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Impact of early life adversity on reward processing in young adults (2014) (plos.org)
125 points by sandwichsphinx 3 months ago | hide | past | favorite | 120 comments



I don't really see how there can be any question that chaos, poverty, moving every year, constantly changing schools, multiple and changing "parent" figures, adults making poor choices over and over, no examples of deliberate planning and saving for the future, screws up kids.

They learn that life is completely unpredictable, that opportunities for reward should be taken immediately because they will not be there later, they never learn to spend extended time on learning anything or saving money for the future because they have never seen anyone in their life do those things.

A few manage to figure it out anyway, but most are doomed to repeat all of that as parents with their own kids. It's sad.


> They learn that life is completely unpredictable

As someone with pretty much the upbringing you described, I don't think this was the takeaway.

For me personally, I learnt adaptability, how to adjust to new situations and people quickly.

I saw what my parents did and said "I don't want to be like that".

The downside is, it's hard to answer "where are you from?", or to know where home is, and it's especially frustrating as an adult to see your parents continue to make bad decisions, to continue to be broke etc.

I know everyone is different, but anecdotally my sister and brother also seem to be doing relatively well.


i also had a lot of that (except for the bad decisions and lack of planning) and i also became adaptable. what i didn't learn was attachment. and it took me decades of my adult life to understand that, realize how it affects me, where it came from, and i still don't know what to do about it. my brother on the other hand suffered from depression. despite being very similar in age and thus similar experience the outcome was very different.


Did you have a counter-example in the nearer family?


I mean, maybe? They experience that life is completely unpredictable, sure. They learn whatever they are taught along with it.

Consider, life was far more unpredictable just a few hundred years ago. Literally stubbing your toe in the forest could go septic and then you were dead. Violently so. Bad harvests could happen with no forewarning at all.


The fact that stubbing your toe meant death in the past doesn't mean that facing massive adversity doesn't have real negative long term impact on one's mental well being.

You're equating psychological harm and learned patterns of behavior that are unresourceful with physical accidents, without explaining why we should see them as comparable.

Even if they were comparable, who's to say Neanderthal younglings with badly stubbed toes didn't also have skewed reward processing as adults?


Example of stubbing toe was about how unpredictable life was. Getting a wound to go septic was basically random for a long long time. Most of the time, stubbing your toe was about the same as it is today. Annoying and nothing more. Have it go septic, though, and it likely looked like someone had been cursed to death. And note that this goes for more than just literally stubbing your toe. Snag on a bush? Bitten by animal. It would have seemed far far more random.

My post is specifically in response to the one above me. It is framed with modern events and pushing that they are obviously going to seem unpredictable to people. My assertion is that they can be seen that way, sure; but don't think this is somehow a modern thing.

To your point, I would expect that reward processing is influenced by these events, sure. I would also expect any indoctrination that was happening at the same time to stick. My current bias is to expect indoctrination to stick more effectively than raw experiences. And yes, this is somewhat cheating because the indoctrination is almost certainly done to compliment experiences.


Arbitrary danger in nature is where religion came from.


This largely runs to my point. It wasn't the arbitrary danger that led to religion. It was people teaching that the danger was from a directed source that did. Put differently, without priests, would there be religion?


It was people teaching that the danger was from a directed source that did

i'd rather think it was the demand for an explanation for those events. and just like any sufficiently advanced technology is indistinguishable from magic, so is any unexplainable event indistinguishable from an act of god.


For this to work, though, you would have seen a convergence of all humanity onto the same explanations?

While I think you can almost make the case that there are some commonalities between origin stories, I think you would be stretching credibility a fair bit there.

This also hits a pretty tough point with regards to other animals. Do they have religions?


For this to work, though, you would have seen a convergence of all humanity onto the same explanations

given the dominance of monotheistic religions this is actually happening. there is no need for origin stories to have commonalities because the convergence can also happen through replacement. if every group comes up with their own explanation for the different experiences they have, their stories are naturally going to differ, and that is what we see in history. but also, commonalities are there. pretty much all stories have some kind of creator of the universe and many refer to someone who will come and bring salvation.


This is still to my point. If you require indoctrination to get "convergence" through replacement, then you would, by definition, not have the same stories without priests.

Yes, you can stretch some stories to say there are commonalities. But you are doing some heavy stretching. And you still don't address other social animals. Do they have religions? Why not?


indoctrination is not required. nor are priests. the story just needs to make sense, and if it does people will accept it.

how are the commonalities a stretch? they are self evident: somehow some entity created the universe. somehow this creator is communicating with us, not just once, but multiple times, and they will communicate again in the future. everything else is the content of that communication, and for that there is no need of any further commonality even though there still are many.

i am not addressing animals because that is completely out of scope. our understanding of the consciousness of animals is still very limited, and even if it is shown that animal are potentially capable of such higher order thinking, as long as we can't actually able to communicate with them, we won't know what they are thinking. the question if animals have a religion is therefore unanswerable for the time being.


The commonalities are a stretch because they largely amount to "a creator exists."

Animals have absolutely been shown to be able to communicate. They are unable to persist this teaching in the wild. Which, again, is to my point.


well, i think there are more commonalities than that but since my argument was that commonalities aren't really needed, to me this point is not really important.

speaking of commonalities, this subthread has diverged from the original topic quite a lot and in an odd way is actually converging with the discussion on "Life is not a story" https://news.ycombinator.com/item?id=41876979

regarding animals, i don't get which point you are making there.


Thanks for the link to the other thread, I skipped that article the other day. (Barely keep up with my threads on weekends.)

Point on animals is that it isn't just the story telling that propagates religion and similar, but persistent story telling. Writing things down and learning the symbols of previous generations is a fairly uniquely human activity.


thanks, now i get your point. essentially what we are discussing is https://en.wikipedia.org/wiki/Evolutionary_origin_of_religio... a topic that i am not deeply familiar with, and to be fair, i also don't hold a strong opinion on. in my naive view i believe the following to make sense: storytelling precedes religion. religion evolved from storytelling and became more elaborate, motivating the development of the role of priests because the skills and knowledge needed took more time than a normal person had available and the role was deemed important enough to warrant significant time investment into learning it by selected individuals as part of the specialization of roles in a community. today priests are no longer needed because the skills needed to create, share and interpret stories can be learned by anyone.

to summarize the argument and bring it back to the main topic, i'd like to argue that adversity influenced storytelling which created religion and religion necessitated priests. so yes, without priests religions may not have persisted, but that's like saying without farmers farming would not have taken hold and we would still all be hunter/gatherers.


Facing adversity when one is young is important. Elon Musk faced it a lot and so did Arnold Schwarzenegger. Both of them credit it for building resilience in them. But again it will back fire if there is too much adversity / trauma.

In fact in one of the interviews Elon talks about implementing structured adversity.


I'm amazed that people still fall for the PR stories from Elom.


Elon Musk is no posterchild for someone who has experienced adversity nor is he an example of good parenting.


Yeah. No advice and ignorance is better than certain advice


It's as simple and as difficult as you want it to be really.

The main thing is that people have to learn that, paraphrased for brevity, life in the "ends" requires a different set of skills to life in the more civilised parts of society.

You have to relearn how to function. Some don't.


Humans are antifragile. They survive disease, famine, loss, death of kin, all sorts of horrible abuse and still manage to build a great life afterwards. Look at all of the people who survived German concentration camps and still were able to live lives worth living after the fact. Not everybody, but it's clearly possible.


> Humans are antifragile.

This is not true at all.

Some survive, but many die from the things you've described. Of those that survive, many fail completely to build a great life afterwards. They succumb to alcoholism, other addictions, and many die later from suicide.

Talk to any therapist and you'll find out that human fragility is the rule rather than the exception. After traumatic events, even those that "still manage to build a great life", as viewed from the outside, are often suffering greatly on the inside. Some of them manage to heal themselves with therapy and loving supportive relationships, but a great many don't. Which is why cycles of trauma unfortunately get passed on.


Can anecdotally confirm as a data point myself along with some people I know.

Certainly, I can be viewed as stereotypically successful by my buddies. Certainly, because the mask we wear should be strong and never come off. But in my nights alone, or even in my therapy sessions, who could possibly see that 'me'?

I have come to realize, though, that most people who didn't suffer much, refuse (implicitly, not explicitly) to empathize with those who have -- perhaps even I may be included in this group which 'refuse implicitly' at time. It's not that big of a deal, though. (Generalized) Empathy is a difficult skill to train.


This is extreme survivorship bias.

The way you say 'look at all the people' implies that a lot of people survived and had good lives, but this needs to be weighed against the number of people total that entered concentration camps to know if this is actually a meaningful number of people to validate your assertion or not.

My guess is that someone who went into a concentration camp were much less likely to live a life worth living than people who did not simply because a large number of them lived a life of torture and then death.


Is it survivorship bias or plain old evolution?


Humans as groups sure are, but only because one succes in a population tends to look like it makes up for all the quiet struggle. For the folks living those quiet struggles though, life and joy is fragile and temporary.


>They survive disease, famine, loss, death of kin, all sorts of horrible abuse and still manage to build a great life afterwards.

That doesn't mean that such factors don't DRASTICALLY reduce the odds of this happening. Moreover, some people being able to build a good life after such trauma doesn't mean that said trauma isn't a hinderance.


There's a real difference between surviving and thriving.

I don't think we're claiming life isn't "worth living" after adversity. Just that it's somewhat obvious that they will make similar mistakes due to the challenges they face, at least more frequently than those who do not face such adversities.


There is a fantastic book on the impact of childhood adversity on long term health outcomes. Highly recommend, especially to prospective parents: https://www.goodreads.com/book/show/33413909-the-deepest-wel...


I'm growing stronger in a belief that teaching/indoctrination matters more than just general experience.

Don't get me wrong, I fully agree that life experiences are their own teaching. However, it seems clear that a coach/teacher added to the exact same experiences can lead to different learning. Curious if folks have any links to studies that disprove that?


Moved a lot when young and generally not the greatest learning experiences but low in comparison to the adversity of many peers.

One teacher recognized I had a learning disability at elementary level before teachers were trained on that kind of thing. Was able to work through that over time.

HS counselor nominated me for a program that involved a long weekend trip to a medium sized university city. Never understood why I alone was chosen over peers.

I think it happens to a lot of kids that way, it didn't take a village, curriculum or a coordinated effort. Just one or two educators doing one thing and changing a life completely. I'm sure just one authority figure over time can have a huge impact.


One such life adversity can be having bad teachers and unhelpful indoctrination in early life. If anything you're corroborating TFA's argument?


Sure? That feels to be stretching the adversity definition, though. Not having a good teacher does not mean you necessarily had a bad one, after all.


Maybe I missed it but the article doesn’t appear to control for genetics. This is crucial because:

1. Dysfunctional reward processing in parents plausibly causes early life adversity in their children, and

2. Dysfunctional reward processing, like practically every other mental trait, is to some degree heritable.

Without controlling for genetics it would be impossible to distinguish the effect of early life adversity from the effect of being the child of the type of parent who creates an environment of early life adversity.

I think it’s plausible that shared environment plays a role, but papers that don’t even try to address genetic confounding aren’t serious.


To get an idea of how serious this omission is to the validity of the conclusions, take a look at "Individual differences in executive functions are almost entirely genetic in origin" https://pubmed.ncbi.nlm.nih.gov/18473654/


"Moreover, a similar activation pattern related to lifetime ADHD may suggest that the impact of early life stress on ADHD may possibly be mediated by a dysfunctional reward pathway."

What is a dysfunctional reward pathway?


It is stated just above the quoted text.

Basically a lower-than-expected response to reward anticipation and a higher-than-expected response upon reward delivery.

I.e. the typical ADHD problem of instant vs delayed gratification and how the brain responds to it.

Neurotypical people’s brains seem to be better at rewarding in anticipation and not just on actual delivery.

IIUC


If you're thinking about 10 different things in quick succession spontaneously flipping between each without control, your brain can't deliver sustained anticipatory reward for the one thing you actually should be working towards. The brain doesn't magically "know" what is important, presence in consciousness is what determines importance and reward allocation. Normal brains are able to fixate without tremendous effort.

My whole life I could barely sustain a conversation with someone because the moment they started speaking I'd reflexively begin thinking about something else. But when I tried Adderall I could actually have genuine conversations with people, hearing them and thinking about what they were saying and then responding, doing this repeatedly for many minutes. It felt like a superpower.


Some of the "Flipping around" might be caused by an inability to discount the reward from the thing you're flipping to - it seems important / rewarding. It's not much different than someone refusing to work on an important thing because they can't stop thinking about this neat thing over here that feels cooler. Just to connect to the subject at hand.


hmmm yes could be that people with adhd,me for example, cant feel the reward of social contact so its hard to listen if not geniunly interested.

sometimes i try to reward myself conscious of something and it works. for example i think conscious about how if i finish a little task it would make me happier. then i kind of force a reward feeling towards the anticipation to have something done. and it works. i feel motivated to do little tasks. and if i do this repeatedly and on bigger and bigger tasks it reduces my adhd symptoms… but then there is suddenly something else to do and then i do this while thinking about the things i should do and what i could do next and suddenly i start 10 things and how the fuck did this happen … where are my keyes? :)


The "where are my keys" thing is the worst. I can get locked in a 5 minute loop trying to figure out the next step to leave the house. I'm busy thinking about a cool problem at work or the next step in a game, or an upcoming fun thing, and I cannot for the life of me focus on finding my keys. Or I'll go looking and get reminded I also need to do X before I leave, then start that instead, and restart the whole problem.

I used to have a little jingle I'd subvocally sing: "Badge, wallet, keys, notes, laptop, phone; Owen's fed, doors locked, leaving home". It was my checklist. It's why I'll throw my backpack in the car even if I'm going to meet friends: It just helps me put aside the preparation anxiety to just do the same thing every time.

Those routines are helpful. I also keep prepacked bags - a backpack for work, a gym bag with copies of keys for gym, etc etc. I even have two or three pre-stocked wallets for those bags or I'll get stuck in optimizing my credit card selection for an activity. My wife laughs, but she's the one who loses her phone, cannot find her wallet, and to this day has no idea where her car keys are.

Atomic Habits was helpful. It's about how to set up your subconcious so you don't have to painfully think about every decision all the time. Maybe it's made me less able, maybe not. But going to the gym at 3 has become so routine that I find myself up in the kitchen before I realize why I left my office.

I'm guessing this is all pre-emergent dementia, honestly.


Yes, the utility behind that behavior is that the brain floods itself with dopamine when task completion feels imminently close in anticipation of the approaching reward. The flooding of dopamine, which is the motivation, does not suggest increased dopamine reception, which is the reward.

That utility alone accounts for gambling addiction. Consider that slot machines are a game of random chance against fixed odds. Every time you play the chance of winning is random against the same odds just like the last time. The more a person plays consecutively without winning, a losing streak, the more the brain anticipates winning the next time which builds dopamine anticipation in the brain even though a person is just as likely to continue losing into the future on each iteration.

What's more interesting is that this addiction behavior can be flicked on or off instantly, like a light switch, with medication. What's more strange though is that medically induced gambling addiction, yes that is a very real thing, effects females far more than males. I don't know if the cause of difference in behavior by sex is identified.


Can you elaborate on what medications impact gambling behaviors?

I have some addictive/compulsive behaviors that have been hard to shake. GLP-1 agonists look promising, but I'm not sure how to get a prescription since I'm not overweight.


This article explains it well: https://pmc.ncbi.nlm.nih.gov/articles/PMC9825131/

My suggestion, and I am not doctor or providing medical advise, is to make the addictive stimulus inconvenient. Each iteration must include more steps to increase labor of effort and each iteration must also take much longer to complete. This will re-balance the brain from prior established condition. The more painful, disconnected, or costly (in time and not money) an activity becomes the more dedicated you must become about achieving that activity before addiction can set in.


> make the addictive stimulus inconvenient

Assumes there is a limit to the amount of effort addicts are willing to put into getting their next dose. Easily disproved by the experience of caring for opioid addicts. Lesser drugs, even. Once upon a time, a seemingly rational benzodiazepine addict got so frustrated with my attempts to get him off of it he rose up from his seat ready to punch me in the face.

There are addicts out there who would sell their own mother for a dose. And I'm not just saying that. One of my former neighbours turned into one of these guys. People wouldn't believe the stories if I told them.


There is always a limit. The realistic constraints of physical and social opportunities available to a given person are limitations irrespective of the person's quantity of motivation, which speaks to asset availability and social enabling. But none of this is relevant. The person to whom I replied is self-motivated to terminate their addictive patterns.


> The person to whom I replied is self-motivated to terminate their addictive patterns.

Kind of. The captain of the ship is motivated, but the helmsman needs to get his shit together.


could you tell me more about the medication. does it decrease dopamine production or does it increase reception?


Here is an article I found about this subject: https://pmc.ncbi.nlm.nih.gov/articles/PMC9825131/


High time preference, in other words (economic terms)


The brain releases dopamine as a "reward"; it's a feel-good chemical that contributes to positive reinforcement of various behaviors. People with ADHD have limited dopamine response, which can express as a lack of motivation relative to others.


nitpick: dopamine means reward anticipation, the longing for the goal, not the satisfaction of achieving the goal.


I was completely sure you were wrong and went and did a bunch of reading on Wikipedia and realized that my understanding of the reward pathway was incorrect. Thanks for educating me a bit today.

I thought dopamine was both the anticipatory neurotransmitters and the reward. But the reward neurotransmitters are different, they're your endorphins, endogenous opioids.


It seems this is a sort of trick our brains evolved to play on us that drives us to act- which makes sense. It is the anticipation of a reward that drives strong feelings and behaviors, but the reward itself is usually not as big of a deal- we work hard for something we expect to be great, but when it actually happens we barely notice and immediately move on to thinking about something else.

If dopamine only happened once you received a reward, it would not cause you to get you to actually act before hand.


"Ya get high before ya actually get high, once ya know ya got it"


The importance of ritual and routine.


Yeah, it is surprising how many of the most dangerous effects of addictive drugs for example happen when you are not immediately experiencing their effects- the actions people take to obtain them. In that sense, I think the idea of downplaying non-drug addictions as categorically less important, e.g. "not chemically addictive" is a mistaken perspective.


I completely agree and you can see it how some people absolutely can't help but destroy their life gambling or thrill seeking or hell, even chasing karma/likes/numbers on social media.

It's still hacking the brain if you make the perfect Skinner box and take all their life savings and then some


All this just means we need an exceptionally strong signal to be able to pay attention. Most things are far too boring to engage us. Even things which were interesting at some point become boring once we figure them out in our minds and all that's left is the execution, the mechanical performance of the work. Hence the tendency to not finish projects.


Your mum has undiagnosed asperberger autism and shows zero emotions towards you besides constantly threatening you with religous terror because thats how god forces ruled on everybody. And thats all you ever expect from mankind.


Normal brain : The joy of considering future reward is greater than the joy of actual reward.

Dysfunctional brain : The reverse.

(Which makes me go hmm)


Other brains: No joy in response to future or present rewards. Anxiety on the journey, shame at the destination.


Spot on


this is literally me irl


Lawrence Kohlberg's pyramid theory (stages of moral development) is flipped and chipped for these kids.

I would additionally posit the more "potential" the youth were given the perception of having, the dramatically worse the comparative results.

I can distinctly, acutely, remember sondering others' unobservable lives, long before I had any distinct sense of agency; comparing their actions against their words and little affects either had on outcomes.

So few times in my life that I have feared repercussions/punishment, it raises the question if its systematic to a group or just an individual anecdote.


So, is this just a way to do early measurements, to determine if someone might develop ADHD later.

Not any indicator of things to 'do' to help not develop ADHD later? No actions to take?

" In contrast, during reward delivery, activation of the bilateral insula, right pallidum and bilateral putamen increased with EFA. There was a significant association of lifetime ADHD symptoms with lower activation in the left ventral striatum during reward anticipation and higher activation in the right insula during reward delivery."


> No actions to take?

The actions to take would appear to depend upon whether one wishes to have fewer adults with lifetime ADHD symptoms, or more*.

The childhood adversities to affect either way are from [RutterQuinton77] and listed in TFA's Table S1, abbreviated here:

  *Low educational level  parent with neither school nor training
  *Overcrowding           more than 1.0 person/room or housing<=50m2
  Parental disorder       moderate to severe DSM-III-R
  Parental history        insitutionalised/deliquent/changes of parental figure
  Marital discord         low partnership in 2 of {harmony,communication,warmth}
  *Early parenthood       a parent <=18 (birth) or relationship <6 months (conc)    
  *One-parent family      (at birth)
  *Unwanted pregnancy     an abortion was seriously considered
  *Poor social network    lack of friends & help in child care
  Severe chronic probs    affecting a parent for more than 1 year
  Poorly coping parent    with stressful events of past year
The ones marked with * are those factors I believe relatively easier to address via social policy.

EDIT: TFA uses different measures, discussed in the section "Definition of Rutter’s indicators of adversity (RIA)":

  low social class     both parents
  marital discord      parents not at same address
  large family size    4+ children
  paternal criminality
  maternal disorder    ICD-8: 290–315 or ICD-10: F00-F99
  foster placement
* for instance, [Huxley32] mentions the practice of inducing fetal alcohol syndrome in order to ensure a steady supply of menial labour


Tread carefully. Your comment has the aroma of exactly the sort of first order thinking that over the past 50yr resulted in welfare programs exacerbating that exact list of problems (among others) that you're saying we can solve with more welfare.

I don't know what the solution is but using government to replace or supplement the kind of support that people traditionally got from their family, friends and network has only reduced the strength of those support streams over the decades.

To call out one well studied example, you can't just do first order stuff like extend bennies to single moms because then people won't get married in the first place and it's easier to split up if you're not married then you've got a legit single mom on your hands with all the poorer outcomes that entails. You can play whack a mole refining the rules forever but that has its own problems.


One simple and cheap thing that we do is have condoms (cheap) right next to the pregnancy tests (expensive) in vending machines.

It's logically possible this doesn't reduce single and early parenthood (although I bet someone had measured), but even in that unlikely event I don't see how it would adversely affect family, friends, or networks either.


> Tread carefully. Your comment has the aroma of exactly the sort of first order thinking that over the past 50yr resulted in welfare programs exacerbating that exact list of problems (among others) that you're saying we can solve with more welfare.

Who says that the welfare programs exacerbate the problems?

Perhaps it is the lack of welfare programs (particularly in the US, the richest country in the world) that causes so much social problems (compared to less rich European countries).


At one point, U.S. welfare programs directed at single mothers appeared to cause an increase in single mothers. Fathers either actually left or had to hide their participation in the family lest the mother become ineligible for assistance. The dominant culture is that the poor are morally unfit and undeserving, and the welfare programs reflect that. Politicians emphasize their benefits to the middle class, almost never the poor.


> you can't just do first order stuff like extend bennies to single moms because then people won't get married and it's easier to split up if you're not married, then you've got a legit single mom on your hands with all the poorer outcomes that entails.

Refusing to provide support to an person who wants to leave a relationship leads to several other factors, some on this very list. Indeed, staying in a dysfunctional, unwanted, potentially abusive relationship, just because finances force you to, is worse than the alternative.


The results of 50yr of various flavors of this policy kind of speak for themselves (which is why I specifically chose to mention it as my example).

It's better for society if people get married, (or perform some other socially agreed upon ritual that both requires investment and signals future investment) BEFORE they start cranking out the crotchfruit. Extending more aid to people who skip this step than those who go through it leads to predictable outcomes.

I get that it's really easy to play this off as some sort of pro-woman thing and try and send the discussion careening off into left field by bringing up domestic violence but we both know that's a red herring.

Edit: It was a mistake to reply to this comment at all. This is all a side discussion (ironic considering the subject of TFA). My point wasn't that you can't have government do things. The point was that you can't just pick a metric and turn government loose trying to address it. The goal of historical welfare was to subsidize basic necessities with certain groups getting priority that was generally accomplished (the programs exist, they doll out bennies pursuant to the rules) but it didn't yield the expected improvement on other fronts as intended and in the process we minted a class of people who are all but trapped in a multi-generational cycle of dependance upon the welfare system.


> It's better for society if people get married, (or perform some other socially agreed upon ritual that both requires investment and signals future investment) BEFORE they start cranking out the crotchfruit

The children of dysfunctional, unwanted, and potentially-abusive relationships speak for themselves: Given a couple with a kid, in a dysfunctional, unwanted, potentially-abusive relationship (marriage or otherwise), it's better for them to end the relationship. Raising a child in such an environment leads to all sorts of disorders (as described in this very article), and is worse than a single parent or separated parents properly raising the child with adequate support, financial and otherwise.

Unfortunately we cannot hand-wave away dysfunctional relationships, unwanted relationships, abusive relationships (to say nothing of domestic violence), and all that comes with them, no matter how easy it is, how much we wish we could, or which fish you wish to change the subject to.


> The results of 50yr of various flavors of this policy kind of speak for themselves

Maybe... just maybe... the US does not have enough social policies to assist the most vulnerable?


> BEFORE they start cranking out the crotchfruit

While you are being all edgy and misanthropic and childfree or whatever, you do realize that you are included in this definition?


The “welfare queen single moms” criticism is a shallow critique of government assistance programs overall and doesn’t move the analysis forward in an evidence backed manner. This is an old Republican USA talking point.

Also arguing that government support reduces the strength of family networks really needs some serious citation to back it up.


any citations for all that?

there's a lot of assumption of causation with no backup.

in particular I'd mention that there are countries with far more extensive welfare programs with measurably better social outcomes, so maybe there's something else going on


what countries? i suspect the ones you're referring to are demographically different from the US and are homogeneous in culture/race/faith.


More than 1 person per room??? Surely everyone having their own room is a very recent development?


I think that's the whole house, not just bedrooms.


That would imply ADHD was profoundly more widespread in the generations of our grandparents and before, since 10 or more people sharing an apartment or living space was incredibly common.


entirely possible that it was, but it was less of an issue when you have to haul water 3km a day and then work in the fields.

kinda like autism numbers are going up, but that might simply be because of increased diagnosis. or how "gay" isn't a new thing that's just trending -- the romans and greeks (and ottomans, and the tang dynasty, etc.) were also pretty damn gay too.

all super common stuff, just not logged as much


Idk, my grandma and my family from her generation had no problem taking a plane ride without entertainment, and didn't compensate with conversation or the seat back screen.


That makes even less sense.


It's a recent development among poor lower class stressed people, not among calm, comfortable successful people


>Not any indicator of things to 'do' to help not develop ADHD later? No actions to take?

Reduce early life adversity.


That's not really how research papers go. You prove a causal link between two things before a future paper tests methodologies to address the link.

Though popular reporting on these types of papers will often have speculation from the journalist


Correlation, not causation. Randomized controlled trials of human suffering are not ethically approved research.


It says towards the end of the abstract that righting this balance, increasing anticipation dopamine and lowering reward receiving dopamine, could help with adhd


I wish scientific papers would have their conclusion at the top of the page.


But they do, it's basically the last part of the abstract.


I wish they'd have nothing but their methodologies and results.


Publishers wouldn't like it, I guess.


Treating it as a chemical error in the brain rather than "a reasonable way to feel given what you've been through", I'm tempted to say something about chemical errors in the researcher's brains.


Many of us agree with you, but if you could make your substantive points here without snark or shallow putdowns, that would be good.

https://news.ycombinator.com/newsguidelines.html


"a reasonable way to feel given what you've been through"

Isn't our brain made of chemicals of all kinds, and how we 'feel' is based on many chemical interactions, and so the "a reasonable way to feel given what you've been through", is the brains natural 'reasonable way to feel' as a reaction given some environment it is in.

So this is just measuring that reaction.

Maybe think of it more as analyzing why things are, and not as fixing an error. Like science does. Measure it.


That's a fallacy, unless you believe the brain is not greater than the sum of its parts.


What you’re describing is emergence, but it doesn’t mean that an emergent system doesn’t have mechanistic underpinnings. Your body gives rise to consciousness, but it doesn’t mean that you can’t treat blood pressure with medication.


It does mean that not all of the body's behavior can be explained by blood pressure. Emergent properties are not necessarily addressable (or describable, in the case of the OP) at the underlying level.


People used to think an Atom was the smallest particle, then they found Protons/Electrons etc.., then they found quarks.

The brain is complicated, that doesn't mean we can't measure it and try and understand it. Right now people are just 'It's impossible, it must be a soul, or something mystical' how else could it be the way it is?


> Right now people are just 'It's impossible, it must be a soul, or something mystical' how else could it be the way it is?

I haven't argued that at all and I'm not saying we can't measure it and understand it. I'm saying reducing it to "just chemicals" is missing the forest for the trees and goes against understanding it better. Might as well reduce it to just atoms, or just protons/electrons, or just quarks... Do you see what I mean? Why are chemicals where you draw the line?


You are right. I was just trying to come up with a generic term for 'the physical world'. Neurons are made up of molecules, Neurotransmitters are molecules, a 'chemical'. Even the spark of the brain, isn't it just calcium ions carrying the charge.

Guess I was just off-hand thinking that 'chemicals' was 'reasonable' cutoff point from going too small, but small enough. It was off the cuff scaling, I have no real evidence where we would stop on the sliding scale from larger emergent properties.

People that go smaller, to quarks, and throw in Quantum Mechanics are usually not super serious. It gets woo-woo.


Alternatively, the opposing view is a "fallacy" in that sense, unless you believe the brain is magical and doesn't obey the laws of physics and chemistry.


You needn't believe in magic, only in emergent properties well within the constraints of science.


"Emergent" properties of the brain aren't magic, they're just multiple chemical and other physical processes working together. Processes which can be measured and altered by chemical and physical means.


The whole water is wet is an 'emergent' property. This is true, linking emergent properties to the underlying smaller scale can be very difficult. Just not impossible. There is recent work on how water molecules interact that can explain 'wetness'. It is difficult, not impossible.


Culturally ingrained toxic positivity?


Depression is rare when you have to spend most of your day walking water.

Or maybe it presents differently.


This is not an allowed opinion in Western thought, regardless of its obviousness.


Psychiatry is the gift that keeps on giving. The strangest part of some of these mental diseases is how they're defined in terms of other people. You're ill because you fail to adapt to society.

They diagnose a person with attention defict because he can't tolerate the government's mass education system. Can't sit still and that disrupts class and gets the guy sent to the principal who calls their parents and refers them to a doctor who prescribes medications to make it stop. Before being medicated, that exact same person used to go home and write computer code nonstop. Ten hours straight, he is a machine.

There are organic causes for this, neurodevelopmental causes. There are treatments. But the truth is what everyone truly wants is to make the guy fit into society's mold. It's easier for them that way.


The therapist, psychologist or psychiatrist cannot make society conform to the patient. They may, however, be able to convince the patient that conforming to society is not so bad. In my experience therapists are genuinely attempting to alleviate the suffering of their patients, and reducing the conflict between the patient's expectations and society's may very well be a route to that.

They are not there to teach you how to live a successful life, or find your purpose, or be your own amazing snowflake self, or code more. They have been trained to diagnose specific disorders and treat those disorders with a particular set of tools, which mainly boil down to drugs and a couple of talk therapies. If you experience remission of your symptoms they were successful at their job. Considering how time and expertise intensive the existing non-drug forms of therapy are, there is no realistic version of this discipline where they can personalize the therapy in the manner you seem to be suggesting. In many cases the only realistic option is to drug the patient because they have a high case load, this will reliably make the patient suffer 20% less and that may be enough to prevent suicide.


The therapist, psychologist or psychiatrist cannot make society conform to the patient

but in the last few decades we have made quite some progress in better understanding people who are not conforming, and we are adapting society to integrate them. the thing is that this adaption and integration takes decades while convincing the patient that conforming to society is not so bad takes a fraction of that time.

They are not there to teach you how to live a successful life

in my opinion actually they are. being able to lead your life is the whole point of the therapy. otherwise, why even bother?

the only realistic option is to drug the patient because they have a high case load

that is a cop-out. not in your argumentation, but in the responsibility of our healthcare system.


I recognize that there is a lot of nuance in this topic.

However I don't think that what I am about to say will be very controversial: Psychologists and psychiatrists are professionals who obtain a PhD in a specific field. Their field, education and training relate specifically to understanding the scientific evidence that exists around diseases of the mind, and treating those diseases. The diseases and the treatments are documented in the DSM. So they are at their core, implementers of what is in the DSM, and their approach is fundamentally grounded in the way that orthodox Western medicine is practiced.

Now mental health is a very broad field and you can pursue better mental health in a lot of ways, there are also are a lot of counselors out there who have different backgrounds. But I think the distinction is both significant and valuable - there is the hard science of attempting to treat disease, and that is different from being a life coach. (Well, psychology sometimes struggles to be a hard science and has issues with things like the replicability of studies, but at least the effort is there.)

You might see one or the other based on your individual needs. If you are e.g. severely bipolar and have a high immediate risk for suicide, this is the type of case which may be more likely to end up in the hands of a psychiatrist and very quickly and correctly prescribed a drug intervention. If you have mild PTSD or just want to work on your marriage, perhaps you have the luxury of time and can go talk about life for a few years with a counselor.

Should "the system" include both? To me it is not that black and white. I absolutely think the system should support the former, medical intervention for people suffering serious disease. As afflictions become milder and more about quality of life, support from the system is certainly nice to have but it would be wrong to prioritize resources toward the latter case at the expense of the former.


"Alleviate the suffering of their patients". Yeah, I know.

I'm still not a fan of telling patients that their world view is all wrong, that their brains don't think right and that they need to be fixed. That invalidates their lives and their experiences.

These aren't Alzheimer's patients whose brains are slowly degenerating. Many of these neurodivergents are very capable people when the conditions are right. Society's conditions just aren't right for them.

You simply cannot tell a hyperactive person to sit down and listen to lectures on subjects he couldn't care less about for 5 hours. It's done because things just are that way. Because the government has decreed that children shall be sent to the mass education system we call schools. How do you educate a whole nation? One to many broadcast. One teacher broadcasting knowledge to an infinite number of students. Giving people standardized tests. It's a machine designed to produce educated human beings. Keeps the kids safe and occupied while the adults are working their jobs too, isn't it convenient? It's a system.

Well these patients just aren't compatible with the machine. They get chewed up by it all the same. Then they get treated for ADHD and depression and anxiety.

Maybe, just maybe, it's the ones who need these patients fixed who are in need of some serious fixing of their own. Once I get that out of the way and I make sure they understand this, then I may offer them treatments and medicine. Not before.

You're right, there isn't much freedom to personalize the care we give these people. Truth is health care is yet another machine. A machine that wants to help as many people as humanly possible with the limited resources at its disposal as efficiently as possible. That means standardization. It also means doctors don't have time for this because of "high case load". There must be about a dozen billion humans on this earth by now, you cannot hope to help them all even if you were superman himself.

There's always something that they like. That's always been my experience with these patients. There's always a signal. Always something that just engages their brain like nothing else ever does. One of my patients is on the spectrum and has ADHD. She likes music and plays multiple instruments. Last week her mother was telling me how impressed she was because she just kinda taught herself to play piano out of nowhere. She's nine.

Could we find the right conditions for these people to develop if we used 100% of our will power? I have no doubt in my mind. Whole books could be written about why it is not done.


Some very good points!


The Nash equilibrium of "treating 'everyone' 'fairly'" so we ignore the ones that we will depend on to continue to have the "privilege" to do continue to do so is an existential irony that will be referred to the "Filter of Nerfed Excellence" by the next sentient sap.




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