Diseased Thinking: Dissolving Questions About Disease
May 31, 2010 1:15 PM   Subscribe

Discussions about obesity on Metafilter often lead to emotionally charged tangents. An article on Lesswrong.com attempts to tease apart the varying perspectives that lead to conflict over whether or not various behaviors should be classified as maladaptive, and whether medical intervention is a desirable means of solving problematic behavior.
posted by Human Flesh (47 comments total)

This post was deleted for the following reason: this seems like it has lead to emotionally charged tangents -- mathowie



 
Sandy is fictional, but similar conversations happen every day

Translation: I made this up, but you can trust me.
posted by doteatop at 1:24 PM on May 31, 2010 [2 favorites]


Is this FPP really necessary? We've been over the disease vs. habit territory over and over again and I'm not convinced there's much that's new in this piece. Also:

Her sister tells her that obesity is a perfectly valid lifestyle choice, and that fat-ism, equivalent to racism, is society's way of keeping her down.

Really? Her fictional strawperson sister is one of the few extremists who actually thinks that, and this isn't just an over-the-top, cartoonish distortion of the (perfectly reasonable) Health At Every Size movement? That was just about enough to trashcan the whole essay for me.
posted by availablelight at 1:26 PM on May 31, 2010 [6 favorites]


Different strokes for different folks. Sometimes literally.

But I kid. I'm having gastric bypass surgery in a few weeks because it was the choice for me. If people are happy, let them be. There's too few minutes in life to spend any of them judging a fat person for having a second helping of stuffing.
posted by inturnaround at 1:29 PM on May 31, 2010


Stuffing is the best thing ever.
posted by chunking express at 1:31 PM on May 31, 2010 [3 favorites]


My determinist consequential position is that the most useful version of this thread will take place upon some helpful soul cutting-and-pasting the below --

Summary

People commonly debate whether social and mental conditions are real diseases. This masquerades as a medical question, but its implications are mainly social and ethical. We use the concept of disease to decide who gets sympathy, who gets blame, and who gets treatment.

Instead of continuing the fruitless "disease" argument, we should address these questions directly. Taking a determinist consequentialist position allows us to do so more effectively. 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.

posted by kittens for breakfast at 1:32 PM on May 31, 2010 [6 favorites]


We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition

So we shouldn't blame and stigmatize people for conditions where blame and stigma are NOT the most useful methods for curing and preventing the condition? Please send out the memo. Because I'm pretty sure if insults and marginalization worked on obesity, depression, etc. there would be a lot less fat people and suicides.
posted by availablelight at 1:38 PM on May 31, 2010 [20 favorites]


Uhh...yeah, I'm with availablelight. I don't think there are any conditions where blaming and stigmatizing is an effective treatment. Otherwise medical schools would offer a doctorate in asshattery (MDA).
posted by Salvor Hardin at 1:39 PM on May 31, 2010 [1 favorite]


Availablelight, do you feel that a quote from someone who supports the Health at Every Size perspective would make the essay better? Discussions about obesity, depression, and ADD lead me to believe that many people have trouble articulating the ways in which the above conditions relate to conceptions of volition and the delegation of rewards and punishment.
posted by Human Flesh at 1:45 PM on May 31, 2010


Otherwise medical schools would offer a doctorate in asshattery (MDA).

I sometimes wonder if they don't and just aren't letting on about it to the rest of us.
posted by wreckingball at 1:45 PM on May 31, 2010 [3 favorites]


Salvor Hardin, establishing rules for the delegation of blame is not a surefire means to turn everyone into a model citizen, but don't you feel that contingencies of blame have at least some ability to alter human behavior?
posted by Human Flesh at 1:52 PM on May 31, 2010


Availablelight, do you feel that a quote from someone who supports the Health at Every Size perspective would make the essay better? Discussions about obesity, depression, and ADD lead me to believe that many people have trouble articulating the ways in which the above conditions relate to conceptions of volition and the delegation of rewards and punishment.

I think it would be more honest, and force a more nuanced discussion. I think it's an unfair, inflammatory setup to have the "sister" argue that "obesity is a valid lifestyle choice." There are many overweight people who have come to the conclusion that, as long as they're treating their bodies well, exercising, eating reasonably, registering good BP and cholesterol levels at the doctor, etc., they're not going to feel any more shame or worry about the actual number on the scale. This is much, much different than saying, "I'm obese because I want to be, so screw you." Quoting an actual advocate for Health at Every Size wouldn't be such a great strawman for the, "we need to make these people feel bad" argument though.
posted by availablelight at 1:54 PM on May 31, 2010 [3 favorites]


but don't you feel that contingencies of blame have at least some ability to alter human behavior?

Sure, in a coercive, damaging, and shitty manner. Just because being a dick might (and I can't emphasize the lack of certainty enough) achieve results doesn't actually excuse being a dick.

I agree with others; this post is weaksauce and it sounds like you're trying to start an argument. Flagged.
posted by Caduceus at 1:59 PM on May 31, 2010 [2 favorites]


don't you feel that contingencies of blame have at least some ability to alter human behavior?

They do have the capacity to alter human behavior, but not for the better, in my opinion. I'm a bit of a pacifist; I don't think stigma or blame are ever the best choice, medically or ethically. Just my opinion.
posted by Salvor Hardin at 2:02 PM on May 31, 2010 [1 favorite]


I don't think Yvain was trying to make obese people feel bad.
posted by Human Flesh at 2:02 PM on May 31, 2010


Metafilter participants are rank amateurs at over thinking plates of beans compared to the professionals at LessWrong. I have read some good articles on that website. This one is not terrible. If you have a lot of time to waste do a site search over there on pickup artists. Try and pick out which discussion thread participants have not been on a real date in the last five years.
posted by bukvich at 2:05 PM on May 31, 2010


Many people are fat for many different reasons. The end result is that you should eat healthy and exercise. Even if you don't lose that much weight, you'll feel better.


-- Formerly obese person who got off her ass and stopped stuffing her face. WITH health problems that made it hard to lose and easy to gain in the first place.
posted by Malice at 2:06 PM on May 31, 2010 [3 favorites]


Salvor, I have trouble imagining how criminal law would function without the delegation of blame.
posted by Human Flesh at 2:06 PM on May 31, 2010


but don't you feel that contingencies of blame have at least some ability to alter human behavior?

Yes, and so does punching someone in the face.

Although neither of those stimuli are A) usually thought through before presenting or B) yield the desired consequent.
posted by P.o.B. at 2:14 PM on May 31, 2010


The article isn't really about obesity, it's about reification, specifically reification of the term "disease". We say that something is a disease when it meets certain criteria, yet we still behave as though we think that the word means something in of itself, without reference to those criteria. This leads to people staking certain states as either representing or not representing disease, depending on how they want people to behave. The article could as easily have focused on another contentious example like paedophilia. Many oppose medicalisation of that behaviour precisely because diseases commonly attract sympathy, and are not seen as being anyone's "fault".
posted by topynate at 2:18 PM on May 31, 2010 [2 favorites]


Hurf Durf - verb. To hurf one's durf.
posted by blue_beetle at 2:21 PM on May 31, 2010 [6 favorites]


I've never felt comfortable viewing obesity as a disease per se, well nor do I grant obese people much sympathy either. That said, obesity is by-and-large caused by essentially criminal behavior among food companies.

For example : All the potato chip companies have investigated various crazy recipes and flavors using taste tests for years. For years, they've ignored sugar because they'd already showed that sugar makes potato chips taste worse. Well, eventually some clever soul discovered that people eat more if their potato chips contain sugar.

Yes, people are responsible for their own decision to buy & eat potato chips, but the companies should be criminally liable for intentionally creating a health problem.
posted by jeffburdges at 2:24 PM on May 31, 2010


Uhh...yeah, I'm with availablelight. I don't think there are any conditions where blaming and stigmatizing is an effective treatment.

How about racism, misogyny and homophobia? There are huge social stigmas attached to all of these mental conditions, and I don't think it's a stretch to say that gains in social rights over the past 150 years have all been coincident with an increase in the degree to which those who are racist, misogynistic or homophobic are stigmatized by society.
posted by nhamann at 2:27 PM on May 31, 2010 [1 favorite]


This is a ridiculously slanted account of "deontologist libertarianism":

Our attitudes toward people with marginal conditions mainly reflect a deontologist libertarian (libertarian as in "free will", not as in "against government") model of blame. In this concept, people make decisions using their free will, a spiritual entity operating free from biology or circumstance. 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.

If you're going to summarize someone else's theory, you should do it in a way where (1) it's not obvious whether you yourself believe it and (2) most adherents of the theory would agree with the account. I knew before reading any further that he isn't symphathetic to what he calls deontologist libertarianism. Also, by using loaded words like "spiritual" and "intrinsically bad people," he's saddling the theory with extraneous baggage.
posted by Jaltcoh at 2:28 PM on May 31, 2010 [1 favorite]


How about racism, misogyny and homophobia?

I think that's a bit of a slippery slope to say those are "mental conditions" rather than perceptions or state(s) of mind.
posted by P.o.B. at 2:30 PM on May 31, 2010 [2 favorites]


I don't think there are any conditions where blaming and stigmatizing is an effective treatment.

Why not? Stigmas can be very effective. Let's not stigmatize stigma!
posted by Jaltcoh at 2:30 PM on May 31, 2010 [1 favorite]


I have trouble imagining how criminal law would function without the delegation of blame.

Dude, obesity is not a crime.
posted by lunasol at 2:33 PM on May 31, 2010



Uhh...yeah, I'm with availablelight. I don't think there are any conditions where blaming and stigmatizing is an effective treatment.

How about racism, misogyny and homophobia?


I actually thought of this, because stigma DOES have a place in policing and enforcing other social/behavioral norms--predominantly in the public sphere (and you can argue that many fat people are sensitive about being seen eating excessive or unhealthy food in public, just as many racists won't bust loose at the office). However, I think you'd have a hard time getting around the fact that people who are fat for emotional/behavioral reasons (comfort eaters) usually up eating MORE, or taking care of themselves less, if they are dealing with a neverending spiral of social shame and blame.
posted by availablelight at 2:35 PM on May 31, 2010


I can't tell whether availablelight and SalvorHardin get it or not. The authors agree that one criterion for the "disease" label is that stigma and blame don't work. They give examples of phenomena where stigma and blame might work, like laziness, that don't get the disease label. Importantly, they are not using "condition" as a synomym for disease. Laziness and cancer are both human conditions in their terminology but only cancer is a disease.

I really think this article would repay a closer reading with your auto-GRAR set to "off". topynate has it.
posted by i_am_joe's_spleen at 2:36 PM on May 31, 2010 [1 favorite]


Well, this went down the rabbit hole quickly, and probably can't get up now that obesity has been compared to racism and pedophilia. Not touching the latter with a 10-foot pole but there's a fair bit of evidence that the former is generally more vulnerable to friendly engagement rather than outrage.
posted by KirkJobSluder at 2:36 PM on May 31, 2010


So wait, this article is saying that obese or overweight people aren't stigmatized enough? What an incredibly radical position!
You know I feel like this all ties in with a human, but also particularly American, need to make systemic problems into problems with human behavior.
Sure we could maybe shame millions of people into eating fewer sweets, but we could also reduce corn subsidies and achieve the same effect.
Or we could pretend that all diseases were preventable if people exercise and eat exactly the right way, or we could actually make preventive care an affordable option.
We could pen countless articles urging people to use less gas or we could actually design and build cities with affordable and convenient mass transit options.
Let's stop pretending that everyone makes choices in a vacuum.
posted by peacheater at 2:38 PM on May 31, 2010 [1 favorite]


now that obesity has been compared to racism and pedophilia.

Oh come on. There's no way that's even close to what was said. They were suggested as possible conditions for which blaming and stigmatizing might be effective in treating.
posted by ODiV at 2:38 PM on May 31, 2010


Salvor, I have trouble imagining how criminal law would function without the delegation of blame.
posted by Human Flesh at 5:06 PM on May 31 [+] [!]


This is heading for a derail, but that's ok. I'm not a huge fan of criminal law. I understand its necessity, because I know that my beloved pacivist collectivist utopia is forever out of reach.

Assigning blame is distinct from assigning responsibility. Fat people are responsible for their own bodies, but I don't "blame" them for it. The only purpose of blame is to make someone feel bad about themselves, and I don't think that can possibly be constructive in the long run.

In the same way, there's no reason why a criminal justice system couldn't operate on the principle that people who violate the social contract should be given two options - rehabilitation or ostracism. Banishment makes a lot more sense than imprisonment. If you ask me punitive law is a brutal relic of violent philosophies about mankind.

But that's besides the point.

Oh, on preview:

How about racism, misogyny and homophobia? There are huge social stigmas attached to all of these mental conditions, and I don't think it's a stretch to say that gains in social rights over the past 150 years have all been coincident with an increase in the degree to which those who are racist, misogynistic or homophobic are stigmatized by society.
posted by nhamann at 5:27 PM on May 31 [+] [!]


I think you've got that analogy backwards. The blame and stigma didn't cause the women to stay at home, or the gay people to straighten out (thank goodness). Besides, there would have been no need for the civil rights revolution if there was no social stigma against women or homosexuals or various ethnicities...because if there was no social stigma to start with, everyone would already be treated as equals.

Not sure if that was clear or not.
posted by Salvor Hardin at 2:40 PM on May 31, 2010 [2 favorites]


Uhh...yeah, I'm with availablelight. I don't think there are any conditions where blaming and stigmatizing is an effective treatment.

How about racism, misogyny and homophobia?


Wait, you're not saying these are equivalent are you. No, you're not saying that I'm sure.
posted by nola at 2:40 PM on May 31, 2010


So wait, this article is saying that obese or overweight people aren't stigmatized enough?

No, it says the exact opposite. You did read it rather than relying on the comments of people who leaped to conclusions, didn't you?
posted by i_am_joe's_spleen at 2:41 PM on May 31, 2010


We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition

So we shouldn't blame and stigmatize people for conditions where blame and stigma are NOT the most useful methods for curing and preventing the condition?


How many times am I going to have to explain this?

GIVEN ANY STATEMENT OF FACT, THE ONLY CONCLUSION YOU CAN DRAW IS THE CONTRAPOSITIVE.

Just what is a contrapositive? Well, I'm glad you asked! Let's take any random statement of (purported) fact. For example:

"Nobody on MetaFilter understands logic."

What would be the contrapositive of this statement?

"If someone does understand logic, then they must not be from MetaFilter."

See how that works? You invert both sides of a statement's truth, then invert the causality. For you logical dabblers and dillentantes, here's the logic broken down:

Statement: A -> B.
Contrapositive: !B -> !A

This is not the same as the opposite.

The opposite is when you reverse the causality.

Statement: A -> B … "Nobody on MetaFilter understands logic."
Opposite: B -> A … "You don't understand logic so you must be from Metafilter." (WRONG)

This is also not the same as the inverse.

The inverse is when you preserve causality but invert truth.

Statement: A -> B … "Nobody on MetaFilter understands logic."
Inverse: !A -> !B … "You're not on MetaFilter, so you must understand logic." (WRONG)

This fucking shit drives me up a goddamned fucking wall. If you can't draw SIMPLE FUCKING LOGICAL CONCLUSIONS you have NO RIGHT THINKING OUT LOUD.
posted by Civil_Disobedient at 2:49 PM on May 31, 2010 [13 favorites]


mayday! mayday! thread.... hit.... going..... down....
*static*
posted by nathancaswell at 2:53 PM on May 31, 2010


I gained my weight back. I don't blame anyone but me, altho I know that now that I work, have less time to plan menus and even less time to go to the gym, it's not surprising that I did.

However, that is between me and my body, and if anyone tries to shame or blame me I will simply consider that they have a personal problem with rudeness. Because MY WEIGHT IS NOT YOUR BUSINESS.

Next question?
posted by St. Alia of the Bunnies at 2:58 PM on May 31, 2010 [2 favorites]


Uhh...yeah, I'm with availablelight. I don't think there are any conditions where blaming and stigmatizing is an effective treatment.

How about racism, misogyny and homophobia?


I'd argue that blaming and stigmatizing have NOT been effective treatments for racism, misogyny and homophobia. Occasionally effective on an individual basis (there's anecdotal evidence for everything), but not successful at all at eliminating the problems in society as a whole, especially when countered by efforts to stigmatize tolerance.
posted by oneswellfoop at 3:02 PM on May 31, 2010


Dude, obesity is not a crime.

Some people advocate punishment as a means of reducing problematic behavior. The author of the essay isn't advocating the use of stigma to deal with compulsive overeaters. I'm not either. Nevertheless, a discussion about the conditions under which people employ blame is relevant to understanding why overeating and and other maladaptive behaviors provoke moral arguments.
posted by Human Flesh at 3:03 PM on May 31, 2010


Because MY WEIGHT IS NOT YOUR BUSINESS.

So you're against single-payer?
posted by ferdinand.bardamu at 3:05 PM on May 31, 2010 [1 favorite]


but... you... just.....
posted by Baby_Balrog at 3:16 PM on May 31, 2010 [1 favorite]


Oneswellfoop,

Do you think that stigma has the potential to reduce racism even further? Also, do you feel that racists have been stigmatized too much, not enough, or just the right amount?
posted by Human Flesh at 3:16 PM on May 31, 2010


In terms of bad habits that we should be discouraging, I think automotive culture deserves a long hard look. Unlike obesity, its negative affects are felt way beyond the individual.
posted by ODiV at 3:18 PM on May 31, 2010


Also, I find whenever I try to bring up the cessation of transport by personal automobile people act like I'm nuts. I think it might very well wind up being a necessity.
posted by ODiV at 3:19 PM on May 31, 2010


Because MY WEIGHT IS NOT YOUR BUSINESS.

So you're against single-payer?
posted by ferdinand.bardamu at 3:05 PM on May 31 [+] [!]


My blood pressure is 100 over 60 and last time my cholesterol was checked it was under 180. Next question?
posted by St. Alia of the Bunnies at 3:27 PM on May 31, 2010


Sometimes I think 'shitstorm' should be added to the list of available flags.
posted by Space Kitty at 3:27 PM on May 31, 2010 [1 favorite]


The stigma against racism never reached the level of 'too much' in my opinion, but it's not particularly relevant (and I've known some very racist people whose upbringing and personal stories make me blame them less than others; never nearly totally excusing it, but that's the way PEOPLE are).

But the human tendency to turn a stigma into a perverse object of pride (let's hear it for the stigma-busting power of being "POLITICALLY INCORRECT") and the ingenious ways people have for concealing their vices/bigotries/etc. (and let's face it - getting back on topic - gluttony/overeating is probably the LEAST concealable) reduce the power of stigma over time, so no, even increased stigma is not likely to reduce racism, obesity, pedophilia OR driving-while-texting.
posted by oneswellfoop at 3:30 PM on May 31, 2010


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