Stephen Eide on mental hospitals; Kurt Gray on morality's evolutionary roots; I review a book on the left authoritarianism; Jason Manning on the appeal of Marxism
An idea I have been pondering is to let social workers place bids on "cases" (i.e., people who need help getting back on their feet). The social worker who bids highest wins. The social worker gets paid the amount they bid, but only if they achieve some measurable success, e.g. if the person they are helping manages to find a job. Harder cases will obviously lead to higher prices, as social workers foresee a lower likelihood of success.
Something that is frequently missed in the asylum debate is that most modern US prisons have what are effectively asylum wings complete with medication line-ups and about as much psychiatric attention as in a formal hospital setting. So we did not really abolish them but shuffled around the people and the institutional responsibilities.
The lower security wings of modern prisons are almost indistinguishable from mental hospitals. Arguably the conditions are a little better in prison because inmates can work. Costs are kept somewhat low by aggressive corrections department budgeting. In the medical setting costs will tend to balloon because the government agencies in that context do not operate from a strict budget.
Perhaps the big problem we have with both corrections and hospitals is that state governments have a strong incentive to inflate the welfare rolls and to dump as many people as possible on federal welfare programs like SSDI. A successful post incarceration outcome for a state government looks like someone on federal subsidized welfare forever.
The attempts to get people back into work post-incarceration tend to be furtive and half hearted because low end workers are reliant on welfare. Low end workers who do not work under the table are socially unattractive because marrying them will often result in loss of benefits. You do not even want to divorce a low end worker to get child support from them because in a lot of states that just results in the same level of benefits for the single mother, but with some of those benefits provided by an unstable creditor (dad) that just get taxed as a clawback of benefits. We made this pariah caste that no one wants to think much about except for the petty local bureaucrats who use their existence as an excuse to whinny for money.
So the issue with the corrective institutions is that they will repeatedly prosecute a malefactor until they do something really bad that makes it so they can't suspend sentences indefinitely anymore, then they go to prison, and "success" in a best case scenario is they're on prescription drugs and welfare forever.
What you say may be true but there are plenty of people with serious mental health issues who never get charged with more than a misdemeanor. Maybe in more cases they should, IDK. Maybe in more cases they should be held longer for lesser offenses. These might be better ways of avoiding both type 1 and 2 errors.
Re: "You can wrongly force someone into treatment, for a type I error. Or you can wrongly fail to force someone into treatment, for a type II error."
Or we can reject altogether the practice of forcing (innocent) persons into treatment.
Simply enforce laws against crime and nuisance.
Perhaps an advocate of forced treatment (i.e., confinement?) of innocent "mentally ill" persons believes that she is preventing crime and nuisance because the "mental illness" is strongly predictive of future crime or nuisance. What could go wrong?
In a liberal society there must be a red line against forcible confinement (loss of liberty) of innocent persons who are not suspects in a criminal investigation, even if they exhibit traits that correlate with crime and nuisance.
You keep using the terms type 1 and type 2 errors. Why not "false positive" and "false negative?" My suggested terminology is just as short and more descriptive - i have a hard enough time remembering important stuff that i can't afford to spend memory on random naming conventions.
The title of Stephen Eide’s article, “Bring back paternalism for the mentally ill Small government is not the answer” raises at least two questions: (1) did paternalism every really go away?, and (2) looking around the world, on what possible basis could one conclude that better outcomes could not be achieved at less cost and by locally administered services?
De-institutionalization followed the introduction of pharmaceutical treatment which is as paternalistic as any other treatment. Drugs were to be the new restraints. And Carter (https://pmc.ncbi.nlm.nih.gov/articles/PMC2690151/#sec8 )
all had major top down initiatives to reform and align the multitude of federal programs (42 by one count) that government agencies force the severely mentally ill to navigate in order to receive treatment. And of course the result is the kludgeocracy we now enjoy and which is the hallmark of US governance (https://www.nationalaffairs.com/publications/detail/kludgeocracy-in-america ).
In the more advanced countries which are noted for excellence in mental health care, we find the common features of a strong role for local administration and direct delivery of services resulting in greater efficacy as well as much lower costs. Italy is a perfect example. The very concept of community care is often referred to as the “Trieste model” (https://www.psychiatrymargins.com/p/an-introduction-to-the-trieste-model ) and a World Health Organization has deemed it “an exemplar.” (https://www.who.int/publications/i/item/9789290211211 ).
So how does the Italian universal care system work? Dedicated centralized base funding and local delivery:
“The public system is financed primarily through two mechanisms:
-A corporate tax (approximately 18.6% of 2018 total funding), which is pooled nationally and allocated back to the regions. Corporate tax allocations are typically in proportion to a region’s contributions. There are large interregional variations in the corporate tax base, resulting in inequalities in financing.
-A fixed proportion of the national value-added tax revenue (approximately 60% of 2018 total funding) collected by the central government, which is redistributed to regions with insufficient resources to provide essential services.
The regions are allowed to generate their own additional revenue, leading to further interregional financing differences.
Local health units are funded mainly through capitated budgets.”
And:
“Universal coverage is provided through Italy’s National Health Service (Servizio sanitario nazionale, or SSN), established through legislation in 1978. The SSN automatically covers all citizens and legal foreign residents. Since 1998, undocumented immigrants have had access to urgent and essential services. Temporary visitors are responsible for the costs of any health services they receive.
Role of government: The organization and delivery of health services is decentralized. Nineteen regions and two autonomous provinces are responsible for delivering care through 100 local health units, which deliver primary care, hospital care, outpatient specialist care, public health care, and health services related to social care. Regions enjoy significant autonomy in determining the macro structure
of their health systems. The local health units each have a general manager, who is appointed by the regional governor.”
One compelling reason for Italy’s success in this regard is its constitution, article 5 of which provides:
“The Republic is one and indivisible. It recognises and promotes local autonomies, and implements the fullest measure of administrative decentralisation in those services which depend on the State. The Republic adapts the principles and methods of its legislation to the requirements of autonomy and decentralisation.”
Another line drive by Arnold Kling. He’s on base again: 10,220 days in a row since 1997. Love your book review, especially this line: “Freedom of speech is necessary in order for people to have a chance to arrive at the best approximation of the truth.”
The book review contains approximately 1,118 words.
Here’s the content of the book review. Count the average number of sentences per paragraph? 3.4.
Folks - Notice that 17 out of 24 of Arnold’s paragraphs contain 2 or fewer sentences. That’s 70%. His other paragraphs are almost never more than 3 sentences.
He begins with a bold, long, and hard to follow excerpt from Conway, but it works — it pulls the reader in. After reading the book review, I re-read the opening excerpt and it made sense. In fact it’s an interesting excerpt in its complexity and information content. Arguably it’s six sentences long; his longest in the whole piece. For someone that sticks to 1, 2, or 3 sentence paragraphs, he boldly opens with a rather long paragraph.
When will Arnold Kling offer a writing class? I suggest a blog essay class, a links sharing class, and a book review writing class.
“Every Western nation deinstitutionalised its mentally ill” is an unimpressive argument. It sounds to me like Robin Hansen’s idea of “cultural drift” that is not selecting for a healthier society or a better future.
"It seems to me scientific thinking about human behavior comes with great difficulty to most people."
Not just scientific thinking, but also the intersection of psychology and history. Once you move backwards in time before computerization and perhaps mechanization what does this robot/baby dyad become a monster/baby dyad?
An idea I have been pondering is to let social workers place bids on "cases" (i.e., people who need help getting back on their feet). The social worker who bids highest wins. The social worker gets paid the amount they bid, but only if they achieve some measurable success, e.g. if the person they are helping manages to find a job. Harder cases will obviously lead to higher prices, as social workers foresee a lower likelihood of success.
Something that is frequently missed in the asylum debate is that most modern US prisons have what are effectively asylum wings complete with medication line-ups and about as much psychiatric attention as in a formal hospital setting. So we did not really abolish them but shuffled around the people and the institutional responsibilities.
The lower security wings of modern prisons are almost indistinguishable from mental hospitals. Arguably the conditions are a little better in prison because inmates can work. Costs are kept somewhat low by aggressive corrections department budgeting. In the medical setting costs will tend to balloon because the government agencies in that context do not operate from a strict budget.
Perhaps the big problem we have with both corrections and hospitals is that state governments have a strong incentive to inflate the welfare rolls and to dump as many people as possible on federal welfare programs like SSDI. A successful post incarceration outcome for a state government looks like someone on federal subsidized welfare forever.
The attempts to get people back into work post-incarceration tend to be furtive and half hearted because low end workers are reliant on welfare. Low end workers who do not work under the table are socially unattractive because marrying them will often result in loss of benefits. You do not even want to divorce a low end worker to get child support from them because in a lot of states that just results in the same level of benefits for the single mother, but with some of those benefits provided by an unstable creditor (dad) that just get taxed as a clawback of benefits. We made this pariah caste that no one wants to think much about except for the petty local bureaucrats who use their existence as an excuse to whinny for money.
So the issue with the corrective institutions is that they will repeatedly prosecute a malefactor until they do something really bad that makes it so they can't suspend sentences indefinitely anymore, then they go to prison, and "success" in a best case scenario is they're on prescription drugs and welfare forever.
What you say may be true but there are plenty of people with serious mental health issues who never get charged with more than a misdemeanor. Maybe in more cases they should, IDK. Maybe in more cases they should be held longer for lesser offenses. These might be better ways of avoiding both type 1 and 2 errors.
Re: "You can wrongly force someone into treatment, for a type I error. Or you can wrongly fail to force someone into treatment, for a type II error."
Or we can reject altogether the practice of forcing (innocent) persons into treatment.
Simply enforce laws against crime and nuisance.
Perhaps an advocate of forced treatment (i.e., confinement?) of innocent "mentally ill" persons believes that she is preventing crime and nuisance because the "mental illness" is strongly predictive of future crime or nuisance. What could go wrong?
In a liberal society there must be a red line against forcible confinement (loss of liberty) of innocent persons who are not suspects in a criminal investigation, even if they exhibit traits that correlate with crime and nuisance.
You keep using the terms type 1 and type 2 errors. Why not "false positive" and "false negative?" My suggested terminology is just as short and more descriptive - i have a hard enough time remembering important stuff that i can't afford to spend memory on random naming conventions.
The title of Stephen Eide’s article, “Bring back paternalism for the mentally ill Small government is not the answer” raises at least two questions: (1) did paternalism every really go away?, and (2) looking around the world, on what possible basis could one conclude that better outcomes could not be achieved at less cost and by locally administered services?
De-institutionalization followed the introduction of pharmaceutical treatment which is as paternalistic as any other treatment. Drugs were to be the new restraints. And Carter (https://pmc.ncbi.nlm.nih.gov/articles/PMC2690151/#sec8 )
, George W. Bush (https://psychiatryonline.org/doi/10.1176/appi.ps.54.11.1467 )
, and Obama (https://www.everycrsreport.com/reports/R44718.html )
all had major top down initiatives to reform and align the multitude of federal programs (42 by one count) that government agencies force the severely mentally ill to navigate in order to receive treatment. And of course the result is the kludgeocracy we now enjoy and which is the hallmark of US governance (https://www.nationalaffairs.com/publications/detail/kludgeocracy-in-america ).
In the more advanced countries which are noted for excellence in mental health care, we find the common features of a strong role for local administration and direct delivery of services resulting in greater efficacy as well as much lower costs. Italy is a perfect example. The very concept of community care is often referred to as the “Trieste model” (https://www.psychiatrymargins.com/p/an-introduction-to-the-trieste-model ) and a World Health Organization has deemed it “an exemplar.” (https://www.who.int/publications/i/item/9789290211211 ).
So how does the Italian universal care system work? Dedicated centralized base funding and local delivery:
“The public system is financed primarily through two mechanisms:
-A corporate tax (approximately 18.6% of 2018 total funding), which is pooled nationally and allocated back to the regions. Corporate tax allocations are typically in proportion to a region’s contributions. There are large interregional variations in the corporate tax base, resulting in inequalities in financing.
-A fixed proportion of the national value-added tax revenue (approximately 60% of 2018 total funding) collected by the central government, which is redistributed to regions with insufficient resources to provide essential services.
The regions are allowed to generate their own additional revenue, leading to further interregional financing differences.
Local health units are funded mainly through capitated budgets.”
And:
“Universal coverage is provided through Italy’s National Health Service (Servizio sanitario nazionale, or SSN), established through legislation in 1978. The SSN automatically covers all citizens and legal foreign residents. Since 1998, undocumented immigrants have had access to urgent and essential services. Temporary visitors are responsible for the costs of any health services they receive.
Role of government: The organization and delivery of health services is decentralized. Nineteen regions and two autonomous provinces are responsible for delivering care through 100 local health units, which deliver primary care, hospital care, outpatient specialist care, public health care, and health services related to social care. Regions enjoy significant autonomy in determining the macro structure
of their health systems. The local health units each have a general manager, who is appointed by the regional governor.”
(https://www.commonwealthfund.org/international-health-policy-center/countries/italy )
Private health insurance is also available, however, even including that, in 2022, Italy spent a third of the amount per capita ($4,291) as did the United States ($12,555) (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita ).
One compelling reason for Italy’s success in this regard is its constitution, article 5 of which provides:
“The Republic is one and indivisible. It recognises and promotes local autonomies, and implements the fullest measure of administrative decentralisation in those services which depend on the State. The Republic adapts the principles and methods of its legislation to the requirements of autonomy and decentralisation.”
And which is more fully developed and explicated in detail in the articles of title 5. (https://www.constituteproject.org/constitution/Italy_2012 )
Similar patterns can be found in Germany, the Netherlands, Japan and elsewhere.
What reason does one have to trust the fastidious few wedded to a mediocre status quo?
"I think if you really dig back into anthropology, we’re a lot more prey than we think,"
No doubt humans were at greater risk at night (still are) but aren't there tribes with a rite of passage requiring the man to face a lion and kill it?
Thank you for recommending Outraged - I just got it after reading the interview you linked to.
Another line drive by Arnold Kling. He’s on base again: 10,220 days in a row since 1997. Love your book review, especially this line: “Freedom of speech is necessary in order for people to have a chance to arrive at the best approximation of the truth.”
ChatGPT: Please count the words in this book review? https://www.econlib.org/library/columns/y2025/klingauthoritarianism.html
The book review contains approximately 1,118 words.
Here’s the content of the book review. Count the average number of sentences per paragraph? 3.4.
Folks - Notice that 17 out of 24 of Arnold’s paragraphs contain 2 or fewer sentences. That’s 70%. His other paragraphs are almost never more than 3 sentences.
He begins with a bold, long, and hard to follow excerpt from Conway, but it works — it pulls the reader in. After reading the book review, I re-read the opening excerpt and it made sense. In fact it’s an interesting excerpt in its complexity and information content. Arguably it’s six sentences long; his longest in the whole piece. For someone that sticks to 1, 2, or 3 sentence paragraphs, he boldly opens with a rather long paragraph.
When will Arnold Kling offer a writing class? I suggest a blog essay class, a links sharing class, and a book review writing class.
What other classes would you like him to offer?
“Every Western nation deinstitutionalised its mentally ill” is an unimpressive argument. It sounds to me like Robin Hansen’s idea of “cultural drift” that is not selecting for a healthier society or a better future.
"It seems to me scientific thinking about human behavior comes with great difficulty to most people."
Not just scientific thinking, but also the intersection of psychology and history. Once you move backwards in time before computerization and perhaps mechanization what does this robot/baby dyad become a monster/baby dyad?