Stupidity as a mental illness

PhilGoetz

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25 Stupidity as a mental illness

by PhilGoetz

10th Feb 2017

3 min read

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It's great to make people more aware of bad mental habits and encourage better ones, as many people have done on LessWrong. The way we deal with weak thinking is, however, like how people dealt with depression before the development of effective anti-depressants:

Clinical depression was only marginally treatable.
It was seen as a crippling character flaw, weakness, or sin.
Admitting you had it could result in losing your job and/or friends.
Treatment was not covered by insurance.
Therapy was usually analytic or behavioral and not very effective.
People thus went to great mental effort not to admit, even to themselves, having depression or any other mental illness.

"Stupidity," like "depression," is a sloppy "common-sense" word that we apply to different conditions, which may be caused by genetics (for instance, mutations in the M1 or M3 pathways, or two copies of Thr92Ala), deep subconscious conditioning (e.g., religion), general health issues (like not getting enough sleep), environment (ignorance, lack of reward for intelligent behavior), or bad habits of thought.

Like depression, it may not be possible to develop effective behavioral therapy for stupidity until its causes are understood, the most severe cases may have physiological causes, and pharmaceutical interventions will probably be much more effective than behavioral interventions for such cases.

Like depression, as long as it's seen as shameful and incurable, people won't admit to having it and won't seek help for it, regardless of the type they have.

The only "anti-stupidity drugs" we have are nootropics. But the nootropics we have weren't developed as nootropics. Piracetam was, I think, developed to treat seizures. L-DOPA was developed to treat Parkinson's. No one knows who started using ginkgo biloba or what they used it for; it was used to treat asthma 5000 years ago. Adderall derives from drugs used to keep soldiers awake in World War 2.

And none of them are very good against stupidity. AFAIK, to date, not one drug has been developed by understanding and targeting the causes of different types of stupidity. We have the tools to do this--we could, for instance, sequence a lot of peoples' DNA, give them all IQ tests, and do a genome-wide association study, as a start.

We don't research these things because society doesn't want to research them. People don't conceive of stupidity as a disease that can be cured. We need, somehow, to promote thinking of stupidity as a mental illness. As something drug companies could make billions of dollars off of.

This could backfire horribly. We could see affirmative action for stupid people. Harvard would boast about how many stupid people it admitted.

But if we don't, we could see something worse--people will argue that stupidity isn't any worse than being smart (much as some deaf activists claim that deafness is a culture, not a disability), and demand protection of the stupid as an oppressed minority (or majority). Like this:

We must stop glorifying intelligence and treating our society as a playground for the smart minority. We should instead begin shaping our economy, our schools, even our culture with an eye to the abilities and needs of the majority, and to the full range of human capacity. The government could, for example, provide incentives to companies that resist automation, thereby preserving jobs for the less brainy. It could also discourage hiring practices that arbitrarily and counterproductively weed out the less-well-IQ’ed. ...

When Michael Young, a British sociologist, coined the term meritocracy in 1958, it was in a dystopian satire. At the time, the world he imagined, in which intelligence fully determined who thrived and who languished, was understood to be predatory, pathological, far-fetched. Today, however, we’ve almost finished installing such a system, and we have embraced the idea of a meritocracy with few reservations, even treating it as virtuous.

-- David Freedman [no, not David Friedman], "The War on Stupid People," The Atlantic, July/Aug 2016

An obvious and simple first step to destigmatizing stupidity is to stop making fun of and heaping scorn on stupid people ourselves. I've done this a lot myself, and so have many others on LW.

Stupid people controlling technology and civilizations developed by smart people are an existential threat. To address the problem, we must destigmatize stupidity as being a disease, and treat it, before it's normalized as a protected class.

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Stupidity as a mental illness

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[-]Lumifer8y160

Let's define "stupidity" as "low IQ" where IQ is measured by some standard tests.

IQ is largely hereditary (~70%, IIRC) and polygenic. This mean that attempting to "cure" it by anything short of major genetic engineering will have quite limited upside.

There are cases where IQ is depressed from its "natural" level (e.g. by exposure to lead) and these are fixable or preventable. However if you're genetically stupid, drugs or behavioral changes won't help.

we could, for instance, sequence a lot of peoples' DNA, give them all IQ tests, and do a genome-wide association study, as a start.

We could and people do that. If you're interested in IQ research, look at Greg Cochran or James Thompson or Razib Khan, etc. etc.

We could see affirmative action for stupid people. Harvard would boast about how many stupid people it admitted.

That, ahem, is exactly what's happening already :-/

[-]Vaniver8y120

IQ is largely hereditary (~70%, IIRC) and polygenic. This mean that attempting to "cure" it by anything short of major genetic engineering will have quite limited upside.

It is worth pointing out that the heritability estimates are determined from current variation, and thus are only weakly predictive of what interventions are possible but unknown. (I do expect that if there were an easy way to make improvements here, we would know about it already, but it's very possible that there are hard ways to do this.)

8Houshalter8y

Just because it's genetic doesn't mean it's incurable. Some genetic diseases have been cured. I've read of drugs that increase neurogenesis, which could plausibly increase IQ. Scientists have increased the intelligence of mice by replacing their glial cells with better human ones.

6Lumifer8y

A fair point, but I still expect gene-level interventions to work better and be developed noticeably earlier than any "cures" for low IQ in adults or even kids. Notably, after the low-hanging fruits have been picked (malnutrition, lead, etc.), there are no clear avenues for advancement. At the moment we don't have a clue as to where even to start looking.

-2Houshalter8y

Well there is a lot of research into treatments for dementia, like the neurogenesis drug I mentioned above. I think it's quite plausible they will stumble upon general cognitive enhancers that improve healthy people.

6PhilGoetz8y

Depression is, according to Google and web pages I haven't studied, polygenic and 40-50% heritable, yet medicine often works for it. It isn't especially hard to develop drugs for genetic diseases. Genetic diseases have single points of attack--receptors to block, proteins to disrupt. "Polygenic" may not matter at all; that may just mean there is one pathway with 30 genes in it, and 300 genes impinging on it, and you need to supplement the pathway's end product. I wasn't going to mention it, but I thought of that example because Harvard's current admissions website boasts that it provides no merit-based financial aid. I thought that was odd when I read it, but it fits in with the idea that a meritocracy is morally objectionable.

2Lumifer8y

For simple genetic diseases where an uncomplicated biochemical mechanism has been knocked out and you know how to fix it. We don't know where even to start for intelligence. Here is a different angle of view on basically the same problem: after people turn 60-70 years old, they start to become stupider and it's a fairly rapid and continuous decline. Why? We don't know. How to fix it? We don't know. You misunderstand. Harvard, being a very rich and a very prestigious school, has a what's known as "need-blind" admission. That means that if they accept you, they will find money to pay for your education even if you're dirt poor. They will not turn away anyone who got accepted but doesn't have the money. Given this, there is no particular need for merit aid.

0Protagoras8y

I'm curious about your claim that at 60-70 years old people start rapidly becoming stupider for reason we don't know. I thought that I recalled reading that while the various forms of dementia become immensely more common with age, those who are fortunate enough to avoid any of them experience relatively little cognitive decline. Unless you mean only to say that our present understanding of Alzheimer's and the other less common dementia disorders is relatively limited, so you're counting that as a reason we don't know (it is certainly something we don't know how to fix, so you win on that point).

2Lumifer8y

I mean things like this.

0Protagoras8y

Hmmm, thanks, but that research doesn't seem to make any effort to distinguish people with diagnosable dementia conditions from those without, and does mention that the rates can be quite different for different people, so I can't tell whether there's anything about it which contradicts what I thought I remembered encountering in other research.

2Lumifer8y

You can look at the UK study directly: paper. They explicitly mention that they are interested in "normative (i.e. non-pathological) age-related differences in cognition" and that they took pains to get a representative sample. If you accept that their sample is representative, it does show major cognitive decline with age regardless of who got diagnosed with what. That decline is not subtle.

0[anonymous]8y

I agree. In fact, it might be more accurate to say that all their aid is merit-based. Certainly they would believe it is.

-2ChristianKl8y

When placebo's have more of an effect on depression than the actual drug I'm not sure that's s good description.

2RainbowSpacedancer8y

That already seems pretty different to what OP is talking about. See - This seems more like stupidity is anything anti-instrumental rationality rather than IQ based. I don't necessarily disagree with anything you've said, but I'm pointing out you might be talking past one another.

2Lumifer8y

Instrumental rationality is often hard to judge since you don't know what the person is optimizing for (not necessarily consciously). The classic Hansonianism ("X is not about X", e.g. "Politics is not about policy", etc.) is one way is which you can be wrong about someone's instrumental rationality.

[-]Bound_up8y150

Love the idea...

I think the key disconnect here is that (AFAICT) you mean that we should treat stupidity as a mental illness in the idealized way we're trying to get everyone to treat the mentally ill (see this video: https://www.youtube.com/watch?v=0B5nfkaeplc)

We don't think of mental illness in such an accepting way yet. Maybe when we do, saying that stupidity is like mental illness is like physical illness is like something that deserves sympathy and help will make sense, but right now it sounds more like prejudice.

I see what you're saying and appreciate the insight, and will try to treat stupid people with sympathy instead of frustration, but think that this comparison doesn't quite work yet.

1WannabeChthonic3y

Prejudice is a good word for describing this post. The article really tries to make the point of "we need less stupid people" without drilling into the "why" and without considering a basic ethical viewpoint.

[-]c0rw1n8y100

http://www.gwern.net/Embryo%20selection

8gwern8y

One interesting aspect of my analysis I would like to highlight is the part on multiple selection and genetic correlations. The immediate implication is that estimates of the value of embryo selection for IQ will be considerable underestimates if they ignore the many other traits that this selection will improve, and also that it is both feasible & desirable to make selection choices based on a weighted average of many polygenic scores. But this has had much broader implications for how I conceptualize the genetics of intelligence. (The following is based on too many papers to easily list at the moment, but if you read through my genetics bibliography compilation you'll find cites for a lot of these.) I used to think that IQ variants were relatively neutral and specific to IQ, and variance in the population was maintained by selective neutrality (ie pro-IQ variants being too metabolically expensive or developmentally fragile to be selected for) and so arguments like in OP that 'we should describe IQ boosting as instead reducing stupidity or reducing the risk of intellectual disability' were, more or less, dishonest rhetorical tricks. (The ID claim is particularly questionable; most ID is from single mutations of large effect, stuff like embryo selection isn't going to override that.) Cochran had discussed the possibility of genetic load and 'grit in the gears' from rare variants, but the GCTAs indicated that most of the additive variance was explained by rather common genetic variants (common being >1% of the population having it) and whole-genome studies looking into de novo mutations and counting rare mutation load and finding it not hugely predictive eliminated that as an explanation. So it looked to me like it was more the case that the glass was half-full and there were 'genes for IQ' rather than 'lack of genes against IQ', and the highly general benefits across health & longevity were due to downstream effects like Gottfredson argued, in being able to take ca

0EmilOWK8y

Multiple selection is discussed in the animal breeding literature. See e.g. this review. Samorè, A. B., & Fontanesi, L. (2016). Genomic selection in pigs: state of the art and perspectives. Italian Journal of Animal Science, 15(2), 211–232. doi.org/10.1080/1828051X.2016.1172034 Sometimes the traits selected for are negatively genetically correlated. This slows down the process, but does not make it impossible unless the genetic correlation is -1.00. For humans, most of the traits we want seem to be positively related, with a few exceptions. Sometimes bipolar and IQ have positive relationships, which may be undesirable. Bipolar is associated with creativity however, so perhaps it's not entirely bad. A larger problem is the negative genetic correlation between fertility and IQ. There's also myopia and IQ.

[-]ChristianKl8y100

Our way to measure IQ is build on the core assumption that IQ doesn't really change. Our way to measure depression is on the other hand build on the assumption that depression changes over our lifetime.

We likely need a new way to measure intelligence or stupidity to say well that a treatment increases it within a span of a year.

4PhilGoetz8y

That's a good point--if a type of question on an IQ test shows variability from year to year, do psychologists say it's a bad type of question and remove it from the test?

7gwern8y

Yes. A high test-retest correlation is one of the most basic criteria for an IQ test question or any inventory/item intended to measure something which is considered reasonably stable. (If it can't even measure itself, how is it going measure anything else?)

2ChristianKl8y

As far as I understand, they do. Or they say that there are training effects and those count really count for the true IQ.

0Richard Korzekwa 8y

They do, but there are also efforts to develop tests that measure other important aspects of cognition, which have an important bearing on things like how well you can function in society and how much of a risk you are to other people (these tests are, more or less, measuring what the rationality community might refer to as rationality). See, for example, What Intelligence Tests Miss: The Psychology of Rational Thought by Keith Stanovich.

2username28y

The situation here is a bit comparable to the standard test for psychopathy, which includes questions like "did the patient ever harm animals as a child?" The test was designed by a psychologist, and not meant to be used in a criminal justice context. But it has nevertheless become standard. The problem is that it makes rehabilitation extremely difficult -- you can't change answers to historical questions, so rehabilitated criminal psychopaths are sometimes unable to score high enough to have their status changed, which affects parole options. Not directly relevant, but a comparable to study if someone seriously takes a stab at a "stupidity test."

0ChristianKl8y

I'm not sure that's completely true. Rehabilitation is difficult in principle. Parole boards should not put dangerous people on the street even if they have improved slightly. In a perfect world, parole boards would give the credence for recidivism and have credence calibration based on it. People on such a board can use questions like "did the patient ever harm animals as a child?" to inform themselves to the extend it helps them make better predictions.

0username28y

Put "psychopath test parole" in your favorite search engine and you'll find plenty of media coverage over the issue.

0ChristianKl8y

Yes, there's are people who complain about the metrics and who think they are unfair. The makers of these scales also don't like them to be used for this purpose. At the same time I'm not convinced that the metrics aren't up to the task.

-1WannabeChthonic3y

Yes, IQ tests are medical measurements and they're helpful to medical practitioners. Yes IQ is only loosely related to what we call "intelligence" in the broader sense. The term "IQ" is really consufing because a) it does not measure intelligence and b) it's not a quotient.

[-]Brillyant8y80

"Stupidity" is a...word that we apply to different conditions which may be caused by deep subconscious conditioning (e.g., religion).

Wow.

[-]Luke_A_Somers8y110

Seems a bit harsh, though after you've debated a few creationists, it doesn't seem so unsupportable.

4DanArmak8y

Do you think it's factually untrue, or normatively wrong, or something?

-2username28y

What's materially different about a God-based religion and the science-centered rationality cult? Other than our miracles actually being real, that is. I almost said "verifiably real", but therein lies the crux of the issue. A religion is basically a foundational system of beliefs, and a framework for constructing new beliefs. That includes even how you verify the truthfulness of statements. Blanket calling religion of all sorts 'stupidly' is oversimplifying the situation, to say the least.

0DanArmak8y

The post doesn't say that all religion is stupidity. It says that one of the things we cal stupidity is subconscious conditioning, and one of the common case of such conditioning is religion. A subset of religion and a subset of stupidity, intersecting. Do you think that's wrong?

[-]Lumifer8y70

No one is going to impose mandatory treatments for stupidity.

A much more likely version is that at some point in the future, parents will be offered an "IQ enhancement package" for their potential kids. Do you accept? This is a much more interesting question.

8ChristianKl8y

In some sense bans on lead are mandatory treatments for stupidity. The same goes for government-mandated addition of iodine to salt.

0JenniferRM8y

It makes me sad to see non-iodized sea salt become trendy in the kinds of circles where vaccines are considered "unnatural" and kids get whooping cough. I think there is a general issue here where "libertarianism" and "paternalism" come into conflict. My preference in nearly all such cases is to default people into the thing that seems to honestly be the best policy, and let people opt out in a way that involves some larger or smaller trivial inconviences if they want to be contrarian for some reason.

0ingive8y

Non-iodized sea salt is trendy everywhere, I blame partly the TV cooks using it in the iconic "grab a pinch"-fashion. I'm not sure sea salt should be mandatory iodized, but areas affected more by IQ loss probably eat processed food which is iodized anyway compared to the new age health crowd. There are a lot of other interventions worthwhile alongside pushing iodized sea salt to 'new health' crowds, like breastfeeding and peaceful parenting. The latter two probably more important in certain areas.

2Elo8y

It's okay, in Australia we have iodine in bread and used to be milk too.

2chaosmage8y

You're right, but gene editing companies might additionally lobby for pathologizing everything they can fix, in order to get the government or charities to make their services affordable for the less affluent.

0ChristianKl8y

It's worth noting that any DNA enhancement package comes with artificial insemination. If parents get a child because their condom broke, they can't use standard DNA enhancement. Whether or not to abort children that are produced naturally will be a big issue even if a parent would prefer IQ enhancement.

0Applesauce8y

That is a more approachable way. ..and still preserves the respect of others.

[-]chaosmage8y50

The simple inroad would be intellectual disability.

Right now you're disabled if your IQ is below 70 and you have trouble functioning in your everyday life. These are 2 to 3 % of the population and there's a societal framework already in place for them.

If you could gradually raise that IQ threshold, you'd achieve much of what you want to achieve here.

I don't know who determines that threshold, but whoever it is is probably more approachable, and more likely to listen to reason, than the public at large.

2[anonymous]8y

Indeed. I'd also like to point out that even though already having this framework in place, we're pretty much clueless om what to do about it. This is despite the fact that these cases should be the most treatable!

[-]aphyer3y40

Let's say I describe a person as 'fighty'. There are two different things I could mean by that:

This person is good at fighting. Perhaps they are large and strong...or skilled at martial arts...or carry weapons...or some combination thereof.
This person is prone to fighting. They tend to resolve problems by fighting. When they dislike something a person has done, they will start a fight.

The first of these I think is...pretty much morally neutral?

The second of these I think is fairly clearly morally bad.

These things are definite... (read more)

[-]Pimgd8y30

So, on one hand, I agree that it would be better if people were smarter on average.

On the other hand, you're using a lot of scary labels. ... Actually, after reflecting a bit, "Stupidity is a mental illness" is the only scary label. But it is a REALLY SCARY label. As in, my overton window is probably shifted, I dunno, 2 or 3 or 4 standard deviations in your direction, compared to the average person. I know about nootropics (at the very least, that they exist). And I'm sort of familiar with this community. And I still got scared reading this.

One o... (read more)

[-]Pimgd8y130

Disclaimer: I have autism. I sometimes worry that despite functioning pretty well in society, some day, people will say "hey, these people have problems integrating with society sometimes! We should cure all the autisms!" and I'll be forcibly "cured" and have my personality (autism is a way of thinking, sometimes, so I think that this counts as part of someone's personality) altered against my will.

Compare with the deaf people, which is BOTH a culture and a disability. Same thing goes on here. I believe that a way should be found to prevent people from being born deaf/with autism (preferrably via curing in the womb, not via abortion, but if people want to abort because their unborn child is deaf/has autism I think they should be allowed to do that because it places a higher burden on the parents). I don't believe you should forcibly (or via social pressure) intervene in people who, for their entire lives, have been deaf/have autism in order to cure them. You should make the means available to them, but it's their decision.

6PhilGoetz8y

From what I've read, most of the protest in the deaf community currently is deaf parents insisting they have the right to deny treatment and audible education to their children--which they want to do because it will be too late for the children to get the treatment themselves when they're adults. If it were possible for their children to get the treatment and learn spoken language once they grew up, and potentially leave the deaf community, parents would have less motivation to deny treatment to them as children.

2Oscar_Cunningham8y

Sometimes I worry that we'll find a way of curing autism in the womb and then all progress in mathematics will grind to a halt.

3DanArmak8y

Another reason to find a cure for stupidity first, then.

0Applesauce8y

yes. Forced treatment might not end well...in terms of emotional scarring, loss sense of identity.

[-]gjm8y110

I would hate to see "treatment" forced onto them because they're not as smart as we'd like.

If the analogy here is with depression, that doesn't seem a likely outcome. Depressed people don't normally have anything forced onto them, unless they make it clear that there's a substantial imminent risk that they'll actually kill themselves.

I think the things that will get a mental illness forcibly treated are (1) that it genuinely makes the person who has it unable to function independently, or (2) that it puts other people at substantial risk. Stupidity has to be really severe before it causes #1; I suppose the question is whether (in a hypothetical world where stupidity is medicalized and treatable) it would often be seen as causing #2.

I do, though, very much agree that the combination of giving "stupidity" a broad enough definition that it applies to a substantial fraction of the population and treating it as a disease seems really dangerous and open to abuse.

0bogus8y

Carlo Maria Cipolla's definition of stupidity is clearly relevant here. (Link is from the Less Wrong Wiki.)

5PhilGoetz8y

Do we force people to be treated for diabetes, cancer, or gout? No; we at most work to make it possible for them to get treatment.

3DanArmak8y

That's the point of this post, I think. Mental illness is a very scary label - because it's a terrible thing to be. And we should work hard on being able to cure mental illness. Stupid is an equally terrible thing to be - terrible to yourself and to your friends and to society at large. We should work just as hard on making people not-stupid as we do on making them not-depressed. But we don't actually work hard on that, and that's a real problem.

0Applesauce8y

Yes, calling stupidity as a mental illness is very offending and dangerous... This can be seen as verbally attacking someone because of its aggressive lying undertones.

4PhilGoetz5y

It's only offensive if you still think of mental illness as shameful.

[-]WannabeChthonic3y10

The contents of this post seem unnecessary ableist to me. We're building a society for all people and thus statements like these carry a rather bad taste:

This could backfire horribly. We could see affirmative action for stupid people. Harvard would boast about how many stupid people it admitted.

This statement shames people which the article previously stamped as "stupid". People with disabilities have the same right to prosper just live everyone else. It seems to me that your post carries with it the assumption that "having less 'stupid' people" some... (read more)

[-]Ernesto Hoffmann3y10

“Stupidity is the result of corrupt decisions, caused by relative intellectual deficit, ignorance, cognitive biases and others. These prevent or distort the collection and storage of information and its intellectual processing, producing decisions without thinking, biased, false, irrational, stupid. "

Kuke Lito, 2019.

I thing it would be very difficult to make a disease out of stupidity, much less to treat it as one.

[-]Mike Coglione5y10

Stupidity is more dangerous than malice. Evil can only persist so long in its destructive nature sowing wreckage before people identify its obvious ills and rise up against it forcing it away or even destroying it by sheer force. It's only a matter of time until people unite and rise up against something malicious.

Stupidity on the other hand is a total loose cannon. The stupid person can not only not be relied upon to accomplish anything of substance but is liable, without their own knowledge or consent, sabotage just about anything they come across w... (read more)

1HumaneAutomation4y

... but malice is the "force" that actually creates "evil" in the first place. I think the intended meaning of the saying "Don't assume malice where stupidity is sufficient [to explain an observation]" is meant to make the problem seem less bad, not worse... At the heart of the intractability of stupidity lies the Dunning Kruger problem. It can be an impossible challenge to make an ignorant person: - admit they are ignorant; - in the process, realize that most of the beliefs and the reasons they had for holding them were entirely wrong; - despite having just realized they need a comprehensive world-view revision find the courage and desire to become more educated while: - having above average difficulties with acquiring new and hitherto unknown and/or too complex material.

[-]Jon Quist5y10

I know a highly educated and well spoken person who is a expert at noticing and making snide remarks about other cars on the road, but he does all the same things; text, not stay in his lane, constantly tail-gates, swerves accross traffic to make his exit, doesnt pull forward so the person behind him can make their order, doesnt pull up to the car ahead of him in the left turn lane (causing traffic jams behind him). But somehow will say "i wish people used their brains more" when somebody tailgates him.

The truth is, people who flaunt their IQ around rarely critisize themselves and only see things from their perspective.

[-]jjeejjee7y10

A diminished IQ, would nor could, be indicative of a mental illness, and I say this because there are plenty of daily examples, you can tell just by observation, that postulate "stupid" people are actually quite healthy. I could actually argue that people conceived as "stupid" present themselves as more charismatic and agreeable then their intelligent counterparts, furthermore, having an easier time acquiring acquaintance with other people.

1Jon Quist5y

I like your point of view. One might suppose that having a exceptionally high IQ puts one at a greater risk of acquiring a mental illness.

[-]dglukhov8y10

I urge you to read the first book of the Evans Third Reich trilogy, in which one of the interesting topics mentioned revolved around eugenics. I fear that the way you've framed your point will prime people towards this direction.

To approach "stupidity", an already vague concept, from a diagnostic point of view would be a disaster. One reason being the history I linked to earlier, eugenics was a popular -enough sentiment then to be a problematic primer, and I fear that while having stupid people around is an existential risk, I think another exist... (read more)

1Applesauce8y

Of course not... I wonder when/if the DSM 6 will come out... Example Intermittent Explosive Disorder... The names speaks for itself in that some children become totally enraged and..explode. Sometimes used to label kids and be done for the day. The implication of this is that, this diagnosis can act as a band aid and not getting down to the root of things for WHY the child is upset. This is how a person can fall through the cracks.

0ChristianKl8y

Most of the problems with the DSM are institutional. I would expect the DSM 6 to have them as well. The way forward would be for another institution to provide a new medical diagnostic system. The European medical establishment might do this. http://lesswrong.com/r/discussion/lw/oe0/predictionbased_medicine_pbm/ might also lead to an organization that has the capability to develop a new and better diagnostic system. An organisation that could easily provide treatments for stupidity.

[-]Dagon8y10

We're not very good at destigmatizing and treating depression. why would we want to carry that model onto anything else?

7chaosmage8y

We're quite good at both, actually, compared to every generation that came before us.

0dglukhov8y

Please name examples to the affirmative. I'm actually quite curious to see such statistics.

6PhilGoetz8y

This is not a thing that we need to check statistics for. Americans now talk openly about seeing a psychologist or having depression. Americans two generations prior did not. Depression was not recognized as a legitimate disease; it was considered a weakness, and psychotherapy was an act of desperation.

2DanArmak8y

I was under the impression that two generations ago, Freudian psychotherapy was all the rage and pretty much universal in certain high-status social circles? Of course, it probably didn't help anyone much. I think that "there's something mentally wrong with many/most people, maybe even everyone by default" has existed for decades as a common belief in some places.

2ChristianKl8y

The fact that it does treated doesn't mean that it can be effectively treated. Kirsch et al (2008) suggested that the treatment with anti-depressives produces only a gain of 1.80 points on the 50 point Hamilton Rating Scale of Depression. What makers you think that it's treated effectively?

0chaosmage8y

Those 1.8 points are 1.8 points over placebo when it is well known that depression responds particularly well to placebo. This study also only looked at first line (least side effects, relatively low effect) antidepressants, it averaged in Serzone which is a particularly weak one that was discontinued 4 years before the study, and it calculated the difference between average drug responses and average placebo responses rather than the average of differences between drug responses and placebo responses, which reduces the perceived effect. For much more, check out http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/

0ChristianKl8y

Do you think that in the past depressives didn't get any treatment that's as good as placebo because they were told that their depression doesn't matter?

0chaosmage8y

Yes. But of course the framing wasn't "your depression doesn't matter" - the concept of "depression" wouldn't even come up. Even doctors would frequently not think to check for it. If it manifested psychosomatically, you'd get painkillers. If it manifested as difficulty sleeping, you'd get sleeping pills. And of course there was always self-medication with alcohol. All of these are worse than placebo in the long term. You could get a depression diagnosis, especially if you made a suicide attempt, but it was much rarer, and not a desirable diagnosis because you could get institutionalized into a psychiatric ward and stay there for months or years (especially if being there depressed you). Before modern times of course, it was basically nothing. If you were lucky enough to see a doctor, and so lucky the doctor was at least equipped with the concept of "melancholia" (basically a catch-all category for mental illnesses), you might be prescribed hot baths and opium, which would have temporarily helped a little. But other than that, your prescription would be prayer and other placebos.

0ChristianKl8y

But what's the problem with that if the difference between placebo's and the drugs is only so small? It's not even clear that praying to a god who supposedly loves you has no positive effects and is worse than the the drugs. There are also a variety of traditional remedies that should at least have placebo effects.

0chaosmage8y

On the treatment side, the difference between placebos and SSRIs is small. But again, SSRIs are only a small part of "the drugs". They're what we try first because they require very little oversight by the doctor and they work often enough, whether by large placebo response or by smaller genuine effect. But if they don't, there are second and third and fourth and more things we can try, ending with electroconvulsive therapy that works really well but is super difficult/expensive to administer. But the bigger difference isn't in the treatment, it is in the diagnosis. Today we distinguish between about a dozen different mood disorders with different treatment plans (although most of these plans do involve SSRIs at some point). And most of all, we've gotten a lot better (though still not perfect) at distinguishing what is pathological and what is, say, a normal reaction to bereavement or an adaptive response to an abusive partner. Without this knowledge, depression would often go unnoticed or one form of it would be mistaken for another. You have depression caused by a testosterone deficiency? You seem to be troubled, go pray. You have depression caused by lead poisoning? You seem to be troubled, go pray. You're decompensating and probably going to have a psychotic break within the month? You seem to be troubled, go pray. Oh, prayer does have some positive effects. We call it religious coping and there are studies that prove it can help with (for example) fear of death in end stage cancer patients. But you have to be fairly intensely religious to get a measurable benefit, and it doesn't help a lot. There are a few studies showing religiosity to be weakly negatively correlated with depression (example), and a few others showing it to be weakly positively correlated (example). If prayer helped a lot with depression the evidence would be much more clear cut. Yes. And terrible side effects, too. St John's Wort and Kava are among the worst examples. Or, again, Opium.

2ChristianKl8y

It doesn't have to be "a lot" to be better than the 1.80 points for SSRI's. Do you have an estimate for the detection rates? How many people who have depression due to testosterone deficiency do you think do get accurately identified by our system? Let alone people who have depression due to lead poisoning. I would estimate most of those not being identified by our present system. Last week I spoke to a person who went to a Freudian psychologists for four years. Partly multiple times per week. They thought it didn't bring them much forward. Depression drugs also have their side effects.

0chaosmage8y

For a single individual, no. But to beat 1.8 points on average across multiple studies with hundreds of subjects, yes that would have to be "a lot". And it simply isn't. Testosterone levels are a standard test, lead poisoning has thankfully become so rare it isn't usually tested. But those are object level distractions from the point that mental health has advanced enormously, and a big part of that is the diagnostic side. Freudian psychoanalysis doesn't (usually) help, of course. That's why I didn't include it in the lists of things that can. Obviously. What's your point?

0ChristianKl8y

I thought we were arguing about actual clinical practice. Testosterone tests do exist but from what I read they are seldomly done in actual clinical practice. Freudian psychoanalysis is still a large part of actual clinical practice. I'm not that certain that St John's Wort really has much worse side effects than many of the regular drugs. It might have more drug-drug interactions than various drugs because it has more active components. There's much money invested into proving that existing drugs do better than something like St John's Wort and we know that this money skrews study results.

2chaosmage8y

Testosterone tests are common in the group that tends to need them (men over 40). Freudian psychoanalysis continues to be paid for by health insurers in Germany for historical reasons and there's an aging cohort of psychoanalysts making their living with it in private practice, but clinics overwhelmingly do CBT instead, even in Germany. What would convince you that St John's Wort is inferior to modern antidepressants?

0ChristianKl8y

I wrote http://lesswrong.com/r/discussion/lw/oe0/predictionbased_medicine_pbm/ for specifying a formal way of how I want to be convinced that something is clinically more effective and better than an alternative. For moral reasons I would also want a clinic who reserves it's right to take people's freedom away to predict outcomes of it's decisions. There might be other reasons to see changes in the system as success. If suicide rates go down, that might be a sign that depression get's treated better. US numbers suggest 15–24 years olds are more likely to commit suicide while people over 55 are less likely to commit suicide. That doesn't suggest a much better system. If you can point to other things besides suicide that caused by depression and the prevalence went down a lot, that might be a sign that our system is more effective. I might also be convinced by an inside view account but it would have to be quite conclusive to overrule the biases inside the system for finding that patented drugs are more effective.

2dglukhov8y

I wasn't aware mental illness was strictly an American phenomenon, as you comment implies. Or perhaps there is a distinct lack of international or foreign effort in characterizing such phenomena, as your comment also potentially implies? I'd like the statistics, please!

[-]Rebecca Losee2y00

Saturday night live needs to apologize for a skit they did on mental illness by calling people stupid. It was very offensive and I am a mental health professional who feels like suing them.

[-]ingive8y00

Rather than forcing people to undergo an alteration of, for example, their genes, you can simply make it a requirement to receiving funding. For example in welfare states (or in a libertarian society, private charities). Other enhancements can be done in a similar fashion, or voluntarily obviously.

If you heap scorn on 'stupid' people or by attribute whatsoever, it's great to note the cause, many times it is probably psychological projection with an underlying anxiety of not being up to part to one's standards.

[-]buybuydandavis8y00

"We have the tools to do this--we could, for instance, sequence a lot of peoples' DNA, give them all IQ tests, and do a genome-wide association study, as a start."

I remember a few years ago the Chinese offering free genomic scans for the sufficiently intelligent. Did anyone sign up for that? Anyone know of how that story turned out? I assume they weren't going to share that info.

4gwern8y

A number of LWers signed up (it was posted here) for the BGI high-IQ project; I believe they got copies of their data. As for the project as a whole: Hsu has mentioned some of how it went, including in a podcast last year which I believe got transcribed; basically, BGI made some disastrous strategic decisions in trying to develop & use a genome-sequencing competitor to Illumina and the high-IQ project got orphaned in the chaos, and is largely irrelevant now as similar high-IQ samples turned up nothing special (so the original premise, that either enrichment would increase power dramatically or that rare variants would be found, I forget which, turned out to be wrong) and the regular GWASes like SSGAC+UK Biobank have made much progress & rendered their relatively small sample mostly irrelevant. Hsu sounded moderately hopeful that something might still be finished & published, but hu knows.

0buybuydandavis8y

So how many 150+ IQ samples did the latest studies have access to? More generally, what's the equivalent general population sample size for the tail sampled high IQ populations? Article about the Chinese Study and it's linking up with the SMPY study http://www.nature.com/news/chinese-project-probes-the-genetics-of-genius-1.12985

4gwern8y

I think they got in the single-digit thousands, perhaps 5-10,000, but I don't really recall. There must have been power estimates done internally, but if there was one ever made public explaining how much power they expected from enrichment, I didn't hear about it. I won't pretend I know the details of what they were thinking sufficient to do my own power analysis, but I didn't think it was a terrible idea at the time; it was worth trying, and the results could always (I assumed) be meta-analyzed with later bigger results.

[-]chaosmage8y00

If you think these are equivalent, I can only hope nobody depends on you for mental health advice.

[-]chaosmage8y00

Depression responds to placebo better than pneumonia does. That's what I mean when I say it responds well to placebo. But depression still responds to modern psychiatric care better than to placebo. That's the linked analysis' main takeaway from the study ChristianKl mentioned.

SSRIs alone do somewhat better than placebo. Modern psychiatric care is way more than SSRIs, these are only one of many tools. There are also anxiolytics and iodine and MAO inhibitors and relaxation exercises and CBT and a whole bunch of other things that all work better than placebo for some patients. And all of them only became available a few years or decades ago.

[-]chaosmage8y00

No I don't. Enlighten me.

[-]Lumifer8y00

That's a bit different and goes back at least to "how can anyone be so stupid as to risk the fires of the eternal damnation". Treatments tended to be... rather drastic.

[-]James_Miller8y00

A necessary condition for anything to be a illness in people not too old to have children should be that it reduces reproductive fitness. Having a sufficiently low IQ does, but having a moderately low IQ, from what I've read, might be correlated with greater reproductive fitness.

6Oscar_Cunningham8y

Why? Reproductive fitness just doesn't seem relevant.

2James_Miller8y

"Nothing in Biology Makes Sense Except in the Light of Evolution" If a condition actually causes you to do a better job of spreading your genes, then to call it a disease seems like to miss the entire point of evolution.

[-]gjm8y160

There is no reason why our values need to be evolution's values.

7James_Miller8y

In the short run yes, but in the long run the only stable equilibrium is for our values to become evolution's values.

8Lumifer8y

There is no stable equilibrium in the long run.

2PhilGoetz8y

This is technically correct, but misleading in context. James' point is, I think, directed towards the idea that for a culture to embrace values that decrease its fitness has a cost, and increases the odds of your culture going extinct. More relevant to us in practice is that such values have an economic cost that inevitably reduces our individual happiness. This is correct regardless of whether you are at equilibrium.

2Lumifer8y

Correct, by so what? We're are talking about what to call a "disease", in the medical sense. You don't want to medicalize "wrong" kinds of culture, do you? That's not obvious to me at all. The point of human life is not to minimize economic costs and I can easily see economically inefficient values generating much happiness.

2gjm8y

The fitness of a culture is not necessarily the same as the genetic fitness of its individuals.

0PhilGoetz8y

I was talking about the fitness of a culture. That's why I said I was talking about the fitness of a culture. Individual happiness is not fitness, but it is of interest to us.

0gjm8y

I know you were talking about the fitness of a culture. But James was talking about the fitness of individuals (that is what is allegedly not harmed by stupidity, after all). Which is why I pointed out that the two are different. Maybe I misunderstood you; I confess it wasn't very clear to me what actual point you were making. I took you to be defending James (even though he was disagreeing with your original proposal). Perhaps that wasn't your intention? I agree that we are interested in happiness as well as fitness (and that was kinda my point in distinguishing our values from evolution's values). I'm not sure exactly what you're intending to say about happiness. On the face of it you seem to be saying that values that reduce a culture's fitness necessarily bear an economic cost (I don't see why that need be true, on timescales shorter than those on which the culture goes extinct as a result) and that economic cost necessarily implies reduced happiness (which also seems doubtful, at least on a timescale of say 50-100 years) but again maybe I've misunderstood.

0PhilGoetz8y

That's basically what I'm saying--well, I think it was; I can't see my original text now. But IIRC I misused the word "necessarily" because I thought doing so was closer to the truth than not using any modifier at all. I wanted to imply a causative link, and the notion that, even in cases where it appears there is no economic cost, the length of and multiplicity of paths from a nation's values to its economic health are so great that the bias towards finding an economic cost on each such path make it statistically very unlikely that the net economic impact is not negative.

4[anonymous]8y

Humans are FULL of weird shit that is not adaptive.

2James_Miller8y

But the weird shit that harms reproductive fitness is under negative selection.

8[anonymous]8y

But it still sticks around. Simple adaptationism is wrong and all kinds of other processes are also at work in evolving systems, especially in multicellular animals with structured populations and piddlingly tiny population sizes compared to microbes.

2gjm8y

That can happen in two ways: we can give up our own values and embrace evolution's, or we can force our own values on the evolutionary process. The latter seems like the better option to me. Or we could go extinct (in the long run we are all dead). Or we could decouple ourselves from evolution entirely (mumble uploading mumble). In the really long run the only stable equilibrium is for us and everything around us to turn into a super-low-density scattering of photons and leptons, too tenuous for gravity to outweigh metric expansion or for any other interactions to occur more than vanishingly often. Does that mean that we should consider something a disease if it tends to move us further away from the condition of being composed of a tenuous gas of photons and leptons?

0entirelyuseless8y

I'm not sure this response is actually coherent. "Force our own values on the evolutionary process" is probably impossible in principle, as is "decouple ourselves from evolution entirely"; uploading would still result in creatures that would make imperfect imitations of themselves, which would mean still more selection, and even faster than before. "Consider something a disease if it tends to move us further away from the condition of being composed of a tenuous gas of photons and leptons"... I do not see a real question here, because nothing can tend to move us further away from that condition. We are always moving toward that condition. In fact when we do things that seem better to us, we are usually moving towards it faster, by expending more energy.

0gjm8y

Really? Consider, for a particularly clear-cut instance which I am not especially endorsing, eugenics. (I don't mean to imply that we could hope to force all our values on the evolutionary process. Any more than evolution can reasonably be said to have, as it were, opinions on most questions of value.) We could move towards it faster or slower. Obviously we should blow ourselves up as violently as possible, in order to be more in tune with the Values of the Universe.

0entirelyuseless8y

I disagree that blowing ourselves up violently would be in tune with the Values of the Universe in the sense we are talking about, for the reason I suggested at the end: if we build Dyson spheres we will generate entropy at a far higher rate and therefore progress far faster towards the tenuous gas. Blowing ourselves up is slow; the high tech things we might really want to do would be fast.

0username28y

There's no reason to presuppose that intelligence correlates with likelihood of spreading genes.

1Jon Quist5y

Its very true. Its not survival of the fittest, it is survival of the sexiest.

0chaosmage8y

Even completely asymptomatic infections are diseases, so it would seem that the people who decide what is and what isn't a disease happen to disagree with you.

[-]Liz Ellis6y-30

You are literally talking about eugenics.

[+]siIver8y-60

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