What's a disease? Or: shoud fat/shy/alcoholic people be blamed or treated?(lesswrong.com)
lesswrong.com
What's a disease? Or: shoud fat/shy/alcoholic people be blamed or treated?
http://lesswrong.com/lw/2as/diseased_thinking_dissolving_questions_about/
16 comments
"Everything that is obviously possible to overcome with self-will, patience and persistence."
There are people who can lower their blood pressure though relaxation and meditation. Should we withhold blood pressure medication?
"Most people didn't even tried. They just blaming everything and everyone else."
And you know this how? You're just making shit up.
"People who cannot stop shooting, drinking, smoking, eating, and avoiding people are ignorant, not sick. At least from the point of view of the one who did."
From the POV of one who did that is quite an ignorant opinion.
There are people who can lower their blood pressure though relaxation and meditation. Should we withhold blood pressure medication?
"Most people didn't even tried. They just blaming everything and everyone else."
And you know this how? You're just making shit up.
"People who cannot stop shooting, drinking, smoking, eating, and avoiding people are ignorant, not sick. At least from the point of view of the one who did."
From the POV of one who did that is quite an ignorant opinion.
Oh, it could be a long discussion, especially in terms of 'withhold medication'.
There are some basics, like the difference between symptoms and their causes. In the cases in which it is possible to deal with causes, not the symptoms, using self-will and altered behavior one should do it.
Medications, in most cases, are eliminating the symptoms but not their causes. Prozac and is the best example.
The complex of cognitive, behavior and psycho therapies in the sub-clinical cases and with medication in the clinical ones usually help, while just a medication without changing the habits will probably fail.
There are some basics, like the difference between symptoms and their causes. In the cases in which it is possible to deal with causes, not the symptoms, using self-will and altered behavior one should do it.
Medications, in most cases, are eliminating the symptoms but not their causes. Prozac and is the best example.
The complex of cognitive, behavior and psycho therapies in the sub-clinical cases and with medication in the clinical ones usually help, while just a medication without changing the habits will probably fail.
I don't think you've read and understood the article. Your posting smacks of ignorance and I find it intolerable.
1. I did.
2. There is a life outside US. =)
3. Try to google 'Tibetan medicine bon tradition' or something like that.
btw, The root (or the trunk) of Tibetan tree of the causes of diseases is ignorance.
btw, The root (or the trunk) of Tibetan tree of the causes of diseases is ignorance.
my last 2c - all those abuses are very easy to deal with compared to http://en.wikipedia.org/wiki/Asperger_syndrome, especially when your parents (and therefore you) know nothing about it or that it even exist. =)
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Disregarding glandular, hormonal, or similar problems, obesity is certainly not a disease: http://www.youtube.com/watch?v=RXTq2_3LfXM.
Out of curiosity, did you read the full article? It does a great job in making the point that disease/not disease may not be the right question to ask (which is a good thing because it isn't straightforward to answer).
l;bra (long; but read anyway)
Articulately put and yummy intellectual fodder. Thank you for the submission brazzy.
Cancer and Obesity should always be "cancers" and "obesities" when we're talking about how we should treat the potential/actual sufferer as it varies from type to type. As pointed out by the article it would seem unhelpful to yell at a cancer patient but we should whine at our kids if they start smoking. Also, as obesity comes in many shapes and sizes maybe do do we know whether Sandy has an underlying genetic condition or whether she likes jam donuts too much.
As a commenter to the article said: a lot of the choices a consequentialist would make sound like utilitarian choices. I'm not big on utilitarianism so I guess I'd be leery of consequentialism.
I absolutely love the idea of breaking down a complex issue into its component parts. It is interesting how some people use outliers rather than type specimens to try to destroy coherent notions which is really unhelpful. For instance to use the example of disease; obesity fails some of the criteria for disease, thus we need to rethink what disease means for us!
Less iPad/Flash submissions and more of this sort of thing would be greatly appreciated :)
Articulately put and yummy intellectual fodder. Thank you for the submission brazzy.
Cancer and Obesity should always be "cancers" and "obesities" when we're talking about how we should treat the potential/actual sufferer as it varies from type to type. As pointed out by the article it would seem unhelpful to yell at a cancer patient but we should whine at our kids if they start smoking. Also, as obesity comes in many shapes and sizes maybe do do we know whether Sandy has an underlying genetic condition or whether she likes jam donuts too much.
As a commenter to the article said: a lot of the choices a consequentialist would make sound like utilitarian choices. I'm not big on utilitarianism so I guess I'd be leery of consequentialism.
I absolutely love the idea of breaking down a complex issue into its component parts. It is interesting how some people use outliers rather than type specimens to try to destroy coherent notions which is really unhelpful. For instance to use the example of disease; obesity fails some of the criteria for disease, thus we need to rethink what disease means for us!
Less iPad/Flash submissions and more of this sort of thing would be greatly appreciated :)
Articles on these "rationalist" sites often tend towards a mix of smug superiority about one's ability to analyze other people's supposed biases, and lots of references to pet concepts. I posted this one because it does such an excellent job of analyzing the issue in clear, objective terms.
Articles on these "rationalist" sites often tend towards a mix of smug superiority about one's ability to analyze other people's supposed biases, and lots of references to pet concepts. I posted this one because it does such an excellent job of analyzing the issue in clear, objective terms.
I think the article you linked is an excellent example of smug superiority with lots of references to pet concepts while deficient in regard to the core subjects under discussion. The author demonstrates little practical experience with or research into the actual science around obesity, the actual medical practices related to obese patients, the reality of being an obese person, or the linguistic meaning of the word disease.
I think the article you linked is an excellent example of smug superiority with lots of references to pet concepts while deficient in regard to the core subjects under discussion. The author demonstrates little practical experience with or research into the actual science around obesity, the actual medical practices related to obese patients, the reality of being an obese person, or the linguistic meaning of the word disease.
It seems you haven't read much else there, and have missed the point; it's not about the scientific details of obesity. And what exactly would be the "linguistic meaning" of the word disease?
I think I've missed the point because there isn't really a point.
The author talks about a hypothetical Doctor but doesn't really seem to know much about medicine. The author asks "what is disease" but doesn't bother to do any real work to answer that question.
To answer your second question, a linguistic analysis of the word disease would look vaguely like the author's "What is a disease?" section, except it would involve real observation about how the word is used and in what contexts. The result is that rather than throwing your hands up in the air saying "it's meaningless to talk about whether something deserves to be a disease" you can say something like: "In a medical context, disease means this' in a research context, disease means this, in a casual context, there are two broad groups of people for whom disease means two different things" Armed with this more accurate language, you can start talking about actual concrete examples and explore more detailed and relevant hypothetical examples.
The author talks about a hypothetical Doctor but doesn't really seem to know much about medicine. The author asks "what is disease" but doesn't bother to do any real work to answer that question.
To answer your second question, a linguistic analysis of the word disease would look vaguely like the author's "What is a disease?" section, except it would involve real observation about how the word is used and in what contexts. The result is that rather than throwing your hands up in the air saying "it's meaningless to talk about whether something deserves to be a disease" you can say something like: "In a medical context, disease means this' in a research context, disease means this, in a casual context, there are two broad groups of people for whom disease means two different things" Armed with this more accurate language, you can start talking about actual concrete examples and explore more detailed and relevant hypothetical examples.
Articles on these "rationalist" sites often tend towards a mix of smug superiority about one's ability to analyze other people's supposed biases, and lots of references to pet concepts.
There should be a name for the 1st phenomenon, so that websites can use it as a tag. The latter would be too hard to distinguish from citation, however.
There should be a name for the 1st phenomenon, so that websites can use it as a tag. The latter would be too hard to distinguish from citation, however.
The fact that people get a rush from picking things apart should be encouraged, not made explicit to be, perhaps, the target of ostracism—because it means that more people will pick more things apart. There is the egocentric impulse toward social status at the root of even the scientific method: that just proves the amorality of egocentricity, not the immorality of science.
Picking things apart is good. Using a good thing as a justification for smug is usually bad.
It's often been noted that the best way to discredit something good is to espouse it badly. How about: The best way to discredit something good is to be a jerk about it. (Disclosure: I'm at least as guilty of this as anyone here!)
It's often been noted that the best way to discredit something good is to espouse it badly. How about: The best way to discredit something good is to be a jerk about it. (Disclosure: I'm at least as guilty of this as anyone here!)
It's not so much a justification for smug; "justifiable smug" is the goal and the positive acts are the means to achieve it. It's a reward intrinsic (a term from game design), usually known as "gamism" under GNS and the people seeking it "Artisans" under the famous MUD paper on the subject: they seek reward by rebalancing power structures in their favor, and by visceral experience.
Combined, these are quite often thought of as "bullying" or "trolling", but not necessarily so—it can also be felt, as the name suggests, while using tools with finesse or performing authoritative power exchanges; surgeons are a good example of someone who has routed gamist reward intrinsics to positive acts. I would interpret the posts you refer to as another.
That is all to say, this is the reverse of a fundamental attribution error: this is just how these people are, not something they can change. It's part of their utility function to "satisfy" their urge to smug, just as one would satisfy hunger or sexual arousal. And, if we want these people in our society, we should learn to accept that as long as it's not actively hurting anyone.
Combined, these are quite often thought of as "bullying" or "trolling", but not necessarily so—it can also be felt, as the name suggests, while using tools with finesse or performing authoritative power exchanges; surgeons are a good example of someone who has routed gamist reward intrinsics to positive acts. I would interpret the posts you refer to as another.
That is all to say, this is the reverse of a fundamental attribution error: this is just how these people are, not something they can change. It's part of their utility function to "satisfy" their urge to smug, just as one would satisfy hunger or sexual arousal. And, if we want these people in our society, we should learn to accept that as long as it's not actively hurting anyone.
I'm not sure how our positions are really all that different, though I wouldn't trust a surgeon who exploited her ability and reputation to engage in emotional agression. Bringing out the fight response in others isn't generally conducive to open, honest, and creative discussion.
Smug emotional agression might not be a big sin in the grand scheme, but it is an annoyance. It can be a signal of immaturity or lack of certain kinds of awareness. It's like a musician who plays out of tune, or someone farting at a gathering of gourmets. I'd much rather spend time with people who aren't willfully or unconsciously annoying.
Smug emotional agression might not be a big sin in the grand scheme, but it is an annoyance. It can be a signal of immaturity or lack of certain kinds of awareness. It's like a musician who plays out of tune, or someone farting at a gathering of gourmets. I'd much rather spend time with people who aren't willfully or unconsciously annoying.
I think we have different definitions of "smug" here (to be expected, because it was mostly made up on the spot.) the surgeon gets their thrill not by acting out some form of agression, but rather by directly holding someone's life in their hands—it is not the cut that is made that excites, but the manifold opportunities for mistaken, fatal cuts that aren't made. The pilot and the police officer get the same thrill: the ability to say afterward (even if only internally), that "I could have killed you—in fact, I would have killed you, by default, if I wasn't just so damn good at this."
That's what I mean by "smug." It's not aggression—it's dominance demonstrated via acts of mastery over the world, and thus its inhabitants. Bullying—actual emotional aggression—is the frustrated refuge of the gamist who has no mastery to show off.
That's what I mean by "smug." It's not aggression—it's dominance demonstrated via acts of mastery over the world, and thus its inhabitants. Bullying—actual emotional aggression—is the frustrated refuge of the gamist who has no mastery to show off.
Welcome to Hacker News, great comment, I upvoted you, but nix the "l;bra (long; but read anyway) Articulately put and yummy intellectual fodder. Thank you for the submission brazzy. ... Less iPad/Flash submissions and more of this sort of thing would be greatly appreciated :)"
- the fluff, basically, we try to kill it around here. Kill the fluff. And I agree with you about consequentialism/utilitarianism - it's in the "nice in theory, but treat with extreme caution in real world" camp. Intelligent deontological ethics seem to be a bit more grounded and less idealistic.
- the fluff, basically, we try to kill it around here. Kill the fluff. And I agree with you about consequentialism/utilitarianism - it's in the "nice in theory, but treat with extreme caution in real world" camp. Intelligent deontological ethics seem to be a bit more grounded and less idealistic.
Understood lionhearted, consider the fluff nixed forthwith.
I have always been more drawn to virtue theory. I have of late been drawn to Wittgenstein's archly enigmatic, "aesthetics and ethics are one". I don't know if Wittgenstein ever said anything about disease. One philosopher I hugely admire is Peter Singer and he's a utilitarian of some stripe so that gives me pause for thought in dismissing consequentialism/utilitarianism but like I said I have been drawn more to virtue theory side of things.
http://plato.stanford.edu/entries/ethics-deontological/
I have always been more drawn to virtue theory. I have of late been drawn to Wittgenstein's archly enigmatic, "aesthetics and ethics are one". I don't know if Wittgenstein ever said anything about disease. One philosopher I hugely admire is Peter Singer and he's a utilitarian of some stripe so that gives me pause for thought in dismissing consequentialism/utilitarianism but like I said I have been drawn more to virtue theory side of things.
http://plato.stanford.edu/entries/ethics-deontological/
When I was a psych major, we dealt with questions like these all the time. I think the author raises excellent points, but presents a rather limited view of the social pressure that people can exert. "We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition, and we should allow patients to seek treatment whenever it is available and effective." There are many conditions that are susceptible to influence by social pressure, but very rarely are blame and stigma the best means of exerting that influence. In most cases, I'd say they are downright harmful.
Take alcoholism. The most effective treatment today for alcoholism is AA. (there are many thing about aa that kind of creep me out, but it is a fact that it has the highest success rate of any course of treatment that has been studied). AA works almost entirely through social influence. But a key component of its social influence is talking about alcoholism as a disease, as something separate from an individual which can be done away with. Talking about alcoholism as a moral failing simply does not help. If you are morally bankrupt, what are the odds of your morally bankrupt self digging your way out of that hole? If you have a disease, though, maybe you can find a cure.
Similarly, as a child, people yelling at me that I was a lazy bum just didn't help. My primary reaction was resentment, not shame. Though I had shame, too. Its just not so easy to motivate oneself when feeling like a shameful failure. When I started thing of laziness as a behavior that I happened to have, rather than something that was intrinsic to myself, (i.e., I am being lazy right now, what can I do about it, as opposed to I am lazy), I started being able to have more control over it. Not perfect control, of course, but much more than I had.
Take alcoholism. The most effective treatment today for alcoholism is AA. (there are many thing about aa that kind of creep me out, but it is a fact that it has the highest success rate of any course of treatment that has been studied). AA works almost entirely through social influence. But a key component of its social influence is talking about alcoholism as a disease, as something separate from an individual which can be done away with. Talking about alcoholism as a moral failing simply does not help. If you are morally bankrupt, what are the odds of your morally bankrupt self digging your way out of that hole? If you have a disease, though, maybe you can find a cure.
Similarly, as a child, people yelling at me that I was a lazy bum just didn't help. My primary reaction was resentment, not shame. Though I had shame, too. Its just not so easy to motivate oneself when feeling like a shameful failure. When I started thing of laziness as a behavior that I happened to have, rather than something that was intrinsic to myself, (i.e., I am being lazy right now, what can I do about it, as opposed to I am lazy), I started being able to have more control over it. Not perfect control, of course, but much more than I had.
I thought Timothy Leary's work with LSD was the most effective way to treat alcoholism.
"Similarly, as a child, people yelling at me that I was a lazy bum just didn't help. My primary reaction was resentment, not shame. Though I had shame, too. Its just not so easy to motivate oneself when feeling like a shameful failure."
This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better...
I think the risk of not doing anything is worse though. If poor behaviour is tolerated, and not given some kind of negative feedback then it can become accepted. I suspect this is part of the obesity problem - if living as a fat person were really horrible less people would be inclined to do it and, at the risk of sounding cruel, if medical help were refused for obesity related problems then the genetic element would take care of itself...
I'm fat - and if I die because my heart clogs up with all the byproducts of that fatness then it is my own /stupid/ fault.
This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better...
I think the risk of not doing anything is worse though. If poor behaviour is tolerated, and not given some kind of negative feedback then it can become accepted. I suspect this is part of the obesity problem - if living as a fat person were really horrible less people would be inclined to do it and, at the risk of sounding cruel, if medical help were refused for obesity related problems then the genetic element would take care of itself...
I'm fat - and if I die because my heart clogs up with all the byproducts of that fatness then it is my own /stupid/ fault.
> This varies with personality and situation - I know exactly what you mean because I was shouted at for being fat and lazy as a child and it never did any good, but I can also think of many situations in my own life where the opposite was true and people yelling at me for failing provided the impetus to do better...
Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good.
In other cases, I take too much to heart.
Human emotions are silly, fragile things.
Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good.
In other cases, I take too much to heart.
Human emotions are silly, fragile things.
Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good.
Punishment is the trickiest of all behavioral modification techniques. It is very likely to backfire, which makes perfect sense. If punishment was very effective on a given individual, he/she would be a perfect slave. Being a perfect slave isn't so great from the perspective of the slave, though it is good for the master. Since human biology doesn't make it easy for a large population of slaves to be related to a master, it makes perfect sense that we'd evolve defenses against punishment. (By contrast, ants and honeybees are all children of their queen, so their arrangement makes perfect evolutionary sense.)
One psych teacher of mine pointed out the behavior of Wile E. Coyote as plausible -- often punishment of a complex organism can result in the subject trying again and again in different ways, despite punishment, particularly if there is a possible reward to be gained.
Punishment is the trickiest of all behavioral modification techniques. It is very likely to backfire, which makes perfect sense. If punishment was very effective on a given individual, he/she would be a perfect slave. Being a perfect slave isn't so great from the perspective of the slave, though it is good for the master. Since human biology doesn't make it easy for a large population of slaves to be related to a master, it makes perfect sense that we'd evolve defenses against punishment. (By contrast, ants and honeybees are all children of their queen, so their arrangement makes perfect evolutionary sense.)
One psych teacher of mine pointed out the behavior of Wile E. Coyote as plausible -- often punishment of a complex organism can result in the subject trying again and again in different ways, despite punishment, particularly if there is a possible reward to be gained.
' Maybe it's that I listened to too much punk rock as a kid, but I have this odd personality trait where if someone criticizes me for something that I consider illegitimate, I get this instant, visceral "fuck you" response, and their critique does me no good.'
Oh, been there, done that. :)
I used to despise the people who would give me grief for smoking. They were wasting their time, and it was none of their fucking business.
Later, after I quit smoking, it occurred to me that those admonitions helped. Much as I hated to accept that, the regular jibes kept alive the idea of quitting.
I hate being told what to do, especially if it's coupled with the idea that what I'm currently doing is both wrong and stupid, but that's just pride.
I didn't quit smoking because people told me to, but having people constantly tell me to quit did help keep the idea percolating in the back of my head, a contribution to my finally coming to terms with what needed to be done and mustering the reserve to just do it.
There's the risk that some people will spite themselves just to show the world how independent they are, and the more you tell them what that must do, the less likely they are to do it. But provoking people into reconsidering their actions, even if it annoys them, may help in the long run.
Oh, been there, done that. :)
I used to despise the people who would give me grief for smoking. They were wasting their time, and it was none of their fucking business.
Later, after I quit smoking, it occurred to me that those admonitions helped. Much as I hated to accept that, the regular jibes kept alive the idea of quitting.
I hate being told what to do, especially if it's coupled with the idea that what I'm currently doing is both wrong and stupid, but that's just pride.
I didn't quit smoking because people told me to, but having people constantly tell me to quit did help keep the idea percolating in the back of my head, a contribution to my finally coming to terms with what needed to be done and mustering the reserve to just do it.
There's the risk that some people will spite themselves just to show the world how independent they are, and the more you tell them what that must do, the less likely they are to do it. But provoking people into reconsidering their actions, even if it annoys them, may help in the long run.
I've reluctantly come to a similar conclusion. I moved to California from the UK in 2001 thinking that the anti-smoking laws in bars, etc were oppressive 'nanny-state' measures. I was finally able to give up smoking though, and it really helped that it was socially unacceptable to light up a cigarette in most situations. It also helped that I left behind my smoking friends and hung out with people who didn't smoke, so it wasn't just the laws, but it made me reconsider my previous position on paternalistic regulations.
When I was quitting smoking I noticed that there were many places I could not smoke, and that when there I did no have quite the same impulse to smoke as when I was, say, home.
Basically, so long as I knew I had the option to smoke I was way more inclined to want to do so, and found it harder to resist. This was sort of encouraging, because it suggested that a lot of the urge was psychological, which seemed better than a relentless chemistry-driven compulsion I might never beat.
That's not to deny the physical addiction part, but to note that appreciating that it's not all physical addiction makes it seem less impossible to beat.
(I also noticed that the urge to smoke in the morning was greater after I had that first one. I then started throwing any remaining cigs down the toilet before going to sleep. That took will power. :) Sure, I would buy smokes on the way to work, or at lunch time, but it helped me cut down. I must say, addiction sucks.)
Basically, so long as I knew I had the option to smoke I was way more inclined to want to do so, and found it harder to resist. This was sort of encouraging, because it suggested that a lot of the urge was psychological, which seemed better than a relentless chemistry-driven compulsion I might never beat.
That's not to deny the physical addiction part, but to note that appreciating that it's not all physical addiction makes it seem less impossible to beat.
(I also noticed that the urge to smoke in the morning was greater after I had that first one. I then started throwing any remaining cigs down the toilet before going to sleep. That took will power. :) Sure, I would buy smokes on the way to work, or at lunch time, but it helped me cut down. I must say, addiction sucks.)
" The most effective treatment today for alcoholism is AA."
Do you have any citations for that? There are a number of studies linked at http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Ano... suggesting conflicting results.
Do you have any citations for that? There are a number of studies linked at http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Ano... suggesting conflicting results.
Do you have any statistics to back up the claim that AA works? I've seen several people end up in AA; all of them are still addicts to this day. I've never seen any numbers that can show it does any good.
I have limited knowledge of AA, so please someone correct me if/where I'm wrong, but have a friend who attends, and from what I gather it's more that their official position is that alcoholism is a permanent condition, and that life from then on consists of how you handle it.
Recognizing this is central, hence the "Hi, I'm Bob, and I'm an alcoholic."
You're never cured and return to drinking socially... (ideally) you don't ever drink. Ever. Whether publicly or not, you refer to yourself as an alcoholic so it's always clear to you what the deal is, and you don't fool yourself.
The permanence of it feels harsh to me, but it does seem to work, perhaps because "admitting the problem" is so important.
Recognizing this is central, hence the "Hi, I'm Bob, and I'm an alcoholic."
You're never cured and return to drinking socially... (ideally) you don't ever drink. Ever. Whether publicly or not, you refer to yourself as an alcoholic so it's always clear to you what the deal is, and you don't fool yourself.
The permanence of it feels harsh to me, but it does seem to work, perhaps because "admitting the problem" is so important.
Well, within your few sentences lies the method through which AA is able to remain a meme (in the original Dawkins sense). The core tenant is that alcoholism is a permanent 'spiritual' disease, that cannot be cured, and can only be treated through perpetual use of the 12-step program for the rest of their lives.
None of this, in reality, is based on science or facts. It is something that the original progenitors made up.
Because most people in their normal lives will not develop an addiction firsthand, and because most people are honest and basically believe what they are told (expecting other people to tell them the truth), this continues to propagate.
One way to tell if something propagates mostly as a meme rather than by functional merit is to cross cultural boundaries and look for it elsewhere. If it were something that had merit, there is a better chance for it to have grown within other cultures independently. AA's own self-published census shows that it is overwhelmingly an American and Canadian phenomenon, with some small sprinkling in the UK. It basically exists nowhere else in the world, except for expatriates from the US.
There is also a correlation between alcohol addiction and AA penetration. Places with more problems with alcohol addiction have more AA meetings. At first this seems to make sense -- more alcoholics, more AA members and meetings to help them. But if you go to places where AA does not exist at all, you'll find the same numbers you'd expect from America if there was no correlation with AA. In other words, places without AA have the same numbers you would get in America if you took the AA slider widget and turned it back down to 0.
My own conclusion is that AA and alcoholism is mostly a cultural artifact, not a physical (or 'spiritual') disease manifesting itself in people's bodies. I encourage you to dig up numbers (which AA openly provides from their own surveys, and are not flattering to themselves) and draw your own conclusions.
None of this, in reality, is based on science or facts. It is something that the original progenitors made up.
Because most people in their normal lives will not develop an addiction firsthand, and because most people are honest and basically believe what they are told (expecting other people to tell them the truth), this continues to propagate.
One way to tell if something propagates mostly as a meme rather than by functional merit is to cross cultural boundaries and look for it elsewhere. If it were something that had merit, there is a better chance for it to have grown within other cultures independently. AA's own self-published census shows that it is overwhelmingly an American and Canadian phenomenon, with some small sprinkling in the UK. It basically exists nowhere else in the world, except for expatriates from the US.
There is also a correlation between alcohol addiction and AA penetration. Places with more problems with alcohol addiction have more AA meetings. At first this seems to make sense -- more alcoholics, more AA members and meetings to help them. But if you go to places where AA does not exist at all, you'll find the same numbers you'd expect from America if there was no correlation with AA. In other words, places without AA have the same numbers you would get in America if you took the AA slider widget and turned it back down to 0.
My own conclusion is that AA and alcoholism is mostly a cultural artifact, not a physical (or 'spiritual') disease manifesting itself in people's bodies. I encourage you to dig up numbers (which AA openly provides from their own surveys, and are not flattering to themselves) and draw your own conclusions.
" The core tenant is that alcoholism is a permanent 'spiritual' disease"
Well, what you hear may vary from one AA group to the next, but I don't think the core point is that it is spiritual, only that it is permanent. (Assorted official books from AA may say otherwise, but actual AA groups very in the application of the key principles.)
The idea is that some people keep chasing the idea that they can drink just a little then stop, yet fail again and again. If you can get them to just give up on that idea they'll be better off.
"AA's own self-published census shows that it is overwhelmingly an American and Canadian phenomenon, with some small sprinkling in the UK. It basically exists nowhere else in the world, except for expatriates from the US."
Do you have a link for this? These sites suggests otherwise:
http://www.aa.org/lang/en/aa_international.cfm?origpage=31
http://markybaby.com/legacy/book/links_index.php
Well, what you hear may vary from one AA group to the next, but I don't think the core point is that it is spiritual, only that it is permanent. (Assorted official books from AA may say otherwise, but actual AA groups very in the application of the key principles.)
The idea is that some people keep chasing the idea that they can drink just a little then stop, yet fail again and again. If you can get them to just give up on that idea they'll be better off.
"AA's own self-published census shows that it is overwhelmingly an American and Canadian phenomenon, with some small sprinkling in the UK. It basically exists nowhere else in the world, except for expatriates from the US."
Do you have a link for this? These sites suggests otherwise:
http://www.aa.org/lang/en/aa_international.cfm?origpage=31
http://markybaby.com/legacy/book/links_index.php
Do you have a link for this? These sites suggests otherwise
Yes I do.
33%? That's still a lot, right?
Occurrence of AA membership in North America: 1 in 265
http://www.wolframalpha.com/input/?i=(population+of+united+s...
Occurrence of AA membership the world, excluding North America: 1 in 9207
http://www.wolframalpha.com/input/?i=(population+of+world+-+...
It makes sense that their international presence is played up heavily on their sites and other material, so as to make it seem as if they are expounding some universal truth, rather than a localized phenomenon.
The idea is that some people keep chasing the idea that they can drink just a little then stop, yet fail again and again. If you can get them to just give up on that idea they'll be better off.
Yes, that is one of AA's core ideas, and not backed up by scientific research or studies. Just because a lot of people (where you live) say it very loudly and frequently does not make it true. This is exactly what I just talked about in my previous post -- people accept these statements as if they are inherently true, without examining them critically.
Yes I do.
Outside of U.S./Canada
704,266 Members
Total Reported
2,103,033 Members
33%? That's still a lot, right?
Occurrence of AA membership in North America: 1 in 265
http://www.wolframalpha.com/input/?i=(population+of+united+s...
Occurrence of AA membership the world, excluding North America: 1 in 9207
http://www.wolframalpha.com/input/?i=(population+of+world+-+...
It makes sense that their international presence is played up heavily on their sites and other material, so as to make it seem as if they are expounding some universal truth, rather than a localized phenomenon.
The idea is that some people keep chasing the idea that they can drink just a little then stop, yet fail again and again. If you can get them to just give up on that idea they'll be better off.
Yes, that is one of AA's core ideas, and not backed up by scientific research or studies. Just because a lot of people (where you live) say it very loudly and frequently does not make it true. This is exactly what I just talked about in my previous post -- people accept these statements as if they are inherently true, without examining them critically.
>> The core tenant is that alcoholism is a permanent 'spiritual' disease
I'm unfamiliar with the program enough that I can't refute the word "spiritual", though another viewpoint might be that alcoholism might rewire your brain permanently, which is conceivable imho.
I'm unfamiliar with the program enough that I can't refute the word "spiritual", though another viewpoint might be that alcoholism might rewire your brain permanently, which is conceivable imho.
Couldn't the AA focus on permanence be simply based on the observation that alcoholism has a high rate of relapse, even years after an apparent cure, and the theory that constant vigilance is the best method to prevent this?
I've heard the same thing from people in AA.
Honestly, I think it is something of an excuse to live with the problem (I'm not judging on that, fair enough). A coping mechanism, if you will, to live with relapses and so forth.
I know at least one Alcoholic who is totally dry now (and will not touch a drink because he is scared of slipping back) and yet another who is a normal drinker again. In the first case the guy is pretty like those in the AA - but his coping mechanism is to have scared himself from drinking (again, no issue there - if it works...). The final example, though, suggests that alcoholism is entirely fixable in at least some cases.
(note: I've had problems with slightly excessive/impulsive/habitual drinking in the fairly recent past, so some of this is from experience)
Honestly, I think it is something of an excuse to live with the problem (I'm not judging on that, fair enough). A coping mechanism, if you will, to live with relapses and so forth.
I know at least one Alcoholic who is totally dry now (and will not touch a drink because he is scared of slipping back) and yet another who is a normal drinker again. In the first case the guy is pretty like those in the AA - but his coping mechanism is to have scared himself from drinking (again, no issue there - if it works...). The final example, though, suggests that alcoholism is entirely fixable in at least some cases.
(note: I've had problems with slightly excessive/impulsive/habitual drinking in the fairly recent past, so some of this is from experience)
Interesting article.
I do object to the medical approaches to obesity, depression etc. it seems a very "un-medical" way to approach the problem and, I'm sorry to say, very American. In many of these cases people do themselves harm through their own actions or inactions - using medicine or surgery to "solve" these problems is curing the symptoms rather than the cause.
Having the freedom to do what we want doesn't free us from the consequences of our actions...
I do object to the medical approaches to obesity, depression etc. it seems a very "un-medical" way to approach the problem and, I'm sorry to say, very American. In many of these cases people do themselves harm through their own actions or inactions - using medicine or surgery to "solve" these problems is curing the symptoms rather than the cause.
Having the freedom to do what we want doesn't free us from the consequences of our actions...
As a counterpoint, I enjoy skiing. My enjoyment of skiing has directly lead to a fairly serious leg injury. Fortunately surgery completely "cured" this and I was back skiing next season, ready to potentially do more harm to myself as if nothing had happened. Did the doctors do the right thing fixing up my leg or should they have let me walk with a limp for the rest of my life as a consequence of my actions?
It's an interesting moral question; there are definitely shades of grey.
The way I've always seen this analogy is that if your going back every year and breaking a leg then, clearly, there is less and less moral obligation to fix it for you (beyond setting it etc.) so that you can ski again.
Or in other words: if you find over and over again you can't ski (by breaking a leg) refusing to take the hint should be discouraged :D
Now lets take obesity; if someone thinks medical work will help them get healthy again then fair enough (it could even be the piece of phsycology needed to fix their attitude if the problem proves to be non-medically caused). But if they are back in 12 months time with the same problem then there is the same lowering of moral imperative to provide help. If nothing else it is likely a temporary solution again and, so, other forms of treatment/help should be encouraged (I'd even argue it is morally better to suggest other ideas first in such circumstances)
(I'm using the royal you btw :))
The way I've always seen this analogy is that if your going back every year and breaking a leg then, clearly, there is less and less moral obligation to fix it for you (beyond setting it etc.) so that you can ski again.
Or in other words: if you find over and over again you can't ski (by breaking a leg) refusing to take the hint should be discouraged :D
Now lets take obesity; if someone thinks medical work will help them get healthy again then fair enough (it could even be the piece of phsycology needed to fix their attitude if the problem proves to be non-medically caused). But if they are back in 12 months time with the same problem then there is the same lowering of moral imperative to provide help. If nothing else it is likely a temporary solution again and, so, other forms of treatment/help should be encouraged (I'd even argue it is morally better to suggest other ideas first in such circumstances)
(I'm using the royal you btw :))
Good point. Its definitely not black and white... but I'd lean on the side of leaving you limping unfortunately. I wonder though - would you ski anyway, if the doctors didn't exist? I'd suspect so...
I "feel" that there is some difference between the injury type situation and the self inflected harm of depression or obesity though - its possible to ski without any injuries, but its not possible to put on loads of weight, or take a depressed approach to life without suffering the consequences. I guess I am more inclined to feel sorry for you because the risk from skiing is such that you might have avoided the injury if the situation were more favorable... its more "unlucky" than "inevitable".
I "feel" that there is some difference between the injury type situation and the self inflected harm of depression or obesity though - its possible to ski without any injuries, but its not possible to put on loads of weight, or take a depressed approach to life without suffering the consequences. I guess I am more inclined to feel sorry for you because the risk from skiing is such that you might have avoided the injury if the situation were more favorable... its more "unlucky" than "inevitable".
If you think depression is a choice, you are incredibly ignorant.
Thanks for the wealth of information with which to undo my supposed ignorance...
I never said its a choice anyway, just that behaviour can cause it... whether its intentional or not is another story, and I'm not going to claim that all depression is not physiological - I'm sure there are real hormonal/neurological problems which lead to depression. My personal experience however is that change in behaviour solved my own depression... so in at least one case it is true. My doctor prescribed me pills and his attitude towards it was unhelpful, despite being very sympathetic and supportive - a good slap round the face about my attitude would have been much more effective.
I should probably add that I'm pretty fat, bordering on obese perhaps, but I don't consciously over eat...
I never said its a choice anyway, just that behaviour can cause it... whether its intentional or not is another story, and I'm not going to claim that all depression is not physiological - I'm sure there are real hormonal/neurological problems which lead to depression. My personal experience however is that change in behaviour solved my own depression... so in at least one case it is true. My doctor prescribed me pills and his attitude towards it was unhelpful, despite being very sympathetic and supportive - a good slap round the face about my attitude would have been much more effective.
I should probably add that I'm pretty fat, bordering on obese perhaps, but I don't consciously over eat...
Honest question: What I don't get about the "obesity is genetic" is, why is the obesity rate climbing? Are obese people proliferating at a quicker pace than before? Are the genes responsible dominant?
Genetics are not the only cause...
Well, with any gene, it takes the proper environmental factors for it to be expressed. So while very few people would argue that height isn't largely genetic, most people also accept that it takes proper nutrition in order to grow tall. So even though height is genetic, and South and North Koreans largely share the same genetics, South Koreans are way taller than North Koreans.
The genetic argument for obesity is that in areas of occasional famine, it made evolutionary sense to horde food in your gut, particularly fatty food. Until very recently in human history, there just wasn't that much fatty food for your average citizen to horde. Now there is, particularly because food corporations have realized over time that the fattier the food, the more of it they sell, and those previously advantageous genes are running amok. Not everyone has those genes because in places of plenty, those genes aren't that advantageous.
I'd agree that that isn't an entirely convincing argument. But I do think it's part of the story.
The genetic argument for obesity is that in areas of occasional famine, it made evolutionary sense to horde food in your gut, particularly fatty food. Until very recently in human history, there just wasn't that much fatty food for your average citizen to horde. Now there is, particularly because food corporations have realized over time that the fattier the food, the more of it they sell, and those previously advantageous genes are running amok. Not everyone has those genes because in places of plenty, those genes aren't that advantageous.
I'd agree that that isn't an entirely convincing argument. But I do think it's part of the story.
There are corporations in Europe too, but people here aren't as fat as in the US. Perhaps because, despite "the corporations", they do have a say in the matter and simply don't eat so much fatty garbage.
Well, the fact that much of what passes for food in the US wouldn't be legal in Europe has something to do with it as well.
You can get plenty of crap here in Italy if you want, and good food in the US, too. I don't really think that's the issue. People here are more discriminating about what they eat.
I don't think you realize just how far we go. :) Do you have products with more artificial flavoring than actual food? Use very large amounts of preservatives to make the food last several times longer than it should? Inject your cattle with steriods? Genetically alter crops to give them certain traits (e.g. larger)?
Obesity is on the rise in much of Europe as well.
Can't we directly conclude from your argument that the obesity epidemy can be entirely solved by fixing the environment, which is probably easier than fixing the genes ?
Heroin harms us because of our genetic makeup, yet we don't talk about how heroin-induced illness has genetic causes. We simply try to keep people away from heroin.
Heroin harms us because of our genetic makeup, yet we don't talk about how heroin-induced illness has genetic causes. We simply try to keep people away from heroin.
Not necessarily. The point is that given the current environment, some people become obese and others do not. The difference between the two groups may be partly due to genetics.
And actually, we do talk about the genetic basis for opioid addiction. I recall one doctor suggesting that a small percentage of the population are born addicted to opioids from birth whereas most people will have greater difficulty developing opioid addiction.
And actually, we do talk about the genetic basis for opioid addiction. I recall one doctor suggesting that a small percentage of the population are born addicted to opioids from birth whereas most people will have greater difficulty developing opioid addiction.
"And actually, we do talk about the genetic basis for opioid addiction."
Plus, a major health issue with heroin is the shit product being sold. Attempts to restrict access makes it more dangerous to use.
Plus, a major health issue with heroin is the shit product being sold. Attempts to restrict access makes it more dangerous to use.
You could fix it by changing the environment - limited food rations, enforced exercise, etc. But the cost to society would probably outweigh the benefits.
That would imply raising food prices specifically targeted at poorer people.
It is a leap from the obvious "propensity for obesity is genetically influenced" to the excuse "obesity is genetically caused".
When people say "obesity is genetic" they are generally talking about variations in metabolism. People are on the whole eating more food and more unhealthy food than before, and this is making the relative differences in people metabolism more apparent than it used to be.
My common reaction to people saying this is the simple fact that you do not get bigger if you consume less calories than you burn throughout a day. If you eat 2000 calories, and you burn 2000 calories then you do not gain weight, period.
Yeah, some people burn calories at an easier/faster rate by just living (they have a fast metabolism), but it's a known fact that walking x miles will burn y calories, so you eat proportionally to your caloric expenditure.
Any obese person that argues otherwise is ignoring physics, and is just not trying. My gut feeling (sorry!) is that these obese individuals playing the genetic card are confusing their hunger for their metabolism. It is shown that obese individuals get hungry sooner and that hunger is present longer even after eating (it's a hormone that causes hunger), but this is still preventable.
Yeah, some people burn calories at an easier/faster rate by just living (they have a fast metabolism), but it's a known fact that walking x miles will burn y calories, so you eat proportionally to your caloric expenditure.
Any obese person that argues otherwise is ignoring physics, and is just not trying. My gut feeling (sorry!) is that these obese individuals playing the genetic card are confusing their hunger for their metabolism. It is shown that obese individuals get hungry sooner and that hunger is present longer even after eating (it's a hormone that causes hunger), but this is still preventable.
It's a lot more complicated than that. The human body is not a simple engine with a fixed metabolism. Even if we switch to a more variable metabolism model, simply scaling your eating to your activity will not necessarily cause you to lose weight. The body first looks for equilibrium, and then when equilibrium is a problem it will start looking into stored energy. It's not just a question of "activity x burns y calories." Some of those calories are burnt in healing - our muscles strengthen by tearing, and then healing larger. You don't eat, your body may delay that maintenance, waiting until energy is available. So you haven't actually lost any weight - you've just prevented yourself from gaining weight, which is actually a bad thing, because that muscle would make you healthier.
Wait, so if I burn 2000 calories in a day but only consume 1500 calories, I won't lose weight?
I am not arguing that it's not as simple as the 500 calorie deficit going 100% towards fat reduction, but I don't see how it is possible to not lose weight like this. Weather or not the exercise builds muscle, it will reduce mass.
I am not arguing that it's not as simple as the 500 calorie deficit going 100% towards fat reduction, but I don't see how it is possible to not lose weight like this. Weather or not the exercise builds muscle, it will reduce mass.
Naturally, if you consume 25% fewer calories than you burn, you will lose weight. However, you will be less healthy as a result. There's a very narrow band where you can actually lose weight in a healthy manner. It varies from person to person, and furthermore, you are making yourself weaker and more vulnerable to disease if you are eating less than your caloric requirements.
So you're saying "you're fat, that's your problem, you should just eat less." The issue is that eating less causes its own problems, and for some people those can seriously outweigh the benefits of being thinner. For some people, their ability to metabolize fat is so retarded that what you suggest really isn't feasible. They will likely starve to death before they get rid of their fat.
These people are, of course, rare, but the same issue exists in lesser values for other segments of the population.
So you're saying "you're fat, that's your problem, you should just eat less." The issue is that eating less causes its own problems, and for some people those can seriously outweigh the benefits of being thinner. For some people, their ability to metabolize fat is so retarded that what you suggest really isn't feasible. They will likely starve to death before they get rid of their fat.
These people are, of course, rare, but the same issue exists in lesser values for other segments of the population.
The human body is incredibly resilient.
You can gain or lose 25 pounds next month easily and without any ill effects of any kind. Try it.
I would like to see any sort of evidence that it is possible for some people to have very little ability to metabolize fat. I think the body type argument is a rounding error when it comes to obesity.
Visit Asia. There are incredibly few obese people, and most people are probably too thin. Why? Caloric intake and expenditure.
You can gain or lose 25 pounds next month easily and without any ill effects of any kind. Try it.
I would like to see any sort of evidence that it is possible for some people to have very little ability to metabolize fat. I think the body type argument is a rounding error when it comes to obesity.
Visit Asia. There are incredibly few obese people, and most people are probably too thin. Why? Caloric intake and expenditure.
I don't have any supporting evidence, but I have read over and over that you cannot exceed more than 2 pounds of loss per week without doing some damage. 25 pounds in a single month is HUGE.
Anecdote: Myself, plus 3 guys I work with decided to lose weight. We all succeeded (I lost about 50 pounds over 9 months), but the guy who lost 3.5 pounds per week started having serious medical issues.
We aren't talking about the "rare" individuals. The obesity problem seen in the United States is almost exclusively due to people eating crap food (sugar sugar sugar) and not exercising, period.
I am not a doctor, but I'd still be willing to wager that the health benefits of going on a diet/exercise regimen, thus losing weight, FAR outweigh any potential downsides to dieting. Seriously, how can you say "oh, overweight people might be harmed by diet restrictions and exercise" when for 99% of the cases out there this simply isn't the case?
There is no way to lose weight besides caloric intake being less than caloric expenditure. By saying "you are making yourself weaker and more vulnerable to disease" you are effectively saying (though probably not meaning) "you should not slim down". Trying to drop 25 pounds in a week is pretty insane, but a well balanced 1-2 year plan, approved by a doctor, will go a long ways towards health and not against it.
I am not a doctor, but I'd still be willing to wager that the health benefits of going on a diet/exercise regimen, thus losing weight, FAR outweigh any potential downsides to dieting. Seriously, how can you say "oh, overweight people might be harmed by diet restrictions and exercise" when for 99% of the cases out there this simply isn't the case?
There is no way to lose weight besides caloric intake being less than caloric expenditure. By saying "you are making yourself weaker and more vulnerable to disease" you are effectively saying (though probably not meaning) "you should not slim down". Trying to drop 25 pounds in a week is pretty insane, but a well balanced 1-2 year plan, approved by a doctor, will go a long ways towards health and not against it.
>We aren't talking about the "rare" individuals.
The linked article specifically talked about a case where the woman's doctor told her there are genetic reasons for her obesity.
Also, there is a limit to where losing weight is an unquestionably good idea. I certainly have enough excess body fat that no one wants to see my bare chest. That said, I'm not clinically speaking overweight, and I have very low blood pressure, and I'm fairly active. I certainly would benefit from cardio (as would most people) but focusing on fat rather misses the point, which is primarily keeping arteries clean and your heart strong. This is actually quite possible for an obese person.
The linked article specifically talked about a case where the woman's doctor told her there are genetic reasons for her obesity.
Also, there is a limit to where losing weight is an unquestionably good idea. I certainly have enough excess body fat that no one wants to see my bare chest. That said, I'm not clinically speaking overweight, and I have very low blood pressure, and I'm fairly active. I certainly would benefit from cardio (as would most people) but focusing on fat rather misses the point, which is primarily keeping arteries clean and your heart strong. This is actually quite possible for an obese person.
The difficult part is the burning the 2000 calories. You do not have complete control over how many calories you burn. In the example DrSprout gives, if your body senses that you are burning too many calories it may adjust what is it does to conserve energy. In this case by delaying the process of healing the muscles.
In short, the way to lose weight is by burning more calories then you consume. But the difficult part is finding out how to do so in a healthy and sustainable weight. The means for doing so will vary from individual to individual.
In short, the way to lose weight is by burning more calories then you consume. But the difficult part is finding out how to do so in a healthy and sustainable weight. The means for doing so will vary from individual to individual.
It's a bit unfair to say obese people are "just not trying". They might be trying very hard, they're just not trying hard enough.
Getting from being obese to an average weight is much harder than maintaining an average weight. Once you get yourself into an obese condition you've got a difficult road back out.
Though I agree with your basic argument - if you eat less than you burn you will lose weight. The tricky part is that your body can vary what it burns to some degree (your metabolism can speed up and slow down), so it's not entirely obvious how much you are burning.
Getting from being obese to an average weight is much harder than maintaining an average weight. Once you get yourself into an obese condition you've got a difficult road back out.
Though I agree with your basic argument - if you eat less than you burn you will lose weight. The tricky part is that your body can vary what it burns to some degree (your metabolism can speed up and slow down), so it's not entirely obvious how much you are burning.
Honest question: [...] Are obese people proliferating at a quicker pace than before?
Honest answer: Yes. Overweight females are more fertile (IIRC fertility reaches a maximum at around 30 BMI) and are more likely to decide to have children due to societal factors (they are less likely to be employed and have lower mean household income). Until recently, the second factor did not exist (the societally accepted role of women was to bear children), and the first factor was limited by affluence -- bearing more children doesn't help you genetically if the extra children die of starvation.
The above (horribly politically incorrect) comments notwithstanding, the environmental pressure in favour of "overweight" genes is a tiny fraction of what would be required to cause the observed surge in obesity over the observed timescale. We're looking at a change in environment, not a change in genetics.
Honest answer: Yes. Overweight females are more fertile (IIRC fertility reaches a maximum at around 30 BMI) and are more likely to decide to have children due to societal factors (they are less likely to be employed and have lower mean household income). Until recently, the second factor did not exist (the societally accepted role of women was to bear children), and the first factor was limited by affluence -- bearing more children doesn't help you genetically if the extra children die of starvation.
The above (horribly politically incorrect) comments notwithstanding, the environmental pressure in favour of "overweight" genes is a tiny fraction of what would be required to cause the observed surge in obesity over the observed timescale. We're looking at a change in environment, not a change in genetics.
Let me answer by analogy.
When western Europeans showed up in the New World, they brought alcohol with them. Suddenly large percentages of the Native Americans were alcoholics.
We know now that some people carry genes that process alcohol better than other people. We also know (and have known) that people who never drink never become alcoholics. Furthermore, we know that when an addictive substance is introduced to a organism there is a point past which the organism will continue to consume the substance at the expense of personal well-being, including up to death. That is, chronic physical addiction.
These people were acting in an unchanged manner -- a normal manner -- but their environment changed.
Should we have berated the Native Americans for being so susceptible to alcohol? Use societal and moral pressure to tell them what lousy choices they have made? Were the NA that lived before alcohol introduction "better" (well) than those who lived after it who were addicted (sick)?
Before we knew about the dosing thing, were those people sick? Or now that we know that a the amount of lifetime exposure that triggers alcoholism in NAs is much less than others, could we call any particular experience with alcohol a bad decision? If I need 4 beers to become an alcoholic, and you need 40 thousand, yet neither of us know which number we have, is going out for a beer in college something society should tell us is bad?
These are complex issues for which simple words that have thousands of years of baggage behind them like "disease" aren't going to work. My opinion is that if the individual makes decisions that he/she knows with greater than a 50% certainty will cause eventual long-term bodily harm, then the consequences are not a disease -- it's a personal choice. Even though it may have attributes of a disease. But I don't think the rising number of obese people is due to a huge number of people making informed choices with probable negative consequence. You eat a few high-carb meals in your teens and now subconsciously you are craving an insulin fix that makes you overeat. I eat a hundred times more high carb meals and I do not have the same condition. When we went out for fish and chips at 21, were either of us committing some sort of purposeful act to get fat? I don't think so, yet one of us now has a lifelong condition. So without any change in our behavior, environmental conditions contribute to changing the way our bodies and minds work. So yes, these people are sick -- in some sense of the word. (forgive the over-broad use of the carb model here. It is incidental to the argument)
However society "dumbing down" illnesses to be everything from shyness to immaturity is also not going to work, because "illness" has this huge social stigma: you are broken, we have an obligation to fix you. Sorry, but I don't need to be fixed for everything I have that you might find as an illness. Some of these things I might enjoy, and some of these things I might feel a personal need to struggle with as a way of understanding the human condition. And I object at people telling me that I "should" do something or another in order to conform to some ever-tightening standard of normality. In addition, I am beginning to suspect that the eventual result here is a homogenized population -- an idea I find so abhorrent that I would rather give up medicine altogether as a species. (I understand this is a radical position) So in that sense, the word "sick" is not correct at all.
When western Europeans showed up in the New World, they brought alcohol with them. Suddenly large percentages of the Native Americans were alcoholics.
We know now that some people carry genes that process alcohol better than other people. We also know (and have known) that people who never drink never become alcoholics. Furthermore, we know that when an addictive substance is introduced to a organism there is a point past which the organism will continue to consume the substance at the expense of personal well-being, including up to death. That is, chronic physical addiction.
These people were acting in an unchanged manner -- a normal manner -- but their environment changed.
Should we have berated the Native Americans for being so susceptible to alcohol? Use societal and moral pressure to tell them what lousy choices they have made? Were the NA that lived before alcohol introduction "better" (well) than those who lived after it who were addicted (sick)?
Before we knew about the dosing thing, were those people sick? Or now that we know that a the amount of lifetime exposure that triggers alcoholism in NAs is much less than others, could we call any particular experience with alcohol a bad decision? If I need 4 beers to become an alcoholic, and you need 40 thousand, yet neither of us know which number we have, is going out for a beer in college something society should tell us is bad?
These are complex issues for which simple words that have thousands of years of baggage behind them like "disease" aren't going to work. My opinion is that if the individual makes decisions that he/she knows with greater than a 50% certainty will cause eventual long-term bodily harm, then the consequences are not a disease -- it's a personal choice. Even though it may have attributes of a disease. But I don't think the rising number of obese people is due to a huge number of people making informed choices with probable negative consequence. You eat a few high-carb meals in your teens and now subconsciously you are craving an insulin fix that makes you overeat. I eat a hundred times more high carb meals and I do not have the same condition. When we went out for fish and chips at 21, were either of us committing some sort of purposeful act to get fat? I don't think so, yet one of us now has a lifelong condition. So without any change in our behavior, environmental conditions contribute to changing the way our bodies and minds work. So yes, these people are sick -- in some sense of the word. (forgive the over-broad use of the carb model here. It is incidental to the argument)
However society "dumbing down" illnesses to be everything from shyness to immaturity is also not going to work, because "illness" has this huge social stigma: you are broken, we have an obligation to fix you. Sorry, but I don't need to be fixed for everything I have that you might find as an illness. Some of these things I might enjoy, and some of these things I might feel a personal need to struggle with as a way of understanding the human condition. And I object at people telling me that I "should" do something or another in order to conform to some ever-tightening standard of normality. In addition, I am beginning to suspect that the eventual result here is a homogenized population -- an idea I find so abhorrent that I would rather give up medicine altogether as a species. (I understand this is a radical position) So in that sense, the word "sick" is not correct at all.
Suddenly large percentages of the Native Americans were alcoholics.
It's a small point but this isn't true. Native Americans had beer and liquor extending back beyond written history.
Here's an example: http://en.wikipedia.org/wiki/Pulque
There are many more, and the effect on Pre-Colombian society is also documented.
I think this pervasive myth is derived from unconscious euro-centric moralizing.
The first accounts of American and European contact are quite interesting, for anyone interested I recommend the accounts of Cabeza de Vaca: http://en.wikipedia.org/wiki/%C3%81lvar_N%C3%BA%C3%B1ez_Cabe...
It's a small point but this isn't true. Native Americans had beer and liquor extending back beyond written history.
Here's an example: http://en.wikipedia.org/wiki/Pulque
There are many more, and the effect on Pre-Colombian society is also documented.
I think this pervasive myth is derived from unconscious euro-centric moralizing.
The first accounts of American and European contact are quite interesting, for anyone interested I recommend the accounts of Cabeza de Vaca: http://en.wikipedia.org/wiki/%C3%81lvar_N%C3%BA%C3%B1ez_Cabe...
Native Americans had beer and liquor extending back beyond written history.
Only certain native groups had alcohol prior to European contact. As far as I know, the Inuit did not, and alcohol is still a devastating problem. Also, hard liquor is a different level entirely. Europeans in Europe had a hard time dealing with it at first.
http://en.wikipedia.org/wiki/Gin_Craze
Only certain native groups had alcohol prior to European contact. As far as I know, the Inuit did not, and alcohol is still a devastating problem. Also, hard liquor is a different level entirely. Europeans in Europe had a hard time dealing with it at first.
http://en.wikipedia.org/wiki/Gin_Craze
Inuit society is unique in general.
I think alcoholism among Native Americans has more to do with genocide and poverty than culture shock.
Most indigenous Americans were exposed regularly to very strong entheogens, including alcohol. Precedent that may of been lost after several generations of European cultural decimation, granted.
The Inca used "regular" liquor by imbibing and rectal absorption, arguably leading to a similar level of drunkenness.
Again I think alcoholism among Native Americans falls along class lines, the same for every ethnic demographic in America.
I think alcoholism among Native Americans has more to do with genocide and poverty than culture shock.
Most indigenous Americans were exposed regularly to very strong entheogens, including alcohol. Precedent that may of been lost after several generations of European cultural decimation, granted.
The Inca used "regular" liquor by imbibing and rectal absorption, arguably leading to a similar level of drunkenness.
Again I think alcoholism among Native Americans falls along class lines, the same for every ethnic demographic in America.
The Inca used "regular" liquor by imbibing and rectal absorption, arguably leading to a similar level of drunkenness.
I would find such an activity invigorating, doubtless, but this bit of data doesn't do a thing to eliminate "culture shock." (Unless we can find a historical account of how smoothly such an innovation was adopted by Inca society, and even then, this should be met by much skepticism.)
I would find such an activity invigorating, doubtless, but this bit of data doesn't do a thing to eliminate "culture shock." (Unless we can find a historical account of how smoothly such an innovation was adopted by Inca society, and even then, this should be met by much skepticism.)
You're right. Frankly I think rates of alcoholism among native populations from the 1600s to today would be the best measure of this idea. This would need to be compared to other subjugated demographic groups, perhaps in other areas of the world at the same time period or similar cultural circumstance.
Neither, they should be held responsible for their actions. Only a change in their actions can change the outcome. Treatment is a nonsense word in this application. "Treatment" is just a way to use social tricks to get them to make different choices while making them believe it's a disease so they don't resist treatment. Real treatment for alcoholism is a liver transplant. Real treatment for obesity is liposuction. They only way to stop damaging yourself is to take responsibility and stop doing what you've been doing. Telling people they are powerless robs them of their dignity and is an outright lie. The person with the problem is the only one with the power to change! The treatment industry in America is a racket that is mostly based on the AA 12 Steps. At best it has a 5% success rate. (http://www.orange-papers.org/orange-effectiveness.html) If you want a good book on the subject, read Rational Recovery http://www.amazon.com/Rational-Recovery-Cure-Substance-Addic...
"Neither, they should be held responsible for their actions. Only a change in their actions can change the outcome."
Experiments strongly suggest that choice and strength of willpower have little to do with body weight. Controlled overfeeding experiments in humans have demonstrated a wide variation in weight gain. Some people's bodies are simply resistant to storing excess food, while other people's store it avidly and gain weight rapidly. After the overfeeding phase of the experiment finished, they then lost weight rapidly with no perceived effort or exercise of willpower.
Meanwhile various nonhuman animal experiments have found that body fat is fairly sensitive to things like gut microbes, details of food composition, and subtle differences in the environment. Not one of these can be changed by simply resolving to eat less.
"Real treatment for obesity is liposuction."
Obesity is a disorder of food conversion and storage, not body fat. Liposuction causes temporary and cosmetic changes. Real treatment is a drug that alters the brain centers responsible for metabolism and hunger. (And indeed such drugs exist and are spectacularly effective. Unfortunately the existing ones also have spectacular and dangerous side effects, but much better ones are rapidly being developed.)
Experiments strongly suggest that choice and strength of willpower have little to do with body weight. Controlled overfeeding experiments in humans have demonstrated a wide variation in weight gain. Some people's bodies are simply resistant to storing excess food, while other people's store it avidly and gain weight rapidly. After the overfeeding phase of the experiment finished, they then lost weight rapidly with no perceived effort or exercise of willpower.
Meanwhile various nonhuman animal experiments have found that body fat is fairly sensitive to things like gut microbes, details of food composition, and subtle differences in the environment. Not one of these can be changed by simply resolving to eat less.
"Real treatment for obesity is liposuction."
Obesity is a disorder of food conversion and storage, not body fat. Liposuction causes temporary and cosmetic changes. Real treatment is a drug that alters the brain centers responsible for metabolism and hunger. (And indeed such drugs exist and are spectacularly effective. Unfortunately the existing ones also have spectacular and dangerous side effects, but much better ones are rapidly being developed.)
Sometimes I think all interesting questions boil down to semantics.
One nit: libertarian (classic, not anti-government) attitudes were described thusly: * People who make good decisions are intrinsically good people and deserve good treatment; people who make bad decisions are intrinsically bad people and deserve bad treatment.*
Er no. Libertarian thought tells us that variations in individuals are more important than societal standards. Not that people are "bad" or "good"
Taking a determinist consequentialist position allows us to do so more effectively.
This strikes me as the difference between an academic argument and a practical one. Academically, sure, the numbers add up. Practically, this is completely terrible advice, for the sole reason that the criteria suggested are not only indeterminate but suffer large variations as applied by different individuals. And offering up some sort of scientific committee or standards for what to blame people for is totally whacked, for reasons I'll leave as an exercise to the reader.
I liked the observation that people who condemn others may do so because others have not sacrificed. This fits intuitively with what I have observed.
I'd add another detail, though. There is a long tradition in western thought that the individual's struggles with character traits that he or she don't like has value in itself. We always should have a place we would like to be that we cannot attain. Western medicine and ideals, however, seem to feel that if we commonly view one condition as "better" or "worse" than another, some sort of chemical or social intervention is required in order to make people better. This worked great when "worse" = the plague, but the model is falling apart when "worse" = too fat. The types of structures and systems of thought we have set up for the plague do not naturally extend to shyness. The word has stretched too far.
I support looking at the necessary and sufficient conditions, but I felt the analysis was loose and incomplete, which led to a muddled set of conclusions.
One nit: libertarian (classic, not anti-government) attitudes were described thusly: * People who make good decisions are intrinsically good people and deserve good treatment; people who make bad decisions are intrinsically bad people and deserve bad treatment.*
Er no. Libertarian thought tells us that variations in individuals are more important than societal standards. Not that people are "bad" or "good"
Taking a determinist consequentialist position allows us to do so more effectively.
This strikes me as the difference between an academic argument and a practical one. Academically, sure, the numbers add up. Practically, this is completely terrible advice, for the sole reason that the criteria suggested are not only indeterminate but suffer large variations as applied by different individuals. And offering up some sort of scientific committee or standards for what to blame people for is totally whacked, for reasons I'll leave as an exercise to the reader.
I liked the observation that people who condemn others may do so because others have not sacrificed. This fits intuitively with what I have observed.
I'd add another detail, though. There is a long tradition in western thought that the individual's struggles with character traits that he or she don't like has value in itself. We always should have a place we would like to be that we cannot attain. Western medicine and ideals, however, seem to feel that if we commonly view one condition as "better" or "worse" than another, some sort of chemical or social intervention is required in order to make people better. This worked great when "worse" = the plague, but the model is falling apart when "worse" = too fat. The types of structures and systems of thought we have set up for the plague do not naturally extend to shyness. The word has stretched too far.
I support looking at the necessary and sufficient conditions, but I felt the analysis was loose and incomplete, which led to a muddled set of conclusions.
> libertarian (classic, not anti-government)
Slightly offtopic, but did you mean 'classic liberal?' I thought original recipe libertarians were anarchists. I only ask because I only recently learned that fact, and found it interesting.
Slightly offtopic, but did you mean 'classic liberal?' I thought original recipe libertarians were anarchists. I only ask because I only recently learned that fact, and found it interesting.
Be careful of words with political annotations -- liberal, conservative, libertarian. The problem is that there is the theory, and then there is application of the theory. For instance, "liberal" has changed quite a bit over the last hundred years, as has "conservative"
You can cherry-pick various people or parties that have called themselves liberal or conservative and come up with all sorts of positions. It's a fun parlor game, but the only thing it proves is that people can take a simple idea and twist it into all sorts of things. Doesn't mean the idea is whacked.
Libertarian is the same as the rest of them.
I'll go with first line in the wiki article The term libertarian in a metaphysical or philosophical sense was first used by late-Enlightenment free-thinkers to refer to those who believed in free will, as opposed to determinism
Historically yes, it was grabbed by anarchists. And you can find examples of libertarian "thought" being used to justify all sorts of crazy stuff. But the point here is that if you are telling me that I am good or bad, you are applying deterministic thought which implies some sort of control. Better to say that we are both free agents acting in our own best interests. If I cut off my toe, you may get very upset. What a bad thing to do! But it was my toe, and if I didn't like it, it was my right to get rid of it. Your tendency to view my actions in terms of your morality is an attempt to layer your version of deterministic morality over my right to do things which may frighten or offend you. The next step would be for you to start labeling my toe-cutting a form of sickness that society would be justified in "fixing" for me.
It's exactly the same thing as the church did, it's just dressed up in science and medicine instead of religion and myth.
You can cherry-pick various people or parties that have called themselves liberal or conservative and come up with all sorts of positions. It's a fun parlor game, but the only thing it proves is that people can take a simple idea and twist it into all sorts of things. Doesn't mean the idea is whacked.
Libertarian is the same as the rest of them.
I'll go with first line in the wiki article The term libertarian in a metaphysical or philosophical sense was first used by late-Enlightenment free-thinkers to refer to those who believed in free will, as opposed to determinism
Historically yes, it was grabbed by anarchists. And you can find examples of libertarian "thought" being used to justify all sorts of crazy stuff. But the point here is that if you are telling me that I am good or bad, you are applying deterministic thought which implies some sort of control. Better to say that we are both free agents acting in our own best interests. If I cut off my toe, you may get very upset. What a bad thing to do! But it was my toe, and if I didn't like it, it was my right to get rid of it. Your tendency to view my actions in terms of your morality is an attempt to layer your version of deterministic morality over my right to do things which may frighten or offend you. The next step would be for you to start labeling my toe-cutting a form of sickness that society would be justified in "fixing" for me.
It's exactly the same thing as the church did, it's just dressed up in science and medicine instead of religion and myth.
Thanks for the well-thought out response. You touch on a subject that I find to be really interesting, in a game-theory sort of way: words are always changing, that's the nature of language. Yet in order to have reasoned discourse, we need to nail down what words actually mean. There's a certain push and pull that goes on between those two sides, I guess, which is why it's so hard to talk about these things. Everyone has different meanings for everything.
In the US "libertarian" means something different than it does... everywhere else.
I don't think "libertarian" is used much outside the US. liberal, on the other hand, is definitely a word whose connotations in the US seem bizarre to anyone outside.
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It's a fairly political question in the US. Emotional people believe in emotional solutions, like the death penalty, physical discipline, healing prayer. Logical people believe in logical solutions, like medicine, research, and education. The main difference that persists is that those approach any issue emotionally will end up ignoring the source of the problem and just attack the result, while the permanent cure is to fix the source.
The semantic criteria listed in the article for defining 'disease' are not rigorous at all and rules out the following conditions that most people would agree are diseases:
Alzheimer's Disease (rule 1)
Any STD, like AIDS (rule 2)
Any pandemic (rule 3)
The Common Cold (rules 2, 3)
Scurvy, Rickets (rules 2, 6)
Also, I'm skeptical that given a clear medical definition of obesity (or more more likely, metabolic syndrome), that it would fail rule 5.
Alzheimer's Disease (rule 1)
Any STD, like AIDS (rule 2)
Any pandemic (rule 3)
The Common Cold (rules 2, 3)
Scurvy, Rickets (rules 2, 6)
Also, I'm skeptical that given a clear medical definition of obesity (or more more likely, metabolic syndrome), that it would fail rule 5.
I think you misunderstood the list. It is not a list of normative criteria for the definition of disease, but of descriptive criteria, and not even a list of descriptive criteria for disease, but for uses of the word disease. That is twice removed from what you seem to be seeing here. Your observation that many common conditions fail several of the criteria is exactly the point of the list.
There is no real point to the list, that's my point.
You're exactly right. It's a partial list of some of the ways that people sometimes under certain conditions use the word disease. That would be merely boring except that he compares the list to the far more carefully specified definitions 'rube' and 'blegg' and subsequently uses the list as criteria in the next 3 paragraphs. He treats the list as if it's an actual list of semantic features, when in fact it's not.
Ultimately he gives up on the question entirely:
So, is obesity really a disease? Well, is Pluto really a planet? Once we state that obesity satisfies some of the criteria but not others, it is meaningless to talk about an additional fact of whether it "really deserves to be a disease" or not.
What a waste of time.
You're exactly right. It's a partial list of some of the ways that people sometimes under certain conditions use the word disease. That would be merely boring except that he compares the list to the far more carefully specified definitions 'rube' and 'blegg' and subsequently uses the list as criteria in the next 3 paragraphs. He treats the list as if it's an actual list of semantic features, when in fact it's not.
Ultimately he gives up on the question entirely:
So, is obesity really a disease? Well, is Pluto really a planet? Once we state that obesity satisfies some of the criteria but not others, it is meaningless to talk about an additional fact of whether it "really deserves to be a disease" or not.
What a waste of time.
Well, in 23andme, my obesity probability is listed under "disease risk" :)
Interestingly, the average obesity risk according to 23andme is 59%, which is higher than any other "disease" that 23andme offers risk evaluation for. (Type 2 diabetes comes in 2nd at 18.2%)
If something is found in the majority of the population, that sounds less like a disease and more a systemic problem.
Interestingly, the average obesity risk according to 23andme is 59%, which is higher than any other "disease" that 23andme offers risk evaluation for. (Type 2 diabetes comes in 2nd at 18.2%)
If something is found in the majority of the population, that sounds less like a disease and more a systemic problem.
Blaming fat/alcoholic is part of the treatment.
It works, because blame gives ill individual additional reason to fix the problem.
Blame can backfire, so it should be used with caution.
It's always good to ask why something is a problem and whose problem it is.
In this case, many people are saying "{x} is a problem and I want to help". That's okay, if it stops there. However, many then conclude "people with {x} are obligated to make my help as inexpensive/effective/etc as possible".
That's incorrect. The folks with {x} are not obligated to do what the helpers deem appropriate. The helpers are free to refuse to help if the helped don't cooperate, but that's the extent of the helper's power.
In this case, many people are saying "{x} is a problem and I want to help". That's okay, if it stops there. However, many then conclude "people with {x} are obligated to make my help as inexpensive/effective/etc as possible".
That's incorrect. The folks with {x} are not obligated to do what the helpers deem appropriate. The helpers are free to refuse to help if the helped don't cooperate, but that's the extent of the helper's power.
I applaud the author's instincts: when you're not sure whether something really is an X, and hence deserves Y, the right thing to do is unpack the definition of X and ask what about it implies Y in the first place. In logic, definitions may have hard edges, but in real life the edges are fuzzy. Is a sham marriage really a marriage? It depends on why you want to know. The answer changes depending on whether you want to seduce the wife, settle a tax dispute, or research domestic social patterns.
The author stops short of really applying this approach. He rightly unpacks the definition of disease and observes that obesity only partially satisfies it. But he then discards the definition as useless and regresses all the way to first principles! You don't want to do that. That definition embeds some wisdom; there's got to be a reason we have it, after all. The next step is to ask which bits of the definition are relevant to the question at hand and see how well obesity satisfies those bits. The question he should be asking is not merely "What is a disease?" but rather "What is it about disease that warrants sympathy or treatment?"
The framing of deontology and consequentialism is particularly poor, and I find it unfair to the deontologist. (It is certainly quite silly to say the deontologist is trying to distinguish good from bad people. It's just a way of thinking about ethics, man, not a religion.) I would say that deontology says intentions matter and some actions are inherently bad, while consequentialism says results matter and some conditions are inherently bad. It is unfair to the deontologist to paint him as ignoring consequences; inasmuch as they can be known, they count as intentions. And it is unfair to the consequentialist to paint him as ignoring character; inasmuch as effects on character can be controlled, they count as results. Allow the two philosophies to account for all the known facts, and you'll find they give you very similar answers.
So, what's the difference between a disease and a character flaw? Why does the one warrant sympathy and the other warrant reproach? Why should the one be treated and the other conquered?
Asked that way, the answer is obvious. Diseases are unpleasant and involuntary -- simple misfortune. Treatment and sympathy are how you alleviate the misery, and there's no more to the story. But character flaws are more complex. They degenerate and run in packs. A sick person doesn't get new diseases, but a person with poor self control definitely accumulates problems. A person needs to conquer himself, conquer his problems, or he will lose his ability to do so. So our efforts are targeted at motivation. The misery of the situation is a mixed blessing: it sucks to experience, but it also teaches you consequences in a way you'll take seriously and motivates you to change. Quick and easy treatment can be counterproductive, and reproach can be useful to briefly raise the pain above the decision threshold--to shock the boiling frog so he jumps. (I say "can be" because people are always complicated...)
The distinction is critical. Treating a disease is the right thing to do, but treating a character flaw actually does damage. We need to avoid using a fire extinguisher on a flood or throwing an inflatable life raft on a house fire.
So is obesity more like a disease or more like a character flaw?
It depends on the case! It can be either or neither or both.
I know someone who is a very large woman--beautiful, self-confident, merry, old and full of life. "Eat right, exercise, die anyway," she might say. As an intentional choice, her obesity is not a character flaw. And it's certainly not a disease. She needs neither treatment nor motivation, sympathy nor reproach. The right reaction is to respect her right to make her own decisions, and not call it a problem if she doesn't think it is one.
I know someone who just had a baby and is carrying a lot of pregnancy weight. She is generally a motivated and disciplined person, and hates being so fat. She misses her old clothes and her old lifestyle. In this case, the obesity is most like a simple disease--unintended (if not exactly unforeseen), a simple misery. Sympathy is appropriate, and if there were an easy medical fix, it would do no harm.
Then again, look at that same woman a few months later. After a good stab at a diet, losing fifteen pounds, she succumbed to stress and sleep deprivation, abandoning the diet in an attempt to stay sane. Months passed. She built eating habits she didn't want, regained much of the weight she'd lost. Life improved, she started getting sleep, and she didn't go back on her diet. She became more used to her condition, though still unhappy about it, and the simple inertia of the circumstance left her with little motivation to change. What had originally become a simple disease was gradually becoming a character problem; she will need to ultimately address it or risk doing damage to her disciplined nature. Perhaps she still deserves sympathy, but a raised eyebrow when she goes for a second bowl of ice cream would probably do more good than harm. A quick medical fix might not help anymore (and might indeed do harm); she has habits that need to change, and only she can do that.
People are complex. That's the real moral here. Just as "disease" has a definition with fuzzy boundaries, obesity is not all the same. Understanding whether it is a disease means modeling the individual case and understanding the causes and effects and consequences.
Reality is almost always more complex than our definitions. The important thing is to learn to ask the right questions.
The author stops short of really applying this approach. He rightly unpacks the definition of disease and observes that obesity only partially satisfies it. But he then discards the definition as useless and regresses all the way to first principles! You don't want to do that. That definition embeds some wisdom; there's got to be a reason we have it, after all. The next step is to ask which bits of the definition are relevant to the question at hand and see how well obesity satisfies those bits. The question he should be asking is not merely "What is a disease?" but rather "What is it about disease that warrants sympathy or treatment?"
The framing of deontology and consequentialism is particularly poor, and I find it unfair to the deontologist. (It is certainly quite silly to say the deontologist is trying to distinguish good from bad people. It's just a way of thinking about ethics, man, not a religion.) I would say that deontology says intentions matter and some actions are inherently bad, while consequentialism says results matter and some conditions are inherently bad. It is unfair to the deontologist to paint him as ignoring consequences; inasmuch as they can be known, they count as intentions. And it is unfair to the consequentialist to paint him as ignoring character; inasmuch as effects on character can be controlled, they count as results. Allow the two philosophies to account for all the known facts, and you'll find they give you very similar answers.
So, what's the difference between a disease and a character flaw? Why does the one warrant sympathy and the other warrant reproach? Why should the one be treated and the other conquered?
Asked that way, the answer is obvious. Diseases are unpleasant and involuntary -- simple misfortune. Treatment and sympathy are how you alleviate the misery, and there's no more to the story. But character flaws are more complex. They degenerate and run in packs. A sick person doesn't get new diseases, but a person with poor self control definitely accumulates problems. A person needs to conquer himself, conquer his problems, or he will lose his ability to do so. So our efforts are targeted at motivation. The misery of the situation is a mixed blessing: it sucks to experience, but it also teaches you consequences in a way you'll take seriously and motivates you to change. Quick and easy treatment can be counterproductive, and reproach can be useful to briefly raise the pain above the decision threshold--to shock the boiling frog so he jumps. (I say "can be" because people are always complicated...)
The distinction is critical. Treating a disease is the right thing to do, but treating a character flaw actually does damage. We need to avoid using a fire extinguisher on a flood or throwing an inflatable life raft on a house fire.
So is obesity more like a disease or more like a character flaw?
It depends on the case! It can be either or neither or both.
I know someone who is a very large woman--beautiful, self-confident, merry, old and full of life. "Eat right, exercise, die anyway," she might say. As an intentional choice, her obesity is not a character flaw. And it's certainly not a disease. She needs neither treatment nor motivation, sympathy nor reproach. The right reaction is to respect her right to make her own decisions, and not call it a problem if she doesn't think it is one.
I know someone who just had a baby and is carrying a lot of pregnancy weight. She is generally a motivated and disciplined person, and hates being so fat. She misses her old clothes and her old lifestyle. In this case, the obesity is most like a simple disease--unintended (if not exactly unforeseen), a simple misery. Sympathy is appropriate, and if there were an easy medical fix, it would do no harm.
Then again, look at that same woman a few months later. After a good stab at a diet, losing fifteen pounds, she succumbed to stress and sleep deprivation, abandoning the diet in an attempt to stay sane. Months passed. She built eating habits she didn't want, regained much of the weight she'd lost. Life improved, she started getting sleep, and she didn't go back on her diet. She became more used to her condition, though still unhappy about it, and the simple inertia of the circumstance left her with little motivation to change. What had originally become a simple disease was gradually becoming a character problem; she will need to ultimately address it or risk doing damage to her disciplined nature. Perhaps she still deserves sympathy, but a raised eyebrow when she goes for a second bowl of ice cream would probably do more good than harm. A quick medical fix might not help anymore (and might indeed do harm); she has habits that need to change, and only she can do that.
People are complex. That's the real moral here. Just as "disease" has a definition with fuzzy boundaries, obesity is not all the same. Understanding whether it is a disease means modeling the individual case and understanding the causes and effects and consequences.
Reality is almost always more complex than our definitions. The important thing is to learn to ask the right questions.
The interesting thing about the treatment of addiction is that one of the most effective solutions (Overeaters Anonymous, AA, Narcotics Anonymous, etc.) is that getting a bunch of these "addicts" in the same room to talk about their addiction can actually help. The first step in all of these programs begins with the word "We".
One of the little euphemisms I've garnered from friends and such through the years is that "Wellness begins with 'We'; Illness begins with 'I'." Most addictive habits are actually resultant from one thing only, and that is loneliness. OA, AA, NA, etc. WORK for people because they actually force them out of their little isolated states, into situations where they can actually communicate their "feelings" (I know! such a dirty word!) to people who actually understand and "get" where they are coming from. Some of the happiest people I've known are members of AA or some other 12-step program. I think it's true: give more than you think you've received, and you'll be happier.
One of the little euphemisms I've garnered from friends and such through the years is that "Wellness begins with 'We'; Illness begins with 'I'." Most addictive habits are actually resultant from one thing only, and that is loneliness. OA, AA, NA, etc. WORK for people because they actually force them out of their little isolated states, into situations where they can actually communicate their "feelings" (I know! such a dirty word!) to people who actually understand and "get" where they are coming from. Some of the happiest people I've known are members of AA or some other 12-step program. I think it's true: give more than you think you've received, and you'll be happier.
Understanding why many of these controversial diseases are problems in the first place is made a little clearer if we look at the problem through the lens of behavioural economics. Alcoholics, nicotine addicts, many obese people, sexaholics, etc place huge discount rates on future rewards so that in the present, these future rewards are almost worthless. Put another way, these people place the most value on their next item of consumption which allows them to overcome the long-term costs of their destructive behaviour or the long-term benefits to quitting (if we assume these people make an instantaneous cost-benefit analysis each time they eat/drink/smoke/etc). This sort of radical discounting behaviour has been shown to be reversible in those who seek treatment.
Now, to one of the main points of the article: What constitutes an acceptable form of treatment to these gray-area diseases? An economist would probably say that you would have to consider the individual in question and then formulate a solution based on that individual's preferences, likelihood of success, and cost of change. For one obese person, gastric bypass might be the only solution between life and death. For another obese person, paying $25,000 for gastric bypass surgery might be "worth it" and allow them to change their eating habits in a way that would benefit them long-term without having to go through the anguish of months or years of diet and exercise. For another obese person with another preference set, diet and exercise would be far less costly than gastric bypass. Why bring right and wrong into the argument when looking at treatment methods?
Edit: Giving the issue some further thought, some might make a value judgement as to how bad or good heavy temporal discounting is. Given the assumption that it is wrong or bad, then you could hypothesize that the American culture of consumerism has gradually conditioned our population as a whole to shift their preferences to the present, valuing the quick fix over long-term, less costly approaches.
Now, to one of the main points of the article: What constitutes an acceptable form of treatment to these gray-area diseases? An economist would probably say that you would have to consider the individual in question and then formulate a solution based on that individual's preferences, likelihood of success, and cost of change. For one obese person, gastric bypass might be the only solution between life and death. For another obese person, paying $25,000 for gastric bypass surgery might be "worth it" and allow them to change their eating habits in a way that would benefit them long-term without having to go through the anguish of months or years of diet and exercise. For another obese person with another preference set, diet and exercise would be far less costly than gastric bypass. Why bring right and wrong into the argument when looking at treatment methods?
Edit: Giving the issue some further thought, some might make a value judgement as to how bad or good heavy temporal discounting is. Given the assumption that it is wrong or bad, then you could hypothesize that the American culture of consumerism has gradually conditioned our population as a whole to shift their preferences to the present, valuing the quick fix over long-term, less costly approaches.
There are a few of special cases, like children of dopers or alcoholics, inherited diseases and other genetic disorders, but even in such cases it is possible to improve their conditions with a right effort.
btw, in the so-called third world word 'disease' means condition which cannot be reversed or cured, such as AIDS, cancer, liver or kidney damages and so on. Everything else, like a fly or stomach aches are just a changing phenomena like weather.
People who cannot stop shooting, drinking, smoking, eating, and passively watching are ignorant, not sick (leaving aside the clinical stages). At least from the point of view of the one who did.