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Press: Traumatic Brain Injury Makes Suicide Rational

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From a story on a professional athlete who committed suicide, suspecting he had traumatic brain injury:

BOSTON — The suicide of the former Chicago Bears star Dave Duerson became more alarming Monday morning, when Boston University researchers announced that Duerson’s brain had developed the same trauma-induced disease recently found in more than 20 deceased players.

What is amazing about this story is this: there is no recommendation for greater mental health screening, detection, and services among former professional athletes. There are recommendations, however, to actually SOLVE THE PROBLEM that made the guy’s life hell in the first place.

Duerson shot himself Feb. 17 in the chest rather than the head so that his brain could be examined by Boston University’s Center for the Study of Traumatic Encephalopathy, which announced its diagnosis Monday morning in Boston.

In this case, the reporter seems to clearly accept the proposition that the former athlete’s suicide was caused by his traumatic brain injury – but NOT because his traumatic brain injury made him insane. Rather, it seems that his traumatic brain injury made his life bad enough that it’s impossible to completely reject the notion that he committed suicide rationally.

The medical model of suicide – the idea that suicide is a pathological symptom of a curable medical condition – has always been dubious, but it is clear from accounts like this that not even the media (repeatedly warned by well-meaning bullies to self-censor) fully buy the story. Everyone knows that there are good reasons to commit suicide. What few acknowledge is that most genuinely good reasons to commit suicide are not as easy to verify as this former athlete’s brain injury.

As David Foster Wallace describes it in Infinite Jest:

Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. [Emphasis mine.]

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Written by Sister Y

May 2, 2011 at 5:17 pm

Chinese Factories Make Workers Promise Not To Kill Themselves

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Workers in the miserable Chinese factories with embarrassingly high suicide rates are being made to sign “suicide contracts” agreeing that they won’t commit suicide, and that their families will get only minimal damages if they do.

Lots of folks in these factories want to commit suicide, and it’s easy to understand why, especially with a basic understanding of the causes of suicide (that is, failed social belonging and perceived burdensomeness). Workers may not talk to each other, stand for 12-hour shifts, work for subsistence wages, and must work upwards of 40 hours of overtime a week, which breaks even the minimal worker treatment laws in freaking CHINA. “Badly performing workers were humiliated in front of colleagues,” says the article ominously.

Conditions at the factories seem basically designed to create the “subsistence conditions” Robin Hanson imagines for his “ems” – conscious AI human brain emulators that must work to pay for their existence, competing against ever-more-efficient creatures being created all the time.

But Robin Hanson seems sure his em-creatures will be fine. Apparently, American middle- and upper-class workaholics are a better model for them than Chinese iPhone factory workers.

Written by Sister Y

May 2, 2011 at 4:03 pm

No Life Is Good

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David Benatar, in The Philosopher’s Magazine:

One common and instant response to [the claim that no lives are good] is indignation. How dare one claim that no lives are good when there are billions of people who say otherwise about their own lives? I dare to make such a claim partly because there is excellent empirical evidence for the conclusion that people’s judgements [sic] cannot be trusted as a reliable indicator of how good their lives really are. For example, research psychologists have shown that people are prone to optimism and to optimistic (that is, inaccurately positive) assessments of their own lives. There are many manifestations of this phenomenon. People are more prone to remember good experiences than bad ones; they have exaggerated views of how well things will go for them in the future; and most people think that the quality of their lives is above average. When it comes to assessing their own moral goodness, people also tend to be overly optimistic. Very few people think of themselves as bad. If we were to trust self-assessments, we would have to conclude that there are very few bad people and evil actions, which is patently false.

Cheery people – those who think that life is, or at least, can be good – invariably attempt to reconcile the many bad things in life with the possibility of a good life. That is to say, they offer what might be called a “secular theodicy”. But, like conventional theodicies, which attempt to reconcile the vast amount of evil in the world with God’s existence, the secular theodicy of optimists puts the conclusion before the evidence. [Bolded emphasis mine.]

Read the entire piece here.

Thanks Rob Sica!

Written by Sister Y

May 2, 2011 at 3:39 pm

Status, Empathy, Dignity

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From Am Yisrael Chai/Israel Is Living by Rabbi Schlomo Carlebach:

Reb Zusia was a poor humble rebbe and on this particular day he looked it. He was taking a coach to the city and waited to board with a few other passengers.

One of the passengers was a rich man and he was looking at Zusia, thinking to himself ‘Ah ha, now here is a man I can make fun of; . . and that is what he did.

They arrived in the city and thousands of people gathered around the coach. Zusia stepped off and disappeared into the crowd. The rich man got off and asked someone what was going on. He said that Reb Zusia has come and we’ve gathered to greet him.

When the rich man found out the man he had been making fun of was Reb Zusia he went up and apologized.

Reb Zusia said, “It’s not me you should be apologizing to . . it’s all the poor people of the world you’re insulting. You have to ask every poor person for forgiveness.”

Memento mori

Written by Sister Y

April 29, 2011 at 5:15 pm

Posted in dignity, empathy, poverty, status

91-Year-Old Woman Selling Suicide Kits Online Claims First Official Fictim

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From the Daily Beast:

A shadowy online company selling suicide kits recently claimed its first confirmed victim. Winston Ross talks exclusively with the entrepreneur behind it: a grieving 91-year-old woman.

People who wish to kill themselves and who order a kit THROUGH THE FREAKIN’ MAIL to enact those wishes are not “victims.”

People who die in an automobile collision caused by a man attempting suicide, who was unable to commit suicide by other means, are victims.

People who are forced to remain alive when they want to die, often in horrible circumstances like akinetic mutism (can’t move or speak) after an unsuccessful suicide attempt, are victims. (That goes double when they have medical experiments performed on them without their consent, as happened in the case linked above. There was no ethical outcry; the study was widely touted as a breakthrough. It makes me want to vomit.)

People who want to die and commit suicide are just lucky.

I envy the fictim in this case, Nick Klonoski, a 29-year-old man with chronic pain and depression. However, his bereaved brother Zach sees things differently. He testified at a hearing:

“In a society where so many people suffer from depression and other mental-health disorders,” Zach said, “this company has found their niche in the market by peddling death. This is analogous to putting a gun-vending machine next to a depression clinic. The Gladd company, so named as to avoid suspicion in case family members happen to sign for or come across the package, made $60 off my brother’s death.”

What about the people making money off our misery – like the medical industry, which makes billions every year forcibly “treating” would-be suicides in an often horrific manner? What is wrong, exactly, with “peddling death” when death is heartily desired? None of us asked to be here.

The fact is that while people’s willingness to pay to improve people’s lives is extremely limited, their willingness to demand regulation to prevent people from taking their own lives is nearly infinite. In essence, this is an involuntary, uncompensated transfer of wealth from suicidal, miserable people, the worst off of society, to their nonsuicidal friends and relatives. It is all done under the flag of the medical model of suicide, which is treated as a religious fact rather than examined as a scientific proposition (since examined as such it is clearly erroneous).

One important piece of information here: the helium thing apparently works (here’s a video, even). I wonder how long it will take for forced life advocates to make helium illegal. Oh wait – it’s already happening.

Written by Sister Y

April 28, 2011 at 6:27 pm

Born Obligated: A Place for Quantitative Methods in Ethics

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Behavioral economics methods may be more reliable than unsupported, sweeping assumptions in understanding the degree to which being born is okay.


Obviousness

That being born is a good thing is treated as axiomatic by the majority of thinkers who consider the issue.

Thomas Nagel, for instance, states that “All of us, I believe, are fortunate to have been born,” even while affirming that not having been born is no misfortune (Mortal Questions, “Death,” p. 7). Bryan Caplan has said, regarding IVF, “How can I neglect the welfare of the children created by artificial means? But I’m not ‘neglecting’ children’s welfare. I just find it painfully obvious that being alive is good for them [emphasis in original].”

There are two elements to this kind of thinking. First, it represents a judgment that life is, on the whole, worth getting and having; but second, all the talk of “obviousness” also implies that there is something wrong with even asking the question.

I want to address here how quantitative methods, rather than intuition and assumption, might be used to measure the downside of existence. I argue that there is a need to analyze quantitatively the obligations that we are all born with and the inherent pain of life, and that, if our lives are to be worth having on the whole, must be made up for with valuable experiences.

Work and Leisure

We might characterize the central unpleasant obligation in our lives as the obligation to “work” (broadly construed) in order to meet the salient and potentially misery-inducing needs we are born with or naturally develop. These needs include not only food, clothing, shelter, and medical care, but also status, love, sex, attention, and company.[1] We can even quantify these needs, by quantifying work done to satisfy these needs, for which we have a great deal of data.

Some of these needs, of course, may actually be satisfied by working – the need to belong, to feel valuable, to not be a burden. However, at the same time, some of these needs are actually increased by working – that is, work may create disutility as well as utility. How can you tell the difference between what people do to merely to ease the pain and discomfort of existence, and what people actually want to be doing?

Many economists have addressed the question of the difference between work and leisure, and how we may quantify and measure them. One crude-but-tempting measure of the value of leisure time is merely a person’s wage. But as Larson & Shaikh (2004) explain, this is much too crude to get at the true nature of work and leisure:

Assuming the average wage is the appropriate opportunity cost of time presumes that the individual faces no constraints on hours worked, derives no utility or disutility from work, and has a linear wage function…. This is unlikely to be true for many people….an individual’s average wage does not necessarily reveal anything about the shadow value of discretionary leisure time, either as an upper or lower bound.

The question of the value of leisure time is intimately related to the question of quantifying the unpleasant obligations placed on us by virtue of existence, so that we may have a starting point for a meaningful comparison of life’s costs and life’s benefits.

How do we characterize “work”? What is the difference between “work” and “leisure”?

Intuitively, we know the difference – or at least, there exist clear cases of “work” and clear cases of “leisure.” Operating a cash register is work. Washing dishes is work. Doing bong rips is leisure. Reading novels is leisure. Watching television and having sex are generally leisure (unless you’re in advertising or a prostitute). For most people, child care and lawn care qualify as work – whether paid or unpaid – but for some people, these may qualify as leisure some of the time.

These examples suggest that leisure is that which is done for the sake of the experience itself, whereas work is done with some goal in mind other than the experience itself, and is done only in service of that goal.[2] Running ten miles is leisure for me, because I do it for the pleasure of the experience; running those same ten miles might be work for someone else, because he does it to lose weight, not for the pleasure of running. A third person might run for both reasons, in which case the action has aspects of both leisure and work. We should not necessarily expect that every action and every hour can be neatly categorized as “work” or “leisure,” even for a particular individual.

This should give us pause when considering the definition of “leisure” preferred by Mark Aguiar and Erik Hurst in their 2006 paper “Measuring Trends in Leisure: The Allocation of Time Over Five Decades,” an hour-by-hour tally of time not spent in market or non-market work (e.g., at work, or doing unpaid work around the house or around town). In reality, a single hour may have substantial aspects of both work and leisure.

Aguiar and Hurst remark on a potentially definitional characteristic of leisure: the degree to which market inputs (money, technology) are consumed to reduce the amount of time spent in the activity. They say:

one definition of whether an activity is “leisure” may be the degree of substitutability between the market input and the time input in the production of the commodity. That is, the leisure content of an activity is a function of technology rather than preferences. In the examples above, one can use the market to reduce time spent cooking (by getting a microwave or ordering takeout food) but cannot use the market to reduce the time input into watching television (although innovations like VCRs and Tivo allow some substitution). [Emphasis mine.]

Let me give a definition of my own, to fit my question:

Work is any action (or omission, perhaps) that we undertake in order to prevent or remedy some unpleasant state, and that we would not undertake if the unpleasant potential state were not a factor. An activity has a strong work component if technology is demanded by individuals to reduce the amount of time they spend in the activity.

In other words, work is what you do only because you have to eat, and you spend as little time doing it as is possible to satisfy your (present and projected future) needs.

Many studies since the 1980s have found that physicians’ demand for leisure directly affects the prevalence of cesarean sections. Cesarean sections are highly correlated to time variables associated with doctors wanting to get the hell out of there, although (further strengthening the theory) this correlation is dependent on the type of insurance covering the patient.

Instead of relying on the “imaginary survey justification” to “prove” that coming into existence is a good thing, economists and ethicists could use more creative, quantitative methods to examine the question of how bad (and how good) life is. Specifically, we need to figure out how to tell the difference between suffering people attempting to remedy their shitty situation, and happy people chilling out – both of which may describe any of us at different times in our life, or even our day. “Are you glad you were born?” is unsubtle, an all-or-nothing approach that relies heavily on people knowing the answer to questions they may have only limited capacity to understand. Analyzing behavior in smaller chunks would give us a better idea of just how happy people are to be here.

Poverty and Pain

Behavioral economics is a strong tool for understanding ourselves and each other. However, many behavioral economists, consciously or unconsciously, rely heavily on the “imaginary survey justification,” and no economist, to my knowledge, has attempted to use behavioral economics methods to figure out how bad, or how good, life is to individuals.

Bryan Caplan published a fascinating, even audacious paper in 2007 entitled “Behavioral Economics and Perverse Effects of the Welfare State.” In it, he argues that giving the poor more life choices through charitable assistance seems to actually harm them, because they are irrational and fail to choose the best option for them. From his abstract:

Critics often argue that government poverty programs perversely make the poor worse off by encouraging unemployment, out-of-wedlock births, and other “social pathologies.” However, basic microeconomic theory tells us that you cannot make an agent worse off by expanding his choice set. The current paper argues that familiar findings in behavioral economics can be used to resolve this paradox. Insofar as the standard rational actor model is wrong, additional choices can make agents worse off. More importantly, existing empirical evidence suggests that the poor deviate from the rational actor model to an unusually large degree. The paper then considers the policy implications of our alternative perspective.

The option Caplan fails to consider is this: the lives of the poor are unacceptably bad without charitable aid.

We don’t think it irrational, exactly, when a person in extreme pain does something to relieve his pain that may have negative future consequences. A shrieking, sweating patient in horrible pain might be perfectly aware of the potential for developing a long-term addiction to opiates, but we do not consider his decision to take opiate medication to be irrational. His pain is so bad that we think it makes sense for him to use any means to stop it, even if they harm his future interests.

Connecting to my discussion of work vs. leisure, I think it a valid hypothesis that poverty is actually dreadfully painful – not only physically, but emotionally and socially. There is only so much pain we can expect a being to endure before his attempts to relieve it through future-damaging means becomes perfectly understandable and, in fact, rational.

The Demand for Pain Relief

An economic theory of rationality, to be in touch with human ethical reality, must include an account of pain. We must attempt to define and study pain (in the broad sense) in a behavioral economics context, rather than to define it away, as Caplan attempts to do.

Karl Smith notes that studies consistently show that health care consumers do not seem to take into account mortality data when choosing between health care providers, even when very good mortality data is widely available in a user-friendly format. Perhaps the demand for life is not as high as we might think. People seem to like spending money on health care, but not to care about outcome. One approach suggested by this is to study revealed preferences/willingness-to-pay for death risk reduction and pain relief (broadly defined), respectively, in different contexts and populations.

Is Loss Aversion Irrational?

A recent paper on behavioral economics, using tufted capuchin monkeys as subjects, demonstrated that the monkeys exhibit what is considered a typical human departure from rationality, “loss aversion.” That is, monkeys trained to use metal discs as money preferred to buy fruit from a graduate student who would give them a smaller food reward but sometimes add a few grapes to it, rather than from a graduate student who would give them a larger food reward but then maybe remove a few grapes. The monkeys weren’t maximizing the number of grapes they got; they specifically exhibited a preference to have things added, rather than have things taken away.

This does not, I think, exactly illustrate irrationality in the capuchins: it illustrates that they are utility maximizers, not grape maximizers. Monkeys experience a loss of utility from losing grapes that is greater than the utility produced by those grapes. Losing grapes, we might say, is painful. Doing the resource-maximizing thing does not necessarily equate with doing the utility-maximizing thing.

A Place for Quantitative Methods

Caplan’s conclusion is that we must not treat the poor as rational actors, because they deviate so heavily (compared to the wealthy) from being long-term best-interest maximizers. Therefore, he says, we should not expect to solve their problems by giving them money or other charitable aid.

An equally supported conclusion would be that being poor is so awful it is unendurable, like severe physical pain, and poor people actually are rational, taking this into account. Caplan also gives us a hint at what might be an indicator of painfulness: the degree to which the actor deviates from resource maximization. He says, “The behavioral literature has documented that the average person frequently violates neoclassical assumptions. But it rarely investigates variation in the tendency to violate neoclassical assumptions. Casual empiricism and limited formal evidence suggest that the poor do deviate more. A great deal more could be learned at low cost if new behavioral studies collected information on participants’ income and education to test for heterogeneity. [Citations omitted.]” Analyzing LOTS of factors for correlation to deviation from resource-maximization rationality, not just income, education, and intelligence, could help us understand the circumstances under which life is so painful that we act irrationally.


1. The extreme seriousness of the basic human need for affiliation and belonging is not widely acknowledged, even though data is available to that effect from a wide variety of sources. Kipling Williams’ meta-studies, Ostracism: The Early Detection System and Ostracism: Consequences and Coping are a good place to start to review the literature on the consequences of failed belonging. For instance, Williams explains experiments using Cyberball, an interactive computer game that can be used to give test subjects the impression of being ostracized in a controlled way. He says experimenters have “found strong negative impact on mood and need levels for those participants who were ostracized” in the Cyberball game, and when the experiment was conducted under fMRI, participants “showed significant increases in activity in their anterior cingulate cortexes, where people also show significant activity when enduring physical pain.” Further, he states that “In all of these Cyberball studies, the effects sizes of the ostracism manipulation are over 1.00 (often above 1.50) indicating strong effects, and subsequent meta-analyses indicate it takes only three people per condition to reach standard levels of significance. [Citations omitted.]” See pp. 17-19 of Ostracism: The Early Detection System. What’s especially amazing is that the effect is clearly not rational – it holds even when ostracized participants have been explicitly told that they’re only playing against a computer (NPCs).

Thomas Joiner’s book Why People Die by Suicide (see my review here) is a book-length treatment of an empirically-tested theory of the causes of suicide, and concludes that three factors are the best predictors of suicidality: failed belonging, feelings of burdensomeness, and competence (ability to physically do it). Two of the three factors are measures of failed social affiliation. Other kinds of sadness (including sadness for other reasons and clinical depression) are not very predictive of suicide. And Phillipe Rochat’s excellent book Others in Mind details the formation of the human “self” through child development studies and other empirical research, concluding that what he terms the Basic Affiliation Need is not only an extremely critical need, but one that is primordial to, and directly causes, the formation of the self. The need to belong and to have a place in society is not a luxury, but a basic need the absence of which is more painful than prolonged hunger or injury.

2. Yesterday, I overheard two high school girls having a conversation. One revealed to her friend that although she realized it meant giving up one’s life, she could see the upside to a diagnosis of terminal cancer – a kind of peace, and an exemption from the future-oriented unpleasantness we must all endure if we are to be considered socially responsible. “You could just have fun in school,” she said. “I work my ass off every day with work and schoolwork, but if you were going to die anyway, you could just relax. You wouldn’t have to worry.” Her friend agreed, but said she wanted to see what it was like to be an adult anyway. “I’m not sure I do,” said the first little girl. School is generally work, not leisure.

Written by Sister Y

April 27, 2011 at 4:02 pm

Heteronormativity and Gay Youth Suicide

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A recent study published in the journal Pediatrics determined that being surrounded by heterosexuals (especially Republican ones) and a heteronormative culture is associated with increased risk of suicide in gay, lesbian, and bisexual youth.

The study by Mark L. Hatzenbuehler (“The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth“) found that in a sample of 31,852 Oregon 11th graders, queerness was a major risk factor in having attempted suicide in the previous 12 months (21.5% of queer kids vs. 4.2% of straight ones), but that the presence of a “supportive environment” was associated with a 20% reduction in suicide attempts by queer kids. From the study:

We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students . . . .

Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96–0.99]). [Emphasis mine.]

This is the first study I’ve seen that links gay youth suicide attempts specifically to the crappiness of living in a controlling, breeder-dominated, heteronormative, redneck culture. The more they’re surrounded by fellow queer folks and Democrats, and the more they’re protected from bullying, the less queer kids try to off themselves.

What about the straight kids? They seem to benefit from liberality as well, with a 9% lower suicide attempt rate in “supportive” counties compared to more anti-gay counties.

It is my hope that findings like these, to the extent that they are replicated by cohort and/or case-control studies as well as studies examining other populations, be used in determining custody and visitation of children when these are contested, and also in placement of children for adoption. To the extent that it is replicated, evidence like this should be considered within the context of neglect and emotional abuse investigations.

Written by Sister Y

April 19, 2011 at 6:32 pm