anxiety

Bundling the stakes to recalibrate ourselves

PNRJ cognitive science, heuristics and biases, personal , , , , , , , , , ,

Mar 31 JDN 2460402

In a previous post I reflected on how our minds evolved for an environment of immediate return: An immediate threat with high chance of success and life-or-death stakes. But the world we live in is one of delayed return: delayed consequences with low chance of success and minimal stakes.

We evolved for a world where you need to either jump that ravine right now or you’ll die; but we live in a world where you’ll submit a hundred job applications before finally getting a good offer.

Thus, our anxiety system is miscalibrated for our modern world, and this miscalibration causes us to have deep, chronic anxiety which is pathological, instead of brief, intense anxiety that would protect us from harm.

I had an idea for how we might try to jury-rig this system and recalibrate ourselves:

Bundle the stakes.

Consider job applications.

The obvious way to think about it is to consider each application, and decide whether it’s worth the effort.

Any particular job application in today’s market probably costs you 30 minutes, but you won’t hear back for 2 weeks, and you have maybe a 2% chance of success. But if you fail, all you lost was that 30 minutes. This is the exact opposite of what our brains evolved to handle.

So now suppose if you think of it in terms of sending 100 job applications.

That will cost you 30 times 100 minutes = 50 hours. You still won’t hear back for weeks, but you’ve spent weeks, so that won’t feel as strange. And your chances of success after 100 applications are something like 1-(0.98)^100 = 87%.

Even losing 50 hours over a few weeks is not the disaster that falling down a ravine is. But it still feels a lot more reasonable to be anxious about that than to be anxious about losing 30 minutes.

More importantly, we have radically changed the chances of success.

Each individual application will almost certainly fail, but all 100 together will probably succeed.

If we were optimally rational, these two methods would lead to the same outcomes, by a rather deep mathematical law, the linearity of expectation:
E[nX] = n E[X]

Thus, the expected utility of doing something n times is precisely n times the expected utility of doing it once (all other things equal); and so, it doesn’t matter which way you look at it.

But of course we aren’t perfectly rational. We don’t actually respond to the expected utility. It’s still not entirely clear how we do assess probability in our minds (prospect theory seems to be onto something, but it’s computationally harder than rational probability, which means it makes absolutely no sense to evolve it).

If instead we are trying to match up our decisions with a much simpler heuristic that evolved for things like jumping over ravines, our representation of probability may be very simple indeed, something like “definitely”, “probably”, “maybe”, “probably not”, “definitely not”. (This is essentially my categorical prospect theory, which, like the stochastic overload model, is a half-baked theory that I haven’t published and at this point probably never will.)

2% chance of success is solidly “probably not” (or maybe something even stronger, like “almost definitely not”). Then, outcomes that are in that category are presumably weighted pretty low, because they generally don’t happen. Unless they are really good or really bad, it’s probably safest to ignore them—and in this case, they are neither.

But 87% chance of success is a clear “probably”; and outcomes in that category deserve our attention, even if their stakes aren’t especially high. And in fact, by bundling them, we have even made the stakes a bit higher—likely making the outcome a bit more salient.

The goal is to change “this will never work” to “this is going to work”.

For an individual application, there’s really no way to do that (without self-delusion); maybe you can make the odds a little better than 2%, but you surely can’t make them so high they deserve to go all the way up to “probably”. (At best you might manage a “maybe”, if you’ve got the right contacts or something.)

But for the whole set of 100 applications, this is in fact the correct assessment. It will probably work. And if 100 doesn’t, 150 might; if 150 doesn’t, 200 might. At no point do you need to delude yourself into over-estimating the odds, because the actual odds are in your favor.

This isn’t perfect, though.

There’s a glaring problem with this technique that I still can’t resolve: It feels overwhelming.

Doing one job application is really not that big a deal. It accomplishes very little, but also costs very little.

Doing 100 job applications is an enormous undertaking that will take up most of your time for multiple weeks.

So if you are feeling demotivated, asking you to bundle the stakes is asking you to take on a huge, overwhelming task that surely feels utterly beyond you.

Also, when it comes to this particular example, I even managed to do 100 job applications and still get a pretty bad outcome: My only offer was Edinburgh, and I ended up being miserable there. I have reason to believe that these were exceptional circumstances (due to COVID), but it has still been hard to shake the feeling of helplessness I learned from that ordeal.

Maybe there’s some additional reframing that can help here. If so, I haven’t found it yet.

But maybe stakes bundling can help you, or someone out there, even if it can’t help me.

What is anxiety for?

PNRJ cognitive science, core principles, personal, tribal paradigm , , , , , , , , , , , , , , , , , , , ,

Sep 17 JDN 2460205

As someone who experiences a great deal of anxiety, I have often struggled to understand what it could possibly be useful for. We have this whole complex system of evolved emotions, and yet more often than not it seems to harm us rather than help us. What’s going on here? Why do we even have anxiety? What even is anxiety, really? And what is it for?

There’s actually an extensive body of research on this, though very few firm conclusions. (One of the best accounts I’ve read, sadly, is paywalled.)

For one thing, there seem to be a lot of positive feedback loops involved in anxiety: Panic attacks make you more anxious, triggering more panic attacks; being anxious disrupts your sleep, which makes you more anxious. Positive feedback loops can very easily spiral out of control, resulting in responses that are wildly disproportionate to the stimulus that triggered them.

A certain amount of stress response is useful, even when the stakes are not life-or-death. But beyond a certain point, more stress becomes harmful rather than helpful. This is the Yerkes-Dodson effect, for which I developed my stochastic overload model (which I still don’t know if I’ll ever publish, ironically enough, because of my own excessive anxiety). Realizing that anxiety can have benefits can also take some of the bite out of having chronic anxiety, and, ironically, reduce that anxiety a little. The trick is finding ways to break those positive feedback loops.

I think one of the most useful insights to come out of this research is the smoke-detector principle, which is a fundamentally economic concept. It sounds quite simple: When dealing with an uncertain danger, sound the alarm if the expected benefit of doing so exceeds the expected cost.

This has profound implications when risk is highly asymmetric—as it usually is. Running away from a shadow or a noise that probably isn’t a lion carries some cost; you wouldn’t want to do it all the time. But it is surely nowhere near as bad as failing to run away when there is an actual lion. Indeed, it might be fair to say that failing to run away from an actual lion counts as one of the worst possible things that could ever happen to you, and could easily be 100 times as bad as running away when there is nothing to fear.

With this in mind, if you have a system for detecting whether or not there is a lion, how sensitive should you make it? Extremely sensitive. You should in fact try to calibrate it so that 99% of the time you experience the fear and want to run away, there is not a lion. Because the 1% of the time when there is one, it’ll all be worth it.

Yet this is far from a complete explanation of anxiety as we experience it. For one thing, there has never been, in my entire life, even a 1% chance that I’m going to be attacked by a lion. Even standing in front of a lion enclosure at the zoo, my chances of being attacked are considerably less than that—for a zoo that allowed 1% of its customers to be attacked would not stay in business very long.

But for another thing, it isn’t really lions I’m afraid of. The things that make me anxious are generally not things that would be expected to do me bodily harm. Sure, I generally try to avoid walking down dark alleys at night, and I look both ways before crossing the street, and those are activities directly designed to protect me from bodily harm. But I actually don’t feel especially anxious about those things! Maybe I would if I actually had to walk through dark alleys a lot, but I don’t, and in the rare occasion I would, I think I’d feel afraid at the time but fine afterward, rather than experiencing persistent, pervasive, overwhelming anxiety. (Whereas, if I’m anxious about reading emails, and I do manage to read emails, I’m usually still anxious afterward.) When it comes to crossing the street, I feel very little fear at all, even though perhaps I should—indeed, it had been remarked that when it comes to the perils of motor vehicles, human beings suffer from a very dangerous lack of fear. We should be much more afraid than we are—and our failure to be afraid kills thousands of people.

No, the things that make me anxious are invariably social: Meetings, interviews, emails, applications, rejection letters. Also parties, networking events, and back when I needed them, dates. They involve interacting with other people—and in particular being evaluated by other people. I never felt particularly anxious about exams, except maybe a little before my PhD qualifying exam and my thesis defenses; but I can understand those who do, because it’s the same thing: People are evaluating you.

This suggests that anxiety, at least of the kind that most of us experience, isn’t really about danger; it’s about status. We aren’t worried that we will be murdered or tortured or even run over by a car. We’re worried that we will lose our friends, or get fired; we are worried that we won’t get a job, won’t get published, or won’t graduate.

And yet it is striking to me that it often feels just as bad as if we were afraid that we were going to die. In fact, in the most severe instances where anxiety feeds into depression, it can literally make people want to die. How can that be evolutionarily adaptive?

Here it may be helpful to remember that in our ancestral environment, status and survival were oft one and the same. Humans are the most social organisms on Earth; I even sometimes describe us as hypersocial, a whole new category of social that no other organism seems to have achieved. We cooperate with others of our species on a mind-bogglingly grand scale, and are utterly dependent upon vast interconnected social systems far too large and complex for us to truly understand, let alone control.

At this historical epoch, these social systems are especially vast and incomprehensible; but at least for most of us in First World countries, they are also forgiving in a way that is fundamentally alien to our ancestors’ experience. It was not so long ago that a failed hunt or a bad harvest would let your family starve unless you could beseech your community for aid successfully—which meant that your very survival could depend upon being in the good graces of that community. But now we have food stamps, so even if everyone in your town hates you, you still get to eat. Of course some societies are more forgiving (Sweden) than others (the United States); and virtually all societies could be even more forgiving than they are. But even the relatively cutthroat competition of the US today has far less genuine risk of truly catastrophic failure than what most human beings lived through for most of our existence as a species.

I have found this realization helpful—hardly a cure, but helpful, at least: What are you really afraid of? When you feel anxious, your body often tells you that the stakes are overwhelming, life-or-death; but if you stop and think about it, in the world we live in today, that’s almost never true. Failing at one important task at work probably won’t get you fired—and even getting fired won’t really make you starve.

In fact, we might be less anxious if it were! For our bodies’ fear system seems to be optimized for the following scenario: An immediate threat with high chance of success and life-or-death stakes. Spear that wild animal, or jump over that chasm. It will either work or it won’t, you’ll know immediately; it probably will work; and if it doesn’t, well, that may be it for you. So you’d better not fail. (I think it’s interesting how much of our fiction and media involves these kinds of events: The hero would surely and promptly die if he fails, but he won’t fail, for he’s the hero! We often seem more comfortable in that sort of world than we do in the one we actually live in.)

Whereas the life we live in now is one of delayed consequences with low chance of success and minimal stakes. Send out a dozen job applications. Hear back in a week from three that want to interview you. Do those interviews and maybe one will make you an offer—but honestly, probably not. Next week do another dozen. Keep going like this, week after week, until finally one says yes. Each failure actually costs you very little—but you will fail, over and over and over and over.

In other words, we have transitioned from an environment of immediate return to one of delayed return.

The result is that a system which was optimized to tell us never fail or you will die is being put through situations where failure is constantly repeated. I think deep down there is a part of us that wonders, “How are you still alive after failing this many times?” If you had fallen in as many ravines as I have received rejection letters, you would assuredly be dead many times over.

Yet perhaps our brains are not quite as miscalibrated as they seem. Again I come back to the fact that anxiety always seems to be about people and evaluation; it’s different from immediate life-or-death fear. I actually experience very little life-or-death fear, which makes sense; I live in a very safe environment. But I experience anxiety almost constantly—which also makes a certain amount of sense, seeing as I live in an environment where I am being almost constantly evaluated by other people.

One theory posits that anxiety and depression are a dual mechanism for dealing with social hierarchy: You are anxious when your position in the hierarchy is threatened, and depressed when you have lost it. Primates like us do seem to care an awful lot about hierarchies—and I’ve written before about how this explains some otherwise baffling things about our economy.

But I for one have never felt especially invested in hierarchy. At least, I have very little desire to be on top of the hiearchy. I don’t want to be on the bottom (for I know how such people are treated); and I strongly dislike most of the people who are actually on top (for they’re most responsible for treating the ones on the bottom that way). I also have ‘a problem with authority’; I don’t like other people having power over me. But if I were to somehow find myself ruling the world, one of the first things I’d do is try to figure out a way to transition to a more democratic system. So it’s less like I want power, and more like I want power to not exist. Which means that my anxiety can’t really be about fearing to lose my status in the hierarchy—in some sense, I want that, because I want the whole hierarchy to collapse.

If anxiety involved the fear of losing high status, we’d expect it to be common among those with high status. Quite the opposite is the case. Anxiety is more common among people who are more vulnerable: Women, racial minorities, poor people, people with chronic illness. LGBT people have especially high rates of anxiety. This suggests that it isn’t high status we’re afraid of losing—though it could still be that we’re a few rungs above the bottom and afraid of falling all the way down.

It also suggests that anxiety isn’t entirely pathological. Our brains are genuinely responding to circumstances. Maybe they are over-responding, or responding in a way that is not ultimately useful. But the anxiety is at least in part a product of real vulnerabilities. Some of what we’re worried about may actually be real. If you cannot carry yourself with the confidence of a mediocre White man, it may be simply because his status is fundamentally secure in a way yours is not, and he has been afforded a great many advantages you never will be. He never had a Supreme Court ruling decide his rights.

I cannot offer you a cure for anxiety. I cannot even really offer you a complete explanation of where it comes from. But perhaps I can offer you this: It is not your fault. Your brain evolved for a very different world than this one, and it is doing its best to protect you from the very different risks this new world engenders. Hopefully one day we’ll figure out a way to get it calibrated better.

The mental health crisis in academia

PNRJ personal, science and academia , , , , , , , , , , ,

Apr 30 JDN 2460065

Why are so many academics anxious and depressed?

Depression and anxiety are much more prevalent among both students and faculty than they are in the general population. Unsurprisingly, women seem to have it a bit worse than men, and trans people have it worst of all.

Is this the result of systemic failings of the academic system? Before deciding that, one thing we should consider is that very smart people do seem to have a higher risk of depression.

There is a complex relationship between genes linked to depression and genes linked to intelligence, and some evidence that people of especially high IQ are more prone to depression; nearly 27% of Mensa members report mood disorders, compared to 10% of the general population.

(Incidentally, the stereotype of the weird, sickly nerd has a kernel of truth: the correlations between intelligence and autism, ADHD, allergies, and autoimmune disorders are absolutely real—and not at all well understood. It may be a general pattern of neural hyper-activation, not unlike what I posit in my stochastic overload model. The stereotypical nerd wears glasses, and, yes, indeed, myopia is also correlated with intelligence—and this seems to be mostly driven by genetics.)

Most of these figures are at least a few years old. If anything things are only worse now, as COVID triggered a surge in depression for just about everyone, academics included. It remains to be seen how much of this large increase will abate as things gradually return to normal, and how much will continue to have long-term effects—this may depend in part on how well we manage to genuinely restore a normal way of life and how well we can deal with long COVID.

If we assume that academics are a similar population to Mensa members (admittedly a strong assumption), then this could potentially explain why 26% of academic faculty are depressed—but not why nearly 40% of junior faculty are. At the very least, we junior faculty are about 50% more likely to be depressed than would be explained by our intelligence alone. And grad students have it even worse: Nearly 40% of graduate students report anxiety or depression, and nearly 50% of PhD students meet the criteria for depression. At the very least this sounds like a dual effect of being both high in intelligence and low in status—it’s those of us who have very little power or job security in academia who are the most depressed.

This suggests that, yes, there really is something wrong with academia. It may not be entirely the fault of the system—perhaps even a well-designed academic system would result in more depression than the general population because we are genetically predisposed. But it really does seem like there is a substantial environmental contribution that academic institutions bear some responsibility for.

I think the most obvious explanation is constant evaluation: From the time we are students at least up until we (maybe, hopefully, someday) get tenure, academics are constantly being evaluated on our performance. We know that this sort of evaluation contributes to anxiety and depression.

Don’t other jobs evaluate performance? Sure. But not constantly the way that academia does. This is especially obvious as a student, where everything you do is graded; but it largely continues once you are faculty as well.

For most jobs, you are concerned about doing well enough to keep your job or maybe get a raise. But academia has this continuous forward pressure: if you are a grad student or junior faculty, you can’t possibly keep your job; you must either move upward to the next stage or drop out. And academia has become so hyper-competitive that if you want to continue moving upward—and someday getting that tenure—you must publish in top-ranked journals, which have utterly opaque criteria and ever-declining acceptance rates. And since there are so few jobs available compared to the number of applicants, good enough is never good enough; you must be exceptional, or you will fail. Two thirds of PhD graduates seek a career in academia—but only 30% are actually in one three years later. (And honestly, three years is pretty short; there are plenty of cracks left to fall through between that and a genuinely stable tenured faculty position.)

Moreover, our skills are so hyper-specialized that it’s very hard to imagine finding work anywhere else. This grants academic institutions tremendous monopsony power over us, letting them get away with lower pay and worse working conditions. Even with an economics PhD—relatively transferable, all things considered—I find myself wondering who would actually want to hire me outside this ivory tower, and my feeble attempts at actually seeking out such employment have thus far met with no success.

I also find academia painfully isolating. I’m not an especially extraverted person; I tend to score somewhere near the middle range of extraversion (sometimes called an “ambivert”). But I still find myself craving more meaningful contact with my colleagues. We all seem to work in complete isolation from one another, even when sharing the same office (which is awkward for other reasons). There are very few consistent gatherings or good common spaces. And whenever faculty do try to arrange some sort of purely social event, it always seems to involve drinking at a pub and nobody is interested in providing any serious emotional or professional support.

Some of this may be particular to this university, or to the UK; or perhaps it has more to do with being at a certain stage of my career. In any case I didn’t feel nearly so isolated in graduate school; I had other students in my cohort and adjacent cohorts who were going through the same things. But I’ve been here two years now and so far have been unable to establish any similarly supportive relationships with colleagues.

There may be some opportunities I’m not taking advantage of: I’ve skipped a lot of research seminars, and I stopped going to those pub gatherings. But it wasn’t that I didn’t try them at all; it was that I tried them a few times and quickly found that they were not filling that need. At seminars, people only talked about the particular research project being presented. At the pub, people talked about almost nothing of serious significance—and certainly nothing requiring emotional vulnerability. The closest I think I got to this kind of support from colleagues was a series of lunch meetings designed to improve instruction in “tutorials” (what here in the UK we call discussion sections); there, at least, we could commiserate about feeling overworked and dealing with administrative bureaucracy.

There seem to be deep, structural problems with how academia is run. This whole process of universities outsourcing their hiring decisions to the capricious whims of high-ranked journals basically decides the entire course of our careers. And once you get to the point I have, now so disheartened with the process of publishing research that I can’t even engage with it, it’s not at all clear how it’s even possible to recover. I see no way forward, no one to turn to. No one seems to care how well I teach, if I’m not publishing research.

And I’m clearly not the only one who feels this way.

The case against phys ed

PNRJ education, ethics, personal , , , , , , , , ,

Dec 4 JDN 2459918

If I want to stop someone from engaging in an activity, what should I do? I could tell them it’s wrong, and if they believe me, that would work. But what if they don’t believe me? Or I could punish them for doing it, and as long as I can continue to do that reliably, that should deter them from doing it. But what happens after I remove the punishment?

If I really want to make someone not do something, the best way to accomplish that is to make them not want to do it. Make them dread doing it. Make them hate the very thought of it. And to accomplish that, a very efficient method would be to first force them to do it, but make that experience as miserable and humiliating is possible. Give them a wide variety of painful or outright traumatic experiences that are directly connected with the undesired activity, to carry with them for the rest of their life.

This is precisely what physical education does, with regard to exercise. Phys ed is basically optimized to make people hate exercise.

Oh, sure, some students enjoy phys ed. These are the students who are already athletic and fit, who already engage in regular exercise and enjoy doing so. They may enjoy phys ed, may even benefit a little from it—but they didn’t really need it in the first place.

The kids who need more physical activity are the kids who are obese, or have asthma, or suffer from various other disabilities that make exercising difficult and painful for them. And what does phys ed do to those kids? It makes them compete in front of their peers at various athletic tasks at which they will inevitably fail and be humiliated.

Even the kids who are otherwise healthy but just don’t get enough exercise will go into phys ed class at a disadvantage, and instead of being carefully trained to improve their skills and physical condition at their own level, they will be publicly shamed by their peers for their inferior performance.

I know this, because I was one of those kids. I have exercise-induced bronchoconstriction, a lung condition similar to asthma (actually there’s some debate as to whether it should be considered a form of asthma), in which intense aerobic exercise causes the airways of my lungs to become constricted and inflamed, making me unable to get enough air to continue.

It’s really quite remarkable I wasn’t diagnosed with this as a child; I actually once collapsed while running in gym class, and all they thought to do at the time was give me water and let me rest for the remainder of the class. Nobody thought to call the nurse. I was never put on a beta agonist or an inhaler. (In fact at one point I was put on a beta blocker for my migraines; I now understand why I felt so fatigued when taking it—it was literally the opposite of the drug my lungs needed.)

Actually it’s been a few years since I had an attack. This is of course partly due to me generally avoiding intense aerobic exercise; but even when I do get intense exercise, I rarely seem to get bronchoconstriction attacks. My working hypothesis is that the norepinephrine reuptake inhibition of my antidepressant acts like a beta agonist; both drugs mimic norepinephrine.

But as a child, I got such attacks quite frequently; and even when I didn’t, my overall athletic performance was always worse than most of the other kids. They knew it, I knew it, and while only a few actively tried to bully me for it, none of the others did anything to make me feel better. So gym class was always a humiliating and painful experience that I came to dread.

As a result, as soon as I got out of school and had my own autonomy in how to structure my own life, I basically avoided exercise whenever I could. Even knowing that it was good for me—really, exercise is ridiculously good for you; it honestly doesn’t even make sense to me how good it is for you—I could rarely get myself to actually go out and exercise. I certainly couldn’t do it with anyone else; sometimes, if I was very disciplined, I could manage to maintain an exercise routine by myself, as long as there was no one else there who could watch me, judge me, or compare themselves to me.

In fact, I’d probably have avoided exercise even more, had I not also had some more positive experiences with it outside of school. I trained in martial arts for a few years, getting almost to a black belt in tae kwon do; I quit precisely when it started becoming very competitive and thus began to feel humiliated again when I performed worse than others. Part of me wishes I had stuck with it long enough to actually get the black belt; but the rest of me knows that even if I’d managed it, I would have been miserable the whole time and it probably would have made me dread exercise even more.

The details of my story are of course individual to me; but the general pattern is disturbingly common. A kid does poorly in gym class, or even suffers painful attacks of whatever disabling condition they have, but nobody sees it as a medical problem; they just see the kid as weak and lazy. Or even if the adults are sympathetic, the other kids aren’t; they just see a peer who performed worse than them, and they have learned by various subtle (and not-so-subtle) cultural pressures that anyone who performs worse at a culturally-important task is worthy of being bullied and shunned.

Even outside the directly competitive environment of sports, the very structure of a phys ed class, where a large group of students are all expected to perform the same athletic tasks and can directly compare their performance against each other, invites this kind of competition. Kids can see, right in their faces, who is doing better and who is doing worse. And our culture is astonishingly bad at teaching children (or anyone else, for that matter) how to be sympathetic to others who perform worse. Worse performance is worse character. Being bad at running, jumping and climbing is just being bad.

Part of the problem is that school administrators seem to see physical education as a training and selection regimen for their sports programs. (In fact, some of them seem to see their entire school as existing to serve their sports programs.) Here is a UK government report bemoaning the fact that “only a minority of schools play competitive sport to a high level”, apparently not realizing that this is necessarily true because high-level sports performance is a relative concept. Only one team can win the championship each year. Only 10% of students will ever be in the top 10% of athletes. No matter what. Anything else is literally mathematically impossible. We do not live in Lake Wobegon; not all the children can be above average.

There are good phys ed programs out there. They have highly-trained instructors and they focus on matching tasks to a student’s own skill level, as well as actually educating them—teaching them about anatomy and physiology rather than just making them run laps. Actually the one phys ed class I took that I actually enjoyed was actually an anatomy and physiology class; we didn’t do any physical exercise in that class. But well-taught phys ed classes are clearly the exception, not the norm.

Of course, it could be that some students actually benefit from phys ed, perhaps even enough to offset the harms to people like me. (Though then the question should be asked whether phys ed should be compulsory for all students—if an intervention helps some and hurts others, maybe only give it to the ones it helps?) But I know very few people who actually described their experiences of phys ed class as positive ones. While many students describe their experiences of math class in similarly-negative terms (which is also a problem with how math classes are taught), I definitely do know people who actually enjoyed and did well in math class. Still, my sample is surely biased—it’s comprised of people similar to me, and I hated gym and loved math. So let’s look at the actual data.

Or rather, I’d like to, but there isn’t that much out there. The empirical literature on the effects of physical education is surprisingly limited.

A lot of analyses of physical education simply take as axiomatic that more phys ed means more exercise, and so they use the—overwhelming, unassailable—evidence that exercise is good to support an argument for more phys ed classes. But they never seem to stop and take a look at whether phys ed classes are actually making kids exercise more, particularly once those kids grow up and become adults.

In fact, the surprisingly weak correlations between higher physical activity and better mental health among adolescents (despite really strong correlations in adults) could be because exercise among adolescents is largely coerced via phys ed, and the misery of being coerced into physical humiliation counteracts any benefits that might have been obtained from increased exercise.

The best long-term longitudinal study I can find did show positive effects of phys ed on long-term health, though by a rather odd mechanism: Women exercised more as adults if they had phys ed in primary school, but men didn’t; they just smoked less. And this study was back in 1999, studying a cohort of adults who had phys ed quite a long time ago, when it was better funded.

The best experiment I can find actually testing whether phys ed programs work used a very carefully designed phys ed program with a lot of features that it would be really nice to have, but the vast majority of actual gym classes do not, including carefully structured activities with specific developmental goals, and, perhaps most importantly, children were taught to track and evaluate their own individual progress rather than evaluate themselves in comparison to others.

And even then, the effects are not all that large. The physical activity scores of the treatment group rose from 932 minutes per week to 1108 minutes per week for first-graders, and from 1212 to 1454 for second-graders. But the physical activity scores of the control group rose from 906 to 996 for first-graders, and 1105 to 1211 for second-graders. So of the 176 minutes per week gained by first-graders, 90 would have happened anyway. Likewise, of the 242 minutes per week gained by second-graders, 106 were not attributable to the treatment. Only about half of the gains were due to the intervention, and they amount to about a 10% increase in overall physical activity. It also seems a little odd to me that the control groups both started worse off than the experimental groups and both groups gained; it raises some doubts about the randomization.

The researchers also measured psychological effects, and these effects are even smaller and honestly a little weird. On a scale of “somatic anxiety” (basically, how bad do you feel about your body’s physical condition?), this well-designed phys ed program only reduced scores in the treatment group from 4.95 to 4.55 among first-graders, and from 4.50 to 4.10 among second-graders. Seeing as the scores for second-graders also fell in the control group from 4.63 to 4.45, only about half of the observed reduction—0.2 points on a 10-point scale—is really attributable to the treatment. And the really baffling part is that the measure of social anxiety actually fell more, which makes me wonder if they’re really measuring what they think they are.

Clearly, exercise is good. We should be trying to get people to exercise more. Actually, this is more important than almost anything else we could do for public health, with the possible exception of vaccinations. All of these campaigns trying to get kids to lose weight should be removed and replaced with programs to get them to exercise more, because losing weight doesn’t benefit health and exercising more does.

But I am not convinced that physical education as we know it actually makes people exercise more. In the short run, it forces kids to exercise, when there were surely ways to get kids to exercise that didn’t require such coercion; and in the long run, it gives them painful, even traumatic memories of exercise that make them not want to continue it once they get older. It’s too competitive, too one-size-fits-all. It doesn’t account for innate differences in athletic ability or match challenge levels to skill levels. It doesn’t help kids cope with having less ability, or even teach kids to be compassionate toward others with less ability than them.

And it makes kids miserable.

Mind reading is not optional

PNRJ cognitive science, heuristics and biases, personal , , , , , ,

Nov 20 JDN 2459904

I have great respect for cognitive-behavioral therapy (CBT), and it has done a lot of good for me. (It is also astonishingly cost-effective; its QALY per dollar rate compares favorably to almost any other First World treatment, and loses only to treating high-impact Third World diseases like malaria and schistomoniasis.)

But there are certain aspects of it that have always been frustrating to me. Standard CBT techniques often present as ‘cognitive distortions‘ what are in fact clearly necessary heuristics without which it would be impossible to function.

Perhaps the worst of these is so-called ‘mind reading‘. The very phrasing of it makes it sound ridiculous: Are you suggesting that you have some kind of extrasensory perception? Are you claiming to be a telepath?

But in fact ‘mind reading’ is simply the use of internal cognitive models to forecast the thoughts, behaviors, and expectations of other human beings. And without it, it would be completely impossible to function in human society.

For instance, I have had therapists tell me that it is ‘mind reading’ for me to anticipate that people will have tacit expectations for my behavior that they will judge me for failing to meet, and I should simply wait for people to express their expectations rather than assuming them. I admit, life would be much easier if I could do that. But I know for a fact that I can’t. Indeed, I used to do that, as a child, and it got me in trouble all the time. People were continually upset at me for not doing things they had expected me to do but never bothered to actually mention. They thought these expectations were “obvious”; they were not, at least not to me.

It was often little things, and in hindsight some of these things seem silly: I didn’t know what a ‘made bed’ was supposed to look like, so I put it in a state that was functional for me, but that was not considered ‘making the bed’. (I have since learned that my way was actually better: It’s good to let sheets air out before re-using them.) I was asked to ‘clear the sink’, so I moved the dishes out of the sink and left them on the counter, not realizing that the implicit command was for me to wash those dishes, dry them, and put them away. I was asked to ‘bring the dinner plates to the table’, so I did that, and left them in a stack there, not realizing that I should be setting them out in front of each person’s chair and also bringing flatware. Of course I know better now. But how was I supposed to know then? It seems like I was expected to, though.

Most people just really don’t seem to realize how many subtle, tacit expectations are baked into every single task. I think neurodivergence is quite relevant here; I have a mild autism spectrum disorder, and so I think rather differently than most people. If you are neurotypical, then you probably can forecast other people’s expectations fairly well automatically, and so they may seem obvious to you. In fact, they may seem so obvious that you don’t even realize you’re doing it. Then when someone like me comes along and is consciously, actively trying to forecast other people’s expectations, and sometimes doing it poorly, you go and tell them to stop trying to forecast. But if they were to do that, they’d end up even worse off than they are. What you really need to be telling them is how to forecast better—but that would require insight into your own forecasting methods which you aren’t even consciously aware of.

Seriously, stop and think for a moment all of the things other people expect you to do every day that are rarely if ever explicitly stated. How you are supposed to dress, how you are supposed to speak, how close you are supposed to stand to other people, how long you are supposed to hold eye contact—all of these are standards you will be expected to meet, whether or not any of them have ever been explicitly explained to you. You may do this automatically; or you may learn to do it consciously after being criticized for failing to do it. But one way or another, you must forecast what other people will expect you to do.

To my knowledge, no one has ever explicitly told me not to wear a Starfleet uniform to work. I am not aware of any part of the university dress code that explicitly forbids such attire. But I’m fairly sure it would not be a good idea. To my knowledge, no one has ever explicitly told me not to burst out into song in the middle of a meeting. But I’m still pretty sure I shouldn’t do that. To my knowledge, no one has ever explicitly told me what the ‘right of way’ rules are for walking down a crowded sidewalk, who should be expected to move out of the way of whom. But people still get mad if you mess up and bump into them.

Even when norms are stated explicitly, it is often as a kind of last resort, and the mere fact that you needed to have a norm stated is often taken as a mark against your character. I have been explicitly told in various contexts not to talk to myself or engage in stimming leg movements; but the way I was told has generally suggested that I would have been judged better if I hadn’t had to be told, if I had simply known the way that other people seem to know. (Or is it that they never felt any particular desire to stim?)

In fact, I think a major part of developing social skills and becoming more functional, to the point where a lot of people actually now seem a bit surprised to learn I have an autism spectrum disorder, has been improving my ability to forecast other people’s expectations for my behavior. There are dozens if not hundreds of norms that people expect you to follow at any given moment; most people seem to intuit them so easily that they don’t even realize they are there. But they are there all the same, and this is painfully evident to those of us who aren’t always able to immediately intuit them all.

Now, the fact remains that my current mental models are surely imperfect. I am often wrong about what other people expect of me. I’m even prepared to believe that some of my anxiety comes from believing that people have expectations more demanding than what they actually have. But I can’t simply abandon the idea of forecasting other people’s expectations. Don’t tell me to stop doing it; tell me how to do it better.

Moreover, there is a clear asymmetry here: If you think people want more from you than they actually do, you’ll be anxious, but people will like you and be impressed by you. If you think people want less from you than they actually do, people will be upset at you and look down on you. So, in the presence of uncertainty, there’s a lot of pressure to assume that the expectations are high. It would be best to get it right, of course; but when you aren’t sure you can get it right, you’re often better off erring on the side of caution—which is to say, the side of anxiety.

In short, mind reading isn’t optional. If you think it is, that’s only because you do it automatically.

How to fix economics publishing

PNRJ core principles, personal, science and academia , , , , , , , , , ,

Aug 7 JDN 2459806

The current system of academic publishing in economics is absolutely horrible. It seems practically designed to undermine the mental health of junior faculty.

1. Tenure decisions, and even most hiring decisions, are almost entirely based upon publication in five (5) specific journals.

2. One of those “top five” journals is owned by Elsevier, a corrupt monopoly that has no basis for its legitimacy yet somehow controls nearly one-fifth of all scientific publishing.

3. Acceptance rates in all of these journals are between 5% and 10%—greatly decreased from what they were a generation or two ago. Given a typical career span, the senior faculty evaluating you on whether you were published in these journals had about a three times better chance to get their own papers published there than you do.

4. Submissions are only single-blinded, so while you have no idea who is reading your papers, they know exactly who you are and can base their decision on whether you are well-known in the profession—or simply whether they like you.

5. Simultaneous submissions are forbidden, so when submitting to journals you must go one at a time, waiting to hear back from one before trying the next.

6. Peer reviewers are typically unpaid and generally uninterested, and so procrastinate as long as possible on doing their reviews.

7. As a result, review times for a paper are often measured in months, for every single cycle.

So, a highly successful paper goes like this: You submit it to a top journal, wait three months, it gets rejected. You submit it to another one, wait another four months, it gets rejected. You submit it to a third one, wait another two months, and you are told to revise and resubmit. You revise and resubmit, wait another three months, and then finally get accepted.

You have now spent an entire year getting one paper published. And this was a success.

Now consider a paper that doesn’t make it into a top journal. You submit, wait three months, rejected; you submit again, wait four months, rejected; you submit again, wait two months, rejected. You submit again, wait another five months, rejected; you submit to the fifth and final top-five, wait another four months, and get rejected again.

Now, after a year and a half, you can turn to other journals. You submit to a sixth journal, wait three months, rejected. You submit to a seventh journal, wait four months, get told to revise and resubmit. You revise and resubmit, wait another two months, and finally—finally, after two years—actually get accepted, but not to a top-five journal. So it may not even help you get tenure, unless maybe a lot of people cite it or something.

And what if you submit to a seventh, an eighth, a ninth journal, and still keep getting rejected? At what point do you simply give up on that paper and try to move on with your life?

That’s a trick question: Because what really happens, at least to me, is I can’t move on with my life. I get so disheartened from all the rejections of that paper that I can’t bear to look at it anymore, much less go through the work of submitting it to yet another journal that will no doubt reject it again. But worse than that, I become so depressed about my academic work in general that I become unable to move on to any other research either. And maybe it’s me, but it isn’t just me: 28% of academic faculty suffer from severe depression, and 38% from severe anxiety. And that’s across all faculty—if you look just at junior faculty it’s even worse: 43% of junior academic faculty suffer from severe depression. When a problem is that prevalent, at some point we have to look at the system that’s making us this way.

I can blame the challenges of moving across the Atlantic during a pandemic, and the fact that my chronic migraines have been the most frequent and severe they have been in years, but the fact remains: I have accomplished basically nothing towards the goal of producing publishable research in the past year. I have two years left at this job; if I started right now, I might be able to get something published before my contract is done. Assuming that the project went smoothly, I could start submitting it as soon as it was done, and it didn’t get rejected as many times as the last one.

I just can’t find the motivation to do it. When the pain is so immediate and so intense, and the rewards are so distant and so uncertain, I just can’t bring myself to do the work. I had hoped that talking about this with my colleagues would help me cope, but it hasn’t; in fact it only makes me seem to feel worse, because so few of them seem to understand how I feel. Maybe I’m talking to the wrong people; maybe the ones who understand are themselves suffering too much to reach out to help me. I don’t know.

But it doesn’t have to be this way. Here are some simple changes that could make the entire process of academic publishing in economics go better:

1. Boycott Elsevier and all for-profit scientific journal publishers. Stop reading their journals. Stop submitting to their journals. Stop basing tenure decisions on their journals. Act as though they don’t exist, because they shouldn’t—and then hopefully soon they won’t.

2. Peer reviewers should be paid for their time, and in return required to respond promptly—no more than a few weeks. A lack of response should be considered a positive vote on that paper.

3. Allow simultaneous submissions; if multiple journals accept, let the author choose between them. This is already how it works in fiction publishing, which you’ll note has not collapsed.

4. Increase acceptance rates. You are not actually limited by paper constraints anymore; everything is digital now. Most of the work—even in the publishing process—already has to be done just to go through peer review, so you may as well publish it. Moreover, most papers that are submitted are actually worthy of publishing, and this whole process is really just an idiotic status hierarchy. If the prestige of your journal decreases because you accept more papers, we are measuring prestige wrong. Papers should be accepted something like 50% of the time, not 5-10%.

5. Double blind submissions, and insist on ethical standards that maintain that blinding. No reviewer should know whether they are reading the work of a grad student or a Nobel Laureate. Reputation should mean nothing; scientific rigor should mean everything.

And, most radical of all, what I really need in my life right now:

6. Faculty should not have to submit their own papers. Each university department should have administrative staff whose job it is to receive papers from their faculty, format them appropriately, and submit them to journals. They should deal with all rejections, and only report to the faculty member when they have received an acceptance or a request to revise and resubmit. Faculty should simply do the research, write the papers, and then fire and forget them. We have highly specialized skills, and our valuable time is being wasted on the clerical tasks of formatting and submitting papers, which many other people could do as well or better. Worse, we are uniquely vulnerable to the emotional impact of the rejection—seeing someone else’s paper rejected is an entirely different feeling from having your own rejected.

Do all that, and I think I could be happy to work in academia. As it is, I am seriously considering leaving and never coming back.

What’s wrong with “should”?

PNRJ cognitive science, ethics, personal , , , , , , , , , ,

Nov 8 JDN 2459162

I have been a patient in cognitive behavioral therapy (CBT) for many years now. The central premise that thoughts can influence emotions is well-founded, and the results of CBT are empirically well supported.

One of the central concepts in CBT is cognitive distortions: There are certain systematic patterns in how we tend to think, which often results in beliefs and emotions that are disproportionate with reality.

Most of the cognitive distortions CBT deals with make sense to me—and I am well aware that my mind applies them frequently: All-or-nothing, jumping to conclusions, overgeneralization, magnification and minimization, mental filtering, discounting the positive, personalization, emotional reasoning, and labeling are all clearly distorted modes of thinking that nevertheless are extremely common.

But there’s one “distortion” on CBT lists that always bothers me: “should statements”.

Listen to this definition of what is allegedly a cognitive distortion:

Another particularly damaging distortion is the tendency to make “should” statements. Should statements are statements that you make to yourself about what you “should” do, what you “ought” to do, or what you “must” do. They can also be applied to others, imposing a set of expectations that will likely not be met.

When we hang on too tightly to our “should” statements about ourselves, the result is often guilt that we cannot live up to them. When we cling to our “should” statements about others, we are generally disappointed by their failure to meet our expectations, leading to anger and resentment.

So any time we use “should”, “ought”, or “must”, we are guilty of distorted thinking? In other words, all of ethics is a cognitive distortion? The entire concept of obligation is a symptom of a mental disorder?

Different sources on CBT will define “should statements” differently, and sometimes they offer a more nuanced definition that doesn’t have such extreme implications:

Individuals thinking in ‘shoulds’, ‘oughts; or ‘musts’ have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Example: You don’t like playing tennis but take lessons as you feel you ‘should’, and that you ‘shouldn’t’ make so many mistakes on the court, and that your coach ‘ought to’ be stricter on you. You also feel that you ‘must’ please him by trying harder.

This is particularly problematic, I think, because of the All-or-Nothing distortion which does genuinely seem to be common among people with depression: Unless you are very clear from the start about where to draw the line, our minds will leap to saying that all statements involving the word “should” are wrong.

I think what therapists are trying to capture with this concept is something like having unrealistic expectations, or focusing too much on what could or should have happened instead of dealing with the actual situation you are in. But many seem to be unable to articulate that clearly, and instead end up asserting that entire concept of moral obligation is a cognitive distortion.

There may be a deeper error here as well: The way we study mental illness doesn’t involve enough comparison with the control group. Psychologists are accustomed to asking the question, “How do people with depression think?”; but they are not accustomed to asking the question, “How do people with depression think compared to people who don’t?” If you want to establish that A causes B, it’s not enough to show that those with B have A; you must also show that those who don’t have B also don’t have A.

This is an extreme example for illustration, but suppose someone became convinced that depression is caused by having a liver. They studied a bunch of people with depression, and found that they all had livers; hypothesis confirmed! Clearly, we need to remove the livers, and that will cure the depression.

The best example I can find of a study that actually asked that question compared nursing students and found that cognitive distortions explain about 20% of the variance in depression. This is a significant amount—but still leaves a lot unexplained. And most of the research on depression doesn’t even seem to think to compare against people without depression.

My impression is that some cognitive distortions are genuinely more common among people with depression—but not all of them. There is an ongoing controversy over what’s called the depressive realism effect, which is the finding that in at least some circumstances the beliefs of people with mild depression seem to be more accurate than the beliefs of people with no depression at all. The result is controversial both because it seems to threaten the paradigm that depression is caused by distortions, and because it seems to be very dependent on context; sometimes depression makes people more accurate in their beliefs, other times it makes them less accurate.

Overall, I am inclined to think that most people have a variety of cognitive distortions, but we only tend to notice when those distortions begin causing distress—such when are they involved in depression. Human thinking in general seems to be a muddled mess of heuristics, and the wonder is that we function as well as we do.

Does this mean that we should stop trying to remove cognitive distortions? Not at all. Distorted thinking can be harmful even if it doesn’t cause you distress: The obvious example is a fanatical religious or political belief that leads you to harm others. And indeed, recognizing and challenging cognitive distortions is a highly effective treatment for depression.

Actually I created a simple cognitive distortion worksheet based on the TEAM-CBT approach developed by David Burns that has helped me a great deal in a remarkably short time. You can download the worksheet yourself and try it out. Start with a blank page and write down as many negative thoughts as you can, and then pick 3-5 that seem particularly extreme or unlikely. Then make a copy of the cognitive distortion worksheet for each of those thoughts and follow through it step by step. Particularly do not ignore the step “This thought shows the following good things about me and my core values:”; that often feels the strangest, but it’s a critical part of what makes the TEAM-CBT approach better than conventional CBT.

So yes, we should try to challenge our cognitive distortions. But the mere fact that a thought is distressing doesn’t imply that it is wrong, and giving up on the entire concept of “should” and “ought” is throwing out a lot of babies with that bathwater.

We should be careful about labeling any thoughts that depressed people have as cognitive distortions—and “should statements” is a clear example where many psychologists have overreached in what they characterize as a distortion.

Terrible but not likely, likely but not terrible

PNRJ cognitive science, heuristics and biases, personal , , , ,

May 17 JDN 2458985

The human brain is a remarkably awkward machine. It’s really quite bad at organizing data, relying on associations rather than formal categories.

It is particularly bad at negation. For instance, if I tell you that right now, no matter what, you must not think about a yellow submarine, the first thing you will do is think about a yellow submarine. (You may even get the Beatles song stuck in your head, especially now that I’ve mentioned it.) A computer would never make such a grievous error.

The human brain is also quite bad at separation. Daniel Dennett coined a word “deepity” for a particular kind of deep-sounding but ultimately trivial aphorism that seems to be quite common, which relies upon this feature of the brain. A deepity has at least two possible readings: On one reading, it is true, but utterly trivial. On another, it would be profound if true, but it simply isn’t true. But if you experience both at once, your brain is triggered for both “true” and “profound” and yields “profound truth”. The example he likes to use is “Love is just a word”. Well, yes, “love” is in fact just a word, but who cares? Yeah, words are words. But love, the underlying concept it describes, is not just a word—though if it were that would change a lot.

One thing I’ve come to realize about my own anxiety is that it involves a wide variety of different scenarios I imagine in my mind, and broadly speaking these can be sorted into two categories: Those that are likely but not terrible, and those that are terrible but not likely.

In the former category we have things like taking an extra year to finish my dissertation; the mean time to completion for a PhD is over 8 years, so finishing in 6 instead of 5 can hardly be considered catastrophic.

In the latter category we have things like dying from COVID-19. Yes, I’m a male with type A blood and asthma living in a high-risk county; but I’m also a young, healthy nonsmoker living under lockdown. Even without knowing the true fatality rate of the virus, my chances of actually dying from it are surely less than 1%.

But when both of those scenarios are running through my brain at the same time, the first triggers a reaction for “likely” and the second triggers a reaction for “terrible”, and I get this feeling that something terrible is actually likely to happen. And indeed if my probability of dying were as high as my probability of needing a 6th year to finish my PhD, that would be catastrophic.

I suppose it’s a bit strange that the opposite doesn’t happen: I never seem to get the improbability of dying attached to the mildness of needing an extra year. The confusion never seems to trigger “neither terrible nor likely”. Or perhaps it does, and my brain immediately disregards that as not worthy of consideration? It makes a certain sort of sense: An event that is neither probable nor severe doesn’t seem to merit much anxiety.

I suspect that many other people’s brains work the same way, eliding distinctions between different outcomes and ending up with a sort of maximal product of probability and severity.
The solution to this is not an easy one: It requires deliberate effort and extensive practice, and benefits greatly from formal training by a therapist. Counter-intuitively, you need to actually focus more on the scenarios that cause you anxiety, and accept the anxiety that such focus triggers in you. I find that it helps to actually write down the details of each scenario as vividly as possible, and review what I have written later. After doing this enough times, you can build up a greater separation in your mind, and more clearly categorize—this one is likely but not terrible, that one is terrible but not likely. It isn’t a cure, but it definitely helps me a great deal. Perhaps it could help you.

Motivation under trauma

PNRJ current events, ethics, personal, science and academia , , , , , , , , , ,

May 3 JDN 2458971

Whenever I ask someone how they are doing lately, I get the same answer: “Pretty good, under the circumstances.” There seems to be a general sense that—at least among the sort of people I interact with regularly—that our own lives are still proceeding more or less normally, as we watch in horror the crises surrounding us. Nothing in particular is going wrong for us specifically. Everything is fine, except for the things that are wrong for everyone everywhere.

One thing that seems to be particularly difficult for a lot of us is the sense that we suddenly have so much time on our hands, but can’t find the motivation to actually use this time productively. So many hours of our lives were wasted on commuting or going to meetings or attending various events we didn’t really care much about but didn’t want to feel like we had missed out on. But now that we have these hours back, we can’t find the strength to use them well.

This is because we are now, as an entire society, experiencing a form of trauma. One of the most common long-term effects of post-traumatic stress disorder is a loss of motivation. Faced with suffering we have no power to control, we are made helpless by this traumatic experience; and this makes us learn to feel helpless in other domains.

There is a classic experiment about learned helplessness; like many old classic experiments, its ethics are a bit questionable. Though unlike many such experiments (glares at Zimbardo), its experimental rigor was ironclad. Dogs were divided into three groups. Group 1 was just a control, where the dogs were tied up for a while and then let go. Dogs in groups 2 and 3 were placed into a crate with a floor that could shock them. Dogs in group 2 had a lever they could press to make the shocks stop. Dogs in group 3 did not. (They actually gave the group 2 dogs control over the group 3 dogs to make the shock times exactly equal; but the dogs had no way to know that, so as far as they knew the shocks ended at random.)

Later, dogs from both groups were put into another crate, where they no longer had a lever to press, but they could jump over a barrier to a different part of the crate where the shocks wouldn’t happen. The dogs from group 2, who had previously had some control over their own pain, were able to quickly learn to do this. The dogs from group 3, who had previously felt pain apparently at random, had a very hard time learning this, if they could ever learn it at all. They’d just lay there and suffer the shocks, unable to bring themselves to even try to leap the barrier.

The group 3 dogs just knew there was nothing they could do. During their previous experience of the trauma, all their actions were futile, and so in this new trauma they were certain that their actions would remain futile. When nothing you do matters, the only sensible thing to do is nothing; and so they did. They had learned to be helpless.

I think for me, chronic migraines were my first crate. For years of my life there was basically nothing I could do to prevent myself from getting migraines—honestly the thing that would have helped most would have been to stop getting up for high school that started at 7:40 AM every morning. Eventually I found a good neurologist and got various treatments, as well as learned about various triggers and found ways to avoid most of them. (Let me know if you ever figure out a way to avoid stress.) My migraines are now far less frequent than they were when I was a teenager, though they are still far more frequent than I would prefer.

Yet, I think I still have not fully unlearned the helplessness that migraines taught me. Every time I get another migraine despite all the medications I’ve taken and all the triggers I’ve religiously avoided, this suffering beyond my control acts as another reminder of the ultimate caprice of the universe. There are so many things in our lives that we cannot control that it can be easy to lose sight of what we can.

This pandemic is a trauma that the whole world is now going through. And perhaps that unity of experience will ultimately save us—it will make us see the world and each other a little differently than we did before.

There are a few things you can do to reduce your own risk of getting or spreading the COVID-19 infection, like washing your hands regularly, avoiding social contact, and wearing masks when you go outside. And of course you should do these things. But the truth really is that there is very little any one of us can do to stop this global pandemic. We can watch the numbers tick up almost in real-time—as of this writing, 1 million cases and over 50,000 deaths in the US, 3 million cases and over 200,000 deaths worldwide—but there is very little we can do to change those numbers.

Sometimes we really are helpless. The challenge we face is not to let this genuine helplessness bleed over and make us feel helpless about other aspects of our lives. We are currently sitting in a crate with no lever, where the shocks will begin and end beyond our control. But the day will come when we are delivered to a new crate, and given the chance to leap over a barrier; we must find the strength to take that leap.

For now, I think we can forgive ourselves for getting less done than we might have hoped. We’re still not really out of that first crate.

Mental illness is different from physical illness.

PNRJ cognitive science, personal , , , , , , , , , , , ,

Post 311 Oct 13 JDN 2458770

There’s something I have heard a lot of people say about mental illness that is obviously well-intentioned, but ultimately misguided: “Mental illness is just like physical illness.”

Sometimes they say it explicitly in those terms. Other times they make analogies, like “If you wouldn’t shame someone with diabetes for using insulin, why shame someone with depression for using SSRIs?”

Yet I don’t think this line of argument will ever meaningfully reduce the stigma surrounding mental illness, because, well, it’s obviously not true.

There are some characteristics of mental illness that are analogous to physical illness—but there are some that really are quite different. And these are not just superficial differences, the way that pancreatic disease is different from liver disease. No one would say that liver cancer is exactly the same as pancreatic cancer; but they’re both obviously of the same basic category. There are differences between physical and mental illness which are both obvious, and fundamental.

Here’s the biggest one: Talk therapy works on mental illness.

You can’t talk yourself out of diabetes. You can’t talk yourself out of myocardial infarct. You can’t even talk yourself out of migraine (though I’ll get back to that one in a little bit). But you can, in a very important sense, talk yourself out of depression.

In fact, talk therapy is one of the most effective treatments for most mental disorders. Cognitive behavioral therapy for depression is on its own as effective as most antidepressants (with far fewer harmful side effects), and the two combined are clearly more effective than either alone. Talk therapy is as effective as medication on bipolar disorder, and considerably better on social anxiety disorder.

To be clear: Talk therapy is not just people telling you to cheer up, or saying it’s “all in your head”, or suggesting that you get more exercise or eat some chocolate. Nor does it consist of you ruminating by yourself and trying to talk yourself out of your disorder. Cognitive behavioral therapy is a very complex, sophisticated series of techniques that require years of expert training to master. Yet, at its core, cognitive therapy really is just a very sophisticated form of talking.

The fact that mental disorders can be so strongly affected by talk therapy shows that there really is an important sense in which mental disorders are “all in your head”, and not just the trivial way that an axe wound or even a migraine is all in your head. It isn’t just the fact that it is physically located in your brain that makes a mental disorder different; it’s something deeper than that.

Here’s the best analogy I can come up with: Physical illness is hardware. Mental illness is software.

If a computer breaks after being dropped on the floor, that’s like an axe wound: An obvious, traumatic source of physical damage that is an unambiguous cause of the failure.

If a computer’s CPU starts overheating, that’s like a physical illness, like diabetes: There may be no particular traumatic cause, or even any clear cause at all, but there is obviously something physically wrong that needs physical intervention to correct.

But if a computer is suffering glitches and showing error messages when it tries to run particular programs, that is like mental illness: Something is wrong not on the low-level hardware, but on the high-level software.

These different types of problem require different types of solutions. If your CPU is overheating, you might want to see about replacing your cooling fan or your heat sink. But if your software is glitching while your CPU is otherwise running fine, there’s no point in replacing your fan or heat sink. You need to get a programmer in there to look at the code and find out where it’s going wrong. A talk therapist is like a programmer: The words they say to you are like code scripts they’re trying to get your processor to run correctly.

Of course, our understanding of computers is vastly better than our understanding of human brains, and as a result, programmers tend to get a lot better results than psychotherapists. (Interestingly they do actually get paid about the same, though! Programmers make about 10% more on average than psychotherapists, and both are solidly within the realm of average upper-middle-class service jobs.) But the basic process is the same: Using your expert knowledge of the system, find the right set of inputs that will fix the underlying code and solve the problem. At no point do you physically intervene on the system; you could do it remotely without ever touching it—and indeed, remote talk therapy is a thing.

What about other neurological illnesses, like migraine or fibromyalgia? Well, I think these are somewhere in between. They’re definitely more physical in some sense than a mental disorder like depression. There isn’t any cognitive content to a migraine the way there is to a depressive episode. When I feel depressed or anxious, I feel depressed or anxious about something. But there’s nothing a migraine is about. To use the technical term in cognitive science, neurological disorders lack the intentionality that mental disorders generally have. “What are you depressed about?” is a question you usually can answer. “What are you migrained about?” generally isn’t.

But like mental disorders, neurological disorders are directly linked to the functioning of the brain, and often seem to operate at a higher level of functional abstraction. The brain doesn’t have pain receptors on itself the way most of your body does; getting a migraine behind your left eye doesn’t actually mean that that specific lobe of your brain is what’s malfunctioning. It’s more like a general alert your brain is sending out that something is wrong, somewhere. And fibromyalgia often feels like it’s taking place in your entire body at once. Moreover, most neurological disorders are strongly correlated with mental disorders—indeed, the comorbidity of depression with migraine and fibromyalgia in particular is extremely high.

Which disorder causes the other? That’s a surprisingly difficult question. Intuitively we might expect the “more physical” disorder to be the primary cause, but that’s not always clear. Successful treatment for depression often improves symptoms of migraine and fibromyalgia as well (though the converse is also true). They seem to be mutually reinforcing one another, and it’s not at all clear which came first. I suppose if I had to venture a guess, I’d say the pain disorders probably have causal precedence over the mood disorders, but I don’t actually know that for a fact.

To stretch my analogy a little, it may be like a software problem that ends up causing a hardware problem, or a hardware problem that ends up causing a software problem. There actually have been a few examples of this, like games with graphics so demanding that they caused GPUs to overheat.

The human brain is a lot more complicated than a computer, and the distinction between software and hardware is fuzzier; we don’t actually have “code” that runs on a “processor”. We have synapses that continually fire on and off and rewire each other. The closest thing we have to code that gets processed in sequence would be our genome, and that is several orders of magnitude less complex than the structure of our brains. Aside from simply physically copying the entire brain down to every synapse, it’s not clear that you could ever “download” a mind, science fiction notwithstanding.

Indeed, anything that changes your mind necessarily also changes your brain; the effects of talking are generally subtler than the effects of a drug (and certainly subtler than the effects of an axe wound!), but they are nevertheless real, physical changes. (This is why it is so idiotic whenever the popular science press comes out with: “New study finds that X actually changes your brain!” where X might be anything from drinking coffee to reading romance novels. Of course it does! If it has an effect on your mind, it did so by having an effect on your brain. That’s the Basic Fact of Cognitive Science.) This is not so different from computers, however: Any change in software is also a physical change, in the form of some sequence of electrical charges that were moved from one place to another. Actual physical electrons are a few microns away from where they otherwise would have been because of what was typed into that code.

Of course I want to reduce the stigma surrounding mental illness. (For both selfish and altruistic reasons, really.) But blatantly false assertions don’t seem terribly productive toward that goal. Mental illness is different from physical illness; we can’t treat it the same.