Mental Health, Treatment, and David Hume

 I am taking the liberty of lumping together some articles from The Hedgehog Review into this post and refer you back to my Indiana's Care of Its Children. Could it be that education will improve our mental health?

Joseph E. Davis' Mental Medicine Are we living in an “emergent democracy of the sick”? contains this nugget:

The first study was an analysis of all 232 randomized, controlled trials of antidepressants submitted by drug companies to the Food and Drug Administration between 1979 and 2016. The researchers did not find what is often asserted about these drugs—namely, that they provide a “small incremental benefit in reducing symptoms (beyond a placebo response)” across patients. Rather, the effect of the drugs was a “large near-term reduction in symptoms” for about 15 percent of the treated patients. The rest, the overwhelming majority of trial patients (85 percent), were subject to the many risks associated with taking antidepressants without any specific benefit from the drugs themselves.

The second study concerned both psychological and drug interventions. Since the 1980s, the researchers observed, the number of people being treated for depression with both types of interventions, but especially antidepressant medications, had sharply increased. Mysteriously, however, the prevalence of depression had been unaffected. What gives? Clinical trial data, the basis for the enthusiastic prescribing of antidepressants, the researchers found, is misleading. It overestimates short- and long-term treatment efficacy, and much of this efficacy disappears when the treatments are used in real-world settings. The prevalence isn’t changing because the treatments, on average, make little difference. And lest we forget, the drugs carry risks and may have “counterproductive consequences.”

Both studies affirm therapeutic value in interventions. The crucial question is: for whom? Consistent with the findings of many other studies, the answer is the relatively small number of those with the most serious, chronic problems. If we want to help, these are the people to identify. But for this limited, targeted, and discriminating task, wholesale screening is woefully misguided.

There is no denying that many people are dealing with emotional distress that is painful and can interfere with daily activities and work performance, but that does not mean they have a mental disorder. Their symptoms might actually be signs of something important outside their head: a problem in a relationship, a strained work environment, real danger, unrealistic standards or ambitions. Throwing prescription drugs at troubles like these will not return a net benefit.

So, what will help? I find my counselor is a lifeline even with my Zoloft prescription.

As for David Hume, this comes from Alan Jacobs's David Hume’s Guide to Social Media Emancipation by the cultivation of taste.

The important issue, then, is what exactly smartphones are doing to teens that makes them so miserable? DeBoer’s answers are quite good—I especially welcome his emphasis on the misery of being constantly bombarded by images of lives none of us can actually live—but I think we can significantly deepen our understanding of these matters by turning to an account of human behavior offered by the philosopher David Hume nearly three centuries ago. Hume begins his first book, A Treatise of Human Nature (1740), with this assertion:

All the perceptions of the human mind resolve themselves into two distinct kinds, which I shall call IMPRESSIONS and IDEAS. The difference betwixt these consists in the degrees of force and liveliness, with which they strike upon the mind, and make their way into our thought or consciousness. Those perceptions, which enter with most force and violence, we may name impressions; and under this name I comprehend all our sensations, passions and emotions, as they make their first appearance in the soul. By ideas I mean the faint images of these in thinking and reasoning; such as, for instance, are all the perceptions excited by the present discourse, excepting only, those which arise from the sight and touch, and excepting the immediate pleasure or uneasiness it may occasion.

From this point, Hume goes on to make a great many distinctions, but here I want to focus on just a few of them. Setting aside Ideas for now, let us turn to Impressions:

Original impressions or impressions of sensation are such as without any antecedent perception arise in the soul, from the constitution of the body, from the animal spirits, or from the application of objects to the external organs. Secondary, or reflective impressions are such as proceed from some of these original ones, either immediately or by the interposition of its idea. Of the first kind are all the impressions of the senses, and all bodily pains and pleasures: Of the second are the passions, and other emotions resembling them.

From these reflections, then, I have derived my thesis: The effect of our smartphones on our mind—as those devices are typically used—is to suppress wholly the realm of Ideas, and to suppress greatly the “impressions of the senses,” and instead to stir the passions.

Why this matters is something Hume explains in an essay he wrote just after finishing his Treatise, called “Of the Delicacy of Taste and Passion.” That essay begins thus:

Some people are subject to a certain delicacy of passion, which makes them extremely sensible to all the accidents of life, and gives them a lively joy upon every prosperous event, as well as a piercing grief, when they meet with misfortunes and adversity.

It is the purpose of our smartphones, and especially the social media apps installed on them, to make us this kind of person. And if our time on our devices gave us as much “lively joy” as “piercing grief,” then perhaps that would not be so bad. But as Hume goes on to explain, that’s not how it works:

Good or ill fortune is very little at our disposal: And when a person, that has this sensibility of temper, meets with any misfortune, his sorrow or resentment takes entire possession of him, and deprives him of all relish in the common occurrences of life; the right enjoyment of which forms the chief part of our happiness. Great pleasures are much less frequent than great pains; so that a sensible temper must meet with fewer trials in the former way than in the latter. Not to mention, that men of such lively passions are apt to be transported beyond all bounds of prudence and discretion, and to take false steps in the conduct of life, which are often irretrievable.

I read that and felt a kinship with what I felt in most keenly in 2009, not through social media as such, but the Internet generally. Business went south, regardless of how much I tried to leverage Google and my law blogs and Twitter and Facebook to get more business. My family life deteriorated by the time I spent on work. When no headway seemed possible, I succumbed to my depression and went nuts. Inertia kicked in then.

Whether I could have followed through on the changes I started at the beginning of 2010, is an open question for me. Not the criminal behavior, that I had put behind me. No, the more general feelings of being a hamster caught in a wheel, of my brain feeling like a pinball machine gone berserk, and most importantly my anger at a life without purpose or meaning or profit. How I shook those feelings came from becoming involved with Orthodox Christianity and being disconnected from work.

I may have stumbled upon what Mr. Jacobs sees as a cure:

Again, there is both simplicity and profundity here. By setting ourselves to cultivate a taste for what is beautiful and wise—and such taste does indeed require cultivation, being neither innate nor instantly grasped—we gradually emancipate ourselves from the power of others who would act upon us, which is to say, from the passions they seek to intensify in us. “And,” Hume continues

this is a new reason for cultivating a relish in the liberal arts. Our judgment will strengthen by this exercise: We shall form juster notions of life: Many things, which please or afflict others, will appear to us too frivolous to engage our attention: And we shall lose by degrees that sensibility and delicacy of passion, which is so incommodious.

Imagine that: Many things, which please or afflict others, will appear to us too frivolous to engage our attention. The cultivation of taste, in morals as well as in art, is neither snobbish nor elitist; it is, rather, the key means by which we emancipate ourselves from the tyranny of passions that the people who make our smartphone apps would like to see dominate us. By cultivating “delicacy of taste,” we become less vulnerable, less manipulable; and as the world of the passions ceases to dominate us, the great domains of Sensation and Idea become available to us once more. If there is a better guide to our current technocratic moment than David Hume, born 310 years ago, I don’t know who it is.

And one of the first people I read after my arrest was David Hume. Then it was Aristotle. With these, I got away from what I see now as an Internet addiction. It is not that I was unaware of Hume or Aristotle. I started reading Hume when I was eighteen; Aristotle, I first read at 25. With me, it was a matter of finding my way back to where I had been before I gave up thinking there was no value in philosophy, or anything else that Hume would consider as improving our delicacy of taste.

To me, education seems to point us towards a delicacy of taste. That sort of education is more than what our schools give, right now it seems American legislators are more interested than picking on transgender kids and banning books. Meanwhile, what I call education is something we can do on our own.

sch 3/17/23