I think four people experiencing psychosis in a period of five years, in a community this large with high rates of autism and drug use, is shockingly low relative to base rates.
[...]
A fast pass suggests that my 1-3% for lifetime prevalence was right, but mostly appearing at 15-35.
And since we have conservatively 500 people in the cluster (a lot more people than that attended CFAR workshops or are in MIRI or CFAR’s orbit), 4 is low. Given that I suspect the cluster is larger and I am pretty sure my numbers don’t include drug induced psychosis, just primary psychosis.
The base rate seems important to take into account here, though per Jessica, “Obviously, for every case of poor mental health that ‘blows up’ and is noted, there are many cases that aren’t.” (But I’d guess that’s true for the base-rate stats too?)
This is a good point regarding the broader community. I do think that, given that at least 2 cases were former MIRI employees, there might be a higher rate in that subgroup.
EDIT: It’s also relevant that a lot of these cases happened in the same few years. 4 of the 5 cases of psychiatric hospitalization or jail time I know about happened in 2017, the other happened sometime 2017-2019. I think these people were in the 15-35 age range, which spans 20 years.
I’m a complete outsider looking in here, so here’s an outsider’s perspective (from someone in CS academia, currently in my early 30s).
I’ve never heard or seen anyone, in real life, ever have psychosis. I know of 0 cases. Yeah, I know that people don’t share such things, but I’ve heard of no rumors either.
By contrast, depression/anxiety seems common (especially among grad students) and I know of a couple of suicides. There was even a murder! But never psychosis; without the internet I wouldn’t even know it’s a real thing.
I don’t know what the official base rate is, but saying “4 cases is low” while referring to the group of people I’m familiar with (smart STEM types) is, from my point of view, absurd.
The rate you quote is high. There may be good explanations for this: maybe rationalists are more open about their psychosis when they get it. Maybe they are more gossipy so each case of psychosis becomes widely known. Maybe the community is easier to enter for people with pre-existing psychotic tendencies. Maybe it’s all the drugs some rationalists use.
But pretending the reported rate of psychosis is low seems counterproductive to me.
I lived in a student housing cooperative for 3 years during my undergrad experience. These were non-rationalists. I lived with 14 people, then 35, then 35 (somewhat overlapping) people.
In these 3 years I saw 3 people go through a period of psychosis.
Once it was because of whippets, basically, and updated me very very strongly away from nitrous oxide being safe (it potentiates response to itself, so there’s a positive feedback loop, and positive feedback loops in biology are intrinsically scary). Another time it was because the young man was almost too autistic to function in social environments and then feared that he’d insulted a woman and would be cast out of polite society for “that action and also for overreacting to the repercussions of the action”. The last person was a mixture of marijuana and having his Christianity fall apart after being away from the social environment of his upbringing.
A striking thing about psychosis is that up close it really seems more like a biological problem rather than a philosophic one, whereas I had always theorized naively that there would be something philosophically interesting about it, with opportunities to learn or teach in a way that connected to the altered “so-called mental state”.
I saw two of the three cases somewhat closely, and it wasn’t “this person believes something false, in a way that maybe they could be talked out of” (which was my previous model of “being crazy”). It was more like “this human body has a brain that is executing microinstructions that might be part of a human-like performance of some coherent motion of the soul, if it progressed statefully, but instead it is a highly stuttering, almost stateless loop of nearly pure distress, repeating words over and over, and forgetting things within 2 seconds of hearing them, and calming itself, but then forgetting why it calmed itself, and then forgetting that it forgot, and so on, with very very obvious dysfunction”.
I rarely talk about any of it out of respect for their privacy, but this is so long ago that anyone who can figure out who I’m talking about at this point (from what I’ve said) probably also knows the events in question.
It seemed almost indecent to have observed it, and it feels wrong to discuss, out of respect for their personhood. Which maybe doesn’t make sense, but that is simply part of the tone of these memories. Two of the three left college and never came back, and another took a week off in perhaps a hotel or something, with parental support. People who were there spoke of it in hushed tones. It was spiritually scary.
My understanding is that base rates for schizophrenia are roughly 1% or 2% cross culturally, and are often on the introverted side of things. Also I think that many people rarely talk about the experiences (that they saw others go though, or that they went through), so you could know people who saw or experienced such things… and they might be very unlikely to ever volunteer their observations.
it wasn’t “this person believes something false, in a way that maybe they could be talked out of” (which was my previous model of “being crazy”). It was more like “this human body has a brain that is executing microinstructions
Feels like there’s more to the story here. Two of the cases you gave do sound like they had some mental thing (Christianity, social fear) that precipitated the psychosis, even if the psychosis itself was non-mental.
I agree with other commenters that you are just less likely to see psychosis even if it’s there, both because it’s not ongoing in the way that depression and anxiety are, and because people are less likely to discuss it. I was only one step away from Jessica in the social graph in October of 2017 and never had any inkling that she’d had a psychotic episode until just now. I also wasn’t aware that Zack Davis had ever had a psychotic episode, despite having met him several times and having read his blog a bit. I also lived with Olivia during the time that she was apparently inspiring psychosis in others.
In fact, the only psychotic episodes I’ve known about are ones that had news stories written about them, which suggests to me that you are probably underestimating the extent to which people keep quiet about the psychotic episodes of themselves and those close to them. It seems in quite poor taste to gossip about, akin to gossiping about friends’ suicide attempts (which I also assume happen much more often than I hear about — I think one generally only hears about the ones that succeed or that are publicized to spread awareness).
Just for thoroughness, here are the psychotic episodes I’ve known about, in chronological order:
Eric Bruylant’s, which has been discussed in other comments. I was aware that he was in jail because my housemates were trying to support him by showing up to his trials and stuff, and we still got mail for him (the case had happened pretty recently when I moved in). I think I found out the details — including learning that psychosis was involved — from the news story though.
I was on a sports team in college, and the year after I graduated, one of my teammates had a psychotic break. I only heard about this because he was wandering the streets yelling and ended up trying to attack some campus police officers with a metal pipe and got shot (thankfully non-fatally).
It’s unclear to me if what happened with Ziz&co at Westminster Woods was a psychotic episode, but in any case I knew about it at the time, but only had the details clarified in the news story.
I feel like people keep telling me that psychosis around me should be higher than what I hear about, which is irrelevant to my point: my point is the frequency in which I hear about psychosis in the rationalist community is like an order of magnitude higher than the frequency I hear about it elsewhere.
It doesn’t matter whether people hide psychosis among my social group; the observation to explain is why people don’t hide psychosis in the rationalist community to the same extent.
For example, you mention 2 separate example of Bay Area rationalists making the news for psychosis. I know of no people in my academic community who have made the news for psychosis. Assuming equal background rates, what is left to explain is why rationalists are more likely to make the news when they get psychosis.
Another example: there have now been 1-2 people who have admitted to psychosis in blog posts intended as public callouts. I know of no people in my academic community who have written public callout blog posts in which they say they’ve had psychosis. Is there an explanation for why rationalists who’ve had psychosis are more likely to write public callout blog posts?
Anyway, this discussion feels kind of moot now that I’ve read Scott Alexander’s update to his comment. He says that several people (who knew each other) all had psychosis around the same time in 2017. No reasonable person can think this is merely baseline; some kind of social contagion is surely involved (probably just people sharing drugs or drug recommendations).
I think part of it is that this isn’t related to your social network, but your news habits and how your news sources cover your social network.
You probably don’t read newspapers that are as certain to write about your neighbor having any kind of “psychosis”, but you read forums that tell you about Rationalists doing the same.
Them leaving out the exact details of what went on with their groups make the whole discussion sketchy. Maybe they just want to keep the conversation to themselves. If that’s the case, why are they posting on LW?
Sampling error. Psychosis is not an ongoing thing, yielding many fewer chances to observe it than months or years long depression or anxiety. Psychosis often manifests when people are already isolated due to worsening mental health, whereas depression and anxiety can be exactly exacerbated by the situations in which you would observe it i.e. socializing. Nor would people volunteer their experience due to much greater stigma.
I am not comparing “number of psychosis among my friends” to “number of depression episodes among my friends”. I am comparing “number of psychosis among my friends” to “number of psychosis among rationalists”. Any sampling errors should apply equally to the rationalists (or if not, that demands an explanation).
The observation is that there’s a lot more reported psychosis among rationalists than reported psychosis among (say) CS grad students. I don’t have an explanation (and maybe there’s an innocuous one), but I don’t think people should be denying this fact.
A hypothesis is that rationalists are a larger gossip community, so that e.g. you might hear about psychosis from 4 years ago in people you’re nth-degree socially connected with, where maybe most other communities aren’t like that?
Certainly possible! I mentioned this hypothesis upthread.
I wonder if there are ways to test it. For instance, do non-Bay-Arean rationalists also have a high rate of reported psychosis? I think not (not sure though), though perhaps most of the gossip centers on the Bay Area.
Are Bay Area rationalists also high in reported levels of other gossip-mediated things? I’m trying to name some, but most sexual ones are bad examples because of the polyamory confounder. How about: are Bay rationalists high in reported rates of plastic surgery? How about abortion? These seem like somewhat embarrassing things that you’d normally not find out about, but that people like to gossip about.
Or maybe people don’t care to gossip about these things on the internet, because they are less interesting the psychosis.
I’m someone with a family history of psychosis and I spend quite a lot of time researching it—treatments, crisis response, cultural responses to it. There are roughly the same number of incidences of psychosis in my immediate to extended family than are described in this post in the extended rationalist community. Major predictive factors include stress, family history and use of marijuana (and, to a lesser extent, other psychedelics). I don’t have studies to back this up but I have an instinct based on my own experience that openness-to-experience and risk-of-psychosis are correlated in family risk factors. So given the drugs, stress and genetic openness, I’d expect generic Bay Area smart people to have a fairly high risk of psychosis compared to, say, people in more conservative areas already.
(Sort of; you did say “more gossipy → more widely known”, but I wanted to specifically add the word “larger”, the point being that a small + extra gossipy community would have a higher that usual report rate, and so would a large + extra gossipy (+ memory-ful) community; but the larger one would have more raw numbers, so you’d get a wrong estimate of the proportional rate if you estimated the size of the relevant reference class using intuitions based on small gossip communities. And maybe even a less gossipy but larger network would still have this effect; like, I *never* hear gossip about people in communities I’m not a part of, even if I talk to some people from those communities, so there’s more structure than just the rate of gossip. It’s more a question of how large is the “gossip-percolation connected component”.)
See PhoenixFriend’s comment, there were multiple cases I didn’t know about, so a lot of people’s thoughts about this post are recapitulating sampling bias from my own knowledge (which is from my own social network, e.g. oversampling trans people and people talking with Michael). This confirms that people are avoiding volunteering the information that they had a psychotic break.
PhoenixFriend alleges multiple cases you didn’t know about, but so far no one else has affirmed that those cases existed or were closely connected with CFAR/MIRI.
I think it’s entirely possible that those cases did exist and will be affirmed, but at the moment my state is “betting on skeptical.”
Kate Donovan messaged me to say:
The base rate seems important to take into account here, though per Jessica, “Obviously, for every case of poor mental health that ‘blows up’ and is noted, there are many cases that aren’t.” (But I’d guess that’s true for the base-rate stats too?)
This is a good point regarding the broader community. I do think that, given that at least 2 cases were former MIRI employees, there might be a higher rate in that subgroup.
EDIT: It’s also relevant that a lot of these cases happened in the same few years. 4 of the 5 cases of psychiatric hospitalization or jail time I know about happened in 2017, the other happened sometime 2017-2019. I think these people were in the 15-35 age range, which spans 20 years.
I’m a complete outsider looking in here, so here’s an outsider’s perspective (from someone in CS academia, currently in my early 30s).
I’ve never heard or seen anyone, in real life, ever have psychosis. I know of 0 cases. Yeah, I know that people don’t share such things, but I’ve heard of no rumors either.
By contrast, depression/anxiety seems common (especially among grad students) and I know of a couple of suicides. There was even a murder! But never psychosis; without the internet I wouldn’t even know it’s a real thing.
I don’t know what the official base rate is, but saying “4 cases is low” while referring to the group of people I’m familiar with (smart STEM types) is, from my point of view, absurd.
The rate you quote is high. There may be good explanations for this: maybe rationalists are more open about their psychosis when they get it. Maybe they are more gossipy so each case of psychosis becomes widely known. Maybe the community is easier to enter for people with pre-existing psychotic tendencies. Maybe it’s all the drugs some rationalists use.
But pretending the reported rate of psychosis is low seems counterproductive to me.
I lived in a student housing cooperative for 3 years during my undergrad experience. These were non-rationalists. I lived with 14 people, then 35, then 35 (somewhat overlapping) people.
In these 3 years I saw 3 people go through a period of psychosis.
Once it was because of whippets, basically, and updated me very very strongly away from nitrous oxide being safe (it potentiates response to itself, so there’s a positive feedback loop, and positive feedback loops in biology are intrinsically scary). Another time it was because the young man was almost too autistic to function in social environments and then feared that he’d insulted a woman and would be cast out of polite society for “that action and also for overreacting to the repercussions of the action”. The last person was a mixture of marijuana and having his Christianity fall apart after being away from the social environment of his upbringing.
A striking thing about psychosis is that up close it really seems more like a biological problem rather than a philosophic one, whereas I had always theorized naively that there would be something philosophically interesting about it, with opportunities to learn or teach in a way that connected to the altered “so-called mental state”.
I saw two of the three cases somewhat closely, and it wasn’t “this person believes something false, in a way that maybe they could be talked out of” (which was my previous model of “being crazy”). It was more like “this human body has a brain that is executing microinstructions that might be part of a human-like performance of some coherent motion of the soul, if it progressed statefully, but instead it is a highly stuttering, almost stateless loop of nearly pure distress, repeating words over and over, and forgetting things within 2 seconds of hearing them, and calming itself, but then forgetting why it calmed itself, and then forgetting that it forgot, and so on, with very very obvious dysfunction”.
I rarely talk about any of it out of respect for their privacy, but this is so long ago that anyone who can figure out who I’m talking about at this point (from what I’ve said) probably also knows the events in question.
It seemed almost indecent to have observed it, and it feels wrong to discuss, out of respect for their personhood. Which maybe doesn’t make sense, but that is simply part of the tone of these memories. Two of the three left college and never came back, and another took a week off in perhaps a hotel or something, with parental support. People who were there spoke of it in hushed tones. It was spiritually scary.
My understanding is that base rates for schizophrenia are roughly 1% or 2% cross culturally, and are often on the introverted side of things. Also I think that many people rarely talk about the experiences (that they saw others go though, or that they went through), so you could know people who saw or experienced such things… and they might be very unlikely to ever volunteer their observations.
Thanks for this account.
Feels like there’s more to the story here. Two of the cases you gave do sound like they had some mental thing (Christianity, social fear) that precipitated the psychosis, even if the psychosis itself was non-mental.
I agree with other commenters that you are just less likely to see psychosis even if it’s there, both because it’s not ongoing in the way that depression and anxiety are, and because people are less likely to discuss it. I was only one step away from Jessica in the social graph in October of 2017 and never had any inkling that she’d had a psychotic episode until just now. I also wasn’t aware that Zack Davis had ever had a psychotic episode, despite having met him several times and having read his blog a bit. I also lived with Olivia during the time that she was apparently inspiring psychosis in others.
In fact, the only psychotic episodes I’ve known about are ones that had news stories written about them, which suggests to me that you are probably underestimating the extent to which people keep quiet about the psychotic episodes of themselves and those close to them. It seems in quite poor taste to gossip about, akin to gossiping about friends’ suicide attempts (which I also assume happen much more often than I hear about — I think one generally only hears about the ones that succeed or that are publicized to spread awareness).
Just for thoroughness, here are the psychotic episodes I’ve known about, in chronological order:
Eric Bruylant’s, which has been discussed in other comments. I was aware that he was in jail because my housemates were trying to support him by showing up to his trials and stuff, and we still got mail for him (the case had happened pretty recently when I moved in). I think I found out the details — including learning that psychosis was involved — from the news story though.
I was on a sports team in college, and the year after I graduated, one of my teammates had a psychotic break. I only heard about this because he was wandering the streets yelling and ended up trying to attack some campus police officers with a metal pipe and got shot (thankfully non-fatally).
It’s unclear to me if what happened with Ziz&co at Westminster Woods was a psychotic episode, but in any case I knew about it at the time, but only had the details clarified in the news story.
I feel like people keep telling me that psychosis around me should be higher than what I hear about, which is irrelevant to my point: my point is the frequency in which I hear about psychosis in the rationalist community is like an order of magnitude higher than the frequency I hear about it elsewhere.
It doesn’t matter whether people hide psychosis among my social group; the observation to explain is why people don’t hide psychosis in the rationalist community to the same extent.
For example, you mention 2 separate example of Bay Area rationalists making the news for psychosis. I know of no people in my academic community who have made the news for psychosis. Assuming equal background rates, what is left to explain is why rationalists are more likely to make the news when they get psychosis.
Another example: there have now been 1-2 people who have admitted to psychosis in blog posts intended as public callouts. I know of no people in my academic community who have written public callout blog posts in which they say they’ve had psychosis. Is there an explanation for why rationalists who’ve had psychosis are more likely to write public callout blog posts?
Anyway, this discussion feels kind of moot now that I’ve read Scott Alexander’s update to his comment. He says that several people (who knew each other) all had psychosis around the same time in 2017. No reasonable person can think this is merely baseline; some kind of social contagion is surely involved (probably just people sharing drugs or drug recommendations).
I think part of it is that this isn’t related to your social network, but your news habits and how your news sources cover your social network.
You probably don’t read newspapers that are as certain to write about your neighbor having any kind of “psychosis”, but you read forums that tell you about Rationalists doing the same.
Them leaving out the exact details of what went on with their groups make the whole discussion sketchy. Maybe they just want to keep the conversation to themselves. If that’s the case, why are they posting on LW?
Sampling error. Psychosis is not an ongoing thing, yielding many fewer chances to observe it than months or years long depression or anxiety. Psychosis often manifests when people are already isolated due to worsening mental health, whereas depression and anxiety can be exactly exacerbated by the situations in which you would observe it i.e. socializing. Nor would people volunteer their experience due to much greater stigma.
I am not comparing “number of psychosis among my friends” to “number of depression episodes among my friends”. I am comparing “number of psychosis among my friends” to “number of psychosis among rationalists”. Any sampling errors should apply equally to the rationalists (or if not, that demands an explanation).
The observation is that there’s a lot more reported psychosis among rationalists than reported psychosis among (say) CS grad students. I don’t have an explanation (and maybe there’s an innocuous one), but I don’t think people should be denying this fact.
A hypothesis is that rationalists are a larger gossip community, so that e.g. you might hear about psychosis from 4 years ago in people you’re nth-degree socially connected with, where maybe most other communities aren’t like that?
Certainly possible! I mentioned this hypothesis upthread.
I wonder if there are ways to test it. For instance, do non-Bay-Arean rationalists also have a high rate of reported psychosis? I think not (not sure though), though perhaps most of the gossip centers on the Bay Area.
Are Bay Area rationalists also high in reported levels of other gossip-mediated things? I’m trying to name some, but most sexual ones are bad examples because of the polyamory confounder. How about: are Bay rationalists high in reported rates of plastic surgery? How about abortion? These seem like somewhat embarrassing things that you’d normally not find out about, but that people like to gossip about.
Or maybe people don’t care to gossip about these things on the internet, because they are less interesting the psychosis.
I’m someone with a family history of psychosis and I spend quite a lot of time researching it—treatments, crisis response, cultural responses to it. There are roughly the same number of incidences of psychosis in my immediate to extended family than are described in this post in the extended rationalist community. Major predictive factors include stress, family history and use of marijuana (and, to a lesser extent, other psychedelics). I don’t have studies to back this up but I have an instinct based on my own experience that openness-to-experience and risk-of-psychosis are correlated in family risk factors. So given the drugs, stress and genetic openness, I’d expect generic Bay Area smart people to have a fairly high risk of psychosis compared to, say, people in more conservative areas already.
(Sort of; you did say “more gossipy → more widely known”, but I wanted to specifically add the word “larger”, the point being that a small + extra gossipy community would have a higher that usual report rate, and so would a large + extra gossipy (+ memory-ful) community; but the larger one would have more raw numbers, so you’d get a wrong estimate of the proportional rate if you estimated the size of the relevant reference class using intuitions based on small gossip communities. And maybe even a less gossipy but larger network would still have this effect; like, I *never* hear gossip about people in communities I’m not a part of, even if I talk to some people from those communities, so there’s more structure than just the rate of gossip. It’s more a question of how large is the “gossip-percolation connected component”.)
See PhoenixFriend’s comment, there were multiple cases I didn’t know about, so a lot of people’s thoughts about this post are recapitulating sampling bias from my own knowledge (which is from my own social network, e.g. oversampling trans people and people talking with Michael). This confirms that people are avoiding volunteering the information that they had a psychotic break.
PhoenixFriend alleges multiple cases you didn’t know about, but so far no one else has affirmed that those cases existed or were closely connected with CFAR/MIRI.
I think it’s entirely possible that those cases did exist and will be affirmed, but at the moment my state is “betting on skeptical.”
See also studies about base-rate here: https://www.lesswrong.com/posts/MnFqyPLqbiKL8nSR7/my-experience-at-and-around-miri-and-cfar-inspired-by-zoe?commentId=pHaq26ZrznpC7D5f4
? 😭😤😂🤔🤔🤔