Experiments as a Third Alternative
As a kid in elementary school, I was diagnosed with ADHD. I think the diagnostic process is dumb and unreliable, and so the fact that I was diagnosed seems like it should only count as weak evidence. But knowing what I know about myself and having read a few books about ADHD, my best guess is that I have (and had) a moderate case of it.
I’ve never taken medication for it though. Why? Well, from my perspective, there has never been anything wrong with me. There’s something wrong with The System. Fight the power!
For example, I’d be in school and the teacher would want me to pay attention to X. But instead of X, I’d want to think about Y. It’s hard for me to focus on X when I am driven to think about Y.[1]
Is this a bad thing? Well, it depends on the values of X and Y. Sometimes X and Y take values that make it good, other times they take values that make it bad.
For example, when I’m behind the wheel of a car and X = “the stoplight in front of me” and Y = “that new Indian restaurant”, it is bad.[2]
But when X = “Bobby’s question about last night’s algebra homework” and Y = “the flip book I’m working on”, I’d argue that my “attention deficit” is good.
Overall, I have always thought that my “attention deficit” does significantly more good than harm.
For this reason, I never wanted to take medication for ADHD. I thought that I was generally prone to paying attention to the “right” things, that the adults generally wanted me to pay attention to the “wrong” things, and that this was a problem with the world they were trying to get me to live in, not with my nature.
But the doctors and my parents had a totally different perspective. They thought my tendencies and behavior were in fact problematic. However:
Academically, I did pretty well in school.
Behaviorally, I was mischievous, but always in a harmless type of way.[3]
I had this involuntary facial tick[4] and apparently there is a risk that the medication would cause me to develop (much?) worse ticks.
For these reasons, they thought it was fine for me to avoid medication.
As a kid it was the doctors and my parents who were ultimately in charge of whether or not I took medication. Maybe if I argued that I wanted medication they would be receptive, but probably not. However, as an adult, it becomes my decision. So once I went away to college, I could have just gone to a neurologist or whatever and re-explored this decision to avoid medication.
I never did that though. Why? Cached thoughts.
I like who I am. My so called “attention deficit” is actually a good thing overall because it allows me to hyperfocus on the things that interest me, which is really valuable. Yes, sometimes this ends up biting me, but the bites aren’t too frequent, nor are they too harsh.
When the topic of my ADHD came up, the above thought is what I would immediately gravitate towards. It’s not as black-and-white as “it’s the only thought I would ever think”, but I gravitated towards it pretty strongly.
But over the past few weeks I’ve been starting to question how accurate that cached thought is.
I have pretty high levels of anxiety[5] in general for various reasons, and I’ve been looking for ways to mitigate it. One cause of this anxiety is that I always have a million things I want to do. Things that are interesting and deserving of my attention. But I don’t have time to do them all, of course.
And a related problem is that if I’m focused on something and need to stop, it feels like pulling teeth. For example, I started writing this post at a coffee shop, but at 3pm when they closed I had to stop what I was doing, close my laptop, and spend 20 minutes walking home. That was very uncomfortable.
But this sort of thing happens all the time. When I’m working and it’s time to eat. When I’m coding and I have to go walk my dog. When I’m reading and it’s time for me to go to racquetball. When I’m thinking and it’s time for me to go to sleep.
Right now, I lean towards thinking that my ADHD does more harm than good and that I should take medication. But this line of thinking is also problematic. Why? Because there’s an implicit and false dichotomy. It fails to seek out a Third Alternative. From the post:
“Believing in Santa Claus gives children a sense of wonder and encourages them to behave well in hope of receiving presents. If Santa-belief is destroyed by truth, the children will lose their sense of wonder and stop behaving nicely. Therefore, even though Santa-belief is false-to-fact, it is a Noble Lie whose net benefit should be preserved for utilitarian reasons.”
Classically, this is known as a false dilemma, the fallacy of the excluded middle, or the package-deal fallacy. Even if we accept the underlying factual and moral premises of the above argument, it does not carry through. Even supposing that the Santa policy (encourage children to believe in Santa Claus) is better than the null policy (do nothing), it does not follow that Santa-ism is the best of all possible alternatives. Other policies could also supply children with a sense of wonder, such as taking them to watch a Space Shuttle launch or supplying them with science fiction novels. Likewise, offering children bribes for good behavior encourages the children to behave well only when adults are watching, while praise without bribes leads to unconditional good behavior.
Noble Lies are generally package-deal fallacies; and the response to a package-deal fallacy is that if we really need the supposed gain, we can construct a Third Alternative for getting it.
What Third Alternative do I have? Well, how about just taking the medication as an experiment?
I realize that I (as well as my parents and the doctors[6]) have been approaching the question as if I am either going to 1) be a person who doesn’t take medication or 2) be a person who does take medication. But option #3 is much better: take medication for six weeks and see what happens.
It reminds me of the thing[7] where thousands of years ago, philosophers thought that it was noble to sit inside and use your mind to figure things out, and that going out to look at the world to see what happens… well… that’s ignoble. A job to be done by a man of much lower social status.
For my ADHD stuff, I’ve been acting like one of those old philosophers. Instead of just trying the damn thing, I’ve been straining to predict whether or not the thing will do more harm than good.
But that sort of “straining to predict” is dumb. I mean, again, why not just try the damn thing? Why predict when you can test?[8]
Well, sometimes the test is costly. Like, an MRI, perhaps. But ADHD medication is not expensive.
Other times the test will have long-term, or even permanent effects. With the ADHD, I think there’s always been a deep part of my mind that was afraid of this. I don’t want the medication to “change me”. In doing some research, this seems quite unlikely though. There’s still some emotional part of me that is a little afraid of it “changing me”, but it’s not too loud.
Sometimes the test is painful. Like one of those biopsies where they stab you with a big needle. That’s not the case here though.
Sometimes you’re confident enough in the outcome that you don’t need to bother testing. But again, that’s not the case here.
I’m sure one can have a long discussion about the abstract question of when it makes sense to test and when it makes sense to avoid testing things. I’m not interested in doing that though. I think that for the purposes of this post, it’s enough to say that when tests are cheap, painless, and don’t have long-term effects, the bar is low and they’re generally a pretty appealing Third Alternative.[9]
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Note that this is not a deficit of attention. It is a difficulty controlling where attention is allocated.
I’ve always really liked the spotlight metaphor for attention. With this metaphor, the spotlight is not dimmed. It’s just more focused and harder to move.
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Which is one of the reasons why I don’t drive.
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For example, I had this teacher for a class called “Research” or something. I thought the things he taught us were incredibly dumb. One thing I remember is how he spent a lot of time emphasizing how you have to underline some things in one color and other things in another color. As opposed to, y’know, the actually important principles of scientific research, a la Richard Feynman.
So I played a bunch of pranks. One time I put a piece of scotch tape under the computer mouse to interfere with the laser motion detector thing. Another time I broke off a piece of my lead pencil’s tip in the door’s lock so that it couldn’t be opened.
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I would lightly bite the inside of my left cheek in a way that caused my face to scrunch up a bit. It always seemed incredibly minor to me, but moderate to my parents and the doctors. I don’t really remember the kids in school ever teasing me about it, or even pointing it out.
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That’s not really the best word, but I’m not sure what a better word would be.
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faithInTheMedicalSystem-- - ^
Actually, I’m not sure how true this is. I remember hearing something along these lines, but I may be misremembering and/or straw-manning. I think what I’m remembering is something related to the philosophy of rationalism and how it stands in contrast to the philosophy of empiricism.
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I really like how chapter 1 of HPMoR explores this. Maybe Eliezer decided to discuss empiricism in the first chapter because empiricism is so foundational to rationality.
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Luck Based Medicine is probably relevant. Even if various treatments are non-standard and uncommon, who knows, maybe they’ll work for you. If it’s cheap to try, why not give it a shot?
If your ADHD is interfering with your driving, that does not sound like a moderate case!
My expectation is that you will likely get a lot of information from trying the meds for 6 days; 6 weeks sounds like a very long experiment. Quite possibly even 2-3 days or just 1 day. 6 weeks sounds like enough time to test out a few doses and types (time release vs not, for example) and form opinions. And possibly get an understanding of whether you want to take it every day or only some days and maybe even how to figure out which is which.
All of which is to say: yes, perform cheap experiments! They’re great! This one is probably far faster (if not much cheaper in dollar terms) than you’re predicting.
It shouldn’t really matter whether it’s one day or six weeks, but knowing now that it could be as little as one day makes it very salient to me how big of an error I made. It’s plausible that medication would significantly improve my life, and it only would have taken (approximately) a day or so, a trip or two to the doctor, and a few dollars to find out.
I tried Adderall and Ritalin each just for one day and it was totally clear to me based on that that I wasn’t interested in taking them on a regular basis.
I came to the same conclusion (of being totally uninteresting in taking any more) although it took me longer than it took you. I’ve had access to plenty of mixed amphetamine salts (generic Adderall), Ritalin and armodafinil.
Oh, maybe. That’s how long my psychiatrist had me try SSRIs before checking in so I chose that duration as a guesstimate.
Yep, those are extremely different drugs with very different effects. They do in fact take a while and the effects can be much more subtle.
Gotcha. In retrospect that actually makes a lot of sense, since kids in school are known to take Adderall for a night of studying.
If you’re looking for an experimental protocol, the ADHD MTA trial’s protocol looks pretty good.
It is described at https://pubmed.ncbi.nlm.nih.gov/10591283/ and explains in detail how the doctors decided when to try increasing the dosage. It supports evand’s assertion that improvement should be noticeable quickly.
There’s actually another recent example of this. I am always hot when I sleep and was exploring potential solutions. I came across the Pod Cover from Eight Sleep. I thought about it, read reviews, looked up various things.
But then I realized: “hey dumb dumb, there’s a free trial!” Yes, it’s like $2,500. But the cost of trying it is just a half hour or so to set it up, and potentially another 15 minutes or so of sending it back. The question is whether it is worth spending up to 45 minutes trying it, not whether it is worth spending $2,500 paying for it.
(Well, that supposes that the trial will meaningfully help me decide whether to keep it. But I am confident that it will. It should be pretty easy to tell how much it improves my sleep, and relatedly how I feel. From there, if it’s at least “a little bit”, given how important sleep is, I feel comfortable with the purchase.)
Why get the pod cover? Just get a decent air conditioning system, it’s far better and isn’t $2500. Make the entire room cold when you sleep.
A few reasons. Roughly in order of importance:
My girlfriend doesn’t like it that cold.
I don’t see $2,500 as too much money. I’m not sure how I’d value my time, but if we just ballpark it at $100/hr, $2,500 is about three 8-hour work days. Thinking about it like that, spending three 8-hour work days on something that will improve my sleep every night for many years doesn’t sound too bad. (FWIW, there is another voice in my head screaming “THAT’S SO EXPENSIVE!!!”. I just don’t endorse that voice.)
In the long run, the pod cover actually will be cheaper than blasting the AC. Guesstimating, maybe it costs an extra $20/month to blast the AC. Using that number, after about 10 years, the pod cover becomes cheaper.
When you get out of bed and aren’t under the covers anymore, it’s really cold. This could somewhat be addressed by putting the thermostat on a schedule, but that doesn’t addressing getting up in the middle of the night to go to the bathroom.
Couple thoughts from having been on a similar story arc in this regard:
Have you explored the possibility that the “but the thing they want me to pay attention to was often stupid” perspective is in part self-defensive to help with discomfort around the fact that you couldn’t attend well to X in that moment even if you attempted to? I’ll bet that at some point, you may have constructed a defense of thinking about “random” stuff, shaped something like “anything is interesting and educational if you just look at it right”. If you have something like that lying around, point it at the stuff you struggle with attending to, and see what happens.
IMO, drug interventions for ADHD can be framed as either a medical necessity thing or a recreational quality-of-life-enhancement thing. Are your views on “recreational” drug use compatible with the “just try it for the heck of it” approach? Recreational isn’t quite the right term, but it’s too wordy to say “substances imbibed primarily due to the expectation that they’ll change one’s subjective experience of the world”. These include caffeine, alcohol, nicotine, and cannabis, as well as the illegal smorgasboard. If you’re on the “I’m cool with at least some of them” or “tried a few and didn’t prefer them but nothing against trying more” side of the fence, absolutely experiment. But if you’re against their use in general, or your use of them in particular (for moral reasons or due to disproportionate risk of addictive behavior), you’d probably do better to frame your experimentation more medically and keep your prescriber more tightly in the loop. Try modeling ADHD meds roughly the same way you model alcohol—you get to be a different version of yourself for a few hours; they’re fine on an as-needed basis for most people; some people have a mix of biology and temperament that make unlimited access a bad idea for them personally.
Hm. I don’t think I ever thought seriously about that. Let me try right now.
I don’t really notice any discomfort, embarrassment, or insecurity about not being able to control my attention. I don’t think I did earlier in my life either. Maybe this is somewhat immature, but it’s actually always been something that I smile at and take take pride in.
Maybe when I was really young I was insecure about it? I dunno. I don’t remember that happening and it doesn’t feel like it was the case.
So yeah, I’m struggling to see anything here. If you (or others) see something, even something that seems worth introspecting more about, please let me know.
I am generally of the opinion that anything is interesting if you look at it right, but for the reasons I discuss above, I don’t think that opinion comes from a place of defensiveness.
That makes sense. I agree with the general point.
I think my feelings are a little nuanced here though.
I have zero moral objections.
Caffeine I respond pretty well to but also try to be careful with because it’s known to amplify anxiety.
Alcohol I’ve tried.[1] I really don’t like the taste. As for the experience of being buzzed/drunk, for whatever reason, it takes a lot to get me to feel it, and I don’t particularly like the feeling.
Nicotine seems a little risky due to the potential for addiction. Plus, at least in the form of smoking cigarettes, seems very likely to do more harm than good.
Cannabis I’ve tried, have had some good experiences with, but also some traumatic and psychotic ones. I’ve since messed around with micro-dosing, but some of the trauma and psychosis kinda still comes back, so I don’t really think it’s worth experimenting any more with. I also tried nano-dosing shrooms once but didn’t feel anything and generally have the same feelings as my feelings towards cannabis.
CBD is something I’ve been meaning to try.
There’s a bit of a funny story here. I tried having a few drinks once or twice and felt nothing. Then I did an experiment that went south. I had one/two drinks an hour, planning to get a sense of what my dose-response curve looks like. I think I was on drink 9 or 10 and only felt mild effects.
The friends I was with were getting bored and wanted to go out. So, stupidly, I had four shots of hard liquor and then walked with them over to the bar. As we were walking, it all hit me at once and I collapsed.
Since then I’ve tried having up to a few drinks on various occasions but have never really felt anything. Once exception is when I had about eight drinks with some friends. I felt a little buzzed, but didn’t feel like it was a strong effect, and wasn’t particularly enjoyable.
Interesting! I think I made a wrong assumption of discomfort/embarrassment/insecurity in reaction to hearing a “something is wrong/suboptimal in a way that experimentation might improve” tone in your original post. If I had to justify this impression with a single source, I’d choose “there has never been anything wrong with me. There’s something wrong with The System.”. I read that as an explicit “something is wrong in a way that’s affecting me”.
I might be misunderstanding, of course, but it does sound like a “something is wrong enough that I’m tempted to try changing my cognition to get different outcomes” theme. If it’s not discomfort, embarrassment, or insecurity… what are you hoping you’d get less or more of?
Back to the theme of the post, I think what I’m actually noticing is an additional caveat to when experiments are useful: they’re best when you know ahead of time what to measure before, during, and after. Maybe you’ve picked out what to measure in a medication experiment and prefer to keep it private (totally understand if that’s the case), but if not, I think the question of what to track/measure is probably worth considering in the general case of experimentation as well as in this particular one.
Gotcha. That is reasonable.
It’s just that sort of “pulling a tooth” feeling. Like when I’m focused on some code I’m writing and have to stop what I’m doing and make dinner. Or when (like right now) there’s four things that I’m eager to work on, but I of course can only pursue one of them (the fact that I’m not pursuing the other three is pretty uncomfortable).
Hm, I’m not sure whether or not I agree here. I lean towards thinking that most of the time you can have a pretty vague idea of what it is you’re measuring.
For the ADHD medication here (I don’t have any preferences to keep it private) I was thinking of just trying to get a sense of how often the unpleasant “tooth pulling” feelings happen, how my cognitive/intellectual performance is, how happy I am, how others perceive me. Stuff like that. Seems good enough.
Thank you for explaining!
Ah. I gloss that one as “discomfort” when describing my own experiences, but I see how it’d also be fine to consider it entirely distinct.
Reminds me of a thing I’m personally encountering quite a bit lately. I’ll notice something about my experience in a way that seems unusual compared to what many others notice. Upon interrogating it, sometimes it turns out that the experiencing is due to my brain being weird, and other times it turns out that it’s a universal experience that brain quirks are causing me to notice or describe differently from how others would.
Stimulants won’t change the underlying fact that there are more excellent things to do in the world than time to do them in, but IMO they can help fine-tune how much of your attention is devoted to that fact while you’re also doing some other task. Sounds almost koanical—“if there are 3 other amazing things I could be doing right now, but I’m not worrying about them, are is it a problem?” =)
English is kind of a problem for this, because we use the same word for rigorously testing a hypothesis or for changing stuff to see what happens. I attempt the gesture of applying the term “experiment” only to the former, but I ultimately don’t do so with the rigor it would take to make any significant difference in the world around me. I think “experimental” tends to imply the latter over the former, but that implication isn’t robust or global enough to make it ultimately worth caring much about.
Some doctors (at least, good ones) tend to start you on one medication, and over time take your feedback/goals/other health info/etc into account, and may change to a different medication.
So… how did it go? Do you use the medications often now or not?
I’m in the process of being evaluated for ADHD. I was diagnosed with it as a kid, but that was over 20 years ago and the psychiatrist wanted me to be re-evaluated. It’s taken a very long time to get an appointment and then go through the process, but hopefully I’m only a few weeks away now and will try to remember to report back!