. But that doesn’t work either. There are people who characterize their own homosexual desires as unwelcome urges, who have a goal of acting contrary to those urges. A psychiatrist who attempts to help such a person attain their goal and resist their urges is guilty of “conversion therapy”, and is therefore a quack.

    There really is no neutrality here. At one point in time psychiatric practice was determined by one view of sexual morality. Now it is determined by a different view of sexual morality.

    On to anorexia.

    Anorexia doesn’t fit your model of psychiatrists helping people attain their goals and overcome their urges. Anorexics do not have an urge to be thin. They have a goal to be thin. It seems absurd to me to say that an anorexic’s problem is that they lack self-control. They must have an urge to eat just like anybody. They are successfully overcoming that urge in order to attain their goal. The problem is that the goal is irrational and destructive. That is a moral judgment, not primary a scientific one.

    Psychiatry can not be thought of as simply helping people overcome their urges and attain their goals in a viewpoint neutral way. If the patients goals are not considered rational and socially acceptable, then they don’t count. Psychiatry does not merely help us attain our goals, it also delineates which goals are considered acceptable and legitimate.

    Psychiatry cannot make the sort of claims of neutrality and objectivity that say, cardiology can. Psychiatrists have some of the characteristics of doctors, but they also have some of the characteristics of priests. This is not usually a problem, because the underlying moral judgments are not widely contested. Not many people contest the value judgment which says an anorexic’s goal of getting even thinner is not worth the damage it will do to her health. But when the underlying value judgments are contested, as they are in areas of sex and gender, then it is important to understand that the dispute is of a moral character, not a scientific one.

    Psychiatrists have often failed to make this distinction. They wade into moral disputes and purport to address them as doctors and scientists. This pretense of objectivity is divisive and harmful.

    I expect that as medical technology advances, we will find more areas beyond sex and gender where psychiatric practice will need to be informed by contested moral judgments. Psychiatry should learn how to make the distinction now.

    1. cuke

      I agree with you that psychiatry/psychology has a long, complex history of smuggling in moral and political arguments under the guise of science or medicine and I totally agree with you about the importance of making the distinction. All of medicine and science has some of this same history. I think it’s more common where there is less we understand. There’s a lot we don’t know understand about the mind.

      On the medicine side, for instance, people with Chronic Fatigue Syndrome (and associated other chronic diagnoses) were also often treated to various moral judgments and the equivalent of “try harder” and “buck up.” As we understand more about poorly understood chronic conditions, the moralizing voice gets quieter and the focus on effective treatment louder.

      At the same time, I think it’s helpful to distinguish between moral judgment and our current characterization of what’s “healthy” from a more evidence-based perspective. On the example of anorexia, it’s not that we make moral judgments that it’s “bad” for a person to have an irrational goal to be more thin; it’s that anorexia kills people. And short of killing people, it makes them really really sick, malnourished, losing bone density, sets them up for long-term chronic illness and disability. To the extent that all of medicine sees pain/disease/suffering/disability as bad and freedom from pain/suffering and healthy functioning to be good, those are baked in values but they are only “moral” in the largest sense that medicine is about helping the person live and function. Moralizing still gets smuggled in, but I think not at that level.

      The language of “goals” is tricky in mental health. People often get to a psychiatrist or therapist because they have a problem that they have made repeated attempts to solve but the solution has created more problems they didn’t anticipate. And often none of it came about through conscious choice or expressing preferences, but out of fear reactions or unconscious adaptations to adversity. So a person with anorexia may be trying to solve a problem of anxiety or feeling out of control or feeling unworthy by trying to control something in their life; this creates a starvation problem, so their attempted solution to the out-of-control/unworthiness problem becomes a bigger problem. The goal a person has is to reduce suffering; they start with the thing that seems to be causing them the most suffering, but sometimes their solution produces greater suffering and then the goal changes. Redefining goals so as to reduce more and more harm is a pretty common stance in treating mental illness.

      I think that’s right that psychiatry has a very problematic history in terms of making “neutral” or “truth” claims and that individual providers have done a really terrible job of misusing their authority, not respecting patients’ autonomy, and misrepresenting their level of certainty. I think this is all true of medicine generally. I would consider it arguable whether psychiatry is more guilty of this than other fields of medicine. There’s a lot of bad shit going on everywhere, as well as some pretty good shit.

    2. niohiki

      a) I known a person who was treated for anorexia, was very aware of it, and definitely knew that she had a problem. Her ultimate goal was for sure not getting thinner, because, well, she sought help, and got it. And still somehow in the meantime she had serious trouble eating, because of the irrational fear she had of getting fatter.

      b) I do not agree with the part (that is a bit of a cornerstone for the argument that follows) where you say

      They prove that judgements about mental illness depend on contestable questions of value in a way that judgments about physical illness do not.

      There are enough religious denominations that seriously consider sickness a blessing, and that it should not be treated by medicine, as it is in defiance of the will of God. We see that as crazy, because we know better, and we have a set of moral values that places the individual human and free will on a central spot, but it needn’t be the case. And we still do draw boundaries on which physical interventions are needed, or critical. Which things should and should not be treated, physical or not, is a matter of value. Just because we have mostly agreed for a long (but not infinite) time on the physical ones does not make it less so.

      c) About homosexuality, I am not evading the point, I just replied to a comment further up.

    3. rahien.din

      There really is no neutrality here. At one point in time psychiatric practice was determined by one view of sexual morality. Now it is determined by a different view of sexual morality.

      But in some part this is a data problem. In an era in which homosexuality could get you fired, ostracized, or killed, homosexuals had to conceal their existence. This means that it seemed more rare, and thus more aberrant. Moreover, this was an awful condition in which to live, causing homosexuality to be associated with other health problems. A psychiatrist’s only experience with homosexuality may have been rare patients who had screwed-up lives. In order even to consider that homosexuality itself was not the problem, they would have had to reject their data and experiences.

      So it is not (not entirely…) that psychiatrists were regurgitating the defunct morality of their time. They were subject to genuine informational constraints.

      Anorexics do not have an urge to be thin. They have a goal to be thin.

      This is incorrect. The defining feature of anorexia is not a goal to be thin, nor an urge to be thin. The defining feature of anorexia is an intense fear of becoming fat. This intense fear is accompanied by distorted perceptions : of body size ; of the importance of body size to intrinsic worth ; of the danger of malnutrition.

      So, in some important sense, an anorexic’s goal is also to be healthy – they just have an extremely distorted vision of health.

      Psychiatrists have some of the characteristics of doctors, but they also have some of the characteristics of priests.

      Hoo buddy, let me tell you a thing or two about medicine…

      All physicians occupy some priestly role. All physicians are subject to societal morality – either as agents or targets or opponents thereof. And insofar as society intrudes upon the medical visit, this is importantly a function of the patient’s difficulties in functioning within society. Just about every patient is voluntarily seeking care, and their problems arise because their behaviors make it hard to achieve their goals within their societal environment.

      That is not to fault either the patient or society – but we must recognize that the patient brings society with them to the visit. You’re not just treating a person, you’re treating their job, the cops, their spouse, their parents, their child.

      (And yes, all physicians are sometimes morality enforcers. A good example is mandatory reporting.)

      So, none of that is what makes psychiatry unique.

      For both patient and physician, the pursuance of medicine comes down to the patient-physician relationship. This relationship is the method by which goals, methods, and expectations are selected. Think of two people using a crosscut saw – both have to hold a handle and pull in order for the saw to cut lumber. The patient and physician must partner together effectively. Luckily, in most cases this partnership is largely separate from the actual disease state.

      What makes psychiatry unique is that the patient-physician relationship is dependent upon the patient’s own mental and emotional state, and often that partnership is its own target. Even to the degree, sometimes, that the patient’s ability to partner with the physician is dependent upon their already having had some treatment.

      1. Lawrence D'Anna

        @rahien.din

        So, in some important sense, an anorexic’s goal is also to be healthy – they just have an extremely distorted vision of health

        OK, good point. This is still goal-directed behavior, not a giving in to urges. Avoiding a bad outcome like getting fat is not an urge, it is more like a goal. The problem is still bad goals, or proximate goals that do not serve higher goals, or a distorted perception that causes the patient to chose the wrong proximate goals. Whatever it is, I don’t see how it can be jammed into the model that says a mental illness is something that creates urges that interfere with the patients goals.

        A form of goal-directed behavior is the problem, even if the patient also may have some even higher goal like “be healthy”, which the doctor would endorse. The doctor is still evaluating the various goals that the patient has and judging which are legitimate.

        I’m not saying the doctor shouldn’t do that, I’m just saying at some point it boils down to a moral judgement that your fear of getting fat is not worth the damage this is doing to your health. Someone with a very broad concept of personal autonomy might object to the doctor making judgments like that for another. I’m not that person, but I have encountered them. I think that’s a moral disagreement, not a scientific one.

        1. rahien.din

          @Lawrence D’Anna,

          I’m just saying at some point it boils down to a moral judgement that your fear of getting fat is not worth the damage this is doing to your health.

          It boils down to some kind of judgment, sure. But what moral judgment are we making?

          This is worth getting clarity on. The implication of “moral” seems to be “disconnected from an objective vantage point,” but there are indeed objective physical harms resulting from malnutrition. “Moral” may also imply “dependent upon societal context,” but this implies circumstances in which destroying your health is justified by an extreme fear of getting fat.

          Moreover, morals aren’t simply value stamps. Morals inform us of our obligation to others. They are demands for action.

          The other crucial aspect is that people with anorexia have disordered perceptions. There are people out there who are extremely afraid of getting fat, but have normal perceptions regarding their body size and its importance, and have both a healthy body size and also healthy eating behaviors. These people do not have anorexia. Anorexics are defined not only by their fear but also by their disordered perceptions.

          Thus, this boils down to a judgment : in what context could a person’s delusions and extreme fears ever justify objective damage to their health (even unto death)? What is our moral obligation to that person?

          Consider a person who has a phobia of spiders, and will not leave their home because they believe that there are enormous spiders outside. If their house catches on fire, what should we demand of their rescuers? What moral judgment should we make about whether their fear of spiders is worth their being burned alive?

          This is not some reductio ad absurdum – anorexia kills people in awful ways.

      2. Lawrence D'Anna

        @rahien.din I think you make an excellent point about the nature of the doctor-patient relationship being the really distinctive thing about psychiatry as opposed to other kinds of doctors.

        @niohiki points out that all medicine is based on a value judgment; that life is better than death, not-pain is better than pain, health is better than sickness. And that even that is contested by some people, who consider sickness a blessing.

        But if I consider sickness a blessing and then I get sick, I’m not even going to the doctor. Why would I want to mess up my blessing?

        Much of medicine can avoid getting tangled up in morals disputes because the mere existence of the doctor-patient relationship implies the doctor and patient are on the same page. When I go in to my doctor and complain about asthma, we’re already implicitly agreeing that it’s a bad thing that my airway is constricted.

        The mere fact that a patient is seeing a psychiatrist doesn’t imply the same kind of obvious pre-existing agreement about the relevant values and goals.

        1. rahien.din

          @Lawrence D’Anna,

          The mere fact that a patient is seeing a psychiatrist doesn’t imply the same kind of obvious pre-existing agreement about the relevant values and goals.

          Agreed. One pertinent example is personality disorders, for which a common symptom is that the person does not believe their behavior is the cause of their difficulties. (This is really, really understating things.)

          One crucial concept within the DSM is that of maladaptivity : whatever the symptoms are, they are objectively impairing normal functioning (or can be expected to). It’s a bar that every diagnosis must clear. You can’t have a disease if there is no negative impact or expectation of negative impact.

          A great example is anxiety. People who have no anxiety are impaired because they do not sufficiently anticipate and plan for problems. People who have too much anxiety are impaired because they are totally paralyzed by fear. People who have just the right amount of anxiety have the best function. A good description of this phenomenon is the Yerkes-Dodson law. You can sub in “anxiety” for “arousal.”

          The necessity of maladaptivity may address some of your concern. Even the people who don’t believe their behavior is a problem may come to a doctor merely out of frustration with everyone else. They are seeking some kind of remedy, even if they feel everyone else around them is at fault. It’s a different sort of patient-physician relationship, with a different sort of goals and methods, but the general principle is the same.

          Edit : niohiki’s point is a good one but I need more time to respond

        2. cuke

          I think this dilemma about getting on the same page around goals and strategies to meet goals exists across all of medicine and in most other caregiving relationships where one person has to consent to participating in a process that entails change over time. Teacher/student and parent/child relationships too perhaps.

          A person who is overweight, smokes, and has high blood pressure goes to a doctor after a health scare. That person may just want to get past the health scare with a minimum of trouble. The doctor may feel that this person is going to need to make some lifestyle changes in order to not keep having health scares. The person may be afraid of making lifestyle changes or doubt their capacity to make those changes. They may think that’s all bullshit or unchangeable and they just want the pills. Maybe they’re right because they know themselves better than the doctor. Maybe the doctor’s right because they’ve seen a lot of people who didn’t want to change or didn’t think they could change, change in the face of a health scare. So goals get negotiated in that context and over time.

          A patient comes to a psychiatrist saying they’re depressed and they want an SSRI. Turns out the patient is a heavy drinker and in an abusive relationship. The patient doesn’t want to stop drinking or get help for the abusive relationship. Over the course of meeting with the psychiatrist to manage the medication, maybe the patient comes to add new goals like leave the relationship or stop drinking. Maybe they don’t. The thing is, no one knows at the start how the person’s goals might change over time. So it’s a process in which the doctor doesn’t get to say; it’s largely a process where the patient gets to say, either by doing/not-doing various recommended things or by staying/not-staying in that doctor’s care.

          I don’t think the distinguishing thing between psychiatry/mental health treatment and the rest of medicine is that one is not moralizing and the other one is. Both physical and mental health treatment entails provider and patient getting on the same page. Sometimes it takes five minutes to do that and sometimes it takes a lot longer. Sometimes they don’t get on the same page and the relationship ends. Sometimes, very often, the patient’s goals evolve as their experience of their situation changes.

        3. niohiki

          Much of medicine can avoid getting tangled up in morals disputes because the mere existence of the doctor-patient relationship implies the doctor and patient are on the same page.

          I actually agree completely with this. My point is that in the past this was not so obvious. For instance, you may go to your local plague doctor because you (correctly) realize you have stomach pain and hopefully he will give some herbs to calm the pain… and you get leeches. Or maybe you do not consider sickness a blessing, but your doctor does (or at least he complies with the norms of his context). Actually, all of these are the reverse of psychiatrists “treating” homosexuality – they are doctors refusing to give due treatment to people who obviously need it, due to their personal values. But there are failure modes on both sides, and in fact the plague doctor who refuses to cure a sickness based on it being a blessing (from the doctor’s perspective!) would play the role of a modern doctor listening to Caplan’s argument and agreeing that his patients do not need such a thing as psychiatric care!

          The road to untangling irrational beliefs from facts, and to even define what is good and necessary and what is enforceable and what are fundamental freedoms is a complicated one that affects much more than psychiatry. Assuming absolute agnosticism just because the problem is not fully solved, and mistakes have been made, is the kind of epistemic defeatism best left for post-modernists.

          Thankfully, we have a pretty useful concept nowadays, that @rahien.din highlights very appropriately as “maladaptivity”, which should help a lot in placing the psychiatric doctor and the psychiatric patient on the same page more often.

    4. Orion

      Anorexics do not have an urge to be thin. They have a goal to be thin. It seems absurd to me to say that an anorexic’s problem is that they lack self-control. They must have an urge to eat just like anybody. They are successfully overcoming that urge in order to attain their goal. The problem is that the goal is irrational and destructive.

      Speaking as a former anorexic, I can tell you it’s a little more complicated than that. The situation you’re describing is accurate for some patients in some stages of the condition, especially early on, but your assumptions don’t hold across all patients or across a single patient’s whole trajectory. After a prolonged period of anorexia, the urge to eat really does go away, and it is very difficult to get it back. Even after abandoning* the goal to lose weight and replacing it with a goal of gaining weight, a powerful urge-to-avoid-eating often remains.

      *Although most people who develop anorexia want to lose weight, it’s not actually universal. I have not once in my life desired to lose weight or attempted to lose weight, but I still got diagnosed with anorexia.

      1. Lawrence D'Anna

        huh. If you don’t mind me asking, how does that work?

        I mean, did it start as a plan avoid gaining weight? Or as an absence of interest in food? Or a powerful feeling of disgust or aversion towards eating? Or were you starving for exogenous reasons and got used to it?

        How does one lose a dangerous amount of weight without in some sense attempting to lose weight? (assuming food is available)

        1. Orion

          (Content Note: disordered eating)
          Or were you starving for exogenous reasons and got used to it?

          This one, but I had psychological risk factors. The proximal cause of my problems were financial and pragmatic. I was attending college in Chicago and living with my girlfriend, who was working. My parents had been supporting me financially, but withdrew the support abruptly and without warning. We had very little money to buy food, my anxiety made grocery shopping difficult, and I started to feel guilty about spending more of my girlfriends money than absolutely necessary. Despite my financial position though, I probably could’ve gone to a food bank or asked friends for help or begged harder for my parents’ money. If I had really wanted to eat, I would’ve tried harder.

          During childhood, my parents alternated between forcing me to eat when they thought I should eat, and withholding food to manipulate or punish me. I ended up thinking of eating as a humiliating and submissive act, of hunger as a weakness of character that made me vulnerable, and of going without food as an ennobling act of self-assertion. When the grocery money went away, I initially felt relieved, like, “now I don’t have to bother dealing with food any more.”

          By the time i realized what I was doing was physically dangerous, I had also discovered that prolonged fasting induced a state of serenity and had become dependent on it as a way to manage my anxiety. If I had to describe my disordered thinking in terms of goals, I’d say my goal wasn’t “to lose weight/be thin” but rather “to transcend the physical and become a disembodied mind.” But most of the time, I didn’t feel very goal-oriented. I was sometimes motivated to fast, but more often I was just averse to eating.

          Tying this back in to topic of this thread, I do want to acknowledge that I was an extremely non-central case of anorexia in 2011, and in 2020 even more so. The DSM-5 introduced a new eating disorder called “Avoidant / Restrictive Food Intake Disorder” which might be a better fit. The diagnostic criteria for anorexia do strongly emphasize concerns about weight and shape, and a typical anorexia patient is very different from me in that regard. I have, however, noticed one similarity between myself and other people I’ve known who voluntarily sought outpatient treatment for anorexia — they also described their most dangerous behaviors as being driven more by fear and disgust than by intention and desire. (Involuntary inpatients are probably a very different population and my results probably shouldn’t be generalized to cover them)

    5. eyeballfrog

      A psychiatrist who attempts to help such a person attain their goal and resist their urges is guilty of “conversion therapy”, and is therefore a quack.

      Conversion therapy is about creating different urges in addition to resisting the undesired ones. More relevantly, it doesn’t work as far as I’m aware, which would make the quack part still applicable.

  36. Mire

    I had to de-lurk just to point out that as a bipolar suffering academic, I am literally incapable of performing the most cognitively demanding aspects of my job when severely depressed, similarly to how Bryan describes physical strength falling when sick. I would be very happy if this were just an issue of willpower and preferences, but even when I fight through the lack of motivation the work produced is of lower quality than it would be if I weren’t depressed. This is straightforward to account for with the illness model, but seems to require positing that I have some other hidden preferences that I am not aware of in Bryan’s model. Maybe I do, but if I have no way of accessing them then that doesn’t seem all that different from the illness model.

    1. cuke

      Thank you for saying this. The wide prevalence of your kind of experience makes it hard for me to understand how Caplan could hold the view he does unless he’s ignorant of your kind of experience and how widespread it is.

  37. vpaul

    I think it’s possible that there is some subset of mental illness that is in fact the brain calculating in a way it believes is rational to overrule conscious preferences.

    Take someone whose spouse and family treats them badly. This person becomesdepressed even though they don’t consciously want to be depressed. Their brain might have calculated that depression is the best route to getting spouse / family to treat them better long term.

    Someone with ADHD wants to focus on a long term project but watches Youtube instead. Maybe that person’s brain has calculated that the long term project will fail anyways, even if the person consciously thinks they would rather work on the project. Their unconscious brain “knows” the expected value of Youtube is higher than the project.

    Or someone addicted to drugs: their brain knows that life sucks and will probably continue to suck, so even if drugs shorten life and mess things up, the drugs are better than being sober (even if consciously the person doesn’t want to be addicted to drugs).

    I think this model matches a lot of things (but not everything). Also I think the gun to the head analogy is poor. I haven’t read Caplan’s arguments but as someone with ADHD I would argue most people with ADHD would in fact end up dead. The gun to the head thing might work once or twice but it wouldn’t work consistently.

    Consider resignation syndrome an example of the brain creating behavior to bring about a result subconsciously: https://www.newyorker.com/magazine/2017/04/03/the-trauma-of-facing-deportation

  38. Ventrue Capital

    1. I’m honored to say that Bryan Caplan is/was my mentor, and there are only three places where I don’t agree with him. (Note that I don’t say I *disagree* with him.)

    Those are his positions on psychology, on Christianity, and on Champions/Hero System being superior to GURPS.

    2. AFAIK nothing from either Caplan nor Alexander contradicts Szasz’s position that “there is no such thing as mental illness; there are only brain diseases, and problems with living.”

    He defines “problems with living” as behaviors — what Alexander and Caplan call preferences, IIUC — which the person dislikes and wants to change.

    3. IIUC nothing from either Caplan nor Alexander contradicts Szasz’s position that we should treat people who have “problems with living” by helping such people change their behaviors, presumably by helping them change their preferences.

    Am I overlooking or misunderstanding something? Or did someone else beat me to pointing this out?

    Also, has anyone else suggested that Scott and Bryan should do an adversarial collaboration thingy?

    1. cuke

      It’s been a long time since I’ve read Szasz, but as his view is described here that sounds like word games to me. What I write below is just questions I’m raising if you’re interested in saying more because you’re closer to this material than I am. I get that you’re not endorsing the view.

      By brain disease does he mean like stroke, head injury, epilepsy? What does brain disease cover?

      Seems to me “problem with living” is overly broad. I’m no fan of the DSM, but at least the DSM has as a criteria for almost all diagnoses that the symptoms cause significant distress to the person and attention is paid to extent of impairment in various domains of life. If one’s extremely outside-the-norm behavior is not causing one distress or preventing one from functioning in a major life domain, then the criteria are not met for diagnosis in most cases.

      What do we make of people with moderate to severe anxiety or depression who seem neither to have “brain disease” nor a “problem with living”? It’s a pretty big chunk of cost to the economy at this point, that group of folks. What do we get by saying that they’re just what, wrong?

      Problem with living includes stuff like unemployment, divorce, difficulty in biochemistry class, falling out with an old friend, homelessness, loss of religious faith, loss of a loved one, etc.

      Anyway, his definition seems both overly narrow and overly broad, and it’s not clear to me rhetorically what’s accomplished by saying there’s no such thing as mental illness. What are the implications of that?

      I had the same reaction reading Scott’s characterization of Caplan above (I’m sorry I don’t have the energy to go read his original argument) — okay, if we say people currently considered to have mental illness are instead people with maladaptive preferences, what are the important implications of that? We get to shame them for lack of willpower? We treat them more effectively by trying to convince them to have different preferences? What’s the evidence that Caplan’s model is either more accurate or more useful in some way?

      1. acymetric

        It’s been a long time since I’ve read Szasz, but as his view is described here that sounds like word games to me.

        The debate between Bryan and Scott sounds a lot like word games to me anyway.

      2. caryatis

        >What do we make of people with moderate to severe anxiety or depression who seem neither to have “brain disease” nor a “problem with living”?

        Why would you rule out anxiety or depression resulting from problems of living?

        Edit: The important implications of the Szasz/Caplan viewpoint are that we should stop forcing people into treatment because other people label them as mentally ill. That, frankly, seems to me that one of the worst human rights violations that our society currently tolerates, and it’s far more than mere “word games.”

        Szasz/Caplan are NOT trying to “shame” people diagnosed with mental illnesses, and I have no idea why anyone would imagine they are.

        1. cuke

          Ah okay, that’s interesting. As Scott presented it, I couldn’t tell what Caplan’s concern was or what the implications were of labeling what we call mental illness “preferences.” The references to economic thinking and supposed rational actors further led me to misunderstand.

          I didn’t intend to rule out anything; I was trying to understand the implications of the argument Caplan was making. It’s quite clear to me that all kinds of problems, mood disorders, etc can result from problems of living.

          I do know Szasz’s writing and do know he is concerned with the cultural/political drivers around labeling mental illness and the violation of rights to people that can result in. I didn’t realize Caplan was primarily concerned about involuntary institutionalization. I confess I don’t see the thread that links his “preference” model to concern for involuntary institutionalization but I’m obviously not well acquainted with his work.

          If Scott had presented this discussion as one around involuntary institutionalization, I would not have said it sounded like word games to me. I share your view that it’s a really important issue. I am also concerned about the “over-medicalization” and “over pathologizing” of varied human behavior.

    2. Ninety-Three

      there is no such thing as mental illness; there are only brain diseases, and problems with living.

      This looks so much like a word game that I’m not sure it’s possible to disagree with Szasz, unless one were to invent one’s own terminology and insist on calling things snarfblats instead of brain diseases.

      1. acymetric

        I can’t say that I am fully on board with Caplan, but I do think it is fair to say that the concept of “mental illness” has, in at least some cases, extended further than it should have.

        @eqdw had a good post that described what I’m trying to get at I think.

    3. Brassfjord

      I guess that with some clever definitions we could put each condition in a special box named disease/ mental disorder/ addiction/ personality trait or just bad attitude. But what have we gained by that?

      Ideally, we should try to assess how much a person is suffering, how much different treatments would alleviate the suffering and at what cost, and then have an algorithm to decide what to do. The goal is to minimize personal suffering for the money available, regardless of the category of the condition or the life circumstances, while also taking into considerations the benefits for the society.

      1. caryatis

        >Ideally, we should try to assess how much a person is suffering, how much different treatments would alleviate the suffering and at what cost, and then have an algorithm to decide what to do. The goal is to minimize personal suffering for the money available, regardless of the category of the condition or the life circumstances, while also taking into considerations the benefits for the society.

        I think Caplan, and most libertarians, would violently disagree with this. “We” (psychiatrists?) shouldn’t be doing anything to people diagnosed with mental illnesses unless those people voluntarily request treatment.

  39. Dagon

    I wonder how much of the disagreement is about representative-ness of example and serious overgeneralization of a very broad topic. His argument applies equally well to physical medicine: most GPs and even ER Doctors don’t really do anything but triage the cases severe enough that intervention is unambiguously necessary, and then make patients more comfortable (physically and emotionally). And it’s worse for educators – most teachers don’t seem to do anything at all beyond punishing non-conformity.

    Also, I’m surprised neither of you have brought up the fact that, even to the extent these are preferences, they’re CONFLICTED preferences, which make it very difficult to follow more reasoned or longer-term goals. Often to the point that it conflicts with many other people’s preferences for the patient as well.

    Following that trail leads one to accepting part of his argument: psychiatry seeks to change behaviors to better match acceptible ranges. Yes, this _is_ partly political, in terms of how individuals interact with society and each other. It’s _also_ individual, in order to help align short-term and unreasoned preferences with longer-term and more personally weighted preferences.

    I don’t think either of you should deny that excesses, waste, and harm happen both medically and psychiatrically. And I think it’s ridiculous to claim that these failings are the primary purpose for most practitioners.

  40. Hitfoav

    “I will refer to this as the ‘Gun-to-the-Head Test’. If suddenly pointing a gun at alcoholics induces them to stop drinking, then evidently sober behavior was in their choice set all along. Conversely, if a gun-to-the-head fails to change a person’s behavior,… ”

    Is this Caplan guy okay?

      1. Matt M

        For a similar, but less confrontational approach, Dennis Prager used to use the “If I offered you a million dollars to go a day without doing *harmful behavior someone wants to stop*, could you do it? Great, therefore you can also do it now, even if I don’t pay you a million dollars,” approach.

        1. ilzolende

          A million dollars a day can buy a lot of functionality. If someone paid me that much to stop being chronically late to things, for instance, I’d hire a personal assistant and a driver, live much closer to the city center, et cetera. If someone paid me that much to consistently refrain from some extremely compelling thing (eating enough calories to maintain my body weight?) I’d spend a lot of money on enjoyable distractions from the compulsion. Et cetera.

  41. gleamingecho

    But if you had put a gun to my head and said “Don’t scratch yourself, or I’ll kill you”, I would have sat on my hands and suffered quietly.

    But you wouldn’t have stopped itching.

      1. gleamingecho

        Itch –> want to scratch –> scratch/don’t scratch

        ____ –> want to drink –> drink/don’t drink

  42. Telomerase

    Can you give us a list of psychiatrists that will actually make anyone more able to get to Hawaii?

    The few people I’ve known that tried to solve their problems with psychiatry ended up dead or in psych prisons rather quickly. (Other than those that used it to solve their employment problems by working as psychiatrists… it seems to be lucrative and results in the ability not to need to lift heavy objects when you have the flu).

    Work on psychotropics and health in general is great, of course. And governments shouldn’t let psychiatrists force people to use drugs, or keep them from using drugs… but for most people, if your mental health isn’t standing up to our removal from the Ancestral Environment, the solution is to take a hike with your border collie, not to play bizarre mental dominance games with an “authority figure” that knows little about how the brain works and less about biochemistry.

    The border collie may well bite you if he thinks you’re crazy, but he won’t be able to lock you up and force Haldol into your veins.

    And even if you avoid involuntary confinement, the employment stigma from any contact with the mental illness industry will follow you forever…. and cause real problems, not imaginary ones.

    Maybe psychiatry would look a little less cultish if it actually encouraged people to walk in the woods, instead of having them lie down and take more drugs. Obviously once someone is walking down the street screaming that tariffs help the economy, we have to do SOMETHING with them, but it’s not obvious why that something should be “psychiatry” in its present (or past) forms.

    1. Conrad Honcho

      Obviously once someone is walking down the street screaming that tariffs help the economy, we have to do SOMETHING with them now.”

      …elect them to Congress?

      1. Telomerase

        That is the traditional “solution”, which is why I’m saying we need something better than what we’ve been doing 😉

    2. Garrett

      The few people I’ve known that tried to solve their problems with psychiatry ended up dead or in psych prisons rather quickly. (Other than those that used it to solve their employment problems by working as psychiatrists… it seems to be lucrative and results in the ability not to need to lift heavy objects when you have the flu).

      There’s a difference between ill-intent and limited capabilities.

      Psychiatry is still in the stumbling-around-in-the-dark phase of medicine, mostly because we don’t really know how the brain works from atoms-to-consciousness. Scott’s written a lot about the mis-steps of psychiatry and psychiatric medicine.

      There are a good number of conditions where psychiatry manages to do quite well: ADHD, anxiety, depression, schizophrenia and bi-polar disease all come to mind with varying degrees of success. Indeed, the major elements of success have been in that these people don’t need to be hospitalized like they used to.

      Psychiatry, especially the in-patient lock-them-up kind isn’t exactly a great job. Almost none of them have insurance coverage, and what insurance coverage exists typically doesn’t pay much for in-patient stays. So you end up only with the most terrible of cases in a facility which usually doesn’t have nearly enough money for maintenance or staff. As Scott has written, most psychiatrists also don’t want to lock people up.

      As for killing themselves, I’d point out that there’s likely a selection bias. The people who are most likely to see a psychiatrist are those who have the greatest dysfunction or suffering are the ones most likely to commit suicide regardless of their contact with a psychiatrist.

      I suspect that this is reporting bias on your part – the large number of people who know people who’ve have mildly-negative to outright positive experiences are unlikely to be the ones posting comments about how psychiatry is terrible. Given how there is still stigma around it, they are likely to keep quiet altogether.

      1. Telomerase

        >Psychiatry is still in the stumbling-around-in-the-dark phase of medicine

        Yes, of course. Which is exactly why it’s not reasonable to expect them to beat the Ancestral Environment for most people with minor problems.

        >conditions where psychiatry manages to do quite well: ADHD, anxiety, depression, schizophrenia and bi-polar disease all come to mind

        The “conditions” change from year to year (“being Jewish” was a “condition” not that long ago… “not believing in the Party” still is in some places), and the “diagnoses” expand whenever there aren’t any checks on them… if you are male and put in a public school, there’s a good chance you’ll be tagged as “ADHD”, marked for life, and drugged to the gills.

        As you say, we’re stumbling in the dark. That calls for some humility and less confidence in whatever happens to be in patent today… read Scott’s post about the psych conference and its saturation in pharma advertising.

  43. Ttar

    Bryan has said before he believes in a pretty strong version of free will. I think that’s where the disconnect comes from. It’s not just that constraints vs preferences are bad categories to apply here, it’s that there literally isn’t a divide between the two — it’s constraints all the way down, because there’s no magical divide between “my legs are not arranged physically to allow me to walk” and “my brain is not arranged physically to allow me to engage in the set of behaviors I can identify as being more optimal to achieve my world-state preferences.”

    Duh.

    ETA: something about definite wrongness with the arrangement of physical objects. The sky is displeased.

  44. slovakmum

    Where was that part, how Szasz declined to stay at any real psychiatric hospital, because he deemed them immoral, so as a result, he did not get experience with mental ilnesses at their worst ? That way, he could form weird theories about mental ilnesses being preferences ? It was a fascinating Catch 22 for me and I thought Scott wrote about it, but I did not find it ib the first “Contra Caplan…” article.

    1. cuke

      Oh interesting, I’d not heard that about Szasz and would love to see the reference if you come upon it.

  45. Deiseach

    Okay, this is a prime example of You Have To Be Really Smart To Be This Dumb.

    If suddenly pointing a gun at alcoholics induces them to stop drinking, then evidently sober behavior was in their choice set all along.

    No, it simply demonstrates that their ‘choice set’ contains “Not wanting my brains spattered all over the walls”. I disagreed with Chesterton when he used this* as a plot device, and I am vehemently disagreeing with Professor Caplan for his usage.

    And Professor Caplan plainly has never been in the kind of mindset where, if someone was threatening to blow your brains out, you’d tell them “Go right ahead”. I’m in two minds as to whether I hope he never gets into such a state; the anti-side wouldn’t wish that kind of feeling on a rabid dog, but the pro-side feels that it would cure him of talking such twaddle.

    *“`Let’s give it a bad name first,’ said the Professor calmly, `and then hang it. A puppy with hydrophobia would probably struggle for life while we killed it; but if we were kind we should kill it. So an omniscient god would put us out of our pain. He would strike us dead.’
    “`Why doesn’t he strike us dead?’ asked the undergraduate abstractedly, plunging his hands into his pockets.
    “`He is dead himself,’ said the philosopher; `that is where he is really enviable.’
    “`To any one who thinks,’ proceeded Eames, `the pleasures of life, trivial and soon tasteless, are bribes to bring us into a torture chamber. We all see that for any thinking man mere extinction is the… What are you doing?… Are you mad?… Put that thing down.’
    “Dr. Eames had turned his tired but still talkative head over his shoulder, and had found himself looking into a small round black hole, rimmed by a six-sided circlet of steel, with a sort of spike standing up on the top. It fixed him like an iron eye. Through those eternal instants during which the reason is stunned he did not even know what it was. Then he saw behind it the chambered barrel and cocked hammer of a revolver, and behind that the flushed and rather heavy face of Smith, apparently quite unchanged, or even more mild than before.
    “`I’ll help you out of your hole, old man,’ said Smith, with rough tenderness. `I’ll put the puppy out of his pain.’
    …“`Help!’ cried the Warden of Brakespeare College; `help!’
    “`The puppy struggles,’ said the undergraduate, with an eye of pity, `the poor puppy struggles. How fortunate it is that I am wiser and kinder than he,’ and he sighted his weapon so as exactly to cover the upper part of Eames’s bald head.
    … “`I rather doubt if it will bear you,’ said Smith critically; `but before you break your neck, or I blow out your brains, or let you back into this room (on which complex points I am undecided) I want the metaphysical point cleared up. Do I understand that you want to get back to life?’
    “`I’d give anything to get back,’ replied the unhappy professor.

  46. blacktrance

    In Caplan’s emphasis on psychiatry’s coercive and excuse-making aspects, he weirdly deemphasizes the third category: when psychiatry actually works. I think I might have ADD, so I go to the doctor (of my own free will). He diagnoses me, prescribes me a stimulant, and my problem mostly goes away. I didn’t go looking for an excuse but for a solution, and found one.

    Though it is true that people sometimes performatively pretend to dislike something and make psychological excuses to keep doing it, e.g. “haha, I’m so addicted!”, when they genuinely like something but it’d be weird/low-status to explicitly say so.

  47. Dacyn

    Consumer theory distinguishes between two different reasons why someone might not buy a Ferrari – budget constraints (they can’t afford one) and preferences (they don’t want one, or they want other things more).

    I think this is a weird example, as most of the time when people say they “can’t afford” something, they don’t literally mean that it costs more than their life savings, just that buying it would interfere significantly with other things they want or need to buy. Maybe a Ferrari is expensive enough that this isn’t necessarily true, but that seems like an edge case.

    Let’s call endorsed preferences which people meta-prefer to have “goals”, and unendorsed preferences which people would meta-prefer not to have “urges”.

    Something I’m not sure is taken into account by this dichotomy: it’s possible to have preferences that people endorse in the sense that they approve of themselves trying to satisfy them, but also they want to get rid of the underlying causes of. For example, if someone itches, they may want to scratch, and they may think that that outweighs the benefits of not scratching (even considering this retrospectively when they are done itching), but obviously they would still prefer to get rid of the itch (and implicitly the desire to scratch).

  48. Alex M

    What is mental illness anyway? And what gives psychiatrists the right to decide it?

    For example, after taking psychedelics, I made a conscious decision to limit my empathy sphere. I would no longer have any empathy for people who do not have empathy for me. This allows me to effectively eliminate toxic people from my life while making space for caring people who are healthier for me.

    Many therapists would say that a lack of empathy is a sign of sociopathy and encourage me to change. After all, we live in a culture where empathy is highly valued (the question of whether such empathy is genuine or simply virtue-signalling for Instagram is something we can discuss at another time). But I think it’s quite obvious that empathy evolved for a reason; to encourage mutually beneficial cooperative relationships in society. If I have empathy for anybody who lacks empathy for me, I am not encouraging a “mutually beneficial cooperation”: I am simply encouraging myself to be exploited. From both a rationalist and an evolutionary perspective, it is the therapist who is insane, whereas I’m being perfectly logical in my choices. I don’t see how somebody could possibly make a coherent argument that I somehow owe them empathy when they lack empathy towards me: any such argument would be seen as the transparently exploitative ploy that it is.

    Of course, since society promotes empathy without questioning the reasons behind the evolution of this emotion, its unlikely that most people would agree with me, and much more likely that they’d agree with the therapist. But society has always been stupid and irrational. Half a century ago, they’d have called me mentally ill for saying that blacks and women were equal to whites and men. So why should we privilege a therapist’s views of mental illness just because they happen to fall in line with our current societal consensus? Maybe as rationalists, our job should be to CHANGE the consensus – to force society to question itself and become more logical and rational rather than gullible and emotional. This is quite easily achievable if you have a big enough toolbox and are willing to use the Dark Arts.

    So how can therapists possibly be competent to judge what’s rational or irrational behavior, when the vast majority of them adhere to the moral and social tenets of a completely irrational society?

    1. cuke

      Speaking as a therapist, I’m a bit lost by your argument. I don’t know a therapist who would consider it their job to convince you that you should have/feel/express empathy for everyone or who would label you psychopathic or sociopathic for making choices about where to expend your emotional energy. There’s a pretty big space between “I don’t experience empathy” and “I don’t want to feel pressured to have empathy for absolutely everyone.”

      The “what is mental illness anyway?” question is a good one and always worth asking. The boundaries of it change across history and culture, same with medicine and other fields. I don’t think that’s sufficient cause to throw out the entire field, but plenty reason to question anyone in the field asserting their opinion dogmatically.

      1. Alex M

        That’s a really good answer. Since you seem like a very smart commentor, let me ask you a follow up question. Since the way I allocate my empathy is rational and logical while the way society allocates its empathy is not, would you say that society as a whole suffers from mental illness?

        Perhaps a more concrete example can be helpful. Scott often advocates the “Principle of Charity” and is compassionate towards people and groups who refuse to apply the same principle towards him. For example, here is a Metafilter thread where users obviously lack the “Principle of Charity” towards Scott. From a purely rational and logical perspective, wouldn’t Scott be demonstrating mentally ill behavior if he applied the Principle of Charity towards them? After all, there is no logical benefit in having compassion towards anybody who lacks compassion for you. In fact, showing compassion towards these kinds of people only incentivizes them to continue this kind of exploitative behavior.

        1. mcpalenik

          I don’t think there’s an objective definition of “rational” when it comes to moral behavior. The rational course of action depends on what goals you think it is your right or duty to pursue. Should you act maximally in your own self interest? Act in the manner that will maximize the happiness of the maximum number of people?
          Attempt to push society in a direction to avoid Nash equilibrium? Maximize the well-being of all living creatures, human and non-human? Pick some arbitrary principle and you’ll find an arbitrary set of actions that you should rationally engage in in fulfilling that principle is “good”.

        2. cuke

          Hi Alex,

          So this is just me opining, okay?

          I would say the way you’re choosing to allocate your empathy is working for your priorities and needs right now rather than it being more or less rational than someone else. It sounds like what you call rational I would call transactional, which is to say that you consider it rational not to “give” someone something if they aren’t also giving the same back to you.

          Other people optimize for other things. Some people find it meaningful/pleasurable /whatever adjective you want to use here to extend well-wishing and kindness more generally in their interactions with a wider range of people — strangers, acquaintances, even people who are not particularly kind in that moment. We can interrogate whether those people’s motives are “purely selfish” or not, but they may also be acting in accordance with values and they may have reasons (rational or otherwise) for why they choose to do that without much regard for specific outcomes or reciprocity from specific individuals.

          So I wouldn’t consider Scott mentally ill for behaving kindly even where he may not expect kindness to uniformly or equally to come back at him. He may be acting according to his own values and find that meaningful; he may find it doesn’t cost him a lot personally and/or that doing something else costs him more. His capacity/energy may be different from yours or mine right now as well.

          I do think it takes us all awhile into our lives to figure out how to take good care of ourselves up against whatever noise we’ve internalized from parents or “society” about how we “should” be. Pushing back against that external (or internalized) pressure takes some strength and effort. It takes some conscious decision-making about where we draw boundaries.

          I can’t wrap my head around big generalizations like is society mentally ill. I would say life is full of suffering and humans add a lot of mental suffering to the inevitable pain that life includes. Is it mentally ill if we’re all doing it?

          In a longer conversation I would want to unpack what we each mean by empathy versus say charity, kindness, or compassion. I will say for me loosely that I consider empathy to be the capacity to feel what someone is feeling — to feel with them. Somewhat differently, compassion I would say is the capacity to non-judgmentally wish someone well in whatever they’re dealing with.

          There are people in my field who would say that empathy is a natural human trait to feel others’ suffering that can lead to burnout pretty quickly in caring professions, while compassion is a kind of “stance” to someone else’s suffering that brings a lot of support and kindness without requiring that we be in their river of suffering with them entirely. Because most of us are wired to respond empathically to suffering, it’s not always something we can just turn on or off, but I think it is possible to take care of oneself while being exposed to others’ suffering without getting drained quite so fast. That’s a longer conversation though.

          I think it’s quite possible to be kind in the face of suffering without feeling obligated to bleed with them. But if a person hasn’t yet gotten a lot of practice at that or if they for various reasons have weak filters, then it’s understandable that they would limit interactions in which they’re likely to be exposed to another person’s suffering over and over again. People who lack the capacity to reciprocate in friendships are often people who are suffering, so it makes sense to me that anyone might as a matter of taking care of themselves limit how much time they choose to spend with friends who have no capacity to show up for something other than their own suffering. Which is to say, it seems to me all healthy people make choices as you are about where you want to invest your time and care and attention. They may make different choices than you, but awareness about the right and capacity to make those choices seems healthy to me.

          1. Alex M

            I can’t wrap my head around big generalizations like is society mentally ill. I would say life is full of suffering and humans add a lot of mental suffering to the inevitable pain that life includes. Is it mentally ill if we’re all doing it?

            Why can’t you wrap your head around this? It’s such a simple question. Less than two centuries ago, Abraham Lincoln asked people to decide whether society was morally wrong to tolerate slavery. Would you have a difficult time deciding? Would you tell him that slavery is OK if we’re all doing it? I hope that you wouldn’t have a problem making a negative value judgement about society in that particular instance, so why do you have a difficult time here?

            I have a theory about why you might have such a hard time wrapping your head around this question, but I’d like to hear your own thoughts about it first. Could you do me a favor and search your feelings to try and pin down the root cause?

          2. cuke

            I can try to explain how I understand your question and maybe where I think we’re talking past each other.

            I don’t have negative judgments about society “as a whole.” I could say things I like or don’t like about specific behaviors, policies, institutions, in specific societies. And I can talk about what tendencies I see to be common to humanity generally.

            A mental illness is something we diagnose in a person, while also understanding that there may be conditions external to the person that are contributing to it. We don’t talk about society as a whole having pneumonia or chronic fatigue syndrome. If you’re using the term “mental illness” in some metaphorical sense to talk about society as a whole, I would need clarification on what you mean by the metaphor. If you mean “bad,” “messed up,” “morally bankrupt,” or something along those lines, I would suggest that “mental illness” is not the word to use here.

            Setting aside the “mental illness” words, what I understood you to be saying was “I’m rational in how I allocate empathy; society does it differently from me; therefore, isn’t society [negative word for something I judge as bad]?”

            So my response above was trying to answer that question a bit by saying I see you’ve made some choices that work for you about where to expend your emotional energy; other people make choices that make sense for them. I don’t think that makes you rational and them irrational or messed up, whether we’re talking about Scott here or society in general.

            Beyond that, I would say “society” isn’t one thing. So when people say “society tells me to…” or “society thinks we should….” what I hear is “I have internalized a story about how some imagined others think I should be and that story is causing me distress because it’s different from how I want to move through the world.” So that was the intent behind the paragraph above that begins “I do think it takes us all awhile into our lives to figure out how to take good care of ourselves…”

            Your comparison to making a moral judgment around slavery doesn’t fit for me. Slavery was a specific practice and set of institutions and laws that violated a whole group of people’s human rights and their physical personhood. That was bad like how murdering people is bad, or stealing from people is bad. What is the parallel question here?

            It seems like you’re saying, “Don’t you agree that society is bad because it expects everyone to have empathy with everyone else all the time?” That’s not real to me like slavery or murder or theft. It’s pretty hard actually to point out instances where society as a whole, or even specific individuals, are doing whatever the thing is that you feel is being done. If there are individuals saying “hey you, it’s your obligation to feel empathy for everyone all the time” I guess I would say those people have unrealistic expectations. Lots of people have unrealistic expectations. I don’t know that I’d call that bad or mentally ill. I’d say it’s human.

            How big are the spaces for you between behaviors that you find to be “irrational” and those that are “morally bad” and those that are “mentally ill”? For me, there’s a lot of space between those things. I gather from what you’ve said here, but am not sure, that these things are fairly coextensive in your mind.

        3. alwhite

          AlexM this seems like an important distinction. Empathy isn’t a feeling. We don’t feel empathy. Empathy is the ability to know what another person is feeling. What you are describing sounds like compassion. You don’t feel compassion for everyone. Nothing wrong with that.

          People who lack empathy can’t understand the emotions of others. Empathy more or less happens automatically, but we can choose to pay attention to it or not. People without empathy literally can’t do it. People without empathy are actually very rare.

    2. NoRandomWalk

      ‘Mental illness’ is behavior that society finds intolerable enough to some-combination-of allocate resources from government to treat/incarcerate people over so they don’t continue to perform that behavior around other people.

      Society changes over time, there is no ‘moral arc to history,’ etc. I accept these as powerful critiques. I recognize also that incentives are very, very important. Just not maximally important.

      For the record, I wish everyone was a pure rationalist utilitarian with a lot of epistemic humility about putting those beliefs into action, and my experience with psychedelics caused me to widen my sphere of ‘caring’ (but not empathy) significantly in a way I recognize as non-game-theoretic-optimal. I guess where we’d disagree, on reflection, is that any set of preferences that are non-game-theoretic-optimal will go extinct, which seems to be a claim that you endorse strongly.

      1. Alex M

        That’s a great answer, and I think you also perfectly captured the difference in our opinions. I do think that any non-game-theory optimal behaviors will eventually go extinct. I think that we are seeing this in Western society today – for example, in the ongoing collapse of the EU and the election of Donald Trump, among other things. Incentive gradients are like water – even if one particular water droplet splashes outside of the pattern laid out by the terrain, the river as a whole will still move in the direction preordained by gravity.

  49. Erl137

    Bryan says:

    When sick, the maximum amount of weight I can bench press falls. (Yes, I’ve actually tried this).

    But how does he know that this is a constraint, not a preference? Did someone hold a gun to his head while he tried to do a flu-infected one-rep bench press max? If not, how can he be sure he was constrained?

    Of course, for the comparison to be fair, he’d also have to try a healthy one-rep handgun max.

    But it’s worse than that! After all, the gunman can’t just say “lift as much as you possibly can or I’ll shoot you”, because the whole purpose is to discover the maximum weight. So we’d need the gunman to set a series of increasing absolute targets until Bryan fails one and is killed; even then all we can really say is that the highest successful weight was lower than his one-rep max.

    But it’s still worse than that! Because how do we know that the threat of death is maximally incentivizing for Bryan? Probably there’s something else he’d be more incentivized by—if nothing else, death PLUS some other penalty, maybe his estate being donated to a detestable cause. So the gunman needs at least a pistol and power of attorney, or potentially total control over the world economy, to make sure that Bryan is maximally incentivized.

    But it’s even worse than that! Because there’s no reason to believe that Bryan’s strongest incentive is rational or known to him. Maybe he can bench press an additional 5 pounds if at the end of the exercise a Dromiceiomimus gently licks his feet while Alan Alda says “I’m proud of you, son.” So really the gunman is no good. Instead we need a cruel and capricious God, who’s willing to try every conceivable experiment possible to find Bryan’s maximal incentive; only then can we guarantee we’ve got his one rep max.

    But it’s WORSE THAN THAT! Because if we’re allowed to try any intervention, we’ll probably find that the correct “incentive” is whatever combination of electrical and chemical stimulus causes Bryan’s muscle fibers to fire as vigorously as possible. Now, maybe we can redefine “incentive” so as to exclude active interventions; it’s just something that we’re promising or threatening to do. But that may be harder to delineate than we wish. A screaming, obviously deranged gunman is probably more of an incentive than a teletype machine with a pistol barrel that prints out a threat. So coming up with a principled restriction on what constitutes an incentive may exclude many ordinary incentives, among them the one we imagined to begin with!

    So in conclusion: if we disregard introspective reports, we have a great deal of trouble successfully verifying any constraint, including the medical one that Bryan uses as an obvious and indisputable example.

    1. Midge

      As I once put it earlier (I know how obnoxious it is I’m quoting myself at length here, but it does seem particularly relevant:

      So, for example, if you put a gun to a deaf man’s head and threatened to shoot him if he didn’t get a cochlear implant to restore his hearing, or if you threatened to shoot a gymnast who’d broken her ankle if she refused to attempt a vault, and both chose cooperation over death, you would… prove that deafness and broken ankles can’t be illnesses because they aren’t really budget constraints?… No, that can’t be right.

      Instead, what you’d demonstrate is that the physically ill aren’t facing the budget constraints Caplan posits, either. They, too, possess some capacity to overcome their difficulties if the stakes are high enough, though they likely must overcome their difficulties at greater cost (in dollars for cochlear implants, in worsening injury for injured gymnasts who refuse to quit) than healthy people do. The same behavior Caplan believes is a “tell” for the mentally ill not “really” being ill – that the “mentally ill” can amend their behavior when the stakes are high enough – is also a “tell” for many people experiencing physical illness, too.

      Kerri Strug is of course the gymnast who vaulted on an injured ankle, and they didn’t even have to threaten to shoot her to get her to do it! Helping her team win gold in the Olympics proved incentive enough. When the stakes are high enough, it’s very common to find ways to muscle through very real, very physical, infirmities, infirmities we wouldn’t bother overcoming otherwise. I’m used to doing so myself, though of course far less heroically than Strug. So when I read Caplan’s pronouncement that, “If you have the common cold, the good of ‘not-sneezing’ suddenly falls on the wrong side of your budget set,” I burst out laughing.

      Anyone involved in theater or music for any length of time learns that sneezes and coughs aren’t something whose avoidance simply falls “in” or “out” of your “budget set”, but reflexes that, with a lot of effort, can be suppressed. Not suppressed with 100% certainty, but suppressed hard enough that the odds of them spoiling a performance become low enough to go on with the show. A group I was in once recorded a CD while I had lung trouble bad enough to leave every cell of my body aching for some nice, juicy, hacking. I had to go to extremes to not cough during recording, but I succeeded. The extremes weren’t pretty, but that’s my point: not-coughing was still in my “budget set”, I just had to resort to costly, “abnormal” extremes to accomplish it.

      1. averageradical

        Gay was considered a psychological disease in the DSM until it was voted out. Why should we trust their judgment on others? In some jurisdictions, they have the power to put people in what are effectively jails.

        1. niohiki

          Sure, institutions are only valid for as long as they have not historically committed anything seen as mistaken from today’s perspective. That’s why we don’t trust the judicial system, because it sentenced women to death for being witches. Or why we do not have a police force, because it is well documented that they sometimes shoot people they should not, or enforce laws that are now considered immoral.

          Great argument there.

          1. averageradical

            @niohiki Institutions don’t magically improve. Psych*ists need to confront their most difficult mistakes if they are to improve. What exactly failed when classifying gay as a disease and how has the field resolved these issues? I suspect treating boys with drugs for “overactivity” is a continuation of these failures.

  50. Midge

    Yes, yes, YESSSS…

    Bryan’s preference vs. constraint model doesn’t just invalidate mental illness. It invalidates many (maybe most) physical illnesses! Even the ones it doesn’t invalidate may only get saved by some triviality we don’t care about – like how maybe you can lift less weight when you have the flu – and not by the symptoms that actually bother us.

    Several years ago, I wrote a post called Contra Caplan on Physical Illness, Too addressing this very point. When I saw Caplan’s response to Scott, I left a comment at EconLib reminding Caplan there was already a rebuttal addressing physical illness out there.

    I am (ha!) a bit cross-eyed with a migraine myself right now, so not in the best position to be engaged in this tussle right now. But anyone who points out how few hard constraints there really are on many physical illnesses — how often physical illness simply makes prosocial behavior costlier, not completely out of budget — is doing God’s work.

  51. CLawnsby

    This is so interesting I love it so much– thanks to both you and Bryan for such an enriching discussion

  52. Fakjbf

    “also, if Bryan uses his gunshot analogy one more time, I am going to tell him about all of the mentally ill people I know about who did, in fact, non-metaphorically, non-hypothetically, choose a gunshot to the head over continuing to do the things their illness made it hard for them to do.”

    I think this is the only rebuttal you really needed to Bryan’s post.

  53. niohiki

    For a rather long period, I was somewhat dysfunctional, making myself and others suffer. I also grew up in an environment that suggested that taking psychiatric drugs was “a failure”. I was not my preference to be like that. In his paper Caplan says

    Making people pay the full social cost of their behavior is the way that we find out if their preferences are as extreme as they say.

    Well, I agree with him: I saw the social cost of what I was doing, and I did not like it. I also saw the social cost of taking drugs because I grew up around people who considered, like Caplan, that psychiatric drugs were only for failures who could not self-control. I didn’t like that either.

    Thankfully, someone convinced me to seek medical help. Changing, in the economical terms Caplan likes, the “social cost” and my preferences. This helped enormously, I was able to put my life on track, and I could eventually stop the treatment as it was my preference not to depend on pills – while some of the symptoms came back, they did so less strongly and in a context where I had the tools and the environment to keep my head up.

    He also says

    Conversely, there are efficiency reasons for political reluctance to regulate extreme preferences.

    Because understanding the brain is extremely complicated and it takes years of preparation to handle this issues, and it would be extremely inefficient for me to study it, our lovely free society has created a whole profession out of psychiatry to cover my needs.

    I had a preference to feel well when I wasn’t, I had a preference to go to a MD and take drugs when I took them, and I now have a preference to keep such an option open to myself, and to whoever else wants it.

    I’m not even sure what Caplan’s point is, other than being contrarian, and telling us how great his life is. I guess he will argue that he does not want to forbid psychiatry, just use his free speech to convince people not to resort to it. But he cannot seriously at the same time acknowledge the importance of “social costs” in influencing people’s behaviour, as he uses as a critical point in his paper, and be part of the crowd that continues to shame psychiatric patients as not being “really” sick and essentially lacking willpower.

    And in general, failing to understand a point that is so relevant and present in so many and so varied people’s lives, should lower anyone’s priors that Caplan is putting any real effort in actually understanding anything that is outside of, as he calls it, bubble.

    1. caryatis

      >I’m not even sure what Caplan’s point is…

      Part of his point is that we should be very, very skeptical of forcing psychiatric treatment on people who do not want it. It’s an insane abuse of human rights that happens a lot more than most people realize. There’s nothing wrong with contrarian when contrarianism is on the side of fundamental human rights.

  54. sripada

    I am loving this debate because it gets to a crucial issue that is pretty much neglected in contemporary psychiatry (I am a psychiatrist myself). I think Caplan is flat out wrong that mental illness is nothing more than wonky preferences. But it is maddeningly difficult to say why. I see Scott *trying* to say why, but he is hamstrung. The problem is that both Caplan and Scott and are holding on to a seductive picture of motivational architecture that I call the “Single Ordering View”. This involves the conjunction of two ideas:

    1. all of one’s preferences are arrayed in a single ranking based on their “strength”;
    2. the processes that produce action follow a master rule: Select the Strongest.

    Scott might call this the “Lamprey View” of motivation. So long as you have this picture of motivational architecture, then you are basically stuck with the Caplan view that mental illness consists of nothing more than having wonky preferences. Introducing meta-preferences (i.e., goals) into the single ordering doesn’t help. Say S is your preference to slap your face and M is your meta-preference to not slap it. Either M is your strongest preference, in which case you don’t have a problem. Or S is your strongest preference, in which case you most prefer to slap your face – i.e., you have wonky preferences.

    My view is that there isn’t just one ordering – there are goal-type motivational states and impulse-type motivational states and they belong to different orderings. And this part is critical: We can use goal-based motivation to perform mental actions (called cognitive control actions) to regulate impulses – we can inhibit, suppress, or otherwise modulate these impulses.

    Regulatory actions are complex to undertake. Temporally-extended impulse states like anxiety affect diverse mental systems (attention, memory, action selection, thought, etc.). A person has to be adept at deploying lots of regulatory actions at the right time, with the right intensity, at the right targets to keep from acting on anxiety. It is a brute fact about us as a species that most of us are pretty bad at this. If this is right, we have the making of a real constraint: a person with the goal of doing something may fail to do it because they fail to appropriately perform the complex mental actions needed to prevent impulse-type states from winning out.

    The Caplan side will surely reply: Well if the impulse “wins out” isn’t it your strongest preference? No! Comparisons of strength only make sense within an ordering. With two orderings, the notion of your strongest preference is basically undefined. What we can say is that the person’s goal is thwarted by problematic impulses that , given their current level of regulatory skill, they were unable to regulate. If that kind of thing happens all the time, and if the goals at stake are serious and central (like the goal of having satisfying social relationships) then the person doesn’t have wonky preferences – THEY HAVE A MENTAL DISORDER!

  55. slatestarreader

    Hi Scott,

    So it’s not constraints vs. preferences. It’s everything is preferences.

    Except when there are constraints! Replace “go to the wedding” with “walk to the wedding” and take away Alice’s legs. She ends up being shot.

    Preferences (urges) and meta-preferences (goals) are a useful way of thinking about this, but another way is to think of constraints as constraints on realizing urges, and urges as constraints on realizing goals (though I don’t know if this is much better, it at least recognizes constraints). I really like your human lamprey model, but it’s glaringly missing constraints. If we’re quibbling over “go to” vs. “walk to”, we’re talking about something that isn’t practically very useful (Alice is probably not considering walking to the wedding if she doesn’t have legs [or is it just a whisper of dopamine? non-zero but for all practical purposes, zero]), but at the same time it does illustrate an issue with a model.

    In a recent paper (though the site is down for maintenance as I write this post, but I expect it to be back up later since it’s a journal), the authors talk about self-control failures as violating a long-term goal and therefore being accompanied by anticipated regret. An alcoholic who doesn’t want to be but also doesn’t anticipate regret would then not be “counted” as experiencing a self-control failure when they drink, and we might even question the “doesn’t want to be” part. In this case, that’s Caplan preferences (aside: what “counts” as a preference is also up for debate here- self-reports vs. “observed preferences”). An alcoholic who doesn’t want to be but does anticipate regret would then be “counted” as experiencing a self-control failure when they drink, as we would see that clearly the urge violated the goal (which we know exists because they anticipated regret).

    You can see this is about labeling- the paper was about inconsistencies in the use of the term “self-control failure”- but that means there must be a “test” for the label; Bryan likes the headgun test, consumer researchers might like the regret test. And on Bryan’s side there’s an intersection with the notion of blameworthiness, which complicates it further but is not a pure exploration of the origins of behavior.

    Great post as always!

  56. Peter Gerdes

    But I’ll add the Caplain is just flat out wrong in his comparison of addiction with the flu. Working during opiate withdrawal is exactly like working through the flu but more intense and longer lasting. You can make yourself do things but willing yourself to do them and slogging through it is just like doing so while having the flu.

    1. acymetric

      We probably need to separate mental and physical addictions here.

      Physical withdrawal is certainly a medical deal, but mental addiction can exist in the complete absence of physical withdrawal, even for substances that can sometimes but don’t always result in withdrawal (or for behaviors).

    2. gleamingecho

      I think this comment illustrates some disconnects in this discussion.

      I think Caplan’s argument about the flu and its effects on weightlifting is not helpful. The attempt seems to be to show that the flu causes *physical* symptoms, while something like alcoholism may not. But then he confuses it by talking about weight lifting with the flu.

      I think a better comparison would be something like the following:

      Does having the flu affect one’s ability to *not* have a fever in the same way that having alcoholism affects one’s ability to *not* have a drink?

      I think that in Caplan’s case, he would argue that having a fever is a first-order effect of having the flu, while having a drink might not be a first-order effect of being alcoholic.

      Whether trying to [work or lift weights or whatever] while [sick/drunk/hungover/in withdrawal] is difficult is not up for debate.

      I guess my point is, assuming all of my presuppositions are correct (unlikely), there seems to be a lot more choice involved in the alcohol situation than in the flu situation. I’m not sure if that presents a meaningful distinction, though.

      I think what I see as a distinction here may start to fall apart when you get into things like depression and bipolar. The flu:fever::depression:being depressed analogy works a lot better…..

      In short, I dunno.

  57. Peter Gerdes

    It ready doesn’t seem to me like there is any real difference in the actual suggested actions recommended by the two theories. I mean whether or not we regard alcoholism as a disease or preference it doesn’t change the fact that some people who might choose in the moment to imbibe have a preference to precommit themselves not to drink (eg via antibuse or via the social mechanism of commiting to their psychologist)

    The real difference here seems to me to be entirely attitudinal and here I somewhat sympathize with Caplain. OF COURSE we should help people realize their more considered preferences via antibuse or Adderall but if we admit that this is continuous with merely helping people realize their more considered prefs over their less considered ones maybe we prescribe Adderall to people who merely want to get more done at their job as well. Indeed there is probably just as much utility to be gained in helping people whose lives are going ok to have excellent lives as helping the depressed have ok lives.

    In short I think Caplain is right that there is no coherent way to draw a line between treating disease and merely helping people achieve things they are struggling to choose to do. However, that doesn’t mean we shouldn’t help them or be any less empathetic about their situation as many people see to imicitly assume. Rather than using this bastard concept of a disease to both decide what meta-prefs we help realize and what we don’t how about we just look at what interventions make lives better and just do those regardless of whether you want to call them enhancements, modifications or cures.

    P.S. I don’t think it’s a coincidence that in some sense the examples which really seem to drive this debate are moral in some character because the only real bone of contention here is over how we should judge and hold responsible certain people not when or how to treat them.

  58. Incandenza

    What about psychopaths? Serial killers? Malignant narcissits and the like? Abusers of various stripes? In these cases there might be no divergence between urges and goals; the problem is that in pursuing their goals they sow misery in those around them.

    It seems that we’d need a model that takes social effects into consideration to account for mental illness in a comprehensive way. It’s not surprising that a libertarian’s simplistic model of human nature fails on this score, but Scott shoud be able to account for such cases, and maybe/probably he can, but I don’t see that here. (At a first pass, you might say the problem is a divergence between the individual’s goals and society’s goals in anti-social behaviors, but then we’ve got to watch the slippery slope toward goose-stepping conformity and Brave New World-style mandated obedience-inducing drug consumption. But I’m not a psychiatrist and I’m sure the field has responses to this question.)

    (I’m not sure if at least some cases of, for instance, schizophrenia and bipolar disorder might also be instances where urges and goals don’t diverge – in these cases because of the effects of the disorder on goals themselves.)

    1. Garrett

      > the problem is that in pursuing their goals they sow misery in those around them

      Note that this can happen for non-psychiatric reasons as well. Someone who breaks into a house and rips out the electrical wiring to sell as scrap for $50 has done easily 20x the amount of damage in terms of cost to repair. For those cases we resort to the criminal justice system where we imprison people for their harmful actions.

      1. acymetric

        To me, one of the problems with overly broadening “mental illness” to include seemingly every maladaptive behavior or unsatisfactory mental state is that…it includes every maladaptive behavior or unsatisfactory mental state.

      2. Incandenza

        Certainly! I’m not saying all anti-social behavior is a symptom of mental disorders. I’m just saying not all mental disorders entail a divergence between goals and urges (as Scott defined those terms).

        1. caryatis

          This is a good point. Most so-called “personality disorders” are not conditions that cause the people who have them to suffer. So defining something like being a loner (schizoid) or callous (antisocial pd) or rigid and super conscientious (ocpd) as an “””illness””” is even more problematic than most mental illnesses.

  59. Matt M

    FWIW, originally I had agreed with Brian, but this post shifted me largely to Scott’s point of view.

    The one objection I might make is that Scott seems to be assuming that classifying mental health issues as diseases is essentially costless. But it isn’t. Getting “mental health treatment” is expensive. Doctors are expensive to see. The drugs they prescribe are expensive. There’s opportunity cost associated with hours of talking to them and navigating the bureaucracy. There’s a stigma associated with “suffering from mental health issues.” Etc.

    On the other hand, the cost of hiring a random guy to occasionally call you up and say “I know you’re feeling depressed, but if you don’t drag yourself out of bed and go to work today, I’m going to come shoot you.” is presumably much lower.

    If we found out those two methods were equally effective, clearly we’d preform the latter, because it delivers more “bang for your buck” (OK, I’ll see myself out now).

    1. Ori Vandewalle

      You also have to hire people who are actually willing to shoot depressed people, otherwise there’s no true incentive. I suspect that’s a job that would command a high salary.

    2. williamgr

      I appreciate the pun, but in case your whole comment wasn’t just a lead up to it, threatening to shoot depressed people as a form of motivation would, in the short term, just result in a large number of dead people, and in the longer term a civil war started by the families and friends of the dead depressed people.

      Institutionally threatening to shoot other mentally-ill people, say schizophrenics, is also unlikely to be helpful.

  60. TJ2001

    There is ONE single major component left off of all this…. The very thing that has haunted recognition of “Psychiatric conditions” for years:

    Cost.

    What is the Fiscal Impact to The Government/Private Insurance/Whomever is deemed “Responsible” of officially recognizing it as “An Actual Problem We Are Liable to Pay For”…

    Lets be mindful that this is a real question and it prevented the official recognition and thus sanctioning of treatment of PTSD/Shell Shock for well over 100 years…. Who is responsible and Who has to PAY? It is VERY easy for a skilled Actuary to come up with the likely costs of accepting this is “A Real Thing Is Our Responsibility To Deal With”… The British Parliament famously calculated and debated this very thing after WWI for Shell Shock… And it was determined that if it was determined to be a “Real problem” – it would saddle the government with billions of pounds of liability for young men who would instantly become permanent pensioners…. And so they denied it.

    I have a very strong feeling that’s an unspoken but implicit objection to official recognition of these mental conditions as “Diseases” or “Disability”…

    Here’s how the argument goes behind closed doors:
    “Yes Scott – we know you are completely correct. This is a hereditary mental condition which the person only has extremely limited and fleeting personal control over. If we acknowledge that they are incapable of working – we have to pay for the entire rest of their life… 80% of the federal budget already goes to payments to citizens through various social programs and this could potentially increase those payments by 50%. This would mean that taxes would increase by 60% and the entire rest of the Federal Budget would fall to 14% of the total money that comes in. Never mind that everybody else will riot in the streets because of their perception that we are creating an entire new class of freeloading ‘Disabled people’ who now won’t seek help to cope or assimilate into society because it’s more profitable for them to take the monthly government check… And so forth…. As you can see – it’s a difficult but real question and probably better if we just leave things as they are.”

    1. NoRandomWalk

      +1. The debate over positive rights has a similar dynamic, although at the object level I think it has much fewer merits.

  61. williamgr

    Obviously the solution to the disagreement is that Scott and Bryan Caplan should do an adversarial collaboration together! 🙂

  62. MattH

    The sort of fun example I keep thinking of while reading this post, is teenagers and masturbation. Suddenly, you hit puberty and your desire to masturbate went from 0 to 1000. This is the result of an age appropriate dose of hormones, produced by a process you have no choice over. This 1000+ masturbate preference is a constraint, as far as your decision making goes, it’s physical, not a disease, and can be resisted, but resistance requires even greater preferences. Just going to leave this here.

  63. Frog-like Sensations

    If this debate goes on too much longer Scott will entirely rederive Harry Frankfurt’s views on free will; he’s already a lot of the way there. The relevant paper is “Freedom of the Will and the Concept of a Person”.

    You can find pdfs by googling that, but the spam filter isn’t happy with me including them in this comment.

  64. Anaxagoras

    What about mental illnesses that change goals? I don’t know if this is a realistic scenario, but suppose I sincerely believe I’m Napoleon and correspondingly want to conquer Europe. I don’t want to be “cured” of this, because in my current state, I interpret that as being brainwashed into forgetting who I truly am. I fail Bryan Caplan’s gun-to-the-head test because I can still think strategically, and I understand that unless I lie to this psycho with a gun, I may get shot and therefore won’t be able to conquer Europe. Urges don’t really come into it — my plan to conquer Europe might still be obstructed by my OCD, but that would bother me because my goal is being thwarted by an unendorsed urge.

    1. Lambert

      I think ‘deluded but not suffering from any of the other terrible effects of psychosis’ is a fairly small subset of mental ilness.

      1. cuke

        The boundary around delusion is pretty fuzzy, both when looking at mental illness and at the general population. I could imagine Caplan putting “severe mental illness” in a different category because it impairs rational thinking and reality-testing and so maybe he would concede it’s more like “real disease” (this would include severe depression that comes with psychotic features, severe forms of bipolar disorder, and schizophrenia, among others). But the truth is that distorted thinking weaves all through the terrain of mental illness and a lot of “normal” neurotic behavior.

        Depression and anxiety, even mild forms, tend to lead to overestimating costs to self of various possible events or courses of action. OCD-type behaviors, even ones that are not really disabling to a person, are often justified or believed in at various levels even if a person can sometimes step back and see that they are irrational. Trauma responses, including those sub-clinical to full-blown PTSD, can lead people to overestimate threats. We are irrational all the way down. It doesn’t mean we aren’t capable of rationality, only that the irrationality is woven all the way through and comes in multiple conflicting voices.

        This is perhaps not the spot to insert this larger point, but I’m lazy, so putting it here… a lot of the conversation around preferences, “revealed” preferences, choice, and behavior seems to suffer from a very simplistic notion of the “self.” As if we have clear hierarchies of preferences, as if there is some more “real” or unitary self hiding in there to be revealed through action. But we are more like shifting weather patterns of thoughts and feelings, with multiple conflicting preferences and priorities, with our behavior always imperfectly “revealing” the outcome of the ongoing internal debates. Buddhist psychology is useful here.

      2. Garrett

        How would we know? If someone actively thought they heard the voice of $DEITY on a regular basis, but all it did was point out cute puppies in a non-distracting way … how would they be counted in a study? Usually symptoms have to be significant enough to merit being included in a study. If a person isn’t functionally-harmed, distressed or rendered strange from the results, they are unlikely to be discovered as having delusions in the first place.

      3. Anaxagoras

        For my point, I don’t think “not suffering from any of the other terrible effects of psychosis” is important. It’s a change that most people would agree is a sign of mental illness, but it’s not really a preference or an urge. If I happen to have a bunch of other unpleasant things going on that, if cured, would also result in the dissipation of my conviction that I am Napoleon, that doesn’t seem like it affects the nature of my belief that I am Napoleon in Scott or Bryan’s frameworks.

  65. Ori Vandewalle

    …can we change a person’s behavior purely by changing his incentives? If we can, it follows that the person was able to act differently all along, but preferred not to; his condition is a matter of preference, not constraint. I will refer to this as the ‘Gun-to-the-Head Test’. If suddenly pointing a gun at alcoholics induces them to stop drinking, then evidently sober behavior was in their choice set all along.

    Right off the bat, this strikes me as a very bad argument and I don’t see how it follows at all. Scott argues against this using some (explicitly) made up quantification, but that all strikes me as really unnecessary. Caplan’s argument is, “If a person can do X under condition A, a person can do X under condition B.” Prima facie, I don’t see any reason to accept this logic.

    1. cuke

      Agreed. We live “under conditions” and they determine our behavior/choices/preferences/constraints as much as what we bring to the conditions.

  66. whatsatararrel

    As a decision theorist, I, naturally, think the problem here is bad decision theory. This makes me biased, so keep that in mind for the following.

    Economists, at least those of us in the particular branch of decision theory I was trained in, are generally much more interested in what are called “revealed preferences”: that is, the choices people make, and what this suggests about their preferences. In fact, in many models, what we call “preferences” is actually just a representation of choice: you choose to stay in bed all day instead of go to your job, therefore we say you prefer that. Obviously this can create some problems when contrasted with how we normally use the word “preference”: first of all, there’s the normative implication that if someone’s doing something they prefer, that’s fine. There’s no reason this has to be the case; this leads to comments like the above that, “Talking about preference only makes sense if people are rational.” This is not so; in fact, defining what it means for a preference to be “rational” is rather difficult, and in my experience, it’s a word best avoided as it only seems to confuse. Second of all, the notion of revealed preference, by design, completely abstracts away from any sort of mental reasoning process. This, in many cases, is a feature, not a bug, because we can’t actually directly observe what goes on in people’s heads, whereas we can observe their choices. As such, it’s better to model how they’ll behave, rather than how they think. This can get misleading, because frequently a particular utility function may suggest a certain way of thinking, and be criticized on those grounds, but the utility function is just a representation of preferences (which, as noted above, is frequently just a representation of choices). It is almost always possible to represent choices with some sort of preferences, so in a broad sense, mental illness can be represented as preferences, and this is unremarkable apart from the normative connotations of “preferences”.

    However, this can be made more sophisticated, and I think Scott gets the better part of the argument here. I think the key is the notion of meta-preferences, which bears a relationship to Gul-Pesendorfer (2001), a model of temptation and self-control. At first glance, temptation seems like a meaningless concept in revealed preference terms. If I say I want to diet, and therefore prefer a salad to a burger, but when I’m actually faced with the choice between a salad and a burger, I choose a burger, because the temptation is overwhelming, from a revealed preference perspective, I prefer a burger to a salad, despite my protestations to the contrary. One interpretation of this would be to say temptation is meaningless, and people who say they want to diet but give in to temptation are lying to themselves. The Gul-Pesendorfer response, however, is to move up a meta-level and consider preferences over menus. Suppose our dieter is, instead of being presented with the choice between a salad and a burger, is presented with a choice between two restaurants. The menu at one restaurant has both salad and burgers; the menu at the other restaurant is just salad. If this person chooses the restaurant with just salad, and indicates they strictly prefer the smaller menu, that can be taken as a revealed preference indication of both a preference for salad and the existence of temptation. This person does, indeed, want to eat salad instead of a burger, and also knows that they will give into temptation if they don’t prevent themselves from doing so, and we can see this from their observable choice of restaurant. The parallels with meta-preferences is pretty clear, I think; the one issue is that it’s hard to construct a situation where people make an observable choice of which preferences they want…except arguably that’s exactly what’s going on when people choose to go to therapy, or take psychiatric drugs. They’re making choices to engage in activities which make their preferences more in line with those they’d prefer. Someone who’s not severely depressed chooses to go to work and not go to therapy instead of stay in bed all day, and instead of go to work and go to therapy; someone who’s severely depressed may choose go to work and go to therapy instead of stay in bed all day, and instead of go to work and not go to therapy, because the latter is not an option. Going to work and going to therapy is a little like choosing the restaurant with only salad: you’re removing the option of doing anything else with the time you spend in therapy in order to make the choices you want to make. As we call it temptation when people prefer a smaller menu in order to make the choices they really want, we could call it mental illness when people seek mental health treatment in order to make the choices they really want. This would be a sense in which mental illness could be described as “preferences”, but more complicated than “depressed people have a preference for staying in bed all day.” Also, this notion REALLY doesn’t jive with the idea of “psychiatric medicine is for people to excuse their bad preferences”; it’s more like psychiatric medicine is what people use to try to change their preferences.

    To be clear, if anyone’s hung up on the normative connotations of preferences and wants to describe mental illness differently, I think that’s fine. I’m not trying here to say mental illness is about preferences, but I do think it’s possible to represent it as such, and I don’t think that’s as meaningful as it might sound.

    MOTTE: Nearly all behaviors, including those generated by mental illness, can be represented as preferences.

    BAILEY: ALL PSYCHIATRY IS EXCUSES AND COERCION!

    1. Egor Duda

      Great comment!
      It made me think about multi-agent model of mind. Here we have at least two sub-agents, and the one choosing the menus instead of concrete dishes. By doing so, it creates a constraint for the second agent, which now have to choose the salad.
      I’m not even sure those two agents are asymmetrical, so that we call first agent’s preferences “meta-” and the second’s — just preferences. It’s just that they are activated in different contexts, and the first has more chances to create constraints for the second than vice versa.

    2. whereamigoing

      I think this post is a good example of why using the word “preference” this way is extremely misleading and economists should stop doing it. If you’re actually talking about choices, use the word “choice”.

  67. eqdw

    Quickly skimming the original posts, and then reading this post in full, I have noticed something about Bryan’s argument.

    Bryan is separating ideaspace into two non-overlapping sets: “preference” and “constraint”. This partition is not symmetric. If I understand Bryan correctly, then a “constraint” is something that, with 100% certainty, changes behaviour, and a “preference” is something that, with <100% certainty, changes behaviour.

    This is a reasonable and interesting dichotomy, but I'm not sure it goes very far to revealing any additional understanding about this scenario. As Scott correctly points out in this piece, a lot of diseases are less than 100% effective at changing (=constraining) behaviour. So does that mean they are better modelled as extremely strong preferences?

    Taking this to its logical extreme, I suspect that you could disprove the existence of constraints entirely if you played enough word games. "I broke my legs, this is a constraint on walking" is it really? Has there never in the history of mankind been someone who succeeded in walking on a broken leg? If I held a gun to your head and said “run”, would you not at least try? And would you move more than zero meters? Then it’s not really a constraint

    I am sympathetic to Bryan’s position, in general. I know I probably shouldn’t question psychiatry to a psychiatrist but it has been my personal experience, both lived and observed, that a lot of what are called ‘mental health disorders’ in 2020 strike me a lot less like health problems and a lot more like either dipshittery or “reasonable reactions to concrete external reality that is nonetheless maladaptive in the current environment”. But at the same time, I’m not sure that the distinction he’s making is that important, and it’s certainly not so black and white (or rather, reifying the categories to make them black and white shrinks the ‘constraint’ category so small as to make it useless)

    If you admit that these categories can be fuzzy, the categories become more useful but the dichotomy goes away. As soon as you admit, eg, that extreme enough preferences can be de-facto constraints, or alternatively that constraints can be leaky while still being constraints, then a lot of the mental health things that he is classifying as “preference” start qualifying as “constraint”, which breaks down the whole argument

    1. Ozy Frantz

      reasonable reactions to concrete external reality that is nonetheless maladaptive in the current environment

      Why on earth would that not be a mental illness?

      1. eqdw

        I don’t think it is useful to call something like that a mental illness. For a few reasons. The main one is an extreme aversion to casting normal human behaviour as ‘ill’. I’m having a hard time coming up with an example that is simple enough to illustrate the point without being oversimplified to the point of unreality, and without being culture war toxic. So hopefully this abstract scenario clarifies.

        Let’s say you wave the magic wand of hypothetical scenarios and you isolate an individual (Bob) away from all of modern society. Maybe they’re a hermit, maybe they’re a hunter-gatherer, maybe they’re whatever. It doesn’t matter. They will fulfill that niche, they will adopt mannerisms and habits and beliefs and patterns and blah blah blah that are appropriate for this.

        Now wave the magical hypothetical wand again and transport the entirety of New York City to a location 300 feet from this guy’s tent. Suddenly the, I don’t know, tracking of animals that he uses to navigate doesn’t work anymore, since animals don’t leave tracks on asphalt. He loses the ability to navigate, and gets lost in the middle of the city. He starts freaking out, surrounded by unfamiliar everything, with his learned behaviours not helping. He ends up in an extreme state of anxiety on account of nothing making sense.

        In this scenario, is it reasonable to diagnose this guy with generalized anxiety disorder? After all, he is surely extremely anxious, and it is definitely impacting his ability to live a worthwhile life in 2020 NYC. And yet, it feels very clear to me that there is nothing wrong with this guy. If anything, NYC is the problem. He was totally healthy and fine until _a bunch of other people showed up and did not interact with him in any way_. But when you magic those other people into the scene, suddenly the previously totally normal and healthy hypothetical man is magically reclassified into having a mental illness.

        Another thought, thought of after originally posting this, and I don’t know how to work it into the flow: the status that we diagnose this individual as having informs how we treat him. If we look at this situation and say “he has anxiety disorder. That means give him benzos”. Does that actually help his situation? It certainly will make him not anxious anymore, but the fundamental problem that is causing his anxiety (he is a hunter-gatherer transposed into manhattan) has not been resolved. If anything, it’s been made worse by being covered up. On the other hand, if we recognize this problem as not a mental health problem but as a “Bob is incompatible with NYC” problem, then this admits a new class of solution, such as “maybe Bob should go move into the mountains” or “maybe the industrial revolution and its consequences have been a disaster for the human race”

        It feels wrong to classify him as mentally ill, because there is no principled difference between Bob-the-mentally-ill and Bob-the-totally healthy that you can draw purely by observing and questioning him. The thing that determines whether or not he’s ‘mentally ill’ or ‘healthy’ is a completely external context.

        It also feels wrong to classify him living his life the way that feels natural to him as mental illness. At first I wanted to phrase this as “telling someone that the way they are is intrinsically broken is evil and cruel” but then I realized that most diseases work this way (eg type 1 diabetics are born that way, their “natural” is “broken” so to speak)and so that is silly. But I still think there’s something here. Casting something natural and normal as “mental illness” is some weapons grade gaslighting, and has historically been used as a tool to manipulate people through guilt (looking at you, middle ages Christianity). As a general illustration of the principle, if one’s definition of “depression” classifies 10% of people as afflicted with this ‘illness’, something is odd. If that scenario attains, then I think that both “your definition is dumb” and “actually there’s an external cause unifying these disparate scenarios” is more likely than “actually just that many people have broken brains”

        In a more general case, I am EXTREMELY uncomfortable with the general idea of “modern society is shitty in way XYZ, and if you disagree with this, you’re insane“. Is homosexuality a mental illness? Is racism a mental illness? Is resistance to the glorious soviet revolution a mental illness? Is being lazy and truant from work a mental illness? As soon as you admit “mental illness” = “anything inconvenient in the current society”, you open the door to all of those things I just listed being framed as mental illness. I don’t think I need to justify to the SSC crowd why “gay people actually just have broken minds and as soon as we find the right enstraightening pills, we’ll cure them right up” is a bad thing

        1. albatross11

          There are definitely disorders that only show up depending on your environment. Move someone from Los Angeles to Anchorage, and there’s a reasonable chance they’ll have terrible depression triggered by the lack of sunlight during the winter. Move someone from Phoenix to rural Iowa, and they may very well turn out to have big problems with seasonal allergies and asthma that weren’t present in Phoenix.

          There’s also clearly societal stuff. Not being able to learn to read was not really a disorder in England in 1200 AD–other than priests and such, nobody really needed to be able to do that. But not being able to read in England in 2020 is a huge life-limiting problem, so serious that both parents and the state are willing to spend significant resources trying to fix it. Not being able to do hard physical labor is a disability even now, but for someone working an office job, it’s a pretty small one–you have to hire someone else to do work around your house or move furniture, but you can be a perfectly fine computer programmer or accountant. Not being able to do hard physical labor, as a man in 1800, was a major issue that was likely to end with you starving to death.

          For that matter, it seems likely that the world has gotten a lot worse for people with below-average intelligence, over time. In 1900, being in the bottom 10% of intelligence was surely not easy, but you could still have an okay life with a little luck–there were plenty of decent jobs for guys with strong backs and weak minds. I think that’s far harder now.

          The practical meaning of “disorder” is probably something like “causes you problems and is rare.” If there’s something you need to be able to do to function in your society, and most people can manage it, your inability is going to look like a disorder. Maybe the solution is to lean on you to somehow force yourself to do it, which can work sometimes. Maybe the solution is to find some way to cure you. Maybe it’s to make some kind of accomodation for you. Maybe it’s to just say “Nope, no place for you in our society, sucks to be you.”

          1. eqdw

            I’m not sure if this is enough nested replies that this will be stuck on the end instead of immediately under the comment I’m replying under

            @albatross11 I agree with all of your statements of fact. Where I disagree is that I don’t think it’s appropriate or useful to characterize those things as medical problems. When I move from Phoenix to Anchorage, it’s not me who has the health problem, it’s Anchorage that is fucking me over with its lack of light. Someone who is illiterate might be at an extreme disadvantage in life but (assuming we’re not talking about retarded people) what they have is a skills deficit, not a medical problem requiring medical intervention. And re: intelligence, that is a grey area I am not really decided on.

            But, like, fundamentally, I am making two claims. The first is about the correct locus of responsibility for problems. The second is about the correct mechanism of solution for problems.

            In all of your examples, with the _possible_ exception of the intelligence one, there is no meaningful sense in which these “disabilities” are attributes of the disabled person. They’re attributes of the world that are being imposed on a normal person. They are absolutely problems. I am not arguing that. But the problem is imposed on them by their surroundings, it is not intrinsic to them. Saying “actually your surroundings are totally fine, what you have is a deep and mysterious problem in your brain” is a really shitty thing to say. (I am asserting that medicalizing these problems is equivalent to saying something along these lines). The underlying cause of all of these problem scenarios is external to the person. So what could it even mean to say that it is a deficiency in the person that is responsible for the problem?

            And on the flip side, like, it is a fact about society that the second you label something a mental health problem, a host of connotations are smuggled in. It is immediately assumed that you are a potential danger. Denying you rights (including things such as driving, firearms ownership, and even in extremes denying you your freedom via being involuntarily committed to a hospital) pre-emptively is seen as justified. The solutions to your problem are immediately assumed to be either medication or therapy. Both of these solutions are solutions that can change your mindstate but cannot actually change external problems.

          2. albatross11

            Anchorage and Central Iowa aren’t broken, they’re just rotten environments for some subset of people. And you can find environments that are rotten for larger fractions of people, until you get to stuff like very high altitude locations where most people can’t comfortably live (but maybe if your ancestors were living high in the Andes or Himalayas, you’ll be fine there).

            I think if lots of people want to live in some environment or do some activity, and a small fraction have some biological problem that makes it difficult for them to do so, they’re probably going to have that difficulty medicalized into a disorder, if only so they can get accomodations/help overcoming the problem paid for by insurance.

            As a practical matter, though, the Arizonan who moves to Iowa may end up visiting an allergist and being diagnosed and medicated for his allergies, even though this wasn’t a problem at all back home in Phoenix. And the Californian who moves to Alaska may well end up being diagnosed with SAD and prescribed special lights to sit in front of for a couple hours a day during the winter.

            I agree that taking away rights for a lot of this stuff is silly–as I understand it, there’s a very small subset of people with mental illnesses that might plausibly be a danger to others, a much larger subset that are plausibly a danger to themselves, and then a huge number of people who shouldn’t have any extra restrictions because they don’t pose any particular risk. But laws often fail to make much of a distinction there.

          3. VoiceOfTheVoid

            @eqdw
            If there’s a “reply” button on the comment you’re replying to, you’re not at max depth yet; if you have to go up to the parent comment (that’s what the little arrow next to “Hide” is for) to compose a reply, you’re at max depth.

        2. cuke

          The diagnosis given in this situation is usually Adjustment Disorder with anxiety. It’s a stress disorder and is brought on by a change in circumstances or a new stressor. If it persists for six months past the resolution of the stressor (which is not always easy to sort out), then you might change it to GAD or MD or something else.

          A huge proportion of people in outpatient psychotherapy or who get SSRIs from their PCP as opposed to from a psychiatrist fall into this category. Job loss, divorce, a move, etc overwhelms someone’s coping skills and they wind up with some mix of anxiety and depression or other stress symptoms like insomnia, etc until they “adjust” to whatever their new circumstances are.

          1. eqdw

            I think this is an egregious abuse of the category ‘mental health’.

            If I lose my job, and I am stressed out by this, I am not the one who has a problem. I am reacting normally. It is one thing to say “Yeah, but it would be a lot easier to find a new job if you take these pills”. I am fine with that. I do that! But it is a very different thing to say “oh, you have an Official Health Problem but don’t worry, this SSRI is the Solution and once you take this pill everything will be all better”. Because it’s NOT BETTER! When you lose your job, the problem is you are unemployed. The only correct solution is find a new job.

            If you are stressed out from not having a job, and you misdiagnose your problem as the stress instead of the not having a job, and then you treat your stress, not only have you not solved the actual problem, but you have gotten yourself into a state where you falsely believe you have solved the problem, which lets the actual underlying problem stay a problem.

            This example is not great, because people don’t generally stop noticing that they are employed. But this dynamic plays out in a million different ways. This dynamic played out in my personal life when I had a particularly shitty job that killed my soul.

          2. cuke

            Just so we’re talking about the same thing. Adjustment Disorder (this from Johns Hopkins Psychiatry but substantially similar to DSMV):

            “The presence of emotional or behavioral symptoms in response to an identifiable stressor…” in which these three criteria are met:

            “* These symptoms are out of proportion to the severity or intensity of the stressor (taking into account the external context and the cultural factors that might influence symptom severity and presentation).
            * This leads to impairment in social, occupational, or other important areas of functioning.
            * Patient may have depressed mood, anxiety, or maladaptive behaviors, but does not have a cluster of symptoms that meet criteria for another mental disorder.”

            There’s more one could say on that and I’m not defending Adjustment Disorder as an awesome diagnosis, only clarifying that it is not diagnosed about any kind of experience of stress. An important feature of it is that the stress overwhelms the person’s existing coping capacity which is why people show up in psychiatrists, other doctor’s, and therapists’ offices as well as hospitals. It’s not like someone loses a job, is unemployed for awhile, stressed out but managing okay, and then gets another job, but meantime a doctor has snuck in and diagnosed them with Adjustment Disorder and made them to take drugs.

            People present as highly stressed, overwhelmed, panicky, tearful and saying things like “I don’t know how to get through this.” Adjustment Disorder is associated with a higher risk of attempted and completed suicide.

            So while there is a proximate life stressor that precedes the diagnosis, it’s understood that lots of people lose jobs, move cities, end relationships, and lose loved ones while still coping okay in their daily lives. They are stressed but they are managing. This diagnosis is really more about people who in the face of these stressors, for whatever complicating reasons about them or their environment, are not coping or managing. They are having trouble functioning at school, work, or in their primary relationships. They are manifesting clinical levels of anxiety or depression across weeks and months that are impairing them in a daily way.

            As a side note, it’s an interesting and long conversation in psychiatry/psychology/mental health fields about where we understand the locus of a person’s problem to be. It’s almost never black and white — either all inside the person or all inside their environment. Mental illness is often triggered by environmental stressors, but not reduced to them because people enter those environments (especially as adults) with a pre-existing set of coping skills, strengths, and vulnerabilities. A huge goal of therapy is to help a person expand their coping skills and learn to accommodate/compensate for their vulnerabilities so that when the next stressor comes along, they are more likely to handle it better.

        3. craftman

          Casting something natural and normal as “mental illness” is some weapons grade gaslighting, and has historically been used as a tool to manipulate people through guilt (looking at you, middle ages Christianity). As a general illustration of the principle, if one’s definition of “depression” classifies 10% of people as afflicted with this ‘illness’, something is odd. If that scenario attains, then I think that both “your definition is dumb” and “actually there’s an external cause unifying these disparate scenarios” is more likely than “actually just that many people have broken brains”

          So…somewhat embarrassingly I follow a lot of “fitness” people on Instagram because that’s a big part of my life. And ALL of these 20-somethings go on and on and on about “I have such bad anxiety, here’s how I deal with it”. And they are all describing their anxiety as just normal, baseline human fears that come with branching out into adulthood, autonomy, and a professional career.

          Your quote above made me think exactly of this. It doesn’t really affect me that people are walking around self-diagnosing themselves with anxiety, but it bothers me that “living a normal human life” has now become something we have to diagnose, treat, and potentially medicate.

      2. acymetric

        Why on earth would that not be a mental illness?

        I don’t know if this will help or not, or even if maybe its not actually about the same topic, but let’s take two people.

        “Jim” has what he calls a “great life” with a family he loves and a job he at least likes well enough, and at least reasonably secure finances. Despite this, he frequently feels sad, or unmotivated, for “apparently no reason”. He might rightly be diagnosed with depression, and treated (maybe SSRIs, maybe vitamins, whatever). This appears to be a mental illness (brain not working/responding properly to what is happening).

        “Steve” made a bunch of bad decisions and/or got hit with some unfortunate circumstances. There is light at the end of the tunnel, but the immediate future is pretty bleak and it will take several grinding, grueling years to dig out of the hole and start to actually see tangible positive results in his life circumstances (might include poverty/homelessness, lack of strong personal connections, so on and so forth). One wrong turn or bad beat on the path forward can cause major setbacks. Steve is pretty down about this. It might make sense to also treat Steve with some manner of drugs to alleviate his down mood and/or anxiety so that he can function as well as possible until he hits the end of the tunnel, but it doesn’t seem that Steve necessarily has any chemical or medical “mental problems” the way Jim did.

        So Jim is suffering from a mental illness/disorder, while Steve is suffering from bad life circumstances. I can see why there would be value in differentiating them even if the treatments end up being similar from a medication perspective.

      3. Hoopdawg

        Why on earth would that not be a mental illness?

        One reasoning I’m sympathetic to is – because treating it as an illness centers the problem around the person, and not reality. I mean, if you’re coughing due to smoke, you don’t want cough medication, you want to put down the fire.

  68. zima

    This was very convincing. With the caveat that I have no expertise in this area, I tend to think of only the desires of the rational conscious part of the brain to be true preferences, while the subconscious parts of the mind ought to be treated as more analogous to a body part. If you want to complete a task but can’t, I see it as the same whether your failure is because of lack of willpower, IQ, or muscle strength.

    Regarding the example of a normal person who wants to be super thin, I would agree that the person’s true preference is to be super thin but his subconscious desire to eat is an obstacle to achieving his true preference, so I would see nothing wrong with that person taking a drug or something else to reduce his desire to eat.

  69. NostalgiaForInfinity

    To take his metaphor literally, it follows from this model that you could mostly eliminate mental illness by having the government credibly threaten to execute anyone who became mentally ill or addicted to drugs. Which seems like a bold claim.

    Not sure how suicide fits into it either. His original paper avoids mentioning it altogether (aside from two mentions in footnotes and not considering its relevance to the topic).

    1. NoRandomWalk

      I think this ‘bold claim’ is true. Still wouldn’t want this policy in place given asymmetric utility payoffs of the false negative.

    2. pilfered-words

      Well, if you shoot everyone who is mentally ill, you will in fact quickly eliminate mental illness in your society, I suppose.

    3. Purplehermann

      Although… this might actually work. I recently… persuaded someone who was mildly (as far as I know) to go do energetic social things for a few days, and it helped a lot (I don’t think he is depressed anymore). If depressed people were forced into action this might fix their issues.

      1. cuke

        This is called behavioral activation therapy and it only works sometimes for some people, but it’s not a bad thing to have in the arsenal of a thousand things one tries for someone when they are not pulling out of depression.

      2. Matt M

        I prefer the Maury Povich method where you find someone who is afraid of cotton balls and have a giant dude dressed as a cotton ball come up and hug them so that they are cured.

    4. teageegeepea

      Mark Kleiman disagrees with the “disease model of addiction” precisely because the Chinese government DID credibly threaten to execute opiate addicts and were quite successful. Similarly, doctors who get addicts are able to get through it via monitoring that credibly penalizes them for slipping up. Hardcore meth addicted burglars in Hawaii managed to stay out of prison after the H.O.P.E program credibly threatened them with even a day in jail if they failed a randomly scheduled drug test. Drunk drivers also seem to be able to get over drinking if that’s monitored. These sorts of things are discussed in his book ‘When Brute Force Fails: How to Have Less Crime and Less Punishment”, which I think every voter should read.

      1. whereamigoing

        I don’t think that disproves its being a disease. For example, I might be able to procrastinate less by using Beeminder — a threat I set up on purpose. But that doesn’t mean procrastination is just a “preference”. Rather, Beeminder is a kind of treatment for procrastination.

        But thanks for the book recommendation.

      2. Confusion

        If there is a sufficiently important deadline near, I can take a bunch of medicine and ‘ignore’ a severe cold to a large extent. A sufficiently powerful motivation can make the mind do wonderful things. That doesn’t mean I don’t actually have a cold and it wouldn’t have been better (for total recovery time and the quality of work) if I’d stayed in bed.

        Neither those taxi drivers nor those opiate addicts quit cold turkey on their own. It wasn’t the motivation alone that made their recovery possible: they also received treatment. What these examples prove is that a sufficiently powerful external motivation can help in making a treatment work.

        1. teageegeepea

          Was the powerful motivation something that “helped make the treatment work” or was it the “treatment” itself? And don’t we “treat” lots of things with motivations, or as economists would say “incentives”? Where Kleiman differs from economic imperialist par excellence Gary Becker is that he thinks people, particularly drug addicts and criminals, are hyperbolic discounters who place high weights on immediate/certain incentives relative to more distant and probabilistic ones. Hence repeatedly violating parole conditions despite being told you’ll eventually getting in trouble, and thus eventually going to prison for years even though a certain day in jail would be enough to scare these people straight.

          1. Confusion

            You’re now displaying typical behavior: you’re dismissing my counterexample by repeating the exact question I am answering as if I didn’t answer it and go back to adding a paragraph once more explaining the favorite example that seems to demonstrate the theory nicely.

            No, the motivation was not the treatment. I was sick as a dog, produced lousy work and my health would have recovered more quickly if I’d stayed in bed.

            Motivation helps. In some cases a lot. It doesn’t help if the recovering addict has measurable physical responses to their discontinued use of their drug of choice that impair their judgment. It assumes some minimum of rational thought at all times during the process, which is absent. Treatment is needed to give the motivation something to work on.

            It’s not a binary thing.

          2. teageegeepea

            Sorry, I wasn’t trying to refer to your instance of being sick, in which your cold medication could count as “treatment”. But in the examples of addicts, it seems like “treatment” can entirely consist of “motivation” and be quite effective. Of course, with a cold the body’s immune system tends to naturally fight it off over time.

  70. Garrett

    Per the preference strength model, doesn’t social shaming also serve to push people to do the “right” thing? And by declaring something a disease that feedback model is being decoupled? Likewise, people with certain conditions lead to negative externalities for others: the Tourette’s case being occasionally disruptive, the ADHD person not turning in their work on time, etc.? At a social level we’ve decided that something which is a disease is to be treated as blameless, so labeling something as a disease allows a person to both avoid the feedback to act “correctly” as well as to avoid internalizing the externalities associated with their condition?

    To take this hyperbolicalically, imagine a coal power plant (corporations are people!) getting “smoke belching” declared a disease. Suddenly they go from being a terrible polluter which is harming people and the environment to “that poor company that just can’t help themselves” in need of hugs and tax breaks.

    1. AnthonyC

      To the “hyperbolic” example – if the end result of that were “We invent a ‘treatment’ based on carbon capture; or a ‘transplant’ or ‘implant’ or ‘prosthetic’ based on replacing the coal power plant’s innards with other-power-plant-type equipment; or ‘medicine’ or ‘dietary intervention’ consisting of replacing coal with another fuel source,” and if we paid for that by “insurance” aka gov’t spending, I’d be totally happy with that result. Both the costs and the benefits accrue to society at large, and the problem gets solved.

      And if we lack the technology to treat the ‘disease’ and have to make ‘accomodations’ like authorizing already-existing plants to continue emitting whatever can’t be mitigated… we already do that.

    2. Ozy Frantz

      I think the solution here is that mentally ill people are, in fact, still responsible for our actions. Of course, a compassionate approach requires being aware of the limitations mentally ill people have: one would not expect a person with ADHD to be as organized as a person without. Living with a person with ADHD means my house is messy, but I can still be cross at him when he leaves his empty bottles on the floor instead of throwing them out.

      1. Aapje

        Do you mean to distinguish between agency and burden?

        As in:
        – A person with X is unable to change to be ‘normal’, so trying to force them to act ‘normal’ is unfair
        – A person with X puts a burden on others, which means we may demand they adapt the way they can, ask for reparations to counterbalance the burdens, choose to exclude the person if the burdens are too high for us, etc

    3. Friendly AI With Benefits

      A prior point to my comment, be careful with the difference between model generating and policy advocating. That the model has implications that might create bad policy in current environ isn’t a point against it’s accuracy. That’s not an accusation that that’s what you’re comment was, more of a just-in-case.

      As to the main point, I think the error lies not in the model but with societies assumption or decision that things that are diseases are blameless. I agree with Ozy below, mentally ill people are still responsible for their actions, and I think also should be held accountable for their participation in their own treatment, and the correct thing would be for society at large to be more compassionate about the shortcomings and more encouraging of their treatments.

      1. cuke

        This may be splitting hairs… the whole legal classification of criminally insane (which includes some mental illness on a case-by-case basis) does mean that some people cannot be considered responsible for their actions. People with memory-related conditions may fall under this category as well. If cognitive function is impaired enough, a person can’t be said to be responsible or even held accountable for their own treatment. I’d like to suggest that in a way we are all somewhere on this spectrum rather than it being a bright line.

        I think it’s an interesting question about whether the partner of someone with mental illness is entitled (if that’s the word) to get mad at that person for not doing something that they habitually have trouble doing. I mean, all of us are entitled to have our feelings, to feel mad or whatever. But in some sense, to hold a person responsible for not doing the thing they have trouble doing, I don’t know. Is it not like getting mad at someone who has a math-related learning disability for doing poorly on a math test?

        It’s hard to watch people suffer and to wish they made different choices. It’s true some people’s issues make them hard or impossible to stay in relationship with them. No one can say what’s workable for another person.

        I have worked with people with non-responsive depression and they are on the receiving end of a huge amount of judgment about not trying hard enough, not trying enough things often enough for other people’s liking. Their friends and family get mad and frustrated with them for not doing enough. Because of course being friends with or related to someone who is unremittingly depressed is really hard. And also, doing stuff when you’re unremittingly depressed and everything you’ve tried so far hasn’t worked is really hard.

        There are a lot of situations in which holding someone who is struggling accountable for actions in the domain where they are struggling is likely to be a frustrating activity. And in some cases the law says indeed as a society we don’t hold this person responsible.

  71. Freddie deBoer

    I never quite know what to do with these attacks on psychiatry/psychiatric medicine. When I am not medicated I come to believe that there is a conspiracy against me and I lash out violently against those closest to me. Unmedicated I have cost myself dozens of friendships, lost jobs, ruined my reputation, hurt others, and generally set my life on fire.

    When I am in treatment my life still sucks, but I don’t do any of that stuff. I have every incentive not to behave the way that I do while manic. Yet I cannot stop myself. More to the point, I cannot occupy the mental space through which we typically weigh incentives and make choices based on them. It’s not that my illness changes the incentive structure. It’s that it destroys the meaning of incentives itself.

  72. alcatrash

    Scott, you mention taking a psychotropic drug to shift your preferences. Can expound on that, or is there an existing post where you talk about what substances you take in order to change your preferences and/or affect your mood?

  73. FormerRanger

    The example of “if you cough I’ll shoot you” makes no sense. I just got over an upper respiratory infection that made me cough. No amount of coercion would have prevented me from coughing at the high (low?) point of this infection. I would have been shot with probability 100%.

    I’ve never had shingles but I know people who have. When they had a flare up they could no more stop scratching than stop breathing. That’s why people with shingles often end up wearing gloves until it’s over; repetitive scratching leads to injury and further, maybe worse, infections.

    1. Friendly AI With Benefits

      I think the point is that, when motivated to extremes by imminent death, you would find ways to not scratch, e.g. a literal straitjacket. It’s a little harder to quickly come up with ways to prevent coughing, but a medically induced coma might do the trick and I’d bet there are simpler ways. If coughing is an irritant response probably a whole lot of numbing agent in the airways would do it.

      People can get real imaginative when the stakes are high.

      1. Confusion

        If we’re going down that road then soon everything, including breathing, is a preference, because you could always have yourself cryogenically frozen until the unusual preference could be made to go away. I think the poor horse has been beaten sufficiently.

    2. Ninety-Three

      Over the years I’ve had a variety of illnesses that made me cough, and some were far less resistible than others. In the worst case, it wasn’t even about wanting to cough: if I suppressed the urge to cough for long enough I started to get coughing-like muscle spasms that were entirely out of my conscious control.

      So yeah, coughing’s not a perfect example, but my experience is that most sources of coughing can be suppressed by force of will in the same way that an especially irritating itch can go unscratched.

  74. Lambert

    I think there’s more to performance than slightly reduced muscle strength.

    Maybe I’m doing unusually cerebral work right now, but there’s times when I’ve really wanted and needed to figure out e.g. jacobians of a flux function but have just been too tired to grok what was going on. Just couldn’t fit all the concept and the connections between them in my head at once.

    If I had the flu or depression, that tiredness would genuinely have been something that impacts my capabilities in a meaningful way.

  75. alwhite

    This kind of feels like a three body problem that Bryan is trying to solve by making it a two body problem. I wonder how he would respond to the idea that it is his dichotomy that is the issue. It seems like economics doesn’t really allow for that and could be shaping his worldview so hard the debate is meaningless. I think my approach would be to plant my flag on the idea that dichotomies are always poor models of reality.

    1. Act_II

      While I agree, you don’t even need to go that far. You can simply say that this dichotomy has clearly been proven to be a bad model of human behavior, and if he continues to stick to it then the discussion is not worth continuing.

  76. tenoke

    >We want some criteria that let us call shingles a disease, but don’t let us call “being thin but wanting to be even thinner” a disease.

    This is the part I think I either disagree with Scott or start thinking the specific word ‘disease’ is hurting – He’s done all this work to show that things that prevent you from achieving from desires are as ‘bad’ as physical diseases and then stops before the finish line.

    Why is wanting to be more attractive but not being able to because of some brain chemistry nonsense not in the same category as wanting to concentrate more but being unable to?

    Anything ‘internal’ that prevents me from achieving my goals is bad in my book. Adhd is a ‘disease’ but so is e.g. regular akrasia, just a lesser one. The last paragraph, with the example about coffee suggests agreement with this, yet the statements a little above it seem like they do not.

    1. inhibition-stabilized

      I think there is some benefit from distinguishing something that’s within the normal range of human experience (e.g. akrasia) from something that falls far outside the normal distribution (e.g. depression). I see two reasons for this. One is practicality: in an ideal world perhaps we would be able to solve both issues, but given our limited resources and knowledge of biology it makes sense to distinguish the latter from the former. The more substantial reason is that to my knowledge things like shingles or depression aren’t just tails of a normal distribution: they typically have specific, abnormal causes and mechanisms that we can (hopefully) understand and treat, whereas solving akrasia just means “make better humans” (although it would certainly be nice to be able to do so).

      1. tenoke

        Among other things under that logic, if instead of (say) 5-10% incidence of depression it was 99% (as to not be outside of the normal range) then we shouldn’t focus on it, which seems counterintuitive.

        1. inhibition-stabilized

          Point taken. My original post was written as I was rushing out the door and I didn’t have the time to think things through properly. I think what I’m trying to say is that where we draw lines is based a lot on context. Scott has convincingly argued that disease is too broad a category. In the context of “things we would in an ideal world like to solve,” we can group shingles, depression, and akrasia together. In the context of “things we should focus on solving in the near-term,” it’s useful to separate akrasia from the others. I think my intuition for why it should be distinguished is less because it’s universal and more because its universality is due to how intrinsic it seems to be to our nature. If depression were universal but with the same causes and solutions as it has now, it might make sense for people to treat antidepressants the way we treat, for example, coffee. But my intuitions here are admittedly kind of shaky.

        2. thisheavenlyconjugation

          I think that’s very plausibly true. After all, it is the case that 99% of people have eepression — which is the name I just invented for the condition of not being as happy as the top 1% of people.

          1. albatross11

            Apply this to aging, and I think you get the current state of the world–most people saying “aging is just the normal way things work, it doesn’t need treatment” and a few people saying “aging is awful and we ought to be trying hard to find ways to reverse or stop it.”

          2. Simon_Jester

            Most people seem very much in favor of developing medical technologies that address the symptoms of old age (cause of death in old people #1 through eight kajillion).

            Most people seem in favor of social changes that protect them from the adverse consequences of old age.

            And I don’t think there are actually that many people who, if there was a big red button that would open a fountain of youth on every street corner in the world, wouldn’t push the button.

            I think most people have a framework in which it’s not realistic to “cure old age” as opposed to just, y’know, gradually doing more to cure medical conditions and slowly pushing life expectancy out a little bit longer at a time. People think “cure old age” is a technological problem that isn’t worth the investment, because throwing more resources at the problem wouldn’t necessarily solve it in a way that compensated for the cost of trying.

            Now, they don’t formalize this and for a lot of them there’s a bunch of rationalization going on because it isn’t formalized. But at he object level, most people prefer non-aging to aging; they just don’t think it’s a realistic choice and don’t want to expend all the resources they have on it, for the same reason they don’t want to blow their life savings on lottery tickets because it would just be so damn good to be a multimillionaire.

        3. Wizek

          (Whoops, I accidentally hit report on your comment while meaning to hit reply. I’m truly sorry about my mistake, especially so since I don’t see a way to undo; I’ve only recently started commenting. I hope, if it comes to that, my message will be seen here as a counterbalance.)

          Onto substance: I very much agree with your position that we shouldn’t draw this imaginary line very much, and if there are two similarly debilitating ills, where one afflicts 99% and the other 10% of the population, the former likely is worth about 10 times more resources thrown at it in attempt at alleviation.

          However, I think you are missing a few reasons why many/most people think differently to us:

          1) If something is unpleasant yet 99-100% experience it, it starts becoming questionable whether it is at all possible to be solved. E.g. what proof do we have that akrasia can at all be solved? Don’t most of us experience if at least some part of our lives? How do we know that it is not an unavoidable side-effect to how a human mind operates, at least in certain ways? How do we know that a cure wouldn’t cause worse side-effects then the malady? E.g. let’s suppose we do find a chemical compound that stops akrasia in most people, meaning they can and do always choose the greater good down the line trading off enjoying the present. Doesn’t it sound like everyone who takes this pill becomes a mindless drone, a moth drawn to flame in a way, robotically marching towards a future they never reach, while never enjoying a single moment in their lives? A life filled with only promises; all unfulfilled.

          Also, wouldn’t this be a trap in the strictest sense? Even though this pill would need to be taken daily, otherwise its effects quickly dissipate, would it not happen that 100% of the people who take this would ciese to be able to choose to stop taking it?

          “Imagine the risk! I’ve been taking this pill for a few years, but if I miss a dose now, I predict that that other, akrasiastic me would not take this ever again once he comes to his senses and realizes how utterly unpleasant the last years were. I suffered in the name of the greater good! And wouldn’t it look to him that his only outlook is more suffering? The greater good would greatly suffer! I cannot let that happen! I cannot give him the chance to stop this pill, therefore it’s at the utmost importance that I never miss a dose!”

          Now, I’m specifically not claiming that akraisa cannot be solved, or that it would definitely lead to the side-effects outlined above (although the latter half of the argument I put together did start to convince even me somewhat! So by all means, please do indulge me by responding to my above points and questions.), I’m more claiming that at certain steps of the above thought process many stop thinking about the question and just resort to: “Let things stay as they already are”. Which leads me to:

          2) Plain old status quo bias. I don’t claim to fully understand what this bias is about, I only heard of it by name recently. But its name at the same time gives me an intuitive understanding as well that braves me to venture this as a guess. As in, if 99% of people were to have been born blind, and some scientists started to propose that with gene therapy we could give ‘super-human’ abilities to some of us in the form of the very rare thing we call ‘sight’, there could be a sizable passive or even active opposition. You know how many are afraid of human cloning and gene editing today, it would be quite the same then.

    2. NoRandomWalk

      I think what’s creeping in is the higher-level awareness that ‘if everyone didn’t have depression, society would be better off’. But if everyone was ‘more attractive’ – would everyone be better off, or would standards change and we’d be right back to competing for who is ‘close to perfectly attractive’ or some completely different measure of status.

      His view in just this post is imperfect, but has less grey areas, and does pretty well for not engaging at all with the purpose for which we even have words like ‘disease’ or ‘preferences’ which he has in other posts successfully.

  77. benf

    I have two priors about Brian Caplan, which are: 1. Brian Caplan is dumb as dirt and engaging with anything he does is a waste of time and 2. Brian Caplan is very smart but is in love with the psychological hit he gets from being a contrarian and so engaging with anything he does is REALLY a waste of time.

    These probabilities sum to one.

    1. Act_II

      I’ve found some of his opinions interesting in the past, but truly head-in-ass takes like the one exhibited in this post make me retroactively more skeptical of those opinions. This is what happens when you think economics as a whole is far more rigorous/interesting than it actually is and don’t interact with anyone outside your bubble.

        1. Act_II

          Convincing random people to take bad bets is not a good metric for intelligence, especially when you have a large public platform. With a few exceptions, most of those bets are pretty safe, and the sucker invested less than Caplan (presumably to make them easier to convince).

          He might be smart, whatever you even mean by that, but that doesn’t mean his takes are especially interesting or worth caring about. Particularly here, where it is incredibly obvious that he has little to no first-hand experience with mental illness and hasn’t bothered to acquire any in 15 years.

          1. sty_silver

            I strongly disagree that these predictions are all safe. And winning 20 in a row would be extremely impressive even if they were.

          2. Act_II

            @sty_silver
            I took a closer look at the bets. I will walk back my statement a little, but not a lot.

            There are 29 bets on the page. One is not Caplan’s bet, and 8 are still open. Of the 20 remaining bets, many seem to simply be taking advantage of people riding on a moment of hysteria. Examples: that Ron Paul would not win the 2008 election, that Democrats would not maintain a federal trifecta for 10 years, and that ebola would not kill over 300 people in the US. Others are not sure things, but still clearly safe bets: for example, that an executive action of Obama’s (from context, it seems to be a DACA expansion) would not give over 1 million extra illegal immigrants work papers, that Gary Johnson would win over 5% of the vote, and that the unemployment rate would go below 8% at some point in the five years after a massive stimulus package was passed.

            I’ll give him credit for taking legitimately risky bets (given the time they were made) regarding Trump’s election. On the other hand, even though he technically won the Brexit bet, I’m reluctant to really give him credit for it since it was only by technicality.

            There are a bunch of bets I’m not able to assess the difficulty of because I don’t know enough about economics. However, Bryan Caplan is an economist. Even if these are all risky bets, his winning them only tells me that he’s a good economist; it doesn’t say anything about his abilities in other areas.

            Winning lots of bets doesn’t take great intelligence. It only takes the ability to find people who make absurd claims and extract money from them.

          3. Scott Alexander Post author

            I’ve tried the same strategy and it’s worked less well for me than for him, make of that what you will.

          4. Act_II

            @Scott

            With respect, there are so many possible reasons for this that I don’t make much of it. Your fields are very different and (as far as I can determine from your posts) the circles you run in seem to be as well.

            I’m not saying Bryan Caplan isn’t smart, or that you aren’t. I just think this is a remarkably bad reason to trust someone’s cross-domain expertise.

          5. sty_silver

            I don’t think your mind did the thing where you compute how impressed you would be with 5 bets of this kind won in a row, and then doubled that level of impressed-ness, and then doubled it again.

            I’m saying this because, if Bryan had won 5 bets in a row, your post seems to make perfect sense as a response. (Aside from the part where you actually state how many there are, of course.) 20 is just crazy. The chance to win 20 bets if you have 90% on all of them is just above 12%.

          6. caryatis

            I can’t speak for Caplan, but some people with extensive experience with mental illness hold the same beliefs. Me, fwiw, and Szasz was a practicing psychiatrist.

            It’s easy to assume that people who disagree with you about mental illness just don’t have any knowledge of it, but it’s always uncharitable and often false.

          7. Witness

            @sty_silver

            The chance to win 20 bets if you have 90% on all of them is just above 12%.

            If they are 99%, the chance of winning 20 is 80%. Many (though maybe not all) of the bets on this list look 99%+ to me – the kind of things that are only taken because the opponent has been mindkilled by politics and/or the belief that “this time things will be different”.

            That said, I have to give him a certain amount of respect for not getting mindkilled himself, and for being able to effectively and publicly demonstrate when people are being mindkilled.

      1. Econymous

        Per Bryan Caplan himself:

        Unlike most American elites, I don’t feel the least bit bad about living in a Bubble. I share none of their egalitarian or nationalist scruples. Indeed, I’ve wanted to live in a Bubble for as long as I can remember. Since childhood, I’ve struggled to psychologically and socially wall myself off from “my” society. At 40, I can fairly say, “Mission accomplished.”

        So you may be right about him failing to interact with anybody outside of his bubble…

    2. Friendly AI With Benefits

      “Look at me I hate the outgroup!”
      Do you think your comment meets 2/3 of true/kind/necessary?

      1. Act_II

        While I found the poster’s first point ruder than necessary, I’m not sure what you mean by this. It seems like this is an accusation of tribalism, but the post was targeted at an individual with unusual opinions. What do you think the poster’s ingroup is and why do you think this criticism is motivated by ingroup/outgroup dynamics?

      2. benf

        True, definitely, necessary because this was a very long post wasted discussing a truly dumb idea. Kind because I included a VERY charitable evaluation of the person in question as a possibility. Three for three.

  78. Scott Aaronson

    To my mind, this post’s model of “urges” versus “goals” seems so obviously right, and so obviously more relevant than a model of “preferences” (that you can suppress with a literal gun to your head) versus “constraints” (that you can’t), that the mystery is how anyone could possibly disagree with you.

    However, I recently had the privilege of hanging out with Bryan Caplan, and I think it gave me insight into this mystery. Bryan, it turns out, has a superhuman ability simply to decide on his goals in life and then pursue them—to the extent that, for him, “urges” and “goals” appear to be one and the same. This ability is an inspiration to the rest of us, and is no doubt closely related to his having become a famous libertarian economics professor in the first place. However, it might make it difficult for him even to understand the fact that most of us (alas) are wired differently.

    1. Neike Taika-Tessaro

      However, I recently had the privilege of hanging out with Bryan Caplan, and I think it gave me insight into this mystery. Bryan, it turns out, has a superhuman ability simply to decide on his goals in life and then pursue them—to the extent that, for him, “urges” and “goals” appear to be one and the same. This ability is an inspiration to the rest of us, and is no doubt closely related to his having become a famous libertarian economics professor in the first place. However, it might make it difficult for him even to understand the fact that most of us (alas) are wired differently.

      I’ll believe it. I was like this before my B12 issue and I’m like this now. I have the questionable benefit of having inexplicably (to me at the time, before the diagnosis) experienced the opposite as well, so I know it’s real. But it was a scary place and I find it only abstractly comprehensible from where I am now (ten months after beginning to supplement B12 later). It’s not too difficult for me to imagine that, had I never had this experience, I would intuitively find it dubious that depression is anything but a strange preference people sometimes exhibit.

    2. Nietzsche

      This seems exactly right to me. If you have only first-order desires, or your second-order desires are immediately converted into first-order ones, you’ll struggle to grasp the experience of anyone wired differently. I confess that I am a little bit like Caplan in this (although probably not to the same extreme). At least, I was until I had a daughter who suffers from depression and inattentive-type ADHD. My experience raising her really drove home the fact that her failure to complete tasks has nothing to do with preferences. I am honestly not sure that even at the point of a gun that she could complete the assignments and homework of ordinary high schoolers, any more than at gunpoint I could beat Roger Federer through sheer willpower.

    3. Eric Zhang

      That sounds pretty incredible. To the extent that that’s true, I would have expected that Bryan Caplan would rule the world.

      1. Conrad Honcho

        And implement the great libertarian plot to take over the world…and then leave you alone?

    4. Scott Alexander Post author

      I agree Bryan is probably extreme on this axis, but that’s why I’ve been trying to use examples (like being tired when you have the flu, or wanting to scratch an itch) that even Bryan ought to be able to sympathize with.

  79. TheAncientGeeksTAG

    That’s a long article, but it seems to me that Caplan’s argument is flawed for quite a simple reason: petitio principi.

    To infer an agents preferences from behaviour, you need to assume that they are rational. So the argument boils down to “assuming everyone is, rational, everyone is sane”.

    1. benf

      Libertarian economists have that assumption so baked into their worldview they don’t notice it anymore. If you pin them down, they’ll start talking about utility functions, and when you point out the circularity between “utility” and “rationality” they’ll call you a statist and stop talking to you.

      1. Murphy

        When I’ve hung out on libertarian boards I’ve felt like it’s a bit of an awkward area people prefer to look away from because while the underlying principles are quite satisfying and elegant…. they don’t cope well with people losing their faculties and cope poorly with dependants without the faculties to bring their own legal cases or otherwise stand up for themselves.

        I think it’s because if you have bodies that can declare someone a pseudo-child and dictate that they should legally be put them into the care/power of others…. that’s a threatening power.

        When grandpa (or generic old man with no family) is going demented and becoming a danger to himself and others someone needs to have the right/duty/power to go in and prize the guns away from him, clean up the infections he’d got from soiling himself and administer his estate to provide for the costs of his care…. even if he vehemently does not want any of that to happen because the dementia has left him thinking everyone else is a Japanese spy.

        It’s not great to wait until he actually murders a neighbour to step in.

        Ditto for a strong aversion to things like child protective services.

        In theory under libertarianism your children own themselves and you’re only a guardian with duties to them… but the idea of a body actually enforcing that: with the power to confiscate your children if you’re a bad guardian is threatening to people. At least those who tend to get attracted to the philosophy.

        So they don’t like the idea of a body with the power to actually enforce the rights of their dependents and the ability to monitor/supervise. So children and incompetent dependents might as well be pseudo-property. Which somewhat conflicts with some of the core concepts.

  80. Neike Taika-Tessaro

    Given I had severe depression, the cause of which was undiagnosed for a long time (several years) but ultimately was nothing other than an unusual vitamin B12 deficiency, I’m sincerely baffled that someone would have thought it was just a preference of mine to be depressed.

    I was using all the meagre motivational strength I could muster (anyone with severe depression will know this was not a lot) toward finding solutions for my depression – getting noise-cancelling headphones, taping dark cardboard over my windows in the bedroom so the sunlight wouldn’t wake me prematurely, changing jobs because the one I was in had just had some layoffs and the atmosphere there was negative, writing an entire book (160k words; you’ve seen it, Scott <3) to deal with my lack of social writing (freeform IRC roleplaying) that had previously filled the hobby niche and the absence of which was tearing my mood down, etc. I honestly want a metaphorical gold medal for everything I tried, given the constraints I did it under – each thing made my life a little better, but did not cure the depression, because it couldn’t. I was managing to pass as a functioning person so well that it took my initiative, following a conversation with my regular doctor about how I was having serious issues sleeping enough and also I can’t seem to find much energy and no my nutrient intake is varied, to see a neurologist before someone (the neurologist, in an afterthought comment, after telling me I wasn’t getting dementia (an unintentional lie, that’s exactly what would have happened if I hadn’t caught it) and should see a psychologist for my “deep-seated issues”) got the idea to get me tested for vitamins.

    Now I supplement B12 (my body is apparently not great at absorbing it, but just throwing more at it is sufficient) and the “deep-seated issues” have just disappeared. They disappeared within a week of me taking B12. I didn’t even have a choice about them disappearing! It was like optimism was being injected into my brain. I can’t not be optimistic, whereas during my depression I was trying all kinds of tricks not to lose my IMO inherent optimism about the world (and, at the time, failing).

    Maybe Bryan Caplan and others with the same ‘preference’ argument would make an exception for this kind of depression, since it was clearly an actual biological issue that was just manifesting (amongst other symptoms) as a severe depression? But surely that’s what the vast majority of depression is – biochemical imbalances that are just arbitrarily hard to diagnose?

    I feel like I might just be confused about this debate.

    1. NoRandomWalk

      I’m sorry you had to suffer this way. Thanks for sharing, and am so glad you found such an easy solution.

      1. Neike Taika-Tessaro

        Thank you! (Needless to say I am, too.)

        I honestly probably overshare this story, really; I tend to plug it in whenever it seems relevant and joke I’m a member of the Church of Cobalamin. But there’s a reason I do it, of course: Because I think/hope there’s a chance it inspires someone to have hope for their broadly similar condition. It’s a very tangible form of hope, too – in the form of getting tested for vitamins, or other micronutrients, or really generally look for highly actionable issues making their lives miserable. Not everyone’s problems will be as easy to solve as mine, but sometimes one just has to find the right lever. I am incredibly thankful that I found the lever for my life and I’m back to being who I used to be. You could say one of my goals in life is help make that happen for at least one other person.

        (This is where I point out to anyone reading that vitamin B12 is over the counter probably-everywhere, and there are no documented side-effects to taking it, so if you have any issues that could potentially be rephrased as “my nerves are cross-talking a lot” (e.g. “I can’t hear myself think over all this sunshine stimulus”), please just try it for two weeks and see if it helps you.)

        1. Seppo

          I’m going to try this right now. I’m putting the chance of it helping at maybe 2%, but given the low cost and huge potential benefit it’s worth a shot. I’ll try to report back in about a month.

          Anyway, your desperately-trying-all-the-things story is all too familiar, and it’s really encouraging to hear of someone actually fixing the problem. Thanks for sharing! 🙂

          1. Neike Taika-Tessaro

            😀 If it ends up helping you, I’d love to hear about it, maybe in a follow-up open thread, or, if you feel comfortable doing so, by giving me a quick heads-up via pinkgothic at gmail dot com.

            In any case, whatever it ends up being for you, good luck finding it!

        2. Telomerase

          Glad you found the correct substance… of course you would have found it faster if it were newly patented and had cute sales reps visiting doctors 😉

          I had a similar experience with nicotinamide riboside.

          1. Neike Taika-Tessaro

            My doctor disallows visits from sales reps, so even that likely wouldn’t have helped. 😛 Alas.

            Vitamin B3 isn’t something I’ve ever heard people being deficient in; is it a common problem? (Quick googling is a bit inconclusive; I will check it out in greater detail later, but I won’t be able to edit this comment then.)

            In any case, I’m so glad you figured that out! Congrats on breaking out of your struggles!

        3. Doesntliketocomment

          I’m going to give B12 a try based on the strength of your recommendation. As you say there’s very little cost and practically nonexistent risk, and as someone on a proton pump inhibitor I’m apparently at higher risk of B12 deficiency. I’ll report back in a few weeks. Thanks!

          1. Neike Taika-Tessaro

            Awesome! Hope it has good effects for you. I’ll check back here periodically, or the next public open thread(s); but if you’re comfortable with it, I’d be equally happy to hear from you at pinkgothic at gmail dot com.

    2. papermite

      I started therapy about six months ago for severe depression. Like you, I made many behavioral and life altering changes to attempt to improve my mood. While these things each helped a little, they didn’t make a huge overall improvement. After about three months of little progress and reading a lot of Scott’s blog posts on the subject, I finally agreed to my therapist’s recommendation to start an SSRI. At the same time, my primary physician did a battery of tests and found that I had low testosterone, B12, and Vitamin D. I started the SSRI and vitamin supplements at the same time about three months ago and I’m now in the best place mentally I’ve been in probably close to 10 years. While I did a lot of things at the same time, I do wonder if the vitamins played more of a role than the SSRI (especially in light of the studies Scott has highlighted around the efficacy of SSRI’s.) While I don’t think I’m going to plan on quitting tomorrow, I had only really intended to do the SSRI’s for a short time anyway.

      Long story short, to anyone out there suffering from depression who hasn’t had a very thorough physical including vitamin levels, that might be a place to look.

      1. Neike Taika-Tessaro

        Wow! I’m really glad you found a set of tangible and lasting solutions for your depression! What fantastic news! Thank you for sharing this and I strongly agree with your verdict. 🙂

        This really does sound much like my story, really, minus SSRIs. What I haven’t mentioned is that like you, I too am supplementing vitamin D now. Nonetheless, it’s very obvious that it’s primarily the B12 that’s primarily improving my quality of life:

        My sound sensitivity is down, my light sensitivity is down, my teeth no longer ‘hurt’ when I brush them with “cold” tap water, I can focus on reading a book when other people are having a conversation in the room, in consequence of the sound/light sensitivity I can get solid sleep again, and my innards are actually functional again (shortly before I took up B12 I was beginning to have severe issues with my digestive system, up from ‘increasingly notably odd’ to the occasional ‘uh, should I be considering going to a hospital about this problem?’ moment).

        I had some very odd subjective sensory effects when I started with B12 supplements. If you had anything notable in that category, B12 might be what’s doing the brunt of the work for you.

        Here are two I can think of off-hand that happened to me:

        (1) one evening I was convinced that the light in our bathroom must have changed in some way (it hadn’t; and indeed I couldn’t put a finger on it at all), because the subjective visual impression had completely changed,

        (2) my ears uncannily “popped” one day while I was sitting in the office, just the audio effect and sound, without the associated physical sensation in the ears, as though my ears suddenly remembered how hearing is supposed to work, and the conversation two colleagues were having right at that moment just next to me seemed to have changed in tonal quality (I was too astounded at that moment to be able to say “this is the actual *point in time* where conversations stopped being distracting”, since the unexpected popping completely derailed the attention I was paying to my task, but I wouldn’t be surprised).

        If nothing happened to you that feels like it might be in a similar category, I would say it is probably not the B12 doing the heavy lifting. These things were very obvious (although unfortunately I can really only talk about the “ears popping” event in a way that’s easy to imagine, and that’s probably highly anomalous). That said, I’m not a doctor, so take it with a grain of salt.

        While these things each helped a little, they didn’t make a huge overall improvement.

        I just want you to know that you’re amazing for having done all that. You really are. Not everyone may realise how hard it was to fight that battle, but you were doing it, and I applaud you. And I am so glad you are feeling better now!

    3. nadbor

      I’m sincerely baffled that someone would have thought it was just a preference of mine to be depressed.

      No, that’s not what he’s saying. That would be simply untrue, but nothing is simple with Bryan Caplan. What he’s saying is weirder than that. It is that your depressed self is just as legitimate a person as your normal self (whether you yourself think this way or not).

      He’s not saying that you chose to have low energy. He’s saying that having low energy and preferring to sit staring at the wall all day is a legitimate way to be be that should not be stigmatized or pitied or given any special status.

      Some people like to work a lot, some play video games and some sit staring blankly at a wall – nothing wrong with that (says Caplan). And it doesn’t make a difference whether that sitting and staring is due to a chemical imbalance either. Every behaviour is ultimately rooted in chemistry and physics one way or another and that doesn’t change anything.

      I think it’s a fascinating perspective. Completely bonkers but at least not boring.

      1. Neike Taika-Tessaro

        What he’s saying is weirder than that. It is that your depressed self is just as legitimate a person as your normal self (whether you yourself think this way or not).

        Does this also mean that we’re different people? (If that’s how it’s meant, I’m not even going to argue with it; depressed-me and now-me are barely comparable, they might as well be different people.)

        Thanks for weighing in, by the way! I appreciate that you’re helping me out of the confusion I mentioned at the end of the comment.

    4. caryatis

      Mental illnesses are diverse. I think you’re overgeneralizing from your own experience. *Some* depressions are in fact curable by the type of things you describe trying unsuccessfully: changes in life circumstances such as changing jobs or leaving an abusive situation, attention to sleep, exercise, and substance use patterns. Mine was. So it seems pretty clear that *sometimes* the problem is in your life circumstances, not (or as well as) your brain.

      1. Neike Taika-Tessaro

        I think you may have misunderstood my comment, which may have been my bad. But just to make it explicit: I’m not trying to generalise at all – I was talking specifically about my case, as a form of depression that exists in the general case (biochemical imbalance) not infrequently, and thus is a form I would expect the debate at hand to consider. I had the impression that whole class of depression was absent from the discussion on Bryan Caplan’s side. (Conversely, I had the impression the kind of depression you describe was considered – perhaps poorly so, but considered nonetheless.)

        I’m very happy to hear you managed to get things fixed with environmental levers, by the way! Always awesome to hear about people breaking out of those problems. 🙂

        (If you have time to, could you go back over my comment and tell me which part made you feel I was overgeneralising? I’d love to know so I can tweak the way I talk about this in future.)

    5. BlackboardBinaryBook

      Someone I care about is experiencing some of the symptoms you’ve described (persistent depression, sensory issues, difficulty concentrating), but we live in the US and their health insurance is garbage so I don’t have high hopes of them getting tested. However, B12 is not terribly expensive and is, as you mentioned, pretty danged safe. What dose range have you found effective? I’m going to suggest it to my loved one.

  81. Lodore

    This is a great post; its thesis should be nailed to the forehead of every sanctimonious prick everywhere who thinks they’re virtuous just because they resist urges they don’t have. And I’m glad, too, that Scott acknowledged the fact that much of mental illness is, in fact, a gun pointed to the head: it’s just that in some cases (i.e. alcoholism) the gun goes off slowly. The alcoholic knows this and drinks anyway.

    I expect the real prejudice informing Caplan’s arguments is animus against hedonic payoff. Addiction gives you a high; depression fosters narcissism; anxiety allows you to displace your fears onto others. None of this is true, for all the reasons Scott outlines, but it exercises a strong hold on a certain type of mind. For instance, my in-laws are religious bigots, and despite the fact that that one of them has a mental illness, they manage to condemn every other mental illness as acting up or moral weakness.

    On that topic, I’d be interested to see how religious believers here accommodate Scott’s arguments. His topic is psychiatry, but the model of behaviour he outlines applies to nearly any behaviour you care to mention.

    1. Conrad Honcho

      I’d be interested to see how religious believers here accommodate Scott’s arguments.

      Can you elaborate? I don’t understand what you’re getting it. If you’re trying to say something about resisting urges to sin, Christianity expects that people sin, and it is virtuous to regret your sins and work towards not doing them.

      1. albatross11

        Also, every system of moral teaching tells you which urges you should resist, whether that’s the urge to eat meat or the urge to sleep around or the urge to murder your next-door neighbor. Christianity broadly defines some principles for answering the which-urges-lead-to-sin question, albeit with some disagreement across subsets of Christians for different questions.

      2. Randy M

        And also that you won’t be able to fully thwart these desires on your own but require a continual divine assistance to overcome.. And then there’s Calvinism, as well as less dogmatic predestination ideas, that seem quite compatible with determinsim.

      3. Lodore

        Can you elaborate? I don’t understand what you’re getting it. If you’re trying to say something about resisting urges to sin, Christianity expects that people sin, and it is virtuous to regret your sins and work towards not doing them.

        Yes, this. And sure, Christianity acknowledges that sin occurs, and makes provision for forgiveness. At the same makes you morally culpable for sin, to the extant that it exalts those who sin less (i.e. saints) and punishes those who sin more by way of Hell. Implicit in this metaphysics is a view of sin as weakness that, with sufficient piety, strength of character, and divine grace, can be overcome.

        But this metaphysics doesn’t stack up. If my propensity for stealing is higher than my neighbours, it makes no sense to castigate me and laud my neighbour when I covet his goods and he doesn’t covet mine.

        You may say in reply that the purpose of religion is to disincentivise sin by altering meta-preferences, and I’d agree–but if so, we can only interpret the claims of religion as a manipulation technique for prosocial purposes. (When the purposes actually are prosocial.)

        1. gbear605

          That’s an inaccurate depiction of Christianity, or at least many branches of Christianity. The general view (among Evangelical Protestants, at least…) is that “punishes those who sin more by way of Hell” is false. No matter how much you sin, you are going to hell, *unless* divine grace is involved. Piety and strength of character are good things, and overcoming weakness and avoiding sins are both good too. But that good attribute is only a way of saying that it is something that should be encouraged, not that you are punished if you don’t do enough good things.

          Theoretically, if a person were sinless then perhaps they wouldn’t go to hell, but it is explicitly said in the Bible that no one is sinless (other than Jesus), and that the only way to heaven is through Jesus: “Surely there is not a righteous man on earth who does good and never sins.” (Ecclesiastes 7:10, ESV); “for all have sinned and fall short of the glory of God, and are justified by his grace as a gift, through the redemption that is in Christ Jesus,” (Romans 3:23-24, ESV).

          The implication in Christianity is that a person whose only sin is a single lie is equally sinful as a mass murderer, and that it is impossible to have no sin. The only separate castigation and lauding is done by individual Christians, not by the metaphysical system. In fact, many branches of Christianity renounce the concept of saints (or at least, saints in the Catholic sense) because of this.

          1. Lodore

            This is an interesting reply, thank you. However, though the evangelical strand of Christianity is obviously important, it is still just a strand. I’d submit (and accept the criticism that follows) that Catholicism can plausibly be taken as the most ‘representative’ expression of Christianity, by reason of numbers, doctrinal inertia, and historical pedigree. And my comments still stand for Catholicism.

            As to your specific points, they’ve given me a new perspective on Zwingli, Calvin and the rest. Maybe they were acquainted with exactly the problems outlined in Scott’s post, and that’s why they evolved the doctrines they did.

  82. Markus Ramikin

    > choose a gunshot to the head over continuing to do the things their illness made it hard for them to do

    hard for them NOT to do?

    1. Aron Szabo

      No, the sentence is fine. Note that “over” implies opposition – the people would rather shoot themselves than do the things that their illness made hard.

    2. AnthonyC

      I stumbled over that one to. It actually works as is, but with a different interpretation. Originally I thought it was supposed to mean, “Their illness made it hard for them to do certain things, so they didn’t do them, and killed themselves as a result.”

      I think as-is it actually means, “They were working really hard to actively force themselves to do the things their illness made it difficult for them to do, until they reached a breaking point and couldn’t do that anymore, and killed themselves instead.”

    3. Fakjbf

      No, it’s fine as is. For example someone with depression might find it hard to have energy to get up in the morning, someone with schizophrenia might have a hard time maintaining relationships, and someone with OCD might find it hard to hold down a job. All of these limitations would make life harder for them, and potentially cause suicidal thoughts and actions. Depression doesn’t directly make you want to kill yourself, it just makes it feel really hard to keep on living and suicide seem like an easier path.

  83. sty_silver

    This all makes perfect sense to me, but I also am convinced that Libertarian Free Will does not exist.

    I don’t have a great model of what would change if I thought Libertarian Free Will existed, but it seems pretty likely that it would change my reaction to this post. I know Bryan said, about a year ago, that he believes in Free Will. He did not specify, at that paritcular time, whether that’s Libertarian Free Will or some sort of compatibilism.

    The point I’m trying to make is just that if I think there’s a reasonable chance that the Free Will stuff is a crux, or at least a necessary thing to resolve in order to change anyone’s mind. This is speculative and could be falsified by Bryan’s next response. But if it’s the case, I very much want you to have that argument explicitly. I also think you already linked to the best argument on the topic.

    1. Anshel_Liu

      Bryan believes in Libertarian free will: http://www.libertarian.co.uk/lapubs/philn/philn046.pdf

      I think this is one of his biggest weaknesses as a thinker, as well as his dismissal of Malthus and Georgist critiques of property rights. Generally, he is a very smart guy. Writes very good books that are always worth reading.

      He is writing a book about moral blameworthiness, which will have to touch on free will which should be interesting. He proposes allowing the underclasses to suffer for their inability to succeed. Generally, I am more of a genetic determinist and think seizing the High-IQ alleles and distributing them to the proletariat is a much better approach to this than either subsidized disfunction or allowing nature to take its grizzly course.

      1. sty_silver

        Thanks, yeah, that’s unambiguous. In that case, I’ll double down on the prediction that this disagreement won’t be resolved without debating free will.

        And yeah, I actually think Brian believing in Libertarian Free Will is the most extreme example of an otherwise rational guy believing something stupid that I know of. Brian is legit smart (just look at his track record with predictions; you have to be impressed by that) and I’d put the libertarian free will question somewhere between easy and trivial.

        1. Johnny4

          @Sty_Silver

          I’d put the libertarian free will question somewhere between easy and trivial

          And why would you do this?

          In any case, why would it matter whether Bryan is a libertarian or a compatibilist? What matters is whether one believes in free will, no?

      2. TheAncientGeeksTAG

        Bryan believes in Libertarian free will

        Yikes.. that was straight from Ayn Rand.

        Of course every *effect* has a cause…thats just what “effect” means. The interesting claim, in the sense that it isn’t tautologously true, is whether every *event* has a cause. If choices are events, then they are necessitated, according to this version of the Law of Causality. If they are not events…what are they?

      3. Godbluff

        You write as if the debate on free will was resolved, or as if belief in free will were in an unreasonable or indefensible position. In fact, many professional philosophers (about 18% according to a PhilPapers Survey) either accept or lean toward libertarianism.

        But I agree. Bryan has unconventional views in many issues.

      4. Godbluff

        Generally, I am more of a genetic determinist and think seizing the High-IQ alleles and distributing them to the proletariat is a much better approach to this than either subsidized dysfunction or allowing nature to take its grizzly course.

        Couldn’t that catapult us into extinction faster?

    2. ksvanhorn

      Can somebody explain to me what observable difference one would expect to see between a universe in which free will exists and one in which it does not? Absent that, I am unconvinced that “free will” is even a meaningful concept, except in a legalistic sense to identify situations in which behavior can be changed via disincentives.

        1. albatross11

          Or we’d feel like we had free will even though it was just an illusion, which I think is the actual position of most people who disbelieve in free will.

        2. Bugmaster

          Right, but ksvanhorn specifically said he’s looking for observable differences. I can’t observe whether you “lack consciousness” or not, I can only observe your behaviour. So, what observable differences should we expect to see in a universe of p-zombies ?

        3. ksvanhorn

          How so? Free will and consciousness are not the same. And consciousness is not externally observable. And locked-in syndrome? That’s an inability to move or communicate despite being conscious and aware; nothing to do with the topic at hand.

          1. blacktrance

            Free will is the ability to consciously direct and control your behavior, so consciousness is a prerequisite. For example, rocks don’t have free will because they don’t have a will at all (unless you think panpsychism is true). Also lacking free will are people who, though conscious, can’t control their behavior, such as those with locked-in syndrome.

            While consciousness isn’t directly externally observable, there’s still considerable evidence in favor of its existence.
            First, you’re conscious. You might not be able to prove that to others, but if you’re going by your own observations, you have evidence. (And from that it’s reasonable to assume that others are conscious as well, since they’re physically and behaviorally similar to you.)
            Second, people talk about consciousness, which would be strange if they weren’t actually conscious. Where would we have gotten the idea of qualia if we didn’t experience them?

          2. Bugmaster

            @blacktrance:
            Firstly, while I can be reasonably sure that I am conscious, that gives me circumstantial evidence at best that other people are conscious. There’s no real way for me to know whether any given person I’m talking to is conscious, or just a very accurate p-zombie. So, the best conclusion I can reach is a sort of solipsism, which is philosophically sound but not very practical.

            Secondly, people talk about lots of things that (probably) don’t exist (that is, not in the same way that rocks exist), such as gods, numbers, circles, and arguably electrons (which aren’t little round particles, after all). Where did we get the idea of Loki if he weren’t real ?

            If there’s no way to detect whether a person “is conscious” or “has free will”, then I don’t see the point in talking about such concepts, since they don’t bring any new explanatory power to the table. On the other hand, if there is a way to detect consciousness, then please let me know what that is.

          3. blacktrance

            “There’s no real way to know” is arbitrary skepticism. You see that people are biologically similar to you, and you observe that they talk about having qualitative experiences that sound like yours. Them being p-zombies isn’t logically impossible, but there’s no evidence for it and plenty of evidence for the alternate explanation that they’re actually conscious.

            From there, we can examine neural correlates of consciousness and their effect on behavior, reported experience, etc, so we can say that a brain-dead person isn’t conscious but a locked-in person is. And since we can track consciousness and detect locked-in syndrome, we can determine whether someone has (compatibilist) free will.
            Excessive adherence to an “explanatory power” requirement is anti-conceptual. Taken seriously, it requires us to drop all of our abstractions and explain everything at the most fundamental level. (The concept of “chair” doesn’t have any additional explanatory power once you know that there are four legs, a seat, and a back arranged in a certain way, but we still see the point of talking about chairs.)

            Where did we get the idea of Loki if he weren’t real ?

            Loki is a fictional composite of real phenomena and simpler composites, e.g. liar + immortal (human – aging) + shapeshifter (composite of animal + person’s ability to change appearance), etc. It’s like how I can talk about a nonexistent gold mountain because gold and mountains are both real.

            But consciousness (or at least qualia) doesn’t seem to be that kind of composite. It’s not the kind of thing you’d get by only combining third-person-accessible stuff. And it’s a posteriori, so it’s different from mathematical objects.

          4. Ketil

            Firstly, while I can be reasonably sure that I am conscious, that gives me circumstantial evidence at best that other people are conscious. There’s no real way for me to know whether any given person I’m talking to is conscious

            Side track, but I think it gives you pretty strong evidence that other people are conscious, too. I can look at myself in a mirror (literally and metaphorically) and notice how I look and behave very similar to other people. Science tells me that we are all created by the same biological and evolutionary processes. Occam’s razor tells me the most parsimonious explanation is that other people are like me.

            The alternative would be that somebody constructed an elaborate simulation around me alone, or that a deity exists and infused me alone with consciousness, or some other theory that raises more questions than it answers.

          5. Bugmaster

            @blacktrance, Ketil:
            I broadly agree with what you said, but now we’re back to saying, “X is conscious if X behaves in a way consistent with consciousness”, perhaps with the added rider of “…and X also has the neural structures consistent with consciousness”. I have no problem with this definition, but then, it does not in any way follow that qualia “is not the kind of thing you’d get by only combining third-person-accessible stuff”. You’ve just spent multiple paragraphs on explaining why consciousness can only be understood in terms of “third-person-accessible stuff”; is this not the case for qualia ?

          6. blacktrance

            Being able to identify and keep track of consciousness is different from understanding it. (I can see that you’re holding a black box; you don’t hold it any more if I take it away from you; but that tells me nothing about what it does or how it works.)

            “X is conscious if X behaves in a way consistent with consciousness” is an inference, not a definition. Other people’s consciousness can be inferred from their behavior, but the concept of consciousness is about first-person experiences. If X talks about being conscious, the qualitative aspects of their experience, etc, that’s first-person stuff.

          7. Bugmaster

            @blacktrance:
            Well, in that case, we’re back to a version of solipsism — since, by definition, you can only ever experience your own first-person experiences. When talking about people other than yourself, you have no choice but to talk about their behaviour, their brain chemistry, and other observable phenomena. The assumption of “free will” (or lack thereof) gives you absolutely no useful data points to build upon.

          8. blacktrance

            You can infer that other people are having first-person experiences as well, based on their similarity to yourself and their behavior. If someone has similar brain chemistry, behaves similarly to you, and reveals details that would be unlikely coming from a non-conscious being (e.g. they talk about qualitative experiences and willing themselves to do stuff), that strongly suggests that they’re conscious. (A chatbot can talk about having conscious experiences even though they don’t, which is why these are evidence, not sufficient conditions.)
            And if they can act in accordance with their will, they have free will. It’s a concept, not a data point. Just like we have the concept of “chair” even though it gives no data points beyond that of “four legs, a seat, and a back assembled normally for comfortable seating”.

          9. Mark V Anderson

            @blacktrance

            Free will is the ability to consciously direct and control your behavior, so consciousness is a prerequisite.

            I certainly agree that consciousness is required for free will to exist, but it also does not in any way prove that free will exists.

            I agree with ksvan that free will is not not really a meaningful concept. Advocates seem to claim that individual decisions are not “determinable” because they have no cause. But if they have no cause, then how is that free will?

          10. TheAncientGeeksTAG

            Not being determined by
            preceding causes is precisely what the free in free will means. Your, question reads like “how can this gluten free product be gluten free when it contains no gluten”

          11. Bugmaster

            @TheAncientGeeksTAG:
            In that case, free will demonstrably doesn’t exist, otherwise we wouldn’t be having this conversation. You’d say,

            Not being determined by preceding causes is precisely what the free in free will means.

            And I’d reply with “kksdjfkmal;ae[ptore”, because my replies would be completely independent of your preceding remarks.

            Admittedly, people do take seemingly random actions now and then; but, by and large, our actions are quite predictable.

          12. Bugmaster

            @zqed:
            Ok, well, if by “X is not determined by Y” you mean “Y is one of many factors that influence X”, then sure, even though the wording sounds a bit disingenuous to me. At that point, we’re just quibbling about coefficients. If your behaviour can be correctly predicted 90% of the time, do you still have free will ? What about 99% ? 99.9% ? Or would you go as low as 80%, which IIRC is average for humans ? In any case, speaking about some idealized philosophical concept of free will seems redundant at this point, since we’re really just talking about probabilistic models.

          13. Johnny4

            @Bugmaster

            I don’t understand why you say we’re “quibbling about coefficients”. If free will is incompatible with determinism, 90% or 99.9% predictability (in principle) allows free will, while 100% doesn’t (assuming a plausible bridge principle between predictability and determinism). And if it’s compatible with determinism, then it’s compatible with 100% predictability!

            I mean, I’m not a compatibilist and I’m a pretty staunch defender of free will, but I think that at least 90% of my actions are predictable (in principle). Indeed, I’m somewhat tempted towards the view that we’re only able to do otherwise on pretty rare occasions, for example where we’re really struggling with a decision (so that 99% of my actions are predictable in principle). Some philosophers think that only akratic actions are free (maybe plus near misses), etc.

            Whether we have free will, and how frequently we exercise our free will, are largely independent questions. Compare: domesticated chickens have an ability that you and I don’t have–they can fly. But they only fly rarely, and they can only sort of barely do it. Still, their ability to fly is a pretty significant ability that you and I lack.

          14. Aapje

            @Bugmaster

            It can both be true that 90+% of our actions are predictable, but that many of these derive from unpredictable or partially predictable choices.

          15. TheAncientGeeksTAG

            In that case, free will demonstrably doesn’t exist, otherwise we wouldn’t be having this conversation. You’d say,

            Or long standing philosophical problem don’t have one line solutions.

            Not being determined by preceding causes is precisely what the free in free will means.

            And I’d reply with “kksdjfkmal;ae[ptore”, because my replies would be completely independent of your preceding remarks.

            Youre taking “not fully determined” to mean “completely undetermined”.

        4. TheAncientGeeksTAG

          In a universe without free will, we’d either lack consciousness or have something like locked-in syndrome.

          Assuming that conscious control is essential to free will, but its only one definition.

          Conscious control of behaviour is compatible with all behaviour, deterministic and indeterministic, being determined. However libertarian free will is explicitly incompatible with free will — but but does not have any stipulation about consciousness. Compatibilist free will only requires absence of deliberate compulsion by external agents, which is orthogonal to the other two definitions.

          Also, while lack of consciousness would imply lack of conscious control, the same is not true in reverse: lack of consciousness is not the only thing that could bring about lack of conscious control.

      1. sty_silver

        Libertarian Free Will implies that determinism is false, as Caplan acknowledges. If you add the axiom that Free Will is a property of complex systems (by which I mean, at least as complex as a molecule), then it further implies that reductionism is false, because…

        … reductionism states that there is only one layer of reality, namely the lowest one. On this layer, we know everything is governed by mathematical equations. Therefore, if reductionism is true, and if Free Will doesn’t exist on the level of quantum fields, there is no way for more complex systems to have causal power via free will.

        “Observable” is a bit tricky, because due to the nature of quantum mechanics, it’s already the case that you canot predict what observations you will make in the future even with perfect information right now (or rather, for each possible observation, there will be one version of you making that observation). But I guess, if libertarian free will was true, there would have to be additional ways in which systems become non-deterministic if they obtain libertarian free will.

        1. Bugmaster

          I think that quantum mechanics is a bit of a red herring in this case, because its unpredictability only becomes relevant at very small scales. At larger scales, you can safely say things like “V = IR” without worrying about where each individual quantum waveform is going.

          Similarly, you can (philosophically speaking) zoom in on an individual human and describe him entirely in terms of quantum waveforms, but it would take way too long. You can zoom out a little, and look at chemical reactions, but that would also take too long.

          Most people tend to zoom out all the way and say things like “Bob prefers chocolate ice cream to vanilla”, as opposed to something like, “When presented with a choice between chocolate or vanilla, Bob will choose chocolate 90% of the time (modulo other confounders)”, or “The chemical changes in Bob’s body that result from ingesting chocolate are blah blah”, etc.

          The bottom line is, Bob chooses chocolate 90% of the time. Adding “libertarian free will” to this equation tells us absolutely nothing new about what Bob would do in any given situation, so what’s the point ?

          1. ksvanhorn

            [quantum mechanics’] unpredictability only becomes relevant at very small scales.

            Not really true. Unpredictability at small scales can get amplified to macroscopic scales. Try out the universe splitter app to see a cute demonstration of this.

            I would expect that any highly nonlinear physical system (human brains?) would, from time to time, amplify small atomic-scale quantum randomness to macroscopic levels. Butterfly effect.

          2. Bugmaster

            @ksvanhorn:
            Is the butterfly effect a real thing ? Don’t get me wrong, there are lots of chaotic systems that can change wildly based on only minor shifts in initial conditions. On the other hand, a butterfly flapping its wings cannot literally start a hurricane. Do you have evidence that minor quantum fluctuations have any effect on whether or not I will choose chocolate over vanilla 90% of the time ? I understand that it might be tempting to trace each individual choice to quantum fluctuations… but… 90% of the time I’d still choose chocolate. Most systems in nature are actually pretty stable, which is a good thing — otherwise, planets wouldn’t exist.

          3. Ketil

            On the other hand, a butterfly flapping its wings cannot literally start a hurricane.

            What “literally” starts a hurricane? If an event A is of such a nature that if A occurs, B occurs later, and if A does not occur, B does not occur – isn’t it reasonable to say that A causes B?

            On the other hand, maybe for chaotic systems it doesn’t make as much sense to talk about causes at all – for every butterfly in the Amazon, there is a bee in Canada and a sparrow in Turkey, and so on.

        2. ksvanhorn

          Libertarian Free Will implies that determinism is false

          As you acknowledged, determinism is false or is at least effectively false. We live in a fundamentally unpredictable universe. But I don’t think most people would agree that an atom of uranium-235 has free will just because it is fundamentally unpredictable just when it will decay. When people speak of free will, they seem to mean something more than just inherent randomness.

          But I guess, if libertarian free will was true, there would have to be additional ways in which systems become non-deterministic if they obtain libertarian free will.

          Again, discussions of free will seem to take for granted that it is more than just inherent randomness.

          1. sty_silver

            As you acknowledged, determinism is false or is at least effectively false.

            I did not acknowledge that determinism is false, I think it’s almost certainly true. I’m against calling many worlds “effectively non-determinism” — they are in fact perfectly deterministic. Calling it non-determinism is just asking for confusion. If you want, you can call them effectively unpredictable.

            Again, discussions of free will seem to take for granted that it is more than just inherent randomness.

            I agree, but I don’t think that’s a logically coherent concept. Suppose libertarian free will did exist. Now suppose I put some agent X with LFW into some particular situation. Now they have free will, so I cannot predict what they do. But they’ll do something. If I now repeat this identical experiment 100000 times, always using the exact same X, I will get relative frequencies, which define a probability. So from my perspective, it is just randomness. Unless the claim is that it wouldn’t ever converge to some relative frequency, which I hope even Caplan can agree is absurd.

          2. VoiceOfTheVoid

            Many-Worlds is deterministic, if you subscribe to that particular interpretation of QM you don’t have to worry about quantum randomness in your philosophy. (To compensate, you get a whole host of other things to worry about.)

            But if you subscribe to Copenhagen or whatnot, then I degree that quantum randomness doesn’t actually do much of anything to help the concept of Libertarian free will.

      2. TheAncientGeeksTAG

        Can somebody explain to me what observable difference one would expect to see between a universe in which free will exists and one in which it does not?

        Whats the difference between a deterministic universe and an indeterministic one? There isn’t a single clinching observation, but indeterminism in general makes prediction in general harder. The same would be true of a universe with libertarian free will.

        Philosophical claims generally do not relate to specific observations and predictions, because philosophy is generally about interpreting the evidence we already have You might think that is illegitimate, but to be consistent you would need to reject all interpretations and stick to something like instrumentalism..

      3. Johnny4

        @ksvanhorn

        Can somebody explain to me what observable difference one would expect to see between a universe in which free will exists and one in which it does not? Absent that, I am unconvinced that “free will” is even a meaningful concept

        Well, what observable difference would you expect in a world in which consequentialism was true and one where it wasn’t? Or a world in which morality exists at all and one where it doesn’t? Or a world in which numbers and other abstract entities exist and one where they don’t? Or a world where meaningful concepts could fail to make an observable difference, and one where they couldn’t?

        The question of whether you have free will is pretty straightforward: have you ever been, or will you ever be, able to do something other than what you in fact do? The semantics of that question is pretty simple, so it’d be surprising if it failed to have a meaning.

    3. Johnny4

      Why does everyone seem to think that ‘Thou Art Physics’ is such an important argument on the topic of free will. I’m not trying to be a jerk, but, um, it’s not like professional philosophers are (generally) confused about the points made there, and while those points aren’t trivial, they simply do not solve the problem of free will. If you want to know what one of the best recent philosophers working on free will thinks, try this. I think it does a pretty fair job of presenting the different sides, and certainly doesn’t commit any of the errors mentioned in TAP. (While I can’t say that those errors never make their way into professional philosophy, I can say that it’s rare, at least when it comes to the better stuff. There’s a whole spectrum of “professional” philosophers, after all.)

      The most important point in the van Inwagen article is that it is compatibilists, not libertarians, who believe in miraculous free will. Libertarians say that, if there is free will, physics had better make room for it: it had better be physically undetermined what we will choose if we really have a choice between options. Free will can’t require miracles, or violations of the laws of nature. Compatibilists, on the other hand, say that, even though we were determined to do X, we were able to do not-X. (Of course, we’re determined to never exercise that ability, but they say we have that ability nonetheless.) Since “doing what the laws of physics entail (given the past) is impossible” is a pretty good definition of ‘miracle’, it is compatibilists who think that free will is miraculous–it is compatibilists who say that free will involves the ability to violate laws of nature. (Again, but it’s important, they also think we never actually do that.)

      I should note that not all compatibilists accept this characterization of their view, but the smartest one does. 😉

      1. VoiceOfTheVoid

        Personally, I was incredibly unimpressed with van Inwagen’s article. Upon reading his definition of free-will, or more precisely the free-will thesis:

        The free-will thesis is the thesis that we are sometimes in the following position with respect to a contemplated future act: we simultaneously have both the
        following abilities: the ability to perform that act and the ability to refrain from performing that act

        My immediate impression was, “Oh, he’s just passed the buck to ‘able’. Depending on how you define ‘able’ I might agree or disagree with that thesis–as a matter of fact, differing definitions of ‘able’ could even explain away some of the disagreement between compatibilists and incompatibilists.” Unfortunately, he spent the next two pages arguing that obviously everyone means the same thing by “free will” and thus the phrases “libertarian free will” and “compatibilist free will” are abominations.

        However, I had a glimmer of hope when he specifically acknowledged that the definitions of free will turn on the word “able”:

        So, if ‘‘free will’’ denotes the property is on some occasions able to do otherwise, there is really nothing for ‘‘libertarian free will’’ to denote but that same property….
        The operative word in both guesses is ‘‘able’’—as in ‘‘Jill says she is able to do what I have asked.’’

        And after a page of listing phrases that he thinks should be replaced with “able” in definitions of free will, he actually gets around to defining the word!…or so it seemed.

        Having said this about the word ‘‘able’’ I want to make what seems to me to be an important point, a point that is, in fact, of central importance if one wishes to think clearly about the freedom of the will: compatibilists and incompatibilists mean the same thing by ‘‘able.’’ And what do both compatibilists and incompatibilists mean by ‘‘able’’? Just this: what it means in English, what the word means. And, therefore, ‘‘free will,’’ ‘‘incompatibilist free will,’’ ‘‘compatibilist free will’’ and ‘‘libertarian free will’’ are four names for one and the same thing.
        [emphasis mine]

        And thus my hopes were dashed and I lost all my remaining respect for Pete. “What do people mean by X? Whatever X means, of course!” isn’t a definition, it’s a tautology! You might as well skip the intermediate definition and just say, “Free will is what people mean when they say free will.” Yes, “able” is a common word, but its meaning is still ambiguous enough that when your entire argument hinges on its precise definition, you should at least make an effort to precisely define it! Did he forget his earlier advice in the second page of the essay about carefully defining one’s terms as clear, declarative statements? Or does he think that “able” is immune from that requirement simply because it’s a commonly-used word outside of philosophy papers? Imagine if a physics teacher said, “Today we will be learning about weight. What do I mean by ‘weight’? Well, just what the word means in English! Now please calculate the weight of a 42-kg object.” Insanity!

        To prove my point, here are three possible definitions of the phrase, “X is able to do Y.”
        1. Given the current state of the universe, there is a nonzero chance that X will do Y.
        2. Given my knowledge of the current state of the universe, I estimate a nonzero probability that X will do Y.
        3. If X were to decide to do Y, Y would be done.

        Your choice of one of these three definition vastly changes the meaning of “free will” as van Inwagen defines it. Definition 1 turns it into an explicit declaration of indeterminism: “With regard to a future action, given the current state of the universe, there is simultaneously a change we will perform the action and a chance we will not perform the action.” Definition 2 instead yields only a statement that we can’t predict the result of our own decision-making processes ahead of time: “When contemplating a potential future action of ours, we simultaneously think that we might decide to take the action or we might decide not to take it.” Definition 3 produces probably the least controversial statement: “For some actions, if we were to decide to take the action we would take the action; and if we were to decide not to take the action we would not take the action.”

        I think that Definition 1 is probably about what van Inwagen means by “able” in his definition of free will. That definition is neither necessary nor sufficient for what I think of as “free will”. Instead, the statements produced by definitions 2 and 3 much more accurately describe the property I would call “free will”, and additionally I think that they are self-evidently true.

        (To avoid ascribing free will to my thermostat, I further define that a particular agent has free will if the above statements are true for actions it takes, and it has an internal experience of making decisions. Van Inwagen’s “free will thesis” specifically concerns “us”, i.e. people, and I think that he and I would both agree that humans are conscious, so this point isn’t relevant to his argument.)

        1. Johnny4

          My immediate impression was, “Oh, he’s just passed the buck to ‘able’. Depending on how you define ‘able’ I might agree or disagree with that thesis–as a matter of fact, differing definitions of ‘able’ could even explain away some of the disagreement between compatibilists and incompatibilists.” Unfortunately, he spent the next two pages arguing that obviously everyone means the same thing by “free will” and thus the phrases “libertarian free will” and “compatibilist free will” are abominations.

          The phrases ‘libertarian free will’ and ‘compatibilist free will’ are abominations. If libertarians and compatibilists aren’t using ‘free will’ to mean the same thing, then they don’t disagree with each other, which they obviously do (and are obviously trying to do). The phrase ‘free will’ has, as a matter of historical fact, been used to mean the ability to do otherwise (roughly). Compatibilists and libertarians disagree about what the world has to be like for it to be true that we have the ability to do otherwise. They’re talking about the same ability (free will), and disagreeing about its nature.

          And thus my hopes were dashed and I lost all my remaining respect for Pete. “What do people mean by X? Whatever X means, of course!” isn’t a definition, it’s a tautology! You might as well skip the intermediate definition and just say, “Free will is what people mean when they say free will.” Yes, “able” is a common word, but its meaning is still ambiguous enough that when your entire argument hinges on its precise definition, you should at least make an effort to precisely define it!

          The whole point of deferring to the actual English meaning of ‘able’ is that if we don’t do that, we just end up talking past one another. (See above.) If you and I are “debating” about whether stealing is always wrong, but you’re just defining ‘wrong’ to mean ‘doesn’t maximize utility’, then we’re not really disagreeing. I happily admit that stealing sometimes maximizes utility. To have a (productive) disagreement about what’s wrong we have to be using ‘wrong’ to mean what it means, not what we think it means. This isn’t some weird PvI quirk, David Lewis and Derek Parfit explicitly endorse this point.

          Anyhow, PvI’s point wasn’t to define ‘able’ in terms of ‘able’, it was to define ‘free will’ in terms of ‘able’, which he thinks is a better-understood term. That seems right to me, but your mileage may vary.

          To prove my point, here are three possible definitions of the phrase, “X is able to do Y.” …Your choice of one of these three definition vastly changes the meaning of “free will” as van Inwagen defines it.

          We can’t choose what ‘able’ means, it means what it means. If we allow ourselves to choose what ‘able’ means, then we’d be able to choose whether we have free will. And again, this isn’t “van Inwagen’s definition” of free will, it’s the definition of free will. What’s true is that the facts about what’s required for us to be able to do something will have a significant effect on what view about free will is right.

          In any case, none of your definitions of ‘able’ are particularly plausible:

          D1 ascribes abilities way too narrowly if determinism is true (unless compatibility about ‘able’ is true at least), and way to broadly if indeterminism is true. There’s a non-zero chance that I’ll quantum tunnel through the wall, but that’s not something I’m “able” to do.

          D2 has nothing to do with ability at all, it just has to do with our limited knowledge. (I estimate a non-zero probability that Trump will play a Chopin sonata this evening, but that could be true even if Trump is wholly unable to play the piano. Maybe, unbeknownst to me, he’s dead.)

          D3, if an indicative conditional, says that I’m able to fly around the block right now, since ‘if [false] then [false]’ is true. If a subjunctive conditional, it says dead people are able to blink (in the closest world where this dead person decided to blink, they would blink). In any case, definitions of ‘free will’ along these lines famously suffer from the problem that, if a chip were implanted in your brain that made you decide to do whatever some evil neuroscientists wanted you to, you’d be “doing what you decided” but you would obviously not be free.

          I have no idea what it means to say that D2 and D3 are self-evidently true. Not that it matters, but I can tell you with certainty that D1 is not what PvI means by ‘able’.

          1. VoiceOfTheVoid

            If libertarians and compatibilists aren’t using ‘free will’ to mean the same thing, then they don’t disagree with each other, which they obviously do (and are obviously trying to do). The phrase ‘free will’ has, as a matter of historical fact, been used to mean the ability to do otherwise (roughly). Compatibilists and libertarians disagree about what the world has to be like for it to be true that we have the ability to do otherwise.

            Exactly! Which is why they ought to explain what a world in which we “have the ability to do otherwise” looks like vs. one in which we lack that ability, before they try to prove whether or not we do.

            The whole point of deferring to the actual English meaning of ‘able’ is that if we don’t do that, we just end up talking past one another.

            I think we still end up talking past each other, since English words don’t actually have single unambiguous meanings. Maybe the specific formulations of the definitions I gave strike you as incongruous with actual usage, but I can think of “X is able to Y” being commonly used in at least two ways. First, it can mean “X is likely to accomplish Y given the current situation and the preferences/values of X (if X is an agent)”. For example, a wife who calls her husband in the afternoon to say, “I finished up early at work; I’ll be able to make it home for dinner,” or “The boss asked us to stay late, sorry I won’t be able to make it home in time for dinner”. I’d say those statements are a reasonable use of English. However, I think it is also reasonable to say that she is able to make it home in time for dinner even if her boss asks her to stay late, in the since that nothing is physically preventing her from running out of the office and driving home at 4 PM–as she indeed might do if there were an emergency at home. So does “able” mean “likely to do something with one’s current motivations” or “likely to do something given hypothetical sufficient motivation”? Either one, depending on context. Since there are multiple related uses of “able” in English that are implicitly defined slightly differently, saying “the English meaning of the word” doesn’t at all clarify which slight variation of the English meaning of the word you’re using. And the slight variations are important when trying to draw broad philosophical conclusions that rest of the meaning of the word. (Those two definitions, by the way, are roughly what I’m trying to get at with D2 and D3 respectively. Intensive definitions are tricky, though.)

            We can’t choose what ‘able’ means, it means what it means. If we allow ourselves to choose what ‘able’ means, then we’d be able to choose whether we have free will.

            I agree that it would be nonsensical to define a word completely differently from common usage. But when a word is commonly used in various ways, there’s no harm and a good deal of benefit in explicitly specifying in which sense you mean the word in your philosophical argument.

            D3 […] if a subjunctive conditional, it says dead people are able to blink (in the closest world where this dead person decided to blink, they would blink). In any case, definitions of ‘free will’ along these lines famously suffer from the problem that, if a chip were implanted in your brain that made you decide to do whatever some evil neuroscientists wanted you to, you’d be “doing what you decided” but you would obviously not be free.

            Perhaps a better version of D3 would be, “Given certain plausible initial conditions, X will do Y successfully.” (thus, dead people are not able to blink.) This would also extend to our use of “able” for inanimate objects, e.g. “Sodium is able to react violently with water.” My response to the evil neuroscientists depends on whether the chip changes my motivations and desires, or bypasses my conscious thought to directly determine my actions. In the former case, I no longer exist and my body has been turned into a new agent with free will. In the latter case, I still exist but have been stripped of my free will, and the neuroscientists are using my body to exercise their free will.

            I have no idea what it means to say that D2 and D3 are self-evidently true.

            I meant that the free-will theses produced by substituting definitions D2 and D3–let’s call them FWT2 and FWT3–seem uncontroversial to me as statements of fact, ignoring whether or not they are good definitions of “free will”.

            but I can tell you with certainty that D1 is not what PvI means by ‘able’.

            Then what does he mean by “able”? Can you give examples and counterexamples?

          2. sty_silver

            Having said this about the word ‘‘able’’ I want to make what seems to me to be an important point, a point that is, in fact, of central importance if one wishes to think clearly about the freedom of the will: compatibilists and incompatibilists mean the same thing by ‘‘able.’’ And what do both compatibilists and incompatibilists mean by ‘‘able’’? Just this: what it means in English, what the word means. And, therefore, ‘‘free will,’’ ‘‘incompatibilist free will,’’ ‘‘compatibilist free will’’ and ‘‘libertarian free will’’ are four names for one and the same thing.

            Without having read anything else, this seems like a perfect example of bad philosophy to me. The philosopher made a complicated argument and then concluded something obviously false. This is precisely the failure mode I’m always envisioning: being so impressed with your ability to argue that you just end up arguing for whatever you want, not for what’s true.

            Obviously, compatibilist free will and libertarian free will are not the same thing. It’s contradicted by the only discussion (as in, debate between two public figures in audio form) on Free Will I’ve ever heard: in his talk with Sam Harris, Daniel Dennet immediately acknowledged that Libertarian Free Will doesn’t exist and then goes on to argue for an hour about why we should insist that people have Free Will anyway, where Free Will is some notion of control compatible with determinism.

            Prominent people use these terms to mean different things. So if the claim was that they don’t, that’s clearly false, and if the claim was that the terms somehow should mean the same, that would be even worse.

            I also think “determinism” and “thou art physics” are the end of the relevant conversation, so even writing elaborately about Free Will feels like a red flag.

          3. TheAncientGeeksTAG

            The phrases ‘libertarian free will’ and ‘compatibilist free will’ are abominations. If libertarians and compatibilists aren’t using ‘free will’ to mean the same thing, then they don’t disagree with each other, which they obviously do (and are obviously trying to do).

            Even if they mean different things, the compatibilists can disagree with the libertarians about the existence of libertarian free will.

          4. Johnny4

            @sty_silver

            Without having read anything else, this seems like a perfect example of bad philosophy to me. The philosopher made a complicated argument and then concluded something obviously false. This is precisely the failure mode I’m always envisioning: being so impressed with your ability to argue that you just end up arguing for whatever you want, not for what’s true.

            Well, the rest of us don’t have intuitions that are always correct, so we need to consider the actual arguments. And in fact, I don’t think your intuition is correct here, so maybe you should look at the argument.

            Let’s come at the question from another angle. Do Consequentialists disagree with Kantians about what acts are wrong (say, lying in a case where that would produce the best consequences)? Yes, obviously. But then they had better mean the same thing by ‘wrong’. If by ‘wrong’ Consequentialists just mean ‘produces the best consequences’, then their theory is trivially true (everybody, including Kantians, agrees that lying sometimes produces the best consequences), but also uninteresting. Their theory would just be the trivial conceptual truth that something produces the best consequences iff it produces the best consequences–something that Kantians and Aristotelians agree with. To get an interesting claim, you need to say that something is wrong (given the actual meaning of ‘wrong’) iff it produces the best consequences.

            Just so, Compatibilists obviously disagree with Libertarians about what acts are free (Compatibilists say that some determined acts are free). But then they had better mean the same thing by ‘free’. If by ‘free’ Compatibilists just mean ‘free according to Compatibilists’, then their theory is trivially true (everybody, including Libertarians, agrees that determined acts are sometimes free according to Compatibilists), but also wholly uninteresting. Their theory would just be the trivial conceptual truth that someone has “Compatibilist freedom” iff they have “Compatibilist freedom”–something that Libertarians and Hard Determinists agree with. To get an interesting claim, you need to say that someone is free (given the actual meaning of ‘free’) iff she is free according to Compatibilism.

            Since the participants in the debates about morality and free will are intending to make non-trivial claims, it follows that they are or should be using ‘wrong’ and ‘free’ to mean the same thing as their opponents: to mean what they actually mean.

            Yes, I know Dennett says stuff that contradicts this. He is wrong. We all are from time to time!

          5. Johnny4

            @VoiceOfTheVoid

            Exactly! Which is why they ought to explain what a world in which we “have the ability to do otherwise” looks like vs. one in which we lack that ability, before they try to prove whether or not we do.

            Van Inwagen can, and does, tell you something about what he thinks is required for us to have the ability to do otherwise. But he correctly refuses to define that phrase to mean what he thinks it means, since then the claims he wants to make about it (e.g., that it’s incompatible with being determined) would be trivial.

            English words don’t actually have single unambiguous meanings.

            This is definitely true! So we certainly have to single out a certain usage/meaning of a word before we can debate about what that meaning is. That makes philosophy more difficult, but I think it’s still possible. In debates about free will, for example, I think it’s clear that it’s the sense of ‘able’ in which the wife is able to come home that is relevant. Your definition of that sense of ‘able’ would be highly contentions and I believe incorrect, but that’s the relevant kind of case to think about.

            I agree that it would be nonsensical to define a word completely differently from common usage. But when a word is commonly used in various ways, there’s no harm and a good deal of benefit in explicitly specifying in which sense you mean the word in your philosophical argument.

            We are getting close to agreement! At least as long as by “specifying the sense” you don’t mean “specifying the meaning”. In the analogy/argument I gave to Sty_Silver, it would be important to specify that by ‘wrong’ we mean morally wrong, not illegal or a breach of etiquette. But, having thus specifying the sense of ‘wrong’ under discussion, we then go on to argue about what’s wrong, given the actual meaning of ‘wrong’ (when used with that sense).

            My response to the evil neuroscientists depends on whether the chip changes my motivations and desires, or bypasses my conscious thought to directly determine my actions. In the former case, I no longer exist and my body has been turned into a new agent with free will.

            Yes, I meant for the chip to change a few motivations and desires. Surely a chip could change a couple of motivations and desires without destroying you, right? Yes, you wouldn’t be free when acting on one of those desires, but that was my point.

            Van Inwagen discusses in some detail when he thinks it is true that some is able to do something (in the relevant sense) here (.doc).

            I should have said this on Friday, but thanks for reading the article, and I’m sorry you didn’t like it!

          6. TheAncientGeeksTAG

            I also think “determinism” and “thou art physics” are the end of the relevant conversation,

            Has determinism been proven?

          7. Johnny4

            @TheAncientGeeksTAG

            Even if they mean different things, the compatibilists can disagree with the libertarians about the existence of libertarian free will.

            Well, that’s not how I would describe any disagreement of theirs. Is the disagreement between preference consequentialists and hedonistic consequentialists about whether preference-consequentialist-wrongness exists? (Or about whether hedonistic-consequentialist-wrongness exists?) That seems like a very odd way of describing things. They’re disagreeing about whether preference consequentialism or hedonistic consequentialist give the right account of one and the same thing: wrongness. Likewise, compatibilists and incompatibilists about free will are disagreeing about whether one and the same thing–free will–is compatible with being determined. People are compatibilists for all sorts of different reasons, but one could be a compatibilist and think that we’re not determined: at least some compatibilists do think this. I don’t know what ‘libertarian free will’ means, but if it means ‘freedom in the absence of determination’ then these compatibilists could grant that “libertarian free will” exists without giving up an ounce of their compatibilism.

          8. chridd

            Do Consequentialists disagree with Kantians about what acts are wrong (say, lying in a case where that would produce the best consequences)? Yes, obviously. But then they had better mean the same thing by ‘wrong’.

            I don’t think that’s obvious. It’s entirely possible that consequentialists and Kantians are just using the word “wrong” differently and talking past each other and don’t have any actual disagreement about facts (except perhaps facts about how other people use the word “wrong”).

            Well, that’s not how I would describe any disagreement of theirs. […]

            As I interpret it (I hope I’m not misunderstanding things), there’s a relevant disagreement between two groups:
            Group 1 (libertarians) claims that a thing with various properties (some of which are incompatible with determinism) exists, and calls this thing “free will”.
            Group 2 claims that there isn’t a thing with all of the properties that group 1 claims free will has, but there is a thing with a subset of those properties (which excludes all of the properties that are incompatible with determinism), and calls this thing “free will”. (This group includes determinists, and people who think the universe isn’t deterministic but that the nondeterminism isn’t relevant to free will.)
            (Note: This is not meant to be an exhaustive list of positions.)

            A compatibilist would be someone who believes that group 2’s position is possible, and that if it were true the thing they claim to exist should be called “free will”. This includes people who aren’t in group 2, but there’s not as much reason to claim that group 2’s position is possible if you don’t believe group 2’s position is actually true.

            An incompatibilist would either be someone who uses a definition of “free will” that excludes what group 2 claims to exist (and therefore possibly not actually disagree with compatibilists, just talking about something different), or they could be someone who thinks that there can’t be something with the properties group 2 says free will has without also having the properties group 1 says free will has (which would mean they do disagree with compatibilists about non-language facts).

            A metaphor I thought of: Imagine you’re in a society where people have historically thought the moon was made of cheese, and this is ingrained enough into society that the definition of moon is usually given as “the big ball of cheese in the sky”. (Moon = free will, cheese = nondeterminism.) If you’re in this society and you think the moon is made of rock, not cheese, do you say the moon exists? You could say, no, there isn’t a big ball of cheese in the sky, therefore the moon doesn’t exist (there isn’t anything that matches the libertarian definition of free will, therefore free will doesn’t exist); or you could say, yes, the moon does exist, but people are wrong about what it’s made of (free will does exist, but it doesn’t work like libertarians think it does; compatibilist). The people who say no and the people who say yes but it’s made of rock agree on everything except what to call the moon, but they both disagree with the people who say it actually is made of cheese.

            (My own position on the issue is that the question of whether free will exists depends on incorrect assumptions and isn’t really relevant to anything outside philosophy, but if I had to choose an answer I’d agree most with group 2.)

          9. Johnny4

            @chridd

            It’s entirely possible that consequentialists and Kantians are just using the word “wrong” differently and talking past each other and don’t have any actual disagreement about facts

            I guess maybe it’s possible, that depends on the correct meta-semantics for words like ‘wrong’. But why would you think this? Do you think this about first-order disagreements about the wrongness of this or that lie, or abortion, or whatever?

            You interpretation isn’t far off, but a more standard and I think simpler way to put things is: there are two related but independent questions:

            1) Does free will exist?
            2) Is free will compatible with determinism?

            There are thus four (main) positions one could have about free will:

            1Y2N: “libertarians”
            1Y2Y: “soft determinists” (often called “compatibilists”)
            1N2N: “hard determinists”
            1N2Y: no name since nobody actually defends this view (sorta suspicious)

            An incompatibilist would either be someone who uses a definition of “free will” that excludes what group 2 claims to exist (and therefore possibly not actually disagree with compatibilists, just talking about something different), or they could be someone who thinks that there can’t be something with the properties group 2 says free will has without also having the properties group 1 says free will has (which would mean they do disagree with compatibilists about non-language facts).

            I think this is the wrong way to think about things. Group 1 says that free will is incompatible with determinism, while Group 2 says it (the very same thing) is compatible. What is “the very same thing”? Somewhat roughly, it’s the ability to do otherwise.

            A metaphor I thought of: Imagine you’re in a society where people have historically thought the moon was made of cheese, and this is ingrained enough into society that the definition of moon is usually given as “the big ball of cheese in the sky”. (Moon = free will, cheese = nondeterminism.) If you’re in this society and you think the moon is made of rock, not cheese, do you say the moon exists?

            Good analogy. There are tricky meta-semantic questions about whether a society could really define the moon to be made of cheese (that would be a horrible definition), but even if that were possible it seems clear that the real debate here is about the makeup of the brightest light in the night sky. But ‘free will’ isn’t a term from ordinary English that might have a crappy meaning because people are stupid (assuming the correct meta-semantics allows words to have such crappy meanings), it’s a philosophical concept that has worked its way into ordinary English. And, historically, that philosophical concept has had a pretty stable definition, and one that was neutral regarding compatibilism: free will is the ability to do otherwise. On that construal, the debate between compatibilists and incompatibilists is about whether there’s a legitimate and relevant sense of ‘able’ in which we’re able to do things that we’re determined not to do.

            It’s true that recently a significant chunk of people have started using ‘free will’ to mean ‘the type of control that is required for moral responsibility’, but that too is neutral with regard to the compatibilism question: it could turn out moral responsilbity is compatible with determinism, or it could turn out that it isn’t.

            I myself strongly prefer the original pre-theoretic “definition” of free will, partly because changing the definitions of words sows confusion, and partly because I think ‘Does moral responsibility require free will?’ should be a conceptually open question.

          10. TheAncientGeeksTAG

            Well, that’s not how I would describe any disagreement of theirs. Is the disagreement between preference consequentialists and hedonistic consequentialists about whether preference-consequentialist-wrongness exists? (Or about whether hedonistic-consequentialist-wrongness exists?)

            That’s unlikely to work on me, since I do think that consequentialist preferability and deontological rightness are different things.

            Likewise, compatibilists and incompatibilists about free will are disagreeing about whether one and the same thing–free will–is compatible with being determined.

            That’s true as well. The “splitting” or “talking past each other” framing is an alternative perspective, that avoids the problem of trying to establish the “real” meaning of the word, but is not the whole story.

          11. Johnny4

            @TheAncient GeeksTAG

            That’s unlikely to work on me, since I do think that consequentialist preferability and deontological rightness are different things.

            Well, I was talking about two different forms of consequentialism, one which says that only preference satisfaction is of intrinsic value, and one that says only pleasure is of intrinsic value.

            That’s true as well. The “splitting” or “talking past each other” framing is an alternative perspective, that avoids the problem of trying to establish the “real” meaning of the word, but is not the whole story.

            Yeah, but I’m trying (evidently unsuccessfully, but so it goes) to argue that the “splitting” framing isn’t an alternative perspective, it’s a distortion of the debate: something that makes dialogue less productive since, e.g., incompatibilists agree that “compatibilist free will” is compatible with determinism, and vice versa. Since the whole debate between compatibilists and incompatibilists is about whether free will is compatible with determinism, this seems like a bad outcome.

          12. VoiceOfTheVoid

            @Johnny4

            I should have said this on Friday, but thanks for reading the article, and I’m sorry you didn’t like it!

            Thanks for providing it! Apologies for my initial vitriol, I was frustrated with the writing style and perhaps went a bit overboard in my response. Lesson learned, I should not attempt to rebut philosophy papers after 1AM. And I think the other two papers you linked (Are we free to break the laws? by David Lewis, and A Promising Argument by van Inwagen) were much better written and convincing, even though I don’t completely agree with all the points made in either.

            In any case, for the sake of not having the same debate in two subthreads, I’ll consolidate all my replies to your points in this one. Once I actually type them up, that is.

          13. TheAncientGeeksTAG

            Splitting is constructive inasmuch as talking past each other is unconstructive. The substantive debate can be cast as an argument about whether CFW or LFW is the true meaning of FW , once splitting has occurred.

          14. Johnny4

            @TheAncientGeeksTAG

            Splitting is constructive inasmuch as talking past each other is unconstructive. The substantive debate can be cast as an argument about whether CFW or LFW is the true meaning of FW , once splitting has occurred.

            Sorry, I just don’t see this as a constructive move. The nature of free will itself–the ability to do otherwise itself–doesn’t depend on what people think about that ability. Most people could think it was incompatible with determinism, but most people could be wrong. The meanings of words, however, depend, at least partly and in the long run, on what people think they are and/or how they’re used. Whether the ability to do otherwise is compatible with determinism is a question about the world, whether ‘free will’ is defined/used to refer to CFW or LFW (if those phrases mean anything) is (at least partly) a fact about language–a fact about our conventions.

          15. TheAncientGeeksTAG

            Things don’t come with labels on them provided by batyre. We can’t examine the nature of free will itself by examining the thing with the “free will” label. What we can do is put forward various theories and see if anything corresponds to them.

            And if you define free will as the ability to have done otherwise, it is incompatible with determinism.

          16. Johnny4

            @TheAncientGeeksTAG

            Things don’t come with labels on them provided by batyre. We can’t examine the nature of free will itself by examining the thing with the “free will” label. What we can do is put forward various theories and see if anything corresponds to them.

            Can you help me understand what you’re saying here? I’m fully in support of coming up with theories of free will, and also trying to determine if anything corresponds to them. What I’ve been trying to argue is that to have different theories of one and the same thing we have to be talking about the same thing–in this case, free will. If libertarians were giving theories of L(free will), and compatibilists were giving theories of C(free will), they wouldn’t be giving theories of the same thing. Hence the importance of using ‘free will’ as a neutral name for the thing you want a theory of, not as something stipulatively defined to accord with your theory.

            And if you define free will as the ability to have done otherwise, it is incompatible with determinism.

            I guess you’re just saying that you’re an incompatibilist? I mean, I agree with you, but what compatibilists have (traditionally–very recent history gets wonky) been arguing is precisely that the ability to do otherwise is compatible with determinism. See this classic defense of that claim, for example.

      2. VoiceOfTheVoid

        In any case, I think the precise definition of “free will” or “able” is exactly what’s at issue, and failing to give a definition of “able” either in words or, preferably, in examples, undermines any point that the author is trying to make. This isn’t the only flaw in the paper, though. He mentions that the “Consequence Argument” is a knock-down argument against compatibilism, but fails to even so much as state it in the paper, let alone defend or apply it, claiming it’s “beyond the scope of this paper
        seriously to discuss”. Instead he just appeals to authority and consensus by describing how this unstated argument has the power to convince philosophers.

        As a matter of fact, he here arrives at the closest thing to an actual definition of “able”:

        [Proposition 3]: Necessarily: If one is contemplating some possible future act, and if the past and the laws of nature do not together determine that one shall perform that act, then one is unable to perform that act.

        This is essentially equivalent to my definition 1 of “able”. He claims essentially that this is incompatible with the free will thesis if determinism is true (i.e. that the past and the laws of nature determine a unique future). My answer to him: They are incompatible, but which is false depends on your definition. If we use my definition 1, then the free will thesis is false; if we use my definition 2 or 3, then the free will thesis is true and your Proposition 3 is false. Either way, one would hope a trained philosopher would present evidence or logical argumentation for one or the other.

        Instead Peter goes for a coup-de-grâce by straight-up attempting to derive an is from an ought. (I thought philosophers knew better than to do that?)

        Suppose that your friend Alice has told a lie, and that you say to her (stern moralist that you are),
        (a) You ought not to have lied.
        Making statement (a), it would seem, commits you to the truth of
        (b) You ought either to have told the truth or to have remained silent.
        And (b), in its turn, commits you to the truth of
        (c) You were able either to tell the truth or [inclusive] remain silent.

        Statement (c) commits you to the truth of
        (d) You were able to do something you did not do,
        and (d) commits you to the truth of (1), to the free-will thesis.

        I agree, the moral statement implies some kind of ability for Bob to choose otherwise; but then taking the moral judgement as true in the first place is assuming the consequent! (Of course, arguing that moral judgments are true and require the ability to act otherwise is, once again, “beyond the scope of this essay”.) Also beyond the scope of the essay: Actually providing a specific counterargument to the “Mind Argument” against libertarianism. He simply says that he himself thinks it must be erroneous for some reason.

        Ironically, van Inwagen’s description of what a hypothetical Alice should not say strikes me as a pretty good description of what Yudkowsky might think one should say after resolving one’s confusion about free will:

        I used to think that free will was one thing, a thing incompatible with determinism. Now I think it is another thing—I mean I think that the words ‘‘free will’’ are a name for another thing—, a thing compatible with determinism. The thing I used, incorrectly, to call ‘‘free will’’ is incompatible with determinism; I was right to think it was incompatible with determinism. But it does not exist (I mean no agent has it), and it could not exist, and if it did exist, it would not be right to call it ‘‘free will.’’

        1. Johnny4

          @ VoiceOfTheVoid

          This isn’t the only flaw in the paper, though. He mentions that the “Consequence Argument” is a knock-down argument against compatibilism, but fails to even so much as state it in the paper, let alone defend or apply it, claiming it’s “beyond the scope of this paper seriously to discuss”.

          What? It’s not a paper about the consequence argument. If you want to read a paper about the consequence argument, PvI has written many. If you want to read a book about the consequence argument, PvI wrote it. Not every paper that mentions the consequence argument needs to rehearse it.

          As a matter of fact, he here arrives at the closest thing to an actual definition of “able”:

          [Proposition 3]: Necessarily: If one is contemplating some possible future act, and if the past and the laws of nature do not together determine that one shall perform that act, then one is unable to perform that act.

          This is essentially equivalent to my definition 1 of “able”. He claims essentially that this is incompatible with the free will thesis if determinism is true (i.e. that the past and the laws of nature determine a unique future).

          Sorry, I don’t mean to be a jerk, but you need to read more carefully. Proposition 3 is saying that we’re unable to do something if it’s not determined that we’ll do it, and so implies that free will is incompatible with indeterminism.

          My answer to him: They are incompatible, but which is false depends on your definition. If we use my definition 1, then the free will thesis is false; if we use my definition 2 or 3, then the free will thesis is true and your Proposition 3 is false. Either way, one would hope a trained philosopher would present evidence or logical argumentation for one or the other.

          It doesn’t depend on which definition we use, it depends on which definition is correct. And van Inwagen has certainly presented “evidence or logical argumentation” for his views about free will. But he’s not defending those views in this article, so he doesn’t present them here. I don’t understand why that’s hard to understand.

          Instead Peter goes for a coup-de-grâce by straight-up attempting to derive an is from an ought. (I thought philosophers knew better than to do that?)

          Maybe you’re thinking of deriving an ‘ought’ from an ‘is’? It’s trivial to derive an ‘is’ from an ‘ought’: ‘I ought to keep my promise’ entails ‘I made a promise’. In any case, the inference is basically of the form ‘ought implies can’, which is…very widely accepted.

          I agree, the moral statement implies some kind of ability for Bob to choose otherwise; but then taking the moral judgement as true in the first place is assuming the consequent!

          Can you please explain what you mean here? He’s not assuming the consequent, he’s taking it as a premise that sometimes people do things they shouldn’t. That seems pretty obviously true to me, but maybe you reject it. But all arguments have to have premises, and while we should try to use premises that are as uncontroversial as possible, we don’t need to restrict ourselves to premises nobody denies.

          Also beyond the scope of the essay: Actually providing a specific counterargument to the “Mind Argument” against libertarianism. He simply says that he himself thinks it must be erroneous for some reason.

          He doesn’t have a counterexample. Nobody does! (Or at least, nobody has one that is generally agreed to be a counterexample.) If there were a counterexample to the Mind Argument we wouldn’t need to worry about it. But nobody has a counterexample to the Consequence Argument either.

          Ironically, van Inwagen’s description of what a hypothetical Alice should not say strikes me as a pretty good description of what Yudkowsky might think one should say after resolving one’s confusion about free will

          Maybe he would–that’s, uh, partly why I linked to this piece. But PvI is right and Yudkowsky is wrong: if we don’t use (at least some) words with their common/public meanings, we just end up talking past one another. For you and I to disagree about free will (or morality, or whatever), we have to be using ‘free will’ (or ‘morality’, or whatever) to refer to the same thing.

          1. VoiceOfTheVoid

            It’s not a paper about the consequence argument. If you want to read a paper about the consequence argument, PvI has written many.

            Fair enough, but I still think that if his goal was to convince people of its validity, a short statement of the argument and brief defense would have been much more effective (in convincing me, at least) than the paragraph he spends arguing from consensus/authority. In any case, SEP provides a straightforward statement of the argument:

            1. No one has power over the facts of the past and the laws of nature.
            2. No one has power over the fact that the facts of the past and the laws of nature entail every fact of the future (i.e., determinism is true).
            3. Therefore, no one has power over the facts of the future.

            I do agree, this argument seems convincing, especially since I agree with premises 1. and 2. However, I think that the conclusion 3. does not follow for a subtle reason–specifically, the reason that Yudkowsky outlines in “Thou Art Physics” and related posts! Namely, that the facts of the past and the laws of nature only determine the facts of the future through the decisions and actions of us sentient beings existing within the laws of physics. By way of analogy: Consider a thermostat which has just been turned on. The thermostat controls a furnace: if the temperature of the house is below 70º, it turns the furnace on; if the temperature of the house is above 70º, it turns the furnace off. Now, having just been turned on, the thermostat has no control over the past temperature of the house. And the temperature of the house completely and uniquely determines whether the thermostat will turn the furnace on. Thus the temperature of the house entails the state of the furnace. But does this mean that the thermostat has no power over the furnace? Of course not–the temperature only controls the furnace through the thermostat, and were the thermostat removed, the furnace would remain off regardless of the temperature! (Like all analogies, this one is imperfect–the thermostat does not exist within the current temperature of the house in the same way as we and it exist within the laws of physics. I think the point still carries.)

            I don’t have time at the moment to respond to your other points; I’ll be able to do so later tonight.

          2. VoiceOfTheVoid

            Sorry, I don’t mean to be a jerk, but you need to read more carefully. Proposition 3 is saying that we’re unable to do something if it’s not determined that we’ll do it, and so implies that free will is incompatible with indeterminism.

            Ah, maybe I didn’t read it closely enough. I still blame van Inwagen for writing abstrusely and, I reiterate, failing to define the word on which all his arguments hinge, making nearly every proposition he defines ambiguous.

            It doesn’t depend on which definition we use, it depends on which definition is correct.

            What does it mean for a definition to be “correct”? I’d say if anything, it means that the definition points out a natural category of things, and that it agrees with at least one common usage of the word, if the word is commonly used. But English words don’t have single unique definitions, as is clear from opening any dictionary. If a word is commonly used to mean two different things, how do we decide which is the “correct” definition? Better to taboo the word and find the real crux of disagreement.

            But he’s not defending those views in this article, so he doesn’t present them here. I don’t understand why that’s hard to understand.

            I guess I went into the article expecting something that it wasn’t actually trying to provide, mainly because you suggested it as a counterpoint to Eliezer’s writings, which I think make clear and convincing arguments for his own position on free will. But I think that van Inwagen also fails to adequately defend the view he’s actually trying to advocate for in this article–namely, that everyone means the same thing by “free will”.

            Maybe you’re thinking of deriving an ‘ought’ from an ‘is’?

            …yup, my bad. Upon further reflection, I agree with his argument that, if “ought” is to mean something intelligible, it must entail some kind of morally relevant ability to do something one did not do or to choose between options, which in turn entails some kind of free will.

            But nobody has a counterexample to the Consequence Argument either.

            See my argument above, “Thou Art Physics”, and the David Lewis paper you linked. (Now there’s a much more sensible philosopher! He isn’t specifically addressing the Consequence Argument per se but is addressing a similar one.)

            if we don’t use (at least some) words with their common/public meanings, we just end up talking past one another. For you and I to disagree about free will (or morality, or whatever), we have to be using ‘free will’ (or ‘morality’, or whatever) to refer to the same thing.

            I completely agree, and so does Yudkowsky–see point 36 of “37 ways words can be wrong“:

            You use a word that has different meanings in different places as though it meant the same thing on each occasion, possibly creating the illusion of something protean and shifting.

            But I strongly disagree that the “common/public meanings” of “able” and “free will” are unambiguous enough that we can just point to “the meaning of the word in common English usage” as any sort of precise definition. Van Inwagen, in a paper whose core thesis is that “we all mean the same thing by ‘free will’ because we all mean the same thing by ‘able’,” does not provide any evidence that both he and compatibilists actually mean the same thing by “able”. You cannot resolve confusion due to people using the same word to refer to different things, by declaring that they must actually be referring to the same thing!

          3. Johnny4

            @VoiceOfTheVoid

            Well, I’m not sure that the SEP’s presentation of the argument in terms of power is the best presentation, but it should do.

            I think that the conclusion 3. does not follow for a subtle reason–specifically, the reason that Yudkowsky outlines in “Thou Art Physics” and related posts! Namely, that the facts of the past and the laws of nature only determine the facts of the future through the decisions and actions of us sentient beings existing within the laws of physics.

            Well, lots of compatibilists agree with you! I myself don’t, because to say that we have the power to do things that the laws of nature (given the past) say are impossible is to say that we have the power to perform miracles, and I don’t think we have that power. But at this point we’ve reached something pretty close to a rock bottom disagreement.

            Still, there might be something useful to say, at least about the specific form of compatibilism you/Yudkowsky seem to be defending. Note that if all that was required to be free was determination “through” the decisions and actions of an agent, you should be fine with saying that someone whose decisions and actions were being manipulated by an evil neuroscientist was free, since their behaviors are still (proximately) coming from them. That seems like a paradigmatic case of not being free though.

          4. Johnny4

            @VoiceOfTheVoid

            If a word is commonly used to mean two different things, how do we decide which is the “correct” definition?

            Well, if a word has two meanings in the sense of being ambiguous, we don’t need to choose. (Similarly if a word is used in different senses, as per above.)

            Better to taboo the word and find the real crux of disagreement.

            Yeah, this is one of the things I think Yudkowsky is most wrong about. I mean, in some cases tabooing a word is a good strategy (‘artificial intelligence’ seems like one), but it’s not helpful in (most of) the interesting cases. Consider the analogy with morality that I’ve been appealing to. If we tabooed ‘wrong’ and the circle of related words or phrases (‘ought not’, ‘should not’, ‘impermissible’, etc.), it wouldn’t be possible to state the disagreement between Kantians and Consequentialists. But there is obviously a disagreement. I think it’s also clear that there’s a substantive disagreement (about the nature of morality).

            Anyhow, van Inwagen is actually in favor of tabooing ‘free will’, and recasting the debate in terms of what we’re able to do, since he thinks ‘able’ has a more stable pre-theoretic meaning than ‘free will’ does. But if we go on to taboo ‘able’ and ‘can’ and all the other relevant words, we’d cease to be able to have a debate at all.

            But I strongly disagree that the “common/public meanings” of “able” and “free will” are unambiguous enough that we can just point to “the meaning of the word in common English usage” as any sort of precise definition.

            Again, van Inwagen doesn’t think that by appealing to the English meaning of ‘able’ he’s providing a precise definition. The point is that using words with their common/public meaning is critical if we want to avoid talking past one another and have an actual substantive debate. ‘We’re sometimes able to do things that we’re determined not to do’ is a substantive and interesting claim. ‘It’s sometimes true that if the past had been a bit different (i.e., if we’d decided differently), we’d do something that we’re actually determined not to do’ is trivial and uninteresting.

            Van Inwagen, in a paper whose core thesis is that “we all mean the same thing by ‘free will’ because we all mean the same thing by ‘able’,” does not provide any evidence that both he and compatibilists actually mean the same thing by “able”.

            Well, the argument/evidence is that compatibilists and libertarians are intending to make non-trivial claims, and intending to disagree with one another about when it’s true that we’re able to do otherwise. If they weren’t using ‘able’ to mean the same thing, that wouldn’t be true. Hence, the charitable interpretation is that they’re using ‘able’ to mean the same thing.

            It doesn’t really matter, but Lewis is addressing one of van Inwagen’s early papers on the Consequence Argument. What is fundamentally the same argument has been formulated in lots of different ways; same with the Mind Argument.

          5. TheAncientGeeksTAG

            @VoiceOfTheVoid

            I do agree, this argument seems convincing, especially since I agree with premises 1. and 2. However, I think that the conclusion 3. does not follow for a subtle reason–specifically, the reason that Yudkowsky outlines in “Thou Art Physics” and related posts! Namely, that the facts of the past and the laws of nature only determine the facts of the future through the decisions and actions of us sentient beings existing within the laws of physics. By way of analogy: Consider a thermostat which has just been turned on. The thermostat controls a furnace: if the temperature of the house is below 70º, it turns the furnace on; if the temperature of the house is above 70º, it turns the furnace off. Now, having just been turned on, the thermostat has no control over the past temperature of the house. And the temperature of the house completely and uniquely determines whether the thermostat will turn the furnace on. Thus the temperature of the house entails the state of the furnace. But does this mean that the thermostat has no power over the furnace? Of course not–the temperature only controls the furnace through the thermostat, and were the thermostat removed, the furnace would remain off regardless of the temperature! (Like all analogies, this one is imperfect–the thermostat does not exist within the current temperature of the house in the same way as we and it exist within the laws of physics. I think the point still carries.)

            So the thermostat has a “power” in one sense — a rather unremarkable one that every stage in a deterministic process is necessary to bring about the result. If doesn’t add up to an argument for compatibilism , since it doesn’t show that the “power” in question is anything like a choice or decision. Although it isn’t clear that it is supposed to be an argument for compatibilism, either — the people who proudly repeat it, following Yudkowsky, tend not to say what the point is.

            It might be that it is a devestating solution to the age old problem of free will that no one was able to think of till Yudkowsky came along. Or it might be an obvious point that mainstream philosophers don’t make much of because it doesn’t have much impact.

          6. Johnny4

            @TheAncientGeeksTAG

            Ah, this helped me see the point of the thermostat example. What’s critical to notice is that phrases like ‘power over’ and ‘control over’ are much vaguer, more ambiguous, or whatever that ‘is able to’. There are various senses of ‘power/control over’ that are just incapable of doing the “jobs” free will is supposed to do. Probably the most important job is making morality possible:

            ‘John should not have done X’ implies ‘John should have done something else’.
            ‘John should have done something else’ implies ‘John was able to do something else’.
            So, ‘John should not have done X’ implies ‘John was able to do something else’.

            Hence, if it’s ever true that someone did something they shouldn’t have, it must have been true that they were able to do something else. I mean, at the end of the day I don’t give a hoot what ‘free will’ means–we can just taboo the word–what matters is the ability to do otherwise. And that matters because if we don’t have that ability then morality goes down the tubes.

            Noting that there’s a sense in which we have power/control over our actions even if we’re determined is sort of irrelevant. I mean, I agree that morality also requires that we have control over our actions, but a story about how control is compatible with determinism doesn’t undermine the above argument, or help us see how we could be able to do otherwise and determined at the same time.

      3. VoiceOfTheVoid

        I was in the process of responding to you point-by-point, but then I realized:
        1. It was getting unwieldily long and a bit repetitive
        2. I had been looking at the entire problem the wrong way

        So, in lieu of that, a dialogue. (which has also, now that I look at it, become unwieldily long and repetitive. So it goes.)

        Libby (a libertarian*), Pat (a soft determinist**), and Harold (a hard determinist) see a boy jumping into a lake.

        “Ah, he jumped in based on his free will,” says Libby. “I’d say he was also able to not jump in, if he so decided.”

        “Indeed!” says Pat. “He clearly made the choice of his own volition.”

        “What are you two talking about?” interrupts Harold. “His jumping in was predetermined by the laws of physics and the past state of the world!”

        Libby replies, “Of course not! His free will in jumping in is just as apparent as my own free will to have this conversation with you.” (Pat nods along.) “Ask him, I’m sure he’ll say he had a choice. And the existence of that free will proves your deterministic physics invalid!”

        Pat suddenly stops nodding. “Funny, I thought we agreed up until now. The boy is part of those laws of physics; within and because of them, he made a conscious choice to jump in.”

        “What kind of a choice is that?” responds Libby. “A choice where there’s only only one possible outcome?”

        “Might as well say that rocks choose to fall to the ground when dropped!” Harold chimes in.

        “Well, at the start of his deliberations, the boy doesn’t know which outcome he’ll ultimately choose,” protests Pat. He looks at the boy splashing around. “Though in this case, I suspect he wasn’t pondering the decision for very long. And in the counterfactual world where he’d decided not to jump, he wouldn’t have jumped.”

        Libby shakes her head. “Counterfactual world? Why bring that up when we can talk about what could have happened in the real world if he didn’t decide to jump? Again, we agreed he was able not to.”

        Pat thinks for a second. “Perhaps, then, we don’t actually mean the same thing by ‘able’—I think the counterfactual is sufficient for a reasonable meaning of the word. Let’s see, how about an easy negative example…would he be able to jump if someone were physically restraining him?”

        “Of course not!” answers Libby. “Let’s think of some more examples…”

        In any realistic scenario they can think of, Pat and Libby agree on whether someone is able to do something or not: A baby is not able to sign their name on a paper, but someone who objects to a contract and refuses to sign it is able. A champion archer is certainly able to hit the bull’s-eye on a target; though a novice might hit it by change, they wouldn’t claim they’re consistently able to. Libby and Pat agree that there are numerous examples of someone being able to do X and simultaneously able to not do X, and that in those scenarios the person exercises “free will.”

        “Odd,” remarks Harold. “You’re both using ‘able’ to refer to the exact same situations, and yet when asked for an intensive definition you provide different criteria, with vastly different metaphysical implications—Pat’s counterfactuals, and Libby’s non-determinism of the final decision. So how do you keep converging on the same answers despite your seemingly different senses of ‘able’?”

        “Practically,” Libby responds, “We must be observing the same phenomena, using the same objective criteria for our determination of ability and free will. But we disagree about what the causes of those objective observations are, or what their metaphysical implications might be.”

        “So what are those empirical criteria we agree on?” asks Pat. “I think the prototypical example would be making a decision myself, free from coercion. I know that I feel able to choose one option or the other, and I can clearly envision the consequences of deciding one way or the other. When I see other people making decisions, I presume that they’re having similar experiences. Further, I observe that a person will sometimes make different decisions in similar situations—it’s more straightforward to conclude that they’re simultaneously able to act either way, rather than switching back and forth in the single way they’re able to act.”

        “Those are exactly the factors that lead me to believe that such choices truly are undetermined, up until the point the decision is made!” says Libby.

        “But that’s nonsense!” Harold objects. “Humans are made of the same electrons and quarks as everything else in our universe—we have no special power, outside the laws of physics, to change an undetermined outcome into a determined outcome. Thus, our sense of being ‘able to do otherwise’ must be illusory.”

        Libby smiles. “Your modus ponens, my modus tollens. I know I have free will, and therefore our universe must contain more than just deterministic billiard balls.”

        “I’m with Harold on the scientific evidence for a materialistic universe being pretty strong,” says Pat. “But he hasn’t explained our sense of free will, just claimed that it’s illusory. I think I can do better: the sense comes from the fact that we are the proximate cause of our decisions, and can consider multiple options. Even if the past state of the world determines our ultimate actions, it only does so though our process of weighing our options—imagining the consequences of each possible action, evaluating them against our goals and morals, and finally deciding which course best satisfies our values and executing it. To me, that process seems sufficient to produce feelings of having free will, of being able to do otherwise. Thus, there’s no need to posit any sort of metaphysical human exceptionalism to explain those feelings.”

        Harold’s brow slowly unfurls. “That all sounds reasonable to me. I don’t think such a process can truly be called ‘free’—but now we’re simply arguing over definitions; I don’t think we disagree on anything substantial.”

        Pat nods. “I do think it’s fair to call the process ‘free will’ and to say one is able to do things one is determined to decide not to do, since I think it’s valuable to distinguish between an action being prevented by external factors, and being prevented by an internal decision. But in any case, we’re arguing over language, not facts.”

        “So then, what’s the crux of our disagreement?” asks Libby. “At least as far as observable data is concerned, we agree on the situations that ought to be described as free choices.”

        “Right,” says Pat, “but Harold and I think deterministic physics is sufficient to describe those scenarios, while you think that the evidence suggests those choices must be truly undetermined and humans must have some special power to determine them.”

        =================

        So, do you think that this is a good statement of the crux of our factual disagreement? That you think what we feel and observe when we make a choice is evidence of indeterminism, and I think that it’s completely compatible with determinism?

        *I try to represent each position as faithfully and fairly as I can, but please do let me know if I’ve turned Libby into a strawman.

        **Technically, one could be a compatibilist without being a soft determinist; either because you don’t think free will exists, but think it could in some deterministic universe (a rare position); or because you think that the universe is indeterministic, but not in a relevant way (in which case you’d make similar arguments to the soft determinist).

        1. Johnny4

          @VoiceOfTheVoid

          Very nice! Seriously, well done. While you largely succeeded in being fair (thank you!), I do think that a couple of false or misleading stereotypes about Libertarians slipped in. Here’s where I would have presented/done things differently:

          First, I’m not sure jumping in a lake is a significant enough of a decision for free will to be involved. (And for reasons that will become apparent, I think a morally loaded case is better.) So I would have set things up more like this:

          Libby (a libertarian), Pat (a soft determinist), and Harold (a hard determinist) see a man in a hotel bar, with a young girl tugging at his arm, trying to get him to go with her to his room. They can see that the man is married (not to the girl, who is clearly under 18), and he’s clearly agonizing about whether to go with her. After looking flustered and confused for a few minutes, they hear him mutter ‘fug it’ and he goes up with the girl.

          Second, I think ‘choice’ is more vexed than ‘able’, so I would have had Libby say something like the following in response to Pat:

          “What kind of a choice is that?” responds Libby. “A choice where there’s only one possible outcome? But whatever, I don’t want to fight about whether there are unfree choices–what matters is whether he was able to refrain from going. If the laws of physics determined that he would go, then obviously he couldn’t have stayed. And if he literally couldn’t have stayed, well, then, we shouldn’t say he ought to have stayed—‘ought’ implies ‘can’. But I’m virtually certain he should have stayed.”

          [An even better case would be in the first person—when I think about times when I’ve been in an extended struggle to decide to do the right thing, and I choose wrongly, I’m basically certain (speaking in terms of subjective probability) that I could have chosen rightly.]

          Third, and perhaps most importantly, I think there are actual or possible cases that are neutral with respect to the question of whether humans are determined in general, and in which Libby and Pat will differ in their ascriptions of ability: e.g., manipulation cases like the evil neuroscientist (manipulating your desires, or your second-order desires, or whatever) scenarios we’ve talked about before. In such cases the “external” causes are still working through you, but it seems really clear that you’re not free. Addiction cases and cases of mental illness will be similar: addiction and mental illness take away or at least impoverish one’s free will, but they are both working through you: there’s no external coercion. There is a huge cottage industry of compatibilists trying to come up with an account of which kind of determination is compatible with free will, but I think there’s a consensus that “determined from within” won’t cut it, for (broadly) the reasons I’ve indicated. (If I recall correctly, this is a pretty good piece on manipulation arguments.)

          Fourth, while I agree that my view about free will entails that determinism with respect to human choices/behavior is false, I don’t think that that conflicts with any science I’m aware of. If we had very strong evidence that humans were determined at the neurological level, I would take that to be evidence against Libertarianism, and not just insist that Libertarianism has to be true based on my feeling of freedom. (I would, however, weigh the level of certainty science was providing in support of determinism with my level of certainty that people sometimes do things they shouldn’t. I’m more certain that we do things we shouldn’t than I am that incompatibilism is true, so if I became convinced that determinism was true I guess I’d become a compatibilist.)

          I also don’t think Libertarianism is inconsistent with materialism, which I’m pretty sympathetic with (at least if materialism is restricted to concrete objects, so that it allows sets, etc.). As a sort of aside, note that we know that all sorts of scientific theories are false just from armchair reflection: for example, we know that any theory inconsistent with what we know about ourselves or armchairs is false.

          Fifth, toward the end, Pat talks about deterministic processes being sufficient to produce feelings of free will. I totally grant that that’s possible, but Pat is supposed to believe that we actually have free will, not just that we feel like we have it. Presumably everybody agrees that we feel like we have it. You basically grant this later, but I just wanted to be clear that feeling free isn’t what’s at issue, and that the main reason I think we have free will is the ‘ought’ implies ‘can’ argument, not that we feel free.

          Sixth, I think Pat and Harold do disagree about something substantial (something that matters): they disagree whether the ability to do otherwise is consistent with determinism (and about whether we have that ability). If Harold is right and determinism is true and ‘ought’ implies ‘can’, then nobody ever does anything wrong, which is a big important conclusion. Consequentialism, for example, requires us to perform the best available action. But if only one action is ever available to us at any given time, we all always perform the best available action, and so do the right thing. Which is (I say at least) absurd. Similarly with Pat and Libby: if Libby is right and determinism is true and ‘ought’ implies ‘can’, etc. (Libby and Harold have a pretty obvious factual disagreement about whether determinism is true.)

          With all that being said, I just want to say thanks again for the very thoughtful (and enjoyable to read) response. Sorry this reply is so inferior!

          1. VoiceOfTheVoid

            Sorry this reply is so inferior!

            On the contrary, you raise a number of very good points! Unfortunately, the semester’s started up again and I won’t have the time to compose a reply in the foreseeable future. Perhaps we could continue this discussion in a future OT sometime.

        2. TheAncientGeeksTAG

          “But that’s nonsense!” Harold objects. “Humans are made of the same electrons and quarks as everything else in our universe—we have no special power, outside the laws of physics, to change an undetermined outcome into a determined outcome. Thus, our sense of being ‘able to do otherwise’ must be illusory.”

          “Physical” does not imply “deterministic” all by itself.

          Libertarians don’t think undetermined things become determined, they just think they happen.

          To me, that process seems sufficient to produce feelings of having free will, of being able to do otherwise. Thus, there’s no need to posit any sort of metaphysical human exceptionalism to explain those feelings.”

          That’s an argument against the claim that the feeling of free will is the only evidence for libertarian free will. But “physical” does not imply “deterministic”, and if there is a physical basis for indeterminism, then LFW could be explicable in non-illusory terms. How the universe works is evidence for and against free will claims.

          Yudkowsky’s approach doesn’t make enough to show that LFW cannot be explained as a real thing.

          1. Johnny4

            @TheAncientGeeksTAG

            “Physical” does not imply “deterministic” all by itself. Libertarians don’t think undetermined things become determined, they just think they happen.

            Well, we have to be careful about exactly how we’re defining ‘determined’. A popular form of Libertarianism talks about “agent causation”, where agents cause some things (behaviors) that are left undetermined by pattern of “event causation” governed by the laws of physics. (Agent causation can’t override physics, of course: Libertarians are incompatibilists!) It doesn’t seem wholly unfair to gloss this as an agent determining and otherwise undetermined outcome.

          2. TheAncientGeeksTAG

            If something is caused by a random event, we don’t say that it became determined, because we link determination to prediction , and random events , and their subsequent effects are unpredictable. So how does agent causation avoid that problem?

  84. blacktrance

    Replacing endorsing with liking seems to get us more plausible answers. The oppressed homosexual doesn’t endorse their urge, but they still like satisfying it. (This is part of the reason there’s nothing actually wrong with them.) Both the obese and thin person dislike the consequences of satisfying their urge to (not) eat. Similarly, the OCD scratcher ultimately doesn’t like scratching (though it may feel satisfying in the moment).

    1. Scott Alexander Post author

      This doesn’t seem right to me – I don’t have a strong sense for whether alcoholics like alcohol, or whether it’s different for some of them than others. I mean, I assume most do, but if some alcoholic were to say “I don’t even enjoy it anymore, it’s just compulsive and I feel bad if I don’t have it”, that would seem plausible enough. But I don’t feel like my opinions on alcoholism depend on this.

      1. blacktrance

        I think if alcoholics liked alcohol so much that the bliss they got from it outweighed the negative consequences of that lifestyle, we would be unjustified in treating it like a disease. If they only like it a normal amount, the effects of alcoholism outweigh the pleasure, so they ultimately don’t like satisfying their urge.

        1. Ozy Frantz

          There are societies in which homosexuality is punished with the death penalty. One assumes this generally outweighs the bliss of having gay sex. Your argument implies that homosexuality is a disease but only in cultures which punish it with the death penalty.

          1. blacktrance

            That’s a consequence of living in a severely homophobic society, not of homosexuality. If we decided to beat people up for having a cold, it wouldn’t make beatings a proper consequence of colds. A disease has to be unpleasant, but when part of that unpleasantness comes from how people with a condition are treated, it’s relevant whether they ought to be treated differently, are entitled to being treated well, etc.
            So if an alcoholic becomes violent and their family leaves them, that’s a legitimate negative consequence of alcoholism because they’re not entitled to keep their family in those circumstances, but execution isn’t a legitimate negative consequence of homosexuality because it’s wrong to execute people for homosexual acts.

            On the other hand, even though homosexuality isn’t wrong in itself, if your homosexual urges push you to engage in it even when it’s extremely risky, that could be a health problem.

          2. Kindly

            So if an alcoholic becomes violent and their family leaves them, that’s a legitimate negative consequence of alcoholism because they’re not entitled to keep their family in those circumstances, but execution isn’t a legitimate negative consequence of homosexuality because it’s wrong to execute people for homosexual acts.

            It doesn’t seem inconsistent to me to believe that an alcoholic’s family is entitled to stay with them even if they become violent, just out of touch with modern society’s values.

          3. Matt M

            The problem with that example is that the alcoholism is incidental to the real offense, which is the violence. A family is entitled to leave anyone who becomes violent. If a homosexual becomes violent, their family should leave them, too.

          4. blacktrance

            Presumably there’s a causal connection between their alcoholism and their violence, whereas a violent homosexual is just a homosexual who happens to be violent.

          5. Matt M

            But whether there is or isn’t is unrelated to the appropriate consequence.

            Families should leave abusers, whether the abuser is an alcoholic, a homosexual, both, or neither.

            Governments should execute people for mass murder, whether the mass murderer is an alcoholic, a homosexual, both, or neither.

            It’s unjust to execute non-violent homosexuals, but it’s also unjust to punish non-violent alcoholics.

          6. blacktrance

            Imagine there were a pill that temporarily made you want to commit murder. Of course, the murder is the actual problem as far as punishment goes – if you took the pill and locked yourself in your room, it’d be unjust to punish you. But if you have urges to keep taking the pill, that’s a health problem because it’s likely to cause you to behave in a way that merits punishment.

            I’m not saying we should punish alcoholics simply for being alcoholics. I’m arguing that alcoholism is a disease because it’s likely to lead to justified negative consequences that outweigh the pleasure of drinking.

          7. unreliabletags

            Interference with job or family is a DSM V criterion for Alcohol Use Disorder. The level of drunkenness that your boss or spouse will tolerate is culturally dependent too.

        2. notpeerreviewed

          I think what blacktrance is saying is that *if* alcoholism consisted only of extreme preference for alcohol, then we would not be justified in treating it as a disease. However, in actual fact alcoholism is compulsive (unfortunately I speak to this from experience) and can’t be reasonably modeled as an extreme preference. Most alcoholics do like alcohol a whole lot, but that’s a prerequisite for the condition rather than its defining feature.

  85. albertborrow

    Typos:

    But if I search hard enough, I can find a way depression depression results in slightly weaker muscle strength.

    Repeated word. There’s a slim chance this is a “the the” scenario where you’re just messing with our heads.

    We want some criteria that let us call shingles a disease, but don’t let us call “being thin but wanting to be even thinner” a disease.

    Should be “doesn’t”. (On second thought, criteria is plural. But it reads awkwardly either way.)

    1. B_Epstein

      “Criteria” is plural.

      ETA of course you edited before I posted 🙂 I honestly don’t see the awkwardness now. How would you phrase it, and could you locate the source of discomfort?

    2. Anthony

      but doesn’t let us call “being thin but wanting to be even thinner” a disease.

      Except that anorexia nervosa *is* (called) a disease.

  86. entirelyuseless

    I thought from the start of this “disagreement” that there was no disagreement to speak of. This is now more evident than ever. Bryan and Scott do not have different opinions about the facts; they have different preferences (irony intended) regarding how to speak about what are obviously the same facts, because different ways of speaking are likely to accomplish different goals.

    1. Scott Alexander Post author

      I sort of agree this is true, but I still think debate is possible here. If I can point out some logical implications of Bryan’s view that are more intolerable than him abandoning it, then I think I can change his mind, or vice versa.

  87. newstorkcity

    Something you hinted at but never really came out and said here is that one of the biggest downsides to having a mental illness (or any illness) is the negative internal experience it generates. A person with tourettes becomes uncomfortable if they don’t move. A person with OCD feels anxious if things are not orderly/clean/etc. A person with depression feels sad.

    The argument has been focused exclusively on behaviors, but even a person who wanted to keep all of their behaviors the same even on a meta level still has an incentive to want relief from their mental illness. For example someone with ADHD who doesn’t feel any desire to sit still more than they already do might not want to feel restless when they do sit still.

    I suppose one good reason to avoid bringing it up is that the only evidence for it comes from self reporting, so an extremely skeptical person might reject it, but if anything the preferences and meta-preferences of individuals seems far more prone to this problem.

    1. Scott Alexander Post author

      Thanks for the reminder. I’ve edited the post to say more clearly that Bryan is assuming behaviorism and I’m grudgingly cooperating with that assumption for the sake of argument.

      1. alphago

        Maybe I’m missing something, but I don’t see where/how in the post you added that you’re grudgingly going along with it. It seems like you now (correctly) point out the flaws in his behaviorist assumptions (e.g. people with migraines can’t choose not to feel pain), but then go on to suggest your own model which also assumes behaviorism (at least in part) without acknowledging this or explaining why. In fact, I’m still unclear why you are accepting these assumptions into your own model; but I’m guessing you think Caplan really is a hard-core behaviorist (as opposed to merely unintentionally falling into some behaviorist-style errors), and that therefore you can only convince him by assuming behaviorism?

        Anyway, for what it’s worth my own view is that the anorexia example is a fairly decisive rebuttal to this endorsed/unendorsed model, i.e. clearly they are irrational and mentally ill even if they “endorse” their dieting preferences at all times; perhaps some idealized rational version of them would not endorse (e.g. based on a proper understanding of the harms of being underweight), but your model doesn’t bring in these types of idealizations. I understand that you think there is realistically no perfect model, but this seems too large a bullet to swallow.

        Sorry if I’ve just somehow missed the clarification that you added (I didn’t reread the full article after you made the edit), just the relevant sections.

  88. Michael Watts

    I want to make a point about the argument itself, as opposed to the question being argued.

    This argument is happening in an environment which grants special legal privileges to people with “mental illness”, but oppresses people with “nonstandard preferences”.

    Preamble:

    Imagine that Bob is prone to migraines and doesn’t want to be in a big open loud room. This person will probably not enjoy working in an open plan office (in which there’s one big room, and everyone sits in it in a loud chaotic mess). So Bob gives his employer notice that under the ADA, he is entitled to a soundproofed office with a door.

    Now imagine that I, too, don’t enjoy working in a loud chaotic mess, and I, too, would like to have a soundproofed office with a door, which would pay benefits in both peace and status. I can’t have one, because Bob is… more dysfunctional than I am. This doesn’t come off as a good reason to give him free stuff.

    Suppose Maya is kind of slow, but her upper-middle-class parents interpret this as a learning disability, get an official diagnosis, and now she’s entitled to extra time taking the SAT.

    Suppose I would like to have some extra time on the SAT, but I’m too smart to qualify for that. Arguably, I could get more benefit from the extra time than Maya could — I’m smarter! Maybe her 20 extra points would be my 40 extra points. But she “has an illness”, and I “don’t”.

    Suppose further that Justin is more or less equal to me, except that his parents got him a diagnosis for a mental issue which isn’t a learning disability, but just so happens to mean that he’s entitled to extra time on the SAT. After all, he has a mental illness.

    (In fact, the design of the SAT is that it’s not intended to be a timed test — you’re meant to have all the time you need. How well this is achieved is open to debate.)

    Thrust:

    Legal privileges for subjective illness mean that you can earn benefits not by doing anything productive, but rather by shrieking loudly about how much you want them. This is not beneficial to society; an arms race in shrieking is pure loss for everyone involved, including the bystanders. In addition, the incentive structure guarantees that many claims of illness will be spurious, driven by the fact that people are paid to make the claims. It doesn’t take much of that before you see the argument “this phenomenon is just a bunch of faking” popping up everywhere.

      1. sclmlw

        I think Michael Watts is getting at what I would characterize as Bryan’s incentive for favoring this unconventional model of mental illness. Bryan’s experiences with mental illness are different from your own, and he probably chooses to endorse this model because it explains what he’s observing in terms he can understand. It’s all personal choices that get pathologized and thereby result in rent-seeking behavior.

        What you might see as ‘edge cases’ where people game a legitimate system to achieve unfair advantage, he sees as the center of the debate. Meanwhile, all you’re talking about, to Caplan, are ‘edge cases’. An example you’ve discussed before probably describes what Bryan imagines: an ordinary person who wants to be a lawyer and therefore gets diagnosed with ADHD so they can take drugs that allow them to hyper-focus on arcane texts for hours in a way people who were hunter-gatherers a few thousand years ago shouldn’t be comfortable with.

        You’ve talked before about defining this kind of case, and it’s possible that Bryan will read your linked articles and sign onto your new proposal. However, it’s more likely that because you focused mostly on mental illnesses he likely doesn’t have personal experience with (and is therefore trying to explain away instead of directly engage with) he’ll default to believing your characterizations remain tangential to what he sees as the substance of the debate.

        In other words, Bryan has an incentive to adopt his unconventional model that I don’t think you’ve directly addressed. Until you do, you’ll both be talking past each other. You’re arguing based on Mistake Theory, and I’m saying that instead of looking at it through that lens or even Conflict Theory you should – like any good economist might – look at it through the lens of Incentive Theory.

        1. Michael Watts

          This may restate much of your comment.

          There are two issues here related to Incentive Theory:

          1. The system rewards people for claiming problems they don’t have. This strengthens the argument that these problems don’t really exist. Mostly, when you look at them, they don’t. But much of that is an artifact of looking at the examples you have.

          2. As you say, the system requires Bryan Caplan to make the argument he’s making here instead of making a stronger argument. If you think special privileges for malingerers and the incapable are both bad ideas, you have to argue that the malingerers are faking, which they are, and that the incapable are capable, which they aren’t. I think everyone agrees that it’s difficult to tell the difference — this also strengthens the claim that the problems are mostly just fake.

          2. (followup) This is analogous to the point I’ve seen made in this community that medieval arguments on religion didn’t reach the level of quality they might have, because it was only legal to be on one side of those arguments.

          1. sclmlw

            My point was less about the incentives of the people within the mental health care system itself, and more about the incentives acting directly on Caplan. If Caplan finds an explanation that explains the majority of his personal experiences with mental health care (i.e. that plenty of people who are within a standard deviation of neurotypical game the system in a variety of ways) he’ll be reluctant to give up that explanation.

            You can push him out of it momentarily, but he’ll find a way to justify rejecting falsification if he doesn’t have something else that explains the phenomena he’s seeking to understand. To convince Caplan, you’d first need to acknowledge his central concern – that sometimes patients, treating professionals, and institutions coordinate to use the mental health system for/against people who might otherwise be considered neurotypical. That done, you’d want to go farther and explain how this fact doesn’t invalidate most of what psychiatrists do because that this narrow bucket only explains part of the whole.

            You would then be free to make the case Scott does above and hopefully convince Caplan of a better model. But without addressing his underlying incentives for believing in his strange theory, Caplan will likely return to it and reject any alternatives presented.

    1. anonymousskimmer

      This argument is happening in an environment which grants special legal privileges to people with “mental illness”, but oppresses people with “nonstandard preferences”.

      I don’t see the oppression here. Oppression generally isn’t application of the status quo.

      I can’t have one, because Bob is… more dysfunctional than I am. This doesn’t come off as a good reason to give him free stuff.

      “You can’t have one unless you’re as dysfunctional as Bob.” – changes the emphasis a bit. The locus of control here isn’t “Bob”, as another business could demonstrate that providing Bob a soundproof room is beyond their means, thus not an accommodation they can make, forcing Bob to put up or leave; a forced decision that you don’t have to make.

      I guess what I’m saying is: Don’t blame the people with the issues, or you might as well blame yourself, because if you try hard enough you could act crazy enough to be diagnosed with “Adjustment disorder”, if nothing else. Blame the people making and justifying the decisions, and the people not-even-faking-it who are taking advantage of it (like my father putting that stupid “service animal” vest on his blind dog, because why shouldn’t he have every privilege anyone else has?).

      In addition, the incentive structure guarantees that many claims of illness will be spurious, driven by the fact that people are paid to make the claims.

      The monetary and embarrassment incentive structures guarantees that many people who need adjustments won’t receive, or even ask, for them. And from where I’m sitting, this is the bigger issue.

      1. Michael Watts

        This is what I mean by oppression:

        Suppose you are relevantly normal. You get whatever passes for normal treatment.

        Suppose you are weird. This freaks people out. They feel funny when interacting with you; they aren’t sure they can trust you or predict what you’ll do. You get worse treatment than the normal people.

        That’s what I’m calling “oppression”. The system is set up to push people into the range of normality with a variety of rewards and punishments. That is itself normal, but it will meet whatever definition of “oppression” you like. You have a judgment that something is unacceptable and a system of punishments designed to get it to stop.

    2. Dacyn

      Arguably, I could get more benefit from the extra time than Maya could — I’m smarter! Maybe her 20 extra points would be my 40 extra points.

      That seems completely irrelevant: the point of giving Maya time is to try to make things more fair, not to increase scores. If they wanted to increase her score by 40 points, they could just give her even more extra time. Increasing scores is pointless from an outsider’s perspective anyway, since it will just result in grade inflation.

      1. Simon_Jester

        In real life, Maya generally has to demonstrate that she can actually perform well if given more time, and that it is *specifically the time* that stops her from performing on the test.

        This is relevant because a timed test where students run out of time is not necessarily a good predictor of the student’s future performance… and insofar as SAT scores are relevant, that is what they are relevant to.

        Furthermore, there has to be some credible causal chain. “A bit slow” is not enough; there has to be demonstrable slowness in a specific area that the extra time can address- for example, dyslexia causing it to take longer for a person to be sure they’ve read a problem correctly. If you want an accurate measurement of the functional intelligence and competence of a dyslexic person, you do not give them a timed speed-reading test. That would be folly.

        1. gleamingecho

          What’s the logical argument for why [Andy can’t do X as fast as Bob] is categorically different from [Andy can’t do X as well as Bob] such that a deficiency in the first area requires intervention while a deficiency in the other area does not?

          1. omegastick

            The SAT isn’t meant to be a measure of how well you do under time pressure. The idea is that you have all the time you need. Some people need more time than others, so they should get it.

          2. Matt M

            The SAT isn’t meant to be a measure of how well you do under time pressure.

            Then why have a time limit at all? Why not give everyone all day?

          3. Doctor Mist

            The SAT isn’t meant to be a measure of how well you do under time pressure.

            This is a new one on me. Fifty years ago it was well-understood that it was important to strategize your use of time: For instance, don’t get hung up on a problem you don’t see the answer to; skip it and come back to it later. Give yourself a budget for the various sections so that you aren’t rushed to finish a section that you might be very good at. Etc.

          4. mtl1882

            Managing time is a component of the SAT, so I disagree with some posters that it is irrelevant, but the purpose of the SAT is to figure out one’s ability to solve logic problems that are deemed relevant to intellectual talent. There *are* some people for whom an extra hour makes the difference between a 750 and a 450 on the reading, for example. There’s no reason this has to be accommodated, but there are good reasons why we might want to do so. Here’s someone who with a little extra time shows strong reading skills, who otherwise would come across as functionally illiterate. That isn’t a useful signal for anyone involved. If college and future work were intensely time-sensitive, then it would be a different story. But that student may well perform much better than someone who gets a 600 with regular time, being willing to put in the extra time and effort needed to pull it off. As someone who does everything super fast, my best friend got extra time, and I knew people who resented it, but I never really did because I could see it made no sense for someone so capable to have a record that made her look incapable because she needed a bit more time. I think that is different from a deficiency unrelated to time because I remember being in math class, which was her strength in my weakness, taking a test. I could have sat there for 5 more hours and would not have made any progress, because I didn’t understand the material. Meanwhile, an extra half hour meant the difference between a C and an A for her.

            Where someone needs 6 extra hours to pull it off, that is more of an issue. Or if we were dealing with Olympic runners, where the time is as much a component of performance as distance run. The time management issue can be related to the way the person naturally processes information, but it can also be related to other factors, such as anxiety. Whether or not someone can manage the anxiety caused by taking a timed test has some level of importance, and as someone who works with kids on standardized tests, I wish more parents would see the anxiety as a good thing to address instead of declaring the student has test anxiety and needs extra time and leaving it there. Not because I think this is a character flaw or malingering, but exactly because it is common and natural and they would be better off in the future if they addressed it directly. (I know lifelong severe anxiety is a thing and am not saying it is an easy thing to fix, just that for some people, considerable improvement is possible).

            The military colleges alone usually request regular-time scores from kids who qualify for extra time. They are selecting for a different set of qualities than most other schools are. These controversies result mainly from disagreements over the purpose of exams and discrepancies between what is being selected for and what is actually required or expected, which is more and more of an issue as we make a college degree a basic requirement for jobs.

        2. NoRandomWalk

          The claim is that the thing the test measures is not what we care about.
          For example, let’s say we care about ‘once you understand X, how long does it take you to conclude Y’. So, we make a test where we write down X, and we ask students to write down the answer, and then see if it matches Y. This is a good test if everyone takes as long to read and understand X. If this is not the case, we figure out who takes longer to read and understand X, and give them more time, so they have on average as much time left over to spend on the ‘figure out Y from X’ part.

          1. Matt M

            As an extreme example, I used to play a trivia game on IRC where I did quite well. When I told friends and family about it, they concluded I was really smart.

            Except in reality, the total set of questions was quite small and pretty much everyone who played on a regular basis had them all essentially memorized. But the points were awarded to whoever answered first. It was basically a typing speed contest. (As another extreme case, some questions were even trivially obvious – like “What color is a red crayon?”)

            My understanding is that the TV show Jeopardy is a bit similar. Anyone good enough to be on the show operates a strategy of “buzz in for basically every question, assuming you know the answer” and the winners aren’t necessarily the people who know the most things, but rather the people who are really good at buzzing in first.

        3. Michael Watts

          In real life, Maya generally has to demonstrate that she can actually perform well if given more time, and that it is *specifically the time* that stops her from performing on the test.

          For reference, if you’re talking about time extensions on the SAT, this is 100% untrue. An Asperger’s diagnosis will get you an extension, because it’s an official piece of paper and for no other reason.

          (Possibly because Asperger’s is considered a social learning disability, but you’ll note that whatever Asperger’s patients are failing to learn, it is no part of the SAT.)

          1. Simon_Jester

            https://accommodations.collegeboard.org/documentation-guidelines/autism-spectrum-disorders

            “Provide relevant educational, developmental, and medical history in support of the diagnosis of autism spectrum disorder and the functional limitation. Information about the student’s history of receiving school accommodations and current use of accommodations helps the College Board understand the nature and severity of the student’s disability and the need for accommodations. Teacher observations are often helpful as well; they may be recorded on the Teacher Survey Form (.pdf/240KB)”

            “A medical note is not sufficient evidence to support the need for accommodations. Documentation should demonstrate that a comprehensive assessment was conducted and include the following:

            -A summary of current symptomatology, treatment, and ongoing needs.
            -A narrative summary of evaluation results with clear evidence of clinically significant impairment in the academic setting.
            -Comprehensive cognitive and academic testing (particularly when requesting extended time). Common Diagnostic Tests list frequently used tests.”

            “It’s not enough to say that a student has an autism spectrum disorder; documentation must show why the student needs the requested accommodations. Most College Board exams are written tests administered in a quiet, structured environment. Some students who receive accommodations in school may not require accommodations on College Board tests.”

            If the College Board is following its own policies, an Asperger’s diagnosis will not get you an extension in and of itself unless you can demonstrate how your specific Asperger’s case will impact your ability to take a timed test in a way they should make allowances for.

      2. Michael Watts

        That seems completely irrelevant: the point of giving Maya time is to try to make things more fair, not to increase scores.

        That depends on your perspective. One of the arguments for giving Bob the office is that the gain to his personal productivity, and therefore also the gain to our employer, is greater than either gain would be if I got the office instead. That isn’t the case for Maya; she’s being given something she can’t use.

        1. Dacyn

          It doesn’t look like we actually disagree. There is a reason to prefer smarter people to get higher scores: not that they “benefit more” from it in the sense of numerical scores, but that society benefits when employers can hire more productive workers.

    3. albatross11

      I suspect we’re stuck with an imperfect tradeoff here–a pure level playing field will utterly exclude some people (sorry, you can’t have an audio or braille interface to take the SAT, even though you’re blind), but special accomodations can give you an unfair advantage (I get to take the calculus exam with my laptop running Sage in front of me, to make up for my difficulties with math). The best we can do is to try to make reasonable tradeoffs between inclusion of people with special needs and fairness.

      1. omegastick

        They key is in making sure the test actually tests what we want it to. In the SAT, you want to estimate people’s reading, writing, and maths skills. By refusing to accommodate blind people, you are disqualifying them not because of their sub-par reading, writing, or maths, but because of their eyesight.

        The time extension is given to Maya because the SAT doesn’t intend to estimate performance under time pressure. As such she needs something an allowance to make her time pressure equal to yours.

        1. uau

          The time extension is given to Maya because the SAT doesn’t intend to estimate performance under time pressure.

          If the test really isn’t meant to test time pressure, then it should just allow everyone lots of time. It’s unlikely that the extensions given on basis of “disabilities” are really calibrated to match exactly how much slower they are anyway.

          If speed is a particular issue for some people, but you still want a time limit for the “standard” test, then the fairest I can think of would be to allow anyone to freely take extra time, but with the limitation that anywhere you use your result you have to explicitly say that it’s a “slow-SAT” score instead of a standard one.

        2. Aapje

          @omegastick

          SAT doesn’t intend to estimate performance under time pressure.

          It’s explicitly recognized that time pressure plays a role, by giving people with certain diagnoses more time.

          A test tests what it tests, regardless of what it is supposedly intended to test.

          By refusing to accommodate blind people, you are disqualifying them not because of their sub-par reading, writing, or maths, but because of their eyesight.

          Poor eyesight produces sub-par reading and writing ability. If it didn’t, blind people wouldn’t need accommodations.

          1. Simon_Jester

            You are conflating “ability to comprehend text” with “ability to perceive text.”

            If I drop you on a planet of Martians who can see near-infrared light and give you a standardized test written in invisible ink that they can see and you can’t, then when you fail the (apparently blank) test, I haven’t tested your ability to comprehend text. I’ve tested your ability to see near-infrared light.

            This is relevant if everyone is being expected to do exactly the same jobs, and so being unable to see near-infrared light disqualifies you from doing the jobs they do.

            It is NOT relevant if people may be considering hiring you to do other jobs, AND, aware that you cannot see near-infrared light, still want to know “so how well will this person perform on a test that uses light between 450 nm and 700 nm?” The question “what is this person’s performance when we compensate for their disadvantage” may be very relevant.

          2. Aapje

            You are conflating “ability to comprehend text” with “ability to perceive text.”

            Because they are related in real life. Employers expect employees to use computers with monitors, to read paper, to be able to navigate the office based on visual clues, etc.

            This is relevant if everyone is being expected to do exactly the same jobs, and so being unable to see near-infrared light disqualifies you from doing the jobs they do.

            Exactly. If they by default use near-infrared monitors, ink, etc; then the ability to see near-infrared light is crucial to be able to function without special accommodations.

            It is NOT relevant if people may be considering hiring you to do other jobs, AND, aware that you cannot see near-infrared light, still want to know “so how well will this person perform on a test that uses light between 450 nm and 700 nm?”

            True, but employees are not expected to supply information about their disabilities with their job application, so they can be filtered out fairly fast if they can’t do the job. In fact, AFAIK this is illegal for the employer to ask.

            So while giving a diploma to people with a severe disability increases the pool of applicants who can do the job for some jobs, it adds more unsuitable applicants for other jobs, increasing the burden for employers. Even for the jobs that the handicapped person can technically do, the cost/burden of the special accommodations may be so high that the person prices themselves out of contention.

            The current ‘official’ stance is that no matter how much of a burden/cost the special accommodations are, or whether there are non-central parts of the job that the person can’t do, the handicapped person should be hired if they can do the central part of the job with special accommodations, without the cost of these special accommodations reducing the pay check.

            It’s not surprising that this results in very many disabled people mysteriously not being hired. So if the goal is to use these people’s talents, it doesn’t seem like a smart approach.

      2. Aapje

        Ultimately, we have a set of jobs that is really varied, as well as a set of people that is varied as well. Yet the cost of individually evaluating each person for each job is absurdly high. Since IQ and perseverance is important for many jobs and in particular the jobs that are most important, we mostly test for these.

        This can be considered unfair to everyone who does worse on the tests than on the jobs that use the tests for gatekeeping, but I think that this is for a large part unavoidable.

        It can also be considered unfair to people who can perform much better with certain accommodations, like blind people, although making special accommodations during schooling increases the costs for employers to filter out applicants (give that people with a disability are less often able to do a job) and these people are more expensive to employ unless their salary is reduced as much as the workplace accommodations cost.

        The employment rate of blind people is less than half than that of non-blind people (although blindness probably correlates with other disabilities), suggesting that lack of vision is a severe detriment in the working place. So a blind person with a diploma may put a relatively high burden on employers during the search for an employee.

        Anyway, our society seems unable to have a rational discussion about this, where instead, the debate largely centers around whether high-IQ and high-perseverance disabled people being entitled to things (that low IQ and/or low perseverance people are not entitled to).

        1. Matt M

          Yeah, I am highly skeptical of the notion that there are any particularly valuable economic pursuits in which “time pressure” is completely and entirely irrelevant.

          Even in jobs in which there aren’t frequent time constraints or quick deadlines, jobs where accuracy is significantly more important than speed, all else equal, you’d still prefer someone do the job accurately and quickly rather than accurately and slowly.

          That’s what labor “productivity” is really. Output per unit of time. What employer would want a less productive employee?

          1. albatross11

            Sure, but there are definitely huge differences in how much you need to be quick rather than thorough. A surgeon needs to be able to think well on his feet; a mathematician can just go back to his office and spend a couple weeks on the problem.

          2. Matt M

            OK. But if you’re Harvard or MIT, and your intent is to hire the best mathematicians in the world, and they’re all willing to work for you, wouldn’t you pick the guy who can go back to his office and figure things out in a day, rather than the one who needs a couple weeks?

            My point here is that yes, there are obviously some professions in which speed is more important than it is in other professions. But I struggle to think of a single profession in which speed is completely irrelevant.

          3. Simon_Jester

            Most employers aren’t Harvard and should be using a “satisfice” approach, not a “keep searching until we find the best” approach.

            There are other ways to determine whether an employee is very productive, and the SAT cannot be turned into a good metric of whether an employee at a difficult job will be highly productive in and of itself. Harvard doesn’t hire its mathematics professors based purely on standardized test scores; it hires them based on their C.V., for instance.

            Measuring how an employee performs under deadline pressure in general might be useful, but the SAT is a very special case of deadline pressure (large number of individually small/simple tasks, switching tasks about every hour or so, low overall number of hours available to work, little opportunity to offset slow performance through long-range planning, preparation, and workflow optimization).

            The point being, employees want more productive employees per unit time, but no one’s interest are being served if the skills and potential productivity of a prospective employee are being artificially deprecated by a miscalibrated test.

    4. Bugmaster

      Imagine that Bob is prone to migraines and doesn’t want to be in a big open loud room… I can’t have one, because Bob is… more dysfunctional than I am. This doesn’t come off as a good reason to give him free stuff.

      I think that, for this example at least, the conclusion doesn’t follow. In this specific case, none of the stuff is really “free”. Instead, the parent corporation/society/government/whatever is implicitly making a cost/benefit analysis. They want to get as much productivity out of their employees as possible, where “productivity” is roughly “productive output minus expenses”.

      Let’s say that an office with a door costs 20 abstract units. If Bob can produce 100 units of work under ideal conditions, but can only produce 3 units in an open floor plan, then by giving him an office we end up with 80 total units — not a bad deal. If you can produce 100 units of work under ideal conditions, but only 90 units in an open environment, then giving you that office with a door still doesn’t make sense. Similarly, if Bob can produce 1,000 units of work under ideal conditions, then it might be totally worthwhile to give him an office, a secretary, a private espresso machine, free massage twice a day, or whatever else he asks for.

      1. Matt M

        That’s what would happen in a hypothetical free market.

        In real life, the employer hires Bob, Bob declares he has a medical condition, and the employer either fires him immediately in hopes he won’t complain, or they give him whatever he demands out of a fear of being sued.

        Meanwhile all the non-Bobs who ask for similar such accommodations are told to pound sand. Regardless of how much more productive it may or may not make them.

        Literally nobody is doing a cost-benefit analysis of office space and productivity on an individualized basis.

        1. Bugmaster

          I think your counter-scenario doesn’t really contradict my point; the only difference is that we need to expand our metrics of “productivity” and “cost” from only “monetary gain to a specific corporation” to “total utility gains and losses in society”. You can absolutely assert that society places too much value on accommodating sick people, but then we’re getting into a factual argument where both sides would need to offer evidence for their positions. Therefore, I think that presenting the argument in terms of cost/benefit analysis is more helpful than appealing strictly to emotions or fairness or what have you. That said:

          Literally nobody is doing a cost-benefit analysis of office space and productivity on an individualized basis.

          That’s not true in the corporate world. Valuable employees get special perks all the time, on a purely individual basis. Admittedly, people oftentimes get perks just because they’re someone’s nephew, as well.

          1. Matt M

            Valuable employees get special perks all the time, on a purely individual basis.

            Sure they do. But not because managers routinely whip out excel and build a model that measures productivity per square foot of office space (adjusting for confounders such as potential psychological conditions) for any individual employee asking for a bigger office.

            They just intuitively ask themselves “Is the risk that this person isn’t bluffing and will quit over this worth the extra expense of giving them what they want?”

          2. Bugmaster

            @Matt M:
            I think it depends on your organization. I’ve worked at companies where management literally “whipped out excel and build a model that measures productivity” — not necessarily “per square foot of office space”, specifically, but based on multiple metrics. They didn’t do this on-demand for each individual employee; rather, if an employee came in and asked for more perks, the up-to-date spreadsheet would tell the management which levels of perks were justified. The “best” people got offices, the rest got open floor plans.

            Of course, spreadsheet or no spreadsheet, being someone’s nephew always helps, as I said above…

    5. Confusion

      Not increasing the productivity of the mentally ill or reducing their drag on others isn’t beneficial to society either. If some people at the margin want to engage in an arms race in shrieking, that’s less costly than not helping the bulk that can’t help shrieking.

      I’d like some Adderall too, but I’m not going to throw anyone under the bus to get it. And neither should Caplan.

      The bottom line problem here is status culture. If you don’t care about status, you don’t envy those at the margin who had the luck of winning a particular lottery and you won’t make arguments that would result in those that have already lost a whole a bunch of lotteries losing the few things we give them to make their life a bit better.

    6. wiserd

      “Arguably, I could get more benefit from the extra time than Maya could — I’m smarter! Maybe her 20 extra points would be my 40 extra points. But she “has an illness”, and I “don’t”.”

      This raises the question of what why the test is timed in the first place. If speed-of-response is part of what’s explicitly being tested for then I agree with your position. However if the test is timed for the expense and convenience of those proctoring the test and setting a time limit is designed to reduce their burden since proctoring a large number of test-takers is more difficult than proctoring a small number then extra time might be appropriate.

      If we’re discussing treating ADD with amphetamines then sure, you might also benefit from access to amphetamines even more than someone with ADD. (And while I’d support you getting them if you wanted them I recognize that this would also lead to a kind of race to the bottom in terms of work expectations.) Society has some interest in seeing that people are minimally competent and self sufficient. It has an interest in preventing harms related to drug use. I don’t want to give too much validity to what ‘society needs.’ I’m simply trying to model its interests.

      Getting someone to the point where they are minimally competent means they’re less of a burden on society. You’re not going to be a burden on society in either case. And maybe you’re less likely to be a burden, on average, if your access to certain drugs is restricted.

      I’m not saying that this is an ideal set of motivations and people with different value systems will prefer different methods. But I could understand it being the kind of model that people work off of.

      1. Aapje

        I don’t think that intent matters very much, because the people using the outcome of the test don’t look that much at intent, but make decisions based on the kind of people that pass the test.

        If the test is long enough so (practically) no one would get a higher score when given more time, then the test is not or minimally testing speed. The more people would get a higher score when given more time, the more timed the test is and the more the people who pass are selected for a timed performance.

      1. Godbluff

        It means that his preferences are to eat popcorn and drink champagne, but his meta preferences are not liking either popcorn or champagne.

        1. drunkfish

          Sounds like it’s time to uncork some CRISPR and microwave a bag of therapy, we can solve this.

  89. Sniffnoy

    This is a good post, but I’m skeptical that bringing in meta-preferences is the right way to go about resolving this. I think one has to acknowledge that in cases like the ones you discuss, the unified notion of “preference” that would apply to an idealized agent breaks down. Wanting, liking, endorsing are three different things; even just wanting and liking are different things. So, one doesn’t have preferences over preferences, but rather various systems that simulate preferences to a greater or lesser extent. Or, as I think you pretty well describe, one has (preference-like-things-of-one-type) over (preference-like-things-over-another-type), but they’re not quite preferences and meta-preferences, just preference-like-things and preference-like-things-of-a-different-type-over-those-preference-like-things.

    1. Scott Alexander Post author

      I agree, but I don’t have a great model of exactly what was going on, and I worry that one of the things that made my last response unconvincing to Bryan was failure to model it in terms that connected with the way he thought of it, so I’m going to settle for what I’ve got here.

      1. Ketil

        I like the terms “urges” and “goals”, even if they (like all categorization) don’t fit 100%. One weakness with the dichotomy is that you are forced to say that Bryan with the flu has an “urge” to not lift as much as he usually “urges”. The point about bench-press is not that it is something very important in itself, but as an existence proof that there are actual physical limitations. I don’t think it is about infinite amounts of dopamine. (Or maybe not – perhaps if, in addition to the gun to the head, also threaten to

        Another point is that how we define goals, urges, and constraints in themselves affect their values. Defining psychiatric illnesses as “mere” urges devalues them in comparison to physical illnesses, and thus there is less dopamine associated with having them, which again affects the cost/benefit analysis of the lamprey-brain dopamine auction. And conversely, ascribing physical causes increases their desirability (so CFD is caused by some virus, obesity by metabolic syndromes, and now OCD is due to bacterial infection). I wonder if this affects incidence – do more people get CFD in the period between when a new cause is proposed and its rejection?

      2. toobes

        I actually think the way you brought in meta preferences is exactly right. It seems Caplan used an over-simplified version of decision making that doesn’t match the domain he’s trying to model (mental illness) well at all.

        Also, if Kaplan believes external incentives (such as a gun to the head) can change behavior, why can’t drugs change one’s incentives internally?

        1. toobes

          It’s almost as if without any model of a mental process Caplan might get mental illness wrong. Sure you can treat human behavior as a black box controlled by preferences and might gain some insights from that. But we all know there’s something worth modeling going on in there.

    2. Murphy

      I have preferences about preferences.

      It doesn’t sound unreasonable to me. If I lived in a scifi post-human world and had the option to make it so I enjoyed vegetables and exercise as much as I enjoy cake and curling up in a blanket then I would take that option. Further I would pay money to have that control over my own preferences.

      I also have preferences about my future preferences. I know I still won’t feel like doing that boring task tomorrow but I know it needs to be done so I might try to take the edge off by going to be early tonight. (ok haha)

      Also, re: “choose a gunshot to the head”, a colleague is working on cluster headache (aka “suicide headaches” ) patients and holy shit that condition is terrifying. Put a gun to a cluster headache patients head and threaten them with death if they don’t stop screaming and they’re liable to rip the gun out of your hands to use it on themselves faster.

    3. desipis

      Wanting, liking, endorsing are three different things;

      I feel like trying to categories and label “preferences” isn’t the way to go. To me the issue isn’t about preferences, it’s about cognitive dissonance related to action. Such a mental state is undesirable for individuals, and may be undesirable for society as a whole. How we choose to help individuals overcome their cognitive dissonance is a policy decision that has value judgements separate from the preferences of that individual.

      In general, I would expect society to provide support that helps behaviour driven by higher level cognition over that driven by lower level base desires, and support long term desires over short term ones. There could be exceptions to this, such where we might choose to support the base desire to eat over the socially driven desire to be skinny, on the basis that the former actually results in outcomes preferable to society.

      1. Simon_Jester

        The problem with this approach is that there are times when you get very bad outcomes from leaving it to society to legislate which desires are and are not supported. And for that matter which desires are “higher level” versus “base.”

        Human beings are very good at falling into the trap of thinking “My needs are only reasonable; your needs are a consequence of your lack of self-control.” And “My actions are rational; your actions are a product of base animalistic urges.”

        For examples of this, see attitudes towards human sexuality in Ancient Greece, medieval Western Europe, Edwardian England, and the modern Anglosphere. Notions of which kinds of sexuality are ‘base’ and which are ‘refined,’ who is giving into unwanted urges and who is doing the right and proper thing, and what people should do about it, have evolved dramatically.

        Sometimes it is necessary for society to legislate which desires are acceptable or unacceptable, but for many parts of human behavior, it isn’t a good thing to put all the power in the hands of society.

        1. albatross11

          Don’t we usually legislate about actions, rather than desires. Wanting to strangle your boss isn’t a crime, but if you actually do it, the police are going to want a word with you….

          1. Simon_Jester

            I am using ‘legislate’ in a broad sense, including concepts like ‘moral law.’ The laws of society, as observed by the culture, not just the laws of government, as enforced by the police and courts.

            What I’m getting at is that society passes judgment on whether a particular desire is reasonable or unreasonable, base or refined, depending on a lot of factors. And it may not always be a good idea to think that our instinctive hierarchy of which desires are ‘base’ and which are ‘refined’ is correct.

        2. desipis

          Human beings are very good at falling into the trap of thinking “My needs are only reasonable; your needs are a consequence of your lack of self-control.” And “My actions are rational; your actions are a product of base animalistic urges.”

          Sure, which is why we should rely on evidence from cognitive and neuro sciences about the issue and not simply people’s opinion.

          Sometimes it is necessary for society to legislate which desires are acceptable or unacceptable

          It’s not about taking away freedom or forcibly preventing certain desires, but rather about helping individuals who are internally conflicted and voluntarily seeking help to resolve those conflicts.

          Consider an analogy to international law. If another country has an internal policy or government structure we (our country) doesn’t approve of, there’s not a strong justification to intervene. If however that other country is in the midst of a civil war between an isolationist dictator factor and a democratic faction that’s asking for assistance, we could justifiably intervene and support the democratic faction. There is a value judgement to intervene in favour of the democratic faction and not to intervene in favour of the dictator faction. There are also rare cases where it might be justifiable to unilaterally intervene, such as the case of a lawless failed state or a genocidal regime.

          1. Simon_Jester

            Sure, which is why we should rely on evidence from cognitive and neuro sciences about the issue and not simply people’s opinion.

            Except that this sort of begs the question.

            I’m not sure cognitive and neuro sciences reliably support a framework where we identify some desires as “base” and other desires as “refined.” That is, indeed, the main reason I’m calling such a framework into question.

          2. wonderer

            If another country has an internal policy or government structure we (our country) doesn’t approve of, there’s not a strong justification to intervene. If however that other country is in the midst of a civil war between an isolationist dictator factor and a democratic faction that’s asking for assistance, we could justifiably intervene and support the democratic faction

            That’s literally how every single CIA-sponsored coup goes. There are competing factions within the country; both seek external help wherever they can (because why wouldn’t they?); the faction that seeks US help gets it if its victory sufficiently benefits US interests. The faction isn’t always democratic, but in the Cold War it was usually anti-communist–which, given the history of communist regimes, is even more important.

            This is also how Rome conquered an empire. When you’re the superpower, every little city state and petty kingdom within a thousand miles wants your help on every little issue. In the First Punic War, a group of Italian mercenaries called the Mamertines butchered the leadership of Messana (in Sicily, across the strait from Italy) and took over. The Mamertines asked for Carthaginian protection, which was granted, and the Carthaginians stationed a garrison in the city. Eventually, the Mamertines, probably the most fickle rulers in history, got tired of the Carthaginians and asked the Romans to kick out the Carthaginians. The Romans, wanting to check Carthaginian power in Sicily (which was by this point on their doorstep), agreed to help. Rome’s eventual victory over Carthage gave them their first overseas province: Sicily. The Second Punic War started because Rome had an ally in eastern Spain called Saguntum. Saguntum wanted Rome as an ally because Carthage was expanding into Spain and Saguntum didn’t want to be next; Rome wanted Saguntum as an ally to check Carthaginian expansion. Hannibal attacked Saguntum, captured it, and put all adults to death. (This was unusually harsh even by ancient standards: usually the women would be sold into slavery.). Rome then declared war on Carthage. Its eventual victory is how it got the provinces of Outer Spain and Inner Spain.

            The point of all this is that saying intervention is acceptable if one faction invites us in justifies virtually all intervention. There is always a faction willing to invite us in.

          3. Simon_Jester

            @wonderer

            The faction isn’t always democratic, but in the Cold War it was usually anti-communist–which, given the history of communist regimes, is even more important.

            It occurs to me that this may involve a chicken and egg paradox.

            If every country in which socialists attempt to take power sees violent and vigorous resistance in the form of “we will kill you for trying to form a socialist government,” that exerts Darwinian pressure on socialist movements as they attempt to become governments.

            Thus, in the relevant parts of the world, the only socialist movements that survive to create a socialist government will be the ones that are very good at killing their enemies before said enemies get a chance to kill them.

            And moreover, future socialists who wish to avoid failure (or being killed) will tend to mimic past socialists that succeeded under similar circumstances. So as long as the threat of “death for starting a socialist government” persists, socialists will tend to display elevated levels of violence. And those who do not, correspondingly, will tend to fail- often bloodily.

            Radicalization sucks.

    1. Simon_Jester

      My personal opinion is that for most people with a functioning moral center…

      It doesn’t take much experience with mental illness, before one becomes very impatient, angry even, with the notion “mentally ill people just have preferences for doing self-destructive things, news at eleven, let ’em.”

      1. bobbert

        >let ’em

        I don’t think that Bryan Caplan would argue that we should just “let ’em” keep living with their harmful preferences.

        I remain unconvinced that Scott has put an end to this debate. I think that the reason this argument has not reached a conclusion is this:

        -Both sides of this argument generally agree that human behavior is deterministic, to an extent.
        -Given that human behavior is deterministic, the difference between a preference and a constraint is as follows:
        -Preferences are determined by a person’s prior value judgements of outcomes associated with a decision. For any given decision, you will choose the option you most prefer, no questions asked.
        -For a mental illness to be a constraint, it must be an imposition upon your mind that significantly deviates your typical course of behavior from that which is generally seen as healthy. It constrains you from acting in either 1) the way that people think you would want to act or 2) the way your meta-preference prefers.
        -To Scott’s argument: Calling a mental illness a preference is seen as too moralizing. Because it expresses a poor choice as a preference, it stinks of “let them eat cake- they obviously want to make these terrible decisions.” This stink is too stinky for Scott’s taste, and is why he is averse to the argument.
        -To Bryan’s argument: Calling a mental illness a preference accurately and mechanistically explains why why a brain with particular existing value judgements would choose an outcome that doesn’t match its meta-preferences. Bryan makes sure to contextualize his argument in a way that does not excessively moralize the chooser.
        -As an individual that experiences tension between my impulses and meta-preferences every day, i can empathize with Bryan’s formulation. It can also provide a good formulation for sitting down and reflection on your own choices throughout the day. Are my daily choices compromising my meta-preferences/ long term goals? To the degree that this is true, I’m harming myself, and marginally mentally ill.
        -Using the term meta-preferences is a workaround to avoiding bringing in “preferences that are dependent on your long-term ability to modify your own preferences.” It’s a somewhat silly distinction.

        I generally agree with Caplan on this one. The bounds of the argument are essentially determined by what we think is healthy.

        1. Simon_Jester

          The problem is that this seems to provide a very bad model for sever mental illness.

          By the standard you describe, “I’m keep neglecting to go take my car in for an oil change” is ‘mildly mentally ill’ in that it involves a revealed preference that contradicts your goal of having a well-maintained car.

          But I’m not sure there’s a smooth continuum between that kind of conflict between ‘goals’ and ‘urges,’ and the kind of conflict that exists in a person with severe depression.

          Furthermore, even if there is, then how does the Caplan analysis cash out in practice? What, specifically, ought we do differently if our model of mental illness is “people who have so-called mental illnesses actually just have counterproductive preferences?”

          Either we accept that here should be a psychiatric profession dedicated to helping them get their preferences into alignment, or we don’t. If we do, then how is the Caplan model different in practice from Scott’s model? What differing predictions or prescriptions does it make?

          And if we don’t, then when the Caplan model is extended to physical illness we find ourselves having to dismiss large parts of physical medical practice too, not just psychiatric mental practice.

          1. acymetric

            By the standard you describe, “I’m keep neglecting to go take my car in for an oil change” is ‘mildly mentally ill’ in that it involves a revealed preference that contradicts your goal of having a well-maintained car.

            I’ll be honest, I’m not sure I see where Scott’s position solves this better other than establishing by fiat “of course that isn’t mental illness”.

          2. Big Jay

            What about mental illnesses that do not fit the urges/goals model? What could Caplan say about, e.g.:
            -Adam, who suffered head trauma in Vietnam in 1971. He has anterograde amnesia. He still believes he is a 19 year old Marine. If asked who the President is, he confidently replies “Richard Nixon”. He forgets new information within a minute. Hospital staff keep him away from mirrors.
            -Beth, who is five years old with Williams syndrome and is neurologically incapable of distrusting others. She has a strong preference for avoiding violent situations and would not deliberately accept a risk of harm. However, she is incapable of recognizing many risks. If you tell her you have candy, she will cheerfully get in your van. No amount of education will enable her to understand that strangers can’t be trusted.

          3. Simon_Jester

            @acymetric

            I’ll be honest, I’m not sure I see where Scott’s position solves this better other than establishing by fiat “of course that isn’t mental illness”.

            Scott’s position and Caplan’s position produce similar predictions and solutions in the ‘shallow end,’ when we’re talking about people who seem to have mostly functional decision-making biomachinery.

            They produce sharply different predictions and solutions in the ‘deep end,’ when we’re talking about people whose biomachinery has been knocked badly out of alignment by some accident, chemical imbalance, major trauma, or circumstance of birth.

            Treating human decision-makers as black boxes that make decisions in response to preferences, and saying “I guess some humans just have counterproductive preferences” only works as long as we can assume that there is no serious doubt about whether the inside of a given human’s black box is working correctly.

            Once that assumption breaks down, any model that is based purely on ‘black box’ analysis will also break down.

          4. anonymousskimmer

            Either we accept that here should be a psychiatric profession dedicated to helping them get their preferences into alignment, or we don’t.

            What if its the preferences of everyone else that’s screwed?

            Why pillory people per their preferences when everyone else around them (including, most especially, gatekeepers) are enforcing their own preferences as gates?

            For those who fit relatively well into the gates of society it’s easier to demonize or therapeutize the others (or “kill all others“, even 🙂 ) than it is to broaden their own habits. Psychiatry is more convenient than sociatry.

            In the realm of ideas there’s a world in which Bryan Caplan would be barely functional.

          5. Simon_Jester

            @anonymousskimmer

            The problem is, it’s easy to say “why should we enforce standards just for the sake of convenience.” But if you make running a society inconvenient enough, it collapses. Logistics doesn’t go away.

            So when you look at a relatively practical question like ‘how do we actually organize society to accommodate people with severe anxiety,’ the answers aren’t simple.

            If everyone just does their own thing while being a basically nice person, the people with anxiety disorders gradually become super-anxious and unproductive and miserable because of their own struggles to participate in society.

            If everyone constantly labors to assuage and care for the very anxious people, then the anxious people are happier, but everyone else is working that much harder, surplus resources of time, emotional labor, and physical material become scarcer, and if you keep doing this long enough for everyone society as a whole starts to break down.

            If you give the anxious people a pill full of psychoactive anti-anxiety chemicals, somehow magically their outlook on life improves and they get the same amount of happiness, without being harmed themselves, and for vastly less expenditure of stress and effort on the part of others (including people who are bad at the relevant labor and unduly burdened by it).

        2. teageegeepea

          Caplan is actually a big believer in free-will rather than determinism. And not just in the sense that he defines things differently, but has actually suggested that some unexplained residuals are the result of free-will.

          1. Akhorahil

            This seems important. My understanding of Caplan (purely from reading here) is that he thinks we have preferences, but can decide to overcome them with free will/willpower. Scott, meanwhile, thinks we will simply go with the strongest preference, and if we overcome one, that just proves we had another, stronger preference.

            Hence, Caplan would (under this interpretation) say that if something creates an undesirable preference, you just need to pull yourself together and decide to not do it anyway in order to get a proper outcome, while Scott would say that since you now have this preference, it’s simply how you will act (barring some other stronger preference).

          2. teageegeepea

            Funny that Scott would then be like the stereotypical economist focusing on “revealed preference” while Caplan is emphasizing an internal process of willpower overcoming that. Of course, Caplan has always been a big believer in introspection over behaviorism…

          3. Simon_Jester

            That raises the question- what, exactly, does it mean to say that I have ‘willpower’ that can direct me to do something other than my ‘preferences?’

            In one informal sense of the words, it makes sense- I have natural inclinations and biases, and I can willpower myself into overriding them if I think there’s a reason.

            But if we unpack what ‘preference’ means a little, it starts looking weird. How do I even know what I’m supposed to willpower myself into doing, without in some sense ‘preferring’ the thing I’m going to target? If we choose to model all our unconscious, unpurposed, in-the-absence-of-willpower default actions as reflecting our preferences, how can we not model our purposeful, will-powered actions as reflecting our preferences as well?

        3. rin573

          Preferences are determined by a person’s prior value judgements of outcomes associated with a decision. For any given decision, you will choose the option you most prefer, no questions asked

          Maybe you’re right that both authors agree with these statements, but if so I think it’s a pretty major conceptual flaw. If we’re working in a revealed preference framework, where “preference” is literally defined by what a person chooses, the statement “you will choose the option you most prefer” is true but circular. If we’re using a more intuitive definition that assumes some internal value or emotion, it seems to overlook the fact that decision-making systems will not always operate perfectly. Systems that compute information about possible outcomes, calculate the values associated with those outcomes in the current context, and compare those values to make a choice can all be fallible, and can be damaged or systematically disturbed in various ways.

          I’m not sure how Caplan’s argument squares with the fact that decision-making systems themselves can be damaged/disordered. Perhaps he considers it irrelevant or distracting, since it leads back to the challenge of determining what counts as disordered, but I think it’s quite important to address. In particular, without knowing how value assignment and decision-making work (and whether they’re altered in certain psychiatric conditions), focusing primarily on incentives is likely to miss important factors that lead to the observed “unusual preferences” – is it how they are identifying relevant choice options in the first place? how they are predicting outcomes? what the outcomes are subjectively like for them? how many factors they can integrate when computing values? how they weigh probability and timing? whether they are engaging typical decision-making systems at all, as opposed to relying on habit-based systems that can’t use information about current contexts or goals very well? Without a more thoughtful assessment of how decision making (and preferences) work as a biological and psychological processes, the “preference vs. constraint” framework strikes me as not-even-wrong. Thought-provoking, though, and I think there’s some value in that.

        4. benito10

          Here is my anecdotal experience, suggesting that Caplan is being needlessly reductive when he uses the language of preferences, constraints, and meta-preferences.

          I have what I would call not-very-bad anxiety. I am functional in most respects, and am able to cope with most situations. Still, I have intermittent panic attacks, which can be pretty bad, involving vomiting, difficulty talking, bodily tension, and then exhaustion. These have been occurring for at least a decade and a half, again, not all that often. There are easily grasped costs: shutting down at dinner with a professional acquaintance, being miserable at a friend’s wedding…

          The attacks tend to occur in normal social situations of the kind that are hard to entirely avoid. But, they can occur or not occur in very similar scenarios. Also, the attacks can occur during periods when I am actively working to control a variety of factors (sleep, caffeine, diet, stressors, etc.).

          I’ve never been able to fully prevent these attacks in the moment. With a gun to my head, I could sit and breath deeply for 10-15 minutes while ignoring conversation, or I could walk away from the panic-causing situation. This is not the same as not having a panic attack.

          I do not currently use psychotropic medication, partly because these attacks are intermittent, and partly because I prefer the self-help approach mentioned above. Does this mean that I have a meta-preference to believe that anxiety is a controllable urge, rather than a constraint or disease? Would the effective incentive be one that pushed me to treat anxiety more like a disease? Perhaps my spouse could hand me a bottle of Klonopin, and say take them or we divorce.

          Caplan suggests that a person in my situation continue to experiment with better ways to cope. Again, I’ve tried a variety of lifestyle changes, targeting the obvious causes and variables. Maybe I could do more, and this expresses a deep meta-preference to continue having anxiety. Should I quit my not-very-stressful job and move to a monastery? Maybe so. But then, why should we apply this logic at the individual level? Maybe we should tweak the incentives so that people have more chance to prioritize spiritual growth, have tighter community bonds, and have greater proximity to the natural environmental (or whatever is empirically shown or expected to drive down rates of mental illness…).

          I don’t dispute that individual choices can express a preference, and that it makes sense to start at that level when thinking about whether you have “symptoms” or “urges” or both. At some point, the analogy to physical disease become a stronger and more useful model than, oh, it’s a meta-preference. But of course, it might take the help of psychiatrist or counselor to figure that out.

      2. caryatis

        I have to say, it’s pretty uncharitable as well as false to claim that everyone on Caplan’s side either has no “functioning moral center” or has no experience with mental illness.

    2. Deej

      I didn’t get anger coming through when I read it.

      I get cognitive dissonance from Caplan though. The point at issue is just so important to his world view and his view of himself as good, clever and right.

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