The mental health EA cause space should explore more experimental, scalable interventions, such as promoting anti-inflammatory diets at school/college cafeterias to reduce depression in young people, or using lighting design to reduce seasonal depression. What I've seen of this cause area so far seems focused on psychotherapy in low-income countries. I feel like we're missing some more out-of-the-box interventions here. Does anyone know of any relevant work along these lines?
A few points:
i think this is a good idea, but perhaps better excecutrd even by "non mental health" people. if your expertise is in psychotherapy why ditch that enormous competitive advantage?
i also think the evidence base on this stuff isn't yet quite there? but I'm not up to date...
My gut feeling based on knowledge, reasoning, and experience is that the low-hanging fruit like diet and lighting is quite low-impact and probably has like low to middling cost-effectiveness — but I haven’t done any math, nor any experiments.
If I had research bucks to spend on experimental larks, I would try to push the psychotherapeutic frontier. For example, I might fund grounded theory research into depression. Or I might do a clinical trial on the efficacy of schema therapy for depression — there have been some promising results, but not many studies.
I think Johann Hari’s core point is correct — or at least a core point can be extracted from what he’s saying that is correct. Anti-depressants are very helpful for some people and moderately helpful for most people. Medical clinics that give ketamine to patients with treatment-resistant depression are helpful. Treatments that stimulate the brain with magnets and electricity are helpful. Neurofeedback may be helpful. But what all these approaches have in common is they’re trying to treat the brain like the engine in a car.
This kind of argument often gets mixed in with people who say that anti-depressants don’t work or are against them for some reason. Or people who advocate for non-evidence-based, woo woo "treatments". But that’s not what I’m saying. Everyone who’s depressed should talk to a doctor about anti-depressants because the evidence for their efficacy is good and, even better, the side-effects for most people most of the time are fairly minor (providing they don’t mix them with the wrong drugs or substances), so the risk of trying them is low. And if one anti-depressant doesn’t work, the standard approach doctors will take is try 3-5 (over time, not all at once), to maximize the chance of one of them working. Other treatments like medical ketamine may be helpful or even life-changing for some people.
But I also think pharmacological and other biologistic approaches only take us so far. Depression is also about loneliness and social connection, and love and intimacy. It’s about trauma and personal history and upbringing. It’s about spiritual and existential questions, and how you find meaning in your life. I think a lot of therapists understand this, but the message isn’t getting across to a wider audience. In one of my favourite pieces of writing of all time, the personal essay "Ugly, Bitter, and True" by Suzanne Rivecca, the author recounts a conversation with her therapist:
There was something uniquely wrong with me, and I was sure of it. I told her my mental-health history: I’d been on SSRIs since I was 18; I hated psychiatrists, who I’d always found brusque and arrogant and reductive; I deeply resented my dependence on antidepressants and the genetic predisposition for major depression and anxiety, encoded in my DNA, that made it necessary to take them.
“Depression isn’t encoded in DNA,” she said.
“But almost everyone in my family has it,” I protested. “It’s a chemical imbalance, right?”
She said, “The brain changes chemically all the time. Trauma changes the brain. Stress changes the brain. Fear and love and connections change the brain. Intergenerational trauma and stress can correspond with intergenerational depression. Some of these responses are learned, not predetermined.”
She said this casually, as if she’d said it countless times to countless medicated Academy fellows bemoaning the tragic exceptionality of their innate neural shortcomings. She munched a cookie.
This probably wouldn’t have been an astounding revelation to most people. But it felt like one to me.
We’re confused about depression because we’re confused about consciousness. We can’t decide whether to treat the brain like a physical like, like a biological organ, or to treat the mind like a non-physical or spiritual or abstract thing. And we don’t know how to integrate these perspectives or to appropriately switch between them. We’ve got (in the terminology of the philosopher Wilfred Sellars) the manifest images of phenomenology (first-person subjective experience) on the one hand, and the scientific image of the brain on the other hand. What do we do with them? We’re not quite sure.
I always notice how people note with apparent surprise that some thing that clearly has an effect on our minds has an effect on our brains, according to some new scientific study. Unless we believe in dualism — if we believe in physicalism — this shouldn’t come as a surprise, since everything that happens in the mind must happen in the brain. If there’s any surprise, it’s only that the effect is detectable with our current knowledge and instruments. Literally everything changes your brain. This sentence is changing your brain in a micro way. If it wasn’t, either you wouldn’t be reading it or you would have an immaterial soul.
I have more optimism, or at least more curiosity, about psychotherapeutic research and innovation than about experimenting more with biologistic approaches. They’re not mutually exclusive, at all, that’s just where my hope/interest is strongest. Depression is a hard problem, and to make meaningful progress, we probably have to wrangle with the hard stuff: love, meaning, trust, trauma, upbringings, the spiritual and existential. Qualitative methodologies in the social sciences seem better-equipped to explore this stuff. We really should try to develop and test more psychotherapeutic methodologies than cognitive behavioural therapy (CBT). CBT is not really equipped to deal with the hard stuff.
For instance, in CBT there is a strong undercurrent of telling you that your anxious or negative thoughts are irrational and pointing out patterns like black-and-white thinking or catastrophizing. That’s fine as far as it goes, but it doesn’t go far. I have come to believe it’s more constructive to figure out the perspective from which your (seemingly) irrational thoughts are rational than to dismiss them as irrational. There is probably a rational reason why you learned to think that your friends might secretly dislike you. It might have been something you learned from experience way in the past. The blanket dismissals of CBT don’t provide the reassurance the soul needs. They don’t provide a healing experience from which a new pattern can be learned. Alternative schools of thought like schema therapy explicitly focus on that. The clinical trial results so far are promising.
U.S. Politics should be a main focus of US EAs right now. In the past year alone, every major EA cause area has been greatly hurt or bottlenecked by Trump. $40 billion in global health and international development funds was lost when USAID shut down, which some researchers project could lead to 14 million more deaths by 2030. Trump has signed an Executive Order that aims to block states from creating their own AI regulations, and has allowed our most powerful chips to be exported to China. Trump has withdrawn funding from, and U.S. support for, international governance bodies like the United Nations and the World Health Organization, thereby removing the world's most influential country from the collaborative efforts necessary to combat climate change and global pandemics. Most recently, the administration even changed nutritional guidelines, encouraging Americans to eat more animal protein than ever, which could drive more demand for unethically-produced animal products. In addition to all of this, Trump has continuously acted undemocratically, brazenly breaking norms and laws meant to protect us from autocracy and dictatorship. This goes to show just how determinative U.S. politics is to our successes and our failures.
On the bright side, we might end up getting an AI pause out of this, if the Netherlands wakes up and decides that it no longer wants to help supply chips for advanced AI which could either be (a) misaligned or (b) controlled by Trump. See previous discussion, protest. I reckon this moment represents a strong opportunity for Dutch EAs concerned with AI risks. Maybe get a TV interview where you explain how ASML is supplying chips to the US, then explain AI risk, etc.
In terms of red-teaming my own suggestion, I am somewhat worried about further politicizing the issue of AI / highlighting national rivalries. Seems best to push for symmetric restrictions on China--they are directly supplying materials to Russia for its war in Ukraine, after all. Eliezer Yudkowsky could be an interesting person to contact for red-teaming purposes, since he's strongly in favor of an AI pause, but also seems to resist any "international rivalry" framing of AI risk concerns?
I agree that this is a very important issue right now, but I’m not sure what we can do about it.
https://www.powerfordemocracies.org/research/our-recommendations/ !!
I think by the nature of how the EA Forum works, any proposed solution is likely to be more controversial than a generic "someone should do something about US politics" message. So any proposed solution will get at least a few early downvotes, causing low visibility. EAs want to upvote things which feel official and authoritative. They usually seem uninterested in improvisational brainstorming in response to an evolving situation. This will cause a paradoxical result where despite the "someone should do something about US politics" talk, proposing solutions will feel like a waste of time.
Maybe it would be good to create a dedicated brainstorming thread to try and mitigate this a little bit.
I agree. Basically anyone not in a politically sensitive role (this category is broader than it might intuitively seem) should be looking to make large donations in this area now and others should be reaching out to EAs focused on US politics if they feel well equipped to run or contribute to a high leverage project.
Unfortunately there is no AMF/GiveDirectly for politics and most things you can donate too are very poorly leveraged. Likewise it is hard to both scope a leveraged project and execute well on it. I know of one general exception at the moment which I'm happy to recommend privately.
I'm also happy to speak to anyone who intends to devote considerable money or work resources to this and pass them along to the people doing the best work here if that makes sense.
Maybe, but this also seems like the kind of extremely broadly salient thing where it would be more difficult for EAs to make a big difference on the margins with their work and funding compared to 'regular' EA causes. (though people should also focus time and money on things important to them)
What do people think of the idea of pushing for a constitutional convention/amendment? The coalition would be ending presidential immunity + reducing the pardon powers + banning stock trading for elected officials. Probably politically impossible but if there were ever a time it might be now.
If we’re doing a constitutional convention then really make it count…
-Statehood for Puerto Rico & Washington D.C.
-Expand the house so each representative represents fewer people.
https://youtu.be/KhQGHY44XPM?si=iLivhjAUAl-igEtd
-Make some extra Senators elected by popular vote.
-Make it easier to remove the president/executive with a congressional vote of no confidence or a 60% referendum vote at each mid-terms.
-Add term limits to the supreme court & elect new justices on a schedule. Or make the Supreme Court a rotating lottery of Appellate judges.
I’m still catching up on some work for a global health contractor, but when I get more spare time I want to develop a website to help people contact their representatives about several EA topics.
And it would be nice to enable multiple channels of contact like email, phone, text message, mail/post-card, social media, etc, so people can partly express intensity of interest through varied & frequent messaging.