Likewise for psychiatry, which justifies incredibly high levels of coercion on the basis of precise-looking claims about different kinds of cognitive impairment and their remedies.
I’ve seen people make the opposite complaint, that we don’t commit enough people to mental hospitals nowadays and as a result the mentally ill make up a large fraction of the homeless. (45% of homeless are mentally ill, according to this source.)
Also psychiatry just doesn’t seem to fit in with the rest of your examples. At least from a layman’s perspective it seems like there is a lot of recognition that pretty much everything is a spectrum and mental illnesses are just extreme ends of the spectra, that many diagnoses are hard to distinguish from each other, that lots of drugs don’t work for lots of individuals, etc.
An alternate response to this point is that if someone comes off their medication, then says they’re going to kill their mother because she is poisoning their food, and the food poisoning claim seems definitely not true, then spending a few days assessing what is going on and treating them until it looks like they are not going to kill their mother anymore seems justifiable for reasons other than “we know exactly what biological circuit is involved with 100% confidence”
(source: this basically describes one of the two people I ever committed involuntarily)
I agree that there are a lot of difficult legal issues to be sorted out about who has the burden of proof and how many hoops people should have to jump through to make this happen, but none of them look at all like “you do not know the exact biological circuit involved with 100% confidence using a theory that has had literally zero exceptions ever”
There are two very, very different arguments one can make for psychiatric coercion:
There are identifiable, specifiable, diagnosable, and treatable types of cognitive impairment. People who have them would, therefore, benefit from others overriding their (impaired) agency to treat their condition.
There aren’t identifiable/specifiable/etc cognitive impairments, or at least psychiatry can’t find them reliably (see: homosexuality in the DSM, the history of lobotomies, Foucault, Szasz). However, psychiatry diagnoses a significant fraction of homeless people with “disorders”, and psychiatrically imprisoning homeless people without trial is good, so psychiatric coercion is good.
The second argument is morally repugnant to many who hold the first view and is also morally repugnant in my own view. If the DSM isn’t actually a much more scientifically valid personality typing procedure than, say, the Enneagram, then locking people up based on it without trial is an ethically horrible form of social control, as locking people up based on the Enneagram would be.
Very few people who accept the first argument would accept the second, indicating that the moral legitimacy of psychiatry is tied to its precise-looking claims about types of cognitive impairment.
I don’t feel qualified to debate what seems to be a very complex issue, but people who advocate for more coercion (mainly AOT) these days seem to do so on the basis of good patient outcomes rather than “high-precision claims”:
Assisted Outpatient Treatment (AOT, formerly known as involuntary outpatient commitment (IOC), allows courts to order certain individuals with brain disorders to comply with treatment while living in the community.
[...]
Research shows Assisted Outpatient Treatment:
Helps the mentally ill by reducing homelessness (74%); suicide attempts (55%); and substance abuse (48%).
Keeps the public safer by reducing physical harm to others (47%) and property destruction (46%).
Saves money by reducing hospitalization (77%); arrests (83%); and incarceration (87%).
If you see an ethical issue with this argument, can you explain what it is?
If the website weren’t making the claim that diagnosable/treatable/etc cognitive impairment exists, they wouldn’t be saying people are “mentally ill”, talk about “Anosognosia”, etc.
Without that language the copy on the page doesn’t really seem justified. There are lots of groups of people (e.g. religious groups) that claim to be able to help people’s life outcomes, but that doesn’t ethically justify coercing people to join them.
I hope you can see the problems of legal order of civil society that would arise if people’s rights could be overridden on the basis of empirical claims that people like them (not even them specifically, people placed in the same reference class) “benefit” according to metrics such as having a house and being out of jail, which are themselves determined largely by the society.
This also isn’t touching the social and informational coercion associated with labeling people as “crazy” and “should be locked up for their own good” (which has psychological effects on them!) based on highly questionable diagnostic criteria. Labeling people who aren’t crazy as crazy is gaslighting.
In general on this topic please see Unrecognized Facts by the Council for Evidence-Based Psychiatry.
(I haven’t even gotten into issues of study methodology, which may be quite serious; the “Research” link on the page you linked simply links to the same page, which is quite suspicious.)
If the website weren’t making the claim that diagnosable/treatable/etc cognitive impairment exists, they wouldn’t be saying people are “mentally ill”, talk about “Anosognosia”, etc.
Do you think psychiatry is totally useless or harmful even for voluntary patients? If not, how would you prefer that psychiatrists talk? If yes (as seemingly suggested by the reference you linked), that seems to be the real crux between you and people like the ones I linked to, so why not argue about that to begin with?
There are lots of groups of people (e.g. religious groups) that claim to be able to help people’s life outcomes, but that doesn’t ethically justify coercing people to join them.
It depends on how much they actually help. I value autonomy and people having justified beliefs but also people not suffering, so if someone was suffering really badly and there is strong evidence that the only way to help them involves coercive religious indoctrination, that may well be a tradeoff I end up thinking should be made.
I hope you can see the problems of legal order of civil society that would arise if people’s rights could be overridden on the basis of empirical claims that people like them (not even them specifically, people placed in the same reference class) “benefit” according to metrics such as having a house and being out of jail, which are themselves determined largely by the society.
This also isn’t touching the social and informational coercion associated with labeling people as “crazy” and “should be locked up for their own good” (which has psychological effects on them!) based on highly questionable diagnostic criteria. Labeling people who aren’t crazy as crazy is gaslighting.
Yes, I grant both of these as real problems.
(I haven’t even gotten into issues of study methodology, which may be quite serious; the “Research” link on the page you linked simply links to the same page, which is quite suspicious.)
Do you think psychiatry is totally useless or harmful even for voluntary patients?
Sometimes yes, sometimes no?
If yes (as seemingly suggested by the reference you linked), that seems to be the real crux between you and people like the ones I linked to, so why not argue about that to begin with?
We’re in a subthread about whether the claims of psychiatry are true. You suggested maybe coercion is good even if the claims are not scientifically valid. I said no, that’s morally repugnant. You linked people making that argument. I see that the argument relies on the premise that the claims of psychiatry aren’t bullshit, so it doesn’t show coercion is good even if the claims are not scientifically valid. So you are not asking for a form of interpretive labor that is reasonable in context.
I don’t have much to say about the research link except (a) this doesn’t look like an unbiased metaanalysis and (b) authoritarian control systems will often produce outcomes for subjects that look better on-paper through more domination but this is a pretty bad ethical argument in the context of justifying the system. Like, maybe slaves who run away experience worse health outcomes than slaves who remain slaves, because they have to hide from authorities, could get killed if they’re caught later, are more likely to starve, etc. (And they’re less likely to be employed!)
(Disengaging because it seems like we’re talking past each other, I don’t see a low-effort way to get things back on track, and this doesn’t seem like an important enough topic (at least from my perspective) to put a lot more effort into.)
I’ve seen people make the opposite complaint, that we don’t commit enough people to mental hospitals nowadays and as a result the mentally ill make up a large fraction of the homeless. (45% of homeless are mentally ill, according to this source.)
Also psychiatry just doesn’t seem to fit in with the rest of your examples. At least from a layman’s perspective it seems like there is a lot of recognition that pretty much everything is a spectrum and mental illnesses are just extreme ends of the spectra, that many diagnoses are hard to distinguish from each other, that lots of drugs don’t work for lots of individuals, etc.
An alternate response to this point is that if someone comes off their medication, then says they’re going to kill their mother because she is poisoning their food, and the food poisoning claim seems definitely not true, then spending a few days assessing what is going on and treating them until it looks like they are not going to kill their mother anymore seems justifiable for reasons other than “we know exactly what biological circuit is involved with 100% confidence”
(source: this basically describes one of the two people I ever committed involuntarily)
I agree that there are a lot of difficult legal issues to be sorted out about who has the burden of proof and how many hoops people should have to jump through to make this happen, but none of them look at all like “you do not know the exact biological circuit involved with 100% confidence using a theory that has had literally zero exceptions ever”
There are two very, very different arguments one can make for psychiatric coercion:
There are identifiable, specifiable, diagnosable, and treatable types of cognitive impairment. People who have them would, therefore, benefit from others overriding their (impaired) agency to treat their condition.
There aren’t identifiable/specifiable/etc cognitive impairments, or at least psychiatry can’t find them reliably (see: homosexuality in the DSM, the history of lobotomies, Foucault, Szasz). However, psychiatry diagnoses a significant fraction of homeless people with “disorders”, and psychiatrically imprisoning homeless people without trial is good, so psychiatric coercion is good.
The second argument is morally repugnant to many who hold the first view and is also morally repugnant in my own view. If the DSM isn’t actually a much more scientifically valid personality typing procedure than, say, the Enneagram, then locking people up based on it without trial is an ethically horrible form of social control, as locking people up based on the Enneagram would be.
Very few people who accept the first argument would accept the second, indicating that the moral legitimacy of psychiatry is tied to its precise-looking claims about types of cognitive impairment.
I don’t feel qualified to debate what seems to be a very complex issue, but people who advocate for more coercion (mainly AOT) these days seem to do so on the basis of good patient outcomes rather than “high-precision claims”:
If you see an ethical issue with this argument, can you explain what it is?
If the website weren’t making the claim that diagnosable/treatable/etc cognitive impairment exists, they wouldn’t be saying people are “mentally ill”, talk about “Anosognosia”, etc.
Without that language the copy on the page doesn’t really seem justified. There are lots of groups of people (e.g. religious groups) that claim to be able to help people’s life outcomes, but that doesn’t ethically justify coercing people to join them.
I hope you can see the problems of legal order of civil society that would arise if people’s rights could be overridden on the basis of empirical claims that people like them (not even them specifically, people placed in the same reference class) “benefit” according to metrics such as having a house and being out of jail, which are themselves determined largely by the society.
This also isn’t touching the social and informational coercion associated with labeling people as “crazy” and “should be locked up for their own good” (which has psychological effects on them!) based on highly questionable diagnostic criteria. Labeling people who aren’t crazy as crazy is gaslighting.
In general on this topic please see Unrecognized Facts by the Council for Evidence-Based Psychiatry.
(I haven’t even gotten into issues of study methodology, which may be quite serious; the “Research” link on the page you linked simply links to the same page, which is quite suspicious.)
Do you think psychiatry is totally useless or harmful even for voluntary patients? If not, how would you prefer that psychiatrists talk? If yes (as seemingly suggested by the reference you linked), that seems to be the real crux between you and people like the ones I linked to, so why not argue about that to begin with?
It depends on how much they actually help. I value autonomy and people having justified beliefs but also people not suffering, so if someone was suffering really badly and there is strong evidence that the only way to help them involves coercive religious indoctrination, that may well be a tradeoff I end up thinking should be made.
Yes, I grant both of these as real problems.
Looks like a bad link. The actual research page is this one: https://mentalillnesspolicy.org/wp-content/uploads/aotworks.pdf
Sometimes yes, sometimes no?
We’re in a subthread about whether the claims of psychiatry are true. You suggested maybe coercion is good even if the claims are not scientifically valid. I said no, that’s morally repugnant. You linked people making that argument. I see that the argument relies on the premise that the claims of psychiatry aren’t bullshit, so it doesn’t show coercion is good even if the claims are not scientifically valid. So you are not asking for a form of interpretive labor that is reasonable in context.
I don’t have much to say about the research link except (a) this doesn’t look like an unbiased metaanalysis and (b) authoritarian control systems will often produce outcomes for subjects that look better on-paper through more domination but this is a pretty bad ethical argument in the context of justifying the system. Like, maybe slaves who run away experience worse health outcomes than slaves who remain slaves, because they have to hide from authorities, could get killed if they’re caught later, are more likely to starve, etc. (And they’re less likely to be employed!)
(Disengaging because it seems like we’re talking past each other, I don’t see a low-effort way to get things back on track, and this doesn’t seem like an important enough topic (at least from my perspective) to put a lot more effort into.)
Does mental illness cause homelessness, or vice versa?
Both. Uncontroversially, I think, though there is some room to quibble about the exact ratio of causality direction.