An approach to doing good is to come up with a metric for what constitutes good or bad, and then trying to do things that will optimally increase or decrease such metric, as the case may be.

If you do this, you have to be careful about what metric you choose.

If you have an ontology where you measure good by “number of people who feel benefited by you”, you might end up doing things like sending everyone you can a doughnut with a signed note. If instead your metric is “number of people classified as poor” you might do best to focus on interventions that get people just over the hump of poverty as defined by your scale. And so on.

Conscientious and systematic altruists tend to see problems with metrics like those above. They realize that “people impressed” and “being poor according to an economic metric” are not metrics that really carve nature at its joints.

Dissatisfied with misleading metrics, one then tends to look closer at the world and arrive at metrics that take into account the length of different lives, their quality, their instrumental effect in the world, how much are they exactly being benefited by the intervention relative to other cost-effective alternatives, and so on. And that’s how you get things like Quality Adjusted Life-Years (QALY), micromorts, and the happiness index.

This is, I think, all moving in the right direction. Metrics that make an effort to carve nature at its joints can provide new lenses to see the world. And looking through those lenses tends to generate novel angles and approaches to do a lot of good.

This is why today I will suggest we consider a new metric: The Hell-Index.

A country’s Hell-Index could be defined as the yearly total of people-seconds in pain and suffering that are at or above 20 in the McGill Pain Index (or equivalent)*. This index captures the intuition that intense suffering can be in some ways qualitatively different and more serious than lesser suffering in a way that isn’t really captured by a linear pain scale.

What does this metric suggest we should do to make the world better? Here is an idea (told as if narrated from the future):

Between 2030 and 2050 it was very common for people to wear Get-Out-Of-Hell-Free Necklaces. People had an incredible variety of custom-fit aesthetic and practical additives to their necklaces. But in every single one of them, you could rest assured, you would find a couple of doses of each of these agents:

  1. N,N-DMT (in case of Cluster Headaches)
  2. Quetiapine (in case of severe acute psychosis)
  3. Novocaine + menthol (for very painful stings)
  4. Ketamine (for severe suicidal feelings)
  5. Microdosed Ibogaine + cocktail of partial mu-opioid agonists (for acute severe physical pain and panic attack, e.g.. kidney stones)

Some other people would get additional things like:

  1. Beta blocker (to take right after a traumatic event)
  2. Agmatine (to take in case you suspect of having being brainwashed recently), and
  3. Caffeine (if you absolutely need to operate heavy machinery and you are sleep-deprived)

In all cases, the antidote needed would be administered as soon as requested by the wearer. And the wearer would request the antidote as indicated by a very short test done with an app to determine the need for it.

But why? What’s this all about?

The Get-Out-Of-Hell-Free Necklace contents were chosen based on a cost-benefit analysis for how to reduce the world’s Hell-Index as much as possible. Cluster-headaches, kidney stones, bad stings, severe psychotic episodes, suicidal depression, panic attacks, and many types of acute physical pain turned out to account for a surprisingly large percentage of each country’s Hell-Index. And in many of these cases, a substantial amount of the suffering was experienced before medical help could be able to arrive to the scene and do anything about it. A lot of that intense suffering happened to be tightly concentrated in acute episodes rather than in chronic problems (save for some notable examples). And by incredible luck, it turned out that there were simple antidotes to most of these states of agony, all of them small enough to fit in a single light necklace. So it was determined that subsidizing Get-Out-Of-Hell-Free Necklaces was a no-brainer as a cost-effective altruistic intervention.

By 2050 safe and cheap genetic vaccines against almost all of these unpleasant states of consciousness had been discovered. This, in turn, made the use of the Get-Out-Of-Hell-Free Necklaces unnecessary. But many who benefited from it- who had been unlucky enough to have needed it- kept it on for many years. The piece was thought of as a symbol to commemorate humanity’s progress in the destruction of hell. An achievement certainly worth celebrating.

* Admittedly, a more refined index would also distinguish between the intensity of different types of pain/suffering above 20 in the McGill Pain Index (or equivalent). Such index would try to integrate a fair “total amount of hellish qualia” by adding up the pain of each state weighted by its most likely “true intensity” as determined by a model, and then do so for each model you have and weight the contribution of each model by its likelihood. E.g. do both a quadratic and an exponential conversion of values in the 0 to 10 visual analogue scale into dolors per second, and then do a likelihood-weighted average to combine those results into a final value.

[Note: Cross-posted in Qualia Computing]

Sorted by Click to highlight new comments since: Today at 9:31 AM

For context, this post is motivated by the realization that pain-scales are logarithmic compressions of what is probably an exponentially-increasing capacity for pain and suffering in sentient beings. Here is a simple example, as told by the guy who stung himself with 80+ insects to put the pain on a scale:

4:28 - The harvester ants is what got the sting pain scale going in the first place. I had been stung by honey bees, old jackers, paper wasps, etc. the garden variety stuff, that you get bitten by various beetles and things. I went down to Georgia, which has the Eastern-most extension of the harvester. I got stung and I said “Wooooow! This is DIFFERENT!” You know? I thought I knew everything there was about sting insects, I was just this dumb little kid. And realized “Wait a minute! There is something different going on here”, and that’s what got me to do the comparative analysis. Is this unique to harvester ants? Or are there others that are like that. It turns out while the answer is now we know what’s later - it’s unique! [unique type of pain].

7:09 - I didn’t really wanted to go out and get stung for fun. I was this desperate graduate student trying to get a thesis, so I could get out and get a real job, and stop being a student eventually. And I realized that, oh, we can measure toxicity, you know, the killing power of something, but we can’t measure pain… ouch, that one hurst, and that one hurts, and ouch that one over there also hurts… but I can’t put that on a computer program and mathematically analyze what it means for the pain of the insect. So I said, aha! We need a pains scale. A computer can analyze one, two, three, and four, but it can’t analyze “ouch!”. So I decided that I had to make a pain scale, with the harvester ant (cutting to the chase) was a 3. Honey bees was a 2. And I kind of tell people that each number is like 10 equivalent of the number before. So 10 honey bee stings are equal to 1 harvester ant sting, and 10 harvester ant stings would equal one bullet ant sting.

Some EAs have already pointed this out, but I suspect that this has yet to make it into "EA Canon" and it thus hasn't really given rise to novel interventions. Brian Tomasik, Jonathan Leighton, Manu Herran, David Pearce, and other "suffering focused ethics" people have been saying this for a while. Read more here.

I realize that it is always kind of depressing to look into how bad suffering gets, but it does seem important to know if one is indeed trying to reduce suffering as much as possible.

I've suggested something similar for happiness ( ). If you don't want to introduce the weird asymmetry where negative counts and positive not, what you get out of that could be somewhat surprising - it possibly recovers more "common folk" altruism where helping people who are already quite well off could be good, and if you allow more speculative views on the space on mind-states, you are at risk of recovering something closely resembling some sort of "buddhist utilitarian calculus".

I appreciate the use of a specific scenario to outline one aspect of suffering-focused thinking -- the range of examples (mental, physical) was especially helpful.

However, my intuition is that the things people consider to be their own least pleasant experiences are often not the moments of greatest pain/suffering in their lives. I've been punched in the face, I've run wind sprints until I dry-heaved, and I've been dragged along a rocky ocean floor by a strong wave...

...but those barely even register on my list of "things I wish hadn't happened", compared both to major negative life events but also to something like "the time I wrote someone an embarrassing love letter", which still bothers me to this day.

How many "hell-seconds" might someone experience from a sense that they never lived up to their potential, or from their parents' acrimonious divorce, or from a friend's instantaneous but untimely death?

Of course, your metric isn't meant to be universal, but as far as metrics of well-being go, I see extreme pain as relatively narrow -- I'm curious whether there are any systems that go beyond DALY and "hell-seconds" in capturing lingering low-valence negative emotions, even if they don't amount to "depression".

Thank you.

Two things:

(1) We are trying to arrive at a metric like you describe at QRI. See: Quantifying bliss and a future for neuroscience for the big-picture idea. I think the suffering you describe is very relevant for instrumental reasons, but perhaps not very large in terms of absolute values (still sucks, obviously!).

(2) I think that another important update that people should make in EA is that hell-seconds are not only much, much, much worse than garden-variety pain and suffering. But also that they are *far more prevalent* than we realize. About 20% of people in the US live with chronic pain, of which 8% is "high-impact" (i.e. severe enough to interfere with life on many fronts). Kidney stones happen to 10% of people, migraines are equally as common, and about 2-3% of people who get fractures develop complex regional pain syndrome, which tops the scale (and worse of all, it is chronic and persistent pain rather than episodic like cluster headaches).

I suspect most people will be horrified when we get an accurate estimate of a country's Hell-Index. Perhaps you don't dip your toes into those realms often, but chances are that your neighbor or two houses down the line someone very close to you does.

I looked up CRPS and kidney stones, and it looks like both of them have relatively mild symptoms in most cases. Are you sure that this isn’t a case of conflating the pain of the most extreme cases and the prevalence of all cases?

You’re right about the 8% figure for chronic severe pain, though.

CRPS sufferer here. There are cases that are mild or that resolve quickly. But when it becomes chronic by some metrics it is the most painful condition in existence, with a persistent pain worse than having a finger cut off without anesthetic or childbirth without anesthetic.

Let's say "the typical pain of the top 5% most painful of the cases of a given condition".

My sense is that the pain scale is exponential. Let's say that kidney stones rank on average at a 7/10 level with a standard deviation of 1. In that case, about 2% of the kidney stone cases are a 9/10, which might be hundreds of times more painful than the 7/10 typical case. In other words, you can't really judge how many hell-seconds a given condition contributes by observing a *median* case... you need either the average or to look at the more painful side of it.

It’s just that your first comment sounded a bit like you’re implying that 10% of the population suffers from excruciating kidney stones. With your estimated numbers (10% of population affected at some point in their lives, 2% of cases at 9/10 on the pain scale), it would be more like 0.2%.

That’s probably still a lot if you multiply by the world population and total pain episode lengths. I don’t know how long such a case typically lasts with modern medical care, but plenty of people don’t have access to it.

Of course, this all depends on whether the 2% number is a reasonable estimate, and whether the pain scale is exponential.

But my guess is that a better strategy will probe better medical prevention and treatment of underlying causes in most cases. After all, flooding the USA with powerful painkillers hasn’t exactly been a boon to the nation (see opioids).

While unpleasant, I don't think being punched in the face is comparable to having kidney stones (a pain so excruciating that often morphine can't touch it). It seems totally believable to me that such an experience might rank as among the worst in one's life.

There are probably also two systems at play here: the experience itself and the lingering memory of it. It's conceivable you might not remember some extremely painful experience as 'bad' (through post-hoc rationalisation, or the peak-end effect or similar); I'm not sure how to weight that against the actual raw badness of the experience itself.

I wonder if we sufficiently understand the psychological dynamics of chronic or extreme pain. The existence of the bullet ant glove ritual makes me wonder to what extent the cultural context of pain influences our remembered perception of its quality, intensity, and meaning.

It seems helpful to distinguish between meaningless, “I would’t wish this on my worst enemy” pain, which probably accounts for the vast majority of extreme pains, “a little pain is necessary to toughen you up” pain, and “this is a sacred extreme-pain ritual.”

What are some resources you'd recommend on understanding the psychological dynamics you mentioned? I'd be especially interested in sources that push against the common (and perhaps very wrongheaded?) idea that people can adjust to almost anything, and that we become somewhat more "numb" even to extreme pain over time.

I'll give that some thought, but I'm no expert on this. Just pulling together some memories of things I've read and experiences I've had. But my impression is that chronic extreme pain is something that we never adapt to.

What is agmatine, and how would it help someone who suspects they've been brainwashed?

Agmatine is an aminoacid you can buy over the counter at supplement stores and online. It is used as a workout supplement, to make weed feel stronger, and as a hangover prevention remedy. Agmatine has a high affinity for a number of receptors sites, and it is currently being debated whether it satisfies the criteria for being called a neurotransmitter.

Of particular note is agmatine's high affinity to the imidazoline receptor, which according to Thomas Ray- who analyzed the receptor affinity of 30+ psychedelics- might be one of the keys to the "magic of MDMA". On 2o to 80mg doses on an empty stomach, agmatine does have a nice and very mild positive effect on valence. Mild relaxation, akin to chamomile tea, and mild feeling of social closeness, akin to a glass of wine or a bit of Indica. According to some anecdotal data, and in line with Thomas Ray's predictions, taking agmatine in conjunction with 5HT2A agonists gives rise to a subtle empathogenic effect.

Now, all of that is for background. If you buy a tube of agmatine you will see that the recommended dose is between 500 milligrams and up to entire grams. After all, it is in food and it has an extremely high safety profile. Somehow the general public has missed that on much lower doses it has a nice mild euphoric quality. Anyhow, at the doses typically consumed, agmatine has a distinct blunting effect. As described by people who have both taken SSRIs and agmatine, the effects of high-dose agmatine on pleasurable and noxious stimuli are of the general type of "blunted quality". Emotions feel more fuzzy, music sounds more flat, thoughts seem less deep, philosophy is more boring, and orgasm is less intense. This type of effect (both cutting the top and bottom ends of valence) is what we expect to happen if you add *neural noise* into your nervous system. Like listening to white noise - it is good if the sound it masks is dissonant and unpleasant, but bad if you are trying to listen to a symphony, or to the voice of your loved ones.

It is the blunting effect of agmatine at 0.5 grams+ doses that makes it a great candidate to reduce the impact of brainwashing. Like an SSRI, but much faster and reversibly, agmatine will make whatever multilevel marketing pyramid scheme feelings of guilt and greed you were subjected to kind of melt away and feel more dreamy and less "real". This psychological effect seems to last after the agmatine has been metabolized.

I really, really, like this idea. Do you know anyone (including yourself) who's made something like this? Perhaps even including a practical guide (e.g. how to store them, expiration dates for various drugs, where to get them)?

Having ketamine at hand could be really important for me, because I sometimes feel very strongly suicidal but still goal-aware enough to take actions to inhibit myself. It would also just be usefwl to have acute pain medication at hand for all sorts of reasons.

But it could use a more professional name if the idea is to take off. Something like "A Cute Necklace", indicating that it's for acute situations. Get it? This is a great marketing strategy, pwomise. :3

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