A review of 'Great and Desperate Cures' by Elliot Valenstein, which examines the history of lobotomy and psychosurgery, explaining how tens of thousands of patients underwent dangerous brain operations from the 1930s-1950s despite poor evidence of effectiveness. Longer summary

The post reviews 'Great and Desperate Cures' (1986) by psychologist Elliot Valenstein, exploring how lobotomy became widespread despite its horrific consequences. The review details the procedure itself (inserting an ice-pick-like instrument through the eye socket into the brain), then examines six factors Valenstein identifies for its acceptance: desperate patients and families, physician ambition (especially Egas Moniz and Walter Freeman), uncritical acceptance by researchers and media, territorial disputes between medical specialties, and cold economics. The post includes extensive details about key figures, particularly Freeman's aggressive promotion of transorbital lobotomy and his traveling surgery roadshows. It discusses patient outcomes, the lack of theoretical justification, media hype, and the procedure's eventual replacement by psychoactive drugs. The review concludes by reflecting on modern parallels and the tragic story of Howard Dully, lobotomized at age twelve, arguing that while Freeman likely had good intentions, the safeguards that might have prevented such harm were inadequate then and remain concerning today. Shorter summary

Scott Alexander rebuts Bryan Caplan's arguments about mental illness, criticizing the preference/constraint dichotomy and providing counterarguments to Caplan's claims. Longer summary

Scott Alexander responds to Bryan Caplan's latest arguments about mental illness, criticizing Caplan's preference/constraint dichotomy and his claim that mental illnesses are just voluntary preferences. Scott argues that the distinction between preferences and constraints is not clear-cut, and that both physical and mental illnesses involve a mix of the two. He provides several counterarguments, including examples from physical illnesses, gradients of ability, and cases where the 'gun to the head' test fails. Scott also discusses how the framing of conditions as preferences or constraints depends on factors like ease of satisfaction and social norms. He concludes by rejecting Caplan's argument that one must either deny mental illness exists or classify homosexuality as a mental illness. Shorter summary

Scott reviews a book on culture-bound syndromes, expanding the discussion to how all mental illnesses are influenced by culture to varying degrees. Longer summary

Scott Alexander reviews 'The Geography of Madness' by Frank Bures, which explores culture-bound syndromes like koro (belief in penis theft by witches). The book traces the history and spread of these syndromes across cultures. Scott expands on the idea, discussing how all mental illnesses exist on a spectrum of biological vs. cultural influence. He argues that even conditions considered 'real' in Western psychiatry, like anorexia or PTSD, have significant cultural components. The review touches on complex issues around gender dysphoria and cultural beliefs, concluding that there is no truly 'neutral' culture free from influence on mental health presentations. Shorter summary

Scott Alexander shares reader comments on his 'San Fransicko' book review, covering homelessness, crime statistics, and urban policy debates. Longer summary

This post is a collection of highlights from reader comments on Scott Alexander's review of the book 'San Fransicko'. It covers various topics related to homelessness, crime, and urban policy in San Francisco and other cities. The comments provide additional context, personal anecdotes, data analysis, and critiques of both the book and Scott's review. Key themes include the complexity of homelessness, issues with crime statistics, debates over housing policy, and differing perspectives on how to address urban problems. Shorter summary

Scott Alexander examines a genetic study distinguishing cognitive and non-cognitive skills in educational attainment, revealing unexpected correlations with mental health conditions. Longer summary

This post discusses a genetic study on educational attainment, focusing on the distinction between cognitive and non-cognitive skills that contribute to it. The study, by Demange et al, uses a method called 'GWAS-by-subtraction' to isolate genes associated with non-cognitive skills from those linked to intelligence. Scott Alexander analyzes the results, which show correlations between these genetic factors and various traits, personality factors, and mental health conditions. He highlights surprising findings, particularly the positive correlation between schizophrenia genes and non-cognitive skills beneficial for educational attainment, contrary to previous beliefs about schizophrenia genes being purely detrimental. Shorter summary

Scott Alexander examines the relationship between handedness, authoritarianism, and cognitive flexibility, finding unexpected results that contradict a recent study. Longer summary

Scott Alexander discusses a study suggesting that consistently-handed individuals are more authoritarian and prejudiced than ambidextrous people. He attempts to replicate these findings using data from a previous SSC survey, but finds opposite results. Scott explores possible explanations for this discrepancy, including coding errors, the Lizardman Effect, and differences in study populations. He then speculates on the relationship between need for cognitive closure, ambidexterity, and various aspects of cognition and identity, including mental illness and intelligence. Shorter summary

Scott Alexander critiques Bryan Caplan's constraints vs preferences model of mental illness, proposing instead a goals vs urges framework that better explains both mental and physical health issues. Longer summary

Scott Alexander responds to Bryan Caplan's critique of psychiatry, focusing on Caplan's distinction between constraints and preferences in mental illness. Scott argues that this model is flawed and doesn't accurately represent mental or even many physical illnesses. He proposes a more nuanced model based on goals (endorsed preferences) and urges (unendorsed preferences), using examples to show how this better explains behavior in both mental and physical health contexts. Scott concludes that this model allows for a more libertarian approach, supporting individuals in achieving their goals, whether through addressing constraints or managing urges. Shorter summary

Scott Alexander reviews Foucault's 'Madness and Civilization', examining its controversial historical analysis of societal attitudes towards mental illness. Longer summary

Scott Alexander reviews Michel Foucault's 'Madness and Civilization', exploring its historical analysis of societal attitudes towards mental illness from the Renaissance to the 19th century. The review highlights Foucault's controversial interpretations, including the mythical 'Ship of Fools', the confinement of the mad with criminals and the poor, and the author's critical view of mental health reforms. Scott notes the book's fascinating historical insights and beautiful writing, while expressing skepticism about some of Foucault's claims and his postmodern approach to analyzing history. Shorter summary

Scott Alexander critiques Bryan Caplan's argument that psychiatric diseases are unusual preferences rather than real illnesses, providing counterarguments and evidence to show this view is untenable. Longer summary

Scott Alexander critiques Bryan Caplan's 2006 paper arguing that psychiatric diseases are better understood as unusual preferences rather than true illnesses. Scott challenges Caplan's distinction between preferences and budgetary constraints, arguing it breaks down for complex human experiences. He provides counterexamples showing how mental illnesses can resemble physical constraints, discusses how most psychiatric patients seek help voluntarily, and examines issues with Caplan's explanations of alcoholism and schizophrenia. Scott concludes that viewing psychiatric illnesses as simply different preferences is not tenable given the evidence. Shorter summary

Scott Alexander shares insights and critiques from a psychiatry conference, covering topics from medication prescribing rights to new monitoring technologies and research methodologies. Longer summary

Scott Alexander humorously recounts his experience at a psychiatry conference, highlighting various issues in the field. He discusses the debate over psychologists prescribing medication, new technologies for monitoring schizophrenic patients, problems with certain study designs, the effectiveness of long-acting injectable antipsychotics, and the superiority of clozapine. He also touches on political lobbying in psychiatry and the influence of drug companies. The post is written with a mix of seriousness and sardonic humor, critiquing various aspects of psychiatric practice and research. Shorter summary

Scott Alexander examines the concept of innate ability and argues for its acceptance, while cautioning against tying self-worth to intellectual achievement. Longer summary

Scott Alexander explores the concept of innate ability and its impact on self-worth, using personal anecdotes and philosophical arguments. He discusses how attributing success to hard work alone can be problematic, as it ignores inherent differences in aptitude. The post compares attitudes towards intelligence with those towards other traits like weight or poverty, noting a inconsistency in how society views these issues. Scott argues for accepting innate differences while still encouraging effort, and suggests that self-worth should not be tied to intellectual ability or achievement. Shorter summary

The post shares insights and anecdotes from a forensic psychiatry conference, covering topics like the insanity defense, criminal psychology, and death penalty cases. Longer summary

This post summarizes highlights from the author's notes taken at a forensic psychiatry conference. It covers various aspects of forensic psychiatry, including the insanity defense, methods for detecting fake insanity pleas, predicting recidivism, death penalty cases, and anecdotes from criminal cases. The author presents surprising statistics about the insanity defense, describes techniques used to detect malingering, and shares interesting fragments of stories from criminal cases. The post also touches on issues related to jury selection in death penalty cases and the effectiveness of capital punishment as a deterrent. Shorter summary