the brain compares the strength of various preferences and executes the strongest. Anything that strengthens your urges at the expense of your goals makes you more likely to do things you don’t endorse, and makes you worse off.
Suppose that when you wake up with a hangover, your goal is to never get drunk again. But later on you find yourself in a social situation that encourages drinking, and your preference for taking another drink becomes stronger than the preference to satisfy your goal of never getting drunk again.
So, should you seek treatment to try to get rid of the preference for taking another drink? Should someone else nudge you to get treatment? Should someone else do more than just nudge?
I don’t see a simple answer.
Accordingly, I don’t see a simple answer to the question of how to think about mental illness.
Maybe not a simple answer, but a relatively simple heuristic is The Golden Rule + Positive Sum Analysis. Bryan Caplan and Scott Alexander help give us the pieces we need to guide us. Caplan’s desire to apply economic thinking to non-economic problem spaces seems to be most applicable to evaluating the behavior of mental health professionals, just like it helps with evaluating politicians rather than thinking of them as selfless philosopher kings.
I think Caplan goes wrong in applying a pure preference model to the mentally ill. Here Alexander’s specialized knowledge informs us of what is purely autonomic, purely a conscious decision, and the sliding scale cases that involve both.
I don’t think the grey area is that big. I think it is important to recognize that many of the preference vs. disease scenarios start off as pure preference decisions in which the Golden Rule applies and evolved over time into pure disease-like scenarios that force the victim/patient into extreme violations of the Golden Rule. It is very rare to find a high functioning alcoholic or drug addict whose behavior does not violate other people’s rights through their entire lifetime (e.g. Howard Hughes).
A Positive Sum Analysis, always imperfect, can help guide us make decisions about the chronically homeless who suffer from some complex form of mental illness, substance addiction, and/or extreme preference depending on how you want to label it.
And especially with regard to mental illness “treatment” is not a well established “behavioral adjustment W or medicine X will have positive effect Y with perhaps side effect Z”, but a whole grabbag of methods and medicines, some of which don’t compare well to a good old fashioned rain dance in producing the desired effect. (Something Scott Alexander does point out regularly in better phrasing.)
Steve Sailer blogged about identical twins this mornin in a post that contained the following sentence, ” During the Freudian Era, it was often assumed that identical twins would be better off apart for reasons that seemed completely persuasive to Freudians with their steely ability to believe whatever rationalizations they made up.” Which instantly made me think of Caplan, forever trapped in his rationalizations. Alexander, on the other hand, seems more willing to accept humans as individuals with complex and mysterious constellations of motives and degrees of autonomy. Derek Parfit thought about this divide and came to the conclusion that it is plausible that we have such desires which conflict with our own well-being, and that it is not necessarily irrational to fulfill these desires. In human existance, pragmatism will trump pure reason. We see this too in economics with Tyler Cowen’ s obsession with Parfit’s mere addition paradox. Economics does not see a paradox but rather a rational how-to-manual. The pragmatic recognize the irrational at times should be preferred.
P.L. Travers, Author of “Mary Poppins,” Separated Identical Twins at Birth
Wow, that is weird in a small world kind of way. As I was reading through the Caplan/Alexander debate, I kept thinking about the documentary Three Identical Strangers. This documentary starts out light and fun but takes a dark turn and ends up being mostly about mental health, parenting (The Nurture Assumption), celebrity, and (for me) progressive misconceptions about all of the above.
I’m curious. What were those “progressive misconceptions”?
The strict father was blamed for the suicide of the triplet under his charge. Separating the triplets for adoption was treated as wanton act of evil. it was assumed that the scientific research surrounding the triplets dehumanized and exploited them. This was living and breathing Nurture Assumption and the film makers seemed oblivious to the concept.
If I remember correctly, it became obvious that the triplets suffered from bipolar disorder and no one raised the possibility that the instant celebrity was not a good thing for young men with this condition. I don’t remember if the question of whether the biological parents suffered from the same condition.
When software gets sufficiently big and complex with lots of interactions between independent modules and systems, there are times the system behaves like it’s mentally ill, and there is no simple way to think about buggy behavior either.
Alcohol definitely has very adverse physical effects on the brain which takes a few years to overcome. It is not a case of mental illness.
I think the compulsion in the presence of the stimulus is as powerful in chronic alcoholics as it is in obsessive compulsive disorder. The toolbox to deal with both disorders is the same. The specialist who has mastered this toolbox is the same. You can say Scott Alexander is a coach instead of a doctor and you can say his clients are behavioral outliers rather than mentally ill. This is just marketing wordplay aimed at shaping public opinion rather than changing the process for anyone with skin in the game.