Sunday, September 30, 2012

Gifts for people who have everything

People my parents' age are hard to get presents for. They've had lots of time to obtain the cheap things they want, and if they can't afford something they want, I probably can't afford it either. Some ideas:

- Record an audiobook. Free programs like Audacity let you record and edit. Full-length books take a really long time, so I've done some short stories.

- Jeff wrote me a waltz once. That was awesome.

- Find a project that needs to be done. Jeff and I revarnished his parents' kitchen floor while they were on vacation.

- Go on an adventure. Jeff's father is especially hard to shop for, so for his birthday people take him on a surprise outing. Yesterday we packed a picnic and piled in the car for such a birthday adventure, and Jeff took us on a deliberately roundabout route to prolong the suspense. Rick's guess as to the destination changed at every turn:

"We're going to the restaurant that looks like a cafeteria...except it's not lunch time."
"We're going to Walden Pond! Except you just drove past it."
"Are we going to Abby's house to walk in the cranberry bog?"
"We're going to the Bolton fair!"

Thursday, September 20, 2012

Open letter to mental health professionals

A couple of years I came across a book on "parenting with depression" in the library. I opened it eagerly, hoping for assurance that I wouldn't necessarily be a terrible parent.

...and then I realized that none of the co-authors had depression. They had just worked with depressed people. The book contained no material by actual parents with depression.

If you work in mental health or social services, you should be reading first-person accounts of your clients' experiences.

I first wanted to be a therapist when I was fourteen, after discovering a message board for self-injurers. I didn't self-injure, but I spent a year reading and responding to what they wrote. I doubt I was very helpful, but it gave me a sense of the day-in, day-out desperation they lived with.

Later, when I was considering adopting a child from foster care, I read message boards for adoptive parents. I read the things they love and hate about their social workers. I heard the things they don't tell social workers for fear of losing the kids. I'm better at working with adoptive families than I would have been if I hadn't read these things.

Every week I read Post Secret. It's an engrossing read, but it's also a good education. People come out with the pains and pleasures they know aren't socially acceptable.

Norah Vincent's Voluntary Madness, an account of her psychiatric hospitalizations, helped me understand how confusing the legal status of psych patients is. I haven't read Andy Behrman's Electroboy: A Memoir of Mania, but I've wanted to ever since reading "When I'm manic, I'm so awake and alert, that my eyelashes fluttering on the pillow sound like thunder." You don't get that in the DSM.

If you limit yourself to material by observers, you're missing out.

Read something you haven't read before. Read a pro-ana site. Read a pro-suicide site. Your clients do.

Tuesday, September 18, 2012

What not to say

In the social justice scene, you're supposed to recognize patterns of oppression. You're supposed to know that women earn less than men, and that black men are disproportionately likely to be imprisoned.

But you're not supposed to apply that knowledge to individuals. It's not okay to openly assume that a woman earns less than her husband, or that the black man you just met is an ex-con, even though you know the statistics. This can land you in tricky situations.

This week I was at a Less Wrong meetup. A man turned to a young woman near him and asked, "Do you actually read the site, or did somebody drag you here?"

I asked him, "Did you say that because she's wearing heels and lipstick?"

He said, "No, no, it's not because of how she's dressed! It's because most of the woman who come here are dragged by somebody else."

I was furious.

The thing is, I understand where his assumption was coming from. It is more common for uninterested women to be towed to the meetup by their boyfriends than vice versa. I knew from talking with her that this woman is an avid reader of the site, but if I hadn't known that, I might have made the same assumption he did. We all judge new people based on people who seem to be like them. It's unrealistic to expect anyone not to do this.

But this is an inside thought. Unflattering generalizations fall into the same category as "Wow, your acne is really bad": it may be true, but you don't say it out loud.

Because Less Wrong is so heavily male, I know people who meet me will judge me as part of a population of women. I feel embarrassed every time a woman says something foolish, because people will judge me as being part of her group. I know that stereotypes have some basis in reality. I know all this, and I hate being reminded of it.

Even if you have a 90% prior that some unpleasant generalization is true of an individual, don't say it to their face. I'm not going to say you should just mind your own business and not ask them questions, because we make community by getting to know each other. But insulting someone is not a good way to get to know her.

If you're really curious to know if your guess is right, ask some more generic question - "So, what got you interested in coming here?" Nobody gets hurt, and you might actually learn something about her.

Tuesday, September 04, 2012

On eugenics

I was interested to read ethicist Julian Savulescu saying that parents should have the option of screening their embryos for potential problems like alcoholism and psychopathy, then selecting embryos with lower chances of those problems.

The comments on the article are predictably negative. "Start the process to revoke this clown's tenure." "Sounds like Nazi propaganda to me." "Hopefully, Christ raptures His church before all this genetics crap really gets put into play."

The practical implications of Savulescu's idea are sketchy. In a different article, he suggests that the testing would be for people who were already having in vitro fertilization for some other reason. Also, I trust he's aware that we don't have a medical test for propensity for alcoholism or any of the other problems he mentions. But we're more likely to develop tests if parents would be allowed to use them.

Here are the two reasons I consider eugenics a personal issue.

First, last year Jeff and I found out that there was a genetic disease in the family that might dispose our kids to cancer. While we were waiting to find out more, I thought a lot about whether I would use in vitro fertilization to select for a child without the disorder. Would we abort a child rather than watch her die of breast cancer in her forties like several of her relatives did? Would we gamble that cancer treatment would be better by then? Would we rather keep the money and hope for the best?

It turned out not to be an issue, because neither Jeff nor I have the gene. But if I had needed to choose, I think I would have done almost anything to have a healthy child.

Second, a couple recently asked me if I would consider being an egg donor for them. We talked a lot about the process and about my medical history. In the end, their fertility clinic screened me out because of my family history of depression. Part of me was devastated — who wants to be told your genes aren't good enough? But I agree with the decision: the child will probably be happier and healthier with a different egg donor. If that couple's child is going to have someone else's genes, they should get the best genes they can.

Some objections to my viewpoint:

It's eugenics. Yes, it is. I understand the history of horrible things that have been done in the name of eugenics. But if this particular idea has merit, we shouldn't reject it because some similar ideas have been abused in the past. It is possible to be in favor of healthier children and not to be in favor of sterilizing people against their will, etc.

It's discrimination. The disability rights platform on this is that gene selection is tantamount to saying people with disabilities shouldn't exist. But honestly, depression sucks. If I could choose to have been born without that tendency (even if it meant being a different person), I would.

It will lead to abortion. Yes. Personally, I consider that a small harm to prevent a greater harm.

It will be used to make "designer babies." Let's consider how IVF works: you pay a fertility clinic about $12,000. For two weeks, you inject your own body with fertility drugs that make your ovaries hyperfertile, creating a sensation I've heard described as "like live goldfish." Then they knock you out and use a needle to withdraw the eggs, fertilize them, analyze them, and put the selected ones back in her uterus. 30% chance of medical complications. Oh, and it probably won't result in a live birth. You will probably need to shell out another $12,000 and try again. And again.

Now, how many parents do you know who would go through that to get a baby with their favorite eye color? And if they did, why would that even be so bad? A hundred years ago, IQs were lower and people were generally less healthy, probably because of poor nutrition. Nobody worries that we have "designer children" who are taller, smarter, and healthier than their grandparents.

If we allow the selection of personality traits, governments will want to breed a docile population. No, I would not want governments to control this process. (Despite allegations of fascism, Savulescu also said nothing about governments controlling how people's babies come out.) The only political rumblings I have heard about this is politicians who don't support screening because parents might choose abortion.

In the end, I think very few parents will screen for most disorders because it's so financially and emotionally costly. But I think the tests should be legal, and if parents decide they want to take extra steps to create healthy children, they should be free to do so.