Discussion about this post

User's avatar
Martin Greenwald, M.D.'s avatar

Seriously Caplan needs to go spend some time touring a psychiatric unit and meet these people. I think he just hasn't talked to enough people with severe mental illness, and most of this is his armchair theorizing.

The crucial element often missed is that any concept of "mental illness", just like any other concept of health or illness, requires a prior notion of the proper functioning of the organism. This means getting into teleology, which a lot of people are reluctant to do, even though I'd argue it isn't as problematic as we tend to believe these days.

The preferences and incentives talk can be very important in some cases, but it seems like everything gets reduced to "if you put a gun to someone's head..." But that just isn't how life and incentives actually work. Put a gun to someone's head and tell them to walk, and even if they have a broken leg, they'll still try to limp along.

The point in mental illness is often less a function of whether someone is simply making "bad decisions", but whether their neurocognitive machinery that is used for perceiving reality, regulating their impulses, managing memory, moods, etc etc is functioning in the way it is supposed to, or if it is systematically thrown off by, say, an infection, autoimmune disorder, metabolic disturbance, or what we call schizophrenia (which is almost certainly what we'd call a developmental synaptopathy and not some Szaszian thing where someone just has different preferences from the crazy society he finds himself in).

Expand full comment
Fika monster's avatar

I like this article but dont think BC would be convinced by it

Expand full comment
11 more comments...

No posts