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Monthly Archives: December 2014

Fears about personal growth

There was a talk at the CFAR alumni reunion, back in August, about “Core Skills Growth.” I don’t actually remember all the content of the talk; the notes that I took were all about my squick reactions, the things that seemed wrong or bad or scary about rapid personal growth and change. (Note: I’m going to use the phrase ‘personal growth’, but I mean a specific kind of rationality-community-cluster personal growth, which probably isn’t the same thing as the mainstream meaning. If you’re not familiar with this usage, it might be confusing, but I’m too tired to try to attempt a full definition now.)

I think this might be one of those “mindspace is wide and deep” areas; a place where humans vary drastically, and my fears might seem completely alien to other people. But they’re real to me and I take them seriously. And pretty much every time I’ve had the thought “I’m probably weird and broken and no one else is like me”, it’s turned out that a bunch of other people were like me but hadn’t been writing about it.

These were the fears on my list:

  • 1) Becoming arrogant
  • 2) Becoming prone to existential angst
  • 3) Moving ahead of friends and then leaving them behind.
  • 4) Not being replaceable anymore.
  • 5) Not being able to hang out with supervillains

 

  1. Becoming Arrogant

I think I might hold this as a Bad Thing on a basic, virtue-ethics level. People have certainly made the argument to me that a measure of arrogance is a good thing. My response tends to be “okay, so it’s a good thing for you. I still don’t want to be arrogant!” This feels similar to the way in which, even though loyalty has its downsides, I still want to be loyal. One of the consequences of having a brain that runs on virtue ethics is that I have an idea of what character I want to have, and some things just conflict with that.

There might be an area of personal growth that would require me to be more okay with arrogance, or at least some aspects of it. (A fully unpacked definition of it would be useful, but I’m not actually 100% sure what rationality-community-cluster people mean.) I think if I could convince myself that ‘not being arrogant’ was an instrumental value that supported other values, like other humans being happy, but that actually ‘being more arrogant’ supported those values better, I’d be okay with it.

 

  1. Existential angst

I think I used to feel a little bit smugly superior for not suffering from this thing that so many people on LW apparently suffered from. I know people who are desperately afraid of death, and others who have conquered their fear of it. I don’t remember ever fearing death much in the first place. I’ve never gone through a religious deconversion, painful or otherwise. I’ve never agonized about the meaning of life. I’ve agonized about plenty of things, but they tend to be personal, even petty.

Growing up, I think acceptance/resignation was the easiest attitude for me to adopt. I am a thing made out of atoms in a horrifyingly neutral universe. The best I can do is survive. At least I can be good at it.

But a lot of personal growth relies on anti-acceptance–on staring reality in the face and saying “no, not okay.” And acceptance relies, at least partly, on thinking of yourself as small and unimportant.

I’m not sure how much a person’s tendency to existential angst is due to beliefs about the world (in which case it seems likely to change), or basic personality traits (less likely). But it does seem like having the tendency would make me less productive, and is thus worth worrying about.

 

  1. Moving ahead

A specific example comes to mind here. I have a friend who I’ve known since we were both twelve years old–the only non-family person I’ve been in contact with that long. In high school and early university, she was often the only person I felt able to be vulnerable with. I could tell her anything, even the humiliating things. I became the godmother of her son; we lived together for a year and a half. In a different version of my life, we could have been lifelong best friends.

The problem is that I have changed, in the past ten years, and she hasn’t–not enough. I don’t know how to connect to her anymore, and I don’t know how to not feel like a terrible human being for wanting to pull away.

I’m afraid of this happening to other people in my life–like my sister, my parents. I haven’t even done that much self-modification in the past ten years, and hardly any of it deliberate. I’m afraid that the five-years-from-now me might look back and find my parents’ values as alien as I find my friend’s now. (This seems unlikely. My parents are really freaking cool. But it still scares me.)

 

4) Not being replaceable

This one is kind of hard to explain. I think I find a lot of security in thinking of myself as a gamepiece interchangeable with others. I’m a nurse. I do valuable, important work…but if I get sick, if I get depressed, if I die, nothing bad happens to the world. There are other nurses.

(It’s hard to explain because other people seem to find this really alien. I know people aren’t fungible, and I know I’m not replaceable to my friends or my parents–but I kind of wish I was? It’s comforting to see my friends having other friends and know that the system is robust even if you take my part out.)

It might be possible to grow a lot and accomplish a lot without changing this, but it seems like thinking of oneself as important (and thus irreplaceable) helps for personal growth.

 

5) Not being able to hang out with supervillains

This is a catchphrase for a complicated idea/feeling that I’m not sure I can convey, but I’ll try. Basically…my current “self”, as a cluster of values, seems pretty robust, pretty stable. No one’s going to be able to convince me that I ought to be more selfish; I doubt even reading Ayn Rand in my teens would’ve done this. (Anna Salamon’s alternate-world-prediction is that it would have caused me to rebel and be less selfish.) No one, by force of argument, can touch the things that I really care about.

That means it’s safe to talk to anyone. I can hang out with neoreactionaries, or social justice people, or the weirdest parts of Less Wrong, or anything in between, and never worry that my values will get hijacked. I don’t get upset about arguments on the Internet because they don’t really touch me. This means that I can be purely curious about the world, and learn all sorts of interesting things and marvel at what a surreal age I live in.

The price of stability? Two years, and I’ve made only a little headway on convincing myself that ambition isn’t always a bad thing. Superficial values aren’t that hard; I was easily coaxed away from ‘saving all your money and never buying things is virtuous’ to ‘making the best use of your resources in all currencies including money, time, and attention is virtuous.’ To the part of my brain that manages virtues, those are the same thing, a value reacting to empirically different world-states.

If I’m going to try to change my values on purpose, it will require being vulnerable in a way I’ve never been before–and I’m not sure it would allow me to shield my core values in the same way. I would have to adopt a kind of epistemic hygiene, avoiding reading and interacting with ‘supervillains’, i.e. people whose values I don’t want to accidentally incorporate into my own.

I’m not sure why that’s so bad, except that it seems really really bad.

Conclusion

I don’t have a better solution to most of these, other than ‘plow ahead anyway.’ I might think of some solutions in the next few months or years. If I do, I’ll probably write about them.

Hufflepuff Tradeoffs

I’m really Hufflepuff. Enough for it to be blindingly obvious to most people I know.

And yet… Once in a while I get the very un-Hufflepuff thought that “wait, I could’ve been a physicist. That would’ve been easier.” (If I’d had programming on my radar at age 15, I might have thought of that too–it fulfills my other criteria of being a steady, dependable career better.)

I think anyone who knew me in high school would’ve pegged me as a Ravenclaw. I read books really fast. I was frequently bored in class. I remember reading ‘The Selfish Gene’ under my desk in biology class; it was technically biology, just more interesting. I’m still Ravenclaw enough to excitedly read Up-To-Date articles on my patients’ conditions, and sort of try to hang out around the nursing station when the staff doctor is quizzing medical students and then try really hard not to interrupt when I know the answer.

In high school, it’s not like math was easy. But it was straightforwardly hard. People were hard hard.

People are still hard.

I’m not amazingly good at nursing. It might (gasp) take me more than five years to get really good at it. Right now I’m okay. My patients often remember and like me–that feels good. I get excited about things, which helps me to eventually get good at them. I’m still pretty rubbish at putting in IVs. I’ve almost entirely gotten over the anxiety involved in making and answering phone calls at work. On a good day, I’m probably a pretty good person to work with–on a bad day, I want to hide in a corner and not talk to humans and I really just want to have intubated patients because my social-anxiety-module has decided they don’t count as humans…but I can generally still provide my patients with safe and competent care.

There are parts that aren’t natural to me and probably never will be. Time management was hard. My younger self lived in Maker time, and learning to deal with interruptions and time pressures and more interruptions and nothing going as planned ever was really hard. (And I think I’ve permanently lost some of my Maker-time ability–writing, at least the sitting-down-and-focusing part, is a lot harder than it used to be. I could also attribute that to the existence of Facebook.)

Even the attention to detail required is hard for me. One of the things other nurses still complain about concerning me is that my patients’ rooms aren’t tidy enough at the end of a shift. They are obviously perfectly fine for me, and other people’s mess has never bothered me. By default, I don’t see it. I’ve had to slowly, painstakingly learn how to see it, and obviously I’m still not succeeding completely, since I’m actually at a loss as to what exactly I should do to make the other nurses happy.

When I was 15, my parents had a friend, a mycologist at a university. He was your stereotypical absentminded professor–brilliant, messy, eccentric, happy as a pig in mud all alone in his lab. My mom said I’d make the perfect academic, like him.

Needless to say, that isn’t the person I grew up to be.

When I started to become more involved with the CFAR community, one of the first characteristics people attached to me was good at logistics. If I’d gone back in time and told my 12-year-old self that was going to happen, she would’ve have believed me. Not because it sounded bad, but because it was so implausible. Me, good at a thing that requires attention to detail, organization, and having to talk to lots of people on the phone?

Being a programmer might have been easier. I could have sat in my little bubble and banged my brain against problems that were straightforwardly hard. I might even have been an above-average programmer, in a way that I’m not an above-average nurse. Danny Reeves said I seemed to pick things up quickly. I’ve probably got an IQ a couple of standard deviations above the average, and that’s more helpful for programming than for nursing, where as far as I can tell it’s not helpful at all.

Every once in a while, the part of my brain that doesn’t like hard things will stage a minor internal hissy fit over how now I’m stuck being the person who’s good at logistics and has to answer phones forever, and that’s not fair why can’t I just be a programmer and always get to sit in a corner?

But there’s a reason why that isn’t the life I picked. There’s a reason why, when I was reading Tilda Shalof’s A Nurse’s Story, it resonated so hard as the life I wanted to have. (Note: if you find it hard to understand why I became a nurse, you should read this book.)

I didn’t start out with Hufflepuff skills–I wasn’t initially any good at being the person I wanted to be in. I’m still not especially good at it. I guess I didn’t start out with many skills period–no one does. At age fifteen I was above average at writing (which is no great praise when you’re comparing yourself to other 15-year-olds) and I had a good memory for stuff I’d read in books.

But I still knew what person I wanted to be.

So I guess I’m “stuck” doing the thing that’s hard for me, forever, and gets frustrated when other people pick it up faster, and when I have to keep doing the thing day in and day out and it’s still hard, every time, it never stops being hard. Being around people when you’re introverted–more than that, learning how to model social dynamics and play status games when it makes about as much sense to you as monkey being insane all the time. Having to keep your Attention to Detail turned on when your native state is wrapped up in the plot of a novel that you’re writing in your head. Lapsing back into that state the moment I get home, and thus living in even more of a pigsty than I would otherwise. (I haven’t done dishes in a week.)

But even so, I chose this and I’m still choosing it, every day, and I’m pretty damn proud of the progress I’ve made. You’ve got to be pretty Hufflepuff, to do that.

Consent in a society of mind

I hold consent as something pretty close to a Fundamental Good Thing. I absorbed it first from nursing culture, along with a few other deontological, maybe-incoherent principles like ‘Autonomy’ and ‘Dignity.’ (I’m not sure how to define dignity, except that my brain screams at me when it sees an example of it being violated). Then I absorbed consent as a Fundamental Good Thing from the social justice community, too.

And it is a good thing. There’s no doubt about that. So many of the ways in which humans hurt one another are because consent isn’t taken seriously, and taking it seriously does make a difference. This is one of the things that it’s great to have a word for.

It’s also kind of complicated.

A few months ago, I had my first PAP smear. I’m sure these aren’t fun for anyone, but as someone with pretty severe vaginismus, I’d been putting it off, and dreading it, for years. As a nurse, though, I can appreciate the importance of public health screening measures. No one likes prostate exams, either, but they’re Recommended.

I called my doctor’s office, booked the appointment, and went in of my own free will–I gave my consent for the procedure, explicitly and implicitly. I told my family doctor, who I like and trust, to keep going even if I was screaming, which I probably would be, because I really wanted to just get it over with.

It still felt really fucking awful, and I was actually mad at her, afterwards. I’d been screaming in pain and she hadn’t stopped. The part of me that was mad didn’t care that I’d asked her not to.

“Personhood” and unitary selves

At first glance, my PAP-smear reaction doesn’t make any sense. The explaining factor is that I don’t speak for all of myself. Having a unitary ‘self’ at all is an abstraction, a simplification over the various drives and desires and inconsistent preferences that make up a human being.

As Melting Asphalt writes:

A person (as such) is a social fiction: an abstraction specifying the contract for an idealized interaction partner. Most of our institutions, even whole civilizations, are built to this interface — but fundamentally we are human beings, i.e., mere creatures. …Even the most ironclad person among us will find herself the occasional subject of an outburst or breakdown that reveals what a leaky abstraction her personhood really is.

I have mixed feelings about this article, but I think it says something important. Society–including laws and norms about consent–runs on the assumption that humans have unitary selves, singular agency. A lot of the time, that model works. And the medical field’s laws and norms about consent also have a way to handle humans who don’t and can’t hold up their end of the “personhood contract” and aren’t able to offer their informed consent; young children, psychotic patients, comatose patients, suicidal patients. Thus: power of attorney, substitute decision makers, “Form One” and forced hospitalization, “assumed consent” to treatment for anyone found unconscious. And there are new norms in the making for general society, like the norm that intoxicated people can’t consent to sex.

Ultimately, though, those are exceptions, special cases. Medicine, and society as a whole, assume that there exists a baseline population who can give their informed consent, who can speak for themselves as unitary agents.

But no one is a unitary agent. We are all societies of mind–more or less coherent, more or less unified.

I don’t want to die of cervical cancer that was diagnosed too late. I’m pretty clear on that, and I’m also pretty sure that five minutes of pain once every several years is worth it. I can do the math–or, at least, the ‘I’ that speaks for me understands math. But I can’t bring all the parts of myself on board with this. The part of me that doesn’t want anything or anyone anywhere near my vagina is…well, not convinced by math, probably not capable of math, and also doesn’t give a shit about reasonable explanations.

Grey areas in consent

I take care of a lot of patients whose “personhood” is somewhat broken down. There’s a continuum here. On the bottom end, I’ve got my intubated, sedated, critically ill patients, who basically can’t communicate any preferences at all, aside from squirming or making faces or trying to pull tubes out. Taking care of them is a bit like having an infant. I don’t feel bad about tying their hands down. I don’t ask them if/when they want to be turned or cleaned or suctioned. I do my best to explain what’s going on.

Midway up the scale, I’ve got patients who are awake and able to talk to me, but might be forgetful or confused or delirious. I hate tying awake patients’ hands, because BASIC HUMAN DIGNITY!!!, but if they’ve pulled out their feeding tube more than twice, or if they really need their oxygen but keep taking it off, I am going to do it. I try to listen to their preferences in other ways, and give them choices, like ‘which side do you want to turn on?’, but ultimately it’s kind of a token effort–I do it to try to comfort them, to make the loss of autonomy slightly less bad.

There’s a converse to this. I don’t hold my patients to the same standard that I would a coworker. If they’ve pulled their feeding tube out for the third time, I do my very, very best not to show any frustration or annoyance. In some sense, ‘it’s not their fault.’ When delirious patients yell swearwords at me, I politely tell them to please stop, but I’m not upset.

After my PAP-smear experience, I went back to work and felt like I was seeing things for the first time. In my doctor’s office, on the exam table, my illusion of singular agency broke down. I left feeling violated and traumatized, even though it was five minutes of discomfort that I’d undertaken voluntarily for a benefit that I thought was worth it.

Most of my patients consented to treatment at some point, unless they came into the ER unconscious with no previous directives. We’re pretty good about, for example, respecting patients’ decisions not to be intubated, not to receive CPR, not to receive dialysis or blood transfusions etc etc etc.

But even for the patients who, at the beginning, consented to “take all reasonable measures to keep me alive”…at some point, a couple of days down the road, they’re loopy on drugs and have a tube down their throat and their hands tied to the bedrails – and when this happens, the part of them that can do math is probably on vacation and the rest of them is screaming.

Ozy writes:

Our culture is really really bad about dealing with sex that you gave permission for but that is still experienced as violating or even traumatizing. Sex where you dissociate to get through it; sex that makes you feel like an object, an orifice being used, rather than a participant; sex where you feel gross and cry afterward and scrub yourself because you don’t want to have had it.

Sex might not be a special case. I kind of feel like our society is bad at dealing with all experiences that were consented to but still traumatizing–that were consented to, but not with all the parts of the mind. Maybe because a society is, basically, a charade where humans put on their “person”-faces and do their best to present as singular agents.

And then what?

If there’s a solution to this, it’s probably a complicated and many-faceted one.

Anecdote: I had a patient recently who refused to be turned. She had an infected bedsore, and it was important that we turn her, but she was afraid of falling out of bed. I think she knew it wasn’t a rational fear; she was a bit self-deprecating about it. But she flat-out refused. She was all there, “alert and oriented” in medical-speak, and so I wasn’t going to do it against her will.

But I did ask her if she thought that, if I asked the doctor to order more medications to control her anxiety, and they were effective, whether maybe then she would agree to turn. She said “maybe, I think so.”

(I ended up turning her at 4 am after I’d given her Gravol for nausea, which made her very drowsy. I felt a little bit bad about that–it was sneaky–but she wasn’t panicking while I did it, at least.)

I had strongly considered asking my family doctor if she could do my PAP smear under conscious sedation. I ended up not asking because it would be inconvenient–I wouldn’t be able to bike home unaccompanied afterwards. But it would have appeased the part of me that was upset about it.

Sometimes, changing societal norms will make there be fewer conflicts. Ozy writes about the societal norm of ‘compulsory sexuality'; changing this, making it more acceptable and normal and okay not to want sex, might take off some of the pressure to consent to it. There are societal norms that would make my job easier, too–I’ve had my fair share of patients who wanted to be tough and thus wouldn’t ever say when they were in pain, or who were ashamed of all their bodily functions.

Sometimes, the only option is to very carefully try to listen to and address all of the parts, whether you’re doing it for yourself or for another person.