Comment author: KrisMartens 14 May 2017 02:41:39PM 0 points [-]

Great post. I'll try to make a useful contribution. Maybe this can be of help as well: the APA list of evidence based treatments: - for bipolar disorder - for psychosis & other related disorders

Maybe one sentence that can use some more context:

They also listed their most important needs during periods of crisis: Getting rid of voices and paranoia

There is nothing that you can do to help someone getting rid of their voices. On the contrary, encouraging them not to hear voices might make it worse. This is why Acceptance and Commitment Therapy is on the list of evidence based approaches. And why Validation of their experience; someone to listen who could be trusted is on that list of needs as well.

As with most psychopathology, trying not to experience stuff that often results in more of those experiences. Off course, do get help, and medication might help to get rid of voices. But changing how you cope with such experiences is also of use.

Eric Morris is one of the researchers on this topic & this is a Twitter feed aimed at contextual behavioral science and psychosis

Comment author: Julia_Wise 17 May 2017 07:51:41PM *  0 points [-]

Thank you!

I agree that trying to force hallucinations and paranoia away or talk someone out of them almost never works. I was citing verbatim the list of what people from the NAMI survey listed as their needs.

Just a note that the APA here is the American Psychological rather than Psychiatric Association (both go by APA, confusingly) and lists only talk therapy and social support methods, not including medication. For psychosis in particular, I think virtually anyone in the field would say medication is the first line of treatment. The kinds of treatment listed there are good for ongoing management, but if I ever became psychotic I would absolutely want a psychiatrist or emergency room to be my first stop. Talk therapy would be good to add in later.

Comment author: TruePath 11 May 2017 07:59:50AM -2 points [-]

Before I should admit my bias here. I have a pet peeve about posts about mental illness like this. When I suffered from depression and my friend killed himself over it there was nothing that pissed me off more than people passing on the same useless facts and advice to get help (as if that magically made it betteR) with the self-congratulatory attitude that they had done something about the problem and could move on. So what follows may be a result of unjust irritation/anger but I do really believe that it causes harm when we past on truisms like that and think of ourselves as helping...either by making those suffering feel like failures/hopeless/misunderstood (just get help and it's all good) or causing us to believe we've done our part. Maybe this is just irrational bias I don't know.


While I like the motivation I worry that this article does more to make us feel better that 'something is being done' than it does anything for EA community members with these problems. Indeed, I worry that sharing what amounts to fairly obvious truisms that any google search would reveal actually saps our limited moral energy/consideration for those with mental illness (ohh good we've done our part).

Now I'm sure the poster would defend this piece by saying well maybe most EA people with these afflictions won't get any new information from this but some might not and it's good to inform them. Yes, if informing them were cost free it would. However, there is still a cost in terms of attention, time, pushing readers away from other issues. Indeed, unless you honestly believe that information about every mental illness ought to be posted on every blog around the world it seems we ought to analyze how likely this content on this site is to be useful. I doubt EA members suffer these diseases at a much greater rate than the population in general while I suspect they are informed about these issues at a much greater rate making this perhaps the least effect place to advertise this information.

I don't mean to downplay these diseases. They are serious problems and to the extent there is something we can do with a high benefit/cost ratio we should. So maybe a post identifying media that is particularly likely to serve afflicted individuals who would benefit from this and urging readers to submit this information would be helpful.

Comment author: Julia_Wise 17 May 2017 07:39:08PM *  0 points [-]

I did question whether this was on-topic enough to be a good fit for this forum. (I don't think awareness about every health issue that affects EAs would be a good use of the space, even if it affects a higher proportion than these problems.)

I do think these problems can be unusually and spectacularly destructive when unchecked, and often even when much effort has been made. I also think most people don't have a good concept of how to recognize these conditions or even what to google; I certainly wouldn't have before getting training as a social worker.

I definitely don't want us to congratulate ourselves for having dealt with these problems, because there have been cases when people in this community have needed help here and not gotten enough. I wrote this in the hope that it will tip the balance in some future crisis toward people having the knowledge they need, not so that we can check this off our list as a solved problem. These are really hard problems to deal with, both for people who have them and for people trying to help, and that's exactly why I wanted a resource available.

I'm so sorry about your friend. This kind of information definitely isn't fail-safe, but I think it's the best we have.

Comment author: Julia_Wise 15 May 2017 02:31:36PM 3 points [-]

Thanks for researching and writing this up! We've been discussing the topic a lot at CEA/Giving What We Can over the last few days. I think this points to the importance of flagging publication dates (as GiveWell does, indicating that the research on a certain page was current as of a given date but isn't necessarily accurate anymore). Fact-checking, updating, or just information flagging as older and possibly inaccurate was on our to-do list for materials on the Giving What We Can site, which go back as much as 10 years and sometimes no longer represent our best understanding. I now think it needs to be higher priority than I did.

For individuals rather than organizations, I'm unsure about the best way to handle things like this, which will surely come up again. If someone publishes a paper or blog post, how often are they obliged to update it with corrected figures? I'm thinking of a popular post which used PSI's figure of around $800 to save a child's life. In 2010 when it was written that seemed like a reasonable estimate, but it doesn't now. Is the author responsible for updating the figure everywhere the post was published and re-published? (That's a strong disincentive for ever writing anything that includes a cost-effectiveness estimate, since they're always changing.) Does everyone who quoted it or referred to it need to go back each year and include a new estimate? My guess is it's good practice, particularly when we notice people creating new material that cites old figures, to give them a friendly note with a link to newer sources, with the understanding that this stuff is genuinely confusing and hard to stay on top of.

Comment author: BenHoffman 13 May 2017 02:22:40AM 1 point [-]

On the ableism point, my best guess is that the right response is to figure out the substance of the criticism. If we disagree, we should admit that openly, and forgo the support of people who do not in fact agree with us. If we agree, then we should account for the criticism and adjust both our beliefs and statements. Directly optimizing on avoiding adverse perceptions seems like it would lead to a distorted picture of what we are about.

Comment author: Julia_Wise 15 May 2017 12:17:09AM *  3 points [-]
Comment author: BenHoffman 08 May 2017 04:13:54PM *  1 point [-]

Thanks for writing this! It's really helpful to have the basics of what the medical community knows.

I've been trying to figure out how to help in ways that respect neurodiversity. Psychosis and mania, like other mental conditions, aren't just the result of some exogenous force - they're the brain doing too little or too much of some particular things it was already doing.

So someone going through a psychotic episode might at times have delusions that seem to their friends to be genuinely poetic, insightful, and important, and this impression might be right. And yet, they're still having trouble tracking what's real and what's just a thought they had, worse at caring for themselves, and really need to eat and get a good night's sleep and friends to help them remember to do this.

Comment author: Julia_Wise 09 May 2017 07:32:00PM 1 point [-]

Yes, I think that's where some kind of an advance plan can be useful: "When I start acting like X, I want you to take step Y" or "When you act like X, I'm going to stop engaging with the conversation and start focusing on helping you get some rest, and we can write down where we were in the conversation and resume 48 hours later if you want."

Comment author: RyanCarey 06 May 2017 06:42:01AM *  3 points [-]

More than half of the time, people who have a psychotic episode will have already had one before. I think the same is true of mania. The incidence for a first episode of psychosis is fairly low, about 0.03% per year [1].

[1] "Over the 8-year period May 1995–April 2003, there were 194 cases of any DSM-IV psychotic illness (117 male, 77 female; Table 2). The annual incidence of “all psychoses” was 31.6/100,000 aged >15, this being higher in males (37.2) than in females (25.7; risk ratio [RR] = 1.44 [95% CI 1.08, 1.93], p < .02; Table 3)."

Comment author: Julia_Wise 08 May 2017 02:57:38PM 2 points [-]

Yeah, incidence for someone who's never had any episodes before is unlikely. So you can assume that your own risk is very low if you know you've never experienced these things before and don't have a family history.

But if a friend seems off and you're not certain of their personal or family history, I do think it's worth considering that they might have experienced mania or psychosis before without you knowing about it.

Comment author: Paul_Christiano 01 May 2017 02:08:32PM 7 points [-]

Scott links to this study, which is more convincing. They measure the difference between "physical mild (slap, spank)" and "physical harsh (use weapon, punch, kick)" punishment, with ~10% of children in the latter category. They consider children of twins to control for genetic confounders, and find something like a 0.2 SD effect on measures of behavioral problems at age 25. There is still confounding (e.g. households where parents beat their kids may be worse in other ways), and the effects are smaller and for rarer forms of punishment, but it is getting somewhere.

Comment author: Julia_Wise 04 May 2017 03:26:30PM 1 point [-]

It's my strong impression that parents are more likely to use harsh punishment when they themselves are more stressed and overwhelmed. I expect this to be a big confounder.

Comment author: Julia_Wise 25 April 2017 07:28:35PM 5 points [-]

How should a couple that donate jointly answer the donation questions? Should one of us answer with the combined income and combined donations?

Comment author: casebash 16 April 2017 04:57:33PM 0 points [-]

We should definitely consider creating some awards for the EA community. Not only do they look good on your CV, but they also encourage people. However, they need to be limited in order to a) maintain value, b) maintain integrity/cred.

Comment author: Julia_Wise 19 April 2017 02:49:06PM 0 points [-]

Speaking at an EA Global event is one such thing. EA Global: San Francisco is designed to have lots of workshops and small presentations by people from the EA community, so please let us know if there's something you'd like to present there.

Comment author: Maxdalton 13 April 2017 04:15:40PM *  21 points [-]

[My views, not my employer's]

I appreciate the spirit in which this was written, and I think we should all be looking out for more ways to help each other, especially in ways that directly improve skills - e.g. through the advice and mentorship you generously offer.

However, some of this feels a little deceptive to me. If people see 'speaking at a top law school' as impressive, that's probably because they think that I was invited because I'm a great speaker/have expertise that lots of people in the law school value. If in fact I was invited just because I was involved in effective altruism, and I only gave a 10 minute talk, I might be giving someone a misleading impression of my talents. Similarly, people might think that receiving the award you describe would require a higher bar of achievement than the one you suggest.

I'm probably overreacting here - this is the sort of thing that people do on CVs all of the time, and so perhaps people automatically downgrade such claims on CVs. However, I think that it's valuable for our internal culture, and for the community's reputation, to hold ourselves to high standards, and I think this article would have been better if it had noted these issues. I'm not sure whether the benefits outweigh the costs.

Comment author: Julia_Wise 13 April 2017 05:30:01PM 6 points [-]

Agreed. And if I'm organizing speakers for an EA event I'd like to know whether a person's past speaking arrangements reflect any kind of merit.

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