The Cost of Kindness
A libertarian economist, Bryan Caplan, believes that mental illness is a false category. He believes that mental illness is a false category used to criticize and control other people’s “unusual preferences.” He is rather adamant on this position. This is an argument that even other libertarians and anarchists find hard to swallow.
This week, the New Yorker published an article on the torture of mentally ill inmates in Florida jails and prisons. The story is shocking, gruesome, and all too tragic. States have slashed budgets for the care of mentally ill people (or people with “unusual preferences” in Caplan lingo), often end up on the street and needing to commit petty crimes in order to eat or by no choice of their own because they are mentally ill and cannot control their actions. This means that they often end up in prisons with under-trained and under-budgeted prison guards who use physical force to control the unruly.
The New Yorker article filled me with despair. I wonder: Why do so many people have ideas on mental illness which seem like they have not changed since the days of Bedlam? Are the people who become prison guards naturally cruel, or quickly become so because of the extremely stressful circumstances? Is Bryan Caplan’s insistence on treating mental illness as a policy preference a form of compassion, or a form of cruelty?
There are kind and compassionate ways for law enforcement to deal with the mentally ill. Portland Police are trying more humane methods. Instead of going to shoot first and quickly, the Portland Police are trying more humane methods. I wonder how much they cost. The article tells the story about a mentally ill man who was thrusting a Samurai sword at random strangers. They surrounded the sword wielder for hours to make sure he did not hurt anyone and in the wee hours, they went home. No bullets were fired, no one was hurt or killed. The would be Samurai was gone in the morning. But this must cost a lot of money. The police had wages to be paid, they could not respond to other emergencies during the time frame.
The citizens of Portland seem willing to pay the price for a more humane method of policing and interacting with the mentally ill. I wonder if Americans as a nation are willing to pay the same price. The answer depressingly seems to be no.
In that light, reconsider Bryan Caplan’s observations or beliefs on mental illness as a choice. Are they a way of curtailing police brutality against the mentally ill? We recognize that people are making a personal choices and leave them alone. Or are they merely away to justify a small government and no spending world-view? People can wave around Samurai Swords in public if they choose, and suffer the consequences of a quick bullet.
The Portland method is more humane. The mentally ill do not know what they are doing from time to time but police need to respond to incidents of crime and potentially dangerous behavior. This includes petty theft and waiving around swords in public. The role of the police should be to fight crime while doing no harm or reducing harm. This means training in conflict de-escalation and non-violent policing methods. These cost money though. So does proper healthcare for the mentally ill and as a nation we seem far away from wanting to pay for these things.
Quick bullets and starvation and murder reign for now.
While I’m more than happy enough to agree that Caplan’s reach exceeds his grasp, it wasn’t *THAT* long ago that homosexuality was a mental illness. In living memory for some.
It wasn’t *THAT* long ago that gender dysphoria was considered a form of body dysmorphic disorder.
Are we going to find out tomorrow that (example that we know today is mental illness) is really just another way of perceiving and interacting with the world?
Well, maybe not tomorrow… but it’s not unthinkable that it’ll happen in the foreseeable future and we’ll have to answer questions about why we stigmatized (example that we know today is mental illness) as a mental illness.Report
It’s a normative judgment, an no better or worse than any other incorporated into DSM – [whatever]. It was excised from the manuals due to political lobbying. It’s difficult to tell whether Burt Likko is just jealous of certain territory or if he fancies that psychiatrists really are who they pretend to be (though some of them are now phoning it in).Report
I’m not sure what I have to do with this discussion.
If you have questions about the commenting policy, there’s another recent post in which it would be entirely appropriate to ask them.Report
It isn’t that difficult to figure out, since you’ve been quite gratuitously verbose on the subject of late.Report
Please be explicit.Report
Art, granting that everybody slips up and such, do you have any interest in participating in the commenting culture laid out by Burt (agreed to in spirit by all of us) yesterday?Report
I’ve heard quite a lot from Likko, Esq. about this and that. That was his initiative, not mine, nor was his initiative a normal response to stimulus. I’ve heard from you too.
Neither one of you have cared to defend the positions you’ve laid out, other than to insist that all decent people think this way (in his case) or that it was a terrible breach of manners to characterize someone thus (in your case).
Strange as it may seem to Likko, Esq, people actually have divergent views about the purpose of sex in peoples lives and the strata of value to be applied to various sorts of domestic arrangements and aspirations (and that’s not the half of it). Strange as it may seem to him also, there are people in this world who find it warped and bizarre to regard his preferred mascots as immune from criticism and assessment. I realize what the fashions are among a certain sort of bourgeois. Who gives a rip about fashion? You expect me to?
As for you, it’s pointed out by others that it’s rather rum to be admonishing people on their conduct when you’re perfectly willing to pass over without comment verbose foul-mouthed rants from one of your protected class. Well, it’s your blog, I suppose.Report
Part of the reason we sent that out is as a general reset. We’ve been letting a lot of things slide from all sides.
So, the question is whether or not you have any intention of trying to act in accordance to the sort of commenting culture we are aiming for.
Do you?Report
He elected to make a scene at great unnecessary length. Other people pick these topics. I neither make scenes nor pick the topics, but you have persisted with this fiction that I am fouling your nest. I am not your problem. Or, rather, I’m not the source of the problem you admit having.Report
So, to be clear, you believe you have not contributed negatively to the commenting atmosphere, will not modify your behavior if asked, and will more or less continue on the path of the past month or so regardless of what we say?Report
Cherry picking negative condescensions?:
”
Ah yes, the “why are you slapping yourself” explanation. Or I suppose the “She shouldn’t have been wearing that short of a skirt”.
”
Although I don’t think it was good/wise that Art called out Burt within the first few comments, comments elsewhere look like business as usual.
If the heavy is to be deployed it probably should be well distributed.
(FWIW I kinda like Art, he’s rowdy.)Report
I like Art, too, most of the time, even if we don’t personally get along. One thing I agree with him about is that he is not the problem here. No individual is. But since the announcement yesterday, we’ve gotten a reasonably good response, or radio silence, from everybody but him. Though I don’t think he’s crossed a line, he’s testing the limits from the get-go, giving the appearance of trying to pick a fight with Burt, after seeming to mock the entire project.
Trying to enforce the rules is hard enough with people that are trying to abide by them. I need to know if Art is going to at least try, or whether he thinks the whole thing is dumb. (Though if he is willing to try despite thinking the whole thing is dumb, I guess we can work with that.)
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“I like Art, too, most of the time, even if we don’t personally get along.”
I didn’t follow that sentence at all.
And after AD’s bit about hoping that Burt dies of natural causes before the angry mob rises up and kills all the lawyers, I find it difficult to be all that fond.
But he does fight hard and fair for his point of view.Report
Well, I don’t know Art personally or anything, so by “like him” I mean “like his presence here.”
I missed that comment about Burt, but I suspect that falls outside “most of the time.”Report
I imagine that Art is irked by the fact that under the guise of “civility”, Burt declared his opinion about homosexuality to be out of bounds, equating it with the obviously non-factual blood libel or the gratuitously insulting “n” word.
I don’t disagree with the need to have that rule for this community, but it would be preferable to frame it as a necessary local taboo in order to facilitate greater participation. That is, unless the desire is to tell social conservatives they’re not welcome here (which is pretty much the de facto situation anyway).Report
Well, it’s possible that putting blood libel and homosexuality-as-mental-illness as two examples in a series of intolerable disrespectfulness was not the best presentation in the same way that putting Russell Saunders and Dennis Hastert as two example of sexual deviancy was not the best presentation. I’m not close to equally worried about offensiveness of the two, however.
It’s not just about a taboo to facilitate greater participation, though. It’s rather difficult to expect anyone to maintain the level of civility we would like to see when their sexuality is being ascribed to mental illness. The expression of those views alone change the parameters respectful discourse, which is a wobbly enough concept as it is.
I hate it if that closes the door on social conservatives – I don’t think anyone on this site has done more to try to recruit them than I have – but this was (and is) an area on which I find it hard to see a middle ground that doesn’t devolve into dissections of the word deviant and its associations. The rule had to be created because the unenforced general taboo failed.Report
For the record I don’t mind Art saying what he says about homosexuality. He epitomizes the core of opposition to homosexuality in general and I find it kind of reassuring to have him say those things; it’s like finding your opponents doing exactly what you expect them to do. It’s easy to stand against y’know?
That said, I’m only one commenter and no doubt other gay people could very easily find the sentiments deeply offensive and incendiary.Report
Not helping! More seriously, I can sort of see both ways of looking at it. But that I can so easily understand and empathize with the other reaction, and therefore believe that a decorum-breaking response as being so reasonable, tilts my thinking in the direction that decorum should preclude that viewpoint for the most part.
(Art’s perspective on the history of the APA falling into a bit of a gray zone, viewed in a vacuum.)
(And if anyone is curious how I would feel if my own viewpoints on some other topic or topics were precluded in a similar fashion: They already are.)Report
Let me add to this a bit since there seems to be some hunger to get into the weeds.
The exchange in question identified to homosexuals as “deviants.” The word “deviant” is susceptible of both evaluative and normative connotations. As an evaluative matter, one might indicate that a “deviant” is a person who acts in a manner different from the majority. (This claim would be what we call the “motte” in a motte-and-bailey tactic.) As a normative matter, the phrase “deviant” is pejorative. (This is the bailey.) I asked Art to clarify what was going on in his mind when he called homosexuals “deviants,” because as drafted, the comment implied the more pejorative condemnation. Art’s response doubled down on the pejorative connotation. The response of someone who wished to point to demographics, perhaps in support of a majoritarian or democratic argument, would have been to retreat from the bailey and dismiss any sort of pejorative implication: “No, I was just pointing out that a very large percentage of people identify as heterosexual.” Subsequently, Art has tried to stake out a position that certain people morally condemn homosexuality, almost but not quite saying that they do so motivated by religion. This concept — a second motte at a different place out on the bailey — was not in any particular play at the time I put him on probation.
So that left an open slur against gay people out there. We have LGBTQ people in our community — frequent commenters, some contributors, alumni, and I’m quite sure many people who are just lurking. Open slurs against members of our community are going to be a problem because that sort of thing, if left without a response from people who appear to be in charge, those folks are very likely to say, “There’s nothing I can possibly say in response to that, so I’ll just go take my eyeballs elsewhere.” That is not something that is in the site’s best interests and it is contrary to the goals I have for the site under my stewardship, goals of expanding readership and expanding the numbers and kinds of people who contribute intellectual content whether in the form of articles or comments.
What’s more, even if there had been the concept of “I say Homosexuality is bad because my religion tells me so” in play at the time, there were all sorts of ways that could have been invoked without insisting that gays are “deviants.” As in, “You all can make whatever moral judgments you want, but my religion tells me that men with men, and women with women, is a sin.” That opens up the discussion to religious pluralism, which is a rather interesting place in our national cultural dialogue right now. But that wasn’t what was going on.
What was going on was coded bigotry. If Art wants to volunteer, “I am not a bigot and I have no moral condemnation to level against homosexuals,” I would very much welcome that. Art is an obviously very smart person who quite often makes sharp, factual, and useful contributions to discussions. I appreciate those kinds of contributions to our comments threads whether or not I agree with the point being made.
This comment, however, exceeded the norms. The viewpoint that homosexuality is morally wrong is not verboten on these pages, as far as I am concerned — but it is one that needs to be expressed in a careful, respectful manner precisely because it is a claim that is so closely associated with outright bigotry. Personally, I do not think such a claim can be ultimately justified absent reliance upon a religious teaching and thus vulnerability to the riposte that not everyone will subscribe to that teaching, but if someone wants to attempt a different argument they’re welcome to try — in a way that isn’t overtly pejorative like the overtly normative use of the word “deviant.”
Finally, @will-truman is quite correct that the “Comment on Comments” post and the “Flag Comments” function were not directed exclusively at Art. A whole lot of people had been indulging themselves in heated rhetoric for some time. The post was intended to hit the emotional “reset button” for the site as a whole and I’m pleased to see that a lot of people engaged in some reflection after that, and resolved to try to do better in the future. I regret that Art thinks I somehow have it in for him, but it’s simply not true. I hope very much that when he shows up to comment again, he answers @will-truman ‘s question in the affirmative, that whatever he thinks of our community’s norms, he will buy into them at least while he’s here. I don’t purport to tell him what to think or what his opinions are; but I do purport to speak for the site, particularly when it comes to our norms and the kind of intellectual interplay we present to the world, our “brand,” as @tod-kelly called it. By analogy: we wouldn’t tolerate remarks that soberly indicated white racial supremacy; someone who wanted to discuss racial differences would need to be very careful about what differences were under discussion and what the intellectual purpose of that argument is. That sort of care and concern for inclusiveness was not evident in the comment that resulted in discipline, and was even more evidently absent after the clarification.
But I’ve been advocating for a “Flag Comments” function for quite some time now behind the scenes. That wasn’t and never was about Art. The question of which comments we review, the problem of finding comments that need review, and then balancing the desire for open debate with the desire for an inclusive environment are ongoing, and likely will never end. The right response to something questionable will never be clear. This goes back a long time, to before I was ever involved with the site and will go on here and in other fora after I’m gone, and are not now and never have been about a single person.Report
Something still bothers me about this. I do think the slur should be a punishable/probationary offense if it was directed toward someone, and maybe if it was directed towards a group, (if it was directed toward ‘our’ group, then hell yeah, hangem by his toes!)
Bigot, racist, xenophobe, homophobe are deployed on this site in disturbing regularity. Not that the grape shot of condescension would hit or stick to any of the attendees here, but it is notable that slurs are in frequent use and aimed over the bow in specific directions. And really it doesn’t matter much because who’s going to promote ‘god save these wrong thinking peeps’.
It sounds like TVD left the stage because he was bad for the brand. The thing I recall after the exit was that Kimmi carried the brand for several months (at least from my vantage point). Not that this was a bad thing, back then she was less cryptic and had pretty good balance.
So what is the brand? I think in the past it had diversity as part of it’s definition. This may be a bit of false advertising or just a disparity of norms. I mean in the general population I see people who have all the ‘flaws’ that the site tends to ‘shelter’ from. It is interesting that religion pluralism was of interest at this point and time, but it is a narrow awareness.
In someways I say the site lacks human pluralism that mirrors the population. Not that this is good or bad, but it is different than what I would expect the term diversity to encompass. I can imagine this conversation:
where are your deeply flawed people?
we don’t have those.
why not?
Oh, we ran them off.
Ok.
Maybe instead of the brand advertised as broad reaching ‘ordinary’ diverse, it should be something else more narrow and exclusive. It would help in making the enforcement of narrow norms much easier and more obvious to those who just don’t belong in “what we aspire to be,”.
Another thing that I would subjectively like to see is less echo of other sites or taking other sites to task for what they said about x,y,z. If you want your product to improve you need to focus on your product, not chase around other peoples product.
I really did just stumble onto OT. I guess in a way I needed to know who these people were that didn’t like guns, think that increasing immigration is a good idea, or sovereignty should be invested not in the individual, but in the bureaus of government agencies. I have learned a lot about other people as well as myself.Report
It seems like, there are a number of people who post here who are pretty clearly bigots. They just are. The word has a meaning. It applies to them.
They’re a minority. On the other hand, if they routinely take kinda-but-not-really-deniable shots at (for example) LGBT people, well I’m gonna notice. I’m not stupid.
If I say something highly critical of evangelicals, and if an evangelical happens to read what I wrote, they are going to figure out that I mean them.
Cuz I do. I precisely mean them. Obviously.
Pretending a real social fault line does not exist, cuz you want to have a nice, detached, egg-head conversation in a nice detached way is privilege.
Yeah I said it! The big scary word!
Some fights are real fights. Some fights are kinda “to the death.” Those involved don’t see it as a game, but many who are not involved want to engage in a kind of semi-serious, intellectually stimulating, exploratory “debate.” These are different goals. They are hard to reconcile.
Democracy tries really hard to sublimate such fights, to capture them, to constrain them. Democracy is great. I am big fan. But still. The Civil War happened. Forced desegregation at gunpoint happened.
Democracy works, until it does not.
I don’t want to get hyperbolic. This is not 1938. This is not Germany. But still, maybe this is 1963 in Alabama, if you get the analogy.
There isn’t much compromise possible between bigots and their targets. It’s just not like that. These are fights where one side or the other must decidedly lose.
Cuz life has stakes, and to be pollyannaish is charming for a child, but we are not children.
I like to know where people stand. They’re certainly gonna know where I stand.Report
“There isn’t much compromise possible between bigots and their targets. It’s just not like that. These are fights where one side or the other must decidedly lose.”
True, but there is a difference in how you can PROSECUTE that war. 1) you can take ground slowly, all the while trying to persuade and negotiate the end to hostilities with the more reasonable groups while marginalizing the true believers, or 2) you can just nuke the whole area. Which one do you think generates the most hostile reaction from the survivors and supporters?Report
Damon:
The best way is to sue folks that won’t make you a wedding cake because it’s the only way to be sure.Report
@damon — From MLK:
This is also known as “justice delayed is justice denied.”
My life is now, not some imagined future. So indeed I say we change things as fast as we possibly can. So to your point, The United States is a functioning democracy, so we should use the tools of democracy, but that include social pressure, civil disobedience, block voting, and ultimately the rule of law.
In other words, I’m not going to re-litigate the Civil Rights Act, up to and including the use of federal troops to force desegregation.
I care very little if the bigots are significantly discomforted by this. In fact, if it is working at a sufficiently rapid pace, then they certainly will be, at least some of them. But that not my fault, nor the fault of other minorities, nor the fault of our allies, nor the fault of law enforcement when they enforce the law. It is squarely, 100%, without even a sketch of mitigation, the fault of the bigots, those who cling to their bigoted views.
After all, they can just stop being bigots.Report
I’ve asked you about this several times and I think this is the first time you’ve responded directly on point, which I appreciate. I understand your POV but I think what you’re doing is alienating more people than necessary and radicalizing the balance. I also understand WHY you want to do this, but you seem to care little for the inevitable push back, which I believe is inevitable. Maybe you don’t care, thinking that the “law” will protect you, until, it doesn’t. You know, ’cause “how many divisions does the supreme court have”, etc. Time will tell whether or not the current path was wise. I wish you success in your efforts.Report
@damon — The pushback results from progress, and you don’t get progress without pushback. Faster progress means more pushback, sure. But slower progress means less progress during my finite life, and the finite lives of others.
I don’t know if their is a linear or non-linear relationship between progress, time, and pushback. Neither do you. If it is linear, then we should progress as quickly as we can, and thus accept the inevitable pushback we get per N units of progress. If it is non-linear, we still have progress N versus time T and pushback P, all mixed together in a non-linear stew.
But it remains the case that T is the denominator, and a lower T is better unless the non-linearity is dramatic.
(I can show my math in more detail here, but obviously I’m hand-waving. However, so is everyone else. Anyway, is this argument clear?)
I don’t know the answer to this, since none of us have actual numbers. That said, when I don’t know the second-order effects, I look to the first-order effects and proceed.
The way I see it, the political process is hard enough and slow enough and the fight is bitter enough under the present terms, and the haters hate us to their bones already and already spread every lie they can and work as hard as they can —
— in other words, they’ll push back no matter what we do. Make your case that they won’t.Report
You seem to misunderstand my point. I’m not saying that there won’t be push back, I’m saying that your pushing alienates marginal players that would most likely come over to your side given a more softer approach, increasing the numbers of those who actively oppose your efforts, and lending support.
The more active defenders the nastier it’s going to get and the greater the chance it’ll turn violent. But whatever, you’ve made your point.Report
@damon — I don’t see how that changes the analysis. Progress is progress. Pushback is pushback. Liberation over time is liberation over time. Sustained oppression is sustained oppression. The variables are the variables.
Plus, if you’re talking about “lukewarm allies,” who say, “Well, I’ll support your rights, but only if you don’t ask for too much or make anyone uncomfortable” — well I don’t think those people are allies after all.
Furthermore, instead of talking about such people, as if they are abstract entities, little bundles of cause/effect, we can talk to such people, as if they are moral agents who can think.
After all, some people reading this probably fall into this “lukewarm/in between” space. Perhaps you do.
I would say, look, I deserve full participation in civic life. The desire to block me from civic life is the opposite of that. Likewise, this is a real cultural fight, but to some degree you gotta pick a side. You’re not going to make everyone happy. Some will dig in their heels and do all they can to hurt us. But that’s on them. We are right. They are wrong.
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On the other hand, perhaps you are making the “tone argument,” that we should be nicer in how we talk about this.
That’s a complicated topic. Certainly in the present age of social media and reblogging and Twitter pile-ons, it feels as if “niceness” is a thing of the past. On the other hand, I like to tell it like it is. I hate lip service and empty words. So I dunno.
I can probably gather 3498203948098409809340984 posts on right-wing blogs calling for violence against us. If we need more niceness, are you sure it’s my side most in need of this advice?
Plus, one can hide some truly hateful garbage behind a “nice” facade. I’d rather speak bluntly, but then do the right thing.
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It is indeed nasty and there will certainly be violence. People will be killed. It is going to happen.
There will be violence. People will get killed. It is going to happen.
Accept this.
The thing about social media is I see a constant stream of posts that say, “Look at how horrible our enemies are.” Those posts then link to our enemies saying horrible things. Many of those things are calls of violence against transgender people, particularly transgender women. Most are posts by dudely-manbros promising to kill a trans woman if they ever “catch us” in the restroom with their kids. There is much flexing and chest pounding.
I use restrooms frequently. Sometimes there are kids there.
But the thing is, they really are saying these things. And their media is pumping this story, fomenting the anger, filling their minds with bogus stories of enemies who do not exist — for they are the bad guys, not us — and so on. Violence will happen.
This is not our fault. It is a result of their anger, their hate.
Not ours.
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We should separate issues of pragmatics from ideology. I’m happy to discuss pragmatics, but often I feel like people are trying to mask bad ideology behind false appeals to pragmatics. Before I’m willing to discuss issues of strategy and compromise with allies, I need to trust that I am talking to an actual ally, and not an enemy trying to play rhetorical games.
I want to maximize progress toward social justice. This is hard to do. There is much that is uncertain. There are higher-order effects we cannot predict. But still, push hard, as much as we can as fast as we can. It matters.
Please help.Report
I’m not talking about middling violence V. Surely you don’t think that the pendulum of freedom is going to ever swing in the current direction? One day soon, perhaps sooner that we all realize, (and I’m not talking about Trump) I’m convinced there’s going to be a nasty turn, and I’m afraid that part of that turn is going to be “let’s put all the XXXX into boxcars”. They’ll be there with other “undesirables”. It’ll all be nice and legal, just like it was before, like so many other horrors. It may be a side note to history for something larger or maybe that’ll be the sum of it, but I’m not optimistic long term. Shit tends to happen when empires fall and “world orders” change-when populations are pushed past their breaking point, or when there is a crisis.
I’d prefer folks realize that getting gov’t to do to others what they aren’t willing to do themselves is wrong, that force is wrong no matter the justification (outside narrow parameters), but that’s the path we’re on. But I hope you, for your sake, have your victory and don’t live long enough to see it all turn to ash along with the rest of what’s been achieved, but I’m ever the pessimist.
Now, writing this on my second tasty adult beverage, perhaps I’ve said too much, but I know I’ve had enough of this topic for a few days. I shall return in a few days to my snarkier self.Report
@damon — Well, I think you are shifting from what we can predict to what we cannot possibly predict. But keep in mind, these people right now want to stop me from having a livable life. They’ve never offered to coexist. If we are honest, we must agree that civil society constrains, but a constraint toward diversity is precisely not the same as a constraint against.
People want to abstract out this difference, but such abstraction is the first tool of dishonesty.
Regarding the boxcars, here is the first page of Phil Sandifer’s Neoreaction a Basilisk [1]: http://philsandifer.tumblr.com/image/143606007641
Here is a cut-n-paste of that from a draft copy I have on disk:
Yeah, the boxcars might come, but if so, it seems likely that they will be just an unpleasant phase on the path to the “dieback.” I dunno. The Malthusians have been predicting doom for a few centuries now, while the anti-Malthusians have been shouting “innovation innovation innovation” etc. Turns out so far the anti-Malthusians have been right.
Except of course, the way things are going the Malthusians only have to be right once. AKA, entropy always wins.
So assume we’re all fucked. We’re gonna burn all the oil. Something will happen.
On the other hand, the enlightenment and liberalism and humanism have together had a pretty good run, and we are innovating, and “post work” abundance is maybe possible, and clean fusion is maybe possible, and space colonization is maybe possible, on and on. And machine intelligence is very real, and perhaps we’ll use it on balance for less evil and more good.
These are grand possibilities, both social and technological. Of course humans for the most part muddle through badly.
Things like poor, sad Kim Davis, or those wedding cake assholes — these are small things. I still gotta pee.
[1] The original title was to be Neoreaction, an Eternal Golden Cuckball, which to my view is infinitely superior.Report
Let me ask you, in this fight, do you hold that your opponents posses any more or less sovereignty to their cause than you do to yours? Are you asking for any advantage outside/above your own individual sovereignty?Report
@joe-sal — Honestly I have no idea what the term “sovereignty” could possibly refer to in the context of contemporary civil society, so I dunno.Report
It was not meant to be hostile or a trick question. I dunno how to speak beyond here without a understanding of it.Report
@joe-sal — Well, we have this: http://www.merriam-webster.com/dictionary/sovereignty
Do you mean sense “b”, which is, “Freedom from external control.”
But no one is free from external control. All freedom is limited.
See, the practical matter of how freedom is limited, by whom, according to what process, is called politics.
The Civil Rights Act said that you must serve lunch to black people, if you serve lunch to the public. This certainly limits freedom in one way, but it expands it in another. It gives black people (and other minorities) a greater ability to operate normally in civil society. It removes not at all the ability to racists to operate in civil society, except inasmuch as they are limited in how they can express their racism. They might have to rub shoulders with a black person. Boo-fucking-hoo.
I have literally zero sympathy for racists who are discomforted by this. Should I? Why?
So it goes for we LGBTQ folks. Obvious analogies are obvious.
So the question is, can we convince the median voter that this analogy holds, and thus we deserve the same consideration as racial minorities? I think we can. I think to a large degree we have.
This is a fair analogy, yes? We LGBTQ folks deserve full access to civil society, right? You agree?
If this limits the ability of homophobes and transphobes to be homophobic or transphobic, just how many fucks should I give about their emotional crisis?
If I reserve a hotel room on Hotels.com, I should trust that, when I arrive at the hotel, and when the manager notices I am transgender, that this must not matter regarding their honoring my reservation. You agree, yes? My money is as good as the next.
How else am I supposed to travel? Must I routinely scramble to re-book a room in whatever bumfuck nowhere town I find myself in? Must I continuously do a magic dance to placate the bigots I encounter, cuz their sad-feels?
If I go shopping and need to pee — well finding a clean public restroom is hard enough. I should be able to find a women’s room like everyone else.
How else am I supposed to shop?
(This is an actual problem for people, you realize.)
We passed the CRA because we saw rightly that Jim Crow made civil life unworkably difficult for black people. So we said “too fucking bad” to the racist, and indeed.
And the poor racist and their sad racist heart?
Fuck ’em. It’s their own damage.
I mean, they can stop being racist, right? They can do that, you agree?
Decent people don’t want to be bigots. They don’t want to be racist or homophobic, etc. They want to have bigger hearts. A cis woman might be uncomfortable seeing me in the women’s room, but if she is a decent human being, she will make an effort to know what it’s like to be trans. She will open her mind.
The hater — she stews in her hate, nurtures it into white hot fury. But it’s a hell of her own making.
Pick a side.Report
“sovereign individuals, which have supreme authority and sovereignty over their own choices, without the interference of governing powers”
https://en.wikipedia.org/wiki/Self-ownership
I don’t see where you and I will have any problems. You repeatedly ask if I agree, it is not necessary. Free people don’t have to constantly ask for agreement. What the good life looks like to me probably in no obvious way conflicts with what the good life looks like to you.
You tell me to pick a side, I do, it’s my own. Same as most people.
The problem occurs when peoples sovereignty conflict. Some of it is just bumping up against each others. Some of it is outright hostile and trying to subtract or run the hell over the others.
As greginak might say, I’m no peacenik. I fully expect the individuals involved to stand their ground and fight, no delays, no waiting for the slow motion of civil society to bend in tolerable ways. It is part of what you say is at stake, I would think.
Maybe it’s a form of civil disobedience. Maybe that is how far we drifted from true freedom, that civil disobedience is the expression of individual sovereignty deployed through rule of law.
Civil society doesn’t have much to do with some text stored in a building in DC, it does have a lot to do with how we interact with each other. The civil rights folk that are long in tooth can explain this. After the buses are burnt, the fire houses rolled back up, tomorrow is another day.
About the only thing I might have useful to say, is that your opponents appear to be making fuel of condescension lobbed in their direction.Report
@joe-sal — Yeah, you’re advocating a kind of Libertarian social theory that doesn’t actual work, which is to say, we are social animals guided by “deep culture” principles. In other words, if I smear feces on myself, I might get kicked off the subway, regardless of any protestations I make of “sovereignty.”
Too bad. I stink. Feces is disgusting. The subway is a shared public space.
In my city, street preachers can stand around in the Boston Common and yell to their heart’s content. However, they cannot do it on the subway. If they try, they are removed by the police. This is good. In the Boston Common, I can walk away and find a different stretch of grass, one without a ranting preacher. On the subway, I am a captive audience. A fulminating street preacher, in my face on the subway, is a formula for needless chaos.
This is called civic life.
Which is to say, we already fought this out when we made rules about lunch counters. And drinking fountains. And swimming pools. And (indeed) bathrooms — cuz trans people are not the first to be denied access to public restrooms. That was common enough during Jim Crow.
You have a right to your own mind. Certainly in a free republic such as ours, few will deny that. But if you open a business serving the public, you are bound by certain legal principles — which in a diverse society requires that you serve minorities, even if you might like to exclude minorities.
I am well aware that some disagree with this, and thus comes political action and the power of the law. Which is deeply unpleasant. But civics is hard and “never experience something unpleasant” is not an option.
One area where I agree with the libertarians, when we talk of restrictions on freedom, we should be clear that we are talking about the authority of the state, and thus implicit violence, to enforce these rules.
And so we get a lovely high school in Little Rock, and the national guard.
Those ranting bigots trying to prevent black students from attending school, they were wrong. Full stop. The government was correct to use troops. Racism had to be fought.
If someone blocks me from the restroom, under a just law I can sue. If they lose their business — cry me a river. They were bigots. They knew the score. Serving a diverse public is a requirement of civic life.Report
If I may step in to this interesting conversation, I think that “sovereignty” is vested in states only. Individuals have rights.
One of the enduring questions of American politics is the extent to which the states are sovereign with respect to each other and to the federal government. Lincoln v. Douglas resolved that issue to a certain extent, along with the Reconstruction amendments, but the marriage cases showed that it is still a live issue. Could someone be legally married in New York but not Mississippi? The Court said no, but it was a close case.
Veronica D is now raising the issue of civil rights for the trans community. Her argument is that the various states are allowing intolerable discrimination against her community. The question now arises whether the constitutions of the various states and the federal government require the state to take pro-active steps to ameliorate the discrimination. Even if the constitutions do not require such action, at a second level she is arguing that the states should adopt and enforce laws that roll back the discrimination. And she plans to engage in the kind of conduct which pressured the states to end discrimination against POC.
At least, that’s how I read it.Report
@francis — Precisely. This is all to say, civil rights was an ugly process, but we can ask why. Was it ugly because black people wanted “too much”? Was it ugly because they wanted it “too quickly”?
I mean, does anyone want to make that case?
I say it was ugly because racism itself is deeply ugly. Furthermore, those who cling to racism are responsible for the ugliness that ensues.
In other words, if I cut my fist punching your mouth, I don’t get to complain that you had sharp teeth.
I’d rather not see anyone put in jail, nor do I want to see the national guard “federalized” to force bigots to honor the law. But it has happened before, and rightly so. Furthermore, the blame falls on the racists, not on black people, nor other civil rights activists, nor the government who passed laws to mitigate racism, and so on.
It’s all on the racists. All of it. No, ALL! Every bit. Their suffering, insofar as they suffer, is their fault. Our suffering, insofar as their active bigotry causes us to suffer, is their fault.
I’d rather this be peaceful, inasmuch as I’d rather bigots stop being bigots. Certainly there are issues of strategy and prudence. That said, I get the impression that those who advocate for a slowdown are not actually on my side. I believe they advocate for a slowdown because they want progress slowed.
“Won’t anyone think of the poor racists!”
Nope. I won’t think of them at all, except how to remove their active civic influence entirely, inasmuch as I can, as quickly as can be practically managed.
Regarding their inactive, internal feelings — I don’t actually care. They can hate me, and chew on the worm in their own bitter heart. I don’t care. But if they sell yummy waffles to the public, and if I wander into their shop, they need to sell me yummy waffles, the same as everyone else.
After all, I’ll sell them yummy waffles, were they to wander into my waffle shop. Civility requires it.Report
Joe Sal,
This is on the list of things I am hoping to ameliorate. Part of the reason its really hard to ask people to refrain from such accusations (even when we believe they are disproportionate) is that it’s hard to talk about decorum while that guy over there is essentially calling this person over there a degenerate, mentally ill, or whatever.
But I do think we need to get past attacks as first response, attributing motivation and then condemning for the attributed motivation, and so on. That applies to a lot of things, but especially bigotry.
We may not be able to compromise, but there is at least a degree of hope for coexistence. That means people are going to need to bite their tongues, even when the shoe fits.
But it doesn’t mean that we’re going to be banning words like bigot or homophobe any time soon. In addition to being attacks, they are often critiques of arguments being made. If you make Godwin’s Law a Law, then somebody is going hide behind it while they talk about Final Solutions. Which is an enforcement nightmare for us, and can add uncertainty for everyone else (which is why we are going to be slow about applying consequences as long as we believe they are not doing it intentionally), but it’s better than the alternatives.Report
Good to hear, still it’s a tough row to filter buckshot from all parties.Report
It is, which is (unflatteringly) a reason we have been reluctant to intervene, which has lead to a pretty bad month.Report
Let’s be honest here. Art isn’t irked in any meaningful way. He is affecting the posture of the reactionary, lamenting his inability to assert his opinions over others and framing it as his own victimization.
There is something very decadent about Art’s position, which essentially boils down to objective reality exists and that reality demands that you take my subjective value judgments seriously!Report
I don’t know about this jr. Usually in the math/science areas we build models that try to simulate as close as possible to reality. To do this we try to account accurately for as many parameters as we can define about reality.
I don’t see a lot of concrete parameters being instituted in some of the areas Art is discussing. If he questions models that have shaky, at best parameters, that’s not so much subjective, or maybe it is, which is a completely different problem that has nothing to do with Art.
If questioning models with shaky parameters is reactionary, what does it say about culture?Report
I don’t know what this means. The belief that homosexualitybis deviant behavior that has been normalized for political reasons is reactionary. That’s the definition of reactionary.Report
Of course it was normalized by politics. What do people think that politics are?
Consider this: the idea that women could wear pants was once considered rather “deviant,” and in fact was against the law in many (most?) municipalities. These notions and laws changed through politics.
In much of eighteenth century Europe, the idea that a country could exist without an established nobility, with all the privileges of rank, was considered literally insane. During its founding, the United States formally rejected ideas of title, except for purposes of diplomatic protocol. This was political. It grew out of the ideas that fueled our revolution and later our constitution.
Some of the early US colonies were founded according to rather strict religious domination. For instance, my lovely city of Boston was once governed by a rather intolerant clergy. Other colonies rejected this notion, and made ideas of religious freedom central to their founding. These were political decisions, and were hashed out according to social and political conflict.
In Massachusetts today, you can still feel the influence of that Puritan rule, at least compared to the region I grew up in. But still, the clergy doesn’t rule here anymore. These changes happened through politics.
Yes indeed, gay liberation is political.Report
Cultural Hegemony rankles, but it’s probably something better pointed out in a full-length post, rather than comments spattered here and there.Report
I was going to say something similar. It’s a societal dermination. It’s likely that the pendulum will swing back the other way at one point in the future. This should not be surprising.Report
I agree that the field of psychiatry and psychology are vastly imperfect like all other fields. However, Frued himself said that homosexuality was not a mental illness.
Caplan seems to want to view things through such an economic lens that everything becomes a preference. Many mentally ill people seem to think that they have diseases that need treating and dislike the pooh poohing that depression is not real. One tweeter said that mental illness is a choice like cancer is a choice.
What Caplan did is find the one expert that agrees with him. Economists hate when liberals find the lone dissenter. Why should physchitrusts not do the same?Report
Freud said a lot of things about homosexuality.
To the extent that we know that (example that we know today is mental illness) is harmful, how much of that harm is based on the social stigmas against (example that we know today is mental illness)?
To use prohibition as an example, to what extent are we blaming such things as wood alcohol tainting bathtub gin on drinking when we should be blaming that sort of thing on prohibition?Report
Focusing on stigma’s and homosexuality seems to miss the giant amount of mental illness that falls under the realms of crushing depression, bi polar disorder, schizphrinia, suicide, etc. Most mental illnesses are things people hate having and which severally harm their lives.Report
There was an amusing article in Harper’s about 15 years ago about the secular increase in the page count of the DSM and the bizarre nominatives used therein.
When you say ‘most mental illness’, you can render any statement about it true just by fiddling with the boundary conditions.
About 0.7% of the population have a history of some sort of schizophreniform episode. Once upon a time, most of the manpower in psychiatry was employed in asylums looking after these sorts of people and those with other sorts of dementia. See Fuller Torrey on the history of American psychiatry from 1935 to 1975. Looking after dements was not a job those who’d been through residencies wanted anymore. As for bipolar disorder, the definition has gotten so fuzzy that estimates of its prevalence are 4 to 15 times what they were when Torrey began writing for general audiences 30 years ago.Report
Most mental illnesses are things people hate having and which severally harm their lives.
In living memory, homosexuals said such things about their own homosexuality.
In living memory, people with gender dysphoria said such things about their own gender dysphoria.
For what it’s worth, I agree with you 100% about (example that we know today is mental illness). I’m just also meditating on my answer to the questions about why we stigmatized (example that we know today is mental illness) as a mental illness.Report
But context matters, no?Report
Would it have mattered in (previous year)?Report
@jaybird
Yes?
I guess my point is that it seems to me there is a difference between:
“This way-of-being creates inherent difficulties across all contexts.”
“This way-of-being creates specific difficulties in specific contexts.”
I mean, to be of African descent in 18th century America was difficult (to say the least). I’m sure many Africans/African-Americans in 18th century America wished they were something other than African/African-American. And their being African/African-American assuredly resulted in harm they experienced.
But that doesn’t mean that being African/African-American in 18th century America was a mental illness. If anything, it was society that was mentally ill.
I would imagine that most gay folk who felt the way you’ve described — and I have no doubt that such people have existed and continue to exist today — felt that way because of the context in which they were existing as gay, namely in a society that was homophobic and which might have actively and explicitly told them of their awfulness and wickedness.
Oddly, context can work the other way, too. My personal belief is that one (of many) reasons we have seen such an uptick in ASD diagnoses is because of contemporary society. I’d venture to guess that a few decades ago, someone who was high functioning autistic could live a relatively normal life. Get a job at the factory, pull the same lever for 8 hours a day, live alone on the edge of town, interact primarily with family who lives nearby and just understands you as weird brother/uncle/cousin Billy. But the context is different now and Billy can’t just sit in the back of math class and memorize his times tables but is instead expected to work in groups to problem solve and collaborate with his peers. The factory jobs are gone so he gets a job at the grocery store bagging groceries which strains his social difficulties. His family members go off to college and settle in far away towns and he is forced to interact more regularly with unfamiliar members of society to get basic things done. And his difficulties mount and become more obvious.
I guess my argument is that looking ONLY at those two metrics yields too incomplete a picture because of how heavily context weigh in.Report
Frued himself said that homosexuality was not a mental illness.
So what?Report
Depression is real, Saul. The question at hand is whether it is properly described as a problem, a condition of life, or an ‘illness’. Is it a bad thing or just a thing? Is attending to people with it a department of medicine or ministry?
Psychiatry is necessarily parasitic on common sense or other departments of knowledge for these evaluations. All of which makes invoking psychiatrists or clinical psychologists as authorities misplaced in discussions like these.Report
https://en.wikipedia.org/wiki/Major_depressive_disorder
Here now, use words.Report
Your point is what?Report
That MDD is different from MDE, which is different from the colloquial description of depression, which can quite easily apply to someone who is markedly bipolar.
And when you ask such questions about “Depression” you sound like you need an education in words, so I linked one.
You are welcome.Report
You’re telling me that mental health professionals have invented terminology and taxa which are of convenience to them on a day to day basis. It still doesn’t answer my questions, because answers to those questions are not to be had by appealing to mental health jargon.Report
As usual, xkcd has a good take on what you’re doing here Art.Report
Who is that and what am I doing?Report
1. Approaching a serious subject that has been studied for decades.
2. Coming up with some obvious complexities off the top of your head, and using their existence to negate the field as a whole.
3. Subsequently refusing to spend any time reading what actual domain experts have to say, confident in your conclusions.Report
No, Trizzlor. I’m pointing out there is a limit to what your doctor, in his capacity as a doctor, can tell you. That remains so even if your doctor wishes to claim otherwise. Not much ‘complexity’ in that.
I might bring up the changing fashions in psychiatry and clinical psychology regarding matters which are not normative questions, and how that rather vitiates the authority they can claim, but I’m talking about questions superordinate to that.Report
It sounds to me like you’re saying “I drove a car once or twice and it was pretty complicated, so don’t believe your mechanic when he recommends oil changes – there is a limit to what your mechanic can tell you”.Report
A similar example:
Football Outsiders just introduced a new metric for potentially projecting how college running backs would do after being drafted into the NFL. It uses a number of stats and measurements, one of which is “how much of the team’s workload did he carry” (backs that have NFL success tend to have seasons in college where they are the workhorse).
Now, someone who has been following college football for a bit might point out that programs differ widely in how often the quarterback keeps the ball, so that difference might introduce a lot of variance to the latter factor. In the article itself, the author went out of his way to point out that they had had the same thought, run regressions, and gave the result of the regressions and how it impacted the overall result.
The third comment boiled down to “Did you consider the effect of running quarterbacks? It might change your results.”
Yes, you have a very interesting idea on whether Shakespeare could have written the plays attributed to him.
Yes, you have a very interesting Biblical exegesis.
Yes, it was a very cold winter where you live.
The professionals have already taken that into consideration.Report
To the question posed the answer is it depends, Many reports suggest that Lincoln was depressed at least from 1860 onwards. Of course being president during the Civil War might be enough to depress anyone, But this suggests that a second criteria is need the ability of the person to function in society. Lincoln was able to function, many others are not.
So then instead of a cure the goal might be to get a patient back into a state where they can function in society.Report
I’ll engage this statement because I believe it has the kernel of a defensible point.
I do believe that some instances of what we (by which I guess I mean the medical community, even though I’m not a member thereof) call “mental illness” are better or more usefully looked at through the lens of something different from illness (like lifestyle choices or practices). But those “some instances” are probably mostly the sub-clinical or mild versions of the more severe instances Greginak mentions above (like depression, bipolar, schizophrenia).
I’m wary, however, of making a sweeping judgment. I know someone with very severe schizophrenia, and while she has some choices, such as whether or not to take her medicine, she also has a lot of things that are very hard to control (paranoia, delusions, maybe hallucinations). Fortunately, she also has a lot of money, which affords her a lot more dignity than many of the people Saul is describing in his OP.
I also know people with very mild “conditions” that may or may not be considered “depression” or whatever who, by making a few simple lifestyle choices would probably improve their lives greatly. For varying definitions of “simple,” of course. What’s simple to me isn’t necessarily simple to them, and not necessarily easy if it is simple, either.Report
Are we going to find out tomorrow that (example that we know today is mental illness) is really just another way of perceiving and interacting with the world?
Inevitably. In addition to empirical investigation, there is a discursive process involved in determining the existence, nature, and even treatment of mental illnesses, and that will produce some pretty dramatic changes over time.
Importantly, recognizing this does not undermine the very concept of mental illness, but is one of that concept’s strengths.
Also worth noting that the proximate cause of removing homosexuality as a diagnosis was empirical research, not merely a change in attitude.Report
I actually think about this question and others like it quite frequently (and I believe Our Tod once had a “Thursday Bar Fight” question on a related topic). Basically, I try to think of what behavior, practice, etc. do we look at today with some sort of negative normative or value judgement that we will view differently in the future and which we will feel regret over our prior view (or chastise those who continue to hold it).
The difficulty, it seems, is threading the needle between saying, “This person is no better or worse than you and I,” and “This person is different from you and I in a meaningful way that is best suited to be identified.”
And that is really, REALLY hard because of our tendency to equate differentness with badness.
And it seems like this can flow in both directions.
We now recognize that homosexuality is not a mental illness or disorder but simply a way of being for some people. Conversely, we now look at a subset of behaviors that might have been labeled any number of awful things in the past and recognize these to by symptoms of autism.
In a way, we end up deep in the weeds of semantics. But language and words matter immensely on a number of levels.
So, yea… this is complicated. And ideally we aim to understand, empathize with, and embrace our fellow human* regardless of how they may differ from us.
* Or animal! Back on Tod’s post, which I believe asked what modern practice will we look back on in horror from the future, I was pretty confident that my general view of animals and animals rights will be widely regarded as exceedingly awful by future generations (and perhaps rightly so!).Report
Its complicated because we don’t have any objective way of determining reality, that doesn’t at some point involve consensus.
Its a disconcerting thought, but I’m not sure of any alternative.Report
we don’t have any objective way of determining reality, that doesn’t at some point involve consensus
Social tools to punish dissenters are very, very interesting in this context.
Ironically, they include such concepts as “insanity”.Report
One of the strengths of the clinical conception(s) of mental illness is that, even if they can’t possibly exclude normative/evaluative components, they also necessarily include some important, relatively objective empirical ones. The research that provided the final push to declassify homosexuality as a mental illness showed, in essence, that on virtually every outcome measure, gay people were “normal,” that is, they weren’t distinguishable from non-gay people. If you can’t show that homosexuality is somehow harmful to the individual, that is that it decreases everyday functioning by itself, then you can’t justify classifying it as a mental illness. This is not to say that society’s changing views towards homosexuality weren’t the main reason it was declassified, but the research made it impossible to make an empirical case for keeping it as a mental illness even for those whose attitudes towards it hadn’t changed.Report
I should also clarify some of my language per what you offer here. If I’m understanding you, you’re saying that the science can tell us that clinical depression is worse than its absence, because the former can have a demonstrative harmful effect on the sufferer. Where problems arise is when we say that the person with depression is a worse person, of less value or self-worth, and therefore deserving of worse treatment. I know you aren’t arguing otherwise; I just realized “worse” was ambiguous as I used it.
While perhaps an imperfect analogy, I try to think of mental illness in the same way I do physical illness: it is not the totality of an individual nor does one component part of an individual functioning atypically mean the entirety of that perspn is atypical, defective, or broken. I actually have a friend with some mental health issues (primarily anxiety and related panic attacks) who often defines herself in these terms because she’s absorbed this mentality. I tell her that a broken bone or infected sinus does not a broken person make, so why allow an ill/disordered/whathaveyou part of the brain levy such a classification?
I understand there are some differences between the brain/pysche and the physical body, but not so profound as to justify such a distinction. My friend is a perfectly functioning member of society: she holds a job (that requires her to care for little ones, no less), raises her daughter, and lives her life. So she takes a daily pill, so what? So do people with heart disease.Report
Depression, for example, can cause great disruptions and dysfunction in everyday life: social dysfunction, work dysfunction, inability to enjoy things that the person usually enjoys, etc., as well as physical symptoms like sleep deprivation, weight loss or gain, lack of energy, etc. up to and including death. If you can show that something does that, then you’ve provided necessary conditions for classifying it as a mental illness (though perhaps not sufficient ones). If you can’t, therefore, what you have is not a mental illness.Report
What is the threshold for disruption? Is it an objective standard or relative one?
I can imagine certain symptoms being far more disruptive to one person’s life than another’s due to other personality traits, preferences, etc.Report
There are set criteria for different disorders, but clinician judgment is also important in some cases.Report
Also worth noting that the proximate cause of removing homosexuality as a diagnosis was empirical research, not merely a change in attitude.
Empirical research does not justify values unless there is some factual question which influences the adoption of the value.
That aside, the sequence of events regarding the removal from the manuals was delineated some time ago.Report
Importantly, recognizing this does not undermine the very concept of mental illness, but is one of that concept’s strengths.
We’re in the middle of what seems to be an open-ended experiment of self-diagnosed Asperger’s Syndrome (and other conditions that are self-diagnosed but put the diagnosee somewhere on the Autism Spectrum) doing what they can to hammer out what is neurotypical and what is neurodiverse. (I encountered the word “Allistic” for the first time this year. It strikes me as less useful than, say, “cis”.)
We’re going to end up in some weird places.Report
we’ve always been in some weird places.Report
I’ve made my views on self-diagnosis clear in the past: it’s no less likely to be wrong, and perhaps dangerously so, than self-diagnosis of physical symptoms. That is, in almost every case, the self-diagnoser is much more likely to be wrong than right. There is simply too much that you don’t know, understand, or see.
The best medical advice anyone can get is, “Don’t Google your symptoms.”Report
Chris,
I’d say self-diagnosis, like self-report is more likely to be wrong with mental issues than biological ones.Report
Selfi-diagnosis of psychological symptoms vs. physical ones, more likely to be wrong than right (or at least more likely to be wrong than a diagnosis from a professional is) – perhaps so.
More likely to be dangerously wrong? I don’t know.
If an incorrect self-diagnosis of some autism spectrum condition results in a person not beating themselves up so much for just being awkward and nerdy, so much the better. If an incorrect self-diagnosis of minor depression results in a person being careful about getting enough sleep and exercise and healthy food, so much the better.Report
What the hell else is Google good for?Report
@chris — That’s good advice for wealthy people with good access to medical care. On the other hand, even for me, to get an adult ASD diagnosis would require a fair amount of effort.
I asked my PCP about it. He basically asked, “What difference would it make?”
Which, none really, but I’m probably a bit “on spectrum,” although clearly not quite like some other people. So I dunno. It might be worth knowing for sure. It might not.
I know a young woman who self-dx’ed, because her parents refused to get her tested. But sometime during her teens she began to figure out shit was not right. Maybe someday she’ll seek a pro-dx. Maybe not. It depends on resources, insurance, executive functioning issues (like organizing appointments), etc. But all the same, her condition is pretty obvious.
Pretty much everyone with gender dysphoria self-dx’es. I mean, I have a pro-dx, which makes getting ‘mones much easier. But all the same, basically you explain to your MD that, hey I got this thing give me the ‘mones.
I was already self-medicating after all. ‘Mones are ‘mones. I didn’t need a doctor to tell me I was trans. (I was getting blood tests for my levels. That’s important.)
I’m self-dx’ed as faceblind and (probably) audio processing disorder. I could probably get a pro-dx, but why bother? There is no treatment really. It’s just, veronica has a wonky brain. I can’t recognize faces for shit. I score super low on those online “faceblind tests”. For APD, I talk loud. I’m hyper literal. I have problems understanding spoken narrative. I need things repeated often, but my hearing is fine. Blah blah et cetera blah. Should I spend the afternoon in the a room with a neuro-psych hitting buttons? I dunno. Sounds tedious. What difference would it makes?
As a kid, I was pro-dx’ed as dyslexic and ADHD (although they just called it “hyperactive” back then.) This was the 70’s, and getting an ASD dx would have been rare in marginal cases such as mine. So yeah.
Furthermore, getting an adult ADHD diagnosis is actually pretty fucking hard if you indeed have ADHD. It’s really kind of a mess. Fortunately I have a trusting and cooperative relationship with my PCP, and he believed me about my childhood DX, even though I could not provide proof.
(Like asking a weird-brained, high-school-dropout fuckup like me if I have some obscure documents that my long-dead pediatrician, whose name I don’t remember, may or may not have given my parents — as if!)
So yeah. At least for neuro/executive function stuff, some people self-dx. It seems better than just letting them wallow in dysfunctional confusion. At least it puts you in touch with a support community, who like you have difficultly negotiating medical bureaucracy.
On the other hand, if you want to help pay for all the social workers and neuro-psychs it would take to make adult ADHD and ASD diagnoses more widely available, I’m all for that. Until then…Report
One reason psych folks recommend getting a professional involved is because if you don’t, some people self-medicate. And selfmedicating with booze and half a dozen other mentally weird substances can be seriously bad.Report
@kim — Agreed. For stuff like clinical depression or anxiety — sure. Seek real treatment instead of floundering around with whatever you can buy from the liquor store or on the street corner.
For gender dysphoria? I mean, you’ll want an endo watching your levels. But for ‘mones, informed consent all the way.
We know we are trans.
For the neuro/executive function stuff? Like, why should I bother seeking a pro-dx for faceblindness? Or APD?
I’m not a kid. I don’t need special ed resources. I’m just a weird adult with a wonky brain and a tech job.
I mean, it explains stuff, such as why I always had to ask my wife who this-or-that character was in the movies, even though it was actually Brad Pitt playing the same guy he has been since the start of the movie — but he changed his hat! — or why I often had to ask her what the actors said, even though I basically hear fine. So yeah. It’s important to me. But in a clinical sense? Probably not so much.
I’m probably a bit autistic. But so what?
For ADHD, on the other hand, I take Adderall.
Which is definitely not something you should self-medicate with. To get help with ADHD, I needed a real MD.Report
@chris, I have a question regarding what I think is your field of expertise, or at least related. I’ve been thinking a lot about depression lately. In part, because I’ve been reading through old posts by Scott Alexander and The Last Psychiatrist and because a little bit ago my wife called me the happiest person she knows.
In my view, there are two broad categories of depression. There is the kind of depression that surrounds everyday life, the cycle of bad feelings that we all run through with varying levels of frequency. Call it the human condition. And then there is clinical depression. I am pretty good at dealing with the former and lucky enough to have never dealt with the latter.
My strategies for dealing with the human condition are mostly behavioral. I want to believe this works, because I’ve taken the lessons learned studying continental philosophy to heart. I want to believe the literal truth of Merleau-Ponty and the mind living the body and the body living the mind. But truth is I just don’t know.
Everything I’ve written about is based on what I know, which when it comes to psychology isn’t much. So my question is: what does the dividing line between “the human condition” and clinical depression look like? Is there a clearly identifiable line or just gradual change in shading? And are the chemical/neural processes that accompany depressive episodes(?) the same for both? Or are my categories completely off to begin with?Report
Obviously Chris can give his own very educated answer but i’ll chime in. Your categories are fine; their is Life with all it pain and hardness that is normal and Clinical Depression. Where that line falls between them is an eternal struggle for clinicians and people to figure out.
Some of the things to look to determine the difference would be time, if you have felt very down for one week or a month that is likely just life and circumstances. Is it over a year, then maybe that is depression. Length of feeling depressed is a big issue. Does the person identify specific incidents that are leading to feeling depressed. If they have a list of deaths, layoffs, illness, etc that have happened to them over a year then they might be diagnosed with depression but that would be called a reactive depression. They have been down for a long time but due to a long list of specific problems. If the person says their life is all good but they are still miserable with a variety of symptoms of depression ( disrupted sleep, poor sex drive, inability to feel joy, no energy and a few other symptoms) then that sounds like Clinical Depression. They have a biochemical problem that is creating a long standing misery that is not connected with any incident.
This is the simple version. One of the things a clinician should be looking for in any diagnosis is, do these symptoms create a problem for the person, do they harm the persons functioning? If yes you might have a diagnosable mental illness.Report
Thanks for the response (I mean that non sarcastically). I’m aware of the difficulties in finding the line. I’m interested in the the specific nueral/neurochemical differences.
Does a clinically depressed brain “look” different than a non clinically depressed brain? Do the same areas light up on a scan when a clinically depressed person experiences depression or anxiety as would on a non clinically depressed person experiencing depression or anxiety?Report
Understanding that I’m neither a clinician nor a neuroscientist, yes, there are neural differences between depression and average everydayness, though they are still being studied, so there exact nature and extent is not known conclusively. The most well-known relate to the receptors for And perhaps production of) serotonin and some other neurotransmitters. Related to this is an extreme reduction, if not outright cessation of neurogenesis in some parts of the brain, particularly the hippocampus. And there are potential differences in more frontal areas, like the medial prefrontal cortex, associated with things like social reasoning, counterfactual thinking, and some aspects of affect.Report
Thanks. That is fascinating, especially the neurogenesis things. If I am understanding this correctly, the implications of what you’re saying are that our brains/egos/consciousness/whatever you want to call it can become so committed to certain emotional states and behavioral patterns that it will literally start shutting down certain parts of the brain to preserve those states and patterns if we try to change. If that is accurate, that might be the scariest thing that I’ve read in some time.
Are there analogies that can be drawn between this and other behavioral/clinical conditions, for instance, between habit and addiction?Report
It is certainly the case that depression’s effect on the brain results in us getting stuck on, or ruminating over, the same shit. It puts us in a neural rut. The reduction in receptors for some neurotransmitters has a similar effect, making it difficult for our affective and cognitive states to change much.
This is certainly similar to some anxiety disorders and other mood disorders. I want to say it’s not unlike the way receptors change (producing tolerance, e.g.) in addition, but that could be a stretch.Report
OK. I’m still scared though.
There is something very frightening about the idea that what we think of us consciousness, our very selves, is just the byproduct of a number of chemical and mechanical processes that don’t even exist to protect us, but mostly just for the purposes of their own continuity. To be human is to be in an abusive relationship with your own mind. That is alienating.
Existential dread is real. Good thing I like pushing rocks.Report
“To be human is to be in an abusive relationship with your own mind.”
though not intended, this is an awesome formulation.
think of it this way – most of the time your body wants “bad” things (either health-wise, socially, etc). eat too much, get addicted to certain chems, react in anger to minor slights, taking the road most travelled, etc…
to be fully human is to engage in a constant struggle with these forces, which emerge from (presumably) the same part of you that “You” come from. it may not be the most heartening thought, but i kinda think it is. every time you make a good choice, you win a battle against the parts of yourself that would sabotage “You”.Report
I don’t know that it’s true that they “don’t even exist to protect us”; like many things, such as overeating and addiction (or allergies), they are the the *over* activation of processes that exist to protect us. We seek out sugar and food because we need energy, but too much sugar and food kills us. Pleasure is “intended” to be a trigger to pursue, say, sex (or a dopamine-producing drug analogue), so we reproduce (and feel close to another), but we can become addicted to the pleasure itself, at the expense of all else it is supposed to be a reward *for*.
There are, I believe, some studies showing that the depressed brain is able to more accurately evaluate potential outcomes (that is, Murphy’s Law being what it is, a depressed person is better able to look at an unworkable plan and say “this will never work”, instead of proceeding down the garden path to ruin with unrealistic optimism). If this is the case, then depression itself (and the causes of it, and even the neurochemical processes which intensify and perpetuate it) IS adaptive; it’s just that like our immune systems (or our fight/flight reaction), it can go haywire and start overreacting to EVERYTHING.Report
“Depressive realism,” it’s called, and it may be less actual realism than a negativity bias that contrasts to our “ordinary” bias towards positive outcomes (or positive self-assessment, or positive whatever). I suppose that on a population level, it’s adaptive to have a few negatively biased people to put a damper on our baseline over-positivity, though it’s certainly not very pleasant for the individual.Report
Right; on a population level all kinds of neurodiverse extremes that can suck for the individual potentially become advantageous to the group. You’ve got the ADD guy who can’t pay attention at storytime but always notices the sabertooth tiger first, the autism-spectrum (or obsessive) guy back in the cave working out a new, better spear design, and the depressed wife of the chief telling the over-ambitious chief that the tribe truly can’t make it over the mountain pass before winter hits, and baby, you got a stew goin’.Report
But in any case, even on an individual level, I think the analogy still holds:
A properly-functioning immune system protects you from infection; an overactive one makes your life difficult, and can even kill you (it’s not the bee sting that did it, it’s your body).
A properly-functioning “depressive system” (for lack of a better word) keeps you from making dumb decisions that can get you killed; an overactive one can prevent you from making positive decisions, or any decisions at all, and again can even kill you.Report
Oh, I think you’re 100% right. We evolved through natural selection; it is tautological that our minds are adaptive. Unfortunately, they’re adaptive fools, easily led astray. All it takes is a change in the availability of a few neurotransmitters, or some slightly off-kilter organization, and you’ve got depression or bipolar or a paralyzing phobia.Report
Chris,
And even some of the adaptive stuff is really fucking weird and totally obsolete.Report
It’s only obsolete because of our unimaginable wealth.
After the world regresses to the mean, we’ll see it as being useful again.Report
Sincerely doubt we’ll lose 90% of our height and width and go back to looking like rats. Really, I do.Report
Oh *THOSE* adaptive traits.Report
That’s why I trust no one, not even me. Total paranoia is the only sane option.Report
It’s not paranoia if EVERYONE IS against you.Report
It’s not paranoia if they’re really out to get you.
But if you tell your parents that “people on the internet are trying to kill me”… don’t blame them if they lock you up.
[I know the idiot that had to break INTO the mental institution (Not Difficult: Pittsburgh Steam Tunnels) to get the other idiot out of the mental institution. AFTER the exit interview where the other idiot decided (as a prank) to use a handpuppet to tell the docs what he really thought of them, in crude terms.]Report
If everyone is against you, maybe you’re just a really bad person.Report
Using some religions as a guide, I really am evil, so there’s that.
But define “bad”. You bad is my good.Report
Subject note 433531.23: Subject “Glyph” exhibits persistent paranoia and suspicion that something is “off.” Recommend capture and reset.Report
You’re assuming that paranoia is not the desired state.
Some people are more creative off their meds than on them.Report
As alluded to above – our minds are adaptive for the species, not necessarily for the individual.
As a group, we need some people who are physically brave and quick to fight raiders, finish off a wounded animal, or rescue someone from rough waters. Those individuals are also probably more likely to die young and leave behind surviving nieces and nephews than surviving children.Report
Glyph,
Take it from the perspective of a creative person (not me) — most of whom suffer from “depression” at some point. Depression is the state in which someone’s mind recharges, so that they can exhibit states resembling mania (where the brain is connecting things faster than is normal, because half the connections were already made unconsciously earlier).
A properly functioning depressive system lets you recharge, so your brain doesn’t break.Report
@glyph
granted, but i think of those processes as being “bad” when they do over-trigger and prevent full immanentization of “You”. (i read a lot of RAW as a yungun)Report
Those patterns and behaviors exist to protect, but do exist to protect “us.” Something like fight or flight more obviously exists to protect us, as in us the whole organism which then gets to pass on is genes that contain the fight or flight instinct. That is a comforting fact.
But what Chris is talking about strikes me as something different. When your brain starts shutting down the parts of it that facilitate reason and the ability to create counterfactuals for the purpose of maintaining some pathological behavior, that brings something into focus. That something being the realization that what we thought was a unitary “us” is in fact a whole tangle of competing behavioral patterns. That’s where the alienation comes in, the realization that we are literally alienated from ourselves.
By the way, this doesn’t really scare me. I’ve long held these beliefs metaphorically. I once had pretennsions of an academic career in continental philosophy. What’s blowing my mind a little bit is the realization that these philosophical metaphors have physiological expressions.Report
Actually, to be clear, people with depression are much more likely to engage in counterfactual reasoning. It turns out that counterfactual reasoning is only good in small doses, as it’s a big part of how we reason about blame/guilt (even if only after feeling blame guilt initially), and one of the things that happens in depression is that we feel overly or unnecessarily guilty.Report
Got it. Thanks for the correction.
Now I’m going to stop talking about this before I sound anymore like Dennis Hopper in Apocalypse Now.Report
“If” is the middle word in “life,” man.Report
@chris
Is there research on why some people tend to be more prone towards feeling guilty than others?Report
Do I look like Google Scholar to you people?! (Kidding.)
Yes, there is such research, and some people are.Report
One thing it brings into focus is that our omniscient intelligent designer sucks at bug fixes.Report
One thing it brings into focus is that our omniscient intelligent designer sucks at bug fixes.
That’s one assumption. Another is that this is the result of a bunch of hard compromises and, at the end of the day, if you’re thinking about designing a bunch of 3D printers with AI capable of making 3D printers with AI capable of making 3D printers with AI, this solution was the most successful over the long term in a large-scale production environment.Report
Jaybird,
No hard compromises. Not adaptive, actually. BrainDamage.
Sentience and Artificial Intelligence make slooooow decision-making, which is nearly always maladaptive. Freak chance made us, and by freakish luck we were able to survive and thrive. Most sentience just got deemed “mistake” and thrown out.
That’s why intelligence is so rare in nature.Report
Sorry, omniscient & all powerful intelligent designer.
Compromises are made by beings with limited knowledge and ability.Report
It’s like theorizing that Linus Torvalds is omniscient and all powerful and then getting pissed off when you find yourself in RPM hell.
The fact that it was sold to you that Linus Torvalds must be omniscient and all powerful is the fault of the Linus Torvalds Fanbois/Fangrrls/Fanspivaks.
Quit blaming Linus for the lies his followers tell about him. Linus is just this guy.Report
Dear Jesus, please save me from your followers.Report
Dear Oscar,
Leaveth me out of this. I cannot eveneth code C Sharp.
Sincerethly yours,
J.C.Report
Space Awesome!Report
Cat has ascended. Devote your prayers to cat in the future. At least you know cat is listening — even if no one’s quite sure where cat is.Report
jr,
wait a moment!!
“The symptoms of major depressive disorder are nearly identical to those of sickness behavior, the response of the body when the immune system is fighting an infection.”
… that’s just quoting wiki.
Don’t treat something like it’s a rogue agent, when you’re really looking at something adaptive that’s gone a little bit haywire.Report
@j-r
Dude for realz, this shit sometimes terrifies me.
Less these days, as I get older. I’m not sure why. Gender transition helped a lot, which is often associated with lower anxiety and better mental functioning, cuz better hormone balances. Blah blah blah. Brains are weird.
But still, yeah, that’s kinda your point. Existential dread.
It might help to thing about: “It all adds up to normality” [ https://wiki.lesswrong.com/wiki/Egan's_law ]. Which is to say, as we unpack the weirdness of the universe, compared to what we thought the universe might be, we are just exploring our views of the world.
The real you is the same you that has always been. Your values are your values, and they work as your values always have.
They are in your brain. They are electro-chemical impulses, but they have always been such. If you thought they were truths inscribed on the universe by the hand of God, well they never were. You are a brain in a body, and indeed, your every fleeting moment of joy was a brain in a body, but that doesn’t make them not joy. More will come.
The beauty you see, it is still there to be seen. You are still you.Report
As an aside, whenever I talk to any psych-pro about anxiety stuff, they always ask, “So, what is making you anxious?”
Which this bugged the crap out of me, cuz the answer is NOTHING I’M JUST WIGGING OUT.
But later I figured something out. This question is diagnostic. If my answer was something like, “I’m having trouble at work,” then maybe it’s not an anxiety disorder, but just normal life shit that we can address normal ways, like helping form better strategies for dealing with work shit. But for an anxiety disorder, that doesn’t work, cuz it’s my brain. So yeah. That’s the sort of stuff psych-pros ask.
I assume they have a bunch of specific shit they know to go through, which I don’t know cuz I’m not psych-pro. But yeah.Report
“Does a clinically depressed brain ‘look’ different than a non clinically depressed brain?”
Given the hard nosed scientific method we might endorse here, the brain is provably a bag of chemicals. The mind separate from the brain is no more provable than a soul separate from it.
And all sorts of things change how brain chemistry “looks.” Going out for a 20 minute run changes your brain chemistry.
That’s why the concept of “chemical imbalance” is challenging. There is such a thing as different brain chemistries (all of ours are unique). But someone still has to make the decision on what constitutes “balance.”Report
Deciding whether something is an illness or a preference isn’t new. It usually involves asking questions like – in the absence of stigma – does this condition prevent you from doing the things you’d like to do? If you could be treated for the condition would your internal quality of life improve? Would you voluntarily undergo such a treatment? With regards to homosexuality and gender dysphoria, the answer to these questions is mostly “no”. Is there something you would put in the “unusual preference” categories that, nevertheless, answers “yes” to these questions.Report
Anecdotally (I’d love to see a peer-reviewed study), “reparative therapy” for “curing” homosexuality seems to have a “success” rate that correlates strongly with how strongly the subject wanted it to work in the first place (and how much the final results are self-reported).
So if you treat it as if it were an illness, the treatment only works on the people who wanted to believe it was an illness in the first place, and not on those who don’t.Report
This is a good point. One fascinating thing is that “wavering” does happen. And there are all sorts of different kinds of bisexualities. Look at what just happened with Sen. Wofford.
Or David Geffen: Gay, really attracted to men; women not so much. Then he meets Cher, falls in love with her and has lots of passionate sex with her. Then they break up. And he’s still … gay. Not “cured.”Report
in the absence of stigma
There’s quite a bit of heavy lifting being done by this clause.Report
Bryan’s never voluntarily made someone mentally ill.
You can say mental illness is sometimes a choice, sure.
It’s not always a choice made by the victim.Report
I think Caplan speaks in the language of “preference” more than “choice.” He follows Szasz. And they make an argument that is logically airtight.
Here is how I understand it: Whether we call it an “illness” or “disorder,” “demons” or “life problem,” what the person is experiencing is real.
Depression that leads to suicide may not an “illness” or a “disorder” technically speaking. The person may not be possessed by an actual “demon.” But they do have a deadly serious “life problem.”Report
Jon,
This is a LOT easier to say when you haven’t been taking medicine that causes suicidal ideation.
This is a HELL of a LOT easier to say when you don’t come out of suicidal fugue states where it seemed like a good idea to go die in a snowbank. And you come out of them thinking, “why in the hell did I think that was a good idea?”
Caplan is overgeneralizing a small portion of mental illness, and in doing so he makes grave and fatal mistakes.Report
This is what I wrote in a comment above:
———————————————————–
I think Caplan speaks in the language of “preference” more than “choice.” He follows Szasz. And they make an argument that is logically airtight.
Here is how I understand it: Whether we call it an “illness” or “disorder,” “demons” or “life problem,” what the person is experiencing is real.
Depression that leads to suicide may not an “illness” or a “disorder” technically speaking. The person may not be possessed by an actual “demon.” But they do have a deadly serious “life problem.”Report
Every 5-6 years Caplan really goes “out there” with some notion in his noggin; the last time it was cloning his own mini-me.Report
One thing I will point out is that corrections officers are usually not police officers, so I think it’s an important distinction to make. I knew someone who worked in corrections for a short time and he used to say that corrections officers were often the guys that would have been criminals if they had a slight nudge in the opposite direction in their youths. So…not surprised there are a lot of abuses there. It’s an enormously corrupt system.
Also, considering how many people the police interact with on a daily basis, and how many walk away safe, this statement could stand to be dialed back quite a bit:
“Quick bullets and starvation and murder reign for now.”Report
Yes, I knew a corrections officer myself for a while and the stories of what they face and what support they are offered surely account for some of my white hairs. Appalling.Report
It would seem to be that the theory discussed in the OP would only make things worse.
“They ain’t sick. Why do the guards need more training? They’re just weirdos with weird preferences. Knock some sense into them and they’ll cut the shit fast.”
In education, we sometimes look at difficult behavior a child presents with and ask, “Is this a ‘can not’ or a ‘will not’?” Now answering this question is hard. But treating a child who can not do something like the problem is because he simply will not do it is highly problematic. This idea seems to convert all can’ts into won’ts.Report
@mike-dwyer :
Hyperbole being what it is, the nugget of truth remains.
Much of the phenomenon observed is the result of the Bush administration’s refusal to re-authorize the Byrne grants, after which many functions of other agencies at the municipal & county levels were re-directed to the police. (Note: Observe how few of the officer shooting deaths involve the state police in any given state.)
This shift in police function, occurring at a time of transition from the community policing model to the intelligence-led policing model (which itself led to significant changes in training & deployment), produced notably undesirable consequences.
The Obama administration’s renewal of the Byrne grants to put even more unneeded officers on the street were the last nail in the coffin, so to speak.
There are a number of measures being floated about, but none of them being taken seriously at this time. Like it or not, the unions play a major role in undermining any substantive reform.
Still, it comes down to separating the “guardian” function from the “warrior” function.Report
Sure, but the mentally ill, who are having an episode, have a higher chance of having a bad interaction with the police, because the police are not trained to recognize or deal with mental illness, etc. So we get stories like Kelly Thomas or Marcus Abrams. Part of the problem is how officers view the public. They are trained to notice & respond to anomalies, and the mentally ill or disabled are clearly anomalous. They also expect the public to obey. Those who do not obey are up to no good. But it’s not a binary set, and officers who fail to accept that reality are more likely to hurt or kill a mentally ill or disabled person.Report
I can’t think of any time in history when the treatment of the mentally ill wasn’t awful to some degree or another.
Mental illness is challenging for us, because often there isn’t a quick and easy solution, and in fact often the only “solution” involves long term discomfort and inconvenience for us.
Even once we clear away all the low hanging fruit of minor neuroses and socially misfits, there will always be people with severe chronic psychological problems, who aren’t warm and cuddly, who make the life of everyone around them difficult and unpleasant.
Here’s where I have to lapse into religious language. I believe we are called to share in their humanity, which means sharing in their pain and suffering. That in order for us to live authentic and full lives, we need to embrace the diversity of experience that includes tragedy and despair.
Healing where we can, fixing where possible, but ultimately accepting things we can’t fix or heal, surrendering our ability to bend the world to our will.Report
I’ll leave you to the fun of getting brained in the head with a Playstation.Report
As for Caplan, this seems like a classic case of someone who’s never seen a hat before walking into a haberdashery and complaining that all the bedpans are leaky.Report
Good for the Portland Police for putting so much effort into not harming that man, but if I’m reading it correctly, the ultimate solution was to lose track of a mentally ill man with a samurai sword and let him be on his way. It sounds like he just ran out of gas and went home, but I really don’t think that’s the outcome we want. A person threatening random bystanders with a sword and getting into an armed standoff with the police is pretty much a poster boy for “danger to himself and others.”Report
@troublesome-frog
I agree but this is a big problem. We don’t have a place to put the mentally ill. Institutilzation is very hard and under budgeted. NYC went through a rash of people being pushed unto subway ledges. The pushers ended up being people with long histories of mental illness who had trouble taking their medications. One guy was homeless. The other woman alternated between group homes and her family. Both had trouble keeping her safe and medicated.Report
“We don’t have a place to put the mentally ill. ”
Yeah, I seem to recall this big movement to get mentally ill out of institutions a while back. That seems to have worked out well.Report
Involuntary detention is a tough issue to address. Err on the side of inclusion and people who are perfectly functional but have unusual preferences get locked up. Err on the side of freedom and people who are at significant risk of harm to themselves and others end up on the streets. Spend too much money trying to figure out who needs what and taxpayers get cranky.
What are the due process rights of the mentally ill anyway? How much liberty do they get in picking their own mental states? How does society deal with those people who like the mental state which makes them prone to delusions and violence?Report
Exactly. I’m not sure that a conversation was actually held to noodle this out, rather, a push to just open the institution’s door.Report
Yeah this seems to be the big issue. I think we might have gone too far the other way.Report
A friend of mine was on a jury to determine whether somebody should be released over the objections of his doctor and the strong impression the jurors got was that on top of all of the other problems with committing people involuntarily, doctors are very reluctant to sign on off on releasing people once they’ve been institutionalized. Saying, “This guy is OK to take care of himself,” is also implicitly saying, “And you can go ahead and blame me if he snaps one day and hurts somebody,” so there’s a strong incentive to play it safe if there’s an hint of a possible problem.
The whole situation is very tough to deal with, but it seems like we have swung pretty far in the direction of, “You’re on your own” with the mentally ill and it’s ultimately not a good result for anybody. We’re stuck choosing between leaving them on their own or treating them like criminals when neither one is really the right approach.Report
tf,
Most insurance won’t pay for any long-term hospitalization — at least for depression. You spend a few days inside to cool off, and then they often have to let you go, whether or not you’re still likely to kill yourself.Report
Actually getting the long term and severally mentally ill out of institutions worked well in general. It gave the MI more freedom and the chance to live higher quality lives. I’m guessing that should appeal to you. What it couldn’t do was solve all their problems or make them not mentally ill in a difficult and debilitating manner.Report
Well yeah, you basically had several outcomes: unjustly imprisoned people were freed, mildly mentally afflicted people were let loose on their own, badly mentally disabled people with families got put back on their families, badly mentally disabled people without families ended up on the streets. So that’s a big yay/boo right there.Report
One thing that was discovered as people were released from the big state long term hospitals was that many needed a lot of support services in the community. As those services were ramped up the outlook for people released improved greatly. There were those who ended up homeless which was a serious problem, but they needed services. My second job out of college was working in a support program for people who had been committed to psych hospitals for years.Report
Oh sure. The evidence is overwhelming that decarceration made an enormous benefit for the lives of many people.
But walking around the streets of Manhattan in early 80s also showed that there were plenty of people not getting the help that they need.
Today, in Los Angeles, both the City and the County are pushing on ‘housing first’ policies for the long-term homeless, many of whom are MI. Unfortunately, many people are so used to life on the streets, on their own terms, that the success rate is apparently pretty mixed for people who have been on the street a long time. But it also appears that early intervention with people who are newly homeless and with MI issues is far more successful.
All of this costs a lot of money. But the govt agencies are hoping to recoup with lower police, hospital and jail costs.Report
Indeed. So the situation went from “full care/less freedom” to “more freedom/less care”. I’m all for freedom, but you just cant take MI folks and push them out the door. As you said services had to ramp up and did. I’d argue that just maybe that services should have been put in place at the same time or prior to the doors being opened, or the doors should have been opened more slowly, or the services should have done better.Report
Yeah the services should have been set up sooner. People wanted to save tax money so they played up the cost savings without enough knowledge about what it would take to help people thrive and survive.Report
It was the left’s big push to get them all out, in CA under the The Lanterman–Petris–Short (LPS) Act. Sadly Reagan got the blame for it.Report
That tends to happen when you sign your name.
But in all fairness to everyone involved, the de-institutionalization push was:
1. Grounded in very real abuses where mildly eccentric people were held against their will;
2. Done with the promise of future funding for halfway houses which would integrate the mentally ill back into society.
It failed because:
1. The mentally ill don’t have an effective lobby to preserve their slice of the funding pie;
2. The halfway houses for the mentally ill are not beneficial to housing prices, and force even the most well meaning of people to make difficult choices.Report
1. In the liberals revision of history Ronnie was a dictator who forced this on unwilling Dems in CA as opposed to being a gov that signed a bill they wanted.
2. It failed because the CA legislature didn’t plan for what was to become of those poor folks once they were on the street. The was no plan other than turn them loose on the streets.Report
Re: funding
Saw a link (or heard on a podcast?) that we have high per capita spending on prisons relative to the world but low per capita spending on police. I’d venture to guess there is a relationship there.
More (and smarter) funding of police departments might lower the need for prison funding (which could stand to be much smarter as well).Report
I wonder where that police funding number comes from. Does it include civil forfeitures and grants from federal agencies? Or is it just a the budget items in state and local government?Report
I’ll try to find the source, @j-r . Anything else is talking out my ass.Report
You can add James Hanley to the list of libertarians who disagree with Caplan on this point:
https://bawdyhouse.wordpress.com/2016/02/03/caplan-and-the-crank-or-dont-touch-my-meds-you-bastard/Report
This is an aside and doesn’t really address the OP (which, by the way, I mostly agree with), but here’s as good a place to say it.
Can we please put a stop to telling someone “you must be off your meds” when they act weird or in a way that we don’t like? I’ve seen this statement lobbed at certain of our “trollish” commenters from time to time. I’m sure I’ve said it in the past and if I haven’t, I’ve probably thought it or didn’t think twice when others have said it.
But as I’ve noted in a comment above, I’ve known people with pretty severe mental illnesses. It just seems insensitive to keep bandying about the “off your meds” joke.
No, I’m not trying to moderate anyone. I’m not insisting we create a special category of THINGS THAT MUST NOT BE UTTERED or some such. I don’t plan to call anyone out. I’m just suggesting that before you (the generic you, including me) use that phrase, you should think twice about whether that’s the best way to say what you want.Report
There are a lot of intelligent, decent people who have things like bipolar but don’t want to admit it publicly when they engage in debate or privately when they engage in negotiations or conflict because that can be used to “write them off.”
“You’re just nuts” is a good “writing off” conclusion.
I think a problem emerges when the behavior of the say, bipolar, gets into the realm of engaging unjustly. All sorts of sword and shield issues. “Don’t blame me, it’s the bipolar.” “Oh, you are just saying that because you are bipolar.”
Look at the story of Christian Slater’s father. He denies being bipolar and schizo and claims Christian and his mother have libeled him to ruin his career. But one thing is for sure. The guy behaves like a piece of shit. And maybe that’s the only relevant thing. We should be able to observe when people behave this way without clinically diagnosing them.Report