The nicest people on the outside were very different behind closed doors. I have been getting pushback, particularly about Barbara Roberts tweets. Barbara has apologized as well.
Posted on August 16, by Scott Alexander [Content note: May be guilt-inducing for people who feel like burdens. All patient characteristics have been heavily obfuscated to protect confidentiality.
People get depressed over all sorts of things. Depression is in part a disease of distorted cognitions, a failure of rationality. I had one patient who worked for GM, very smart guy, invented a lot of safety features for cars.
In cases like these, you can do a little bit of good just by teaching people the fundamental lesson of rationality: So maybe depressed brains are not the most trustworthy arbiters on these sorts of issues.
Some people just have no easy outs. Had some brain damage a few years ago, now has cognitive problems and poor emotional control. Got denied for disability a few times, in accordance with the ancient bureaucratic tradition.
Survives on a couple of lesser social programs he got approved for plus occasional charity handouts plus some help from his family. Now he attempts suicide, says he feels like a burden on everyone around him. Well, what am I going to say?
In the absence of better alternatives, I have used this strategy.
It always feels like the worst sort of emotional blackmail. Not helping them want to live, just making them feel really guilty about dying.
We were here first. Maybe his cognitive problems would make him a slightly less proficient hunter than someone else, but whatever, he could always gather.
He might get in a fight and end up with a spear through his gut, but in that case his problems would be over anyway. Otherwise he could just hang out and live in a cave and gather roots and berries and maybe hunt buffalo and participate in the appropriate tribal bonding rituals like everyone else.
But society came and paved over the place where all the roots and berry plants grew and killed the buffalo and dynamited the caves and declared the tribal bonding rituals Problematic.
This increased productivity by about a zillion times, so most people ended up better off. Think of it as the ultimate use of eminent domain; a power beyond your control has seized everything in the world, it had some good economic reasons for doing so, but it at least owes you compensation! This is also the basis of my support for a basic income guarantee.
Imagine an employment waterline, gradually rising through higher and higher levels of competence. In the distant past, maybe you could be pretty dumb, have no emotional continence at all, and still live a pretty happy life. As the waterline rises, the skills necessary to support yourself comfortably become higher and higher.
And so on, until everyone is a burden.
It might be based around helping others in less tangible ways, like providing company and cheerfulness and love. It might be a virtue ethics celebrating people unusually good at cultivating traits we value. Or it might be a sort of philosophically-informed hedonism along the lines of Epicurus, where we try to enjoy ourselves in the ways that make us most human.
And I think my advice to my suicidal patients, if I were able and willing to express all this to them, would be to stop worrying about being a burden and to start doing all these things now. This entry was posted in Uncategorized and tagged psychiatry.Dating.
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