Consciousness and how it got to be that way

Sunday, April 29, 2018

Psychiatrists Per Capita in the US, in Outpatient Practice Terms

The number is psychiatrists per 100,000. Data from Dartmouth Health Atlas. If you make simplifying assumptions, you can get an idea what that means. 1 in 6 people lives with mental illness (currently, not lifetime prevalence.) So if in your city there are 10 psychiatrists per 100,000 people, that means 1 psychiatrist per 10,000 people, and 1 psychiatrist for 1,667 people with mental illness. How long would it take to see them? The most under- and over-served areas are Oxford, Mississippi with 3.4 psychiatrists per 100,000 and San Luis Obispo, California with 36.5 psychiatrists per 100,000. (although I'll wager the later is counting psychiatrists at Atascadero State Hospital.) If you assume all these people being seen on an outpatient basis, by psychiatrists working 48 weeks a year, 5 days a week, with 16-30 minute shifts per day about 2/3 full, then in San Luis Obispo you could see your whole share in a little over 2 months (that is, the average follow-up time would be two months.) In Oxford it would be just under two years.

You'll note the long tail, which begins right around 15 per 100,000, and those locations are: Morristown NJ, Alameda County (Bay Area) CA, New Orleans LA, Honolulu HI, Springfield MA, Durham NC, Santa Cruz CA, Ridgewood NJ, Hartford CT, Portland ME, Hackensack NJ, Lebanon NH, East Long Island NY, Pueblo CO, Evanston IL, Baltimore MD, Washington DC, Bridgeport CT, New Haven CT, Bronx NY, San Mateo County (Bay Area) CA, Boston MA, Manhattan NY, San Francisco CA, White Plains NY, Napa CA, and San Luis Obispo CA. There's an obvious bias toward cities with academic centers and/or places where white collar workers like to live, although the last two locations (at least) also have large state psychiatric hospitals.

Sunday, January 7, 2018

How Steep is Your Empathy Curve?

Let us suppose that the great empire of China, with all its myriads of inhabitants, was suddenly swallowed up by an earthquake, and let us consider how a man of humanity in Europe, who had no sort of connection with that part of the world, would be affected upon receiving intelligence of this dreadful calamity. He would, I imagine, first of all, express very strongly his sorrow for the misfortune of that unhappy people, he would make many melancholy reflections upon the precariousness of human life, and the vanity of all the labours of man, which could thus be annihilated in a moment. He would too, perhaps, if he was a man of speculation, enter into many reasonings concerning the effects which this disaster might produce upon the commerce of Europe, and the trade and business of the world in general. And when all this fine philosophy was over, when all these humane sentiments had been once fairly expressed, he would pursue his business or his pleasure, take his repose or his diversion, with the same ease and tranquillity, as if no such accident had happened. The most frivolous disaster which could befall himself would occasion a more real disturbance. If he was to lose his little finger to-morrow, he would not sleep to-night; but, provided he never saw them, he will snore with the most profound security over the ruin of a hundred millions of his brethren, and the destruction of that immense multitude seems plainly an object less interesting to him, than this paltry misfortune of his own. To prevent, therefore, this paltry misfortune to himself, would a man of humanity be willing to sacrifice the lives of a hundred millions of his brethren, provided he had never seen them? Human nature startles with horror at the thought, and the world, in its greatest depravity and corruption, never produced such a villain as could be capable of entertaining it.
- Part III, the Theory of Moral Sentiments, Adam Smith

If we are honest, we all must admit that there are some people in the world we care about more than others. While we're horrified (at least in our culture) about the idea of having a favorite child, almost everyone is pretty quick to say they'd rather save their child than a stranger that they've never met. But how about ten strangers? Or a hundred "millions"?

Of course people differ. Someone with no empathy for anyone including him or herself (autistic; badly depressed narcissist) would look like this:

A narcissist, psychopath or very young child would look like this.

This is what most of us look like.

This is what many people want to look like, but probably don't. Scott Alexander noted that people on the left often make a point of showing empathy for people more unlike them. (Is this a stable strategy?)

And finally, this is what the Buddha demonstrates, and how some progressive people claim to act - equal empathy for all beings (on the far right presumably are nonhuman primates, other animals, plants, etc.)

Of course these are all quick-and-dirty qualitative graphs to give you and idea, but they illustrate the hallmark of empathy curves. For most of us, empathy curves are sigmoidal - there is an inflection point at some level of non-self. Questions that are raised by considering this relationship are:

a) Before you get all excited that the graphs above are showing some progression toward a desirable goal - is it sustainable to show the same empathy to all others - either zero (narcissists) or full empathy (the Buddha)? Or even to show empathy in inverse proportion to how much like you someone else is? Empathy has real world impacts and there are obvious sociobiological reasons why most people's curves look like the third graph, but from a purely practical perspective, if your empathic behavior leads to your rapid extinction, it doesn't seem to be effecting much good in the world. The steepness of the empathy curve also produces a lot of the current political divide in the West - i.e., the less able to abstract a principle beyond their ingroup, the more contentious a faction.

b) Empathy curves can change over time for an individual, and finding what else is different about individuals who undergo change (neuroanatomically, psychologically) may be informative. For example, in psychiatry, there is the concept of the "burned out" antisocial, the person who commits vicious crimes indicating low empathy when he (usually he and not she) is younger. Then after about age 40, the same person is much less likely to commit further violent crimes. My speculation is that these people are not burned out but rater finally "grown in", i.e. their orbitofrontal cortex has finally produced enough synapses to affect their behavior, in the same way that ADHD symptoms often fade into and through adulthood as the cortex matures (again, in more often in males.) Many of us can think of anecdotal examples of a male who in his youth was a hell-raiser only concerned with himself, then transforms into a devoted family man - but he still has a very steep empathy curve that drops off once you move outside the family. (That guy who dotes on his daughter but was in a biker gang when he was younger? He might actually be a very good father - but he still doesn't have much concern about anyone's pain but that of his wife and kids, and if you're past his steep sigmoidal drop-off, you definitely don't want to test that.)

I've looked for evidence of differing oxytocin levels or even ADH/vasopressin (or receptor mutations) in the literature about psychopaths and antisocial PD. If you accept crime as a proxy for low empathy, there's a small literature on testosterone's role, but it's not nearly as clear as you would think. For one thing, there's actually a meta-analysis undermines the argument that testosterone is behind the pattern in crime spike and then decrease after early adulthood (Archer et al 2001), and Ulmer and Steffensmeier (2014) point out that though testosterone does not drop precipitously after adolescence and very early adulthood, crime typically does. There is a vague signal about aggression dropping as testosterone declines with age (including in women - Dabbs and Harbison 1997) but neither this nor any of the previous studies track testosterone and crime in the same individuals, which would be most informative. Overall the research on decreasing crime is scant - it seems once these people stop committing crimes, we're less interested in studying them.


Archer J, Graham-Kevan N, Davies M. Testosterone and aggression: A reanalysis of Book, Starzyk, and Quinsey's (2001) study. Aggression and Violent Behavior. Volume 10, Issue 2, January–February 2005, Pages 241-261

Ulmer JT, Steffensmeier D. The age and crime relationship: Social variation, social explanations. In The Nurture Versus Biosocial Debate in Criminology: On the Origins of Criminal Behavior and Criminality (pp. 377-396). SAGE Publications Inc.. 2014.

Dabbs JM Jr, Hargrove MF. Age, testosterone, and behavior among female prison inmates. Psychosom Med. 1997 Sep-Oct;59(5):477-80.

Why Do People Remain Loyal to a Losing Team?

Cross-posted to the MDK10Outside and the Late Enlightenment.

tl;dr Sports fan behavior is explained by a combination of constant identity-forming team loyalty which is an end in itself, and status signaling by association which is modulated by team performance. These two factors differ between individuals and are associated with different cognitive styles, with constant loyalty more associated with moral foundations and intransitive preferences.

It's been observed that you can tell who a team's true fans are by noticing who remains loyal to the team even when that team is losing. I think this is meaningful, but it does beg the question: what are those fans getting out of it?[1] Of course any speculation about this must mention the very real example of the Cleveland Browns, who over the past 2 years have a 1-31 record, and this year after going 0-16 they were on the receiving end of a sarcastic "perfect season" parade.

Humans get utility from associating with others with high status. Much of the happiness that a sports fan gets from their emotional connection to their team derives from this, and many observations are consistent with what a status-by-association theory would predict: fans are happier when their teams win because they feel high status and can signal higher status, they engage in extreme dominance displays when their teams win important contests (i.e., people acting like idiots as they come out of a championship game if their team won, yelling, jumping on cars, setting off fireworks) but not if they didn't win, they attend games more when the team is winning and less when the team is losing, and they wear branded gear to identify themselves with the team and otherwise let others know of their association.[2]

But this theory falls short of explaining why, for example, there is any such thing as a team's consistent fanbase. By this model, everyone should just cheer for the best team, game by game (or even play by play!) It especially doesn't explain why the the Cleveland Browns have any fans left at all; supposedly they're a football team but I've seen a number of convincing arguments against that, for instance, every game of the 2017 season. During an 0-16 season you would expect that if fandom is about fully rational people maximizing utility by associating with high status teams, the fans would stop posting on forums, they would put their gear away and deny to others that they were fans, and the stadium would not just have lower attendance, it would be completely empty. Yet this is not what happened.

I think the answer here very likely has to do with the gap we see between two types of beliefs/behaviors that often produce apparent impasses in other domains of life, especially religion and politics, the intensity of which differs between individuals. This gap in rational and more instinctual behavior will seem very familiar to readers of books like Jonathan Haidt's Righteous Mind, or Simler and Hanson's Elephant in the Brain. Humans demonstrate some domains in their cognition which are inflexible and impervious to reason - to use Haidt's categories, harm, fairness, loyalty, authority, and purity. By "inflexible" I mean "not open to discussion, or conversion into money or other goods/services." For example, you likely do not believe that murdering children is morally acceptable. Are you interested in hearing arguments about why it might be morally acceptable? If you would never consider such a thing, and you're uncomfortable that I would even suggest it in a thought experiment, you're showing inflexibility in discussing it. Okay - would you kill an adult for $50,000? I see that also upset you, I'm sorry to have opened with such a low offer! $75,000 then? You're being inflexible (I hope!) in reacting by thinking "It's not about the number!" Okay, what's the conversion rate between adults and children? Forget murder, how about urinating on a picture of your family for money? etc., you get the point. "Inflexible" means it can't even be suggested as open for discussion, which includes not being allowed to convert between moral-foundation-violating acts and money, or between different types immoral acts. (A favorite of action movies and dramas to demonstrate the extreme evil of an antagonist is to have them force someone declare the relative value of immoral acts, e.g. Sophie's Choice.) To connect back to the abstract, the philosophical term for having values that cannot be negotiated, and for which there is no relative value like this, is that they are intransitive.

I took you on this little tour of moral darkness to illustrate that morally normal humans do not adhere to consistent rationality, and the ones that actually do are psychopaths.[3] (You may be interested to know that Haidt found that when he surveyed the business students he was teaching, they scored low on every single moral dimension, taught as they are that everything is negotiable.) So what does all this have to do with the Cleveland Browns? Many of us have noticed that "hardcore" sports fans - the ones who stick around with long faces even when the Browns are losing, and falsify the first model above - tend to have certain personality and cultural characteristics that fit well with some of these inflexible moral foundations: they tend to be more religious, more nationalistic, more conservative and more valuing of loyalty and authority.[4] Sports fans rarely become hardcore about a team after entering adulthood, and very often there is a family lineage of fandom - and these are exactly the times and ways in which characteristics of core identity are formed. Also telling, while there were about 3,000 people who showed up for the Cleveland Browns parade, there were many fans who were quite angry about it - but online objections were mostly that it was "embarrassing". (No mention of the 0-16 record that inspired the parade.)

Before I put into words what might be motivating them and make predictions, here's a summary of the two kinds of of beliefs, producing two kinds of motivation. While these beliefs exist in everyone, there is going to be a distribution in the population, with one category of beliefs dominating the fandom-related cognition of some fans, and the other category dominating that of others.

motivated by moral foundations by utility calculations
end in themselves deliberate, external goal-oriented
higher value on loyalty lower value on loyalty
adopted in childhood, maybe from familyadopted voluntarily in adulthood
not negotiable negotiable
central to identity not central to identity
unwilling or unable to verbalize position clearly verbalized
more often encountered in person more often encountered online
sees casual fans as untrustworthy, sleazysees hardcore fans as stupid, gullible

Of course it's a spectrum, and every fan is somewhere on this spectrum, but many of us clearly lean toward one or the other end. (If you're reading this, you're more likely in the right column than the left.)

To summarize the hardcore fan: he is motivated by more basic, instinctual moral drives, especially loyalty. Being a good fan is an end in itself, and an offer to burn a team jersey, to cheer for the other team, etc. in exchange for money is likely to not only be immediately refused but to provoke active offense. These fans consider their fandom a crucial part of their identity, to the extent of including team-related themes in their weddings or mentioning it in obituaries ("he lives and dies by the Browns"; "a Browns fan to the core.") He can get uncomfortable when the business aspects of a professional sport are discussed and overshadow the games on the field. Asking him to explain his fandom will be met with puzzlement, anger, or a jumbled set of team cheers and slogans, in the same manner as a person asked to explain why they are patriotic or follow a certain religion - "If I have to explain it to you, you'll never understand." And finally, because tribal loyalty sentiments are more warning-barks or team cheers than any kind of actionable proposition, you're more likely to hear such sentiments when talking to him in person, where the nonverbal (affect-laden and irrational) part of communication dominates. He will be a fan for life. When the bandwagon people disappear during losing seasons the hardcore fan says "Good riddance, good-time Charlie."

To summarize the casual fan: he is motivated by utility calculations about external goals (this team might win this year so I'll cheer for them, maybe I can make friends this way, maybe I'll look successful if I follow a good team.) He doesn't see what's impressive about staying loyal to losers, and really doesn't understand why making fun of your team when they lose is shameful or embarrassing. He probably picked up his fandom after college, maybe when he moved to a new city. He probably don't care either way about the business dealings of the team. If someone offered him money to stay home from a game or burn team logos, he would seriously consider the offer. He doesn't introduce himself to strangers as a fan, and five years from now he might not be following the team, or might not be following the sport at all. He can give clear reasons why he started following the team, and you're more likely to hear from people like him online. He shakes his head at the hardcores who keep shelling out cash for losing teams' jerseys.

Both the hardcores and non-hardcores gain utility in proportion to the team's performance. A team's performance can be negative, causing you to lose utility by associating with them.[5] But there must be another source of utility for the hardcores, who somehow gain utility from the association no matter the team's performance - and that source of utility is a constant ability to demonstrate loyalty, period, to others as well as to themselves to reinforce their own identity. And this signal is most informative when your side is losing.[6] Speaking quantitatively, in the utility equation for this model, there are two terms, loyalty (a constant for everyone, hardcore or not), plus the product of team performance times associative utility. Associative utility is how much your utility changes per team winningness. Both loyalty and associative utility vary by individuals, and team performance of course is determined by the team. The equation looks like this:

Total utility = Loyalty-based utility + (Team performance * associative utility)

Team performance can be positive or negative. For the hardcores, loyalty is such a large term that it doesn't matter how negative team performance is, loyalty will alway be greater and the total utility will always be positive (this could be the definition of "hardcore", "rain or shine", etc.) Further toward the other end of the spectrum, the value of loyalty signaling decreases and the team performance makes more of a difference in whether people keep following the team. It's also worth pointing out that this explains people who don't care about sports at all, because they have zero loyalty and zero associative utility - that is, it doesn't matter how much the team wins, they still won't care.


Many of these predictions seem trivial, but the point is to relate these predictions to specific components of the hardcore fan's motivation structure as noted in the table above, which would be more informative.
  • While utility is hard to measure directly, there are good proxies for it, like revenues, attendance, or Nielsen ratings. Given that there will be a distribution of hardcore to non-hardcore fans, there will be a non-zero floor to revenues so even 0-16 teams don't go to zero, as we observed. If we graph all of the teams on performance vs utility proxy, I would expect a mostly linear-looking scatter plot with an increase in the slope at the good end, for those teams with some expectation of a national championship, and possibly a flattening at the bottom. This may depend more on expected utility (if fans are pleasantly surprised by a win vs. they expect their team always to win.) I plan to try to collect some kind of utility-proxy data and see if this is in fact the case.
  • In general a sport will be more successful in inspiring loyalty, the more similar it is to tribal warfare (always a reliable revenue stream for every team); maybe this is why football has eclipsed baseball as the national pastime.
  • The more hardcore, the more they will pay attention to the outside charity activities of their own team, and the more outraged they will be by disloyalty-demonstrating acts, e.g. kneeling during the national anthem. They will also be more interested in the moral failings of opposing teams, especially rivals.
  • The more hardcore, the less they will be interested in statistics, especially of other teams, even ones their teams are playing in important games.
  • The more hardcore, the greater the difference in their interest in a player when he is on their team, vs. after he is traded. That is, hardcores think each of their players is a great person on and off the field - when he plays for their team - and any suggestion that they'll stop caring about him the second he is traded is likely to be met with hostility, but in fact this is the behavior they demonstrate. (He will also be annoyed when asked why, or when Seinfeld is cited - "Essentially you're cheering for clothing.")
  • The more hardcore, the more they will feel sad or angry after a loss, and the more likely they are to attend or watch the next game despite having been very sad or angry at the last game's outcome.
  • The more hardcore, the less tolerant they will be of fans behaving negatively toward the team, even when the team loses (very concrete and contra expectations here: you might expect hardcore fans to support a parade showing anger against the people making their Browns lose, but it seems to be exactly the opposite. Parallels to gay marriage here too: how exactly does the 0-16 parade degrade your fandom, when you didn't attend?)
  • The more hardcore, the more they will confuse the team with a government agency or public good (i.e., demanding that the city finance a new stadium.)[7] More recent teams with cities that have highly educated and/or mobile populations (i.e. the coastal Pacific) will therefore find that they can't get what they want from those cities, because the voters don't care (Seattle, San Francisco, San Diego) where other cities filled with less mobile, less educated people would crucify their mayor for allowing a team to leave on their watch.
  • It's often been noted that the Midwest with its brutal early winters has far more rabid sports fans than the mild West Coast. One possibility is that the loyalty-demonstration value of attending every game is diminished when all of those games are 70 F and sunny, vs some of them being freezing cold. (Think of the people who still wait in line in the cold and dark on Black Friday morning to buy things for their families. They do know that Amazon exists. So what do you think they're really doing?) Of course there could be a climate-independent cultural difference between east and west coast, but the model's prediction would be that Miami has equally low loyalty.
  • The more hardcore, the more they will be upset if a star player leaves for another franchise, or the whole team moves to another city, and they use words like "betrayal."[7]
  • The more hardcore, the less tolerant they will be of long-term, off-field strategies, especially ones that alter play and result in on-field losses. (Both the 2008 Detroit Lions and 2017 Cleveland Browns had 4-0 preseasons, then went 0-16. Tanking (here and here) and/or salary cap manipulation? Difficult to explain as mere incompetence. And if it were confirmed that this is what is happening, the hardcore fans would be angry; casual fans might say "Huh, that's kind of clever, although it means you've been putting a bad product on the field." "My team is not a 'product'!" the hardcore fan says.)
  • I'm not sure what to predict about the impact of hardcoreness on betting. The hardcores' loyalty may make them become overconfident in their team's performance. On the other hand, moral foundations-related beliefs are often kept carefully separate from anything affecting real-world decision-making. By that I mean: sacred beliefs are often more tribal chant than actionable proposition, and in general, people desperately avoid any bet that touches their moral foundations (next time someone makes a verifiable statement about religion or politics that you disagree with, offer to bet them, and see what happens. Typically they backtrack to a non-verifiable version of what they said, and/or get very offended that you would "cheapen" such an important matter by betting on it - which are all moves to avoid testing their belief.) Then again, the hardcore fans presumably know more about their team than most others, which means they should be more confident in their predictions, and be more willing to bet. Consequently they may be less willing to bet proportional to their claimed confidence, than would a casual fan with equal knowledge of the team would be. In my one test of this during March Madness, I found that self-identified fans did more accurately predict the outcome of a game involving their team than non-fans, but I collected no information on willingness to bet.

[1] This very article is diagnostic. By trying to dissect loyalty, instead of taking it as an obvious good and discussing it in the context of a specific team, I mark myself as someone with a small loyalty term in my equation - whereas people whose sports utility equation is dominated by loyalty would not understand, and/or be actively be offended by, a question like "What do you get out of being a fan of your team?"

[2] One might argue that a purely rational human being would ignore sports altogether - what do a bunch of guys chasing a ball on a field somewhere else in my city have anything to do with me, I've never even met them! - and I'm sympathetic to that argument.

[3] I hope no one read the paragraph about the price of murder and thought, "Hmmm...What is my price to kill someone?" In the case of exemplar psychopath Richard Kuklinski, he got positive utility from harming people so he kept doing it even after he ran out of work.

[4] When people do not have VNM-consistent rationality (that is, they have these inflexible, non-negotiable, non-fungible beliefs - i.e., intransitive preferences) - they can be turned into money pumps, by observant and unscrupulous characters who can carve their motivation structure at the joints, i.e. focusing on the the inconsistencies. While this has been reproduced now in artificial settings, not only salespeople but politicians have been doing it since the dawn of civilization. The NFL and in particular the Cleveland Browns are doing exactly this to the fans by exploiting the intransitive preference of loyalty, and I would be very surprised if their marketing does not already have a model of their fans and spending patterns similar to what I've described here. Another follow-up is to look for literature on whether psychopathy allows one to see these disconnects more easily, or (hopefully) the ability to see them and the willingness to act on them are unrelated and therefore form a mercifully narrower sliver on a Venn diagram of the population.

[5] There's probably a Markovian/hedonic treadmill effect here too, where the utility multiplier from a team's win is not constant but rather influenced by expectations based on the team's record. Next year if the Patriots go 9-3, fans leaving a game after a win won't be as happy as Browns fans if the Browns have the same record.

[6] Remember Karl Rove dragging out the 2012 election night broadcast and refusing to accept the outcome, seeming a little nuts? But simultaneously advertising to ten million Republicans watching that he never ever gives up. Say what you will about Karl Rove, but "bad strategic thinker" was not among the many epithets hurled at him.

[7] When the Baltimore Colts were about to move to Indianapolis in 1984, the city actually tried to pass an eminent domain act (!) to take over the team, but the Colts escaped with the team's property under cover of darkness the night before. Other teams like the Chargers have found a much more lukewarm reaction on threatening to leave, and found themselves without many fans.

[8] While I wrote this post I was wearing a Garfunkel and Oates sportsball T-shirt, so you can guess which end of the spectrum I'm near.

Evil Gandhis and Poor Executive Function: How the World Looks if You Have Poor Impulse Control

Cross-posted to the Late Enlightenment.

Imagine that in some distant, cloudy mountain hideaway there is a city of evil Gandhis - or just unempathic monks - who spend all their waking hours meditating. As a result of the self-control they've created in this manner, their executive function is superhuman - after all, extensive meditation builds not just cognitive discipline but EEG-measurable physical changes in the brain. When finally you scale the last soaring frozen wall and scramble over the edge onto the floor of their lookout points, you have finally arrived in this storied, isolated monastery-city. You are greeted by intellects vast, cool, and unsympathetic, studying you from their great central plaza with piercing eyes. You find that you are the first visitor from your country. Suddenly a horrific pain erupts from the back of your neck, and you turn to see one of the monks withdrawing a red hot brand that he has just poked you with.

Obviously you demand to know why you deserved that. As they are merely dispassionately interested in collecting knowledge, this one calmly explains that they would like to see if your skin burns in the same way theirs does. You turn to see several more of them calmly approaching you with various glowing metal rods; behind them, in the fire at the center of the plaza, someone is handing out more metal rods. You tell them to stop, but they ignore you. Finally, you turn to the closest one approaching you, and punch him in the face. Your punch lays him flat out and his metal rod clangs to the ground.

"That's assault," one of the monks says. "We're going to have to lock you up now."

"Assault?" you shout. "What was I supposed to do? You made me assault you!"

The monk rolls his eyes. Only then do you notice various burns, knife and whip scars all over his face and arms. "You're like a child. It's not our problem if your self-control is so poor that you can't stand being burned a few times."

To a person with a Cluster B personality disorder - including narcissistic PD or especially borderline - the world must seem to be filled with such evil cold-blooded monks. If I have BPD, then these people just can't see that when they withhold affection, that's so intolerable - it's just the same as a hot iron - that they're making me attack them to protect myself. (I have heard a severe narcissist in a psychiatric hospital, fighting while being restrained by staff after being refused special treatment, literally say "Look what you're making me do! You're making me do this!" The resemblance to what a five year-old might say is not coincidental.)

But this is more than just an interesting perspective - it's relevant to a critical assumptions that we make in liberal democracies. Namely, that people have agency, and this agency allows them to be responsible for themselves, and to some degree others. While (so far as I know) pain-tolerating monks do not exist, people with severe borderline and narcissistic personality disorder - with poor executive function and low distress tolerance - do exist. And we do lock them up.

It turns out that "agency" has buried within it many components, which do vary quite a bit across the population, and which profoundly affect people's ability to run their own lives and live with others. The one case where we're comfortable saying that humans don't have agency is children - but even that is somewhat arbitrary and agranular (many of us can think of a sixteen year old more capable of running her own life than a twenty-eight year old.) The monks would lock you or me up because we're at the extreme bad end of their distribution, just like we lock up people in jails or long-term care facilities, but we wait for someone to commit an act, of the sort that they are guaranteed to commit at some point, if they're at the extreme end of the distribution. As society becomes more complex, more and more people will commit such acts, and we'll have to get more honest and clear about exactly how we deal with them.