Building on psychiatrist Thomas Szasz’s philosophy of mind, this article argues that most mental illnesses are best modeled as extreme preferences, not constraining diseases. This perspective sheds light not only on relatively easy cases like personality disorders, but also on the more extreme cases of delusions and hallucinations.
The economic nature of mental illnesses, addictions, and compulsions is a topic worth exploring. The problem is that mental illnesses aren’t experienced by everyone, and those who do experience it might experience it in radically different ways. It’s very tempting for someone struggling with one of these conditions to say that Caplan and Szasz just don’t understand what it’s like to be depressed or addicted. Other analogues have been floated that might straddle the preference/constraint line, like sexuality or cilantro aversion, but I think there’s another option that both more closely resembles the debate over mental illness and is more universal: sleep.
Is the amount of sleep you get the result of preferences or constraints? I’m not entirely sure, just like I’m not entirely sure about mental illness.
In favor of sleep as a preference:
- Sleep is responsive to changing incentives. For example, people sleep more on weekends when the opportunity cost of sleep is lower, or sleep less before a big test when the opportunity cost of sleep is higher.
In favor of sleep as a constraint:
- Some decisions about sleep aren’t responsive to incentives. An insomniac probably wouldn’t fall asleep even with a gun to her head. Similarly, someone under a sedative would not be able to wake up regardless of the benefits of doing so.
- People consume caffeine or set alarm clocks to make themselves want to sleep less, or diphenhydramine to make themselves want to sleep more. This makes sleep seem more like an exogenous constraint than an endogenous preference.
The good thing about this question is that everyone on earth sleeps, so what do you think? Do you see the amount of sleep you get as a preference or a constraint?