I’ve read two columns here that discussed Trump and dangerous behavior. I wrote my comment for the first column (as you can tell from the date it was posted), and when I saw that a second column had been posted that touched on this, I decided to copy and paste instead of composing it anew, as the former is faster.
Ciao.
I only get emails about comments posted as replies to me, so you must have responded to me by mistake, when you meant to reply to Steve. Thanks for clarifying.
You responded to me saying “I’m not disagreeing with your distinction, but it’s more of a philosophical distinction than pure logic.”
I’d say that it’s more a social science distinction than a philosophical one, in the sense that psychology (not psychiatry), sociology, linguistics, … are social sciences. Are you familiar with the construct of “linguistic register”? One aspect of registers is that the same word can be used by different subsets of people with different meanings, sometimes overlapping and sometimes not. For example, in everyday English, “rational” refers to logical thinking, whereas in math, “rational” refers to a number that can be expressed as a ratio (non-overlapping meanings). “Narcissist” is an example where the meanings in psychiatry vs. everyday English overlap but aren’t identical.
“It’s based on accepting the “medical model” of illness (correct me if I’m wrong) …”
No, it only accepts that psychiatrists exist and have a linguist register, and that some of the words they use are also used in everyday English.
I’m unlikely to respond further. Take care.
Hi Steve,
Just a quick note of appreciation. I’m fairly new to this site, and I’m glad that you take time to moderate comments and prevent the kinds of personal insults that are so common in many online discussions. I’ve found that there’s a huge difference in the kinds of exchanges that occur on moderated vs. unmoderated sites. Thanks for your time.
I agree with Steve’s response (“‘Narcissistic’ is a colloquial description of a certain kind of behavior …”) to your other question to me and don’t have anything to add.
Steve,
Our knowledge is incomplete, but I wouldn’t say that we’re “flying blind,” as quite a bit of relevant knowledge exists: about earlier coronaviruses (SARS, MERS, etc.), about effective responses in earlier pandemics (e.g., the 1918 flu), from our ability to genetically analyze DNA, …
Agreed that “New information is coming in and best practices will change as we learn more.” I’m struck by the vast number of researchers working around the world to help us learn more about all sorts of aspects of this (medicine, genetics, epidemiology, sociology, political science, …).
Steve,
I don’t think that these questions are imponderable. But with few exceptions, we don’t want to purposefully expose people, so some of these questions have to be addressed through observation studies and not randomized controlled trials. Here’s a discussion (not a research paper) that I found helpful: https://www.erinbromage.com/post/the-risks-know-them-avoid-them
As she notes, there are other important factors, such as: how long is the exposure? what is the exhalation force (is the person breathing, talking, singing, yelling, sneezing)? how many droplets are released on average per exhalation?
Agreed that the risk of outdoor transmission is low, but if you’re standing closely together (say, at an outdoor rally) and someone next to you is infected but asymptomatic and sneezes, or if you’re simply standing next to each other for a long time, then that’s still higher risk — even though it’s outdoors — than being outdoors and having an infected walker or cyclist pass by briefly a few feet away.
If you’re indoors and trying to stay distant (say, at a grocery store or in a non-crowded bus), wearing a mask will help protect others if you’re unknowingly infected/asymptomatic. Will it guarantee that there’s no transmission? No, but it will lower the number of people who are affected, which is important. As it’s getting warm, we also have to worry about air conditioning, as the virus lives longer in the cold than in heat and the air circulation is different.
Each of several different choices — handwashing, distancing, masks, keeping in-person interactions short, … — reduces risk, and the more of these actions we combine, the lower the net risk.
Just to be clear, I haven’t at any point been discussing “psychiatric terminology” or the DSM. My “craziest of the quotes” claim was about a statement, not about a person, and as I noted earlier, my use of terms like “narcissism” was intended in its everyday sense (which preceded the psychiatric use), not as a diagnosis.
Steve McCrea has asked that we not discuss Trump further, and I’m going to abide by that.
I’ve briefly looked at your link (https://swprs.org/a-swiss-doctor-on-covid-19/), but I don’t have the time to look at the underlying data in order to reach a conclusion about their claims.
Steve,
Thanks for clarifying about the reply button.
Re: “The truth is, we don’t know if masks help or not, or how much, or on whom,” I think we do already know that masks help (as long as they’re worn properly, and depending to some extent on the material(s) used), as they reduce the expulsion of drops from an asymptomatic or presymptomatic infected person who doesn’t know s/he’s infected, but who can nonetheless transmit the disease. If fewer droplets get into the air, it’s less likely that someone who isn’t infected will breathe enough of them in to become infected. There’s already research about how much masks decrease the exhaled aerosols, and how it varies with fabric type. There are aspects of mask wearing that are less certain (like “how much” — I’m not sure if you’re looking for an average percent reduction if everyone wears masks, …), and there’s lots of ongoing research about all of this (e.g., how the kind of expulsion — breathing, talking, singing, sneezing, … — influences the number of droplets and likelihood of transmission).
I’m pretty good about distinguishing between “known” and “possible” / “uncertain.” I try not to confuse them.
I won’t respond further re: Trump, per your request.
Steve,
Since you’re a moderator, can you explain to me why some comments have a “reply” button under them and others don’t? I could not reply directly to your most recent comment to me and had to search for this one earlier in the thread so that I could reply to you.
Re: your comment “Part of the challenge of this set of events is the inability to know what information is reliable or not,” that’s true for some information (e.g., the actual number of cases and deaths isn’t totally reliable, due to lack of sufficient tests to assess all suspected cases), but it’s false for a great deal of other information that’s relevant. All of the following is reliable:
We can read a copy of the Pandemic Playbook that the Obama Administration left for the Trump Administration, and no one contests its existence. We know that the NSC pandemic response team was disbanded in 2018 and can read the contemporaneous news and criticism of that choice. We can read/view the widespread pleas for PPE from healthcare workers, and it’s a fact that Trump has never invoked the Defense Production Act to produce them, even though he could have. We know that Trump was warned by government officials about diverse concerns that he didn’t respond to in a timely way, as there are copies of the written warnings. We know Trump’s many public lies, as we have video of them. We know that we still don’t have a test and trace program, and months have been wasted when one could have been established. We know that the test and trace program was central to South Korea’s containment of the disease and that orders of magnitude fewer people have died there. Etc.
FWIW, I’ve worked on research that involved distinguishing between knowledge (true and warranted belief) and not-knowledge (false beliefs, beliefs whose truth-value is unknown, beliefs that lack a sufficient warrant, values that aren’t T/F). I’m actually quite sensitive to the reliability of information.
Berzerk,
For some reason, there is no “reply” button under most of your comments, so my replies aren’t threaded appropriately for the comments I’m replying to. I’ll just quote from your most recent comments here.
You say “I found the video where you got the idea that Trump has the nuclear codes and could suddenly use them in a fit of rage. It was an interview with a psychiatrist and an author of one of Trump’s books.” But I said nothing about him “suddenly us[ing] them in a fit of rage.” That’s something *you* added. Nor was my comment motivated by an interview with a psychiatrist.
Re: “In terms of dangerous behavior of Trump causing over 20,000 deaths directly due to his handling of the pandemic …, since you know what per capita deaths mean, according to official death counts from Covid-19, Belgium, Spain, Italy, the UK, France, Ireland, the Netherlands and Sweden, all rank higher than the US. You could say Trump (if you want to put the blame on one person) is doing better than any of these countries. It would, at the least, suggest something else is going on. Are the death counts attributed to Covid-19 accurate? Or, is something more sinister going on?”
In comparing deaths/million in different countries, there are a bunch of things to keep in mind: the age profiles of the countries (because the virus is more deadly for older people), the relative dates of first deaths (because you want to compare the same length of time for each country), the quality of the testing and other data collection (because you’re comparing deaths identified as caused by Covid-19, and there may be undercounts if there aren’t enough tests to confirm whether that’s the cause), population distribution (because it’s mainly transmitted by close contact, so dense countries or those with higher mass transit use makes transmission easier — that’s one of the reasons it’s been so awful in NYC), …
All of thee countries you listed have a larger % of people over 65 (https://en.wikipedia.org/wiki/List_of_countries_by_age_structure ). The other countries all reached 3 deaths per million sooner than we did and so their cumulative #s are over a longer time span.
For example, this is a log scale graph of cumulative deaths per million comparing the U.S. and Belgium: https://ig.ft.com/coronavirus-chart/?areas=usa&areas=bel&areasRegional=usny&areasRegional=usnj&cumulative=1&logScale=1&perMillion=1&values=deaths
You can see that their graph is longer, meaning that they reached 3 deaths per million earlier than we did. If you look deaths per million after 49 days for both countries, Belgium is still much worse, but not as bad as comparing the totals to date.
I’m not going to look up data for the other issues that affect how directly comparable countries are; I’m just telling you that looking solely at deaths/million isn’t an appropriate comparison, especially since my comment wasn’t solely about the people who’d died but also about “longterm health and economic problems for many more.”
“Why would all these countries promote an experimental vaccine as (in the words of Bill Gates) the ultimate solution? Do you see how insane that is?”
I haven’t seen quotes showing that they’re all promoting a vaccine as “the ultimate solution,” but vaccines have long been important in dealing with highly contagious and harmful diseases (small pox, polio, etc.). I don’t think this is “insane,” and I have no desire to get into a vaccine debate, nor would I focus on Bill Gates rather than health experts.
“Trump set up a task force to deal with the Corona virus spread. It was (set up in late January) headed by former pharmaceutical lobbyist Alex Azar. You can look up who the others are. Including Fauci. Trump isn’t smart (or dumb) enough to have made all those decisions himself. Emphasizing Trump distracts from what the real motive behind all this is. Other countries are making the same (apparent) blunders.”
I don’t think it’s a distraction at all. Trump has final say on key issues and more than once has overruled things recommended by his task force. He is the only person authorized to invoke the Defense Production Act. He’s the one who OK’ed disbanding the NSC pandemic response team at Bolton’s prompting. He’s the one complaining about skilled people like Dr. Bright and Dr. Messonier when they push back on stupid ideas of his, even removing Bright from his position. (An insightful comment of Laurie Garrett’s: “When a leader uses kill-the-messenger governance, underlings stop sending bad news upstairs. That’s what happened in China: local Wuhan CCP bosses didn’t tell #XiJinping about the new #coronavirus. And that’s what’s happ’ing in USA, as #Trump offs bearers of bad #COVID19 tidings.”) Trump was the one having rallies where the virus could circulate among large #s of people packed together. And on and on.
And I don’t need to look up the other members of the task force; they’re listed in the JustSecurity document I referred you to, where they noted that “Officials are alarmed by the absence of the FDA Commission[er], Dr. Stepehn Hahn on the task force, which they believe hampers coordination between the FDA, CMS, and commercial labs on testing.” Did you even skim this document?
Again: we need an extensive testing and tracing effort, and despite months having passed, we still don’t have one. Do you seriously believe that Fauci would choose not to have this if he could move forward on it without Trump’s approval. Did you hear Trump’s nutso comments yesterday? He said:
“we’ve been doing testing at a level that nobody has ever done it before” (this is false)
“we’ve done more testing than all of the countries in the world added up together.” (this is false)
“It could be that testing is, frankly, overrated.” (no doubt that’s why so many people want tests and can’t get them)
“And don’t forget: We have more cases than anybody in the world. But why? Because we do more testing. When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.” (this is the craziest of the quotes, as it conflates “cases” and “confirmed cases” and pretends only the latter matter)
I don’t know that it makes sense to continue this exchange, which has already gone on for quite a bit. I’m open to changing my mind in response to good evidence, but simply claiming that Trump is a distraction is an opinion, not evidence. You and I have very different opinions here.
Berzerk,
You say “From your initial comment on Trump with regards to HCQ, from what you say, at least 25% of deaths in the US from Covid-19 are attributable to HCQ alone or in combination with those needing HCQ for other diseases and not being able to get them at the pharmacy due to a shortage.”
That’s a drastic misinterpretation of what I wrote. What I said was “Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day.”
You then responded “‘Magic solutions’. You mean, for example, HCQ…”
But now you seem to think that my long and incomplete list “his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, …” (incompleteness indicated by the ellipses in the original) just refers to HCQ. Not only is HCQ *not* the only “magic solution” that I was referring to (and I assumed that you understood this, since you originally said “for example, HCQ,” which implies that that example is one of several), but “advocacy of magic solutions” was only one of the many issues in my list.
I’m absolutely not blaming “deaths of tens of thousands and to longterm health and economic problems for many more” on use of HCQ or people who need HCQ not being able to get it. By “advocacy of magic solutions,” I was mostly referring to his response that he doesn’t need to do much, because a magic solution will take care of the problem (not just his advocacy of HCQ when it hadn’t gone through clinical trials as a preventative or treatment for this, but all of his claims that COVID-19 would just “go away”: https://www.youtube.com/watch?v=r8yOv4PwttM , his later comment “I see the disinfectant, where it knocks it out in a minute, one minute. And is there a way we can do something like that by injection inside or almost a cleaning …,” etc.). But that’s only one of the factors that influenced his awful response. Other drivers of the needless deaths and other harm are things like his choice to ignore the Pandemic Playbook that the Obama Admin created (https://www.documentcloud.org/documents/6819258-Playbook.html ), trying to cut pandemic-preparedness and global health funding, disbanding the NSC pandemic team, refusal to take the illness seriously in January and February and immediately make sure that there would be widespread effective testing available, sufficient PPE available for healthcare workers, capacity to do contact tracing, checking for symptoms in people returning to the U.S. from areas where the virus was already known to be infecting people, etc., and endlessly lying about the situation (e.g., in March: “We’re having to fix a problem that, four weeks ago, nobody ever thought would be a problem,” when he was literally handed a playbook years earlier and had received warnings months earlier). He crows about having shut down travel from China, but ignores that 40,000 Americans who’d been in China returned and he made no attempt to test them or advocate that they self-quarantine. When Americans were finally flown back from the infected Diamond Princess cruise ships, he mixed infected passengers and healthy passengers on the flight home (letting the State Dept. take control of this, where they chose to act against CDC guidance) and then didn’t provide PPE or guidance to the people meeting them in the U.S. When he created the Europe travel ban, there were no plans for how to keep the thousands of returning Americans sufficiently far apart in the airports (and airplanes are themselves a context that increases spread, because air is recirculated). He kept talking about the Defense Production Act but hasn’t invoked it to produce PPE. He lied over and over about sufficient tests being available (e.g., “Anybody that wants a test [for the coronavirus] can get a test.”) and when asked if he took responsibility for the lag in testing, responded “No, I don’t take responsibility at all.” He has frequently tried to shift responsibility to governors for things that could more effectively and cheaply be done by the federal government (e.g., PPE production and distribution), forcing states to compete with each other and sometimes seizing supplies that states had ordered. He’s allocated items from the national stockpile not on the basis of state need but as a reward to the states where he has more political support.
I could go on and on with the list of his mistakes, which originate in the many features of his dangerousness that I listed originally. But the bottom line is: until there is a vaccine, then testing / tracing / self-quarantine for exposed people is the primary means of reducing the number of infected people, and he has squandered MONTHS refusing to deal with this, months during which tens of thousands of people have become infected and many have died unnecessarily and many others now have other health and economic harm. It’s been over 4 months since he became aware of this pandemic and we STILL don’t have an effective test and trace program.
I accept that you think I’m “showing too much trust in protocol,” but you don’t actually have a good basis for your claim, since you have made zero effort to gather sufficient data from me (via interview) that would allow you to justifiably conclude this.
I found and skimmed the paper you quoted from, which focuses on peer review in biomedical research, not peer review across all fields that use it. So it’s relevant to the discussion of research on HCQ, but not great evidence re: my response to your claim that peer review “means people at the bottom arse-licking those higher up,” as my response was about peer-review in general, not peer review solely in biomedical research. More to the point, Smith’s paper doesn’t support your claim.
I’m not going to read all of the articles he cites in order to assess whether his is a good analysis, but I did skim the second one (https://jamanetwork.com/journals/jama/fullarticle/194989 ), and strangely, the quote that Smith attributes to those authors doesn’t appear in their paper. If I were trying to do a good review of Smith’s paper, I’d also want to look at research on peer-review that’s been published since his (2006), but I’m not going to take the time to do that.
All of science is “rooted in belief,” with a focus on the proper subset of beliefs that constitute knowledge: true and warranted/justified belief. But knowledge isn’t the only kind of belief that’s relevant to science. For example, conjectures/hypotheses are central to science, and those are known not to be warranted (the hope is that a warrant will be confirmed or disconfirmed). And when scientists judge that a piece of research is “important,” that’s a different kind of belief: opinion.
Berzerk,
Just to be clear, the bracketed comment “[what does this mean?]” appeared on the page you directed me to; it wasn’t inserted by me / wasn’t a question from me. I do know what peer-review is (I worked as an assistant to a journal editor while in grad school), and I disagree that “It means people at the bottom arse-licking those higher up.” Not only does it not mean that for the reviewers, it doesn’t mean that for the authors. A researcher worth his/her salt will use productive feedback from reviewers to strengthen the paper.
No, I’m not too trusting of protocol. I have a critical mind, a strong math background (so I understand how increased testing impacts number, the difference between absolute #s and per capita rates, the difference between total cases and reported cases, log scales, etc.), and I search out and read quite a bit on my own. I was already familiar with chloroquine, having taken it decades ago as a Peace Corps vol in Africa (though we later had to switch to Fansidar, as there was chloroquine-resistant malaria in my host country), and I also participated in a clinical trial for Loa loa prophylaxis and understand that drugs can have adverse effects.
It’s totally irresponsible for Trump to be promoting a drug that hasn’t been approved for *this* and hasn’t been tested sufficiently for *this*. There are other medical problems where it has been tested and approved; in fact, Trump’s advocacy of HCQ to treat COVID-19 has created access problems for people who use it as ongoing treatment for conditions like lupus.
Berzerk,
IIRR = “if I’m remembering right”
At the top of your link, it says “This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.”
If you do a Google Scholar search (https://scholar.google.com ) on something like [COVID-19 Efficacy safety hydroxychloroquine], you’ll find much more research. I’m guessing that most of it consists of preprints and letters. (Google Scholar attempts to limit results to research or other scholarly responses, like letters to academic journals.)
Mostly I was thinking that neurologic tests can help to identify people with problems like the beginnings of dementia.
If someone I knew exhibited the language decline that I see in Trump (decreased sentence complexity, rambling, overreliance on pronouns, difficulty finding words, word-slurring, difficulty reading, …), I’d encourage him or her to make a doctor’s appointment to check for neurologic problems.
So far controlled trials haven’t shown HCQ to be effective against SARS-CoV-2, and it was rash to encourage people to try it without controlled trials. The answer to his question “what can you lose [by trying it]?” is: you can die from the medication or have other serious adverse effects. IIRR, one of the controlled trials was stopped early because of adverse effects.
No, Berzerk asked “What does dangerous behavior mean, anyway?” and I said why I personally think Trump is dangerous. That’s not changing the subject, because I was initially replying to Berzerk. You said “Once again you confirm the author’s point,” and I disputed that. At no point have I been trying to discuss “the legitimacy of psychiatrists making such judgements.”
Thanks, I hadn’t realized that, and that’s not what I had in mind, so when I said “I’m inclined to agree” above, I was mistaken. What I meant was the kind of testing done by a neurologist, not a neuropsychologist.
oldhead,
I’m not sure that I understand your comment.
I’m not “psychiatrically labeling” anyone. If you’re referring to my use of terms like “narcissism” and “sadism,” these terms first entered the English language about 200 years ago, before they were used in medicine, and I’m using them in their everyday sense, not as some sort of psychiatric diagnosis. I’m claiming some these things as my opinion (an opinion shared by many others), not as medical facts. I’m claiming others as facts that aren’t medical; for example, it’s a fact that he makes a huge number of false claims (what I referred to as dishonesty), but medicine doesn’t enter into that.
How would you rather that I talk about these features?
Or are you suggesting that one cannot make an argument for why one believes him to be dangerous without “psychiatrically labeling” him? If so, I disagree. And I think it’s essential for those of us who believe he is dangerous to be able to say so and explain why we believe that.
With COVID-19, do you dispute that his choices/actions have directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more?
Yes, of course people who are neurologically healthy can be capable of horrible things. But that doesn’t imply that neurological health is unimportant for someone who is a pilot or has nuclear codes.
“So you want to psychiatrically diagnose Trump but pretend it’s neurological?”
No.
I think he’s an extremely dangerous person as president. Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day. And it’s not as if his response to the pandemic is the first example of his dangerousness. His willingness to tear kids from their parents and cage them, to remove environmental safeguards, to embolden white supremacists, to fire skilled civil servants who don’t display personal loyalty to him, to weaken international alliances, and his gaslighting, his failure to safeguard our elections from foreign interference because it benefits him, his refusal to eliminate his business conflicts of interest, … — there’s a long list of acts that endanger people and the country’s broader well-being.
Re: “he doesn’t seem to have changed much over the years as President,” I think that there’s been a noticeable decline in his language use (e.g., decreased complexity in sentence structure, increased rambling/incoherence, increased word-slurring).
Re: the article, I read a suggestion by someone that any candidate for President should be required to take the same kind of neurologic tests that pilots have to take, arguing that if the person isn’t neurologically fit to fly an airplane, s/he isn’t neurologically fit to have the nuclear codes. I’m inclined to agree.
“It’s pretty obvious to me that if almost everyone qualifies as mentally ill at some point, then no one does.”
Why?
Would you also say that “It’s pretty obvious to me that if almost everyone qualifies as physically ill at some point, then no one does”?
It’s quite common for people to have physical maladies. For some people, it’s temporary, and others have chronic physical health conditions (e.g., high blood pressure, asthma, epilepsy, diabetes, cerebral palsy, blindness, deafness, muscular dystrophy). Offhand, I don’t see why the same wouldn’t be the case with mental illness: that it’s common, and for some people it’s temporary, and for others it isn’t. However, that doesn’t imply that we understand mental health conditions as well as physical health conditions in terms of diagnosis or treatment.
Thanks.
I interpret “[science] doesn’t deal with ethics” as much more sweeping than “science can’t determine ‘what is [ethically] right’ by the scientific method.” I agree with the latter.
When you say “Psychiatry would be FAR better off if it viewed itself as a sociological/anthropological soft science and proceeded accordingly,” what are examples of some of the research you wish psychiatrists were carrying out?
I’m well aware that ethics is a branch of philosophy that focuses on the concepts of right and wrong behavior. I didn’t claim that science can tell us what conduct is right or wrong. But that doesn’t imply that no scientific claims can be made about ethics, ethical reasoning, the structures that people create to try to combat acts viewed as unethical, …, and I gave you examples of why the former doesn’t imply the latter. Do you dispute that if many people believe that X is ethical, but others disagree, then “many people believe that X is ethical, but others disagree” is a factual (true) claim?
Even though we cannot answer questions of right and wrong with science, we can still study many aspects of people’s ethical beliefs and behaviors scientifically. Science is not limited to what can be measured. Qualitative research can be carried out scientifically. As I noted earlier, a central feature of science is *the nature of the research*: developing a hypothesis, gathering relevant data, analyzing the data for both confirming and disconfirming evidence of the hypothesis, revising or perhaps abandoning the hypothesis in light of both, … One can carry out this kind of research with qualitative questions/data, including research on aspects of people’s ethical beliefs and behavior.
I read Pirsig’s book long ago in college, but haven’t reread it since. I’ll think about rereading it.
There’s plenty of social science research about ethics.
You seem to be conflating “science” with “natural sciences” again.
The claim “X is ethical” is a matter of opinion; however, that doesn’t imply that there are no factual claims that can be made about ethics. For example, if many people believe that X is ethical, but others disagree, then “many people believe that X is ethical, but others disagree” is a factual (true) claim. If Person A reasons that X is unethical because of DEF, then “Person A reasons that X is unethical because of DEF” is a factual (true) claim. If institutional review boards were created to help protect against certain research deemed to be unethical, then the claim “institutional review boards were created to help protect against certain research deemed to be unethical” is a factual (true) claim. There are all sorts of scientific claims that can be made about ethics, ethical reasoning, structures that people create to try to combat acts viewed as unethical, … If you’d like to read some of the research on ethics, https://scholar.google.com is one place to search.
I certainly accept that you don’t think the Goldwater Rule is a problem, but I’m baffled by your claim that “There is absolutely no reason for anyone to criticize Donald Trump on his supposed dangerousness.” I think he’s an extremely dangerous person as president. Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day. And it’s not as if his response to the pandemic is the first example of his dangerousness. His willingness to tear kids from their parents and cage them, to remove environmental safeguards, to embolden white supremacists, to fire skilled civil servants who don’t display personal loyalty to him, to weaken international alliances, and his gaslighting, his failure to safeguard our elections from foreign interference because it benefits him, his refusal to eliminate his business conflicts of interest, … — there’s a long list of acts that endanger people and the country’s broader well-being. And the changes in his speech over time suggest significant cognitive decline, which is also dangerous in a person who has so much power and who regularly puts his personal desires ahead of the country’s needs.
I agree that “Trump has committed crimes in office that would get an ordinary man arrested,” but unfortunately the DOJ is deferring to the decades-old OLC opinion that a President cannot be indicted while in office (https://www.justice.gov/olc/opinion/sitting-president’s-amenability-indictment-and-criminal-prosecution ). Many lawyers disagree with that judgment, but even they agree that the President cannot be tried by the DOJ for crimes while in office, though he could have had a true trial in the Senate if the GOP Senators had taken their oaths seriously. FWIW, your list includes some things that aren’t statutory crimes (e.g., “repeatedly lying during presidential addresses”) and some of these issues are matters of civil law rather than criminal law (e.g., more than one EC violation suit has been filed and some are still working their way through the courts, though others have been dismissed due to lack of standing to sue). The House should have impeached him for additional high crimes, which need not be statutory crimes.
Thanks, I think that I understand your views much better now, and I appreciate your having taken the time for the exchange.
Going back to Trump, I have no problem saying that he’s “A person who lacks ethics and empathy and is willing to hurt others to get what he wants.” I’d probably add some other descriptors to that list or elaborate on some of the ethical problems (e.g., that he’s extremely narcissistic in the everyday sense of the word, extremely dishonest, greedy). Re: “he is simply acting out HIS morality in a world where the majority find that morality unacceptable,” I think of him as “ill” partly because I see his morality as sick and partly because I believe that he is incapable of change (e.g., incapable of reconsidering his moral views, incapable of acknowledging and correcting his false claims). I sometimes find myself wondering whether he’s knowingly making false claims (i.e., lying) or is instead deluded, so that he believes his false claims to be true regardless of evidence to the contrary.
Thanks for elaborating. I think I understand the distinction that you’re trying to draw between “scientific answers” and “social answers,” but am not comfortable using those phrases for the distinction. Both the natural sciences and the social sciences are sciences, in that a central feature of science is the nature of the research: developing a hypothesis, gathering relevant data, analyzing the data for both confirming and disconfirming evidence of the hypothesis, revising or perhaps abandoning the hypothesis in light of both, … Contrasting “scientific” vs. “social” seems to reject that social sciences are sciences. I think that the distinction you’re trying to make is better captured by a contrast between beliefs that have a truth-value (true, false, or yet to be determined, where a proper subset of these beliefs are “knowledge”: true and warranted belief) and those that don’t (opinions/values/… that are shared or not shared, rather than T/F). Your claim that “There is no scientific test for selfishness or dishonesty – it is entirely a social judgment” is an oversimplification. How best to define “selfishness” and “dishonesty” is a matter of shared/not shared beliefs, but we can draw on evidence to argue for or against specific definitions, and having chosen a definition, we can gather data to assess whether a given person acts in selfish or dishonest ways according to that definition. Sometimes evolutionary evidence is relevant to choosing the definition. You note that selfishness and dishonesty might increase passing along one’s DNA to the next generation (especially for men), but they can also undermine survival of offspring, and if we’re trying to analyze with respect to evolution, we need to consider both. I don’t think it’s just happenstance that there are “behaviors that most people don’t like very much.” Arguably, the set of behaviors that *most* people dislike derives from our being a social species where certain behaviors undermine social well-being.
When it comes to personality disorders, saying that someone is a malignant narcissist is somewhat different from saying that he’s a jerk, in that “malignant narcissism” has a more precise definition specifying a constellation of traits, and we can use data (from his talk and actions) to test whether that person demonstrates this constellation of traits. That doesn’t imply that “malignant narcissist” is a medical term, but not being medical doesn’t imply that it can’t be explored scientifically, as a psychological (not psychiatric) matter. Social scientists develop discipline-specific vocabulary just as natural scientists do.
I have no psychiatric expertise, and if you want to limit “medical” and “ill” to physiological maladies, OK. I’m not inclined to limit “ill” that way. Many words have multiple meanings, and I find the phrases “mental health” and “mental illness” useful in talking about non-medical psychological problems.
I’m puzzled by your claim that “‘malignant narcissist’ … seems to imply that he is suffering from some sort of ‘health problem’ when what he is really suffering from is a moral/ethical problem.” It suggests that the two sets — health problems and moral/ethical problems — are disjoint sets rather than intersecting sets. I see them as intersecting sets and believe that Trump’s behavior and statements put him in the intersection. If I’ve understood your statement correctly, why do you see them as disjoint sets? Also, we do indeed have scientific ways of determining some of the things in your list. For example, there’s a tremendous amount of evidence that he doesn’t “deal[] honestly with those whom he encounters.” I count social scientific evidence (e.g., his public statements) as scientific evidence. Don’t you?
I’ve read two columns here that discussed Trump and dangerous behavior. I wrote my comment for the first column (as you can tell from the date it was posted), and when I saw that a second column had been posted that touched on this, I decided to copy and paste instead of composing it anew, as the former is faster.
Ciao.
I only get emails about comments posted as replies to me, so you must have responded to me by mistake, when you meant to reply to Steve. Thanks for clarifying.
You responded to me saying “I’m not disagreeing with your distinction, but it’s more of a philosophical distinction than pure logic.”
I’d say that it’s more a social science distinction than a philosophical one, in the sense that psychology (not psychiatry), sociology, linguistics, … are social sciences. Are you familiar with the construct of “linguistic register”? One aspect of registers is that the same word can be used by different subsets of people with different meanings, sometimes overlapping and sometimes not. For example, in everyday English, “rational” refers to logical thinking, whereas in math, “rational” refers to a number that can be expressed as a ratio (non-overlapping meanings). “Narcissist” is an example where the meanings in psychiatry vs. everyday English overlap but aren’t identical.
“It’s based on accepting the “medical model” of illness (correct me if I’m wrong) …”
No, it only accepts that psychiatrists exist and have a linguist register, and that some of the words they use are also used in everyday English.
I’m unlikely to respond further. Take care.
Hi Steve,
Just a quick note of appreciation. I’m fairly new to this site, and I’m glad that you take time to moderate comments and prevent the kinds of personal insults that are so common in many online discussions. I’ve found that there’s a huge difference in the kinds of exchanges that occur on moderated vs. unmoderated sites. Thanks for your time.
My first comment was prompted by your question about “dangerous behavior” (https://www.madinamerica.com/2020/05/presidents-fitness-can-professionals-help-decide/#comment-172009). You can reread that exchange if you want.
We already discussed those tests as well: https://www.madinamerica.com/2020/05/presidents-fitness-can-professionals-help-decide/#comment-172139
I agree with Steve’s response (“‘Narcissistic’ is a colloquial description of a certain kind of behavior …”) to your other question to me and don’t have anything to add.
Steve,
Our knowledge is incomplete, but I wouldn’t say that we’re “flying blind,” as quite a bit of relevant knowledge exists: about earlier coronaviruses (SARS, MERS, etc.), about effective responses in earlier pandemics (e.g., the 1918 flu), from our ability to genetically analyze DNA, …
Agreed that “New information is coming in and best practices will change as we learn more.” I’m struck by the vast number of researchers working around the world to help us learn more about all sorts of aspects of this (medicine, genetics, epidemiology, sociology, political science, …).
Steve,
I don’t think that these questions are imponderable. But with few exceptions, we don’t want to purposefully expose people, so some of these questions have to be addressed through observation studies and not randomized controlled trials. Here’s a discussion (not a research paper) that I found helpful: https://www.erinbromage.com/post/the-risks-know-them-avoid-them
As she notes, there are other important factors, such as: how long is the exposure? what is the exhalation force (is the person breathing, talking, singing, yelling, sneezing)? how many droplets are released on average per exhalation?
Agreed that the risk of outdoor transmission is low, but if you’re standing closely together (say, at an outdoor rally) and someone next to you is infected but asymptomatic and sneezes, or if you’re simply standing next to each other for a long time, then that’s still higher risk — even though it’s outdoors — than being outdoors and having an infected walker or cyclist pass by briefly a few feet away.
If you’re indoors and trying to stay distant (say, at a grocery store or in a non-crowded bus), wearing a mask will help protect others if you’re unknowingly infected/asymptomatic. Will it guarantee that there’s no transmission? No, but it will lower the number of people who are affected, which is important. As it’s getting warm, we also have to worry about air conditioning, as the virus lives longer in the cold than in heat and the air circulation is different.
Each of several different choices — handwashing, distancing, masks, keeping in-person interactions short, … — reduces risk, and the more of these actions we combine, the lower the net risk.
Just to be clear, I haven’t at any point been discussing “psychiatric terminology” or the DSM. My “craziest of the quotes” claim was about a statement, not about a person, and as I noted earlier, my use of terms like “narcissism” was intended in its everyday sense (which preceded the psychiatric use), not as a diagnosis.
Steve McCrea has asked that we not discuss Trump further, and I’m going to abide by that.
I’ve briefly looked at your link (https://swprs.org/a-swiss-doctor-on-covid-19/), but I don’t have the time to look at the underlying data in order to reach a conclusion about their claims.
Steve,
Thanks for clarifying about the reply button.
Re: “The truth is, we don’t know if masks help or not, or how much, or on whom,” I think we do already know that masks help (as long as they’re worn properly, and depending to some extent on the material(s) used), as they reduce the expulsion of drops from an asymptomatic or presymptomatic infected person who doesn’t know s/he’s infected, but who can nonetheless transmit the disease. If fewer droplets get into the air, it’s less likely that someone who isn’t infected will breathe enough of them in to become infected. There’s already research about how much masks decrease the exhaled aerosols, and how it varies with fabric type. There are aspects of mask wearing that are less certain (like “how much” — I’m not sure if you’re looking for an average percent reduction if everyone wears masks, …), and there’s lots of ongoing research about all of this (e.g., how the kind of expulsion — breathing, talking, singing, sneezing, … — influences the number of droplets and likelihood of transmission).
I’m pretty good about distinguishing between “known” and “possible” / “uncertain.” I try not to confuse them.
I won’t respond further re: Trump, per your request.
Steve,
Since you’re a moderator, can you explain to me why some comments have a “reply” button under them and others don’t? I could not reply directly to your most recent comment to me and had to search for this one earlier in the thread so that I could reply to you.
Re: your comment “Part of the challenge of this set of events is the inability to know what information is reliable or not,” that’s true for some information (e.g., the actual number of cases and deaths isn’t totally reliable, due to lack of sufficient tests to assess all suspected cases), but it’s false for a great deal of other information that’s relevant. All of the following is reliable:
We can read a copy of the Pandemic Playbook that the Obama Administration left for the Trump Administration, and no one contests its existence. We know that the NSC pandemic response team was disbanded in 2018 and can read the contemporaneous news and criticism of that choice. We can read/view the widespread pleas for PPE from healthcare workers, and it’s a fact that Trump has never invoked the Defense Production Act to produce them, even though he could have. We know that Trump was warned by government officials about diverse concerns that he didn’t respond to in a timely way, as there are copies of the written warnings. We know Trump’s many public lies, as we have video of them. We know that we still don’t have a test and trace program, and months have been wasted when one could have been established. We know that the test and trace program was central to South Korea’s containment of the disease and that orders of magnitude fewer people have died there. Etc.
FWIW, I’ve worked on research that involved distinguishing between knowledge (true and warranted belief) and not-knowledge (false beliefs, beliefs whose truth-value is unknown, beliefs that lack a sufficient warrant, values that aren’t T/F). I’m actually quite sensitive to the reliability of information.
Berzerk,
For some reason, there is no “reply” button under most of your comments, so my replies aren’t threaded appropriately for the comments I’m replying to. I’ll just quote from your most recent comments here.
You say “I found the video where you got the idea that Trump has the nuclear codes and could suddenly use them in a fit of rage. It was an interview with a psychiatrist and an author of one of Trump’s books.” But I said nothing about him “suddenly us[ing] them in a fit of rage.” That’s something *you* added. Nor was my comment motivated by an interview with a psychiatrist.
Re: “if it can even be called a pandemic,” yes, it can absolutely be called a pandemic. It’s a novel virus that’s infected people all over the world. Johns Hopkins has good global data: https://coronavirus.jhu.edu/map.html So does the Financial Times: https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441 and https://ig.ft.com/coronavirus-chart/ (which lets you compare country graphs in diverse ways.
Re: “In terms of dangerous behavior of Trump causing over 20,000 deaths directly due to his handling of the pandemic …, since you know what per capita deaths mean, according to official death counts from Covid-19, Belgium, Spain, Italy, the UK, France, Ireland, the Netherlands and Sweden, all rank higher than the US. You could say Trump (if you want to put the blame on one person) is doing better than any of these countries. It would, at the least, suggest something else is going on. Are the death counts attributed to Covid-19 accurate? Or, is something more sinister going on?”
In comparing deaths/million in different countries, there are a bunch of things to keep in mind: the age profiles of the countries (because the virus is more deadly for older people), the relative dates of first deaths (because you want to compare the same length of time for each country), the quality of the testing and other data collection (because you’re comparing deaths identified as caused by Covid-19, and there may be undercounts if there aren’t enough tests to confirm whether that’s the cause), population distribution (because it’s mainly transmitted by close contact, so dense countries or those with higher mass transit use makes transmission easier — that’s one of the reasons it’s been so awful in NYC), …
All of thee countries you listed have a larger % of people over 65 (https://en.wikipedia.org/wiki/List_of_countries_by_age_structure ). The other countries all reached 3 deaths per million sooner than we did and so their cumulative #s are over a longer time span.
For example, this is a log scale graph of cumulative deaths per million comparing the U.S. and Belgium:
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=bel&areasRegional=usny&areasRegional=usnj&cumulative=1&logScale=1&perMillion=1&values=deaths
You can see that their graph is longer, meaning that they reached 3 deaths per million earlier than we did. If you look deaths per million after 49 days for both countries, Belgium is still much worse, but not as bad as comparing the totals to date.
I’m not going to look up data for the other issues that affect how directly comparable countries are; I’m just telling you that looking solely at deaths/million isn’t an appropriate comparison, especially since my comment wasn’t solely about the people who’d died but also about “longterm health and economic problems for many more.”
“Why would all these countries promote an experimental vaccine as (in the words of Bill Gates) the ultimate solution? Do you see how insane that is?”
I haven’t seen quotes showing that they’re all promoting a vaccine as “the ultimate solution,” but vaccines have long been important in dealing with highly contagious and harmful diseases (small pox, polio, etc.). I don’t think this is “insane,” and I have no desire to get into a vaccine debate, nor would I focus on Bill Gates rather than health experts.
“Trump set up a task force to deal with the Corona virus spread. It was (set up in late January) headed by former pharmaceutical lobbyist Alex Azar. You can look up who the others are. Including Fauci. Trump isn’t smart (or dumb) enough to have made all those decisions himself. Emphasizing Trump distracts from what the real motive behind all this is. Other countries are making the same (apparent) blunders.”
I don’t think it’s a distraction at all. Trump has final say on key issues and more than once has overruled things recommended by his task force. He is the only person authorized to invoke the Defense Production Act. He’s the one who OK’ed disbanding the NSC pandemic response team at Bolton’s prompting. He’s the one complaining about skilled people like Dr. Bright and Dr. Messonier when they push back on stupid ideas of his, even removing Bright from his position. (An insightful comment of Laurie Garrett’s: “When a leader uses kill-the-messenger governance, underlings stop sending bad news upstairs. That’s what happened in China: local Wuhan CCP bosses didn’t tell #XiJinping about the new #coronavirus. And that’s what’s happ’ing in USA, as #Trump offs bearers of bad #COVID19 tidings.”) Trump was the one having rallies where the virus could circulate among large #s of people packed together. And on and on.
And I don’t need to look up the other members of the task force; they’re listed in the JustSecurity document I referred you to, where they noted that “Officials are alarmed by the absence of the FDA Commission[er], Dr. Stepehn Hahn on the task force, which they believe hampers coordination between the FDA, CMS, and commercial labs on testing.” Did you even skim this document?
Again: we need an extensive testing and tracing effort, and despite months having passed, we still don’t have one. Do you seriously believe that Fauci would choose not to have this if he could move forward on it without Trump’s approval. Did you hear Trump’s nutso comments yesterday? He said:
“we’ve been doing testing at a level that nobody has ever done it before” (this is false)
“we’ve done more testing than all of the countries in the world added up together.” (this is false)
“It could be that testing is, frankly, overrated.” (no doubt that’s why so many people want tests and can’t get them)
“And don’t forget: We have more cases than anybody in the world. But why? Because we do more testing. When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.” (this is the craziest of the quotes, as it conflates “cases” and “confirmed cases” and pretends only the latter matter)
I don’t know that it makes sense to continue this exchange, which has already gone on for quite a bit. I’m open to changing my mind in response to good evidence, but simply claiming that Trump is a distraction is an opinion, not evidence. You and I have very different opinions here.
Berzerk,
You say “From your initial comment on Trump with regards to HCQ, from what you say, at least 25% of deaths in the US from Covid-19 are attributable to HCQ alone or in combination with those needing HCQ for other diseases and not being able to get them at the pharmacy due to a shortage.”
That’s a drastic misinterpretation of what I wrote. What I said was “Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day.”
You then responded “‘Magic solutions’. You mean, for example, HCQ…”
But now you seem to think that my long and incomplete list “his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, …” (incompleteness indicated by the ellipses in the original) just refers to HCQ. Not only is HCQ *not* the only “magic solution” that I was referring to (and I assumed that you understood this, since you originally said “for example, HCQ,” which implies that that example is one of several), but “advocacy of magic solutions” was only one of the many issues in my list.
I’m absolutely not blaming “deaths of tens of thousands and to longterm health and economic problems for many more” on use of HCQ or people who need HCQ not being able to get it. By “advocacy of magic solutions,” I was mostly referring to his response that he doesn’t need to do much, because a magic solution will take care of the problem (not just his advocacy of HCQ when it hadn’t gone through clinical trials as a preventative or treatment for this, but all of his claims that COVID-19 would just “go away”: https://www.youtube.com/watch?v=r8yOv4PwttM , his later comment “I see the disinfectant, where it knocks it out in a minute, one minute. And is there a way we can do something like that by injection inside or almost a cleaning …,” etc.). But that’s only one of the factors that influenced his awful response. Other drivers of the needless deaths and other harm are things like his choice to ignore the Pandemic Playbook that the Obama Admin created (https://www.documentcloud.org/documents/6819258-Playbook.html ), trying to cut pandemic-preparedness and global health funding, disbanding the NSC pandemic team, refusal to take the illness seriously in January and February and immediately make sure that there would be widespread effective testing available, sufficient PPE available for healthcare workers, capacity to do contact tracing, checking for symptoms in people returning to the U.S. from areas where the virus was already known to be infecting people, etc., and endlessly lying about the situation (e.g., in March: “We’re having to fix a problem that, four weeks ago, nobody ever thought would be a problem,” when he was literally handed a playbook years earlier and had received warnings months earlier). He crows about having shut down travel from China, but ignores that 40,000 Americans who’d been in China returned and he made no attempt to test them or advocate that they self-quarantine. When Americans were finally flown back from the infected Diamond Princess cruise ships, he mixed infected passengers and healthy passengers on the flight home (letting the State Dept. take control of this, where they chose to act against CDC guidance) and then didn’t provide PPE or guidance to the people meeting them in the U.S. When he created the Europe travel ban, there were no plans for how to keep the thousands of returning Americans sufficiently far apart in the airports (and airplanes are themselves a context that increases spread, because air is recirculated). He kept talking about the Defense Production Act but hasn’t invoked it to produce PPE. He lied over and over about sufficient tests being available (e.g., “Anybody that wants a test [for the coronavirus] can get a test.”) and when asked if he took responsibility for the lag in testing, responded “No, I don’t take responsibility at all.” He has frequently tried to shift responsibility to governors for things that could more effectively and cheaply be done by the federal government (e.g., PPE production and distribution), forcing states to compete with each other and sometimes seizing supplies that states had ordered. He’s allocated items from the national stockpile not on the basis of state need but as a reward to the states where he has more political support.
I could go on and on with the list of his mistakes, which originate in the many features of his dangerousness that I listed originally. But the bottom line is: until there is a vaccine, then testing / tracing / self-quarantine for exposed people is the primary means of reducing the number of infected people, and he has squandered MONTHS refusing to deal with this, months during which tens of thousands of people have become infected and many have died unnecessarily and many others now have other health and economic harm. It’s been over 4 months since he became aware of this pandemic and we STILL don’t have an effective test and trace program.
For a very helpful “timeline of major U.S. policy events related to the novel coronavirus pandemic”: https://www.justsecurity.org/69650/timeline-of-the-coronavirus-pandemic-and-u-s-response/
I accept that you think I’m “showing too much trust in protocol,” but you don’t actually have a good basis for your claim, since you have made zero effort to gather sufficient data from me (via interview) that would allow you to justifiably conclude this.
I found and skimmed the paper you quoted from, which focuses on peer review in biomedical research, not peer review across all fields that use it. So it’s relevant to the discussion of research on HCQ, but not great evidence re: my response to your claim that peer review “means people at the bottom arse-licking those higher up,” as my response was about peer-review in general, not peer review solely in biomedical research. More to the point, Smith’s paper doesn’t support your claim.
I’m not going to read all of the articles he cites in order to assess whether his is a good analysis, but I did skim the second one (https://jamanetwork.com/journals/jama/fullarticle/194989 ), and strangely, the quote that Smith attributes to those authors doesn’t appear in their paper. If I were trying to do a good review of Smith’s paper, I’d also want to look at research on peer-review that’s been published since his (2006), but I’m not going to take the time to do that.
All of science is “rooted in belief,” with a focus on the proper subset of beliefs that constitute knowledge: true and warranted/justified belief. But knowledge isn’t the only kind of belief that’s relevant to science. For example, conjectures/hypotheses are central to science, and those are known not to be warranted (the hope is that a warrant will be confirmed or disconfirmed). And when scientists judge that a piece of research is “important,” that’s a different kind of belief: opinion.
Berzerk,
Just to be clear, the bracketed comment “[what does this mean?]” appeared on the page you directed me to; it wasn’t inserted by me / wasn’t a question from me. I do know what peer-review is (I worked as an assistant to a journal editor while in grad school), and I disagree that “It means people at the bottom arse-licking those higher up.” Not only does it not mean that for the reviewers, it doesn’t mean that for the authors. A researcher worth his/her salt will use productive feedback from reviewers to strengthen the paper.
No, I’m not too trusting of protocol. I have a critical mind, a strong math background (so I understand how increased testing impacts number, the difference between absolute #s and per capita rates, the difference between total cases and reported cases, log scales, etc.), and I search out and read quite a bit on my own. I was already familiar with chloroquine, having taken it decades ago as a Peace Corps vol in Africa (though we later had to switch to Fansidar, as there was chloroquine-resistant malaria in my host country), and I also participated in a clinical trial for Loa loa prophylaxis and understand that drugs can have adverse effects.
It’s totally irresponsible for Trump to be promoting a drug that hasn’t been approved for *this* and hasn’t been tested sufficiently for *this*. There are other medical problems where it has been tested and approved; in fact, Trump’s advocacy of HCQ to treat COVID-19 has created access problems for people who use it as ongoing treatment for conditions like lupus.
Berzerk,
IIRR = “if I’m remembering right”
At the top of your link, it says “This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.”
If you do a Google Scholar search (https://scholar.google.com ) on something like [COVID-19 Efficacy safety hydroxychloroquine], you’ll find much more research. I’m guessing that most of it consists of preprints and letters. (Google Scholar attempts to limit results to research or other scholarly responses, like letters to academic journals.)
Mostly I was thinking that neurologic tests can help to identify people with problems like the beginnings of dementia.
If someone I knew exhibited the language decline that I see in Trump (decreased sentence complexity, rambling, overreliance on pronouns, difficulty finding words, word-slurring, difficulty reading, …), I’d encourage him or her to make a doctor’s appointment to check for neurologic problems.
So far controlled trials haven’t shown HCQ to be effective against SARS-CoV-2, and it was rash to encourage people to try it without controlled trials. The answer to his question “what can you lose [by trying it]?” is: you can die from the medication or have other serious adverse effects. IIRR, one of the controlled trials was stopped early because of adverse effects.
No, Berzerk asked “What does dangerous behavior mean, anyway?” and I said why I personally think Trump is dangerous. That’s not changing the subject, because I was initially replying to Berzerk. You said “Once again you confirm the author’s point,” and I disputed that. At no point have I been trying to discuss “the legitimacy of psychiatrists making such judgements.”
Thanks, I hadn’t realized that, and that’s not what I had in mind, so when I said “I’m inclined to agree” above, I was mistaken. What I meant was the kind of testing done by a neurologist, not a neuropsychologist.
oldhead,
I’m not sure that I understand your comment.
I’m not “psychiatrically labeling” anyone. If you’re referring to my use of terms like “narcissism” and “sadism,” these terms first entered the English language about 200 years ago, before they were used in medicine, and I’m using them in their everyday sense, not as some sort of psychiatric diagnosis. I’m claiming some these things as my opinion (an opinion shared by many others), not as medical facts. I’m claiming others as facts that aren’t medical; for example, it’s a fact that he makes a huge number of false claims (what I referred to as dishonesty), but medicine doesn’t enter into that.
How would you rather that I talk about these features?
Or are you suggesting that one cannot make an argument for why one believes him to be dangerous without “psychiatrically labeling” him? If so, I disagree. And I think it’s essential for those of us who believe he is dangerous to be able to say so and explain why we believe that.
With COVID-19, do you dispute that his choices/actions have directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more?
Yes, of course people who are neurologically healthy can be capable of horrible things. But that doesn’t imply that neurological health is unimportant for someone who is a pilot or has nuclear codes.
“So you want to psychiatrically diagnose Trump but pretend it’s neurological?”
No.
I think he’s an extremely dangerous person as president. Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day. And it’s not as if his response to the pandemic is the first example of his dangerousness. His willingness to tear kids from their parents and cage them, to remove environmental safeguards, to embolden white supremacists, to fire skilled civil servants who don’t display personal loyalty to him, to weaken international alliances, and his gaslighting, his failure to safeguard our elections from foreign interference because it benefits him, his refusal to eliminate his business conflicts of interest, … — there’s a long list of acts that endanger people and the country’s broader well-being.
Re: “he doesn’t seem to have changed much over the years as President,” I think that there’s been a noticeable decline in his language use (e.g., decreased complexity in sentence structure, increased rambling/incoherence, increased word-slurring).
Re: the article, I read a suggestion by someone that any candidate for President should be required to take the same kind of neurologic tests that pilots have to take, arguing that if the person isn’t neurologically fit to fly an airplane, s/he isn’t neurologically fit to have the nuclear codes. I’m inclined to agree.
“It’s pretty obvious to me that if almost everyone qualifies as mentally ill at some point, then no one does.”
Why?
Would you also say that “It’s pretty obvious to me that if almost everyone qualifies as physically ill at some point, then no one does”?
It’s quite common for people to have physical maladies. For some people, it’s temporary, and others have chronic physical health conditions (e.g., high blood pressure, asthma, epilepsy, diabetes, cerebral palsy, blindness, deafness, muscular dystrophy). Offhand, I don’t see why the same wouldn’t be the case with mental illness: that it’s common, and for some people it’s temporary, and for others it isn’t. However, that doesn’t imply that we understand mental health conditions as well as physical health conditions in terms of diagnosis or treatment.
Thanks.
I interpret “[science] doesn’t deal with ethics” as much more sweeping than “science can’t determine ‘what is [ethically] right’ by the scientific method.” I agree with the latter.
When you say “Psychiatry would be FAR better off if it viewed itself as a sociological/anthropological soft science and proceeded accordingly,” what are examples of some of the research you wish psychiatrists were carrying out?
I’m well aware that ethics is a branch of philosophy that focuses on the concepts of right and wrong behavior. I didn’t claim that science can tell us what conduct is right or wrong. But that doesn’t imply that no scientific claims can be made about ethics, ethical reasoning, the structures that people create to try to combat acts viewed as unethical, …, and I gave you examples of why the former doesn’t imply the latter. Do you dispute that if many people believe that X is ethical, but others disagree, then “many people believe that X is ethical, but others disagree” is a factual (true) claim?
Even though we cannot answer questions of right and wrong with science, we can still study many aspects of people’s ethical beliefs and behaviors scientifically. Science is not limited to what can be measured. Qualitative research can be carried out scientifically. As I noted earlier, a central feature of science is *the nature of the research*: developing a hypothesis, gathering relevant data, analyzing the data for both confirming and disconfirming evidence of the hypothesis, revising or perhaps abandoning the hypothesis in light of both, … One can carry out this kind of research with qualitative questions/data, including research on aspects of people’s ethical beliefs and behavior.
I read Pirsig’s book long ago in college, but haven’t reread it since. I’ll think about rereading it.
There’s plenty of social science research about ethics.
You seem to be conflating “science” with “natural sciences” again.
The claim “X is ethical” is a matter of opinion; however, that doesn’t imply that there are no factual claims that can be made about ethics. For example, if many people believe that X is ethical, but others disagree, then “many people believe that X is ethical, but others disagree” is a factual (true) claim. If Person A reasons that X is unethical because of DEF, then “Person A reasons that X is unethical because of DEF” is a factual (true) claim. If institutional review boards were created to help protect against certain research deemed to be unethical, then the claim “institutional review boards were created to help protect against certain research deemed to be unethical” is a factual (true) claim. There are all sorts of scientific claims that can be made about ethics, ethical reasoning, structures that people create to try to combat acts viewed as unethical, … If you’d like to read some of the research on ethics, https://scholar.google.com is one place to search.
I certainly accept that you don’t think the Goldwater Rule is a problem, but I’m baffled by your claim that “There is absolutely no reason for anyone to criticize Donald Trump on his supposed dangerousness.” I think he’s an extremely dangerous person as president. Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day. And it’s not as if his response to the pandemic is the first example of his dangerousness. His willingness to tear kids from their parents and cage them, to remove environmental safeguards, to embolden white supremacists, to fire skilled civil servants who don’t display personal loyalty to him, to weaken international alliances, and his gaslighting, his failure to safeguard our elections from foreign interference because it benefits him, his refusal to eliminate his business conflicts of interest, … — there’s a long list of acts that endanger people and the country’s broader well-being. And the changes in his speech over time suggest significant cognitive decline, which is also dangerous in a person who has so much power and who regularly puts his personal desires ahead of the country’s needs.
I agree that “Trump has committed crimes in office that would get an ordinary man arrested,” but unfortunately the DOJ is deferring to the decades-old OLC opinion that a President cannot be indicted while in office (https://www.justice.gov/olc/opinion/sitting-president’s-amenability-indictment-and-criminal-prosecution ). Many lawyers disagree with that judgment, but even they agree that the President cannot be tried by the DOJ for crimes while in office, though he could have had a true trial in the Senate if the GOP Senators had taken their oaths seriously. FWIW, your list includes some things that aren’t statutory crimes (e.g., “repeatedly lying during presidential addresses”) and some of these issues are matters of civil law rather than criminal law (e.g., more than one EC violation suit has been filed and some are still working their way through the courts, though others have been dismissed due to lack of standing to sue). The House should have impeached him for additional high crimes, which need not be statutory crimes.
Thanks, I think that I understand your views much better now, and I appreciate your having taken the time for the exchange.
Going back to Trump, I have no problem saying that he’s “A person who lacks ethics and empathy and is willing to hurt others to get what he wants.” I’d probably add some other descriptors to that list or elaborate on some of the ethical problems (e.g., that he’s extremely narcissistic in the everyday sense of the word, extremely dishonest, greedy). Re: “he is simply acting out HIS morality in a world where the majority find that morality unacceptable,” I think of him as “ill” partly because I see his morality as sick and partly because I believe that he is incapable of change (e.g., incapable of reconsidering his moral views, incapable of acknowledging and correcting his false claims). I sometimes find myself wondering whether he’s knowingly making false claims (i.e., lying) or is instead deluded, so that he believes his false claims to be true regardless of evidence to the contrary.
Thanks for elaborating. I think I understand the distinction that you’re trying to draw between “scientific answers” and “social answers,” but am not comfortable using those phrases for the distinction. Both the natural sciences and the social sciences are sciences, in that a central feature of science is the nature of the research: developing a hypothesis, gathering relevant data, analyzing the data for both confirming and disconfirming evidence of the hypothesis, revising or perhaps abandoning the hypothesis in light of both, … Contrasting “scientific” vs. “social” seems to reject that social sciences are sciences. I think that the distinction you’re trying to make is better captured by a contrast between beliefs that have a truth-value (true, false, or yet to be determined, where a proper subset of these beliefs are “knowledge”: true and warranted belief) and those that don’t (opinions/values/… that are shared or not shared, rather than T/F). Your claim that “There is no scientific test for selfishness or dishonesty – it is entirely a social judgment” is an oversimplification. How best to define “selfishness” and “dishonesty” is a matter of shared/not shared beliefs, but we can draw on evidence to argue for or against specific definitions, and having chosen a definition, we can gather data to assess whether a given person acts in selfish or dishonest ways according to that definition. Sometimes evolutionary evidence is relevant to choosing the definition. You note that selfishness and dishonesty might increase passing along one’s DNA to the next generation (especially for men), but they can also undermine survival of offspring, and if we’re trying to analyze with respect to evolution, we need to consider both. I don’t think it’s just happenstance that there are “behaviors that most people don’t like very much.” Arguably, the set of behaviors that *most* people dislike derives from our being a social species where certain behaviors undermine social well-being.
When it comes to personality disorders, saying that someone is a malignant narcissist is somewhat different from saying that he’s a jerk, in that “malignant narcissism” has a more precise definition specifying a constellation of traits, and we can use data (from his talk and actions) to test whether that person demonstrates this constellation of traits. That doesn’t imply that “malignant narcissist” is a medical term, but not being medical doesn’t imply that it can’t be explored scientifically, as a psychological (not psychiatric) matter. Social scientists develop discipline-specific vocabulary just as natural scientists do.
I have no psychiatric expertise, and if you want to limit “medical” and “ill” to physiological maladies, OK. I’m not inclined to limit “ill” that way. Many words have multiple meanings, and I find the phrases “mental health” and “mental illness” useful in talking about non-medical psychological problems.
I’m puzzled by your claim that “‘malignant narcissist’ … seems to imply that he is suffering from some sort of ‘health problem’ when what he is really suffering from is a moral/ethical problem.” It suggests that the two sets — health problems and moral/ethical problems — are disjoint sets rather than intersecting sets. I see them as intersecting sets and believe that Trump’s behavior and statements put him in the intersection. If I’ve understood your statement correctly, why do you see them as disjoint sets? Also, we do indeed have scientific ways of determining some of the things in your list. For example, there’s a tremendous amount of evidence that he doesn’t “deal[] honestly with those whom he encounters.” I count social scientific evidence (e.g., his public statements) as scientific evidence. Don’t you?