Reb Zusia was a poor humble rebbe and on this particular day he looked it. He was taking a coach to the city and waited to board with a few other passengers.
One of the passengers was a rich man and he was looking at Zusia, thinking to himself 'Ah ha, now here is a man I can make fun of; . . and that is what he did.
They arrived in the city and thousands of people gathered around the coach. Zusia stepped off and disappeared into the crowd. The rich man got off and asked someone what was going on. He said that Reb Zusia has come and we've gathered to greet him.
When the rich man found out the man he had been making fun of was Reb Zusia he went up and apologized.
Reb Zusia said, "It's not me you should be apologizing to . . it's all the poor people of the world you're insulting. You have to ask every poor person for forgiveness."
Friday, April 29, 2011
Thursday, April 28, 2011
A shadowy online company selling suicide kits recently claimed its first confirmed victim. Winston Ross talks exclusively with the entrepreneur behind it: a grieving 91-year-old woman.
People who wish to kill themselves and who order a kit THROUGH THE FREAKIN' MAIL to enact those wishes are not "victims."
People who die in an automobile collision caused by a man attempting suicide, who was unable to commit suicide by other means, are victims.
People who are forced to remain alive when they want to die, often in horrible circumstances like akinetic mutism (can't move or speak) after an unsuccessful suicide attempt, are victims. (That goes double when they have medical experiments performed on them without their consent, as happened in the case linked above. There was no ethical outcry; the study was widely touted as a breakthrough. It makes me want to vomit.)
People who want to die and commit suicide are just lucky.
I envy the fictim in this case, Nick Klonoski, a 29-year-old man with chronic pain and depression. However, his bereaved brother Zach sees things differently. He testified at a hearing:
"In a society where so many people suffer from depression and other mental-health disorders,” Zach said, “this company has found their niche in the market by peddling death. This is analogous to putting a gun-vending machine next to a depression clinic. The Gladd company, so named as to avoid suspicion in case family members happen to sign for or come across the package, made $60 off my brother’s death."
What about the people making money off our misery - like the medical industry, which makes billions every year forcibly "treating" would-be suicides in an often horrific manner? What is wrong, exactly, with "peddling death" when death is heartily desired? None of us asked to be here.
The fact is that while people's willingness to pay to improve people's lives is extremely limited, their willingness to demand regulation to prevent people from taking their own lives is nearly infinite. In essence, this is an involuntary, uncompensated transfer of wealth from suicidal, miserable people, the worst off of society, to their nonsuicidal friends and relatives. It is all done under the flag of the medical model of suicide, which is treated as a religious fact rather than examined as a scientific proposition (since examined as such it is clearly erroneous).
One important piece of information here: the helium thing apparently works (here's a video, even). I wonder how long it will take for forced life advocates to make helium illegal. Oh wait - it's already happening.
Wednesday, April 27, 2011
See also: The Mathematics of Misery: What Human Behavior Teaches Us About the Value of Life
That being born is a good thing is treated as axiomatic by the majority of thinkers who consider the issue.
Thomas Nagel, for instance, states that "All of us, I believe, are fortunate to have been born," even while affirming that not having been born is no misfortune (Mortal Questions, "Death," p. 7). Bryan Caplan has said, regarding IVF, "How can I neglect the welfare of the children created by artificial means? But I'm not 'neglecting' children's welfare. I just find it painfully obvious that being alive is good for them [emphasis in original]."
There are two elements to this kind of thinking. First, it represents a judgment that life is, on the whole, worth getting and having; but second, all the talk of "obviousness" also implies that there is something wrong with even asking the question.
I want to address here how quantitative methods, rather than intuition and assumption, might be used to measure the downside of existence. I argue that there is a need to analyze quantitatively the obligations that we are all born with and the inherent pain of life, and that, if our lives are to be worth having on the whole, must be made up for with valuable experiences.
Work and Leisure
We might characterize the central unpleasant obligation in our lives as the obligation to "work" (broadly construed) in order to meet the salient and potentially misery-inducing needs we are born with or naturally develop. These needs include not only food, clothing, shelter, and medical care, but also status, love, sex, attention, and company. We can even quantify these needs, by quantifying work done to satisfy these needs, for which we have a great deal of data.
Some of these needs, of course, may actually be satisfied by working - the need to belong, to feel valuable, to not be a burden. However, at the same time, some of these needs are actually increased by working - that is, work may create disutility as well as utility. How can you tell the difference between what people do to merely to ease the pain and discomfort of existence, and what people actually want to be doing?
Many economists have addressed the question of the difference between work and leisure, and how we may quantify and measure them. One crude-but-tempting measure of the value of leisure time is merely a person's wage. But as Larson & Shaikh (2004) explain, this is much too crude to get at the true nature of work and leisure:
Assuming the average wage is the appropriate opportunity cost of time presumes that the individual faces no constraints on hours worked, derives no utility or disutility from work, and has a linear wage function.... This is unlikely to be true for many people....an individual's average wage does not necessarily reveal anything about the shadow value of discretionary leisure time, either as an upper or lower bound.
The question of the value of leisure time is intimately related to the question of quantifying the unpleasant obligations placed on us by virtue of existence, so that we may have a starting point for a meaningful comparison of life's costs and life's benefits.
How do we characterize "work"? What is the difference between "work" and "leisure"?
Intuitively, we know the difference - or at least, there exist clear cases of "work" and clear cases of "leisure." Operating a cash register is work. Washing dishes is work. Doing bong rips is leisure. Reading novels is leisure. Watching television and having sex are generally leisure (unless you're in advertising or a prostitute). For most people, child care and lawn care qualify as work - whether paid or unpaid - but for some people, these may qualify as leisure some of the time.
These examples suggest that leisure is that which is done for the sake of the experience itself, whereas work is done with some goal in mind other than the experience itself, and is done only in service of that goal. Running ten miles is leisure for me, because I do it for the pleasure of the experience; running those same ten miles might be work for someone else, because he does it to lose weight, not for the pleasure of running. A third person might run for both reasons, in which case the action has aspects of both leisure and work. We should not necessarily expect that every action and every hour can be neatly categorized as "work" or "leisure," even for a particular individual.
This should give us pause when considering the definition of "leisure" preferred by Mark Aguiar and Erik Hurst in their 2006 paper "Measuring Trends in Leisure: The Allocation of Time Over Five Decades," an hour-by-hour tally of time not spent in market or non-market work (e.g., at work, or doing unpaid work around the house or around town). In reality, a single hour may have substantial aspects of both work and leisure.
Aguiar and Hurst remark on a potentially definitional characteristic of leisure: the degree to which market inputs (money, technology) are consumed to reduce the amount of time spent in the activity. They say:
...one definition of whether an activity is “leisure” may be the degree of substitutability between the market input and the time input in the production of the commodity. That is, the leisure content of an activity is a function of technology rather than preferences. In the examples above, one can use the market to reduce time spent cooking (by getting a microwave or ordering takeout food) but cannot use the market to reduce the time input into watching television (although innovations like VCRs and Tivo allow some substitution). [Emphasis mine.]
Let me give a definition of my own, to fit my question:
Work is any action (or omission, perhaps) that we undertake in order to prevent or remedy some unpleasant state, and that we would not undertake if the unpleasant potential state were not a factor. An activity has a strong work component if technology is demanded by individuals to reduce the amount of time they spend in the activity.
In other words, work is what you do only because you have to eat, and you spend as little time doing it as is possible to satisfy your (present and projected future) needs.
Many studies since the 1980s have found that physicians' demand for leisure directly affects the prevalence of cesarean sections. Cesarean sections are highly correlated to time variables associated with doctors wanting to get the hell out of there, although (further strengthening the theory) this correlation is dependent on the type of insurance covering the patient.
Instead of relying on the "imaginary survey justification" to "prove" that coming into existence is a good thing, economists and ethicists could use more creative, quantitative methods to examine the question of how bad (and how good) life is. Specifically, we need to figure out how to tell the difference between suffering people attempting to remedy their shitty situation, and happy people chilling out - both of which may describe any of us at different times in our life, or even our day. "Are you glad you were born?" is unsubtle, an all-or-nothing approach that relies heavily on people knowing the answer to questions they may have only limited capacity to understand. Analyzing behavior in smaller chunks would give us a better idea of just how happy people are to be here.
Poverty and Pain
Behavioral economics is a strong tool for understanding ourselves and each other. However, many behavioral economists, consciously or unconsciously, rely heavily on the "imaginary survey justification," and no economist, to my knowledge, has attempted to use behavioral economics methods to figure out how bad, or how good, life is to individuals.
Bryan Caplan published a fascinating, even audacious paper in 2007 entitled "Behavioral Economics and Perverse Effects of the Welfare State." In it, he argues that giving the poor more life choices through charitable assistance seems to actually harm them, because they are irrational and fail to choose the best option for them. From his abstract:
Critics often argue that government poverty programs perversely make the poor worse off by encouraging unemployment, out-of-wedlock births, and other "social pathologies." However, basic microeconomic theory tells us that you cannot make an agent worse off by expanding his choice set. The current paper argues that familiar findings in behavioral economics can be used to resolve this paradox. Insofar as the standard rational actor model is wrong, additional choices can make agents worse off. More importantly, existing empirical evidence suggests that the poor deviate from the rational actor model to an unusually large degree. The paper then considers the policy implications of our alternative perspective.
The option Caplan fails to consider is this: the lives of the poor are unacceptably bad without charitable aid.
We don't think it irrational, exactly, when a person in extreme pain does something to relieve his pain that may have negative future consequences. A shrieking, sweating patient in horrible pain might be perfectly aware of the potential for developing a long-term addiction to opiates, but we do not consider his decision to take opiate medication to be irrational. His pain is so bad that we think it makes sense for him to use any means to stop it, even if they harm his future interests.
Connecting to my discussion of work vs. leisure, I think it a valid hypothesis that poverty is actually dreadfully painful - not only physically, but emotionally and socially. There is only so much pain we can expect a being to endure before his attempts to relieve it through future-damaging means becomes perfectly understandable and, in fact, rational.
The Demand for Pain Relief
An economic theory of rationality, to be in touch with human ethical reality, must include an account of pain. We must attempt to define and study pain (in the broad sense) in a behavioral economics context, rather than to define it away, as Caplan attempts to do.
Karl Smith notes that studies consistently show that health care consumers do not seem to take into account mortality data when choosing between health care providers, even when very good mortality data is widely available in a user-friendly format. Perhaps the demand for life is not as high as we might think. People seem to like spending money on health care, but not to care about outcome. One approach suggested by this is to study revealed preferences/willingness-to-pay for death risk reduction and pain relief (broadly defined), respectively, in different contexts and populations.
Is Loss Aversion Irrational?
A recent paper on behavioral economics, using tufted capuchin monkeys as subjects, demonstrated that the monkeys exhibit what is considered a typical human departure from rationality, "loss aversion." That is, monkeys trained to use metal discs as money preferred to buy fruit from a graduate student who would give them a smaller food reward but sometimes add a few grapes to it, rather than from a graduate student who would give them a larger food reward but then maybe remove a few grapes. The monkeys weren't maximizing the number of grapes they got; they specifically exhibited a preference to have things added, rather than have things taken away.
This does not, I think, exactly illustrate irrationality in the capuchins: it illustrates that they are utility maximizers, not grape maximizers. Monkeys experience a loss of utility from losing grapes that is greater than the utility produced by those grapes. Losing grapes, we might say, is painful. Doing the resource-maximizing thing does not necessarily equate with doing the utility-maximizing thing.
A Place for Quantitative Methods
Caplan's conclusion is that we must not treat the poor as rational actors, because they deviate so heavily (compared to the wealthy) from being long-term best-interest maximizers. Therefore, he says, we should not expect to solve their problems by giving them money or other charitable aid.
An equally supported conclusion would be that being poor is so awful it is unendurable, like severe physical pain, and poor people actually are rational, taking this into account. Caplan also gives us a hint at what might be an indicator of painfulness: the degree to which the actor deviates from resource maximization. He says, "The behavioral literature has documented that the average person frequently violates neoclassical assumptions. But it rarely investigates variation in the tendency to violate neoclassical assumptions. Casual empiricism and limited formal evidence suggest that the poor do deviate more. A great deal more could be learned at low cost if new behavioral studies collected information on participants' income and education to test for heterogeneity. [Citations omitted.]" Analyzing LOTS of factors for correlation to deviation from resource-maximization rationality, not just income, education, and intelligence, could help us understand the circumstances under which life is so painful that we act irrationally.
1. The extreme seriousness of the basic human need for affiliation and belonging is not widely acknowledged, even though data is available to that effect from a wide variety of sources. Kipling Williams' meta-studies, Ostracism: The Early Detection System and Ostracism: Consequences and Coping are a good place to start to review the literature on the consequences of failed belonging. For instance, Williams explains experiments using Cyberball, an interactive computer game that can be used to give test subjects the impression of being ostracized in a controlled way. He says experimenters have "found strong negative impact on mood and need levels for those participants who were ostracized" in the Cyberball game, and when the experiment was conducted under fMRI, participants "showed significant increases in activity in their anterior cingulate cortexes, where people also show significant activity when enduring physical pain." Further, he states that "In all of these Cyberball studies, the effects sizes of the ostracism manipulation are over 1.00 (often above 1.50) indicating strong effects, and subsequent meta-analyses indicate it takes only three people per condition to reach standard levels of significance. [Citations omitted.]" See pp. 17-19 of Ostracism: The Early Detection System. What's especially amazing is that the effect is clearly not rational - it holds even when ostracized participants have been explicitly told that they're only playing against a computer (NPCs).
Thomas Joiner's book Why People Die by Suicide (see my review here) is a book-length treatment of an empirically-tested theory of the causes of suicide, and concludes that three factors are the best predictors of suicidality: failed belonging, feelings of burdensomeness, and competence (ability to physically do it). Two of the three factors are measures of failed social affiliation. Other kinds of sadness (including sadness for other reasons and clinical depression) are not very predictive of suicide. And Phillipe Rochat's excellent book Others in Mind details the formation of the human "self" through child development studies and other empirical research, concluding that what he terms the Basic Affiliation Need is not only an extremely critical need, but one that is primordial to, and directly causes, the formation of the self. The need to belong and to have a place in society is not a luxury, but a basic need the absence of which is more painful than prolonged hunger or injury.
2. Yesterday, I overheard two high school girls having a conversation. One revealed to her friend that although she realized it meant giving up one's life, she could see the upside to a diagnosis of terminal cancer - a kind of peace, and an exemption from the future-oriented unpleasantness we must all endure if we are to be considered socially responsible. "You could just have fun in school," she said. "I work my ass off every day with work and schoolwork, but if you were going to die anyway, you could just relax. You wouldn't have to worry." Her friend agreed, but said she wanted to see what it was like to be an adult anyway. "I'm not sure I do," said the first little girl. School is generally work, not leisure.
Wednesday, April 13, 2011
And re Ennet House resident Kate Gompert and this depression issue:
Some psychiatric patients — plus a certain percentage of people who've gotten so dependent on chemicals for feelings of well-being that when the chemicals have to be abandoned they undergo a loss-trauma that reaches way down deep into the soul's core system — these persons know firsthand that there's more than one kind of so-called 'depression.' One kind is low-grade and sometimes gets called anhedonia or simple melancholy. It's a kind of spiritual torpor in which one loses the ability to feel pleasure or attachment to things formerly important. The avid bowler drops out of his league and stays home at night staring dully at kick-boxing cartridges. The gourmand is off his feed. The sensualist finds his beloved Unit all of a sudden to be so much feelingless gristle, just hanging there. The devoted wife and mother finds the thought of her family about as moving, all of a sudden, as a theorem of Euclid. It's a kind of emotional novocaine, this form of depression, and while it's not overtly painful its deadness is disconcerting and . . . well, depressing. Kate Gompert's always thought of this anhedonic state as a kind of radical abstracting of everything, a hollowing out of stuff that used to have affective content. Terms the undepressed toss around and take for granted as full and fleshy — happiness, joie de vivre, preference, love — are stripped to their skeletons and reduced to abstract ideas. They have, as it were, denotation but not connotation. The anhedonic can still speak about happiness and meaning et al., but she has become incapable of feeling anything in them, of understanding anything about them, of hoping anything about them, or of believing them to exist as anything more than concepts. Everything becomes an outline of the thing. Objects become schemata. The world becomes a map of the world. An anhedonic can navigate, but has no location. I.e. the anhedonic becomes, in the lingo of Boston AA, Unable To Identify. . . .
* * *
Hal isn't old enough yet to know that . . . dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this condition clinical depression or involutional depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton's melancholia or Yevtuschenko's more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.
It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self's most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also throughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably the most indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.
It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain, a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.
The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who's being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who's not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it's a closed circuit: the current is both applied and received from within.
The so-called 'psychotically depressed' person who tries to kill herself doesn't do so out of quote 'hopelessness' or any abstract conviction that life's assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire's flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It's not desiring the fall; it's terror of the flames. And yet nobody down on the sidewalk, looking up and yelling 'Don't!' and 'Hang on!', can understand the jump. Not really. You'd have to have personally been trapped and felt flames to really understand a terror way beyond falling.
But and so the idea of a person in the grip of It being bound by a 'Suicide Contract' some well-meaning Substance-abuse halfway house makes her sign is simply absurd. Because such a contract will constrain such a person only until the exact psychic circumstances that made the contract necessary in the first place assert themselves, invisibly and indescribably. That the well-meaning halfway-house Staff does not understand Its overriding terror will only make the depressed resident feel more alone.
One fellow psychotically depressed patient Kate Gompert came to know at Newton-Wellesley Hospital in Newton two years ago was a man in his fifties. He was a civil engineer whose hobby was model trains — like from Lionel Trains Inc., etc. — for which he erected incredibly intricate systems of switching and track that filled his basement recreation room. His wife brought photographs of the trains and networks of trellis and track into the locked ward, to help remind him. The man said he had been suffering from psychotic depression for seventeen straight years, and Kate Gompert had had no reason to disbelieve him. He was stocky and swart with thinning hair and hands that he held very still in his lap as he sat. Twenty years ago he had slipped on a patch of 3-In-1-brand oil from his model-train tracks and bonked his head on the cement floor of his basement rec room in Wellesley Hills, and when he woke up in the E.R. he was depressed beyond all human endurance, and stayed that way. He'd never once tried suicide, though he confessed that he yearned for unconsciousness without end. His wife was very devoted and loving. She went to Catholic Mass every day. She was very devout. The psychotically depressed man, too, went to daily mass when he was not institutionalized. He prayed for relief. He still had his job and his hobby. He went to work regularly, taking medical leaves only when the invisible torment got too bad for him to trust himself, or when there was some radical new treatment the psychiatrists wanted him to try. They'd tried Tricyclics, M.A.O.I.s, insulin-comas, Selective-Serotonin-Reuptake-Inhibitors, the newand side-effect-laden Quadracyclics. They'd scanned his lobes and affective matrices for lesions and scars. Nothing worked. Not even high-amperage E.C.T. relieved It. This happens sometimes. Some cases of depression are beyond human aid. The man's case gave Kate Gompert the howling fantods. The idea of this man going to work and to Mass and building miniaturized railroad networks day after day after day while feeling anything like what Kate Gompert felt in that ward was simply beyond her ability to imagine. The rationo-spiritual part of her knew this man and his wife must be possessed of a courage way off any sort of known courage-chart. But in her toxified soul Kate Gompert felt only a paralyzing horror at the idea of the squat dead-eyed man laying toy track slowly and carefully in the silence of his wood-panelled rec room, the silence total except for the sounds of the track being oiled and snapped together and laid into place, the man's head full of poison and worms and every cell in his body screaming for relief from flames no one else could help with or even feel.
The permanently psychotically depressed man was finally transferred to a place on Long Island to be evaluated for a radical new type of psychosurgery where they supposedly went in and yanked out your whole limbic system, which is the part of the brain that causes all sentiment and feeling. The man's fondest dream was anhedonia, complete psychic numbing. I.e. death in life. The prospect of radical psychosurgery was the dangled carrot that Kate guessed still gave the man's life enough meaning for him to hang onto the windowsill by his fingernails, which were probably black and gnarled from the flames. That and his wife: he seemed genuinely to love his wife, and she him. He went to bed every night at home holding her, weeping for it to be over, while she prayed or did that devout thing with beads.
The couple had gotten Kate Gompert's mother's address and had sent Kate an Xmas card the last two years, Mr. and Mrs. Ernest Feaster of Wellesley Hills MA, stating that she was in their prayers and wishing her all available joy. Kate Gompert doesn't know whether Mr. Ernest Feaster's limbic system got yanked out or not. Whether he achieved anhedonia. The Xmas cards had had excruciating little watercolor pictures of locomotives on them. She could barely stand to think about them, even at the best of times, which the present was not.
— David Foster Wallace, Infinite Jest, pp. 692-998 (Little, Brown, 1996). Footnotes omitted.
When I first read Infinite Jest, around 1999, I felt particularly comforted by this passage. I was comforted at seeing the thing It named and described, but on a more practical level, I was comforted by the reminder that I could always try ECT, and maybe even surgery. (I read about the practice of trepanation with longing.) Something about this thought seemed a little traitorous to me, believing as I did at that point that suicide was wrong. Is there, at the most essential level, any difference between suicide on the one hand, and attempting to erase one's experience with electroconvulsive therapy or psychosurgery on the other? What is the difference, if there is one, between suicide and having one's capacity to feel emotion removed?
I suspect that many people who would want to prevent Ernest Feaster from committing suicide would want to allow him to get his desired emotion-destroying psychosurgery. This, I think, is inconsistent.
The most essential thing another human being is to us is a co-experiencer. To experience ourselves and to have a truly human experience of the world, we need to see ourselves and our environments reflected through the eyes of another person. A body without an experiencer within is but an animate doll, of no use to the doll himself, and by that fact of no morally appropriate use to those who love him.
If we want to offer mercy to a man by ridding him of painful aspects of his experience, how different, then, to allow him to rid himself of all aspects of his experience, if all he experiences is pain? What reason, save religion or cruelty, to force a man to experience pain against his will?