Effective altruism’s odd attitude to mental health

I think I agree with the general thrust of your post (that mental health may deserve more attention amongst neartermist EAs), but I don't think the anecdote you chose highlights much of a tension.

>  I asked them how they could be so sceptical of mental health as a global priority when they had literally just been talking to me about it as a very serious issue for EAs.

I am excited about improving the mental health of EAs, primarily because I think that many EAs are doing valuable work that improves the lives of others and good mental health is going to help them be more productive (I do also care about EAs being happy as much as I care about anyone being happy, but I expect that value produced from this to be much less that the value produced from the EAs actions).

I care much less about the productivity benefits that we'd see from improving the mental health of people outside of the EA community (although of course I do think their mental health matters for other reasons).

So the above claim seems pretty reasonable to me. 

As an illustration, I can care about EAs having good laptops much more than I care about random people having good laptops, I am much more sceptical about giving random people good laptops producing impact than giving EAs good laptops.

If malaria and other easily preventable/treatable debilitating physical issues were common among EAs, I'd guess that should be a much higher priority to address than poor mental health among EAs.

What follows is mere speculation on my part.

I tend to assume that the physical health interventions we promote via global health initiatives are also the most tractable ways to improve mental health. Losing a child to malaria, or suffering anemia due to a worm infection, or being extremely poor, or living and dying through wars and plagues, seem like they’d have a devastating impact on people’s mental health.

Because EAs don’t typically suffer from these problems, and because we allow for a lot of self-care, it does not surprise me that EAs focus on specifically mental health interventions for themselves. This can smack of “for me but not for thee,” but I read it as “I expect that therapy will do me more good than bednets, and bednets will do you more good than therapy.”

If that’s false, it might be useful to promote the counter argument to that more loudly. I expect you’ve researched it deeply, given your work, and so it might just be a matter of promoting that research more vigorously.

I'm not convinced there's actually a deep tension here (perhaps some) but I want to add that I'm really glad that people like Michael and co. care deeply about the mental health of others around the world* and are working hard to improve it. I hope HLI succeeds!

*Not that other commenters don't also care about this, I just want to state the obvious that this is a Good Thing.

People (including I think some of the research at the Happier Lives Institute) often distinguishes "serious mental illness (SMI)" which is roughly schizophrenia, bipolar I, and debilitating major depression, from "any mental illness (AMI)", which includes everything.

The term "mental health" lumps together these two categories that, despite their important commonalities, I think probably should be analyzed in very different ways.

For example, with SMI, there are often treatments with huge obvious effects. But the side effects are bad, and patients may refuse treatment for various reasons including lack of insight. Treating these diseases can have a huge impact -- the difference between someone being totally unable to work or care for themselves and then dying young by accident or suicide, vs. being able to live an independent and successful life. But they are fairly rare in the population.

Whereas it seems that with the set AMI minus SMI, like generalized anxiety, etc., effect sizes of treatments are small and hard to measure. There's often so much demand for treatment that rationing is required. Impairment and suffering can be really bad but not, I think, typically as bad as SMI. But these diseases are much more prevalent so even if effect sizes are smaller, maybe the total impact of an intervention is much greater.

This distinction is obvious, but I want to point it out explicitly, as I think even though everyone kind of knows this, it's still underrated, and probably important for thinking about expected impact.

I think there's a conflation of "mental health is difficult to measure", "mental health interventions are difficult to study well", and "my mental health is such a winding road" that often people kind of end doubting that mental health interventions are worthwhile even while seeking them in their own lives. 

Personally for me it seems like global mental health should be way higher of a priority than mental health just restricted to EA community. This is not to say we shouldn't have resources for EAs in terms of mental health, but we should avoid tribalism in thinking that mental needs for EAs are so different from rest of the population and so much more high-priority than general population. 

Often, when people talk about mental health on conferences, the conversation shifts to 'how to ensure better mental health among EAs' and often the response is psychotherapy services and therapists who are tailored to EA community.  Being a psychotherapist is definitely a good career choice, but not the most high-impact one as you are restricted to mostly benefiting your own patients. Being an EA-only therapist is even more restrictive in terms of impact you could have, because you are missing out on a lot of people who might need your help more than EA people. Choosing patients or a therapist just by their belonging to EA community for me seems like incredibly unwise decision, especially in a world where mental health causes so much suffering. 

 

For me, mental health is a notable topic because it is one of the few downsides of modernization. I have a pretty grim view of humanity, and I've talked to a lot of people about how I think the median human living 5$ a day probably has a terrible life. 

The response is always something along these lines: they've never experienced anything else, so for them it's really not that bad of a life. That is, people have some underlying intuition that there is always hedonistic adaptation to new "quality of life", and that someone's perspective on their own life matters maybe even more than their actual life.

In rich countries, this looks like mental health issues. People get so used to their physical needs being taken care of that any emotional struggles in their life feel amplified, leading to anxiety and depression.

So I think it is accurate that the most important issues in this world are global health, poverty, etc., simply because so much of the world is underdeveloped. However, if we want to get to a really great world, a world approaching perfection, we will have to tackle mental health issues.