TIL: JRR Tolkien’s great granddaughter, Ruth Tolkien, is the only blind person in the UK to be a competitive fencer. She is currently ranked the #186th best fencer in the country.

(at a lecture on the Oedipus complex)

Lecturer: Oedipus was a character from Greek mythology. He was the son of Laius and…uh…um…

Me: Jocasta?

Lecturer: No, that was his wi…wait, I’m an idiot.

At the child psych hospital, we have a kid who came in with a photo of his parents, freaked out when staff tried to take it away from him, said he carries it with him everywhere he goes.

Those of you who haven’t worked in institutions before are probably saying “Awww, how cute, he really loves his family.”

Those of you who have worked in institutions before are probably asking “Was there a shiv hidden in the photo frame?” And yeah, there was.

https://srconstantin.wordpress.com/2017/06/27/in-defense-of-individualist-culture/ is a good post. The summary:

1. Individualism and strong communities both have good points and bad points
2. But individualism is better
3. Also, you couldn’t rebuild society on the model of a strong community anyway, because if you tried people who didn’t like it could leave, and you’d have to become a tyranny to prevent that.
4. It’s perfectly fine to have a generally individualistic society where people are allowed to voluntarily form communities that they like.
5. And realistically we should expect most people to eventually exit from them.
6. If those are good nice communities, people will exit peacefully.
7. If they’re bad communities, they’ll use a lot of abuse and shaming to keep people from exiting, but eventually people will still exit.
8. And in any case, we’ll always have regular individualist society, which is pretty good.

Sarah mentions Ron Dreher’s “Benedict Option” thing as an example of someone forming a community in a generally individualist society where they can do what they want, and so sort of a success story. But I actually find Dreher really scary.

Dreher’s fundamental question is: what if regular individualist society becomes unbearably bad? What if the best culture isn’t the one that succeeds in a free marketplace of ideas? Or, more idiosyncratically: what if Moloch wants to kill everything you love?

(this last one is definitely true for everyone, but I mean in the sphere of culture in particular, in the short-term)

Like, what if arguments for false things are more convincing (to the average person who debates politics) than arguments for true things? What if certain ways of life are irresistably addictive but ultimately unsatisfying? What if the Iron Law of Institutions / the principle of cancer means that people who defect against everyone else in certain ways will inevitably rise to the top?

Dreher’s plan is “build your own community isolated from the greater culture behind strong walls”. The problem is, either you restrict information flow and exit rights (in which case you’re abusive and evil) or you allow these things (in which case Moloch can still get to you and you’re dead).

The only reason Dreher isn’t more pessimistic than he is is because he’s Christian and assumes God will sort this out in some sense. Like, he talks about “preserving” Christian culture until such time as the outside world is ready for it, but more realistically, he’s trying to slow entropy. Which is a fine thing to do as long as you realize you’ll fail at some constant rate until you die.

I don’t care about Christianity. What scares me is the possibility that the kinds of cultures that promote *my* values are memetically unfit. Liberalism hasn’t been looking so healthy lately. There are all these people saying that we should stop resolving problems through debate, that violence is good, that free speech is stupid, that scientific truth-seeking should be circumscribed by the greater good, et cetera. These people are on both the left and the right, but the left is scarier since it has momentum and the tide of history on its side. The left is losing badly in the sense that Republicans control everything, but most Republicans are sort of idiots (sorry, it had to be said) who are resisting illiberalism for the wrong reasons, kind of by coincidence. Like, regressive-leftism would have conquered everything by now except for the weird coincidence that 51% of the population is kind of crazy in a way that happens to exactly counterbalance them. THe number of people who are resisting for the right reasons is a small minority.

I think this is what the (tiny percentage of) insightful NRx people are saying. That everything other than the worst Twitter hatemob you’ve ever seen is an unnaturally low-entropy state, and is going to fail unless we use the traditional tools of closed societies (eg restriction of information, autocracy, etc) to protect ourselves from it. That tolerance and free thought are basically as fragile as the strains of Christianity Dreher wants to save, only without the illusion that God is protecting them.

But even tyranny isn’t a long-term solution. Tyrannies eventually fail: the USSR fell, most cults dissolve quickly, this isn’t *actually* a good fix. Instead, I think it’s more useful to just argue for good things and against bad things as best I can, hope that I’m part of the gradient pushing towards a better attractor state. Also, genetically engineer people for higher intelligence to change the game in our favor. Also, AI.

I wish I could just start appointments by asking “So, do you prefer mildly condescending platitudes, or medications with a bunch of side effects?”, and then people could just tell me, and I wouldn’t have to guess, and they couldn’t get angry if I gave them the one they wanted.

There’s a court case called Tarasoff where a psychiatrist’s patient killed someone, and they found the psychiatrist liable for failing to warn the victim. The case established a “duty to warn” - psychiatrists need to warn anyone threatened by any of their patients that there’s a guy out there trying to kill them. This makes sense and has basically been universally accepted.

The other day I went to a lecture on so-called “Tarasoff expansions”. The guy giving the lecture basically admitted they made no sense. The principle seems to be that if anyone ever does anything bad, people can sue their psychiatrist and and win.

So for example, suppose you treat a psychotic person in the hospital, and after they’re better, you let them out. There are no signs of any problems and they are exactly like all your other successfully-recovered psychotic patients. Then a few months or years later they stop taking their medicine, snap, and attack someone. Can the victim sue you? You bet they can. Can they win? If the judge and jury really want someone to blame, absolutely. The specific charge will be that you failed in your “duty to warn”. To warn who, exactly? Uh, the general public. About what? Uh, that somebody might become a threat a few years down the line.

None of these cases specify what it means to warn the general public. Also, you can’t actually tell the general public about any specific patients of yours, or you could be sued for violating confidentiality. Also also, you have only the faintest idea which of your patients might become violent in the long-term future.

(also, it doesn’t have to be violence. One person got successfully sued under a Tarasoff expansion case because their patient drove under the influence and killed someone in a car crash)

One of my colleagues suggested some kind of non-specific warning. We came up with the idea of hiring one of those skywriter planes to write the message “PSYCHOTIC PEOPLE MIGHT BE TRYING TO KILL YOU” in the air above major cities. Sounds like this can’t possibly go wrong.

Public service announcement: if you have a kid with some kind of horrifying predatory criminal, and now your kid is a horrifying predatory criminal, and you have no idea how this happened because the father left before he was even born and your new husband is a great guy and you’ve both always done your best to raise your kid well and give him a good home, your kid’s psychiatrist will listen empathetically to your story, and then empathetically give you a copy of The Nurture Assumption.

…maybe not actually. But it will definitely be on his mind. And maybe it would get people to stop having so many kids with horrifying predatory criminals. Seriously, I’m doing inpatient child psychiatry now and I get multiple cases like this every day.

Today at the child hospital, I asked a kid if he knew what his diagnosis was. He said “multiple personality disorder”, which isn’t a real diagnosis anymore and which he didn’t have. I asked him if he had multiple personalities, and he said no. I asked why he thought he was diagnosed with multiple personality disorder, and he just shrugged.

I looked in his files, and he’d been diagnosed with borderline personality disorder (not technically supposed to diagnose in kids, but when someone obviously has it, it’s hard to stick to technicalities). Somebody had told him, and the only name he knew ending in “_____ personality disorder” was multiple personality disorder, so he assumed that was the diagnosis.

For me the sad part was that he didn’t really care or want to challenge the claim that he had a diagnosis he obviously didn’t. I assume at that age (12ish) he just figured the mental health system was so arbitrary and beyond his powers to influence that he just accepted it and moved on.