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Culture War Roundup for the week of January 23, 2023

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Scott has posted a short article: You Don’t Want a Purely Biological, Apolitical Taxonomy of Mental Disorders.

Takeaway:

if “political correctness” sounds too dismissive, we can rephrase it as: “they want something that doesn’t think about ethics and practicality at all, but which is simultaneously more ethically correct and pragmatically correct than other taxonomies”.

Some of Scott’s best work comes from the tension between categories-as-descriptive and categories-as-prescriptive, so I’m pleased to see him tackling this subject.

He has a couple potentially spicy sentences which have been interspersed with extra letters to ward off journalists. Legends say they aren’t able to remove text without an invitation, preventing context-removal. A handful of commenters immediately proceed to demonstrate why this will do nothing to keep some people from thinking Scott is literally Hitler, but perhaps it will keep them from publishing that? I’m not optimistic this will keep an opportunistic editor from stripping out letters with no direct relevance unless they’re legally required to put “…” in their place.

As I pointed out, the reason why newspapers have to point out when they remove words is not some principle of responsible journalism, it's the "does removing context and not pointing it out makes it easier to accuse me of lying than removing context and pointing it out?" Removing extraneous N's won't lead to such accusations, so the media would be perfectly willing to do it.

Scott's running on mistake theory and the media are not.

From a purely biological point of you foo and bar are propably pretty similar. Both are a person having AIDS. If this is accurate, the relevant difference between foo and bar is moral, not biological. Both involve getting infected with HIV, but in the foo case, the effected person is sexually oriented towards getting infected and participated willingly, and so its fine. In the bar case, the effected person is unwilling, so its bad.

So, should your purely apolitical taxonomy of mental physical disorders classify foo as a mental illness, or should it refuse to classify bar as a mental illness?

When the FTX thing happened recently and people argued about consequentialist justifications for lying, I realised Scotts theory of categories literally cant tell the difference between the truth and the highest-utility-thing-to-say. Now, he doesnt seem to know this. He thinks that:

There are facts of the matter on each individual point – whether a whale has fins, whether a whale lives in the ocean, whether a whale has tiny hairs, et cetera. But there is no fact of the matter on whether a whale is a fish. The argument is entirely semantic.

But thats not how it works. If tomorrow the Ministry of Hide-tanning decides that whale skin is hairless, you might insist that it obviously has hair, I mean look at it (possibly with some magnification). But they could just as well say "Well, there are facts on each individual point - whether they hold water, whether they resist against the grain, whether theyre made of ceratin, etc. But theres no fact to the matter whether theyre hairs."

More generally, "X falls in category(set) Y" and "X has property Z" are isomorphic - everything you can express in the first form, you can also express in the second, and vice versa. If "is a fish" really were just semantic, then by the same mechanism "has tiny hairs" would be just semantic. So there would be no facts based on which you can classify things.

The only thing that makes this theory remotely workable is that you already know which things you want to apply it too. Its pure Humpty-Dumpty-ism in practice.

I’m having trouble understanding your point, with a lot of what seem to me like unsubstantiated yet controversial assertions.

I think Scott's title is actually wrong. People do want a purely biological apolitical taxonomy of mental disorders - they just also want the world to be just, so there wouldn't be any conflict. That what is true and what we want to be true do, in the end, coincide; that the truth would never be inconvenient to those with the correct values.

I read Scott as saying “No, you don’t want to eat that tub of ice cream, even though you are tempted. It comes with consequences, laid out here, that you are not actually willing to accept”. Is that your read in this paragraph? I don’t think so, but I’m not sure what you’re getting at either.

To take a very different example: Todd Akin's claim that "legitimate rape" could not cause pregnancy: often considered an example of rank misogyny, but even if so, I would say it's much more importantly clear just-world thinking.

I’m not familiar with this person or claim. I’m struggling to understand how pregnancy can be ruled out, given PIV intercourse, whether coerced or not.

EDIT: Akin said “legitimate rape” rarely causes pregnancy, because because their bodies prevent them from doing so. “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

I have no idea of the biology there. Maybe stress hormones in a traumatic situation somehow prevent conception? Does this still comport with your point?

I’m struggling with the rest, likely because of the above.

I’m not familiar with this person or claim.

Wikipedia has a quick rundown here. It was enormously controversial in 2012.

Thanks. I didn’t see any serious wrangling with the idea that the trauma and stress of a violent rape may induce physical changes that prevent conception. The wiki article showed many plausible statements from conservative doctors in support of the idea, and just bare rebuttals from the medical establishment, presumably along the lines of “there is no evidence…”, likely driven by mood affiliation. I dug into the most direct rebuttal but it 404d and I stopped there.

My understanding is that pregnancy from rape is no less common than pregnancy from consensual sex and that the contrary position is not taken seriously by many medical professionals.

That’s my prior, but I’d also be surprised if there were zero effect on conception from the stress and trauma of a violent rape. Direct evidence would be impossible to gather, but I can imagine studies based on other forms of stress and trauma.

This post continues Scotts tradition of having jarringly different Ideas about what relationship categories have to truth than me. Scott is of the opinion that categories are just word games and that technocrats should be able to shift their borders are any time to maximize public utility. Being rhetorically gifted as he is he describes this position well. There is no natural force that decides whether whales are fish or some other category so we ought to define fish however this best serves us. It's a difficult position to assail. And yet...

I think firstly that there is such a thing as a natural category. These are things people can intuit about the territory, like canyons etched by the simple combined implications of gravity causing water to flow down hill and precipitation taking that water back uphill. This forms natural borders between things. Creatures capable of flight are an intuitively useful category, people use it for things like determining if a wall is going to keep that creature out. This kind of category cannot and will not bend to our word games. We may call it something different or create new categories that mostly but don't exactly match this category(maybe you'd like to include or exclude insects based on some further need) but the natural category remains.

What people want out of things like the DSM is for it to have as its first goal to reflect a natural category. And there are a few options here, I think whether we pick a natural category that includes or excludes homosexuality is an important debate that could go either way. But it should be about which category to pick, not whether we should shift between different categorical systems from line to line. Because if you're switching up the justifying for inclusion from one definition to the next the actually underlying category is just "Whatever I find expedient" which is a maximally bad fit for a document meant to describe reality. It makes a farse of the whole project and in the end it turns the DSM into just another locus of power in the culture war with no more legitimacy than a piece of paper that says "I do what I want".

I mostly disagree, there are a few natural categories like periodic elements, since every element has an exact integer number of protons; but pretty much everything more complex than an atom does not fit into a natural category.

For flight, you'll get into blurry areas when you consider stuff like gliding, whether an animal can fly but only under optimal nutrition and wind conditions, animals that have true flight but for shorter distances than some other animals can jump, etc.

For whatever definition of "flying animal" you can come up with, I'm pretty sure I could come up with an exception, unless maybe you write a couple hundred words in your definition explicitly listing exceptions to the point where it's a very obviously unwieldy and not particularly natural category.

The map won't exactly match the territory I agree, but maps can be made to as faithfully match the territory as possible. It's when an aim comes in other than to match the territory that the process is corrupt. A genuine disagreement can be had over whether homosexuality belongs in the territory, but it should be decided by discussing the territory, not considering special interests.

I think I still agree with Scott's opinion that while trying to make your map match the territory as much as possible is respectable, it can still provide not nearly as much utility as trying to make a map that's just useful. Having something like stuff that DSM categorizes as mental illness be "bad stuff that we want insurance to cover" is a pretty unnatural category, but might be a lot more useful for real life than some sort of biological definition about deviations from a mentally healthy human.

This just seems like a lack of imagination. It's like thinking one to many relationships in a relational database are impossible because you store everything in a flat table. If you are willing to maintain good database schema this is not a problem. The fundamental problem is you have this single table trying to handle two or more things that ought to be separated. The trade offs disappear if you simple use three tables referenced to each other. One to describe to the best of our ability mental disorders. One to enumerate treatments that do and do not work for those disorders. And one to actually map which of those treatments insurance should cover. Really I could easily see half a dozen or more tables being useful.

I don't know much about mental disorder taxonomies. Looking through Scott's post, my guess as to his response to this would be "That would be great! But you'd never get anyone to actually use your system because people would still be shouting about how homosexuality appears anywhere in it, even if it's under the 'don't stigmatize these' table". But that's just my guess.

I guess one of my frustrations is that we as a society have decided to give the kind of people that object to things like that so much control over things that matter. We've decided it's more important to neuter the tools we use to think clearly to protect fools from offense.

For whatever definition of "flying animal" you can come up with, I'm pretty sure I could come up with an exception, unless maybe you write a couple hundred words in your definition explicitly listing exceptions to the point where it's a very obviously unwieldy and not particularly natural category.

Yeah, even 'flying animal' for the purposes of fence building I'm sure for any given fence there's some animals capable of limited flight that would nonetheless find it insurmountable.

There's a difference between a category that's fuzzy in in some cases because it's hard to have a perfect category, and a category that's fuzzy in in some cases because the category is gerrymandered for some reason other than its stated purpose.

there are a few natural categories like periodic elements, since every element has an exact integer number of protons; but pretty much everything more complex than an atom does not fit into a natural category.

Here too there are intermediate states where its unclear whether a proton is part of the atomic core. During radioactive decay, at what point does the atom change element? Now, these intermediates are fine to ignore 99% of the time... just like with lots of other categories that people want to deny being natural.

What people want out of things like the DSM is for it to have as its first goal to reflect a natural category.

I don't think that's true. The very premise is informing/influencing public policy. No matter how well a natural category cleaves reality at the joints, if it doesn't enshrine how we should react to the category, it's no good.

The actual underlying category should be akin to "phenomena that are mental AND have bad consequences to society." This isn't a natural, Platonic category because other people are involved. But it's also not line-to-line word games. "Pedophiles want to have sex with kids" fits both criteria. "Birds can fly over walls" only fits the second. "Homosexuals want to have gay sex" used to be viewed as fitting both. DSM authors say that it only fits the first, now, so it doesn't belong. It's a claim that the categorization was wrong, not that the category must be fluid.

Scott observes that a purely-biological-apolitical category does not fulfill the goals of the DSM authors, or really of the policymakers that would use the DSM. That's because it really only handles the first category. Leaving out the second one for being political/judgmental/whatever removes most of its utility.

I think you're confusing the use of the DSM with it's purpose. The DSM is supposed to reflect reality as its primary goal, it's written by unelected technocrats. To the degree that those technocrats are using the DSM to control industry they are usurping the role of the people. As a sanity check imagine if the APA was run by a right wing extremists group and they included leftist beliefs as a mental condition requiring involuntary hospitalization. It would certainly "fulfill the goals of the DSM authors" to include things like this, but I'd argue it is not the intended role of the DSM or its creators to be making politically salient points. They're doing a run around social consensus making and the political process itself and this would be very obvious to its defenders if it were their own ox being gored.

Sure, in a perfect scenario, the Best DSM (BDSM) measures the public impact of each response to each phenomenon. Then Congress enforces using the BDSM's best-impact response whenever insurance asks if something is covered. Popular opinion is preserved.

How should such a document be updated?

If social consensus changes, and people on aggregate believe that gay sex is okay, or that tiktok is a mental illness, or that the appropriate treatment for anxiety is mockery, that should be reflected in the BDSM. Scott might suggest a prediction market solution, or Congress could vote on each line item like a spending bill. In the interest of avoiding stalemates and weird corner cases of our full economy or democracy, we'd be incentivized to import a lot of those systems, too. For the BDSM to fully respect "the role of the people" it has to include a lot of overhead.

The solution we've used instead is delegation. As citizens are bound by judges with tenuous connections to any actual voters, insurance companies are bound by recognized experts. Yes, this leaves room for said experts to abuse their authority. So does every other practically implementable system! The fundamental principle of popular will remains even when diluted.

I understand believing the experts have exceeded their mandate on a specific issue. There is enough friction in the process that they really aren't held very accountable, and the cost to spin up an alternative is eye-wateringly high. Call it a market failure. The fact remains, though, that an effective DSM must include some level of value judgment. Without it, an apolitical/biological document cannot fulfill the delegated purpose.

Does the BDSM include a category for people who like to be tied up and called mean names?

The apa isn't elected, they just produce a document that is currently being fed into the legitimate system. It's like there being an exposed config file for some important system that has been found and captured by a special interest, in time the hole will be patched. But we shouldn't pretend this is a legitimate purpose of the design, it was never intended for the DSM to be used as a political lever. To the extent it is being used as one it should be objected to.

This impulse people have, to recognize that there is a legitimate process for achieving some goal but instead using some hacked work around to subvert the process because it is easier than arguing your case convincingly to the public is just tyranny. That's all it is. Of course tyranny is expediant. I do not trust people who defend this impulse.

No, I think choosing whether or not homosexuality is a disorder is exactly the legitimate purpose, as intended, of the DSM.

The government wants a way to tell what insurance should and shouldn't pay for. That means it absolutely has to include judgment about what requires treatment. There can be no alternative that just describes symptoms.

Consensus, at some point, settled on this document produced by some technocrats. Now you're convinced that they've altered the deal, that the earlier version was privileged in some way that DSM-5 is not.

How do you propose such a document gets updated, if not by the authors coming together and saying "hmm yeah, that's a good pull request"?

The government wants a way to tell what insurance should and shouldn't pay for. That means it absolutely has to include judgment about what requires treatment. There can be no alternative that just describes symptoms.

You could have, you know, two different lists? You understand that what insurance has to pay for mean the rest of us are required to pay into it right? This is a tax benefits system with extra steps.

How do you propose such a document gets updated, if not by the authors coming together and saying "hmm yeah, that's a good pull request"?

Yes, unelected authors. Not the people. Unelected beaurocrats vetted by the industry that brought us frontal lobe lobotomies and repressed memories. I am not impressed by this process.

So what process would impress your cynical self?

I get that you're unhappy about unelected bureaucrats raising your taxes. What's your solution?

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Perhaps some terms really do (or really should) denote "natural categories" or "natural kinds". Examples might include "iron" and "mammal". But I don't think all terms can be like that. Some seem to fit better with a "family resemblance" model. Moreover, some terms have normative implications or consequences. I sympathize with the idea that we should try not to let our normative views "contaminate" our scientific understandings of how things work, or of the terms we use to express those views. But I don't think we can really dispense with using some words that reflect values and goals - perhaps including goals about which treatments are funded by health insurance.

I would dispute even "mammal" -- in the present time, you have basal species like the platypus that, while solidly classified under Mammalia, have generally un-mammal-like features such as laying eggs and lacking nipples; and in prehistory, you have the whole series of mammalian ancestors gradually emerging from reptiles, developing the characteristics trait of mammals through many intermediates. Granted, in most practical circumstances this is pointless pedantry, and the intuitive category works just fine -- how often are you going to deal with a platypus or a Procynosuchus in real life? But there are very few categories that have really sharp borders; most things blur at the edges.

What's interesting to me is that the statements in question mean the exact same thing in context as they would out of context.

"from N a N biological N point N of N view N, homosexuality N and N pedophilia N are probably N pretty N similar."

"the N relevant N difference N between N homosexuality N and N pedophilia N is N moral N, not N biological."

"So N, should N your N purely N biological N, apolitical N, taxonomy N of N mental N disorders N classify N homosexuality N as N a mental N illness, N or N should N it N refuse N to N classify N pedophilia N as N a N mental N illness?"

"That N means N that N a N purely N biological N apolitical N taxonomy N of N mental N disorders N which N classifies N all N things N with N similar N biological N causes N in N the N same N way N would N also N probably N classify N homosexuality N as N a N mental N disorder."

"Pedophilia N is N worse N than N homosexuality N, not N because N the N biology N necessarily N involves N different N processes N or N brain N regions, N but N because N it’s N important N for N your N sexual N partners N to N be N able N to N consent."

Amazingly, you can just quote all of the “PLEASE DON’T TAKE THIS OUT OF CONTEXT” sentences, in order, and get a perfectly functional 1-paragraph summary of the entire blog post.

I think his intention was to use that as an example of why biological definitions of mental illness were bad, not give the impression of homosexuality being wrong.

Slightly aside from this, is there even such a thing as a biologically defined mental illness? Is there a single mental illness that’s diagnosed with a blood test or some other empirical measurement that doesn’t involve a checklist of symptoms that the patient describes to the physician?

Sure.

There's a whole DSM section for substance abuse disorders. Alcohol/nicotine/opioid withdrawal are real, measurable things.

Or the variety of conditions with a single, specific response. REM Sleep Disorder is measured on a "polysomnograph." Actually, there's a bunch of sleep-specific ones. Elimination disorders like enuresis are also fairly obvious. For something like PTSD I imagine you could objectively measure a panic response.

Does an effective, selective drug count as evidence? Ex. prescribing antipsychotics seems like a rather objective way to measure schizophrenia.

I'd argue that you could count certain behavioral disorders as empirical. It's not a lab test, but if someone compulsively gambles all his money away, he doesn't have to tell the physician it's a disorder. Likewise for the paraphilias.

Plus, at a certain point, it just gets lumped into physical illnesses. Rabies includes anxiety, hallucinations, and fear of water or blowing air on one's face. It's diagnosed with virus isolation. Obviously, it doesn't get counted as a mental illness on account of all the non-mental symptoms.

To the question of an effective drug counting, I would say no. I’m more concerned that there is a physiological symptom from which the supposed mental condition is diagnosable.

I’m not sure that someone having a physiological withdrawal symptom from a substance to which they’re addicted would count either as someone who is not an addict will still experience those.

The sleep disorders seem a better candidate.

I’m more concerned that there is a physiological symptom from which the supposed mental condition is diagnosable.

Things like Down Syndrome, Parkinson's disease, Huntington's disease etc. can be. I'm guessing your asking this question, because you don't really view them as mental illnesses and are gerrymandering the category to only include things not easily physiologically measurable. The DSM doesn't do that and includes these things.

I’m just thinking it through out loud.

My family has a lot of mental illness of the OCD and bipolar type, and those family members insist this is a well understood science and then make claims that seem essentially religious. I’m feeling out the edges of where measurable physiological issue versus vague “chemical imbalance?” meet.

Want to share what those claims are exactly? Hard to know if they’re backed by science or not without actually seeing them.

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No, because then it would be a physical illness with neurological symptoms rather than a mental illness.

Funny enough, the desire to avoid my statements being taken out of context later generally leads me to do things like add parentheticals (where appropriate), or include a brief aside, as I am doing with this particular segment at this very moment to illustrate the point, and thus force someone trying to smear me to either accurately quote the statement with context intact or to deceptively edit it and thus undermine their own credibility. This does cause a lot of my sentences to become unwieldy, sadly enough.

Scott was maybe going for ghoulish overkill with that one but yeah, when your risk of being quoted in national publications is a bit higher maybe that sort of caution is warranted.

Is there anyone left who will all three of being shocked by equating homosexuality and pedophilia from the perspective that it’s beyond the pale, know who Scott Alexander is, and not dig into the claim?

Journalists misleadingly quoting subjects is something that is difficult to defend on non-partisan grounds. I, personally, would prefer if what a person said and what journalists thinks about that statement to be clearly separated and obvious to the average reader which is which. For example, I think ACLU crossed the line when they changed RGBs statement from:

The decision whether or not to bear a child is central to a woman’s life, to her well-being and dignity, it is a decision she must make for herself. When government controls that decision for her, she is being treated as less than a fully adult human responsible for her own choices.

To:

The decision whether or not to bear a child is central to a [person’s] life, to [their] well-being and dignity…When the government controls that decision for [people], [they are] being treated as less than a fully adult human responsible for [their] own choices.

The original text doesn't consider the possibility of abortion being about bodily autonomy of men, while the latter does, without making it clear what the original said.

It is revision of fact, such as that defended by /r/ssc posters who compare silenly misquoting text to removing "uhh"s from speech, or my example, that brings to mind a quote from a book often cited, yet never ceaseing to be prescient, 1984:

Every record has been destroyed or falsified, every book rewritten, every picture has been repainted, every statue and street building has been renamed, every date has been altered. And the process is continuing day by day and minute by minute. History has stopped. Nothing exists except an endless present in which the Party is always right.

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