Grasp the Nettle

NYTimes has an interesting article on Asperger’s and psychiatric classification:

THE Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the bible of diagnosis in psychiatry, and is used not just by doctors around the world but also by health insurers.

Changing any such central document is complicated. It should therefore come as no surprise that a committee of experts charged with revising the manual has caused consternation by considering removing Asperger syndrome from the next edition, scheduled to appear in 2012. The committee argues that the syndrome should be deleted because there is no clear separation between it and its close neighbor, autism.

So Aspie diagnoses have no content? Who knew?
Also, it is humorous the writer sets up this document as their Bible and then discusses the changes they are considering to it …

The question of whether Asperger syndrome should be included or excluded is the latest example of dramatic changes in history of the diagnostic manual. The first manual, published in 1952, listed 106 “mental disorders.” The second (1968), listed 182, and famously removed homosexuality as a disorder in a later printing. The third (1980) listed 265 disorders, taking out “neurosis.” The revised third version (1987) listed 292 disorders, while the current fourth version cut the list of disorders back to 283.

So what a mental disorder is changes according to fashion and societal values? Again, who knew?

This history reminds us that psychiatric diagnoses are not set in stone. They are “manmade,” and different generations of doctors sit around the committee table and change how we think about “mental disorders.”

This in turn reminds us to set aside any assumption that the diagnostic manual is a taxonomic system. Maybe one day it will achieve this scientific value, but a classification system that can be changed so freely and so frequently can’t be close to following Plato’s recommendation of “carving nature at its joints.”

Urgh.

First, a good shake of the fist at Plato and his wretched Essentialism (capital E for irony). Nature has no joints. The taxonomic systems in biology are unavoidably arbitrary to a degree, and have changed over time, though they are useful for certain purposes.

The main issue is not that psychiatry isn’t carving nature at the joints, but that what it seeks to classify is itself dubious. The author is on to something: the fact that the classifications shift so often is an indicator of something. But it’s not an indicator of psychiatry not having gotten down the right methodology yet — it’s that what they’re trying to classify mostly isn’t there. Imagine some superstitious Dark Ages “scientist” being criticized due to his classifications of Demons shifting around all the time; it’d be far better, it is said, far more scientific, if he just adopted some objective principles, like number of horns or tails. This would be missing the point, to put it mildly.

While I’m not quite willing to rule out that some people have something which we might reasonably call mental illness, a lot of the “mental illness” which we medicalize is either caused by really bad ideas (suicidal depression), or is merely a classification foisted on people who are outside of the mainstream (homosexuality as a mental illness, or Asperger’s, or ADHD). Maybe I should reject the whole kit-and-kaboodle, I dunno. But I’m certainly willing to junk most of it. The author, though:

… science hasn’t had a proper chance to test if there is a biological difference between Asperger syndrome and classic autism. My colleagues and I recently published the first candidate gene study of Asperger syndrome, which identified 14 genes associated with the condition.

We don’t yet know if Asperger syndrome is genetically identical or distinct from classic autism, but surely it makes scientific sense to wait until these two subgroups have been thoroughly tested before lumping them together in the diagnostic manual. I am the first to agree with the concept of an autistic spectrum, but there may be important differences between subgroups that the psychiatric association should not blur too hastily.

In counterargument to the argument that the distinction doesn’t make sense, he wants to maintain the distinction so he can do tests to see if the distinction makes sense? Is that how it normally works?
If there’s some objectively measurable criteria of Aspieness (say high IQ plus low Emotional Intelligence or whatever), there’s nothing to stop him from doing tests to find what he thinks are Aspies and then doing his research studies. If there’s not, and he needs the diagnosis to exist so that psychiatrists can unscientifically create a pool of candidates for him to do his studies on via their off-the-cuff diagnoses, well, he shouldn’t want to do that research anyways.

One thing I’ve taken for granted in the past is that two parents are better for a child than one — helping kids is tough, and it seems as though the more help, the better.

There is an issue with this. Three people helping a child is better than two, and four better than three, and so on; there’s no reason to cut it off at the number that seems justified by biology.

But even when you get to two people, the potential for conflict over how to raise the child, what ideas to impart, etc., can be quite serious, and damaging for the child. There’s nothing wrong, of course, with the child having lots of people who want to help them in their lives, but there are serious problems with having multiple people with responsibility for the child in a legal sense.

It’s become an article of faith in the West that even when parents separate, the ideal is for both parents to maintain their relationship with and authority over the child. The old approach was for the mother to get sole custody, a sexist old norm we’ve thankfully been moving away from. But the new approach can be very complicated if the parents have very different ideas about parenting, and among the subgroup of parents that feel the need to divorce, this is probably somewhat more likely to be the case.

Japan has a different solution:

http://www.cnn.com/2009/WORLD/asiapcf/11/11/japan.custody.battle/index.html

A guy who was separated from his wife tried to sneak kids out of Japan and failed. That is not the relevant part. This is what I found interesting: “Japanese law follows a tradition of sole-custody divorces. When a couple splits, one parent typically makes a complete and lifelong break from the children.”

Sounds harsh, and bad. There’s no reason one parent should have to make a lifelong break from the child if the child still wants the parent in their lives to some degree

This is an interesting example though, because it shows that the presumption that things like joint custody are good (or at least, better than the alternative if they are viable) is certainly not a universal one. And I’d bet the Japanese tradition evolved to avoid some of the sorts of problems that are encountered when you do it our way (though I could be wrong).

The strength of the presumption towards sharing legal responsibility for children doesn’t only apply in cases of divorce – the presumption that both parents should be substantially involved in a child’s life is so strong that even neglectful parents who reappear after long stretches of absenteeism are often presumed to have a valuable influence to impart in their child’s lives and a right to exercise authority over the same. This isn’t even a presumption granted to anyone with a biological claim – for sperm donors and parents who give their children up for adoption aren’t allowed to enter or re-enter the lives of their biological offspring. Perhaps this is in recognition of the problems having too many people with claim of authority over a child’s life can cause.

It’s also interesting how much this presumption has held given that both parents working is the norm. Having a dedicated child-raising parent makes a certain amount of sense, but if much of the child-raising duties are being outsourced to other actors anyways, what’s the big deal?

Ultimately, the value of the presumption towards joint custody and authority of multiple parents (potentially increasing the amount of help a child can get) has to be assessed against its very serious cost.

One alternative to consider is a norm placing responsibility for every child in the hands of one parent at birth. This would reduce the amount of destructive fighting, damage to child, and state oversight needed over custody disputes, etc.

This would have to be part of a broader cultural shift, of course; it wouldn’t work if it were statutorily imposed for a couple of reasons. The first is that a major issue with sole custody as it presently functions is one parent trying to override the child’s preferences to see the other parent – a cultural norm towards sole responsibility would require parents to take their children’s preferences much more seriously to avoid this outcome. Another problem is that people might not take the assignment of responsibility very seriously. (It would function like a mandatory custody pre-nuptial agreement, and since people are irrationally optimistic about future, they would delegate the responsibility carelessly, and then eventually litigate it, and courts will allow litigation because they want to do what is best for child now; back at square one.)

Perhaps a more realistic improvement is for the default to go back to sole custody after divorce, but in a non-sexist way? The issue with this, of course, is that while you avoid some of the problems of joint custody, you magnify the potential problems of the judge making the custody decision getting it “wrong.” If one parent has sole custody, but child likes other parent more, the child is more unhappy, whereas if you have joint custody, at least child is happy some of the time. (Of course, if the child winds up with the parent they like, that’s great, and maybe you could increase the likelihood of that by taking children’s preferences more seriously, but it’s a crapshoot in the current system). Also, judges are likely to be biased towards the more coercive parent to begin with (since “structure” and “discipline” are supposedly good things), compounding the problems with this approach.

Do people have other ideas?

Revision 1

People think certain traits are inherent, even when they cause harm.

Why? Sometimes genes are blamed. Sometimes no real explanation is put forth.

• Examples: A person who eats to excess might blame genes. A person who has a temper, and knows this is bad, may say “that’s just the way I am.”

Sometimes people will deny that the trait is bad, and make a claim that diversity is good, even when it includes bad things.

• Example: a depressed person will say “Well, it takes all kinds. Happy people, sad people. Many great artists were depressed. This shows that being depressed is good.”

The failure to appreciate memes’ superior role relative to genes in affecting personality, and the (somewhat morally relativistic) overvaluation of differences in personality, are both topics that deserve and will receive their own analyses in future posts.

For today’s post, though, I want to focus on one aspect of people’s way of thinking about traits and problem solving I think is important. It is a psychological reason I think all these memes are so successful in preventing people from thinking clearly about how to improve their lives and fix their defective ideas.

The issue that I see is this: people would rather be off the hook morally than solve the problem. They think that being wrong indicates badness. They don’t want to be bad.

If they buy the premise that the behavior is bad, criticism of their behavior is seen as pointless victim blaming. They can’t change it.

What they’ve failed to understand is that rational criticism is a tremendously more optimistic scenario. The implication of their current worldview is that they are blameless but stagnant. Is this really desirable? Or is it better, as a rational criticism approach suggests, to be blameworthy but improvable?

No one will blame a paraplegic for not swimming to someone’s rescue. The pessimistic morality of victimhood would suggest that, in approaching life’s problems, it is better to be crippled than capable of failure. This is horrible.

Compulsive eating, anger issues, depression, addiction to substances … these are just a few of the serious problems people try and shift responsibility for. And for what? The pain of the fear that will occur when one looks into the mirror and realizes the force responsible for the issue is looking at them?

This is not to say that these are easy or trivial problems to solve, of course. It is merely to say that it is far better to be on the hook morally for potential failure, than off the hook categorically due to an inability to act. Blameworthiness indicates responsibility, and thus the potential for excellence. Truly, blameworthiness is an exalted state, and one should embrace it, rather than hide from it.

I’d make a joke about how you can’t spell blameworthiness without worthiness, but that would veer the post into dangerously mainstream self-help territory

Edited mildly for grammar and analogy clarity:

The debate around Indigo children is one of those things that leaves me dissatisfied all around.

Essentially,  the Indigo Children movement argues that some children are a quasi-magical next stage in human evolution. There’s some claim of paranormal abilities, but let’s put that aside and look at the more mundane characteristics:

Descriptions of indigo children include the belief that they are empathetic, curious, possess a clear sense of self-definition and purpose, strong-willed, independent, often perceived by friends or family as being weird, and also exhibits a strong inclination towards spiritual matters (e.g. God) from early childhood. Indigo children have also been described as having a strong feeling of entitlement, or “deserving to be here.” Other alleged traits include a high intelligence quotient, an inherent intuitive ability, and resistance to authority.

So in essence, they are curious, assertive, purposeful, and smart. Doesn’t sound like this needs its own useless New Age quasi-scientific concept, but doesn’t sound bad either.

According to research psychologist Russell Barkley, the New Age movement has yet to produce empirical evidence of the existence of indigo children and the 17 traits most commonly attributed to them were akin to theForer effect; so vague they could describe nearly anyone.

This could certainly be a legitimate critique…

Many children called indigo by their parents are diagnosed with ADHD. Robert Todd Carroll points out that labeling a child an indigo is an alternative to a diagnosis that implies imperfection, damage or mental illness, which may appeal to many parents, a belief echoed by many academic psychologists. He also points out that many of the commentators on the indigo phenomenon are of varying qualifications and expertise. Linking the concept of indigo children with the use of Ritalin to control ADHD, Carroll states “The hype and near-hysteria surrounding the use of Ritalin has contributed to an atmosphere that makes it possible for a book like Indigo Children to be taken seriously. Given the choice, who wouldn’t rather believe their children are special and chosen for some high mission rather than that they have a brain disorder?”

I don’t buy Indigo Children theory, but “brain disorder” is a very strong claim, and the tone of condescension in the quote is galling. Does the explanatory power of the theory back up the bold assertion? Some symptoms of ADHD:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new

And there are various proposed explanations, including genetics, diet, and social factors, with no compelling explanatory model.

The symptoms above seem to boil down to “likes to change tasks often (apparently to the annoyance of others), except when the task is fun.”

I don’t think the alternative theory psychiatrists put forward (ADHD) is terribly more compelling than that of the Indigo Children movement. The Indigo Children movement’s theories may be more facially suspect, because they often involve explicitly paranormal and magical claims. But the specious approach of psychiatry  – which claims that children have brain disorders and wants to browbeat parents into giving children drugs for those disorders, based on some vague symptoms which could describe pretty much anyone and an explanatory framework which needs work —  has much to answer for as well.

This is frustrating. On the one hand, we have mystical people who think their children are magical and probably treat them somewhat better than the norm as a result (a similar phenomenon happens with many Aspies, I think). On the other hand, we have advocates of “science” who want to drug children for getting bored too easily because this means their brains must be broken.

What is the truer theory?

A relevant post from curi gives us some direction: in it, he uses a very fancy graph to make the point that as memes regarding child-rearing have changed, Asperger’s syndrome has skyrocketed.

In the thread that followed, an individual was very resistant to the notion that Asperger’s could be so meme-driven. I pointed out that people tend to systematically underestimate the degree to which old-school parenting memes were vicious and cruel to children. I would add that people tend to underestimate the degree to which memes, in *general*, can have a huge impact on the development of individuals in ways that give rise to traits which seem almost “inherent” or “biological.”

An analogy: New Yorkers are known for their propensity for jaywalking (or crossing in the middle of the street as opposed to the intersection). Mayor Giuliani tried to implement some measures to curtail this behavior (which he apparently disapproved of), including issuing citations and throwing up concrete barriers in some places to prevent people from doing so. But people carried on jaywalking anyways. Does this mean New Yorkers are an inherently less lawful people than, say, people in Singapore? No. New Yorkers may have some different values about respect for certain parts of the law. This difference in values could be overcome to bring about a change in behavior: New York Police Department snipers on roofs shooting people in the leg every time they tried to jaywalk would probably be sufficient. The “character” of New Yorkers afterwards would be different; it would seem tamed and cowed. But we’re not willing to go that far to change the behavior. Maybe a fascist regime would be willing, but not us.

One has to realize that up until fairly recently (in the history of mankind anyways), the parallel to shooting people in the leg was the default approach to child-rearing: disobedience was met with terrifying violence not even necessarily tied proportionally to the infraction, largely for the purpose of maintaining control, upholding parental authority for its own sake, and quieting the nuisance that children were thought to be. But then a huge shift in values occurred, and has continued to progress: the past few decades in our cultural history, we’ve suddenly started caring a lot more about the happiness of our own children, and about enabling them to find and pursue the things that will make them happy.

And we’re surprised that this has led to a huge number of children who act very different than children are “expected” to? And that one commonly identifiable problem is that children get bored easily, when for the longest time the culture didn’t bother creating any knowledge at all about how to help children find interesting things? To expect that children’s preferences would start to be taken seriously without their being some new problems arising from that due to  lack of cultural knowledge, is sort of like expecting the old Soviet Union to have transitioned smoothly from an authoritarian socialist regime to  a Hong Kong style free-market laissez faire system despite having no knowledge of how free markets work. It’s a necessary transition, but it’s going to be messy.

And so, not unlike the political debates that sometimes occur about things like democratic and market reforms in other countries, you have people decrying and mocking the effectiveness of the new approach because of some bumps in the road, advocating not that you go back to the old ways, but that you just need some modification and control (psychiatrists and left-of-center bureaucrats, respectively), and you have some people who want to bring back the old ways (authoritarians of politics and parenting), and you have some people who are in favor of the changes, but for not-quite-the-right reasons (Indigo Children movement types and democratic socialists).

There are various theories as to what sort of state humans should try and get themselves in. This probably asks the wrong question (we should expect that people will wind up in a good mental state by solving problems, and focus on doing that, not the end result), but one approach seems worth talking about.
The Buddhist conception of Nirvana, which is considered the highest state in Buddhism, involves a lack of suffering, desire, or sense of self. This seems pretty bad on its face: while no suffering is awesome, having a sense of self and desires are good. Buddhism, I think, aims to eliminate the former by eliminating the latter.
Desires don’t cause suffering. Specific theories attached to desires to. For instance, right now I very much desire a new computer. Am I sad I don’t have one? No (well, not most of the time!). That’d be silly. There’s a whole universe of things worth desiring out there, and I’m rational enough to realize that it’s a lot more fruitful to figure out what the most interesting and important ones are and happily pursue those, than irrationally sulk about my not having them.
There are many times, however, where people fall short of this ideal of happy, rational pursuit of desired ends. Physical attraction is a common one. You want someone – they don’t reciprocate. It hurts. Why? It is because you think you should have them. At some level, you think that it’s wrong that you can’t have them; the state of not having them causes an expectation of yours not to be met. This causes pain.
Romance is a loaded example, so let’s try another. Say you make plans to go to the movies with someone. You go; they don’t show up and can’t be reached. You get mad. Should you? While some amount of anger in this situation seems pretty defensible, it’s not; what purpose does it serve? Sure, people should let you know when they’re not going to be able to make it, and you’ll take the possibility of that happening into account when making plans with this person the next time. But it’s not some injustice in the situation that’s causing you to be mad – it is your belief that getting mad is an appropriate reaction. Instead, you should be figuring out how to best spend your time that evening (see the movie anyway, go home and play video games, whatever).
So does this mean that the solution is not wanting other people physically, or not wanting to see movies, or not wanting anything? No, that’s silly. Buddhism proves too much. On the other hand, it does say you can feel better about things by changing your memes, which is notable. But its end goals are bad.
The better approach is always trying to maximize your happiness from whatever place you find yourself. Don’t cease desiring – but stop letting the gap between your expectations and what actually happens be a justification for self-inflicted pain. Instead, try reminding yourself of the pretty awesome premises that often are below the surface of the situations you are torturing yourself about. Knowing people worth wanting physically, for instance, is pretty cool (well, assuming you have good values about that kind of thing).