But I say unto you, Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you. – Matthew 5: 34
I’ve been reflecting further on this passage in Scott Alexander’s critique of my perspective on mental illness:
And the others? The alcoholic who says “Yup, I’m drinking myself to death and you can’t stop me?” I agree that it is in some sense rational. It is rational because that person has so many problems that drinking alcohol becomes more pleasant than dealing with them. Often, these problems are related to psychiatric issues – for example, many people with PTSD become alcoholics because alcohol helps them briefly forget their traumatic memories. There are many people who say they don’t want help with their drinking problem because they expect “help” to mean “take away the alcohol but give them nothing in exchange”. If “help” meant “replace the alcohol with some healthier coping mechanism that works just as well”, many of these people would take it in a heartbeat.
“Many of these people would.” I agree.
But note: a writer as careful as Scott doesn’t say “many” when he means “most” or “all.” Which should make you wonder: Why wouldn’t every alcoholic take Scott’s deal?
On reflection, the list of contrary motives is long.
Many alcoholics would refuse out of sheer stubbornness.
Others would spurn the offer out of pride.
Still others would keep drinking because the bottle doesn’t just help them “cope”; it gives them affirmative pleasure.
Some people would refuse because they actually enjoy upsetting the people close to them. As in “I wouldn’t give you the satisfaction.”
If you’ve ever tried persuading any person to start making choices that seem obviously superior for them, you’ll recognize these motives. You can call such motives “diseased” if you want. The word you’re really looking for, though, is: bad. As in: morally bad.
I understand why working psychiatrists like Scott avoid such talk. Telling people, “You’re morally bad!” rarely opens a fruitful conversation. Yet many unproductive statements are, in fact, true.
You could reply, “Stubborn alcoholics aren’t morally bad. You’re morally bad for judging them.” Needless to say, you’d be in good company. After all, Jesus preached radical forgiveness in his Sermon on the Mount.
What’s deceptive about psychiatry, though, is it masks this extreme moral position in the language of medicine. If psychiatrists merely preached, “Forgive heavy drinkers no matter what they do, and no matter how many times they do it,” who would listen? Yet when they solemnly remind us, “Alcoholism is a disease like any other,” the world listens.
Questions for Scott: To what extent do you personally embrace the ethic of radical forgiveness? If you do, to what extent is psychiatric language a rhetorical tactic rather than a neutral description of human behavior?
READER COMMENTS
Chris S
Jan 7 2020 at 11:54am
This question uses a contrived idea of forgiveness. Two thoughts:
Forgiveness generally is an interpersonal process and is rendered by the party that was wronged/harmed by the forgiven behaviour. It is unclear to what extent continued consumption is to be considered an immoral act towards Bryan or a psychiatrist. Thus it is also unclear an “ethic of radical forgiveness” would be necessary for the solution-oriented language of therapists to be consistent.
The system of morals used by Bryan to consider certain motives for lack of behavioral change”morally bad” seems arbitrary at best and inconsistent at worst. For example, “wanting affirmative pleasure beyond coping” is not in and of itself an immoral motive. Even the ones that evoke negative connotations, like stubbornness, are not unquestionably immoral. So the question on forgiveness seems to beg the question of morality of these motives [even leaving aside the issue of culpability, which is a different beast altogether]
Phil H
Jan 7 2020 at 1:32pm
Here I think Bryan is ignoring the obvious conclusion of his own argument.
Yes, it’s really hard to persuade people to change their (bad) behaviour. Yes, it becomes more difficult to do so when you begin the attempt by telling them that they’re morally bad.
But there is one tactic that quite often works: not telling them that they’re bad, but telling them that they’re *ill* and curable.
Even if you’re right about mental illness (and I don’t think you are, for reasons I’ll put in a separate comment), did you not notice that the way the mental health profession acts is a surprisingly good solution to precisely the problems you describe?
Hazel Meade
Jan 8 2020 at 12:08pm
Yes, good point – saying that addiction isn’t a disease isn’t about us, it’s about them. It’s not meant to assuage people’s feelings of anger at the addict, or force them to forgive the addict, it’s meant to make it easier for the addict to get help.
One could just as easily say that Bryan’s interest in labeling the addiction as a preference is really about Bryan, not about the addict. It make Bryan feel better to tell addicts they are bad for not quitting. It’s not about helping the addict at all – it’s about making Bryan feel good.
Calling addition an illness makes the addict more likely to be motivated to get treatment and also makes it more likely for treatment to be made accessible and easy for the addict to get. Forgiveness has nothing to do with it.
RPLong
Jan 9 2020 at 9:40am
You have to wonder about the kind of person who would rather be diseased than morally wrong. No, really, think about it: What kind of person would prefer to be diseased than morally bad?
Here’s one answer: the kind of person who already knows that their drinking problem is a moral issue, but doesn’t want to admit it. This is a pretty common pathology of addiction, which is why every addict in the world, when confronted about their addiction, quickly recedes into either (1) “You have no right to judge me!” or (2) “You don’t understand what it’s like to be me!” It’s pathological. Every addict I’ve ever met does this, and I’ve met a lot.
Some people believe that treating alcoholism like a disease enables the patient to stop drinking alcohol, and thus improve their lives, and so it’s a lie worth telling if consequentialist outcomes are the bottom line. As long as the result is “less alcoholism” then the treatment is right and good. This is the disease model, where the alcoholics just shut out everything except the mantra, I have a disease, alcohol doesn’t work with me, I must avoid… Basically replaces an obsession for drinking with an obsession for not drinking. The underlying personal problem persists, only now it’s not called “alcoholism,” it’s just called, “that guy is a recovering alcoholic and can’t stop talking about Jesus… but he’s nice enough.”
Then you’ve got the Dr. Laura model, the Jordan Peterson model. This is the less popular model, but I’m not convinced it’s less effective. This model involves stating in plain language that bad behavior is bad. Drinking your sorrows away is bad because everyone around you suffers and you die an early death, and this is all horribly immoral. So, if you don’t want to be immoral, isn’t it time that you stopped doing that?
Some people take great offense to the Dr. Laura model. They don’t want to be judged. They don’t want to be called wrong or bad. But psychology has a deep understanding of this: it’s called a defense mechanism. If we can somehow get off the hook, morally speaking, then we can still be the same person, the same melancholy drunk only without the booze. The mind resists change. The only way to change your mind is to admit in plain language that you screwed up big time and work to make things right. “Doing the hard mental work of change.”
When you come out the other end of the Dr. Laura model, you feel embarrassed of what you did, and it probably sticks with you for the rest of your life. But your life, meanwhile, often improves, where “improvement” means more than just “I stopped drinking, so there’s that.” “Improvement” means you recognize all the people you were hurting, you take responsibility for the hurt you caused them, and you stop hurting them. You might even still be able to enjoy the occasional drink, because the reason you were an alcoholic is gone.
I admit, it’s scary, unpleasant, annoying, and humiliating to have some smug suit like Jordan Peterson or Laura Schlessinger tell you that you’re a jerk who screwed up. But there’s no way to really change and grow as a person unless you let down your defenses — and your defense mechanisms — and analyze the criticisms objectively.
The only question I have is why does Bryan Caplan believe that what he’s saying is contrary to psychiatry? Just because some psychiatrists believe in the disease model doesn’t mean they all do. It’s like being against economics just because you don’t agree with New Keynesian macro policy.
Phil H
Jan 7 2020 at 1:40pm
Second comment: a quick and easy way, based on criteria that I think Caplan will accept, to distinguish between mental illness and preferences.
Ask the question “would you do it the same way again?” This is similar to the question “will you accept treatment” (which many people do), but removes the disincentive of fear of treatment. Other questions are possible; basically anything that could reliably surface the fact that a person was suffering from a bad split in their preferences (the desire to do the mentally ill behaviour + the desire not to do it/not to be ill). If that split is present, it’s mental illness!
robc
Jan 7 2020 at 1:47pm
Either I don’t understand your point or you just defined laziness as a mental illness (at least based on my life choices).
Phil H
Jan 7 2020 at 3:10pm
Hi, Rob. Yes, I think you’re right, that is where this kind of definition ultimately leads. And wouldn’t you know it, the psychiatric profession is there ahead of us, with pills that can make you concentrate harder for longer (I think Ritalin is the most common one).
robc
Jan 7 2020 at 3:21pm
Nah, my problem isn’t an inability to concentrate. Its not concentrating ON THE RIGHT THING.
Hazel Meade
Jan 8 2020 at 3:45pm
Maybe a lot of what we assume to be “laziness” actually is mental illness. Maybe a lot of people we call lazy are actually suffering from depression and would stop being lazy if they took Zoloft.
Joel Pollen
Jan 7 2020 at 4:30pm
Bryan, I think you have the teachings of Jesus, at least as they are understood by many Christians today, completely wrong here. You say that telling people they are morally bad rarely opens a fruitful conversation. Yet that’s exactly the tactic of Jesus and Christianity in general (cf. Matthew 12:33-37, Romans 3). Obviously, this fails to work a lot of the time. But for some people it inspires significant lifestyle change.
Moreover, the radical forgiveness of Christianity isn’t a denial of moral culpability, as you seem to imply. Christians (or at least the ones I’m familiar with) emphasize both
1) that people are very morally bad and should feel very bad about it, and
2) that they can be completely forgiven if they, among other things, make a good-faith commitment to try to stop being bad.
The quotation that starts your post isn’t taken by Christians as an imperative to absolve one’s enemies of all guilt, but to be kind to them in spite of their obvious moral guilt.
That aside, I agree with your post completely! I’m glad you got around to responding to Scott’s piece.
I’m looking forward to seeing your debate in the spring at the University of Wisconsin!
JFA
Jan 7 2020 at 6:54pm
So Bryan just wants to know who to blame, not whether the actions are best described as deriving from constraints or preferences.
Mark Z
Jan 8 2020 at 1:29am
I don’t think psychiatry takes any such extreme moral position most of the time. Nowadays, in most cases, psychiatry is a service provided to a willing customer. If we’re to phrase mental disorders as preferences, then the alcoholic who seeks treatment has a higher order preference that he lose the lower order preference of alcoholism. The psychiatrist’s job is the functional task of aiding him in that endeavor. That, I think, is what leads him to think of the lower order preference as a disease. But no value judgment is necessary. Think of an extreme case: a convicted pedophile who wants to abandon his criminal sexual preferences. I don’t think there’s any assumption of ‘radical forgiveness’ in a psychiatrist treating said pedophile as a patient and seeking to rid him of his disease/lower order preference. However much or little he thinks the offender deserves to be punished in the meantime is irrelevant to how best to rid them of the harmful preference (or the tendency to act on it). Bryan seems to be suggesting that the psychiatrist is perpetuating some Straussian ‘noble lie,’ but I don’t see it. If it won’t help treatment, psychiatrist has no more an obligation to inform his patient that he’s immoral than a surgeon treating a gunshot wound caused by immoral behavior has to inform his patient he’s immoral while removes the bullet, or insist that he be punished before he remove it. The surgeon who fails to do so isn’t implicitly accepting radical forgiveness. To the extent that psychiatrists do routinely make moral claims, I think they’re more of the type “you’re not responsible for your urges” (which is reasonable) rather than “you’re not responsible for your actions.”
I also don’t think this example works in Bryan’s favor. I don’t know precisely what percent of alcoholics are threats to others, either by drunk driving or violence or whatever, but I suspect most are only mainly harming themselves, and it is by no means ‘radical’ to take the position one should readily forgive people for self-harm (indeed, I’d say it’s rather puritanical to argue that self-harming habits are eo ipso immoral; self-harm is principally seen as bad because it harms the person doing it, not because it’s ‘just wrong’). And while I don’t think that believing someone is immoral for habitually doing something that harms himself makes one morally bad, just as believing that writing with one’s left had is immoral doesn’t make one morally bad, punishing someone for such a habit (or for writing with their left hand, or any other act that isn’t actually immoral) would make one morally bad.
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