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Jun 29, 2023
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The opposite is the case, Caplan hardly wants to talk about those at all. He's a libertarian economist much fonder of Szasz' ideas than the typical libertarian economist, and so modeling mental illnesses as preferences follows naturally from him. The reclassification of homosexuality is just a piece of evidence that Szasz/Caplan can cite to claim psychology/psychiatry is political rather than scientific.

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But it's obviously some amount of both. I guess it's understandable that they're miffed about their opponents (also understandable) reluctance to admit the political component, but going off the deep end in response doesn't seem like the greatest idea.

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If the field was "obviously" scientific then pseudoscientists like Freud & Jung wouldn't have been such big deals :)

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I'm very sympathetic to this line of criticism, except coming from economists it's prime pot calling kettle black territory.

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You might be surprised by how much better economists are than other social scientists:

https://twitter.com/cremieuxrecueil/status/1650932077267767297

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I'm not sure I understand what's going on there. Can you help me figure it out?

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No, I think if there's a specific aspect of this that excites him, it's alcoholism, degenerate gambling, drug abuse, etc. Certainly, alcoholism is his go-to referent. Over the past several decades, these pathologies have been re-imagined, so they are now seen as mental diseases rather than personal and moral failings, and Caplan doesn't like it.

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That was my sense as well. I'd love to hear from him about that so we don't have to guess about it.

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Jun 29, 2023
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If true, then that's a tale as old as Aesop. "Bah! The grapes were probably sour, I didn't want them anyways!"

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He’s been on it for many years, academic articles with this argument going back decades.

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No, he was making Szaszian arguments long before TikTok existed. I have no idea where you got your idea.

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Right, the first piece Caplan published on this was in 2006 https://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf

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Mental illness is physical illness is illness. It’s all the same stuff at rock bottom. Maybe Caplan is in some senses just a dualist. Or he believes in a “faculty of will” that just decides things.

And it’s hard to believe he’s ever really known a severely mentally ill person in his life given how he misunderstands it.

Great article thanks for writing.

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I think he is a dualist. He believes in free-will, and rejects cryonics because he doesn't think an emulation behaving exactly like him will really contain his consciousness.

I believe Greg Cochran would agree that mental illness is physical illness, and his primary criteria for determining if something qualifies is its effect on Darwinian fitness.

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I'm sure Cochran's real criteria are more complex, but as written doesn't that suggest that not-having-ADHD is an illness?

(ADHD people tend to have more children - my theory is that they're too impulsive to use contraceptives)

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If it only applies in our unusual environment with contraception, then he might make an exception (his criteria for assuming a pathogen involves both the loss of fitness and having been around a long time). He has mentioned that normal mating preferences we've evolved would result in men finding a robot attractive if it actually resembled Sean Young in Bladerunner, even though that wouldn't be conducive to fitness (he wrote that prior to the release of Bladerunner 2049).

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Is there a reason why it's obvious which of ADHD and not-ADHD we should consider the diseased state?

Not-ADHD seems more adaptive for the exact modern first-world environment with schools and office jobs and taxes, etc. But ADHD seems perfectly adaptive to plenty of other actual human environments that still exist, have existed, and will exist again.

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I don't see how this is true? Non-ADHD seems to mean you can shift your attention when you want to, vs ADHD which seems to mean your attention shifts without your control. What environments is that more adaptive for?

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I think that's not the most productive way of looking at it. Non-ADHD means it takes longer for your attention to shift without your control, but it will shift eventually. Moreover, your attention shifting without your control can be beneficial, because it prevents you getting stuck in a rut, or eaten by a hostile predator while you're gazing at interesting pebbles. I've seen it likened to a safety mechanism for your attention.

So the question is do you want a relatively relaxed safety mechanism, or a relatively trigger-happy mechanism. Compared to the ancestral environment, today we spend more time poring over boring spreadsheets and less time running from predators [citation needed] so ADHD has become less adaptive.

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fair, I can see how it might be more like a spectrum!

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This might be controversial, but it seems like ADHD is also correlated with some positive traits like creativity and responding well (and quickly) to surprising and unfamiliar situations. These are definitely adaptive traits.

And, given that the negative effects of ADHD are almost invisible in a large number of environments (notable excluding the environment of modern highly-organized first world society), the benefit doesn't need to be very large for ADHD to be more adaptive than not-ADHD in these other contexts.

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Since becoming a mom to two kids, I’ve found my mild ADHD feels so much like an adaptation for motherhood I’ve actually put off trying Ritalin so I can leverage it until they start school. As a parent you get interrupted constantly. For my husband who has excellent focus, this is *exhausting*. For me, it kind of slots into the “normal”(typical?) functioning of my brain. There was space in my head for incessant gear switching and noise, and while it is tiring and annoying at times, it doesn’t leave me wiped out the like it does to my husband. I’m convinced that it the tendency to ADHD must have served some purpose, at least when its expression is fairly mild.

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That's very interesting to hear! I hadn't considered the other side of the coin (that being interrupted with 'normal' focus levels leads to exhaustion).

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This is my experience as well. Whether I have ADD or not, I was diagnosed with it as a kid and put on medication... As a mom-of-four I don't need any medication to get through my day. Starting things? Yes, I have hundreds of things to do each day. Finishing them? Housework is never done. There will always be more dirty clothes or hungry kids or books to read... Many of my duties are simultaneous, like cooking breakfast and feeding the pets and watching the baby. Focusing on getting one task "all done" would mean not doing any of the other tasks, which would be bad!

I think of it as "working in circles": doing a little bit of each task until I arrive back at the beginning.

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I suspect this is true for many mental illnesses, and for that matter, some physical illnesses. PTSD is likely more adaptive in an environment where you experience trauma with no hope of escape, such as slavery. Anxiety is likely adaptive if conditions are constantly life or death. Obesity is likely adaptive in societies with frequent famines.

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> Is there a reason why it's obvious which of ADHD and not-ADHD we should consider the diseased state?

You wouldn't want to consider either of them a diseased state. That's just natural variation. (Of course, that's exactly what Caplan wants to say about everything.)

The fact that a particular strategy outcompetes every other one in a particular environment does not mean that following other strategies is a symptom of a disease. We maintain reservoirs of genetic variation because (1) innovating new adaptations is extremely difficult, and (2) the environment frequently changes. Thus, we hold on to our old adaptations, in the form of people who struggle to reproduce, against the day when they turn out to be superior to us in the face of some new feature of the world.

As I point out in a root-level comment sidethread, the better way to think about "disease" or "not disease" is whether or not you are functioning as intended.

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For another example, would that mean that Alzheimer's is often not an illness, because at the onset of symptoms the person involved has already reproduced as much as they were ever going to?

(Based on my limited understanding of when Alzheimer's usually manifests and human fertility rates as a function of age)

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I think one's ability to boost one's fitness declines more gradually than that. Women have menopause, but it's believed the reason that evolved was to push them toward boosting the fitness of their existing offspring rather than trying to have more, and Alzheimer's would reduce their ability to do that.

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^ this. Everything bad that happens to a member of such a social species as ours decreases fitness. Fortunately for us we've had enough extra fitness that we've been able to absorb the cost of our best hunter or spearmaker slowly declining from old age, or even our best warrior losing his right arm and requiring subsidy as an honored hero. But cost there always is.

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In a sense, it's obvious that our "healthy" state, as judged by ancestral environment standards, is sub-optimal in terms of fitness in the post-industrial environment. The not-having-an-urge to donate to sperm banks is a popular "disability" to mention around these parts.

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The ADHD people having more children thing. Is this sex differentiated?

I could see it being forgetfulness/inattentiveness/in-ability to keep to a routine/schedule/habit. If so I would say forgetting to take the pill sometimes would differentiate from males "forgetting to put on/bring a condom" if we are presuming the partner is on average neurotypical and it takes two to tango.

Lack of condom etiquette in my opinion would be much much harder to go by unnoticed in the moment. I would expect in a theory like this for there to be more adhd women than ADHD men having a higher than average number of kids?

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Scott has proposed a theory and you are investigating his theory, but is there any evidence that the underlying assertion (ADHD people have allegedly have more children) is actually true? Do you have citation(s) for the assertion?

As an assertion about humanity globally, I can't think that that can possibly be true. (Shrug.)

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I have no citation! Honestly I just kinda went with the assertion based pretty much on respect for Scott, and the assumption he had seen something credible and I got caught up on modeling the causes and was too distracted/polite/cowardly to ask for a source.

I would love if someone could link on any source for the base claim!

I mostly just jumped on this as, over the last two weeks, I've been investigating ADHD stuff since it turns out if you draw a box around all my "personality quirks", issues, idosyncracies etc I have been coping with undiagnosed ADHD for 30 years now. Just got out of a psychotherpist who specializes in it and yuuuup.

The last 10 years would have been a looooot different with some Ritalin or what-have-you.

Turns out fundamentally not being able to connect your knowledge and values with your actions is not something one is supposed to be hugely struggling with every moment of every day to this degree????

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Hard to speak for Cochran, he's a very clever man. But I wonder if he *would* think not-having-ADHD is a disease in modern conditions. After all, give it a few generations and all-other-things-being-equal beyond the realms of sanity, and the whole population will have ADHD, and the few weirdos who refrain from breeding when they get the chance because of something that happens in their heads will look mysteriously asexual.

Is asexuality a disease?

I'm far from asexual but as far as I know my preferences have resulted in me having no children, and I'm not signed up for cryonics either. I'd be happy to call that a disease in the Darwinian sense. I don't expect there to be many copies of me in the future.

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"Is asexuality a disease?"

I'd be willing to say it's a disorder, and I'm speaking as one. Given that 99% of the humans around me would crawl over broken glass to get their ashes hauled, being "nope, not one glimmer of interest in anyone or anything" does look unnatural or at the least 'something went wrong in the wiring'.

I'm very happy the way I am, but from the way the rest of yiz go on about "what makes us human is the ability to love" (where love means romantic/erotic love), then I'm a robot or an alien not a human. Fine by me!

I wouldn't say it's a choice, as such; I didn't choose to be this way. Caplan might say I could always choose to have sex, so it's not whatever. Well yeah, and I could also choose to stick my hand in a blender, but I'm not gonna do that either, Bryan.

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"get their ashes hauled"

I'm not familiar with that saying, but in context is that a euphemism for having sex?

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I learned it all from seeing this performance on TV back in the 80s 😁

https://www.youtube.com/watch?v=ZLoPKQZRjOQ

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"Too impulsive" is one explanation, "staying on top of birth control appointments and timing isn't trivial and requires executive function" is another part of an explanation.

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This is a very careless sort of metric, but perhaps there's a difference between a trait which harms Darwinian fitness and the lack of a trait which aids it.

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"ADHD people tend to have more children" What?

Could you please provide citation(s) to support this assertion?

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"Both men and women with ADHD have

been shown to become parents earlier than adults without ADHD and to

have more children compared to adults

without the disorder (Barkley et al., 2008)"

I don't have access to the initial study, but the study that cites it is here: https://guilfordjournals.com/doi/pdf/10.1521/adhd.2016.24.7.1#:~:text=Both%20men%20and%20women%20with,context%20of%20a%20supportive%20romantic

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I’d argue strict physicalism rules out true emulations of our consciousness. Our consciousness is literally in the physical stuff of our brains; the substrate does matter. There’s no uploading. An emulation of a hurricane doesn’t get you wet, as they say. And an inorganic robotic arm that is functionally indistinguishable from a human arm doesn’t make it a replica of your arm.

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I dunno, what if consciousness is literally just electrons in a neural net? Then all we'd have to do is connect your brain to the new substrate before killing you.

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Why electrons?

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They seem generally important to computation, in both digital computers and possibly in brains. It does raise the question of whether non-electrical computers could have consciousness I guess. But it seems like as good a starting place as any to me.

I guess the basis of the intuition besides that is just that electricity is the only other thing besides the whole network which is involved in the whole network.

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Even an abacus contains electrons

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It's true that electric charges are important in the brain, but they are carried by ions and not by electrons.

Excitation is generally caused by an influx of Sodium (or calcium) ions, inhibition by an influx of Chloride ions, getting back to the resting state from a depolarized state is caused by an outflow of potassium Ion. Release of neurotransmitter after an action potential is triggered by an influx of calcium ions.

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What if I start replacing your neurons one at a time with artificial versions? At what point do you stop being you?

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There is no essential “me”.

EDIT: What are the artificial neurons made of? If they are made of the exact same stuff as the rest of me then there's no difference. If they're made of inorganic material then that's an (interesting) empirical question we may be able to test someday as to whether your thought experiment is even possible.

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No one mentioned an essential you, they mentioned a physical you

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Wait, so you're saying that consciousness is tied to the form the matter takes? You're mostly made up of carbon, hydrogen, oxygen, and a few other things. If I made an artificial neuron out of those things that didn't look like a natural one, but performed the exact same function, would you count that as preserving consciousness? What if I took a neuron from another person instead? What if I used a particle collider to synthesize atoms from hydrogen and put together an atomically identical neuron, and replaced yours with those?

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"Wait, so you're saying that consciousness is tied to the form the matter takes?"

This is far from rare - it's what John Searle uses to argue against conscious AI, for instance, that matter and not merely abstract function is what's relevant. I don't *think* this is the case, but it isn't silly.

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" If I made an artificial neuron out of those things that didn't look like a natural one, but performed the exact same function, "

That's a big if. Compare with proteins: They only work because of the shape which is dependent on the their composition and the environment in which they exist.

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Given the number of neurons in a typical human brain and the typical human lifespan, "when I die of old age" is probably the correct answer here.

Though to be fair it's less than two orders of magnitude off if you're replacing one per second.

The worry is that there's one neuron in particular in there that, when you disconnect it, everything goes black for *you*, and after that it's just something else wired up to the meatsuit you were piloting. And, for obvious reasons, "you" are not going to have any way to protest that they've made a mistake, because "you" are lost in an increasingly large sea of thirty-or-so excised neurons per second.

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What if you start replacing my neurons one at a time with tiny pieces of plastic? At what point do I die?

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There's uploading in the sense that it creates two instances of your consciousness, with all the gnarly moral questions about what, if anything, to do with multiple instances of "yourself", at what point they sufficiently diverge and become unique etc. etc.

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Have you ever heard of the Moravec Transfer? An interesting thought experiment that you might enjoy philosophising about!

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This kind of "physicalism" is ruled out by physics, since fundamental particles have no persistent identities over time.

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You can't just say "the substrate does matter" without giving any reason to believe that. "An emulation of a hurricane doesn’t get you wet" is an analogy, and analogies aren't evidence, just hints. An inorganic robotic arm is not a replica of a human arm, because the definition of "replica" includes being made of the same material.

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Making claims about other people's internal mental states is fraught at the best of times. The strength of behaviorism is that it only talks about observable phenomena. The weakness (of the strong version) is that its predictions are shit.

In the language I prefer, behaviors are the observables, but there ARE hidden-variables.

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When it’s an illness, yes. The problem is that it’s not always clear when something is an illness. Is it an illness for the second toe to be longer than the first? It doesn’t make someone’s life much worse, so we say no (though it is annoying how many shoes aren’t shaped well for this condition). Similarly for being gay.

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We say no mostly because the liberal individualist paradigm has crushed the conservative collectivist one as far as elite tastemaker opinions are concerned. LGBTetc. expression was (more or less) suppressed for thousands of years on conservative grounds. It's not clear whether this was ever optimal even on conservatives' own terms, but the toe analogy would've never been considered relevant until the last 60 years or so.

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What work is “elite tastemaker” doing here? Do elites have different views about toe length or am I misunderstanding something?

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Hm, probably misunderstanding. Elite tastemakers hold high-status opinions. Previously, "homosexuality is a society-corrupting sin" was an elite opinion, whereas now it's one that only an irrelevant fringe holds. Nobody has ever thought that having an unusually-sized toe has any society-wide implications.

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I am pretty sure there is a history of body modifications or corrections that involve changing indivduals feet to match elite tastes.

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Yeah, it’s inconvenient to have Greek toe. I do have trouble finding shoes that fit, but at least I have good company. The lady portrayed in the Statue of Liberty is in the same boat.

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TIL my toe is weird

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Disagree. I read several papers by an obscure mid-twentieth century cardiologist that explain very clearly how what mainstream medicine derisively calls "heart attacks" are really just the body's physical expression of a preference for reduced blood flow. You're welcome to read me sledgehammer every modern example of physical illness into this conceptual framework at great length at my new Substack, SitOnIt.

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Right. Just because I can't tell you exactly how many grains of sand constitute "a heap" does not mean that "heap" is meaningless or a false category. And no amount of pointing to edge cases on the definition of "heap" will make the Sleeping Bear Dunes cease to be a major geographic feature.

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I don't think Scott is arguing that the distinction between constraints and preferences is meaningless; he gives examples of things that are clearly on each side. It's more the claim that Caplan's attempt to draw a clear boundary doesn't work because there is no clear boundary, so if we're considering edge cases we need to take into account that they are genuine edge cases where the categories don't work well.

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To make this a bit more precise, if Caplan is arguing that a condition has some property of a preference (you could stop it if you had a gun to your head) therefore it can't also have properties of constraints (like deserving help to cure it), pointing to the existence of edge cases is a reasonable counter-argument. What matters is not whether the category exists at all, but whether it's fuzzy or mutually exclusive.

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Caplan explicitly said that the flu changes both your constraints & preferences.

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So to steelman his model, we need to be trying to determine for each individual patient and illness to what extent they have a constraint vs preference and then tailor our treatment (aid/gun to head) based on that? I am wondering how that will do useful work.

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If diseases vary in the extent to which they are preferences vs constraints then that DOES indeed affect how we should respond. The late Mark Kleiman in a Bloggingheads episode noted that the "disease model of addiction" is falsified by Mao's success in clamping down on opium addiction, and that this fit with the most successful treatment for opiate-addicted doctors being monitoring with consistent immediate consequences.

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That seems interesting! Has Bryan ever dug into or expounded on that data and what studies/interventions/personal techniques it might point toward?

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Ah, I see how you could get the impression I was critiquing Scott, but my "Right" was, in fact. a genuine statement of actual agreement with Scott.

My intended point was rather that Capalan's "no preference is a disease" amounts to "no number of grains of sand is a heap".

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I'm beginning to see the problem with behaviorism, with which I have limited familiarity. The problem is in a clinical setting it serves the function, or is the thing that currently best serves the function, of preventing neurotypical midwits from making bad and abusive decisions based on bad theory of mind. If you let the average behavioral health professional make any inferences at all into the behavior of an autistic person, or a mentally handicapped person, or whatever, that will lead to dark and dangerous roads pretty consistently. If you want examples of this you can just look at the troubled teen industry, which relies on folk psychology and religious theories of the human mind rather than behaviorism.

Complete digression but I have to say it as it reflects an important takeaway I got from practicing ABA for three years.

The distinction between behavior as disease and behavior as preference that I keep coming back to is whether it preserves optionality or not. This is probably strictly as bad as Caplan's because I have never discussed it with anyone (as a general rule I never have an opportunity to discuss anything with anyone: I am immediately dismissed as aggressive and insane whenever I articulate anything).

So anything that causes death trivially fails to preserve optionality. Anything that cripples a person or reduces their intelligence or health trivially fails to preserve optionality. Getting into a machine that injects an optimized dose of heroin into you continuously while keeping you alive indefinitely trivially fails to preserve optionality, etc. Environmentally I think of this as a problem that can sometimes be solved by reducing the strength of incentives or attractors. Some behavioral incentives are basically singularities to humans in some or even most mental states. I can't think of a good reason any environment should be engineered in a way that creates such singularities.

Please critique, develop, or steal this.

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Given how many people have accounts of being abused by ABA practicioners and how openly abusive Ivar Lovaas was, I think you're either wrong about behaviorism preventing abuse, or gesturing at the existence of some dramatically more abusive environment than all the behaviorism-based abuse I've heard of. I wish I could be more confident that you were just wrong.

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Abuse is the norm in the setting. It was before ABA and if ABA is abolished it will be afterward as well. But yes, the troubled teen industry is worse than the average ABA setting. Diamond Ranch Academy alone has something like a half dozen easily preventable deaths now.

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Wikipedia says that the JRC practices ABA, and they sure also have a death rate: https://en.wikipedia.org/wiki/Judge_Rotenberg_Educational_Center#Deaths

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It's possible my experiences were moderated by unique factors and the overall situation is worse. I don't believe that the people who killed these victims would have not killed them if it weren't for ABA, but you're steering me away from the belief that ABA might have any advantages.

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There is a certain type of person for whom any theory, organizational schema, or ideology is just a pretext under which to conduct and camouflage abuse. There are a lot of these people in certain professions. I don't think ABA solves this problem. I don't think the average person even notices or believes this problem exists for various reasons. My only observation is that for some, theory of mind doesn't exist, they are only capable of falsely inferring antisocial inner states or motives, and getting them to rotely follow mechanical procedures would be a step up for everyone involved given the limited workforce available (the 90-105 IQ pseudo professional range)

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The problem is that “optionality” isn’t that clear either, as all of Scott’s examples show.

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Still feels less bad to me and like it can probably be placed on the grounds of physics and just needs to avoid physical nihilism. I also suspect most definitions of optionality converge rather than diverge and it's just a book keeping problem.

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Ironically, Caplan often criticizes his fellow economists for being too inclined toward behaviorism and not taking seriously intuition & reports about mental states. I'm more behaviorist than Caplan and think he relies too much on the latter sort of evidence.

I do think Caplan's gun to the head test is somewhat stronger than you give it credit: even with a gun to the head you will have reduced capacity with a physical illness relative to your capacity without that, and we don't need to look at a bright line like traveling a specific distance when we have other observables like how fast & steadily you're moving, how heavily you're breathing etc.

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But as Scott points out: even with a gun to the head you will have reduced capacity with many mental illnesses relative to your capacity without that. So this argument is refuted.

(And even with a gun to your head, you will have reduced capacity of you don't exercise regularly, or if you eat a big Christmas dinner. Is not exercising regularly or eating a big dinner diseases?)

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The problem is

1) Several mental illnesses pass the "gun to the head" test, as Scott clearly illustrated in the post, both in terms of having cognitive effects that can't be overcome by any incentive and by empirically preferring the gunshot in extreme cases.

2) In the case of ADHD and I suspect other disorders involving executive dysfunction, the whole nature of the disorder is that the sufferer's ability to respond to incentives is malfunctioning. They can respond to ICNU incentives, but not other kinds. Note that this is a statement about their incentive structure, not their preference structure. Often someone with ADHD has the same preferences as anybody else, but can only take action towards those preferences by reframing that action to satisfy ICNU. (Healthy version: an instant-gratification point system for errands can slot them into I. Unhealthy version: neglecting your work until your boss threatens to fire you can slot it into U.) That is, an ADHD person is operating under the constraint that they are essentially incapable of responding to non-ICNU incentives. So gun-to-the-head, plainly an ICNU incentive, doesn't reveal anything about their preferences, it just removes that constraint.

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What does ICNU stand for?

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Interest, Challenge, Novelty, Urgency. It's a framework for understanding ADHD that comes from ADHD specialist William Dodson. I used it because it's expressed very concisely; I've seen other specialists use different language to convey similar ideas about incentive structures and intention versus action. I'm not sure how widespread it is among non-specialists, actually; I'm not a psychiatrist and I've sometimes been mildly surprised at the way Scott writes about ADHD.

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In other words they just have poor discipline. That is not an illness. Just because you can change a behavior with drugs doesn't make it an illness. If I had spring shoes I could dunk a basketball, that doesn't mean I have "no dunk" illness.

Kid who I believe has a mental illness related to attention: Kid where you tell them "just stand here for one minute and watch your sister play soccer" and you turn your head. When you turn around ten seconds later the kid is off running in the street. This type of lack of focus and ability to follow instructions is consistent throughout their life, and severe consequences change nothing.

Kid who I DON'T believe has a mental illness related to attention: Kid where they are perfectly functional in most environments except work, homework or anything involving self discipline, but severe consequences see immediate improvement in discipline.

This is just an undisciplined person who doesn't actually have incentives to change their behavior, and also seems like it is currently a majority of the people "diagnosed" with this "illness". And the accommodations that are made for them just increase the problem, since it is provides incentives to be "ill" and insulates them from consequences.

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You're far from alone in that opinion. Thankfully, it doesn't really matter what you think unless you're put in charge of some unfortunate ADHD kid or employee. People with the ability to research, diagnose and/or treat ADHD seem to disagree with you on balance.

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>People with the ability to research, diagnose and/or treat ADHD seem to disagree with you on balance.

Well sure if you can make normal human variability into a big business requiring counseling and constant medication why not? Pills pills pills!

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I mean everyone's entitled to their opinion and certainly some mental disorders are incorrectly or over diagnosed. Same with people who get orthopedic surgery, etc etc. But I would want someone trained to diagnose ADHD to be drawing the lines and making determinations even if they get it wrong sometimes. Your second example, depending on other factors, is potentially a central example of ADHD and not even an edge case. Functional in some environments but impaired at school or work and non-responsive to medium-level consequences is a lot of ADHD. Distinguishing that from malingering, trauma, depression, or anxiety isn't easy to do just from watching.

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>Functional in some environments but impaired at school or work and non-responsive to medium-level consequences is a lot of ADHD.

That isn't an illness it is a personality defect. You want to "treat" it with pills whatever, but don't act like it it is some "illness".

I am not someone with "non-dunking illness". I am 5'10".

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What would you think about my kid's friend, who had impulse control problems where he could not stop himself from getting enraged at his classmates, even when threatened with severe consequences? (The consequences eventually encompassed being expelled from a school that he really loved and had good friends at.) He'd try and try to keep hold of his temper, and he'd even succeed for a little while (so there's your improvement -- but only temporarily, like in Scott's post), and then he'd explode in a way that was at least as bad, maybe worse, as if there hadn't been consequences in the first place.

This kid then was diagnosed with "classic" ADHD and put on medication, and now he is perfectly functional and doesn't do that kind of thing anymore.

(Interestingly, he was mostly functional in regard to schoolwork even when he was having his worst anger issues -- he's an extremely smart kid, so even though he also did have the classic lack of focus, he was smart enough that he could get by without focusing too hard. So "perfectly functional in most environments" might fit him, actually.)

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> In other words they just have poor discipline. That is not an illness.

Something feels wrong about this type of argument. Not sure I can put my finger on it, but it sounds like:

"I have a flu. It makes me sneeze all the time."

"In other words, you just sneeze all the time. That is not an illness."

Sounds like: if X can be reduced to components, it is not a true X.

The problem is that "poor discipline" is a symptom that can have many possible causes. Tired people probably have poorer discipline on average that well-rested ones, but that shouldn't make us conclude that being tired is not a thing (because it is "just poor discipline").

From certain perspective, the diagnosis of ADHD is like saying: these people have poor discipline *because of* their shape of brain or their internal chemistry. As opposed to people who have poor discipline merely because of their habits or the incentives they have at the moment.

Basically, by saying that ADHD is "just poor discipline", you seem to imply that a relatively simple set of incentives applied consistently for a few weeks could easily make the ADHD go away. Which I believe is wrong.

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> In other words they just have poor discipline. That is not an illness.

ADHD is directly related to a physiological issue with dopamine. That's why stimulants calm people with ADHD down, while it amps "normal" people up.

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How many people who get pills are actually physically diagnosed with dopamine disorder?

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What do you make of adults who want to change their behavior and focus, but find themselves drifting off at work and they're worried that it's going to impact their job performance, so they go to the doctor on their own to ask for help? Are they faking or is it real?

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That’s not a mental illness that is a performance enhancing drug. And like I said, from a public policy perspective it is a bad idea since it creates an arms race.

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But why should people believe you have a healthy capacity that is greater than your current one just because you say you’re impaired?

Verifying the greater, healthy capacity can be tough, even if one is really present.

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People should believe it if the person has demonstrated that larger capacity earlier. And certainly determining someone's maximum capacity is going to be more difficult than checking if they can meet some minimum, but so what?

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The Prader–Willi syndrome reminds me of the taxxons from the Animorphs series.

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Same, I wonder if it served as an inspiration, or if "ravenously hungry to the point that you will eat until you explode" is a more general trope that people would come to even without knowledge of that or similar illnesses. Another historical example, although I don't think it's known which disorder in particular caused it, is Tarrare: https://en.wikipedia.org/wiki/Tarrare

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Some dog breeds sometimes eat themselves to death if given unlimited food. Many pet owners have heard about this, so that could be another source of inspiration.

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I have heard this about horses as well.

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The phenomenon is called "eating to gorging". It's not so much that the animal will kill itself. It's whether or not it will hurt itself by eating excessive food if that much is available. People who work with animals (e.g. the large majority of all premodern people) need to know which ones will eat to gorging and which won't. It is, as illustrated here, most typically thought of as a trait of the species, though there is abundant evidence that some individual humans will eat to gorging in the presence of sufficient food and others won't.

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That story essentially sounds like a real-life case of the first victim in the movie "Seven".

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I said something to this effect on Caplan's post itself, but his ideas on mental illness are the perfect example of the incoherence that results from applying market-based reasoning to areas outside its proper domain. Markets and economistic modes of analysis are useful tools, but when you insist on applying them to literally everything you end up with nonsense like insisting mental illness doesn't exist because something something preferences. Remember people: just because you have a model that can explain a lot of things in a really cool way, doesn't mean you have to apply it to literally everything in the universe!

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This is precisely what Caplan is responding to in his post on Scott getting married (the mental illness angle is just that Scott had made a similar argument about economics in an earlier post).

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Looking at that post, Caplan seems to be saying "look, you admitted to applying economics to an area people don't usually apply it to! That means I'm right and you should apply it to literally everything!" which seems like a gotcha that still isn't strong enough to imply the very extreme claim he wants it to. You can say people should apply economistic reasoning to more areas than they currently do, while still recognizing there are some areas it simply doesn't apply. All that one would have to say in response to this post is that marriage is an example of the former, and mental illness the latter.

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That just raises the question of why we should believe it applies in some areas like marriage but not others.

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I suppose because upon observation, in some cases it makes predictions that mesh with empirical reality, while in other cases it doesn't.

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