4 ms·

When I was a psych major, we dealt with questions like these all the time. I think the author raises excellent points, but presents a rather limited view of th

When I was a psych major, we dealt with questions like these all the time. I think the author raises excellent points, but presents a rather limited view of the social pressure that people can exert. "We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition, and we should allow patients to seek treatment whenever it is available and effective." There are many conditions that are susceptible to influence by social pressure, but very rarely are blame and stigma the best means of exerting that influence. In most cases, I'd say they are downright harmful. Take alcoholism. The most effective treatment today for alcoholism is AA. (there are many thing about aa that kind of creep me out, but it is a fact that it has the highest success rate of any course of treatment that has been studied). AA works almost entirely through social influence. But a key component of its social influence is talking about alcoholism as a disease, as something separate from an individual which can be done away with. Talking about alcoholism as a moral failing simply does not help. If you are morally bankrupt, what are the odds of your morally bankrupt self digging your way out of that hole? If you have a disease, though, maybe you can find a cure. Similarly, as a child, people yelling at me that I was a lazy bum just didn't help. My primary reaction was resentment, not shame. Though I had shame, too. Its just not so easy to motivate oneself when feeling like a shameful failure. When I started thing of laziness as a behavior that I happened to have, rather than something that was intrinsic to myself, (i.e., I am being lazy right now, what can I do about it, as opposed to I am lazy), I started being able to have more control over it. Not perfect control, of course, but much more than I had.

dantheman 16y ago
I thought Timothy Leary's work with LSD was the most effective way to treat alcoholism.
jheriko 16y ago
"Similarly, as a child, people yelling at me that I was a lazy bum just didn't help. My primary reaction was resentment, not shame. Though I had shame, too. Its just not so easy to motivate oneself when feeling like a shameful failure." This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better... I think the risk of not doing anything is worse though. If poor behaviour is tolerated, and not given some kind of negative feedback then it can become accepted. I suspect this is part of the obesity problem - if living as a fat person were really horrible less people would be inclined to do it and, at the risk of sounding cruel, if medical help were refused for obesity related problems then the genetic element would take care of itself... I'm fat - and if I die because my heart clogs up with all the byproducts of that fatness then it is my own /stupid/ fault.
- steveklabnik 16y ago
  > This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better... Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good. In other cases, I take too much to heart. Human emotions are silly, fragile things.
  - stcredzero 16y ago
    Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good. Punishment is the trickiest of all behavioral modification techniques. It is very likely to backfire, which makes perfect sense. If punishment was very effective on a given individual, he/she would be a perfect slave. Being a perfect slave isn't so great from the perspective of the slave, though it is good for the master. Since human biology doesn't make it easy for a large population of slaves to be related to a master, it makes perfect sense that we'd evolve defenses against punishment. (By contrast, ants and honeybees are all children of their queen, so their arrangement makes perfect evolutionary sense.) One psych teacher of mine pointed out the behavior of Wile E. Coyote as plausible -- often punishment of a complex organism can result in the subject trying again and again in different ways, despite punishment, particularly if there is a possible reward to be gained.
  - jamesbritt 16y ago
    ' Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good.' Oh, been there, done that. :) I used to despise the people who would give me grief for smoking. They were wasting their time, and it was none of their fucking business. Later, after I quit smoking, it occurred to me that those admonitions helped. Much as I hated to accept that, the regular jibes kept alive the idea of quitting. I hate being told what to do, especially if it's coupled with the idea that what I'm currently doing is both wrong and stupid, but that's just pride. I didn't quit smoking because people told me to, but having people constantly tell me to quit did help keep the idea percolating in the back of my head, a contribution to my finally coming to terms with what needed to be done and mustering the reserve to just do it. There's the risk that some people will spite themselves just to show the world how independent they are, and the more you tell them what that must do, the less likely they are to do it. But provoking people into reconsidering their actions, even if it annoys them, may help in the long run.
jamesbritt 16y ago
" The most effective treatment today for alcoholism is AA." Do you have any citations for that? There are a number of studies linked at http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Anonymous http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Ano... suggesting conflicting results.
tumult 16y ago
Do you have any statistics to back up the claim that AA works? I've seen several people end up in AA; all of them are still addicts to this day. I've never seen any numbers that can show it does any good.
- ekanes 16y ago
  I have limited knowledge of AA, so please someone correct me if/where I'm wrong, but have a friend who attends, and from what I gather it's more that their official position is that alcoholism is a permanent condition, and that life from then on consists of how you handle it. Recognizing this is central, hence the "Hi, I'm Bob, and I'm an alcoholic." You're never cured and return to drinking socially... (ideally) you don't ever drink. Ever. Whether publicly or not, you refer to yourself as an alcoholic so it's always clear to you what the deal is, and you don't fool yourself. The permanence of it feels harsh to me, but it does seem to work, perhaps because "admitting the problem" is so important.
  - tumult 16y ago
    Well, within your few sentences lies the method through which AA is able to remain a meme (in the original Dawkins sense). The core tenant is that alcoholism is a permanent 'spiritual' disease, that cannot be cured, and can only be treated through perpetual use of the 12-step program for the rest of their lives. None of this, in reality, is based on science or facts. It is something that the original progenitors made up. Because most people in their normal lives will not develop an addiction firsthand, and because most people are honest and basically believe what they are told (expecting other people to tell them the truth), this continues to propagate. One way to tell if something propagates mostly as a meme rather than by functional merit is to cross cultural boundaries and look for it elsewhere. If it were something that had merit, there is a better chance for it to have grown within other cultures independently. AA's own self-published census shows that it is overwhelmingly an American and Canadian phenomenon, with some small sprinkling in the UK. It basically exists nowhere else in the world, except for expatriates from the US. There is also a correlation between alcohol addiction and AA penetration. Places with more problems with alcohol addiction have more AA meetings. At first this seems to make sense -- more alcoholics, more AA members and meetings to help them. But if you go to places where AA does not exist at all, you'll find the same numbers you'd expect from America if there was no correlation with AA. In other words, places without AA have the same numbers you would get in America if you took the AA slider widget and turned it back down to 0. My own conclusion is that AA and alcoholism is mostly a cultural artifact, not a physical (or 'spiritual') disease manifesting itself in people's bodies. I encourage you to dig up numbers (which AA openly provides from their own surveys, and are not flattering to themselves) and draw your own conclusions.

dantheman 16y ago

I thought Timothy Leary's work with LSD was the most effective way to treat alcoholism.

jheriko 16y ago

"Similarly, as a child, people yelling at me that I was a lazy bum just didn't help. My primary reaction was resentment, not shame. Though I had shame, too. Its just not so easy to motivate oneself when feeling like a shameful failure." This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better... I think the risk of not doing anything is worse though. If poor behaviour is tolerated, and not given some kind of negative feedback then it can become accepted. I suspect this is part of the obesity problem - if living as a fat person were really horrible less people would be inclined to do it and, at the risk of sounding cruel, if medical help were refused for obesity related problems then the genetic element would take care of itself... I'm fat - and if I die because my heart clogs up with all the byproducts of that fatness then it is my own /stupid/ fault.

steveklabnik 16y ago
> This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better... Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good. In other cases, I take too much to heart. Human emotions are silly, fragile things.
- stcredzero 16y ago
  Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good. Punishment is the trickiest of all behavioral modification techniques. It is very likely to backfire, which makes perfect sense. If punishment was very effective on a given individual, he/she would be a perfect slave. Being a perfect slave isn't so great from the perspective of the slave, though it is good for the master. Since human biology doesn't make it easy for a large population of slaves to be related to a master, it makes perfect sense that we'd evolve defenses against punishment. (By contrast, ants and honeybees are all children of their queen, so their arrangement makes perfect evolutionary sense.) One psych teacher of mine pointed out the behavior of Wile E. Coyote as plausible -- often punishment of a complex organism can result in the subject trying again and again in different ways, despite punishment, particularly if there is a possible reward to be gained.
- jamesbritt 16y ago
  ' Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good.' Oh, been there, done that. :) I used to despise the people who would give me grief for smoking. They were wasting their time, and it was none of their fucking business. Later, after I quit smoking, it occurred to me that those admonitions helped. Much as I hated to accept that, the regular jibes kept alive the idea of quitting. I hate being told what to do, especially if it's coupled with the idea that what I'm currently doing is both wrong and stupid, but that's just pride. I didn't quit smoking because people told me to, but having people constantly tell me to quit did help keep the idea percolating in the back of my head, a contribution to my finally coming to terms with what needed to be done and mustering the reserve to just do it. There's the risk that some people will spite themselves just to show the world how independent they are, and the more you tell them what that must do, the less likely they are to do it. But provoking people into reconsidering their actions, even if it annoys them, may help in the long run.

jamesbritt 16y ago

" The most effective treatment today for alcoholism is AA." Do you have any citations for that? There are a number of studies linked at http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Anonymous http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Ano... suggesting conflicting results.

tumult 16y ago

Do you have any statistics to back up the claim that AA works? I've seen several people end up in AA; all of them are still addicts to this day. I've never seen any numbers that can show it does any good.

ekanes 16y ago
I have limited knowledge of AA, so please someone correct me if/where I'm wrong, but have a friend who attends, and from what I gather it's more that their official position is that alcoholism is a permanent condition, and that life from then on consists of how you handle it. Recognizing this is central, hence the "Hi, I'm Bob, and I'm an alcoholic." You're never cured and return to drinking socially... (ideally) you don't ever drink. Ever. Whether publicly or not, you refer to yourself as an alcoholic so it's always clear to you what the deal is, and you don't fool yourself. The permanence of it feels harsh to me, but it does seem to work, perhaps because "admitting the problem" is so important.
- tumult 16y ago
  Well, within your few sentences lies the method through which AA is able to remain a meme (in the original Dawkins sense). The core tenant is that alcoholism is a permanent 'spiritual' disease, that cannot be cured, and can only be treated through perpetual use of the 12-step program for the rest of their lives. None of this, in reality, is based on science or facts. It is something that the original progenitors made up. Because most people in their normal lives will not develop an addiction firsthand, and because most people are honest and basically believe what they are told (expecting other people to tell them the truth), this continues to propagate. One way to tell if something propagates mostly as a meme rather than by functional merit is to cross cultural boundaries and look for it elsewhere. If it were something that had merit, there is a better chance for it to have grown within other cultures independently. AA's own self-published census shows that it is overwhelmingly an American and Canadian phenomenon, with some small sprinkling in the UK. It basically exists nowhere else in the world, except for expatriates from the US. There is also a correlation between alcohol addiction and AA penetration. Places with more problems with alcohol addiction have more AA meetings. At first this seems to make sense -- more alcoholics, more AA members and meetings to help them. But if you go to places where AA does not exist at all, you'll find the same numbers you'd expect from America if there was no correlation with AA. In other words, places without AA have the same numbers you would get in America if you took the AA slider widget and turned it back down to 0. My own conclusion is that AA and alcoholism is mostly a cultural artifact, not a physical (or 'spiritual') disease manifesting itself in people's bodies. I encourage you to dig up numbers (which AA openly provides from their own surveys, and are not flattering to themselves) and draw your own conclusions.