[epistemic status: shower thought]

I'm starting to wonder if there's an odd tension within EA thinking about mental health. Members of the EA community seem increasingly aware that mental health can have a really big impact on our welfare and productivity and that we should pay more attention to it - see e.g. this great post on imposter syndrome last week or that apparently the most popular 80k podcast is about the difficulties of working with poor mental health. However, when we put on our cause prioritisation hats, we seem to forget about the existence and importance of psychological suffering. If we want to help others, it's clearly got to be bednets, cash transfers, deworming, etc. It appears not to cross (many) people's minds that mental health might be a plausible global priority.

[Content warning: anecdata] What brought this out to me was a chat I had with someone who breezed up to me at the careers fair at EAG London the other day. They were talking to me about how they wanted to run a project providing more mental health support for EAs because it was such a big problem. I was encouraging but explained I wasn’t that looped into mental health for EAs because I think focus more broadly on improving global wellbeing. 

I then told them about my work at the Happier Lives Institute comparing the cost-effectiveness of cash transfers to treating depression and how we'd found the latter was about 10x better (original analysis, updated analysis). They suddenly switched to sceptical mode, saying they didn't believe you could really measure people's mental health or feelings and that, even if you could, targeting poverty must still be better. 

After a couple of minutes of this, I suddenly clocked how weirdly disconnected the first and second parts of the conversation were. 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. They looked puzzled - the tension seemed never to have occurred to them - and, to their credit, they replied "oh, yeah, hmm, that is weird".

Now, I don't mean to pick on this nameless person, but I was struck by how vividly it revealed something I've observed more generally but not quite been able to put my finger on. It seems like many EAs have recognised mental health is a serious problem for people like them - community members are generally young, highly educated individuals from the global north  - but not yet had the further thought that it is also a serious problem for others

Clearly, it’s not the case that being depressed, anxious, traumatised, and so on are magically not bad if you're also poor and marginalised. At the very least, the line of thinking should be "oh, wow, mental health can be bad for people like me. I guess it could be a really serious issue for anyone. Let's see how it compares to our current priorities."

I'm not claiming that everyone has one thought too few; I'm just reporting that, in my experience, this disconnect seems oddly common.


 

94

22 comments, sorted by Click to highlight new comments since: Today at 10:39 AM
New Comment

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.

Pretty much this. I don’t think discussions on improving mental health in the EA community are motivated by improving wellbeing, but instead by allowing us to be as effective as a community as possible. Poor mental health is a huge drain on productivity.

If the focus on EA community mental health was based on direct wellbeing benefits I would be quite shocked. We’re a fairly small community and it’s likely to be far more cost-effective to improve the mental health of people living in lower income countries (as HLI’s StrongMinds recommendation suggests).

Has anyone done the analysis to determine the most cost-effective ways to increase the productivity of the EA community? It's not obvious to me that focussing on mental health would be the best option. If that is the case, I feel confused about the rationale for prioritising the mental health of EAs over other productivity interventions.

I don't know for sure that we have prioritised mental health over other productivity interventions, although we may have. Effective Altruism Coaching doesn't have a sole mental health focus (also see here for 2020 annual review) but I think that is just one person doing the coaching so may not be representative of wider productivity work in EA.

It's worth noting that it's plausible that mental health may be proportionally more of a problem within EA than outside, as EAs may worry more about the state of the world and if they're having impact etc. - which may in turn require novel resources/approaches to treating mental health problems that aren't necessarily widely available elsewhere. 

Other things like how best to work productively may be well covered by existing resources and so may not need EA-specific materials.

I think you could be right about this AND that Michael's anecdote could also be pointing to something true about the idea that personal or proximate experience with a problem could increase the salience of it for people conducting supposedly dispassionate analysis. We shouldn't pretend that the cognitive biases that apply to everyone else don't also apply to people in the EA community, even if the manifestation is sometimes more subtle.

Naively I'd have guessed that the "biases clouded by personal experience" angle would cause upper-middle class young Westerners to overrate the global importance of problems that they or people close to them personally experience (e.g. mental health issues, racism) and are shared by other moral patients, rather than overrate the problems that they do not suffer from, but others do (e.g., malaria, being trapped in a battery cage).

I agree, but the situation here is a bit more complex. Michael's telling a story about someone who was emotionally invested in the problem of improving mental health among EAs, but then "suddenly switched to sceptical mode" as soon as the conversation turned to helping people who were more distant. While in skeptical mode, this person (in Michael's telling) appeared to be relying on the intellectual judgments of more proximate people in the EA community rather than connecting emotionally to the subjective experience of the more distant people, whether we are talking about malaria or depression. The point is about people selectively choosing to apply "sceptical mode" based on the context.

Maybe, but FWIW, lots of people have the view that mental health is only - or, least, is primarily - a problem for wealthy people. The idea seems to be that only the rich have the luxury to obsess about their emotions, whereas the poor are pretty happy and/or too busy dealing with their other problems to stop and 'fuss' about it. I don't know why they think this, but I'm surprised at how often I encounter this view

I note it's in some tension with another attitude common, namely that the rich are almost uniformly happy whereas the poor are miserable.

I agree that many people believe that mental health problems only affect the rich, and that this belief is incorrect.

I don't share this view, and I agree that it is weird. But maybe the feeling behind it is something like: if I, personally, were in extreme poverty I would want people to prioritize getting me material help over mental health help. I imagine I would be kind of baffled and annoyed if some charity was giving me CBT books instead of food or malaria nets. 

 

That's just  a feeling though, and it doesn't rigorously answer any real cause prioritization question.

Hmm, not sure you've spotted the tension. The tension arises from recognising that X is a problem in your social world, but not then incorporating that thought into your cause prioritisation thinking. This is the puzzling phenomenon I've observed re mental health.

Of course, if someone has - as you have - both recognised the problem in their social world, and then also considered whether it is a global priority, then they've connected their thinking in the way I hope they would!

FWIW, I think improving the mental health of EAs is plausibly very sensible purely on productivity grounds, but I wasn't making a claim here about that either way.

I think the point Caleb is making is that your EAG London story doesn't necessarily show the tension that you think it does. And for what it's worth I'm sceptical this tension is very widespread.

Like IanDavidMoss says, I think the more interesting phenomenon you mention is the sudden and unnoticed switch to skeptical mode:

I then told them about my work at the Happier Lives Institute comparing the cost-effectiveness of cash transfers to treating depression and how we'd found the latter was about 10x better (original analysis, updated analysis). They suddenly switched to sceptical mode, saying they didn't believe you could really measure people's mental health or feelings and that, even if you could, targeting poverty must still be better. 

After a couple of minutes of this, I suddenly clocked how weirdly disconnected the first and second parts of the conversation were. 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. They looked puzzled - the tension seemed never to have occurred to them - and, to their credit, they replied "oh, yeah, hmm, that is weird".

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.

That's fairly dismissive. You could have written:

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

Isn't it in the end about what's more cost-effective? I can interpret you as pointing to "if ~depression was more cost-effective to address than ~smallpox, it would have been addressed first in the developed nations," this might be a good heuristic but a well-thought cost-effectiveness estimate is more convincing to me. Seems like criticizing MichaelPlant's cost-effectiveness estimates could have been more productive here. (TBC: I myself haven't engaged with HLI's work/methal health charities much).

And mental health being comparatively cost-effective doesn't sound ridiculous to me. StrongMinds attracted some donations from EAs in the past including GiveWell staff.

(I sorta feel that this comment and 23 upvotes / 7 votes support OP's observation that people seem to be dismissive about mental health as global health and development intervention.)

Sorry, I should have been more mindful of how the brevity of my comment might come off. I didn't mean to suggest the question doesn't come down to what's most cost-effective, which I agree it does. I was trying to point to the explanation for my differing attitudes to the priority of mental health when thinking the cause area of making the ea community more effective vs. the cause area of present people's wellbeing more generally, which I'd guess is also the primary explanation for other people's differing attitudes, which is: debilitating and easily treatable physical illnesses are not that common among EAs, which is why they aren't a high priority for helping the EA community be more effective.

Thanks for clarifying! I think our misunderstanding comes from different framings: EA meta/infrastructure v. global health; within global health, MH v. disease/poverty alleviation. I agree with you and calebp on the former.

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. 

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.