I don’t think my own experiences are terribly important and I’m much more interested in arguing about the points themselves.
I’m not sure how you can disagree with the statement that mental health disorders are worse than poverty in terms of happiness; that’s true simply in virtue of what they are. Being depressed means you experience lots of negative mental states (i.e. are unhappy). Being poor doesn’t mean that. Actually being unhappy has to be worse than being a state that is likely to make you unhappy.
Putting this the other way round, you could say “depression is bad for your income, but being in poverty is worse”. Depression might cause you to earn less, but if you’re looking at income, then the state of having a low income has to be worse than having something liable to cause you to have low income. It’s also not true that all people in poverty are depressed. So I think it makes more sense to target misery, not poverty.
Do you think I’ve misunderstood your point? Sorry if I have.
I’m also very much in favour in targeting violence, crime, etc. as those seem obviously bad for happiness. However I’m not sure how bad, nor do I have a potential solution. On that note, the problem of adaptive preferences, as discussed by Sen, etc. is quite interesting. He argues that the poor adapt to their terrible condition and thus they seem surprisingly happy—they are making the best of a bad lot—and that is an additional reason to do something.
I take the other line: if I could save person X who will be made happier, or person Y who won’t be because person Y will adapt to the new condition, I’d want to treat X, not Y.
I feel like this is a motte-bailey argument. Sure, in some trivial sense “depression” is what everyone cares about, in that everyone wants to prevent suffering. A chicken on a factory farm is “depressed”. An acid attack victim is “depressed”. But it seems like when you say depression, what you really mean is “feelings of lethargy, apathy, and discouragement that afflict many people (particularly Westerners) at some point during their lives”—this is what most people understand depression to mean. It’s certainly arguable whether this is worse than many other forms of suffering, and it feels a bit arrogant to glibly dismiss other experiences.
Furthermore, you continue to use “mental health disorder” as synonymous with “depression”. As I asked before, where’s your solution for schizophrenia?
I’m not sure how you’ve reached your conclusion on the basis of what I’ve said. I’m taking ‘depression’ to be a mental health disorder with certain symptoms, including substantially lowered mood. I’m not using ‘depression’ as a synonym for ‘feeling a bit bad’.
I’m making the claim that depression, which is constituted by lots of negative emotional states (i.e. states that feel bad to the person) is probably worse that many, if not all, other forms of suffering in terms of happiness (your ‘happiness’ = the sum total of momentary positive mental states less your negative ones). In part this is because depression induces intense negative states, in part because we don’t seem to be able to hedonically adapt to the condition in a way we can to, say, becoming paraplegic.
I’m not glibly dismissing other cases of suffering. I think you seem to be objecting to doing all things considered evaluations of how bad various things are. If you don’t want to do all things considered evaluations it’s quite hard, if not impossible, to make important moral choices.
Depression is just one of a range of mental health disorders, that’s true. Where I’ve used them synonymously that was simply careless and definitely my mistake.
And I don’t have solution for schizophrenia, nor did I realise I was supposed to! I’m a philosopher who researches happiness, not a psychiatrist.
I think the claim that depression “is probably worse that many, if not all, other forms of suffering in terms of happiness” is far too strong and you haven’t provided sufficient evidence for it. As you said, you’re not a psychiatrist, and I think you’re relying too much on a priori (and somewhat tautological) reasoning, evidence from self-reporting of questionable validity, and outdated research on adaptation (see the meta-analysis that I linked in another comment). There’s a case to be made for your position, but it needs to be strengthened to justify your sweeping statements.
The reason I brought up schizophrenia is because it felt like you were moving the goalposts, not because I expected you to have a solution. You brought up aggregate mental illness statistics but then only discussed depression. But thank you for admitting the mistake.
Just to add to this. Acute schizophrenia is one of the worst health conditions on GBD13 DALY weightings (c.0.8). Severe depression is also one of the worst (c.0.65).
So Michael—I agree it’s very possible that mental health disorders are underweighted by DALY weightings because of the focusing illusion. But they are actually weighted quite highly at the moment. 10 years with severe depression is worth approximately 3.5 years of healthy life.
yes, it’s interesting that schizophrenia tops the list anyway, although this could be the case in virtue of the face it stops you from leading a normal life part of the disability (this being based on the EQ-5D), rather than because severe schiozophrenics are less happy than severely depressed people.
although they are weighted highly, that doesn’t stop them from being underweighted. Given the way DALYs are constructed—measuring health, not happiness; using preferences, not adaptation—it’s conceptually very hard to see how mental health conditions can’t be underweighted in terms of happiness. Unless and until we measure people’s experiences of various diseases we really won’t know.
My guess is that depression could be the most comparatively underweighted health state: if you can function normally, but you’re just really sad, you might do pretty well on an EQ-5D metric because you’re only doing badly in 1 of 5 criteria, and that’s the criteria most linked to happiness.
As an aside, do you know how the GBD project takes episode duration into account? Or is it just a measure of intensity?
I don’t think my own experiences are terribly important and I’m much more interested in arguing about the points themselves.
I’m not sure how you can disagree with the statement that mental health disorders are worse than poverty in terms of happiness; that’s true simply in virtue of what they are. Being depressed means you experience lots of negative mental states (i.e. are unhappy). Being poor doesn’t mean that. Actually being unhappy has to be worse than being a state that is likely to make you unhappy.
Putting this the other way round, you could say “depression is bad for your income, but being in poverty is worse”. Depression might cause you to earn less, but if you’re looking at income, then the state of having a low income has to be worse than having something liable to cause you to have low income. It’s also not true that all people in poverty are depressed. So I think it makes more sense to target misery, not poverty.
Do you think I’ve misunderstood your point? Sorry if I have.
I’m also very much in favour in targeting violence, crime, etc. as those seem obviously bad for happiness. However I’m not sure how bad, nor do I have a potential solution. On that note, the problem of adaptive preferences, as discussed by Sen, etc. is quite interesting. He argues that the poor adapt to their terrible condition and thus they seem surprisingly happy—they are making the best of a bad lot—and that is an additional reason to do something.
I take the other line: if I could save person X who will be made happier, or person Y who won’t be because person Y will adapt to the new condition, I’d want to treat X, not Y.
I feel like this is a motte-bailey argument. Sure, in some trivial sense “depression” is what everyone cares about, in that everyone wants to prevent suffering. A chicken on a factory farm is “depressed”. An acid attack victim is “depressed”. But it seems like when you say depression, what you really mean is “feelings of lethargy, apathy, and discouragement that afflict many people (particularly Westerners) at some point during their lives”—this is what most people understand depression to mean. It’s certainly arguable whether this is worse than many other forms of suffering, and it feels a bit arrogant to glibly dismiss other experiences.
Furthermore, you continue to use “mental health disorder” as synonymous with “depression”. As I asked before, where’s your solution for schizophrenia?
I’m not sure how you’ve reached your conclusion on the basis of what I’ve said. I’m taking ‘depression’ to be a mental health disorder with certain symptoms, including substantially lowered mood. I’m not using ‘depression’ as a synonym for ‘feeling a bit bad’.
I’m making the claim that depression, which is constituted by lots of negative emotional states (i.e. states that feel bad to the person) is probably worse that many, if not all, other forms of suffering in terms of happiness (your ‘happiness’ = the sum total of momentary positive mental states less your negative ones). In part this is because depression induces intense negative states, in part because we don’t seem to be able to hedonically adapt to the condition in a way we can to, say, becoming paraplegic.
I’m not glibly dismissing other cases of suffering. I think you seem to be objecting to doing all things considered evaluations of how bad various things are. If you don’t want to do all things considered evaluations it’s quite hard, if not impossible, to make important moral choices.
Depression is just one of a range of mental health disorders, that’s true. Where I’ve used them synonymously that was simply careless and definitely my mistake.
And I don’t have solution for schizophrenia, nor did I realise I was supposed to! I’m a philosopher who researches happiness, not a psychiatrist.
I think the claim that depression “is probably worse that many, if not all, other forms of suffering in terms of happiness” is far too strong and you haven’t provided sufficient evidence for it. As you said, you’re not a psychiatrist, and I think you’re relying too much on a priori (and somewhat tautological) reasoning, evidence from self-reporting of questionable validity, and outdated research on adaptation (see the meta-analysis that I linked in another comment). There’s a case to be made for your position, but it needs to be strengthened to justify your sweeping statements.
The reason I brought up schizophrenia is because it felt like you were moving the goalposts, not because I expected you to have a solution. You brought up aggregate mental illness statistics but then only discussed depression. But thank you for admitting the mistake.
Just to add to this. Acute schizophrenia is one of the worst health conditions on GBD13 DALY weightings (c.0.8). Severe depression is also one of the worst (c.0.65).
See http://www.thelancet.com/action/showFullTableImage?tableId=tbl2&pii=S2214109X15000698
So Michael—I agree it’s very possible that mental health disorders are underweighted by DALY weightings because of the focusing illusion. But they are actually weighted quite highly at the moment. 10 years with severe depression is worth approximately 3.5 years of healthy life.
yes, it’s interesting that schizophrenia tops the list anyway, although this could be the case in virtue of the face it stops you from leading a normal life part of the disability (this being based on the EQ-5D), rather than because severe schiozophrenics are less happy than severely depressed people.
although they are weighted highly, that doesn’t stop them from being underweighted. Given the way DALYs are constructed—measuring health, not happiness; using preferences, not adaptation—it’s conceptually very hard to see how mental health conditions can’t be underweighted in terms of happiness. Unless and until we measure people’s experiences of various diseases we really won’t know.
My guess is that depression could be the most comparatively underweighted health state: if you can function normally, but you’re just really sad, you might do pretty well on an EQ-5D metric because you’re only doing badly in 1 of 5 criteria, and that’s the criteria most linked to happiness.
As an aside, do you know how the GBD project takes episode duration into account? Or is it just a measure of intensity?