Diseases, Disorders and Illnesses, Oh My

This will serve as an addendum of sorts to my article, The Harmless Psychopaths.

Medicine as a science is a modern phenomenon. It was not all that long ago that going to a doctor was more likely to hurt than help, a fact which persisted, some think, until as late as the 1930s. Medical researchers tend to just keep plugging away at their specialist interest and are unconcerned with what to them seem like instrumentally useless philosophical minutiae. Moral philosophers might argue about meta-ethics: the essence of moral statements, but this does not seem a necessary prerequisite to a relatively harmonious social order. One might just as well ask what is the use of “meta-medicine,” to wonder at the underlying assumptions of medical diagnoses, when scientists are quite happy getting on with finding cures for cancer, and whatever else.

Unfortunately, medicine is as subject to such human frailties as status-seeking and fashion as anything else. It became unfashionable in the 20th century to look for pathogenic causation to diseases thanks to the then nascent science of genetics, which is why it was not accepted as common knowledge that bacteria cause peptic ulcers until the 1980s despite this having been suspected, on good evidence, for well over a hundred years. Note that most cancers are only dimly heritable, in contrast with, say, autism, and have no clear Mendelian inheritance pattern. (Fill in the blank.)

Medicine is an applied science and so obviously has a prescriptive dimension to it, i.e. what is worth treating? Call this is the meta-medical question if one likes. The answer to this is not so complicated when dealing with physical disorders which glaringly go against the sufferer’s interests and those of peers, such as the flu, atherosclerosis, whatever. But what about disorders of the mind? Surely a meaningful concept, but surely far more prone to spurious theorising and fashion-biases in answering the meta-medical question, due to the diversity of moral viewpoints about what is “disordered” behaviour. For the purposes of this post, I use the terms disease, disorder, and illness interchangeably – which they more or less are in everyday usage.

This is how the DSM-IV defines mental disorder:

A. a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual

B. is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom

C. must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one

D. a manifestation of a behavioral, psychological, or biological dysfunction in the individual

E. neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual

The inadequacies of this are manifold and torturously obvious. Childbirth seems to fit quite snugly with condition B. Also, it is generally unhelpful to include a word itself or its synonyms in its own definition, such as in D. with “dysfunction.” E. seems to take it as read that the distinction between biological dysfunction and normal deviance is obvious, yet it is apparently not to most psychiatrists. It is for that reason that the traits branded “psychopathy,” for example, are continuously distributed in the population and usually harmless, but there exists an arbitrarily defined cut-off at the right tail of the distribution where it is conveniently labelled “disorder,” and the relevant convenience is just relative to the interests of whosoever finds these traits unappealing or whoever lacks the theory of mind to understand them. See also: ADHD, and teachers.

How to get around this arbitrariness? If ADHD and psychopathy are not useful to us WEIRDos, who or what are they useful to? Well, they are adaptations: they have a fitness benefit, i.e. a reproductive edge, in at least some environments, even if they are unpalatable to individual persons. This evolutionary view is what tempts some to propose a purely Darwinian definition of disease in which disease is conceived as any embodied phenomenon that is counter-adaptive across all environments. This would make homosexuality a disease, but “Asperger’s syndrome,” “ADHD,” and “psychopathy” not. This could certainly be illuminating from a solely descriptive angle where the only interest is to scientifically describe the causes of disease, but it is useless to practitioners of medicine and psychiatry, for whom the relevant question is “What ought to be treated?” If one asks doctors what the problem is with flu, they are unlikely to say anything about how it affects one’s reproductive chances, and, well, it doesn’t. Not much.

Whether one finds this distasteful to mention as a dispassionate intellectual, it is also a fact that the word “diseased” in popular usage carries a certain moral valence, even when applied to activities that one does not think morally important. To say that “Behaviour X is a disease” is not simply to say that it is evolutionarily maladaptive, but that it is wrong. This would seem an unhelpful confusion.

For the application of medicine, I tentatively suggest that what I think is the best formulation of the conventional usage of “disorder” be merged with the Darwinian definition: anything, internally generated (which may be another bone of contention, but that is a separate topic), which leads to non-trivial suffering in the individual and also has no conceivable fitness benefit. As for the descriptive-only theorists and researchers, the Darwinian definition is fine on its own, although perhaps it is worth while to find a word other than “disease.”

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Unrealistic Adaptations

Of all the mental shortcuts embedded in human languages which impede understanding of mindless processes (such as natural selection), few are more obnoxious than “because.” From this comes a tendency to anthropomorphise, and read all outcomes in nature as if they were ordained by something approximating an “intention.” Religion has to be an adaptation, because the religious (currently) outbreed the irreligious.” The second clause in that sentence is (currently) correct, but the “because” makes it sound as though the current religious selection advantage represents some “design feature” with the desired (by what?) end of promoting reproductive fitness (adaptation). And fitness is where the matter rests. Contrast with the following sentence:

“Under current conditions in which the religious outbreed the irreligious, religion is adaptive.” This statement is of course tautologous, since to say that a trait or behaviour is adaptive means merely that under condition X it gives one a reproductive edge. The term “adaptation,” though, is often applied to traits or behaviours which are selectively neutral or even counter-adaptive in particular environments. Genes which contribute to an overzealous appetite may be fitness-neutral to a subsistence farmer but become obesogenic in the modern world of easily available food. The genes’ carrier still exercises this “adaptation,” but it is no longer adaptive, reproductively useful, except in an environment full of fat-fetishists.

Human society has changed so dramatically in the last two centuries that it would be hasty to say the least to assume that everything with a current selective disadvantage is an “illness” (due to pathogens, mutational load, or whatever). Just as equally, one cannot assume that something with a current advantage exists having evolved by resolving an adaptive problem. Religion was ubiquitous across cultures before the 20th century, yet now the religious fraction represent an ever tinier percentage of the population in many countries, and it remains to be seen just how tiny the “genetic hard core of religiosity” will get before the trend is reversed. If the presence of religion were explicable in terms of fitness benefit, why are the genes not already more widespread? This alone should be enough to tell you that genes (and thus, adaptation) per se had little to do with religion’s evolution.

But apparently this is not obvious to some. Many people are inclined to view adaptations as intricate mechanisms, which by dint of their intricacy are delicate and susceptible to dysfunction, rather like the springs and levers of a pocket-watch. All analogies are imperfect, but this is a useless one. Some traits, and indeed behaviours, are more prone to changing by exogenous insults than others. For instance, a particularly naive person might imagine that in a pandemic of severe endometriosis, whereby female beauty and youth cease to be predictive as indicators of fertility, males would be disincentivised from their sexual attraction to these traits because the attraction would no longer perform its original “functions.” Needless to say, this would not happen. Male callogamy (“attention to beauty”) has proven so reliably fitness-enhancing over the eons, since even before the human species, that it is extraordinarily resilient to any incentive change: selection will always favour a deterministic developmental pathway for such consistently valuable traits. General intelligence is yet another example: the current dysgenic trend is a product of the last few generations and on the order of ~1 point per generation despite ramping up of mutational load globally (we’ll see how long it can last), and almost no non-genetic factors seem capable of depressing its expression to any appreciable degree. Lead looked plausible at some point, but then you remember that Victorians liked to use mercury in their make-up, and yet the 19th century was the most intellectually productive in human history.

Viewed under this light, the “religion as adaptation” thesis looks all the more dubious. Evolutionary forces – selection, mutation, drift, etc – are just as capable of acting on general intelligence and other psychological traits as anything else, hence the well-documented evolved changes in the European peoples since around AD1000: declines in violence, and probably gains in intelligence, culminating ultimately in the zenith of the 19th century. Evolution can indeed happen fast, but not that fast. The bulk of these changes took place over a period of, at minimum, 20 generations, not 2-3, and our intelligence has more or less survived the last 2-3 generations intact. Religion has not. It has none of the hallmarks of an adaptation, but all the hallmarks of a complex socially learned behaviour, maintained by powerful norm-enforcers and epistemic authorities, which has lost currency in recent decades for a variety of reasons, the most commonsense explanation being that it no longer appeals to the educated because the answers it gives are inferior to those of other epistemic authorities, i.e. scientists.

The human capacity for cultural transmission through language makes a nonsense of the notion that anything which is not adaptive, even across all environments, should be impossible to sustain. The most obvious example in Christian cultures is the vow of celibacy, and there are numerous others such as taboos against eating highly nutrient-dense foods, which persist among the undernourished tribes of Papua New Guinea. So too with the European wars of religion, which resulted in millions of young men dying childless in their haste to protect a non-existent natural resource, i.e. God’s favour.

Group selection is another temptation when formulating theories about the origin of religion – the idea that even a behaviour which reduces fitness at the individual level can persist if it provides some advantage at the level of the social group. It is a neat idea, but clearly unworkable in practice. Suppose some cohort of one’s country likes spreading the word of God through warfare – call this behaviour X. They can seize new territory in God’s name and provide new land for others in their group who are not quite so zealous, and this may look like a “success” to the people who reap those rewards, but at the end of the day: the behaviour is still going to diminish because everyone who engages in it is at a massively elevated risk of dying before reproduction. Evolution does not care about states or dominions.

It is understandable why post hoc stories about religion as adaptation are popular, even among well-informed people. Intelligence is not a good predictor of having sensible views where political matters are concerned, since politics is about group loyalty more than anything else. This is why the number of US Democrats who thought immigration was an important social issue declined precipitously in the 2010s when it became the issue “of” the right; what mattered was showing solidarity against rival political coalitions (i.e. the right) rather than the truth. Adaptive stories about religion seem to appeal an awful lot to European traditionalist-nationalists who are hoping to use Christianity as the conduit for some kind of renewed ethnocentrism to uplift the European spirit. The Chinese do not seem to need it, oddly enough. Nor even the Czechs, much closer to home. It did not work for Rome, and it sure as fuck won’t for us.

The Age of Orangutans

There is much talk of incentivising fecundity. It did not work for Imperator Augustus, nor will it for us, for a simple reason: kids are a pain in the arse. And land grants for chavs are probably not the best idea; need I explain why? One must differentiate based on intelligence or education level (a proxy for the former) to avoid pouring money into the sewer, and since no earthly government has the balls for that, we can forget it.

Alternatively, technology promises that which the Romans could scarcely have dreamt of. The demographic “problem” is not low fertility. Only in light of mass migration, which need not be, is low average fertility bad, and selection pressure will deal with that regardless. The problem is that the cognitive elite are infertile. Conversely, would the African population explosion be worrisome if the children all had IQs upwards of 180?

Even if you adhere to an ethical system such as libertarianism and so place all emphasis on freedom from coercion, there is a lot to be said for a state-enforced rewriting of human genetics, perhaps even a global one – setting aside the practicalities thereof. If the rewrite is imposed on all, well, there goes the problem of an inherited continuity of stupid. I am sympathetic to a lot of anti-paternalist intuitions where paternalism is liable to exacerbate a problem or make no odds, but it does make odds when one contemplates a future of regression to the mental acuity of orangutans. There will be no liberty then, nor indeed anything worth speaking of (assuming people could still speak). The desire for paternalism often arises from the knowledge that most people have poor reasoning abilities, but that need not always be, thanks to forthcoming technological interventions, too numerous to list. True, this may not be coming soon. What was that about caring for the long-term?

As per, pessimism is sensible. In the zeroth approximation, bet on China. Beyond that, don’t bother. This is where we are at.

Over the Borderline With Bernie

To the dismay of some of supporters and to the misplaced enthusiasm of some disillusioned Trump voters, Bernie made some waves again by reiterating his opposition to open borders. It’s no secret around here that support for “open borders” is only a recent phenomenon on the left (especially in socialist and communist circles.) Bernie has made arguments against mass immigration before(interestingly this article no longer appears on the BernieSanders.com website, though that may or may not mean anything and could just be the result of a design change.)

Anyhow, don’t panic everyone, rest assured! Bernie for all practical purposes, supports open borders. At the most recent event, the questioner let him off too easily. Next question should have been, “Okay there are hundreds of thousands of people trying to get into the United States. People are complaining about them being detained. If 100,000 people from Honduras and Ecuador were to arrive at the US border tomorrow, how many would you turn back?” My guess is he would not send very many back at all, because to do so would require levels of brutality his supporters would not be comfortable with. Bernie would not risk the bad publicity that comes with pictures of poor tender tots crying on tv. “Oh no, look at the poor kiddies! We must take them in!”

He says he’s not for “open borders,” he’s for “comprehensive immigration reform.” “Comprehensive immigration reform” is basically just a euphemism for amnesty and allowing mass immigration from the third world, even if technically the border will not be absolutely, 100% “open.” Bernie knows that open borders is an unpopular term, which is why he resists embracing it, even if we all know he’s not going to be rounding up and deporting illegals by the millions, which is what having a genuinely secure non-open border would actually entail, at least until people got the message and stopped coming in droves.

“I’m against open borders, but I wouldn’t detain people or deport families who came here illegally for a better life,” (not an actual quote) is basically Bernie’s position in practice. It amounts to a distinction without a difference.

I wish these politicians would just be honest and say that no one has the balls to restrict immigration in any meaningful way. The demographics have already changed to a degree where significant immigration restriction is no longer possible electorally. The replacement has for the most part, already happened. “America” is nothing but a post-national land mass at this point. We just need to adapt and find creative ways navigate the dystopia until some opportunity for escape or partition presents itself.

In the meantime, at least we can safely say that Angela Nagle has been vindicated.