Thursday, August 28, 2008

Cheery Social Policy

The "cheery," frequently alluded to by David Benatar in Better Never to Have Been, might be defined as those people experiencing optimistic bias, who are as a result untroubled by, or overly dismissive of, serious problems involving human suffering. Cheeriness is an extremely common trait, and the cheery certainly make up a majority of the human population and exert a major influence on social policy.

The fundamental problem with cheeriness is the assumption that a good life - a pleasant life - is relatively easy to achieve. This assumption is, of course, true for the cheery, but the cheery are able to ignore - and perhaps can't even conceive of - the suffering of a significant minority of the population. A good life is not easily achieved for many of us.

The cheery do not need to use extraordinary means to achieve a tolerable life. Behaviors that others engage in, perhaps in pursuit of a tolerable life - weird sex with lots of people, say, or using steroids or marijuana or LSD or benzodiazepines - strike the cheery as unnecessary and harmful. And, for a cheery person, these behaviors are wholly unnecessary - life is perfectly tolerable without them. And they increase the risk of harm! Who wants harm?

What the cheery cannot imagine is the importance, the function of these behaviors, and others like them - the pursuit of the interesting, and the temporary suspension of the intolerability of existence, which intolerability (for many) the cheery do not even perceive, and therefore do not properly weight as a problem.

I suspect that the same cheery social policy is at work with the question of suicide. Groundless faith that anyone can have a good life, bar none, leads to a general policy of suicide prohibition. A more mature understanding of the seriousness of suffering, and a more realistic evaluation of the possibility for its amelioration, would lead at least to a policy with more exceptions.

Thursday, August 14, 2008

Is Coming Into Existence an Agent-Neutral Value?

David Benatar argues that bringing someone into existence is always a harm, and grounds his argument in a particular asymmetry - the "goodness" of absent pain, versus the mere neutrality of absent pleasure where no one is thereby deprived.

Seana Shiffrin, on the other hand, doesn't argue that procreation is always a harm, but does refuse to characterize procreation as a "morally innocent endeavor" and argues for a more equivocal view of bringing people into existence. While procreation is not necessarily always a harm, it is often a harm, and procreators should bear moral responsibility for the harm they do. (Shiffrin, Seana Valentine. "Wrongful Life, Procreative Responsibility, and the Significant of Harm." Legal Theory, 5 (1999), 117–148.) Shiffrin defends her view with a different asymmetry - that, while it is fine to harm someone in order to prevent a greater harm to him, even without his consent (the rescue case), it is not fine to harm a person without his consent merely to provide him a benefit. Her core example involves a wealthy recluse, Wealthy, with no other way to help others, dropping $5 million cubes of gold from the air on a neighboring island. Many receive his presents with no complications, but one recipient (Unlucky) is hit with the cube and breaks his arm. While the recipient might, after the fact, be glad to have been hit with the gold cube, and consider the broken arm worth it, intuition suggests that dropping $5 million gold cubes on people is wrong. Unlucky
admits that all-things-considered, he is better off for receiving the $5 million, despite the injury. In some way he is glad that this happened to him, although he is unsure whether he would have consented to being subjected to the risk of a broken arm (and worse fates) if he had been asked in advance; he regards his conjectured ex-ante hesitation as reasonable. Given the shock of the event and the severity of the pain and disability associated with the broken arm, he is not certain whether he would consent to undergo the same experience again.

Shiffrin goes on to flesh out the intuition that Wealthy has wronged Unlucky - for instance, we would say that Wealthy owes Unlucky an apology, and if Wealthy refused to pay for Unlucky's corrective surgery, Unlucky would properly have a cause of action against Wealthy for the cost of his injuries.

Shiffrin's focus on unconsented harm accords well with my thinking on procreation. I wish to question, though, whether it is the benefit/harm distinction that matters when motivating an unconsented harm. In my view, Shiffrin's benefit/harm distinction is unnecessarily confusing and subject to contrary individual interpretations of harm and benefit; the very idea of harm and benefit are, in my view, too subjective to form the basis for the rightness or wrongness of inflicting unconsented harm. I think it is both more correct and more general to say that unconsented harm may be only be done in the service of a genuinely agent-neutral value.

Shiffrin considers, as a possible objection to her framework, that the real reason that a rescue is morally right, while Wealthy's action toward Unlucky is morally wrong, is that in the rescue case, hypothetical consent may be said to exist, whereas not even hypothetical consent exists in Unlucky's case (he is not sure he would have consented ex ante). Shiffrin argues that it is the asymmetry between harm and benefit that grounds our intuition on hypothetical consent, rather than the other way around. She argues that

there seems to be a harm/benefit asymmetry built into our approaches to hypothetical consent where we lack specific information about the individual’s will. We presume (rebuttably) its presence in cases where greater harm is to be averted; in the cases of harms to bestow greater benefits, the presumption is reversed.

My view is that we can be clearer than this. It is not the harm/benefit distinction that is driving the willingness to infer hypothetical consent; it is the different level of agent-neutrality of the inflicted harm's consequence.

Thomas Nagel introduces the concept of agent-relative and agent-neutral value in The View from Nowhere. Agent-relative values are values which an agent holds, but which no one but the agent has much reason to promote. Agent-neutral values are values which anyone has reason to promote, whether or not the promotion of the values would benefit him directly. An agent's desire to climb Mount Everest would be an agent-relative value; he may place genuine value on it, but I have no reason to assist him in his endeavor. However, relieving pain may be said to be an agent-neutral value; if someone is suffering severe pain, I have good reason to alleviate his pain.

In the rescue case, the rescuer causes harm to a person in order to prevent greater harm - to save his life, or to prevent more serious physical injury. Both saving life and preventing physical injury would probably be classified as agent-neutral values. In Unlucky's case, however, the $5 million gold cube could well be seen as something with only agent-relative value. Shiffrin specifies that inhabitants of Unlucky's island are well provided for even without the gold. While there might be an agent-neutral reason to provide people with a certain minimum level of money or material comfort, beyond this, there is not much reason to give substantial gifts to strangers. A person might want $5 million, but I have no particular reason to see that he gets it, while I do have a reason to ensure that his basic nutritional needs are taken care of.

A major problem with the agent-neutral/agent-relative classification is whether agent-neutral values exist at all. Eric Mack, for example, argues that there are no agent-neutral values ("Against Agent-Neutral Value," Reason Papers 14 (Spring 1989) 76-89.) Mack argues that an agent-neutral value must necessarily be an "agent-external" value - something that is valuable in itself, even if no one is ever in a relationship with it so as to value it. Otherwise, all such values are "reducible to [their] value for someone," that is, they are agent-relative (emphasis mine). Few are prepared to claim that there are truly agent-external value in this sense (things that would be valuable even if there would never exist any sentient beings in the world). I find the possibility of the nonexistence of agent-neutral values disturbing, calling to mind as it does relativism/subjectivism, though I could imagine an ethical system that recognized the existence only of agent-relative values, but also recognized reasons other than personal preference for taking the values of others seriously. Interestingly, Mack refers to the possibility for agent-relative values that are nevertheless, in his words, objective; as long as there can be reasons for taking the (agent-relative) values of others seriously, then the project of ethical philosophy doesn't fall into dust.

George R. Carlson (in "Pain and the Quantum Leap to Agent Neutral Value," Ethics, Vol. 100, No. 2 (Jan., 1990), pp. 363-367), while not exactly precluding the possibility for agent-neutral value, argues that Nagel's chief example, pain, fails to be a genuinely agent-neutral value. He argues that while a person might have reason to alleviate the pain of another, these are not agent-neutral reasons. Rather, they are grounded in the perceptions and empathy of the agent.

What I find most concerning with the benefit/harm classification, as well as allegations of agent-neutral value, is that any of the examples so far examined may, depending on the individual circumstances, be either a harm or a benefit. Saving a life would generally be seen as an "agent-neutral" value; however, since I am a suicide, a rescuer saving my life would do only harm to me. Preventing pain is seen as an agent-neutral value; however, hiding my friend's car keys so he cannot drive to a club and get beaten up by his dominatrix friend (and thereby preventing him physical pain) would certainly do him harm, not good. And studies of lottery winners seem to indicate that even loads of unnecessary money can do harm. (As J. David Velleman points out, even choice can be a harm.) Can these values really be especially agent-neutral if they are often harms? Is it not more appropriate to call them the agent-relative values of the majority, rather than genuinely agent-neutral values?

Shiffrin points out a "related asymmetry," from Thomas Scanlon (Preference and Urgency, 72 J. PHIL. (1975) 655–69.). This is the asymmetry between the harm that is is morally correct to inflict on another, and the "harm" that a person may inflict on himself. In Shiffrin's words (summarizing Scanlon),

One may reasonably put much greater weight on a project from the first-person perspective than would reasonably be accorded to it from a third-party’s viewpoint. A person may reasonably value her religion’s mission over her health, but the state may reasonably direct its welfare efforts toward her nutrition needs rather than to funding her religious endeavors.

This "related asymmetry" is, it seems to me, concerned with both the problem of consent and, indirectly, with the idea of agent-neutral versus agent-relative values. A person may consent to "harm" for any reason whatever, agent-relative or otherwise; but in order to inflict harm on another without consent, we must either (a) have such a good model of the person's values that we can infer hypothetical consent based on agent-relative values, or (b) act in furtherance of genuinely agent-neutral values.

The ultimate question, of course, is whether coming into existence is the kind of value that it is morally acceptable to inflict harm on others, without their consent, in order to procure for them. Pain, suffering, illness, unrequited love, shame, sexual frustration, sorrow, disappointment, fear, and death are all guaranteed (or nearly so) by the fact of being brought into existence; these are certainly harms. The pronatalist might argue that despite these certain harms, it is not wrong to bring others into existence, because the unconsented harm in the service of an agent-neutral value: coming into existence. (I find the "hypothetical consent" argument unpersuasive, because we have no model, much less a reliable model, of the agent's future agent-relative values when we contemplate bringing that agent into existence. This is my core problem with R.M. Hare's "Golden Rule" argument that we should bring into existence those who will be happy to exist and not bring into existence those who won't. How do we tell the difference ex ante?)

Is coming into existence an agent-neutral value? The problem we run into at this stage is that we have little theory of what qualifies an agent-neutral value. Carlson's chief criticism of Nagel seems to be a lack of a theory for determining what counts as an agent-neutral value versus an agent-relative value (other than the unsatisfying "pain is awful"). Indeed, there seems to be a genuine question as to the degree to which agent-neutral values exist at all.

Actually, even under Mack's restrictive definition, I think there is, in some sense, a clear example of a genuinely agent-neutral value, a peculiar value that would retain its value even if no sentient beings ever come into existence to appreciate it. This is the value of no sentient being coming into existence. If no beings exist, no suffering can occur; this is good, even though (and precisely because) no being ever come into existence to appreciate this pleasant state of affairs. The alternative would be worse; it is good that this worse option does not obtain, even though the only way anyone would perceive its better-ness would be by the worse alternative coming to pass.

There may be disagreement over whether coming into existence is an agent-neutral value. I certainly think that it is not, but I think that an argument could be made in good faith that it is. I think there is a stronger argument, however, that no one coming into existence is an agent-neutral value - perhaps the only such peculiar value - and, under my theory, an agent-neutral value is one in the service of which unconsented harm may be countenanced.

Sunday, August 10, 2008

Incentives Will Fail: Why Procreation is Like Prostitution and Drugs

In a previous post, I said that an outright prohibition on birth would be a moral horror, because given our current level of technology, it would mean forced abortion, forced sterilization, or both. While a pure consequentialist might still argue that the harm of later generations being born might outweigh the extra suffering a "forced abortion generation" had to undergo, there are strong agent-relative reasons to not forcibly perform abortions, even though by not doing so, we allow a greater violation of rights to occur.

In attempting to formulate an example to illustrate this, I noticed that all the examples in the anti-consequentialist literature (people like Thomas Nagel and Bernard Williams) feature an agent faced with a choice of harming someone himself, or having someone other than his possible victim do much greater harm. The antinatalist forced abortion dilemma is different: one would be faced with a choice of harming someone, or allowing that person to do harm to another person. The forced abortion case has a great deal more in common, perhaps, with defense-of-others cases than the typical anti-consequentialist examples. (It should give us pause, however, that anti-abortion fanatics follow this same logic to the conclusion that it's morally appropriate to shoot abortion doctors.)

There is an alternate political possibility to forced abortion and forced sterilization: creating an incentive structure that provides negative incentives for birth and positive incentives for not procreating (and which, one would hope, would legitimize refusing to give birth and remove some of the social and moral legitimacy of voluntary procreation.) But both an outright ban and an incentive structure suffer from the same problems as those in place to curb prostitution and drugs.

Anti-prostitution laws exist for a variety of reasons, but the most common justification in our modern era is that they exist to protect women who are or would become prostitutes from exploitation. The problem with anti-prostitution laws is that they universally seem to do greater harm to the very class of people they're intended to protect - prostitute women. It is impossible to imagine an anti-prostitution law that would not harm prostitutes. Even laws that provide for prosecution of prostitutes' customers only, and not the prostitutes themselves, drive traffic underground and thereby make it much less safe for prostitute women.

Anti-drug laws are, in theory, motivated by a desire to minimize harm to people, including drug users and those otherwise affected by the drug trade, such as those whom drug users might steal from to support their habits. But a consensus seems to be developing among economists and social scientists that the drug prohibition does more harm than it prevents - to the very people it is intended to protect.

Birth seems to have in common with prostitution and drugs the status of being a good with inelastic, or close to inelastic, demand, especially for the first child. China's one-child policy has had some success, though there are reports that it functions both as an incentive structure and as an outright ban (I can't figure out if reports of forced abortion are reliable). But the one-child policy is not an antinatalist policy but a limited procreation policy. There is reason to believe that increasing the cost of procreation in an attempt to drive procreation to zero - either through a sort of tax structure, or through positive incentives for non-procreation - would fail miserably, and, as with prostitution and drugs, would harm the very people the policy was intended to protect. Any incentive against procreation (a) would likely not significantly reduce procreation, since, based as it is in a strong biological drive, some level of procreation likely has near-inelastic demand (and supply is hard to control); and (b) would necessarily harm the children who were nonetheless brought into existence.

For example, let's say procreation now carries a $10,000 fine or 6 months in jail if the fine is not paid. Most people would likely procreate anyway, and either pay the fine or serve the jail sentence. And a child brought into the world would be faced with parents who have either $10,000 less to spend on his upbringing, or 6 months less time to work to save money for the child's upbringing.

I think there is one possible hope: incentives for voluntary, permanent sterilization. While, at some point, the majority of humans seem to want to procreate, humans have a notoriously high discount rate. If a great enough incentive were offered early enough in life, many might accept the incentive and be permanently sterilized; while they might regret the decision later, their children and grandchildren would never exist, and would therefore never have reason to regret their lives.

Saturday, August 9, 2008

Concern for Truth

Longevity-enthusiast Hopefully Anonymous proposes this definition of the "politically incorrect," in a discussion thread on Entitled to an Opinion:
I think a useful, natural definition is where there are social mechanisms to reduce the expression of an idea for reasons other than its utility in creating the most accurate models of reality. It’s not that the idea is empirically incorrect, it’s that it’s politically incorrect.

That is, the reasons for the suppression of the "politically incorrect" statement, by various social mechanisms, are unrelated to the truth value of the statement.

The (implied) definition of the social mechanisms to reduce the expression of the "politically incorrect" idea is very close to Harry Frankfurt's definition of bullshit: bullshit is, says Frankfurt, not a lie, but a statement which, while outwardly protesting concern for truth, is actually utterly unconcerned with truth. The liar is at least conscious of the truth enough to formulate a lie; the bullshitter eschews even a conception of the truth.

But is the "politically incorrect" really so broad? Certainly, all objections to genuinely politically incorrect ideas on the basis of political correctness are bullshit, but certainly we can't say that all bullshit objections are objections based on political correctness. As TGGP puts it,

So, could good etiquette, which often means avoiding frankness or expressing thoughts even if others suspect we have them, be considered a form of political correctness, even when it has no connection to policy?

A few years ago, I was riding in a car with a friend who has Asperger's, and another friend who doesn't have Asperger's. The non-Aspie friend made a kind of offhand, lame joke, and I laughed. My Aspie friend asked why I had laughed, since the joke wasn't funny. I explained that laughing at jokes is a socially polite thing to do - like saying "bless you" when someone sneezes, regardless of a belief in God. He seemed to understand and for the rest of the ride, he practiced "polite laughter" - it was a bit ghastly, really. Anyway, my laughing at the lame joke was certainly bullshit - a response unconnected with the truth, but engaged in for some other reason (politeness). It wasn't a lie, because I laughed even before evaluating the merit of the joke. But I think few of us would classify my response as the "politically correct" response. Only a subset of bullshit is politically correct bullshit.

I, for one, often feel the need to liberally coat my politically incorrect beliefs in charming bullshit in order to make them more palatable. I think, in this case, the motive is politeness - and an eye to genuine communication - ideas can be more or less understandable depending on their presentation and context. But even ideas that are not politically incorrect may need to be ensconced in bullshit for maximum communicative value.

We can get closer to a phenomenological definition of the politically incorrect. Folklorist Linda Dégh might be regarded as an expert on the folkloric legend, as distinct from märchen, magic stories that we might refer to as "fairy tales." The main difference is that the legend is a personal story that invites genuine disbelief (think "urban legend"), whereas märchen are impersonal stories that are clearly not intended to be believed. In discussing the definition of the legend, Dégh says that there are some stories that she excludes:

Arguing for the disputability factor as crucial, I excluded legend-like narratives that enforce belief and that deny the right of disbelief or doubt, narratives that express majority opinion and are safeguarded by moral taboos from negation and, what is more, from deviation. ["Tape-Recording Miracles for Everyday Living," in American Folklore and the Mass Media, Indiana University Press, 1994. Emphasis mine.]

Dégh's examples are "religious (Christian, hagiographic, or saint's) legends," and the "patriotic (heroic) legends dispensed through school education by governments, confirming citizens in civil religiosity."

I propose the following: For an idea to be genuinely politically incorrect, (a) the idea must be in conflict with majority opinion, (b) there must be social mechanisms to reduce expression of the belief for reasons other than the idea's truth value (i.e., bullshit is set against it), and (c) these social mechanisms must have the function of a moral taboo to protect an important cultural narrative from negation.

Interestingly, my requirement of being opposed to "majority opinion" would exclude from the "politically incorrect" cases where people speak out against the narratives promulgated by their government, if the narratives are not believed by a majority of the population, as with Chinese dissidents challenging Mao's bullshit about the man-made famines of 1959-1961 and beyond, and opponents of the war in Iraq today.

Friday, August 8, 2008

Why We Should Keep Knitting Booties

See also, Incentives Will Fail: Why Procreation Is Like Prostitution And Drugs.

Many of us believe that everyone has a moral right not to be born, a strange sort of right that one only holds in its breach, as David Benatar puts it. But what consequences should this moral view have on our actions?

Obviously, someone who believes an action is wrong should avoid taking that action himself. But what is one to do about others who take actions that one believes to be wrong?

David Benatar addresses the political side of this question in Better Never to Have Been. Benatar concludes, and I agree, that although procreation is always a harm, a political prohibition on birth would be a greater moral horror. A political prohibition on birth would mean, with our current technology, forced abortion and forced sterilization. No matter how great the harm of birth - even though it entails death - forced abortion is worse, especially considering the widespread fear and suffering that the policy would cause to currently-living people.

So the political answer is, I think, do nothing, except perhaps to increase funding for voluntary birth control, abortion, and education. But what of the personal realm? Should we still knit booties when our friends have babies? Or should we flip off people with "Baby On Board" stickers in their windows?

Cory Doctorow is one of my heroes. His work, more than anyone's except perhaps Michael Gondry's, often leaves me with at least a temporary sense that there are worthwhile, interesting projects for sentient beings other than pursuing nonexistence.

As I have previously mentioned, I find Doctorow's story I, Rowboat, the story of Robbie the sentient rowboat, extremely affecting. Doctorow displays a deep grasp of the ethical problems involved in creating new sentient beings. (In a subplot, a coral reef is brought to sentience by a chaotic-evil being, described as a "capricious upload god," wakes up very angry, and apparently spends the rest of eternity chasing the "upload god" in an attempt to destroy it. The main plot centers on Robbie the rowboat's poignant, lonely experience of sentience.)

Given Doctorow's apparently nuanced understanding of the problems of coming into existence, some experienced a bit of cognitive dissonance when Cory had a baby. Some reacted with uncharitable crankiness, such as BoingBoing commenter Kyle Armbruster (re-emvowelled by me):
It's like, just when you thought Cory Doctorow couldn't possibly be more of a self-aggrandizing, pedantic know-it-all prick, he has a kid.

If there's any justice in the universe, his daughter will legally change her name to get rid of the 40 extra ones her parents tacked on and become the CFO of Sony BMG.

(Kyle got "put on time out" from BoingBoing for three days for that, and that kind of vitriol probably indicates the usually-well-behaved user needs a bit of a break.)

I believe it is a serious moral harm to have children, but I think it is a great harm to be a total self-righteous cunt toward people who decide to have children. The morally correct action, in my view, is to openly espouse antinatalism, but at the same time to welcome babies into the world and knit them booties. Benatar himself leads the way with this, by dedicating his book to his parents and his brothers. We have all been harmed by being brought into existence, but once we exist, let us enjoy each other's company.

Just as there should be no forced abortion or forced sterilization in the political realm, even though more babies will thereby be created, there should be no additional suffering heaped onto parents and children because of this wrong. We should continue to develop and spread our ideas with the hope that people will make ethical choices, but, as I have said, we should keep knitting booties.

Even a generation ago, children who had the misfortune to be born "out of wedlock" were treated horribly by the adults in their communities. My own grandmother suffered greatly from this, born into a highly religious community when my great-grandmother was not married. The horrible treatment was related, at least in part, to the moral belief that procreation is only appropriate between married people. But however strongly held, however correct even, this belief may be, it is not a license to treat babies and children badly. The mistreatment of babies and children is a moral horror. Likewise, it's pointless, mean, and immoral to flip off the people with the "Baby On Board" stickers.

Taking a page from abortion centrists, let our movement's slogan be this: Make procreation safe, legal, and rare. And keep knitting booties.


On a related note, I want to trace the implications of a thought I briefly entertained in dealing with my own cognitive dissonance upon the birth of Cory Doctorow's child: when a man fathers a child through natural means, how can we be sure that procreation was the man's decision? (Again, I do not at all mean to imply that Cory's daughter was unplanned or unwanted! By all reports, she was most wanted, and is a charming baby destined to be brilliant, creative, and highly capable.)

In most first-world countries, contraception is widely available. Effective contraception may be utilized by either partner, even without the cooperation of the other. However, in practice, men often rely on women for contraception. Also, contraception failures are frequent.

Again, in most first-world countries, abortion is the prerogative of women. A woman who becomes pregnant may choose to give birth, or to abort. But a man's freedom not to procreate ends with ejaculation. A woman can procreate with or without a man's consent to the procreation. A man can only procreate with a woman's continuing consent.

Given the alternatives - forced abortion, forced birth - this is the best system. A forced abortion is worse than a man being obliged to procreate against his will. A forced birth is worse than a man being prevented from procreating against his will.

While abortion as a female prerogative is better than the alternatives, it is not without problems. The general requirement, again in first-world countries, that parents monetarily support their children until they reach majority creates a major (and undeserved) hardship for men who conceived accidentally and do not desire to have a child. And this is not to mention the emotional consequences. Is an act of sexual intercourse enough to morally justify saddling someone with an unwanted child? If not for women, then why for men?

I think people ignore the injustice inherent in our system of allocating procreative responsibility, because its obvious flaws are not amenable to a political solution. It is another limit on human happiness.

One of the implications of the de facto female monopoly on reproductive decisions, in first-world countries, is to render antinatalism primarily a female issue.

However, an example of undeniable, active male participation in reproduction (other than through artificial means) is related by Mary Beth Bonacci, professional chastity lecturer and realtor. Her 2001 article in the Arlington Catholic Herald told the story of a married Catholic couple who considered, but ultimately rejected, divorce:

But there’s more. Back in the fast-track days, Greg had a vasectomy. After their conversion, they felt called to reverse that procedure — a very expensive proposition. But, through yet another miracle, they found a doctor inspired by their story, who was willing to do the reversal — essentially for free. He did so, and on Feb. 9, 2001, Katharine Marie Alexander was welcomed into the world.

God is truly good.

Most men are not as lucky as Greg was in controlling their procreation. It is a moral issue that deserves consideration.

Wednesday, August 6, 2008

On the Permanence of Suicidality

Opponents of an institutional right to suicide (advocates of forced life) often defend their views by citing evidence that relatively few people who attempt suicide, but are "rescued," go on to commit suicide. One often-cited study is a 1976 study published in the Journal of the American Medical Association, which found that, of 886 patients with a "serious" suicide attempt, "only" 4% went on to kill themselves within the following five years (Rosen, The Serious Suicide Attempt: Five Year Follow Up Study of 886 Patients, 1976:235 JAMA 2105, 2105).

However, a 2004 study published in the American Journal of Psychiatry gives us some perspective on this. The findings of the newer study, "Completed Suicide After a Suicide Attempt: A 37-Year Follow-Up Study," (Am J Psychiatry 2004; 161:563–564) follows a cohort of attempted suicides (all self-poisoning attempts), as the study's title suggests, over a 37-year period. At the end of the period, 13% of the attempters has committed suicide (though that figure increases to 19% when suspicious deaths that weren't clearly suicides, but may have been, are factored in). But the most surprising result of the study is that the rate of suicide didn't substantially decrease over time. A major proportion of the suicides occurred decades after the initial attempt. The rate of suicide did not fall significantly even decades after the attempt.

It is important to consider that self-poisoning is considered by many to be a less serious method of attempting suicide than more reliably lethal means, such as jumping from heights and gunshot. The proportion of completed suicides after an attempt using these methods is unknown, but we might expect it to be significantly higher than the proportion for the attempted self-poisoners.

This evidence - that suicidality is, to a high degree, permanent, that the "urge to end it all" never goes away - conflicts meaningfully with Scott Anderson's muddle-headed but unfortunately influential July article in the New York Times, entitled "The Urge to End It All." Anderson parrots questionable statistics, like the statistic that 90% of suicides have a mental illness, which I have previously attempted to debunk. He concludes that, based on his extremely unscientific interviews with past suicide attempters, a suicide attempt magically clears up the desire to die, and if we could only rescue suicide attempters, they would all happily continue living, cured forever of the "urge to end it all."

Another important piece of data recently became available about the suicidal brain. A study published in Biological Psychiatry found that the brain of a person dead by suicide, compared to a person dead of other causes, such as a heart attack, was likely to display altered gene expression. DNA methylation, a process which generally works to impede unnecessary gene expression (for instance, to prevent a brain cell from "acting" like a kidney cell), was much more extensive in the brains of suicides (who had all been previously diagnosed with Major Depressive Disorder) than in the brains of other deceased people.

The study's leader, Dr. Michael O. Poulter, commented to Science Daily that "the nature of this chemical modification is long term and hard to reverse, and this fits with depression."

The study highlights the gaping holes in our understanding of the etiology of suicide and "depression," and lends support to the idea that suicidality is permanent - or, at least, "long term and hard to reverse."

Monday, August 4, 2008

Mark Twain's Fairy Tale

The Five Boons of Life
by Mark Twain


     In the morning of life came the good fairy with her basket, and said:
     "Here are the gifts. Take one, leave the others. And be wary, choose wisely; oh, choose wisely! for only one of them is valuable."
     The gifts were five: Fame, Love, Riches, Pleasure, Death. The youth said, eagerly:
     "There is no need to consider;" and he chose Pleasure.
     He went out into the world and sought out the pleasures that youth delights in. But each in its turn was short-lived and disappointing, vain and empty; and each, departing, mocked him. In the end he said: "These years I have wasted. If I could but choose again, I would choose wisely."


     The fairy appeared, and said:
     "Four of the gifts remain. Choose once more; and oh, remember - time is flying, and only one of them is precious."
     The man considered long, then chose Love; and did not mark the tears that rose in the fairy's eyes.
     After many, many years the man sat by a coffin, in an empty home. And he communed with himself, saying: "One by one they have gone away and left me; and now she lies here, the dearest and the last. Desolation after desolation has swept over me; for each hour of happiness the treacherous trader, Love, has sold me I have paid a thousand hours of grief. Out of my heart of hearts I curse him."


     "Choose again." It was the fairy speaking. "The hears have taught you wisdom - surely it must be so. Three gifts remain. Only one of them has any worth - remember it, and choose warily."
     The man reflected long, then chose Fame; and the fairy, sighing, went her way.
     Years went by and she came again, and stood behind the man where he sat solitary in the fading day, thinking. And she knew his thought:
     "My name filled the world, and its praises were on every tongue, and it seemed well with me for a little while. How little a while it was! Then came envy; then detraction; then calumny; then hate; then persecution. Then derision, which is the beginning of the end. And last of all came pity, which is the funeral of fame. Oh, the bitterness and misery of renown! target fo rmud in its prime, for contempt and compassion in its decay."


     "Choose yet again." It was the fairy's voice. "Two gifts remain. And do not despair. In the beginning there was but one that was precious, and it is still here."
     "Wealth - which is power! How blind I was!" said the man. "Now, at least, life will be worth the living. I will spend, squander, dazzle. These mockers and despisers will crawl in the dirt before me, and I will feed my hungry heart with their envy. I will have all luxuries, all joys, all enchantments of the spirit, all contentments of the body that man holds dear. I will buy, buy, buy! deference, respect, esteem, worship - every pinchbeck grace of life the market of a trivial world can furnish forth. I have lost much time, and chosen badly heretofore, but let that pass: I was ignorant then, and could but take for best what seemed so."
     Three short years went by, and a day came when the man sat shivering in a mean garret; and he was gaunt and wan and hollow-eyed, and clothed in rags; and he was gnawing a dry crust and mumbling:
     "Curse all the world's gifts, for mockeries and gilded lies! And mis-called, every one. They are not gifts, but merely lendings. Pleasure, Love, Fame, Riches: they are but temporary disguises for lasting realities - Pain, Grief, Shame, Poverty. The fairy said true; in all her store there was but one gift which was precious, only one that was not valueless. How poor and cheap and mean I know those others now to be, compared with that inestimable one, that dear and sweet and kindly one, that steeps in dreamless and enduring sleep the pains taht persecute the body, and the shames and griefs that eat the mind and heart. Bring it! I am weary, I would rest."


     The fairy came, bringing again four of the gifts, but Death was wanting. She said:
     "I gave it to a mother's pet, a little child. It was ignorant, but trusted me, asking me to choose for it. You did not ask me to choose."
     "Oh, miserable me! What is there left for me?"
     "What not even you have deserved: the wanton insult of Old Age."

Friday, August 1, 2008

My Work on Antinatalism

The following are pieces I've written addressing various aspects of philanthropic antinatalism.

Procreation and Suicide, written before I read Better Never to Have Been, arguing that one reason it is unfair and wrong to require a sentient being to remain alive against its will is that the being took no voluntary action to come into existence. I argue that the "social contract" justification for state power is weaker in states that prohibit suicide. And I argue that if one voluntarily reproduces, one may not ethically commit suicide under the earlier justification, since one has at that point acted to ratify one's life.

Benatar's Account of Value (It's Not Nihilism) - in which I explain why philanthropic antinatalism is incompatible with nihilism.

Birth and Consent: An Alternate Philanthropic Route to Antinatalism, in which I attempt to ground antinatalism in concern for unconsented harm, without reference to the antinatalist asymmetry, and explain how birth is similar to genital mutilation.

Life Rights and Death Rights, in which I briefly introduce J. David Velleman's "option to live without explicitly deciding to live," which option is removed by an institutional right to die, and also introduce the symmetric "option not to exist without explicitly choosing to die," which Velleman very much does not address, and which is removed by birth.

Velleman's Sorrow of Options, in which I map out several arguments from different starting points using Velleman's concept of options as potentially harmful, including the "options" granted to an entity by virtue of its being brought into existence.

Unfriendliness is Unsolvable, in which I argue that the fact that being brought into existence is always a harm may preclude the existence of a friendly, powerful AI.

Where Do Rights Come From? (Or, A Weird Consequentialist Reason Why Pure Consequentialism Fails), a fairly silly essay in which I explore the concept of rights Thomas Nagel develops in "Personal Rights and Public Space" and attempt a consequentialist justification for avoiding consequentialism. I go on to explore a possible right not to be born, as well as a right to die.

Three Meditations on the Sweetness of Life, in which three instances of the widespread cannibalism of children by parents are related.

Tort Law and the Harm of Death, in which I examine the harm of death with reference to Nagel and O.H. Green and explain how American tort law accords with the counter-intuitive view that death is not a harm to the person who dies.

Moral Dilemmas Involving Harm to Children, in which I argue that ethical problems involving whether it is wrong to harm a child if one feels it is ultimately in the child's interests are insoluble in a particular way, in that the true responsibility for any harm to a child lies with his parents' decision to create that child, and the justification that the harm is "in his interests" is irrelevant.

Limits on Human Happiness, in which I examine some of the problems facing humans that are insoluble except by radical biological or brain changes.

The Moral Effect of "Being Glad It Happened," in which I argue by analogy that it is irrelevant to an action's morality that the object of the action is subjectively grateful for the action after the fact.

The Austrian Basement and Beyond: Consequences of Rejecting the Antinatalist Asymmetry, in which I present examples with a view to pointing out the ethical horror entailed by rejecting the antinatalist asymmetry on the grounds that it is counter-intuitive.

The Sense of the Asymmetry, in which I explain some of the implications of my earlier examples, and present another example that does not involve the creation of new people.

Inflicting Harm and Inflicting Pleasure on Strangers, in which I present another example, this one about ecstasy and peanuts, over which there is wide agreement of intuition. The example illustrates one of the arguments for antinatalism: that it is wrong to harm a stranger without his consent merely to provide him with a pure benefit (as opposed to preventing greater harm). It also supports a stronger claim: when evaluating actions that will harm non-consenting strangers, their potential pleasure doesn't count.

The Rape Doctor Hypothetical, which I will let speak for itself.

What the DSM-II Got Right

The DSM-II, or Diagnostic and Statistical Manual of Mental Disorders, Second Revision, was the diagnostic guide specifying the criteria for psychiatric disorders between 1968 and 1980.

In general, the DSM-II is very suspect. Until 1974, the DSM-II famously listed homosexuality as a mental disorder - specifically, it was listed under Personality Disorders and Certain Other Non-Psychotic Mental Disorders, Sexual Deviations, as DSM-II 302.0, Homosexuality. (Certain wacky Christian fringe groups and many Catholics still think the removal of homosexuality from the DSM was a real shame.) The DSM-II uses quaint terms like "neurosis" and includes controversial diagnoses like "Psychosis with childbirth," "Involutional melancholia," and "Depersonalization syndrome."

More recent revisions of the DSM (DSM-III, DSM-IV, and DSM-IV-TR) are generally considered to contain diagnoses that map more scientifically onto observable real-world phenomena.

Partially due to a realization of ignorance of the etiology of many diseases, revisions beginning with the DSM-III tended to erase etiology from the names and diagnostic criteria of many conditions (except conditions where the etiology is obviously central, such as 292.1, "Psychosis with other syphilis of central nervous system" (psychosis caused by syphilis).

Unfortunately, the refusal to link mental diseases with etiology resulted in a step backwards in the diagnosis and treatment of depression, according to Professor Gordon Parker ("Is depression overdiagnosed? Yes," British Medical Journal 2007:328).

"Fifty years ago [under DSM-II criteria]," says Professor Parker, "clinical depression was either endogenous (melancholic) or reactive (neurotic). Endogenous depression was a categorical biological condition with a low lifetime prevalence (1-2%). By contrast, reactive depression was exogenous - induced by stressful events affecting a vulnerable personality." In other words, the DSM-II recognized a type of biologically-determined depression, with a population frequency similar to other major, debilitating psychiatric disorders such as schizophrenia. (In fact, for various reasons including the severity and similar lifetime prevalence as schizophrenia, my reading of this is that endogenous "melancholic" depression, if studied in more detail, would be found to be specifically genetically linked, just like schizophrenia.) Another type of depression, much less severe and much more common, resulted from people "becoming depressed" secondary to negative life events.

Then, in 1980, the DSM-III revisions changed all that. They created a new taxonomy of depression, and rather than exogenous and endogenous, began to classify depression as "major" or "minor," with no reference to etiology. Only the diagnostic modifier "melancholic features," which I've previously discussed in my essay "Depression, Cognition, and Value," was left of the endogenous depression distinction.

Unfortunately, the major/minor classification has never been borne out by scientific studies (though the "melancholic features" modifier is scientifically robust). As Professor Parker points out,
Meta-analyses show striking gradients favouring antidepressant drugs over placebo for melancholic depression. Yet trials in major depression show minimal differences between antidepressant drugs, evidence based psychotherapies, and placebo. . . . Extrapolating management of the more severe biological conditions to minor symptom states reflects marketing prowess rather than evidence. Depression will remain a non-specific "catch-all" diagnosis until common sense prevails. [Emphasis mine; citations omitted.]

Scientific studies do not back up diagnoses of "major" and "minor" depressive disorders as true disorders. The DSM-III criteria for major depression has "failed to demonstrate any coherent pattern of neurobiological changes or any specific pattern of treatment response outside in-patient treatment settings," says Professor Parker. In other words, while the quaint diagnosis of "melancholic depression" under the DSM-II retains some scientific validity, the diagnosis of Major Depressive Disorder under the DSM-IV is not scientifically valid in any of the normal senses.

The implications for suicide rights are several. First, to the extent that everyone who is suicidal is assumed to be suffering from "Major Depressive Disorder," we are being diagnosed with a disease whose scientific validity is extremely questionable. The laughable overdiagnosis of "Major Depressive Disorder," coupled with the diagnosis' failure to "demonstrate any coherent pattern of neurobiological changes or any specific pattern of treatment response," must shake our confidence in the fashionable hypothesis that all suicide is secondary to a genuine mental disorder. Second, to the extent that our psychiatric establishment chooses to use these diagnostic criteria (Major Depressive Disorder), and since meta-studies generally show little significant difference between antidepressant medications, "evidence-based psychotherapies," and placebo, if we have depression, we must be said to have an incurable disease. Both citizens in general the those in medical professions should be much more circumspect about their willingness to force people with "Major Depressive Disorder" to remain alive against their will, and especially to forcibly medicate or "treat" this "disease."

While I think endogenous depression is a "real" disease, unlike DSM-IV Major Depressive Disorder, I do not think that all suicides have endogenous depression - not even close - nor do I think that endogenous depression is always treatable. At best, it is marginally more treatable than DSM-IV Major Depressive Disorder - that is to say, not very. The famous study that found that SSRIs work no better than a placebo found a slightly significant difference between drug and placebo for the most severely depressed people, which could be tracking endogenous depression, but this was primarily due to that group's much lower response to placebo. From the study:

Drug–placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very severely depressed category. . . . Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.
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