Astral Codex Ten

psychiatry

9 min read

psychiatry

Article

psychiatry is a recurring concept in the Astral Codex Ten archive, appearing 2 times across 2 issues between May 30, 2023 and July 18, 2024. The archive places it in contexts such as “One of the hardest things in psychiatry is to look at a group of extremely unhealthy people doing some weird thing”; “Once you are in the ‘clutches of psychiatry’, they don’t let you go”. It most often appears alongside Access Pass, advanced meditators, Africa.

Metadata

  • Category: Concepts
  • Mention count: 2
  • Issue count: 2
  • First seen: May 30, 2023
  • Last seen: July 18, 2024

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Are Woo Non-Responders Defective?
May 30, 2023 · Original source
One of the hardest things in psychiatry is to look at a group of extremely unhealthy people doing some weird thing, and figure out whether the weird thing is causing their problems vs. a useful coping strategy. Schizophrenics smoke much more often than other people; is this because nicotine causes schizophrenia, or because it controls the symptoms schizophrenia (studies suggest the latter). What about marijuana? (here the studies are unclear, a lot of people think it might contribute). This is hard because you see schizophrenic people using lots of drugs, and you naturally think “man, every schizophrenic I know is a druggie, probably drugs are bad”. This is fair enough if you go on to avoid drugs yourself. But it’s less innocuous if you use it to justify taking the drugs away from the schizophrenic people, on the grounds that it’s perpetuating their condition.
Highlights From The Comments On Mentally Ill Homeless People
July 18, 2024 · Original source
$1 billion/year in projected costs, translated into Californian, means $100 trillion quadrillion/year in actual costs. Of these, I think 3 is the biggest deal. If it’s as hard to commit someone to these institutions as it is to convict them of a crime, then these institutions don’t help much above how much the existence of prison also helps (eg not much). If you invent a new legal maneuver where it’s easier to commit someone than to convict them of a crime, then why do you even need the step where you build the institution? Just invent the legal maneuver and send more people to prison! I think that maybe the thought is that the institution seems more “humane” than prison, and so people will be more willing to allow low-friction legal maneuvers for confining people there. I think this is cope; not only won’t the institutions be more humane than prisons, but people won’t believe they are and won’t allow the low-friction legal maneuvers. Drethelin writes: What if we abolish the DEA and just let anyone buy anti-psychotics over the counter? This would be the FDA we’re abolishing, but otherwise yes, this is the sort of clever outside-the-box thinking that I appreciate from my commenters. Antipsychotics are very cheap (some well-regarded drugs like Abilify and Seroquel cost about ~$10 per month of pills). On the other hand, homeless people have very little money. So if you were going to do this, it would make sense for the government to give them away for free. These drugs have many potentially serious side effects. But it’s not clear how much homeless people’s 5-minute monthly visits with a bored Medicaid doctor does to avert these side effects, over having some kind of pharmacist or advocate or social worker in the free distribution center giving helpful advice. Like everything, I think this would only help around the edges - the fraction of homeless mentally ill people who drugs can help, who are willing to take the drugs, and who are prevented only by cost and bureaucracy. What percent is that? Low confidence guess 25%. DZ writes: I think you’re missing the goal of a short arrest (few days). Part of the problem is the homeless are in areas where society doesn’t want them to be. They’re near city downtowns where tourists spend time or near commercial districts or in otherwise nice parks. If you can arrest them for a few days and keep arresting them until they move somewhere else … the goal is to eventually force them to move to the more acceptable areas vs. least acceptable areas. This is obviously not ideal but in the mean time the city gets more tourism, more office rentals, etc. Europeans ruthlessly arrest homeless people who hang out in the touristy areas. SF doesn’t, yet. I commented that I was worried that “out of touristy areas” means “into residential areas”. And I feel worse making residents deal with this than tourists, and am less confident that the city cares enough about them to fight back. DZ responded: Agreed. People don’t want them in the residential areas or suburbs either and for good reason. But my guess is cities can identify certain areas where they would prefer the tents to set up. Something like industrial areas or run down parks. The key is that city officials should be able to use arrests as a strategy to move the tents/homeless concentrations without having to face a million lawsuits. I don’t know if there are really areas like this, but I welcome learning more from people who know cities better. SMK writes: This probably sounds draconian and cruel, too, but in fairness, all these discussions seem to assume that this person is in San Francisco and can never ever leave for some other, more affordable place. I get it -- it's tough leaving home, and maybe they'd be leaving friends. But they wouldn't be the only people leaving SF over rent prices, and they'd pretty clearly be among the most rational. So I dislike articles like this when they say things like "the average wait time for a homeless shelter bed is 826 days" or "cheap apartments in SF are $1000 / month." I have a friend who was homeless for around a year in another major American city, and he said it was always 100% feasible to get a shelter bed if he wanted one. Indeed, there were several options. On a different note, I also think that if one were going to go a "cruel and draconian" route, homeless shelters might be able to change policies to better support that and prevent some of the issues you highlight. If it takes 826 days to get a shelter bed, then zero of the typical people you mention who are briefly homeless are getting shelter beds. If all of the people who were homeless for longer were either leaving or in jail, then more of those people probably would get beds. Am I saying this is the policy I favor? No, I agree it's a hard problem and I'm not sure what the right answer is. But things like this need to be kept in mind, too. Again, I think it’s helpful to go to the specific policy level. What’s the policy here? Give homeless people brochures reminding them that other cities exist? I’m sure they know this. Give homeless cities free mandatory bus trips to those other cities? What prevents the other cities from giving them free mandatory bus trips back? Even if they don’t, what if the homeless prefer being homeless in San Francisco to having a better situation in a cheaper city? A bus from Phoenix to SF is only $60; even a homeless beggar might be able to scrounge up that much money if they’re motivated. Maybe some plan like making a deal with a big cheap city in Texas to take SF homeless in exchange for money, and as soon as the homeless get off the bus, they’re met by a Texan social worker who gives them a shelter bed and social services? Might help along the edges, but remember that only about half of homeless people want/will accept shelter beds (depending on how good the shelter beds are). Sergei writes: After checking a bit, let me point out the obvious. What works elsewhere is PATERNALISM. Once you are in the "clutches of psychiatry", they don't let you go. Upon release you are placed into some sort of housing, your appointments are monitored and a social worker will find you and drive you there. You will be given multiple chances to get a job and/or rehab. Your meds will be delivered to you if you cannot pick them up. They remind you to take them. There will be a social safety net so you are never in a situation where you end up on the street unless you really really try to. In retrospect, it makes sense: people who are not able to take care of themselves for a time because of a fixable mental infirmity are taken care of by the state, until they can. That's what we do with children already. I continue to want people to provide details. “They don't let you go" - okay, so the person is in a locked facility? Placed in "some kind of housing"? Does the housing have locks on the door, or can they leave? What if they do leave? "Multiple chances to get a job", oh, great, with whom? How are you enforcing that they take mentally ill people? What happens when the mentally ill people are less good workers than other people they could hire, or have some kind of crisis on the job, as even the best-treated person might once in a while? Maybe we can charitably fill in the details. Something like: Ban some combination of camping outside and being visibly mentally ill.
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