Thursday, October 1, 2009

Is High IQ a Treatable Medical Condition?

I have argued for a right to suicide grounded in personal freedom and dignity; I have argued that there is, in addition, no right to forcibly prevent people from committing suicide. My views on this extreme example of patient choice still apply; but what about less extreme solutions to suffering?

The predominant view of medicine seems to be a doctor-controlled, paternalist one. We must all get a doctor's permission to access most drugs; most people apparently do not find this to be a serious intrusion into privacy and dignity. I think a better view of medicine is that of a doctor as a consultant, who assists the patient with medical knowledge and advice, but does not ultimately control the patient's treatment.

What is the purpose of medicine? (Please feel free to answer this below - it's not just rhetorical.) Is it to relieve suffering? To enforce proper behavior? To extend life? Certain definitions of medicine's purpose (like that last one) rely on idiosyncratic values that perhaps should not be forced on others. A fairly radical, but I think value-neutral, definition of the purpose of medicine might be: to assist patients in maximizing their own values by providing knowledge of human biological systems and applying available medical techniques as chosen by the patient.

One of these might be a prescription for Nembutal.

But another of these "available medical techniques" might help a patient reduce his general intelligence in various ways if it is a burden to him.

The DSM-IV definitions of diseases tends to include the rider that the symptoms "cause marked distress" to the patient. Perhaps it is time to consider whether conditions thought to be desirable that "cause marked distress" should also be treatable.

High intelligence is clearly treatable with a variety of substances and treatments, from ECT to antipsychotics to medical cannabis. If, say, extremely good memory or other symptoms of high intelligence are a burden to the patient, shouldn't he be entitled to use available technology to eliminate them? And why not have a physician's advice on how to do it in a manner that maximizes the patient's other values?

Is it different from suicide?

20 comments:

  1. I had to laugh when I read the title of this piece. Cool idea to bring this up.

    I like your definition of the purpose of medicine. However, I'm not so sure in what sense it is value-neutral. It obviously presupposes that autonomy and following your own conception of life are values. It's not superior to the "extend life"-view because it's less normatively loaded. Rather, it's superior because its normative content is better justifiable.

    Should high intelligence be considered treatable? Sure. I think they way to go about the concept of mental illness is to let every subject define for themselves whether they are mentally ill or not. That means that one and the same condition can be both an illness and no illness, depending on the person. And then, of course, any part of an individual mental make-up qualifies as a potential illness.

    It seems to be an interesting question whether physical diseases have to be treated like that as well, or whether they're a different thing entirely. It doesn't seem that unimaginable that one could find and "objective" definition for a physical disease, but I don't have any.
    On the other hand, if we think of them just like of mental illnesses, then the question arises what public health insurance should cover (I sort of presuppose such insurance here because I'm very much convinced it's obligatory for a state to provide such). This, however, is only part of a larger question: To What extent should bad luck in the lottery of life be compensated for? After all, if we take the lottery seriously, shouldn't we have to start compensating people for, say, being born ugly? Someone, I think it was Thomas Pogge, has levelled exactly this as an objection to the lottery argument, but I have to admit I'm far from convinced it is one.

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  2. If we are to mention memory as a burden, let's remember Funes the Memorious.

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  3. Constant - those are exactly the issues I find interesting as well!

    The public health/insurance coverage question is very important. Accepting the idea that medicine should be based on individual desires is not THAT hard to swallow. But it pumps up the moral hazard-ish problem when you put it in an insurance context. Should fellow citizens pay for essentially recreational medical care?

    I don't think you can get to the answer without going deep into political philosophy. I would want to ground at least public health care in Rawls - e.g., we make sure people have the sort of "primary goods" that allow them to pursue their personal desires. But in a specific case, it might be hard to tell what fits where - I like your ugliness example.

    Again, antinatalism is a tidy answer, but it's an interesting question from a non-antinatalist perspective as well. I am in favor of compensation for e.g. people born ugly, grounded in the fact that they didn't choose to be here. But I think one form of that compensation is just total freedom to figure out how not to suffer. Of course, if you are allowed to have plastic surgery but don't have the funds, lot of good it's going to do you. When I was practicing I had a legal client who desperately wanted gender reassignment, but couldn't afford it, so he was basically fucked. But people with apotemnophilia who want limbs removed don't even have the freedom to do it if they CAN afford it.

    I'm fascinated by the purpose-of-medicine problem lately. It does seem like there should be an objective definition of physical disease - but I don't have one, either.

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  4. Mitchell, I've always loved that. Here's a real life example: Woman has perfect 'episodic memory'.

    From the piece:

    In addition to good memories, every angry word, every mistake, every disappointment, every shock and every moment of pain goes unforgotten. Time heals no wounds for Price. "I don't look back at the past with any distance. It's more like experiencing everything over and over again, and those memories trigger exactly the same emotions in me. It's like an endless, chaotic film that can completely overpower me. And there's no stop button."

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  5. The ugliness example is not mine, it's Pogge's. I could try to dig out the reference if you want... It's a paper where he criticizes Rawls for the unmitigatedly consequentialist element in the latter's theory.

    I, too, have an inclination to follow the lottery argument (which I personally think is crucial for Rawls; I don't have the book here right now to look up what exactly he himself says about it - and I'm just starting to hate myself for not doing political philosophy anymore in the last year), but one really has to buy rather extreme consequences, among which is - other things being equal - the obligatoriness of genetic manipulation to the better if it should become possible. And also the obligatoriness of pursuing research in that direction. And of compensating those who are still disadvantaged... On the other hand, it's not exactly clear that other things are equal.

    Of course, antinatalism is a trivial solution to all that. In fact, it's a trivial solution to a large number of ethical problems, for purely locial reasons. However, it's quite possible that there are also other, non-trivial solutions...

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  6. You must be joking: you’d rather be an ignoramus than a free-thinker or a pig wallowing in the mud than a thinking, feeling human-being? There’s freedom, beauty, satisfaction and moments of supreme peace and contentment in having a lively imagination and an active mental/intellectual life. Do you have so few worthwhile, pleasurable intellectual experiences you’d rather have none at all? I’ve suffered a great deal myself but some of my best moments have been related to discovering new ideas, reading mind-blowing books and having intelligent, pleasurable and meaningful discussions with like-minded individuals. Besides: as far as I know there have been no studies correlating depression with high intelligence (apparently patients are pretty evenly spread out among the Gauss-curve) so this would hardly be a solution to your problem. Sure in moments of desperation you’d wish for a lobotomy or a complete shut-down of the higher mental functions but you don’t need a doctor for that: just start a serious drug-addiction or become an alcoholic (alcoholism truly is a mind-killer) and I guarantee after even a few months you no longer will be bothered by deep thoughts or flashes of insight. Will you be happier? I seriously doubt it though.

    You should be thankful for your intelligence (might as well have been born a dunce) as this is what separates you from the common stock of mankind with their inherent stupidity, herd-mentality and general malevolence. Intellectuals may not be the happiest people on earth but they do have experiences and exquisite pleasures that are completely unknown to the rest of the world (as well as peculiar vulnerabilities like an increased receptiveness to boredom and meaninglessness). In my opinion one who has never had the pleasure of listening to the divine music of Bach, Mozart or Beethoven (to me their best works are the St. Matthew-Passion, Requiem in D-minor and the Missa Solemnis respectively) has not lived at all and I do think my reasonably high intelligence had something to do with my receptiveness to these great products of the human mind.

    I care little for the so called benefits of our biological evolution (I happen to think animals suffer less than we do, in large part due to the simple fact they don’t really have an imagination and can never be conscious of future suffering or death) but the cultural evolution of our race (meaning humanity, there is only one human race after all) is invaluable to me since it offers a counterbalance (more or less) to the added suffering we humans are heir to and it may very well be the only legitimate reason for keeping the human race alive. The best representatives of mankind are its greatest thinkers, writers, scientists, artists and spiritual teachers and you’d rather be part of the common herd of humanity (the factory-product of nature as Schopenhauer called them or the way-too-many according to Nietzsche) than strive to emulate the former and be a part of a true brotherhood of intelligent, decent human-beings? If I ever produce a thought that is more or less comparable to Nietzsche’s legacy (or any one of my favorite philosophers) than I’d die a happy man, no matter the cost. Just imagine what the world would come to if all truly intelligent people would think like you and just want to off themselves, we would descend into barbarism and the world would be darkened by a cloud of stupidity comparable only to the nazi-reign over much of Europe during WW2. ...

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    1. What a drag. I don't have the brains to pick out the points of your reply that I disliked, or disagreed with. I consider myself a slow learner, I used to appreciate fast learners. Now after slowly learning more, I realize smart people like you, still can have information that is very inaccurate,or in your case, a little inaccurate. I am just an efilist wanna be. I have ignored the issue in regards to what the original author meant, and now I could agree with you that maybe she is joking, or maybe being sarcastic.
      Instead, I got interested in your talk about "enjoying life, music,or whatever". I put up with this site, but it is still not close to laying out what inmendham has on his site. Yes, I am glad the author has a book out. Yet there is more to be done. I am a dummy, and a slow learner, but put your brain on the idea of decreasing suffering for all sentients.
      Sorry to ramble, but I am not academically oriented, analytically oriented, but I stay around to spread the good memes, and to try to reduce suffering, and to acknowledge that some of the things I do are very wrong, such as eating meat. I too tired to be annoyed by your words, I am only cheering you on to use your brain for the good that you eluded to. If you can't be quoted some day from a book you wrote, at least you can get on board as you may already be, and support the great ideas that are already out there. I probably won't check back to this post, but I might, so thanks in advance if you reply.

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  7. The problem with the modern era (psychiatry being an off-shoot of this train of thought) is that suffering is considered necessarily bad and consequently must be eradicated at all cost: this not only causes more suffering (if you expect life to be swell at all times or an easy ride you’re in for a rude surprise and will likely end up miserable and severely depressed) but also prevents that suffering to be used constructively for a good and worthy cause. I think our biggest problem is nihilism: it’s not suffering in itself that is unbearable (not every kind anyway) but the thought that all suffering is necessarily evil and pointless. Beethoven suffered a lot from his deafness and the social-isolation this brought on, yet he composed some of his greatest work after he could hear almost nothing anymore. The flower of life has thorns and it originated from the mud of filth of creation but it’s also capable of carrying great fruit and exquisite beauty. When you weed your garden do you also destroy the roses that grow in it?

    Zara

    PS: if you’re not convinced by my other arguments just think of yourself as a drooling Alzheimer-patient who can’t even remember the names and faces of the people close to her, do you still consider this such a desirable outcome? Yet this is the ultimate consequence of your line of thinking: if a lower intelligence is better than a high intelligence than it follows that having no (or almost none, no intelligence would mean brain-death) intelligence would be even better. I’ve known some pretty smart people who developed a serious cannabis-addiction: after a few months they were completely incapable of reasonable conversation and if kept up for years this can become a permanent condition, truly a pity and a waste of potential and talent. I’d consider losing your higher brain-functions (memory, reasoning…) a better reason for suicide than having a highly functional brain which may cause you some inconvenience (or even downright suffering in some people) you otherwise wouldn’t experience. Besides it’s emotions that cause you pain, not abstract thought or memories themselves.

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  8. you’d rather be an ignoramus than a free-thinker or a pig wallowing in the mud than a thinking, feeling human-being?

    I wonder whom you're addressing. As far as I can see, no-one here has expressed such desires for themselves. I certainly don't have one. I, personally, would prefer death to stupidity under all but maybe the most unimaginably horrible circumstances.

    just start a serious drug-addiction or become an alcoholic (alcoholism truly is a mind-killer) and I guarantee after even a few months you no longer will be bothered by deep thoughts or flashes of insight. Will you be happier? I seriously doubt it though.

    Now, obviously, incurring an addiction is not a nice thing, so one can't really say that you can do it anyway... Apart from that, it's all very well that you're happy with you intellectual identity and such, but you've not really made a strong case if you wanted to show that a desire to get rid of one's intelligence is always irrational. It's like a cheery person saying "Look, suicide is irrational, because you can live happily - look at me!". (Now I hope this goes through as a bad argument with you...)

    Just imagine what the world would come to if all truly intelligent people would think like you and just want to off themselves, we would descend into barbarism and the world would be darkened by a cloud of stupidity comparable only to the nazi-reign over much of Europe during WW2. ...

    I'm having trouble seeing the difference... I thought that was exactly what the world is decending into again right now.

    The problem with the modern era (psychiatry being an off-shoot of this train of thought) is that suffering is considered necessarily bad and consequently must be eradicated at all cost

    What is bad, if not suffering? ...

    this not only causes more suffering

    ... which doesn't speak for the methods people are using when they try to get rid of suffering. And this is about all it says, I think.

    I think our biggest problem is nihilism: it’s not suffering in itself that is unbearable (not every kind anyway) but the thought that all suffering is necessarily evil and pointless.

    This is self-contradictory. If you're a nihilist, how can you have such strong evaluative judgments towards suffering?

    When you weed your garden do you also destroy the roses that grow in it?

    No, but I happen to have the habit of trying to avoid the roses so as not to incur wounds. I don't know about you, though; maybe you should give rose stings a try.

    truly a pity and a waste of potential and talent.

    Isn't there an article on this blog arguing that this is a rather... indecent thing to say because it implies some wish to instrumentalize the person? ...

    Besides it’s emotions that cause you pain, not abstract thought or memories themselves.

    ... and? Thoughts and memories happen to cause emotions quite frequently.

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  9. So just to clarify: I did intend the post and title to be sort of funny, but I'm also serious. The greater project is thinking about cases that are close to the suicide case in terms of self-ownership, dignity, etc. I'm actually interested in alternatives to suicide right now - but many of my "alternatives" are things that seem destructive from the outside.

    I do experience intense intellectual pleasure, for what it's worth. I don't think suffering is necessarily bad at all. But I think it's up to each individual to choose how much suffering he or she is willing to accept. I do not think anyone but the individual should be setting this "desired" amount of suffering. And correlates of intellectual ability, especially unusually good memory, might reasonably be seen by some as causing more suffering than they're worth.

    I'm interested in exploring "addiction" as a valid alternative to suicide. I'm trying to finish a little piece on PRNs and suicidal despair. I'm not interested in telling anyone that drugs or ECT are going to solve their problems - but I do think it's worth opening up the possibility space. "Healthy" life choices don't work for all of us. Otherwise we wouldn't be suicidal, probably.

    I second Constant's reference to the "instrumentalizing" idea. "Don't do drugs, because society has a use for you" is a sentiment I find disturbing. I do try to work for good as I see it, but I find it hard to swallow that "society" has any particular claim on my work or talents or life, any more than a political prison has a claim on the labor of its inmates.

    I should add a personal note: I am finding that drugs that interfere with memory (not just cannabis) are effective in making my life tolerable and even relatively pleasant. The chemicals have not been the only part of my strategy - but there's probably no part of my strategy that an average person would find appropriate or healthy. Except that they seem to work. For now.

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  10. This piece by the editor of the controversial journal Medical Hypotheses might be of interest.

    As for the "instrumentalizing" idea, I take Zara to be making a more interesting suggestion than that individuals' values should be regimented by what benefits society, but by the pursuit of something like excellence or splendor, rather than ceding highest authority to a merely hedonic personal calculus...

    Now, I don't think anyone or thing has the legitimate authority to impose this kind of evaluative self-regimentation on anyone, but if excellence and splendor are the highest values one wants to live by and promote the pursuit of (albeit among the few capable of doing so), such an outlook might be reason enough to be wary of efforts to make suicide any more appealing or easy an option than it is already ( --excepting, of course, the kind of cases covered by assisted suicide laws in the UK or Switzerland, for instance).

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  11. Rob, awesome article. I'm all for treatment of symptoms and not silly fake-scientific "syndromes." The recommendation of nicotine and caffeine as first-line agents for demotivation is hilarious and right-on.

    I don't think anyone or thing has the legitimate authority to impose this kind of evaluative self-regimentation on anyone, but if excellence and splendor are the highest values one wants to live by and promote . . . such an outlook might be reason enough to be wary of efforts to make suicide any more appealing or easy an option than it is already.

    I think it's reasonable and good to want to promote excellence and splendor over relief from suffering. I'm grateful people do it; otherwise there would be no Linda Barry or Christopher Brosius or John Thorne or Iris Murdoch and life would be worse.

    But I think the bright line has to be drawn between coercive and non-coercive means of "promoting" a particular value system such as that. You doubt, as I do, whether anyone has legitimate authority to impose this value system on anyone. The only quibble I have with your statement is that making suicide a "more appealing or easy" option means, to me, removing coercive barriers to suicide (e.g. drug restrictions and mandatory involuntary resuscitation). I think being against the removal of coercive practices necessarily means supporting those coercive practices.

    There are all kinds of non-coercive means of promoting excellence and splendor. Instantiations of excellence and splendor themselves tend to lead those in proximity to them to value just those qualities. Force seems both wrong and counterproductive here.

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  12. Promoting excellence is a very problematic thing. I guess it's justifiable to have economic and academic excellence favored by incentives. But when it comes to more personal things, Perfectionism (that is the name for a system where the state promotes some particular set of values), be it coercive or not, seems very objectionable to me.

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  13. Sister Y,

    There's a fascinating documentary called "American Eunuchs" that is relevant to your approach here. It's about the subculture of men who seek castration for subjectively compelling reasons that, in your words, "seem destructive from the outside."

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  14. A recent case of a nurse accused of encouraging suicides online.

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  15. Did anyone catch tonight's episode of "House"? Am I paranoid to suspect that the show's writers may be TVfH habitues?

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  16. Jesus. You guys are still here talking about suicide?!?!?!?!

    A couple of weeks ago, a friend's husband hung himself. Last summer, someone close to me jumped off a cliff.

    I wish all of you who spend your time like this could go to some fucking funerals.

    Your lives will be over soon enough, in the blink of an eye. And you will have spend most of it in your heads, stuck in an endless loop of delusional thinking.

    This makes me very, very sad. But I don't want to kill myeslf.

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  17. I can see that you are putting a lot of time and effort into your blog and detailed articles! I am deeply in love with every single piece of information you post here. HealthMD

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