As AI advances, the cost of pure instruction—unbundled from childcare, mentoring, and other human services—will fall dramatically. AI tutors like Khan Academy’s Khanmigo and SpaceX’s Synthesis cost just $4 and $29 per month, respectively. Tools like these will empower leaner models of education—such as micro-, home-, and hybrid-schooling—and help build out the growing school-choice movement.

I discuss Alpha School and Primer, two innovators in this space working to bring AI-driven options to families. While I don’t go as in-depth on homeschooling in the article, I think that’s an area where there is clear value to AI-tutoring tools that can replace subject-matter educators at low cost. I’m personally less concerned at this point about effectiveness than about choice, but I do want to see these things studied so parents can make the best decisions for their kids.

I also touch on issues with ideological bias in AI tools, the need for markets in AI ed tools so parents with different values can choose value-aligned options, and more. Read the full piece here.

NOTE: I normally edit podcasts myself, but this time I tried using Riverside’s AI editing tools. As a result, there are fewer filler words, but some clicks, cuts, and bumps in the audio. Let me know what you think.

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Jordan Peterson Podcasts mentioned in the intro:

  • The Meaning Crisis: Resolution | Dr. John Vervaeke

  • Wisdom, Delusion, Consciousness & the Divine | Dr. Iain McGilchrist

  • The Immortality Key; Psychedelics and the Ancient Age | Brian Muraresku & Prof. Carl Ruck

• Jordan Peterson, Maps of Meaning Lectures (2017)

• Jordan Peterson, Personality Psychology Lectures (2017)

• Jordan Peterson, 12 Rules for Life

• Jordan Peterson, We Who Wrestle with God

• Sam Harris + Peterson podcast on what is true

• Jonathan Pageau + Peterson podcast on the perfect mode of being

• Alex O’Conner + Peterson on how Peterson’s beliefs have changed

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Frawley et al., “Constructing a Crisis: Mental Health, Higher Education and Policy Entrepreneurs”

• Frawley, et al., “Mental Health, Higher Education, and Regulatory Capitalism: Steering not Rowing.”

• Ashley Frawley, Significant Emotions: Rhetoric and Social Problems in a Vulnerable Age

• Ian Hacking, The Taming of Chance

• Kenan Malik, The Meaning of Race

• Cabanas & Illouz, Manufacturing Happy Citizens

Consider student behavior. Teachers, principals, and superintendents have expressed alarm at the rising number of students acting in disruptive and even violent ways. “Students throw furniture, overturn desks, shout insults, threaten violence, and curse out teachers, support staff, and classmates,” reports Cindy Long, senior writer for NEA Today. This permissive school climate has been facilitated by major federal- and state-led efforts to reduce suspensions and expulsions, out of concern that minority and disabled students get disciplined at disproportionately high rates.

In lieu of traditional disciplinary measures, schools direct students to participate in quasi-therapeutic interventions intended to address the trauma and mental-health challenges that purportedly cause behavioral issues. While arguably well-intentioned, practices like “restorative circles” (teacher-guided group counseling) and “restorative conferences” (facilitated conversations between a victim and offender involved in a conflict) have taken up valuable class time while failing to improve student behavior.

Attendance, too, has suffered under this more lenient approach. During the Covid-19 pandemic, schools understandably relaxed attendance requirements. But long after the pandemic’s peak, many schools still hesitate to enforce their pre-pandemic attendance policies, such that one in four students is now chronically absent.

Academic standards have similarly eroded. Schools are increasingly adopting practices that inflate grades, such as allowing students to retake tests, accepting late assignments without penalty, giving credit for minimal effort, and even refusing to give failing grades. One study of 33,000 student grades found that 40 percent were inflated beyond what might have been expected, given those students’ standardized test scores. Standardized testing itself is falling out of favor among many education officials, who now advocate for more subjective measures of success to boost the passing rate for lower-performing students.

We go on to discuss causes and solutions in broad terms. Read here.

I’m not saying there shouldn’t be any standards whatsoever. The mentally ill are a vulnerable population, and there should be barriers to protect them from incompetent or malevolent actors. But the current situation doesn’t make sense.

The United States is experiencing a psychiatrist shortage, with patients in rural areas and poorer urban settings most lacking access. While the conversation around addressing this shortage has mainly focused on how to persuade medical students to enter psychiatry, we should be discussing whether it makes sense for would-be psychiatrists to go through 12 years of education and training in the first place. Clinical psychologists are also in short supply, with 56% no longer taking new patients. It takes between 9 and 12 years to become one.

The lengthy path to completing these advanced degrees is a historical accident more than anything else. Psychiatry originated within the field of medicine, which is why psychiatrists must study to be physicians even though they end up treating mental illnesses. After World War II, there was a shortage of psychiatrists to care for returning soldiers with mental health problems, so psychology PhDs were permitted to step in and provide treatment, birthing the field of clinical psychology. 

While there is a lot to learn about the science of mental illness and its treatment, it shouldn’t take longer to become a psychologist or psychiatrist than to become a lawyer, civil engineer, or military officer. Representing a defendant in criminal court, designing a bridge that millions of cars will drive over, or making life-and-death decisions on the battlefield involve risks that are at least comparable to the most critical decisions in mental healthcare, such as whether to involuntarily hospitalize a patient. Shortening the length of these programs or allowing people to start them as undergraduates would lead to more people entering and completing them. This is especially true for clinical psychology, which takes a similar amount of time to complete as psychiatry but pays less than half as much.

A master’s degree in counseling, social work, or psychotherapy is typically required to be a psychotherapist. Yet therapists with more education or training do not have significantly better client outcomes, and different psychotherapies are similarly effective at treating common mental health conditions. Given that the most robust predictor of success in therapy is the quality of the relationship between therapist and client rather than the therapist’s expertise in academic psychology or the specific type of therapy they are trained in, it would be sensible to scale back the educational requirements to become a therapist. 

One could agree with my previous points and still support current educational and training requirements because of the selection effects they create. Lengthy and competitive processes filter out individuals who are less competent or dedicated, and the differences in time it takes to complete different degrees loosely correspond with a hierarchy of knowledge and skill. Additionally, the time it takes means that psychiatrists and psychologists tend to be older when they begin practicing, and in mental healthcare there's generally a preference for older and wiser professionals relative to fields like law or engineering.

All that said, there’s likely a sweet spot we’re overshooting. Many caring and intelligent people avoid these careers because they don’t want to be a student for a decade, and while longer educational requirements may bump up the average age of skilled clinicians, it also deters middle-aged people looking for a second career from switching in.

Finally, there are laws that regulate what treatments and services different kinds of mental health professionals can provide. For instance, psychologists can administer psychotherapy and conduct psychological testing but not prescribe medication in most states. While these regulations exist to protect patients, relaxing them may save lives. States that have granted psychologists with psychopharmacological training the ability to prescribe psychiatric drugs have seen a 2% increase in the number of children receiving mental health medication and a 5 to 7% drop in suicides compared to states in which psychologists cannot prescribe.

Here are some suggestions for how we could lower the amount of time it takes to become a mental healthcare professional while keeping standards high:

1. Let aspiring psychiatrists, clinical psychologists, and psychotherapists begin their specialized training during undergraduate studies.

2. Offer undergraduate programs in psychiatry and clinical psychology with direct pathways into these advanced degrees.

3. Create an alternative medical school curriculum for people who want to be psychiatrists with a greater emphasis on psychopathology, neurobiology, and psychopharmacology.

4. Allow undergraduate psychology programs to offer a pathway to become a registered psychotherapist, such that graduates who complete the requisite coursework and practicum can practice once they graduate.

5. Enable psychologists with appropriate psychopharmacological training to prescribe psychiatric medications in all states, following the model of states that have already implemented this.

6. Maintain high student standards by continuing with standardized tests, comprehensive exams, and challenging practicums.

I’m not advocating for anything radical here. I still think mental health professionals should be educated, trained, and supervised for a time. But more people want mental health care than ever before, and there simply aren’t enough licensed professionals to treat everyone right now. Wait times are long, and people with the worst mental illnesses often have access to the least amount of care. All we have to do is cut down on the amount of time mental health professionals spend in school and expand their capabilities by a reasonable amount, and the supply of mental health care professionals would rise to match the growing demand.

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Carolyn’s new report

• Daniel Goleman, Emotional Intelligence: Why it Can Matter More Than IQ

• Allen Frances, “No Treatment as the Prescription of Choice”

• Jonathan Haidt, The Anxious Generation

• Carolyn’s review of the Anxious Generation

Ives Parr is an independent scholar known for his writing on the science and ethics of genetic enhancement. I invited him on the podcast to talk about how polygenic screening and embryo selection could be used to prevent or reduce the risk of mental illness.

Ives and I discuss whether there are trade-offs between mental well-being and other traits, potential arms races in selection for mental and physical abilities, which kinds of psychological diversity we should value, whether parents with mental health issues or physical disabilities should be permitted to intentionally create children with those same problems.

The Science of Genetic Enhancement

Jonah: Most people, when you say genetic enhancement, are probably thinking of CRISPR. The kind of genetic enhancement that you’ve been writing about has mostly been a different kind called embryo selection. Can you start by explaining how you see genetic enhancement and what the current state of genetic enhancement looks like?

Ives: Sure. You’re correct that CRISPR gene editing is higher in the public consciousness. In 2018, there was an incident where a scientist actually edited two embryos of young girls, Lulu and Nana. They eventually grew up to become two babies, and this was the first public case of that. And so a lot of people are more familiar with that incident than they are with the current available technology.

The most interesting technology at present is the ability to use polygenic screening. Polygenic screening takes place when a couple is undergoing in vitro fertilization. They want to decide some criteria to select the embryos on the basis of, so most commonly couples are deciding to select for embryos that are healthier.

In the recent past, it’s been very common for couples undergoing IVF to decide that they want to implant an embryo, and when they were looking into which embryo they wanted to implant, they would look for a condition called aneuploidy. Aneuploidy is an abnormal number of chromosomes. The most common example of this is Down syndrome. People with Down syndrome live very short lives that are much more difficult, and they suffer from cognitive impairment. So generally people want to avoid implanting an embryo that has any form of aneuploidy. Other aneuploidy conditions are also typically pretty bad, and most of the time aneuploidy pregnancies actually don’t result in successfully carrying the child to term. So it’s been common practice that couples would do screening for aneuploidy.

More recent developments and understanding of genetics have allowed couples to also screen for what are called monogenic conditions. Monogenic conditions are when a couple may be concerned about having a disorder associated with a single gene. It’s possible that one is recessive or dominant. So you could have some cases where future offspring may not have the condition, and some offspring may have the condition. A famous example of this is Tay-Sachs disease. When couples are deciding if they’re at risk of having a child who may suffer from these monogenic disorders, they may be inclined to undergo monogenic screening. That’s been common for quite some time now.

But the most recent and exciting development is polygenic screening. This polygenic screening looks at a larger portion of the genome and it looks for polygenic traits. Monogenic is associated with one gene. Polygenic is associated with many genes, and so this allows couples to select on the basis of diseases that are associated with many different genes. These are much more common, and more people are at risk of these sorts of things. It’s more like diabetes, heart disease, Alzheimer’s, cancer, and these sorts of conditions.

Now, this was only possible due to recent advances in technology that made sequencing and genotyping much less expensive. So now we can actually study our genome and understand which genes are associated with which conditions, and it’s now affordable for couples to biopsy the embryos and have them genotyped to determine whether or not they’re at higher or lower risk. And the company that’s using that sort of technology currently that’s most prominent is called Genomic Prediction.

The first baby born using that technology was born in 2020. The baby is Aurea Smigrodzki, and there is a video I have written about showing the father and his wife taking care of the baby. More recently, there’s also been a public case in which Malcolm and Simone Collins selected on the basis of both health and psychological well-being, and I also posted about them more recently.

Jonah: Polygenic versus monogenic screening gets a lot of people confused because oftentimes when social scientists or geneticists say oh, well this thing is genetic, being gay is genetic or depression is genetic, the retort to that from a lot of people has been, well, where’s the gay gene or where’s the depression gene? It’s common to see science write-ups where some journalists are saying, oh, it turns out depression isn’t genetic because there is no depression gene. You see this sometimes in the antipsychiatry community too.

The important thing to understand is that most of these conditions that are of social interest, they’re not one hundred percent caused by genes, but to the extent that they are, it’s going to be many genes and very rarely just one.

Ives: That’s exactly right. People tend to think in simplistic terms about genetic architecture, thinking that one gene equals one trait, whereas really these traits are very complicated, and many genes make small contributions. Psychological traits such as depression, schizophrenia, and bipolar are polygenic traits.

This should go along with people’s intuitive sense of these traits because almost everyone recognizes that there are levels to this. Some people are very depressed most of the time or experience a brief bout of depression. Some people experience milder depression. The genetic contribution to these traits is polygenic, and so the result is that these traits end up looking like bell curves. They form normal distributions because people tend to fall somewhere in the middle of the average of schizophrenia or propensity for depression, these sorts of things.

Embryo Selection for Mental Health

Jonah: Oftentimes, when people are talking about genetic engineering through embryo selection, they’re often talking about traits like IQ, health, and happiness. But as you’ve just said, by the very same logic, we could also make it so that people have the choice to select an embryo that is less likely to have a mental illness. That could involve screening different embryos to see if one is in the 99th percentile for likelihood of having schizophrenia or something like that.

That’s an extreme example, but maybe even something like anxiety, which is less heritable than the other mental illnesses, a person could then say, okay, I’m not going to choose that embryo to continue with and instead I’m going to choose an embryo that has very low polygenic risk score for these mental illnesses. Right?

Ives: Absolutely. I know one concern that people have is that, say you’re selecting strongly against schizophrenia, you may inadvertently select for depression; or you’re selecting against depression, you may inadvertently select for a very anxious person. Fortunately, there’s more positive pleiotropy. These negative psychological outcomes tend to correlate together. They tend to have shared overlapping genetic architecture so much that some believe we could characterize psychiatric conditions with a general p factor, and if we were to select against the p factor, we could probably reduce the incidences of all mental illnesses.

Most people agree that that would improve psychological well-being, but they raise specific objections and many concerns to these interventions that they would not normally raise towards an intervention that would make children psychologically healthier. They’re very concerned about the genetic angle. If you knew that you could reduce your child’s risk of psychiatric conditions through breastfeeding, people would have not many objections. They wouldn’t say, well, we need kind of crazy people or something like that. I think they would be fully on board. But as soon as you start talking about genes, people get very concerned

Jonah: We’ll talk about those concerns in a bit. But just to stay on the p factor, this is an important and under-discussed idea in psychology. We know that so if your father was schizophrenic or bipolar, you’re more likely to be schizophrenic or bipolar. That’s well-established and intuitive. But what we also see is that all these different mental illnesses are somewhat genetically related. Sometimes they’re weaker or stronger than others, but they all kind of cluster together. The p factor is based on the g-factor of intelligence, where all the different kinds of smarts correlate strongly. We see that with mental illness too.

There’s also been some recent work looking at the d factor, which is a disease factor, and so some people are arguing now that not only do we see mental illnesses clustering together, but also physical illnesses and mental illnesses cluster together. We can say that some people are just, unfortunately for genetic reasons, more prone to all types of illness. That’s on the one hand quite sad because it suggests that some people are getting the short end of the stick in life through no fault of their own. They are just born extra susceptible to mental and physical illnesses. On the other hand, it does raise the possibility that if couples could select against this d factor, it would be easy to select against that and improve the health of those future children, and perhaps over time the population.

Ives: This may be the way to go in terms of marketing: There’s a general overall health factor, and if you just select for overall health, you’ll make people mentally healthier, you’ll make them physically healthier, and probably have higher average cognitive ability. That may be a good framing as all of those are aspects of health. But the good thing about these sorts of positive correlations and these general factors that are positive is that it makes the task of selection much easier.

One concern, like I was saying earlier, is you have this sort of antagonistic pleiotropy wherein you try to make someone smart, you end up making them very sickly; you try to make them healthier, you end up making them mentally ill. It looks like that’s really not a concern when you’re doing selection. The good things tend to go together reducing how complex the embryo choice problem is for couples.

Jonah: You point out that if you sell it on physical health, that seems much less controversial than selling on mental health. This is kind of strange because mental illnesses can be just as debilitating as physical illnesses. But for some reason, people don’t get as upset and are less sensitive about most physical problems than mental problems. If you say we’re going to try and use genetic engineering to outbreed diabetes, everyone would say, oh, of course, great. But if you said, oh, well, we’re going to try and get rid of depression, ADHD, something like that, people would have a lot more reservations, maybe along the lines of, I identify with my mental illness, it’s in some way a part of me, and I don’t like that you are trying to get rid of it.

This is sort of the argument people say with Down syndrome will make against these more basic kinds of embryo screening to get rid of Down syndrome. They will say, why would anybody not want to be alive just because they’re like me? I have a great life. This is part of who I am. So I mean, do you think the sell, if there is a sell is going to be mostly around physical health, or do you think there’s a way to make it more palatable around mental illness?

Ives: I think that people are probably most susceptible to physical health, and the monogenic testing and the aneuploidy testing go largely uncriticized. People don’t necessarily care. People care in the case of abortion, but abortion is quite morally different to people than in vitro fertilization, and I don’t see huge public backlash for monogenic disorders or aneuploidy. People are hesitant towards polygenic screening for health and will be for a while, but eventually people will fully accept that and there’ll be high rates of acceptance for that.

Now, things like mental health, I think people will also be largely receptive to, but there’ll be some concerns about improving cognitive ability and maybe changing personality to some extent. People form their identity around their personality and trying to mess with that is kind of concerning. There’s a stigma around the association between psychological traits and genetics that makes people feel very uneasy, but I think eventually this technology will be totally embraced and will hopefully be considered an ethical thing to do. I think that mental illness will probably not face too much backlash if it’s stuff like schizophrenia, depression, or anxiety. Hopefully parents are receptive to that.

Selection against those traits will actually be more important than selection for physical health because a lot of the diseases that the company Genomic Prediction is selecting against have late onset. You don’t experience Alzheimer’s until you’re quite old or you’re not necessarily getting prostate cancer until you’re quite old, whereas these sorts of psychological conditions can come early. You can become schizophrenic or experience depression and anxiety early on, and I would think that these sorts of conditions reduce welfare more than physical illness except in extreme cases. So I think selection against mental disorders is a moral priority and more important than selection against physical health, although people will be more receptive to the physical health stuff.

Jonah: Yeah, I mean one kind of counter-example I could think of is take something like psychopathy, right? Psychopathy seems to be quite a successful strategy in some cases. If you were born a psychopath and you’re surrounded by people who are not psychopaths, who are just kind of pleasant and nice, you could prey on them quite easily. Psychopathy is usually something like 1% of the population, and I think it’s kind of stayed around that number consistently because that seems to be an equilibrium number. So I wonder if that’s an example of a trait where keeping that trait might confer some advantages to the people who have it over not having it.

Ives: Yeah, there’s a problem where if you genetically engineer everyone to be nice they’re more susceptible to being taken advantage of. There are a lot of these game theoretical issues that the author Jonathan Anomaly addresses in a book called Creating Future People. Another point about this is, for example, height in men. Women tend to prefer men who are taller than them, and they tend to prefer the taller of the men generally speaking. But if you were to genetically engineer everyone to be taller and taller and taller, it’s this sort of runaway problem where people end up being way too tall, physically unhealthy, and so forth. Now, if you were to make everyone as nice as possible, you would open yourself up to exploitation by people who are psychopaths.

The point about whether we should intentionally make people somewhat psychopathic if it confers an advantage in some cases, maybe we could capture the advantage of certain psychological traits without having the necessary downsides because the human genetic architecture is so complex, so it has so many dimensions to it that we may be able to have sort of the ruthless, hardworking person who’s trying to get to the top, but also make them really not prone to violence. We want CEOs and leaders of industry, but we don’t want serial killers and psychopaths who take advantage of others. I think that the genetic architecture of people is complex enough that at some point we’ll be navigating through this space, and we’ll be able to create people that are very driven but not prone to violence and hurting others.

Art and Culture Post-Mental Illness

Jonah: Thinking about psychological diversity brings up kind of an interesting question. People with mental illness add a lot of cultural richness. So you think about artists like Van Gogh, Ian Curtis of Joy Division, Woody Allen, people who are psychotic, depressed, anxious, they add a lot of richness to art and culture. They look at things in a different way than psychologically healthy people do. Personally, I would find life boring if people who didn’t have similar experiences to me weren’t creating culture and weren’t putting out works that looked at the world in a more depressing way. Psychologically healthy people often appreciate those kinds of works too. Will curing or preventing mental illness at a population level lead to a leveling of culture? Do we lose something when we do not have the same psychological diversity interpreting the society around us?

Ives: It’s an interesting question. I think psychological diversity will be important. To what extent is creativity and interesting cultural contributions dependent on unusual thinking, and how much is actually driven by mental illness versus personality? There’s an interesting article by Jonathan Anomaly, Christopher Ingal, and Julian Valles, called “Great Minds Think Different Preserving Cognitive Diversity in the Age of Gene Editing” that discusses why we can’t all psychologically be the same. There are some benefits to having people that think differently.

An important question is, how many of these great intellectual contributions are dependent on psychological suffering? To some extent, we would hope that maybe they just have very different personality differences and that you could just select for different personality differences. And the result could be that you get geniuses who make interesting creative contributions while not necessarily suffering from depression or anxiety.

It may be important for some people. When you have super geniuses that make really important intellectual contributions, sometimes they’re really weird and there is an interesting discussion about whether or not that’s necessary. Or is it a consequence of their intelligence? I don’t think it is. I think that being intellectually weird predisposes you towards creative and intellectual success. And I think that maybe for example, if you have someone that’s so strange that they don’t have any friends and they don’t have a girlfriend or boyfriend and they spend all their time on mathematics or something like that, they may be way more likely to make a breakthrough contribution to mathematics. Do we want that sort of thing, and can we avoid if it is necessary?

I think if we allow for reproductive autonomy fully, we’re going to see a diversity where parents who are more similar meet with each other and then have offspring that are more similar to them, and hopefully the interesting, creative, intellectual genius sort of contributions are dependent on personality rather than actually experiencing suffering.

Jonah:  Maybe if you have a mentally healthier population, the audience for that kind of cultural content also drops significantly. Maybe if there are fewer sad people, there’s going to be fewer Kurt Cobains who are making a lot of money off of sad music because people don’t want to listen to sad music. Or if they do, they want to listen to a very mild kind of sadness or something like that. Perhaps as the diversity of cultural creators shrinks so will the audience, and nobody will be complaining. I mean, in the end, there’ll just be a world where everybody’s listening to pop music and they’re watching fun, happy movies, but nobody’s upset about that or nobody cares. Maybe the problem solves itself.

Ives: Yeah, I think it’ll be a long time before everyone is a product of genetic enhancement. That would take a very long time. And then we would probably see if it really is a sort of, I think maybe if we need more sad people, you could use environmental interventions, but I don’t think people would be receptive. Because one concern is you could say, well, we need more sad artists or something like that. Maybe we could expose them to chemicals that distort their mood or give them brain damage and make them act crazy or something like that. But I don’t think anyone would be receptive to that sort of thing. What do you think about that idea?

Jonah: Yeah, that would be wrong. I could imagine some people doing it voluntarily, but I agree with you. It’s more going to be along the lines of people will stop caring. Maybe there’ll just be fewer Dostoevskys, but there’ll be fewer people who want to read novels like that.

Ives: I think that artificial intelligence is getting so good that it’s plausible we can just automatically create any sort of media that we want soon. I think you could go to Midjourney and generate sad pictures all day long or sad novels and maybe it’d be extremely high quality in the near future.

Can Impairment be Ethical?

Jonah: What if there’s someone who in the current year knows about this technology and wants their child to be anxious or depressed like they are? And the reason they want that is because they want to be able to relate to their kid. They want that kid to have similar experiences as they did. They want them to grasp the sadder side of life because that will sort of help them relate to the parent. And even though they know it’s not necessarily in the best mental health interests of their kid, they see it almost as a personality or character trait.

It strikes me as something that a lot of people, even as they are concerned about mental illness and mental health, might consider doing because increasingly we identify with our mental illness or issues. We say, oh, it’s part of my identity, it’s also part of my culture. Increasingly that seems true versus it being something you don’t tell anybody else about. So I’m wondering if that will be something that people want to do. And if so, I mean, is that wrong? Is that morally reprehensible? What do you think?

Ives: That’s morally wrong. It’s probably unlikely that a clinic would provide that service for you to have a child that suffers more. It’s kind of akin to if a person was violently abused as a child, they want to violently abuse their child. Maybe it’s not quite akin to that, but I try to think in terms of analogies with environmental comparisons.

I’ll propose a counter thought experiment: Imagine that a couple wanted a child that experienced depression and anxiety and by the luck of the genetic lottery, the child was born extremely psychologically healthy. Do you think it would be ethical for the parents to make the child’s life bad, to inflict treatment on them that would make them anxious and depressed? Maybe not allow them to have friends, physically hurt them, verbally abuse them, or do any sort of thing to better relate to them?

Jonah: I agree, it seems very wrong. There is a real-life example that is similar to that. Deaf people have these things called cochlear implants, which give some the ability to hear. And if a deaf kid grows up with those cochlear implants, then they will be able to live life as a normal person. They don’t need to learn sign language, although many do. But you’re basically going through life like a hearing individual. Some people in the deaf community are against cochlear implants for kids or anyone, and the reason they give is that they say, well, deafness is its own culture with its own community sign language is its own language. If we have a technological solution to this problem, we are going to lose that culture, community, and language.

From the outside looking in at that community, that seems cruel. How could you ever want to deny someone the ability to hear just for the preservation of your group? But a lot of these groups naturally have this group mentality where maybe they’re united around a defect or a flaw or a problem, but they want to preserve that. They’ve come to identify with it and don’t like other people telling them that it’s something that needs to be done away with.

Ives: Yeah, it’s interesting. There was a case a long time ago that was often discussed among bioethicists where a lesbian couple, both of whom were deaf, wanted to have a deaf child. So they intentionally selected a donor with congenital deafness. They ended up having one child who was deaf, I believe, and then they had a second one. The second child ended up being discovered and it got media attention, and that’s when it was debated. The second child was able to hear a little bit, and they said that they needed to start teaching him English or give him cochlear implants or something along those lines for him to properly develop speaking and hearing successfully. I think they intentionally decided not to give it to him. In my mind, it is unethical to deprive him of that environmental intervention.

But I also think it was unethical of the couple to intentionally have a child that they wanted to be deaf. I know some bioethicists disagree. I like Julian Savulescu, but I believe he defended their right on the grounds of reproductive autonomy. They decided to choose a donor that they knew the child would end up deaf with. But Julian Savulescu interestingly believes that, or I believe created a principle called “procreative beneficence.” He believes among the available embryos, you should pick the one that to experience the best life. But he also believed in reproductive autonomy, and he believed that that couple had the right to have that child and that having that child is not immoral because the child in a counterfactual world wouldn’t have experienced anything whatsoever. They wouldn’t have existed otherwise. So no harm was brought upon the child.

In my view, that’s kind of an irrational preference. I can understand why someone would want that, but that makes the child’s life difficult and it doesn’t prevent them from actually learning sign language and communicating with the deaf community, but it does ensure that they can’t communicate with other people. I think that level of desire is too far, and it reduces the well-being of that child. It is obviously a disability because you have less ability to do things, and we have accommodations in place to take care of people that have disabilities. I don’t think that people should feel bad for having them, but when we’re creating people we should want to create people that have experienced high welfare.

If a couple were to select an embryo they expected to be deaf. It’s not quite equivalent, but morally, I think that’s intentionally deafening your child when others that are not deaf are available. So inflicting that environmental deprivation on the child is somewhat like that. It’s very clearly immoral and most will recognize that taking out your child’s eardrums is morally wrong. But I think also for similar reasons, it’s not quite equivalent, but intentionally having a deaf child is also not morally good. I think it’s wrong to do that.

Conclusion

Jonah: Yeah. Well, I have been following the conversation around embryo selection for a while, and I’m optimistic about it, especially for mental illness. One thing that people have not wrapped their heads around enough is that mental illness to a large extent, especially bad mental illness, is quite genetic. It’s not that trauma isn’t bad, can’t make people unhappy, or can’t make someone go into a depression or something like that; I’m not suggesting that trauma isn’t terrible. But we have to focus more on the genetic aspect because that is doing a lot of the heavy lifting, especially for some of the most debilitating mental illnesses.

Ives, I’m glad there are people like you out there who are writing on this topic and who are trying to push for a better future, a healthier, happier future. Where can people find you?

Ives: I’m on Substack at https://parrhesia.substack.com. You can find me there. That’s pretty much the only place. I’m not active on Twitter or anything like that, so check out my stuff there and I really appreciate you having me on. Thank you very much.

Jonah: Thank you.

Mental health issues among kids and teens have been rising for the past few years. Schools have attempted to deal with this surge by integrating mental health interventions into the school day. This can be overt, as in mental health awareness programs, or covert, as in Social Emotional Learning (SEL) which sneaks emotional education into normal subjects like math and P.E.

Whether or not one agrees with such an approach in principle, Gorman and Dziengelski are correct in pointing out that there is no solid evidence for its efficacy:

Decades of research have found little rigorous evidence that universal school-based mental-health programs prevent youth mental illness or suicide. These programs do not direct clinical resources based on the severity of a child’s condition. Instead, students least in need of mental-health services get outsized attention, while those who most need psychiatric care fall through the cracks.

“All sorts of so-called universal interventions, in which a big group of teens are subjected to ‘healthy’ messaging from adults, have failed,” writes Olga Khazan in The Atlantic. In fact, she highlights, some studies find that such interventions result in worse outcomes, even when the programs were developed from evidence-based approaches like dialectical behavior therapy and cognitive behavioral therapy.

Why aren’t these programs working? One reason may be the difficulty of adapting new versions of evidence-based programs outside of a research context. Another reason, as Abigail Shrier has documented, may be the iatrogenic effects of such anticipatory therapeutic interventions—that is, the treatment itself can make things worse. “Awareness” programs, for instance, can make kids glamorize or ruminate on mental states they previously hadn’t been inclined to indulge, to sometimes harmful ends. Just as D.A.R.E. didn’t succeed in reducing drug use and WebMD has not made people healthier, educating kids on a wide-range of disorders won’t prevent them from developing psychiatric issues.

The authors cover a growing number of worrying trends: Teachers being forced to act as pseudotherapists to their students; a growing class of “mental health promotion” workers whose careers are based on them delivering these ineffective public health-style programs, and the lack of resources and attention available for the severely mentally ill children who need them most.

Read the full piece here (highly recommended).

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Jules Evans, How to Communicate the Risk of Psychedelics

• Jane Hu, 5 Questions for Kristin Nash

• Canadian Psychedelic Survey

• Jules Evans, Extended Difficulties Following the Use of Psychedelic Drugs

• Huberman Lab, Dr. Robin Carhart-Harris: The Science of Psychedelics for Mental Health

• Tate et al., Trends in Hallucinogen-associated Emergency Department Visits and Hospitalizations in California from 2016–2021

• Andrew Cutler, Eve Theory of Consciousness 3.0

• Clinicaltrials.gov

• Theo Von Describes the Difference Between DMT & Ayahuasca

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• William Fleming, Employee well-being outcomes from individual-level mental health interventions: Cross-sectional evidence from the United Kingdom.

• Ellen Barry, Workplace Wellness Programs Have Little Benefit, Study Finds.

• Jonah Davids, Corporate Mental Health Programs Don't Work.

• Jesse Singal, The Quick Fix.

• Kelly et al., Overload: How Good Jobs Went Bad and What We can Do about It.

• David Graeber, Bullshit Jobs: A Theory.

• Soffia et al., Alienation is not 'bullshit': An empirical critique of Graeber's theory of BS jobs.

• Simon Walo, ‘Bullshit’ After All? Why People Consider Their Jobs Socially Useless.

• William’s Twitter, LinkedIn, Email

Few studies evaluate autistic children’s negative experiences of [ABA], making it hard to conduct an adequate cost-benefit analysis. Those studies that report children making long-term gains in functioning are of middling scientific quality, casting doubt on the therapy’s status as an authoritative treatment. Practitioners and parents swear by the therapy, while many of those who receive it don’t support its use. It’s plausible that ABA is helpful in some cases and harmful in others, but without a commitment to the scientific process and rigorous policy evaluation, we will never be sure whether, and for whom, the therapy works.

One autism researcher came to a similar conclusion as me while writing a report on the evidence for autism treatments, and was harassed by members of the autism care community.

Soon after Whitehouse released his report, numerous clinicians, therapy providers, and professional organizations went after him. They complained to his employer about his research, threatened to sue him, and harassed his family members. Their desire to attack a scientist who exposed the shabbiness of this literature—rather than the generations of scientists who compiled a low-quality body of work—speaks to how little the field today is focused on successfully understanding autism. A whole credentialing apparatus—professional organizations, certification bodies, and college-degree programs—revolves around ABA. As long as parents and the public believe the therapy is scientific, the ABA apparatus can keep profiting.

This looks like a typical case of trying to cancel someone whose research offends you, but in this case the topic of the research is literally whether the treatment we are using on some of society’s most vulnerable people is effective or not. Shouldn’t everyone want to know the truth?

Read the full article here.

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Stoa Conversations, How to Think Fast, Slow, and Stoic.

• Brittany Polat, How Do Stoics Care?

• Johnny Thomson, Naive Stoicism: Why Pop Philosophy is Bad for your Mental Health.

• Mamat & Anderson, Improving Mental Health by Training the Suppression of Unwanted Thoughts.

• Mental Disorder Podcast, Kevin McCaffree - Suicide Research has Failed.

• Philipp Reiff, Freud: The Mind of the Moralist.

• Thomas Szasz, The Myth of Psychotherapy.

• Bruce Alexander, The Globalization of Addiction.

• The Stoa App.

• Caleb’s Substack, Twitter.

In it, he analyzes data from Britain’s Healthiest Workplace, a yearly survey of thousands of British workers and hundreds of organizations. The survey asks workers whether their employer offered any mental health/well-being programs and whether they had participated in one or more in the past year. The results suggest that these programs did nothing to increase worker well-being on average. This is the abstract:

Initiatives that promote mental well-being are formally recommended for all British workers, with many practices targeting change in individual workers' resources. While the existing evidence is generally positive about these interventions, disagreement is increasing because of concerns that individual-level interventions do not engage with working conditions. Contributing to the debate, this article uses survey data (N = 46,336 workers in 233 organisations) to compare participants and nonparticipants in a range of common individual-level well-being interventions, including resilience training, mindfulness and well-being apps. Across multiple subjective well-being indicators, participants appear no better off. Results are interpreted through the job demands–resources theory and selection bias in cross-sectional results is interrogated. Overall, results suggest interventions are not providing additional or appropriate resources in response to job demands.

Looking at a variety of classes, programs, and apps offered by employers, Fleming found that most of them had little to no impact on measures of well-being or workplace satisfaction. More specifically, he found no difference between those who did and didn’t participate in relaxation practices, time management, coaching, financial well-being programs, well-being apps, online coaching, and sleep apps. He also found that those who participated in mindfulness and resilience programs fared worse on important measures, while workplace volunteering opportunities seemed to have small but consistent positive effects.

Given that the survey is cross-sectional, Fleming discusses the possibility that these results are driven by selection bias, with less mentally healthy individuals being more likely to opt into these programs, driving down the well-being of those within them. While he finds no differences in well-being from program participation among those who reported feeling unwell due to work-related stress in the past year, selection may still play a role in explaining the results.

While there may not be long-term benefits to well-being for people who participate in corporate mental health programs, it still might be enjoyable, relaxing, or educational in the short term. Of course, most corporations invest in mental health programs because they think it will save them money down the line, and don’t actually care whether Paul from accounting felt better for 24 hours after taking a mindfulness class.

Fleming concludes the paper by stating what I think most people, other than corporate consultants, obviously know to be true. If you want people to be happier and less stressed at work, it’s better to make work less stressful rather than offer people mental health treatments to take the edge off their jobs. “Organisational interventions, such as changes to scheduling, management practices, staff resources, performance review or job design, appear more beneficial for improving well-being.”

Read the full paper here.

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Awais Aftab, Epistemic Justice and Psychiatric Clinical Practice.

• Anti-psychiatry reading list.

• Awais Aftab, Antipsychiatry as an Analogue of Populism.

• Freedland and Zorumski, Success Rates in Psychiatry.

• Peter Simons, JAMA Psychiatry: No Evidence that Psychiatric Treatments Produce “Successful Outcomes.

• Awais Aftab, Lost and Found in Translation: From JAMA Psychiatry to Mad in America.

• Robert Whitaker, Answering Awais Aftab: When it Comes to Misleading the Public, Who is the Culprit?

• Awais Aftab, What Whitaker wants us to know about Mad in America.

• Robert Whitaker, Anatomy of an Epidemic.

• Awais Aftab, The Case for Antidepressants in 2022.

• Awais’ Substack, writings in Psychiatric Times, professional website, Google Scholar, Twitter.

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• John Hirschauer, The Last Institutions.

• John Hirschauer, A Failed 'Solution' to 'America's Mental Health Crisis’.

• Robert Shavelle, David Strauss and Steven Day, Deinstitutionalization in California: Mortality of Persons with Developmental Disabilities after Transfer into Community Care, 1997-1999.

• John’s Twitter

Written by Tristan Maclean, PhD.

Intro

There is much controversy surrounding the field of psychology as a whole and much discourse separately and relatedly about therapy (“everyone needs to be in therapy” vs. “therapy is fake.”) However, there has been little discussion of a more practical issue: how the perverse incentives of healthcare organizations and administrators are forcing psychologists and other licensed therapists to provide a much lower quality of psychotherapy than is desirable, effective, or “evidence-based.”

My Background

I’m an early career clinical psychologist who took a somewhat non-traditional route to obtain my doctorate and now practice in a managed care organization. My doctoral program provided high-quality clinical training and ensured I gained experience in embedded healthcare settings with an intentional eye to the growth of this therapy delivery model. My non-traditional background, clinical and didactic training, and current experience within a managed care organization inform my perspective on issues in the field.

Evidenced-Based Treatment

Psychiatrist Scott Alexander has written in some depth on whether therapy works, and I would direct the reader to his writings on the matter if interested. For this essay, it’s sufficient to note that research on different therapies shows a range of efficacy in reducing symptoms. Efficacy rates are typically no higher than 40%, with the effect sizes tending to reduce from medium to small the longer the therapy exists and is studied.

A variety of therapy modalities fall under the umbrella of “evidence-based treatment.” While these modalities often differ in their language and pacing, they all share some aspects as “evidenced-based” treatments: A record of research including randomized control trials; testing and validation for specific treatment manuals, with typical treatment based on some number of set weekly 60-90 minute sessions often 8-16 weeks in length; and some recommended way to monitor outcomes. Treatment will also include “homework” to accomplish in the intervening days between sessions. While this is what treatment is supposed to look like, it rarely does in practice for the reasons given below.

Embedded Psychologists

For this essay, I am referring to an “embedded” psychologist as one that does not have a private or group practice but instead practices within a larger healthcare organization. They exchange easy access to internal referrals for less autonomy in managing schedules and caseloads. My training program impressed on its students that this was the model of the future and that it benefited both clinical psychologists (access to referrals, fewer administrative hassles, more liability protection) and patients (less difficulty following through on referrals, more likely to be covered by insurance).

Managed Care Organizations

Most people obtaining healthcare in the US today do so through a managed care organization. Managed care organizations attempt to manage “cost, utilization, and quality” of care. What this means in practice is people with degrees in “healthcare administration” or other non-clinical fields are the ones actually directing your care. Their job is to cut costs by reducing your quality or quantity of care. Healthcare administrators treat clinical hours as fungible widgets in ways that are incompatible with the delivery of psychotherapy described earlier in this essay. In my managed care organization, I am simply not allowed to provide any psychotherapy modality as designed, researched, and manualized because I have next to no control over scheduling or caseload.

Follow-up times are incredibly important for delivering effective mental healthcare. It really matters that a patient struggling with, say, suicidal ideation can see his psychotherapist two days after a session as opposed to two weeks or two months after. However, the administrators in charge of managing specialty care, which includes mental healthcare, come from a background of managing primary care, in which follow-up times matter far less. In my experience and in talking with peers, these managers neither understand nor care about the unique scheduling needs of patients undergoing psychotherapy for serious mental health issues. Sessions which should last 60-90 minutes are limited to 45 minutes or less, crisis services are pushed to emergency rooms or a random provider assigned “triage” availability, and the exorbitant length of time it takes to receive a follow-up appointment leads to higher dropout rates as well as failure to follow through on treatment plans by both patient and therapist.

Of course, the trade-off for autonomy in practice is then needing to deal directly with insurance companies, referral sourcing, and other overhead costs, all of which have their own challenges and which I am not well qualified to speak on, never having operated in private practice myself. There are, in some cases, insurance coverage-related problems in accessing psychotherapy in a way that has full fidelity to treatment modalities, and again I cannot speak to the intricacies or details of this issue with my current experience. What is clear is that there are economic and bureaucratic pressures towards centralization of healthcare delivery, and it’s coming at a cost to your access to and quality of care. There is no incentive for managed care organizations or insurance companies to understand these problems and plenty of incentives for them to continue in ignorance or apathy.

What Does This Mean?

If you find yourself in need of psychotherapy and are one of the millions of people in the US accessing their care through a managed care organization or requiring insurance coverage for payment, you may think you are getting therapy, but what you are likely to get is something watered down and compromised. If you cannot see your therapist weekly because their caseload is too full, that’s a problem, and unless they are in private practice, it’s likely not their fault. You may still obtain a benefit, but your odds are worsened. This problem is likely to grow worse in the near future rather than better, as demand continues to outstrip the supply of licensed mental health professionals of any level of qualification, and persistent calls for single-payer healthcare push us further towards centralization under a bureaucracy equal parts blind as malign.

In summary, there are real problems rooted in healthcare management practices that greatly overshadow any imagined or real problem within the realm of psychotherapy, and potential or current clients of therapy services should keep this in mind.

Tristan Maclean is a clinical psychologist based in the United States.

You can find the podcast on Apple Podcasts, Spotify, and YouTube.

Links:

• Kevin McCaffree, Pulling Back the Curtain on Suicide Research.

• David Philipps, The Influence of Suggestion on Suicide: Substantive and Theoretical Implications of the Werther Effect.

• Lubin et al., Decrease in Suicide Rates After a Change of Policy Reducing Access to Firearms in Adolescents: A Naturalistic Epidemiological Study.

• Tyler Black, Associations Between Income-Based Nutrition Programs and Suicidality.

• Tyler Black, Children’s Risk of Suicide Increases on School Days.

• Kevin McCaffree, The Secular Landscape.

• Landon Schnabel, Opium of the Masses? Inequality, Religion, and Political Ideology in America.

• John Gray, Seven Types of Atheism.

• Jean Twenge, Generations.

• Kevin McCaffree, Review of Generations.

• Kevin’s Google Scholar.

• Skeptic Research Center, @SkepResCenter.

In September, Statistics Canada released the results of their 2022 Mental Health and Access to Care Survey, and it shows that far more Canadians are depressed and anxious today than they were a decade ago.

The survey, which is conducted every ten years, involves thousands of Canadians reporting their mental health symptoms in depth. Statistics Canada then uses those symptoms to determine whether individuals meet the diagnostic criteria for mental disorders.

Since 2012, the number of Canadians with major depressive disorder has increased by 62 percent. Today one in 13 Canadians, 7.6 percent of the population, qualify for the diagnosis. The number of Canadians with anxiety disorders has doubled, with one in 14 (7.1 percent) now suffering from social anxiety disorder. Rates of bipolar disorder rose and substance use disorder fell by 0.6 percent each, with the fall in substance abuse driven by declining alcoholism. 

While mental illness is much higher among the general population today than it was a decade ago, the rates among young Canadians, particularly young women, are staggering. One in four Canadian women between the ages of 15 and 24 qualify for social anxiety disorder, and nearly one in five qualify for major depressive disorder. This is a big increase from a decade ago when those numbers were about half of what they are now. 

Young Canadian men are half as likely to have a mood disorder as young women but are more likely to be addicted to alcohol, cannabis, or drugs, with one in 10 qualifying for a substance use disorder. They are also three times as likely to die by suicide though young women are far more likely to attempt.  

The surge in mental health issues among Canadians in the past decade is the result of several factors. Canada’s stagnant economy and the rising cost of living play a significant role. In a recent poll from Mental Health Research Canada, 39 percent of Canadians said that economic issues were impacting their mental health with debt, inflation, rent or mortgage payments, and food costs driving up anxiety and depression. Worse still, the poll showed that 41 percent of Canadians facing financial challenges had thought about killing themselves in the past year. 

Read the rest here.

Listen on Apple Podcasts, Spotify, YouTube, or wherever else you get your podcasts.

Links:

• Mel’s Substack Headlines, her Twitter

• Winkler et al., “Startup Cerebral Soared on Easy Adderall Prescriptions. That Was Its Undoing.”

• Pi.Ai

• Schwarts & Schweezy, “Internal Family Systems Therapy: Second Edition.”

• Mel, “The Dark Side of the Shroom.”

• Contact (1997 Film)

• Jonah Davids, “Will Psychedelic Therapy Lead to a Religious Revival?”

• Mel, “Social Prescribing.”

• Jonah Davids, “Loneliness Isn’t a Public Health Problem.”

• The Economist, “Dramatic Growth in Mental-Health Apps has Created a Risky Industry.”

• Mel, “An Apple a Day.”

• Talkspace