craschworks

[I prefer no welfare subsidies at all, but Kling's proposal seems better than the current welfare system.]

http://www.techcentralstation.com/092903A.html

Bleeding-Heart Libertarianism
By Arnold Kling

“I am a bleeding heart libertarian. Because I'm a nice guy and want to address society's problems and I want disadvantaged people to become better advantaged. By instincts and experience I believe that government seldom delivers the benefits the “bleeding heart liberals” and “big government conservatives” always seem to hope for. In many cases government only makes things worse. As with technology and prose, less is often more. I'm not one of those doctrinaire Big-L Libertarians who want to eliminate government. My aim is to improve government by making it smaller. The most important part of this process is to persuade our fellow citizens to demand less of our government.”
– Stefan Sharkansky

Of the roughly $3 trillion that government in the United States at all levels collects in taxes of all kinds, close to two-thirds goes to pay for Social Security, education, and health care. This is the Welfare State.

The conventional wisdom is that the intent of the Welfare State is to reduce the disparity between the unfortunate and the well-off. The Welfare State supposedly redistributes income and reduces poverty. In fact, I believe that the Welfare State redistributes poverty and reduces income. As Karl Kraus once said of psychoanalysis, the Welfare State is the disease which it purports to cure.

The Bleeding-Heart Libertarian Approach

To contrast with the Welfare State, let me offer the Bleeding-Heart Libertarian approach to income redistribution. Conceptually, it would involve abolishing public education, all forms of free or subsidized health care, and Social Security. It would abolish all forms of taxation other than a tax on personal consumption. All consumer spending, including spending on education and health care, would be subject to tax. To assist the poor, there would be a negative consumption tax, somewhat like the negative income tax that was originally proposed by Milton Friedman.

The entire Bleeding-Heart Libertarian Welfare State can be summarized by the equation:

T = .4C* – $7000

where T is the total taxes that an individual would pay and C* is the person's consumption expenditures including spending on education and health. $7000 is a constant term that creates a personal exemption of $5000.

For a family of four, the equation would be T = .4C* – $28,000. Because there are four people, the constant term gets multiplied by four. Below is a table that shows how a family of four would be taxed assuming that it spends exactly 100 percent of its disposable income.

Income

Spending

Taxes

$0

$20,000

-$20,000

$14

$30,000

-$16,000

$28

$40,000

-$12,000

$42

$50,000

-$8,000

$56

$60,000

-$4,000

$70

$70,000

$0

$84

$80,000

$4,000

$98

$90,000

$8,000

$140,000

$120,000

$20,000

I chose the parameters in order to redistribute as much income as the current Welfare State, and also to collect enough additional taxes to fund the remaining functions of government. In the aggregate, personal consumption spending plus spending on education and health care amounts to roughly $8.5 trillion. Multiplying (.4) times $8.5 trillion gives $3.4 trillion in gross taxes, which is roughly what is collected today. Multiplying $7000 per person times a population of 280 million gives roughly $2 trillion in total exemptions. Thus, the net tax take of this system is about $1.4 trillion, which is close to the amount needed to fund that part of the government that is not the Welfare State.

If we had a larger exemption, we would have a more generous bleeding-heart welfare state, but we would not have enough money to fund the rest of the government. Another way of saying this is that the table above is indicative of the most redistribution that can be accomplished with a marginal tax rate of 40 percent.

Remember that in the table it is assumed that a family consumes all of its income. Suppose instead that a family with $90,000 in income spends only $70,000. Because the family would pay taxes only on its spending, such a family would pay no taxes. If they spent $80,000, the family would pay $4000 in taxes.

Some liberals would object that this consumption tax is “regressive.” People with high incomes who choose low consumption would pay less in tax than people with low incomes who choose high consumption. However, I think it is a misnomer to call this “regressive.” As an economist, I view consumption as the more reasonable indicator of well-being. There is no reason to tax people on the income that they save — to do so reflects only dogmatic anti-capitalist prejudice.

Winners and Losers

A low-income family of four would have quite a struggle. Remember, under the bleeding-heart libertarian approach they have to pay for schooling for their children. Also, they have to pay for health insurance. There is no Medicaid, and no freeloading at the hospital emergency room. There would be no food stamps or other forms of assistance. Only cash in the form of the negative consumption tax, plus the family income. For example, with an income of $14,000 supplemented with $16,000 from the government, such a family would have to afford food, shelter, education, health care, and everything else on a budget of $30,000.

Does the bleeding-heart libertarian approach seem harsh? Actually, the Welfare State is worse. The Welfare State targets much more of its largesse to people who are less needy. Medicare pays for hospital bills for everyone over 65, including millionaires. The school districts with the highest per-pupil spending rates tend to be those with the wealthiest residents. Many of the elderly who receive Social Security are well-to-do.

Where does the Welfare State get the money to fund benefits for the non-needy? Mostly, it comes from the working poor. Families with incomes in the range of $15,000 to $40,000 face effective marginal tax rates of 100 percent, or even more. That is because as their income increases, they lose eligibility for housing subsidies, food stamps, Medicaid, and so on; at the same time, their tax burdens rise, primarily because of the payroll taxes that fund Medicare and Social Security. In the bleeding-heart libertarian model, a family with an income of $28,000 would receive a supplement of $12,000 from the government. Under our current system, such a family would receive very little government assistance, apart from the “benefit” of a bottom-of-the-barrel public school. Moreover, it would be subject to payroll taxes, property taxes, sales taxes, and state income taxes.

The bleeding-heart libertarian approach systematically redistributes resources to people in need. The Welfare State arbitrarily creates winners and losers among people with similar income and spending circumstances. Compared with the bleeding-heart libertarian model, in today's Welfare State:

* Well-off elderly who spend a lot on health care are winners. So are people who choose not to buy health insurance but instead receive free care at emergency rooms. The working poor who have health insurance and pay taxes for Medicare are the losers.
* Among people who can afford to save for retirement, those who choose not to do so are rewarded with Social Security benefits. Those who do save are punished with taxes on their investment income.
* Children who live in school districts located where there is a lot of high-priced real estate are subsidized. Children who live in rural areas and small towns, or children whose parents pay for private school, are penalized.

To put it succinctly, the Welfare State makes losers out of people who want to get ahead through hard work, thrift, or education. Those are precisely the activities that produce economic growth and social wealth, and they are hit particularly hard by Welfare State redistribution.

Politics and the Welfare State

The Welfare State certainly has well-organized constituencies. The winners, such as the AARP and the teachers' unions, know who they are. The losers — the working poor, children stuck in low-quality school districts — have much less political clout. The Welfare State has friends in both parties, as evidenced by the move to add a prescription drug benefit to Medicare.

As the Baby Boomers age, longevity increases, and new medical technology is developed, the cost of the Welfare State is going to rise. Economists agree that in another generation the share of GDP required by the Welfare State will exceed the share of GDP of total tax revenues today. The outlook for the working poor and other Welfare State losers is decidedly grim.

The Bush Administration is undermining the Welfare State by trying to limit taxes as a percent of GDP. However, no one in either party is willing to talk plainly about the failures and inequities of the Welfare State. Those failures and inequities are the crazy aunt that politicians on both parties try to hide.

Suppose that the Welfare State is abolished or curtailed, and no redistribution mechanism is erected in its place. In that case, I am not certain what would happen to poverty. It certainly would be redistributed: some current beneficiaries would lose, while some who are trapped in poverty by the current system would escape. With overall economic growth higher, we might very well see a decline in overall poverty.

However, the scheme I outlined above would provide a better alternative. If it were adopted, there would be improved overall living standards, as a result of encouraging the activities that lead to growth. Overall higher living standards, combined with the efficiency of the redistribution mechanism, would drive out poverty. The working poor would see their effective tax burdens plummet. Thrifty people would live very comfortably in their retirement. Access to a good education would be more equal.

All things considered, it seems to me that the risk involved in embarking on a course to abolish the current Welfare State is actually rather small. I think that there are much better alternatives available, along the lines of the bleeding-heart libertarian model. Committing ourselves to the Welfare State as it exists today amounts to robbing the poor.

http://www.washingtonpost.com/ac2/wp-dyn/A14217-2003Sep28?language=printer

Grasping Why We Reach for a Taste of Calm

By Rob Stein
Washington Post Staff Writer
Monday, September 29, 2003; Page A16

When the going gets tough, the tough (and not-so-tough) often get hungry. Why that happens has been a mystery.

Although researchers have had clues that there might be some scientific basis for the notion of “comfort food,” the precise link between stress and eating has been fuzzy.

Now, scientists have developed a model for a biological link between stress and the drive to eat: Food with lots of sugar, fat and calories appears literally to calm down the body's response to chronic stress.

In addition, research indicates that stress hormones encourage formation of fat cells, particularly the kind that are the most dangerous to health. That may be at least one reason why obesity rates are skyrocketing in the United States and many other modern societies.

“In highly industrialized countries, people do apparently seem to feel more stressed — more under the gun,” said Mary F. Dallman, a professor of physiology at the University of California at San Francisco, who outlined her theory in a paper to be published in an upcoming issue of the Proceedings of the National Academy of Sciences. “And they certainly are eating a lot more.”

The new theory has been drawing praise from other scientists since it was posted on the Internet earlier this month.

“It's an important new model,” said Alan G. Watts, a professor of neuroscience at the University of Southern California. “She's brought together under one roof two parallel processes. This is the first time anybody's been able to put together a united theory on stress and energy metabolism. It presents a new way of thinking about this.”

While the relationship between stress and eating is driven by a complex mixture of emotional, psychological, social and physiological factors, the new research does appear to explain puzzles that have long baffled researchers, said Elissa S. Epel, an expert on stress, eating and fat at the University of California at San Francisco.

“There's a multitude of behavioral, attitudinal and psychosocial factors that determine whether humans engage in comfort eating. So it would be a real distortion to say it's all driven by the stress response,” Epel said. “But this explains mysteries that stress researchers have been unable to resolve for a long time.”

Scientists have long known that during times of stress, parts of the brain emit a chemical signal called corticotropin-releasing factor (CRF), which in turn causes the adrenal gland to pump out large amounts of hormones known as adrenal corticosteroids, including cortisol. These “stress hormones” flood the body, producing a wide array of effects designed to get ready to flee or fight: The immune system gets damped down. Alertness increases. Heart rate quickens. Activity jumps.

During acute stress — a car accident, an argument — a feedback system kicks in and shuts down this response fairly quickly. But during chronic stress, the system keeps going, caught in a vicious cycle.

To examine the relationship between chronic stress and food, Dallman and her colleagues conducted a series of experiments with rats, which are considered good models for how the same systems work in people. The researchers studied levels of stress hormones, brain activity and chemical signals, as well as fat distribution in the rats' bodies, comparing animals experiencing acute and chronic stress induced by exposure to cold or being restrained. The researchers also manipulated some animals' stress hormone levels by removing their adrenal glands, administering stress hormones or injecting them with the chemical signals that produce stress hormones.

When the rats were under chronic stress and had high levels of stress hormones coursing through their bodies, they became very active. They ingested large amounts of high-calorie lard, eschewing their normal feed, and drank prodigious amounts of sugar water. They ignored water containing saccharin, even though it tasted equally sweet. This, in turn, tended to make the rats develop deposits of fat cells in their abdominal areas. In humans, fat that gathers around the waist tends to increase the risks for various health problems.

“When you've got animals in the wild, or people in underdeveloped countries facing, say, a drought, they will turn on their adrenal corticosteroid system. That will make them run to get food and then they get food and eat and create stores of fat, which they need to do,” Dallman said.

“It works beautifully when there isn't plenty of food around,” she said. “But when there is plenty of food around, like in our society, where there's a McDonald's on every corner, it gets us into deep doo-doo, because this is the kind of fat that if it stays on is very bad for you. It's associated with diabetes and heart disease and stroke.”

The fat cells, in turn, appear to send signals back to the brain, shutting down the production of stress hormones, which makes animals — and people — feel better and relax until they burn off those fat deposits. After ingesting high-sugar, high-fat diets, and developing fat deposits, the levels of CRF in the laboratory rats dropped.

But losing weight apparently reactivates the stress response system, starting the whole process again, said Norman Pecoraro, who works with Dallman.

“You're losing that metabolic signal to the brain that's calming things down. So you're removing that yourself by dieting. So one thing that's going to happen is that you'll feel more anxious and won't feel as good and you'll mount this compulsion system to go get the goodies,” Pecoraro said.

Other researchers said that the work needs to be followed up with additional studies in animals and people.

“I think it's a fascinating new insight into this thing we refer to as comfort foods,” said Bruce S. McEwen, a professor of neuroendocrinology at the Rockefeller University in New York. “Often what we call old wives' tales turn out to have a scientific basis, and this seems to be the beginning of understanding this old wives' tale.”

If scientists can identify some of the chemical signals involved in the feedback loop of eating, fat and stress, and then design drugs to block them, that could lead to new treatments for obesity, McEwen said. “One might be able to find a drug that helps to calm this system down, so to speak.”

Dallman hopes the new understanding might help people control their appetite without drugs.

“It seems to me that when I know there's a reason for something that's happening,” she said, “then maybe I can have more control over it.”

� 2003 The Washington Post Company

Does anyone know of any good reviews on the neurobiology of boredom? I'm familiar with Mihalyi Cziksentmihalyi's books (Flow, etc.) Any suggestions would be appreciated.

I've always been fascinated by the question: why don't the political beliefs of people of good will and intelligence converge more often than they do? For example, James Hughes is an energetic and prolific leader of the World Transhumanist Association (WTA). He's also a socialist. I remember back in the early '90's, when I was on the extropians list, he would get into lengthy rows with the (mostly) libertarian crowd on the list. Now I'm on one of the mailing lists of the WTA, and he's making the same arguments that he was a decade ago. Why have seemingly none of his views changed over the years?

More alarmingly, I perceive that few of my values or beliefs have changed radically in the past 10 years or so either. Why not?

One of the few examples where I can recall my views changing is the issue of abortion. When I was in high school, I was strongly pro-life. My memory of the reasons why I held that stance are probably distorted but as I recall, it went like this: historically, whenever there has been a clash over what constitutes a human deserving of full human rights (slaves, Nazis), those who favored the less expansive definition were almost always, in retrospect, considered evil monsters. Therefore, it seemed prudent to me to grant fetuses full human rights from the time of conception forward. I'm sure my Mormon upbringing also influenced my beliefs, as well, as Mormons believe that the soul enters the embryo at conception, and therefore aborting the embryo constitutes murder.

Now I think women should be able to have an abortion at any point during pregnancy. As best as I can tell, my views changed as a result of a number of things I've read. After reading Bart Kostko's Fuzzy Thinking, I realized that “humanity”, however you defined it, was a continuous characteristic, and that any line you drew between human/non-human would be arbitrary. After reading Rand, I became an atheist, so I no longer believed that embryo's have souls. I also began judging laws in terms of their effects on my long term self-interest. I don't care about embryos, but I do care about people who are dying of diseases that could be treated with embryonic tissue. Moreover, enforcing anti-abortion laws would cost a great deal of money in court/prison costs, as well as the opportunity costs to women who were killed/injured from botched back alley abortions.

Now, I don't want to get into an argument over abortion, at least, not in this post. I present the evolution of my thoughts about abortion above as an illustration of the process, as best as I can recall, of how my beliefs changed.

Have you ever held strong beliefs that changed substantially? For example, did you go from being a democrat to being a libertarian? (or vice versa). An atheist to a believer? If so, how did your beliefs change? What catalyzed the change?

CRAN, or “calorie restriction with adequate nutrition”, is one of the few, if not only, methods of increasing maximum lifespan that has strong scientific evidence to support it. It has been shown to work in everything from nematodes, to fruit flies, to rats. Preliminary studies in monkeys suggest that it will work in primates as well. However, what if you don't start CRAN until middle age? Does it still provide a benefit? Current research suggests that even starting late in life may significantly increase lifespan.

THE FOLLOWING ARTICLE APPEARED ON CNN.COM/HEALTH 9/22/03
Study: Even mid-life diet change can extend life
WASHINGTON (AP) –It has long been known that laboratory animals live longer
on a low-calorie diet. Now a study suggests that even if sensible eating is
delayed until middle age, health can be improved and life extended.
A study on diet and life in the journal Science dealt only with laboratory
fruit flies, but researchers said some of the same effects may apply to
mammals, perhaps even humans.
In the study, British researchers compared the effects of different
calorie-restricted diets on the mortality of fruit flies. They found that
fruit flies on restricted diets lived about 90 days, twice as long as those
fed on a normal diet.
But the scientists also found that when heavily fed fruit flies were
switched at middle age — day 14 to 22 — to leaner diets, then the animals
converted from the shorter life pattern of the overfed to the longer-lived
pattern of flies that had been on a restricted diet all their lives.
The carry-home message from the study, said Linda Partridge of University
College London is that it is never too late to improve health by switching
to sensible eating habits.
“If this works in humans, then it means that from the time a person starts
on a restricted diet, they'll be like individuals of the same age who were
always on that diet,” she said. “Their prospects of survival are the same.”
Partridge said that although the life-extending effects of short rations
have never been proven in humans, it has been shown in monkeys, mice, rats
and fruit flies that diet restrictions will lead to longer lives.
“There is no reason to suppose it wouldn't apply equally to humans,” she
said. “There are diet restriction studies now underway with monkeys and all
the indications appear the same [as with mice, rats and fruit flies].”
James R. Carey, a University of California, Davis, researcher who studies
the biology of aging, said the Partridge study is “important to the field,”
but does not provide final answers about the true effects of restricted
diets.
He said that fruit flies and other animals on restricted diets tend to stop
reproducing. In mammals, for instance, the females stop ovulating and,
hence, cannot reproduce.
As a result, Carey said, animals on restricted diets may live longer simply
because they are not expending energy and stress in the rigors of
reproduction. He said studies still need to specifically isolate and prove
that it is the lean diet alone that leads to longer life, and not related
factors.

's recent post regarding her dream wedding reminded me of my sister Jen's wedding.

It was held at the LDS 5th ward church building in Jerome, ID. Jen looked gorgeous in a lace gown, hand-sewn by my aunt Vesta. A faux white trellised arch stood at the beginning of the “bridal path”. Relatives from both Kelly and Jen's family sat in chairs on either side. After a brief, but beautiful ceremony, Jen and Kelly stayed for photographs. Everyone else was instructed to take a packet of birdseed and line up outside the chapel doors.

My sister Heather had prepared dozens of small packets of birdseed, wrapped in green paper and finished with a curly yellow ribbon. I passed them out to everyone–Grandma, 5-year old nieces and nephews, bridesmaids, my parents, etc. Heather instructed everyone to open their packets and throw them into the air as soon as Jen and Kelly exited the church.

Finally, Jen and Kelly emerged. We all cheered and whistled. The five-year olds enthusiasticly tossed their birdseed into the air, as did everyone else.

Then it began. First the babies started crying and rubbing their eyes. The five year olds. Then the bridesmaids. Even the groomsman were rubbing their eyes. People began rushing into the church to wash out their eyes.

It was, of course, the birdseed.

I went into the kitchen and found the packages.

The second ingredient?

Cayenne pepper.

We had all been enthusiasticly throwing cayenne pepper into each other's eyes. I learned later that the cayenne pepper was added as deterrent to squirrels and other rodents.

Why birdseed rather than traditional rice? Heather had read somewhere that some pigeons gorged on the rice thrown at traditional weddings. The dry rice then expanded until their stomach exploded and they died. Kindhearted soul that she is, she thought it would be better to substitute rice.

You know, I liked the cayenne birdseed, but exploding pidgeons would be kinda cool too.

A couple of speakers will be coming to Duke that may be of interest to some of you Raleigh folk. I'm not sure if they're open to non-students.

Forwarded text, courtesy of Nathan Carleton:

“…John Stossel of ABC's 20/20 will be at Page Auditorium (West Campus) at 8:00 pm. The speech, sponsored by the Major Speakers Committee, will be free and is entitled “Freedom and Its Enemies.” There will also be a free reception following the lecture in the Old Trinity Room, (ground floor of the West Union Building). Stossel is somewhat of a libertarian and does great work…should be worthwhile.

ALSO, Ann Coulter, the author of instant classics Slander and Treason , will be speaking at 7 pm at the UNC Law School. Perhaps some of us could meet at the West Campus bus stop and take the 5:30 or 6 Robertson bus.

Seating for the Stossel speech will not be a problem, but it will be for Ann Coulter. The guy from UNC needs to know how many of us to expect so if you want to see her Wednesday e-mail me back ASAP….”

What I did for my summer vacation.

I flew to Boise, ID. People in hairnets and booties sliced open my eyes with razor blades. Then they fired lasers at my eyeballs at pointblank range.

And Lawndarts are illegal? Yet these people walk the street?

I am, thankfully, not blind. In fact, I can now see 20/20 out of my right eye, and 20/25 out of my left. Without glasses. Without contacts.

Yes, I had LASIK surgery.

I've worn glasses since the sixth grade. My first pair was made of heavy brown plastic with a miniature picture of Linus (of Peanuts fame) along the sides. Y in the early '80's, this was not fashionable.

Now I don't have to blearily hunt for my glasses in the morning. If I wake up in the middle of the night, I can see the clock without peering at it from 5 inches away. No more. Hallelujah.

I would highly recommend Dr.

Courtesy of

Conan O'Brian's commencement speech to the Harvard Class of 2000

Fresh Air interview with Terry Gross.

Good stuff for would be comics.

(Courtesy of )

http://www.newscientist.com/opinion/opinterview.jsp;jsessionid=OMKKDNPJEBCJ?id=ns24101

Meet the people shaping the future of science

This interview was first published in New Scientist print edition, subscribe here

Power to the patients!
Photo: John Angerson

He found himself sobbing uncontrollably, unable to work a sandwich dispenser and consumed by guilt. Clinical psychologist Richard Bentall had taken a psychiatric drug as part of an experiment. Add in personal tragedy and a spell of depression, and he could never see mental illness the same way again. Now he thinks diagnostic labels have no more predictive power than star signs and that plenty of people can live happily with severe psychotic symptoms. And as he told Liz Else, the people doing the suffering should have power restored to them

Saying psychiatry is no better than astrology is a bit strong, isn't it?

No. I've tried to show in my book that there is truckloads of research that shows that these categories are meaningless. They are remarkably similar to star signs because people think that star signs say something about them and about what will happen in the future. They think the same with psychiatric diagnoses, which don't predict the course of the illness, which treatments will work, or say anything about aetiology.

Though bodies like the World Health Organisation say there are core definitions for, say, schizophrenia…

Those definitions were drawn up by psychiatric committees in smoke- filled rooms, so they are psychiatric folklore institutionalised by committee. They look very precise, but that does not make them scientifically useful. The experiences and behaviour of patients diagnosed as schizophrenic or whatever are understandable in terms of processes that are relatively well known by psychologists. Take two of the most extreme symptoms – delusion and hearing voices. These are usually seen as signs of schizophrenia. But over the past 10 years, research has shown that many more people experience them than we thought.

How many?

Two large epidemiological studies in the US and in the Netherlands show that when people go round knocking on doors and doing psychiatric interviews, 1 in 10 say that at some point in their lives they have heard voices.

And they will actually admit this?

Yes. Now that is really baffling because it sounds like 10 per cent of the population has schizophrenia. But think about how hearing voices relates to everyday experiences. All of us have an inner voice – this has been understood by psychologists for centuries as inner speech. What's happening to people who hear voices is that they are producing this inner speech in what looks like a normal way, but for some reason are misattributing it to an external or alien source.

What about delusions?

The most common type is where the patient believes there is an organised conspiracy to persecute them or to do them harm. There has always been a problem of defining when a belief is delusional, but it seems that a history of victimisation or marginalisation markedly increases the likelihood of developing these beliefs. But perhaps the most striking evidence is that immigrants have a very high risk of paranoid symptoms.

Is that all immigrant groups?

My guess is all, but the jury is out. It started off with a study of British Afro-Caribbeans, who have an increased risk of psychosis, especially paranoid psychosis. Depending on the research , they are somewhere between 4 and 10 times as likely to develop psychotic paranoid symptoms as other groups. The most likely explanation seems to be that being an immigrant in a culture that you are not too comfortable with, or which maybe persecutes you, increases your chances of having paranoid delusions. One of the most interesting studies published in the British Medical Journal a year ago found that Afro-Caribbeans in London had a higher rate of psychosis if they lived in white neighbourhoods, but not if they lived in mostly black areas.

If we can understand delusions and voices, are environmental factors back in fashion?

Thinking about that led me to two surprising observations. One was that you could only really understand these symptoms if you looked at psychosis as the end point of a developmental pathway. That is not radical: even the biological people may buy that. The other thing that really shocked me was that I had believed the textbooks, that nobody had proved an environmental influence on psychosis. But buried in the literature is a lot of evidence of environmental factors. It is common sense that being persecuted will make you paranoid. When you are traumatised, it can generate a flood of intrusive thought and it is probably that that makes patients mistake inner speech for an external voice. And blows to self-esteem in development increase the probability of getting mood problems, while problems in regulating sleep seem to increase vulnerability to mania. So there is a coherent story to be told about how all these symptoms are related to developmental processes, which will undoubtedly include neurobiological factors, but also some major environmental determinants.

How do you differ from the anti-psychiatry advocates of the 1960s and 1970s?

In a word – I am a scientist. The anti-psychiatrists R. D. Laing and Aaron Esterson were very insightful but they couldn't do research to save their lives. Laing was extraordinarily imaginative, a genius at relating to patients, but didn't know when his ideas were inconsistent. The idea that madness is understandable was his real contribution.

So you want to keep your distance?

My approach is grounded in a lot of experimental research. That is why, although I've tried hard to make my book readable to the non-specialist, the reference section is over 100 pages long. Because I am saying things a lot of people will not want to hear so it's important to show that my ideas have come from research.

Was some of that research a bit personal?

I was involved in an experiment by a colleague, David Healy, at the North Wales Hospital in Bangor. We took a very low dose, 5 milligrams, of droperidol, very similar to the widely used drug haloperidol. Parts of the study were never completed because nearly everybody had a terrible reaction to the drug. Mine was not the most extreme. There was a psychiatrist who became so deeply depressed that she was put under observation.

What happened to you?

I drank this stuff and I felt lethargic and sedated. I thought I had got away with it. Then a psychologist walked in and said: “Oh, this is embarrassing, Richard, but we'd like you to fill in this test.” The embarrassing thing was I had designed the test myself 10 years earlier. I looked at it and I could as soon have climbed Mount Everest. I felt a sense of depression and hopelessness but also an inner sense of restlessness and agitation. It was a combined wanting to do something and not being able to. Then she said: “You don't look too well – would you like some lunch?” I interpreted that as an order – and I've read since that people on neuroleptic drugs take statements as orders. So I said yes. Then she said: “We've a sandwich machine – will that do?” And I said yes because it was all I was up to saying. But I couldn't get the energy to decide what money to use. I just grabbed a coin and it was enough to get a Mars bar, which I was too ill to eat.

Did the drug wear off?

I had to do these neuropsychological tests, and it was embarrassing, but I burst into tears halfway through. I started weeping uncontrollably, so much so that I was given an anticholinergic drug as an antidote and David took me out to get some fresh air. I suddenly felt I had to tell him about all the things I had ever felt guilty about. Then I went back and fell asleep for 3 hours. I woke up with a woozy hangover, like there was a glass wall between me and the world and that lasted for about a week after a single dose. The akathisia – the combined agitation and depression I felt – is experienced by 40 per cent of patients. It tends to go away after about a week, but imagine: you've had a crisis, you're admitted to hospital, you're hearing voices, then someone gives you a drug that makes you feel like that!

But they are designed for sick people…

About 40 per cent of patients have the same experience. That's the great unasked question of psychiatry: what was it like for you? Patients' experiences have been completely ignored.

So are the antipsychotics effective?

It's more complex. There's no doubt these drugs help some people by reducing the hallucinations and delusions. But there are really important caveats. First, something like 30 per cent of patients get benefits from the drugs – and we don't know which ones they will be. Secondly, these drugs have the most horrendous side effects. The old type of antipsychotic drugs produced what we call extrapyramidal effects, including Parkinsonian tremors, tardive dyskinesia (uncontrolled movements of the mouth and tongue) and akathisia.

But surely you just give low doses?

There is a scandal which I must get on my soapbox about – neuroleptic dosage. These drugs were discovered in the late 1940s and in wide use by the 1950s. Bizarrely, the first studies to look at the most appropriate dosage were not published until the 1990s. It turned out that low doses work at least as well as high doses. And for much of that period it wasn't uncommon to find patients on 80 to 90 milligrams of haloperidol. We now consider it irrational to give more than 10 milligrams and better to keep it at 5 milligrams a day, although you can still find patients on higher doses. We've got a massive amount of drug-induced illness – millions of people – and some of them have even been sent to early graves because of the increased risk from heart attacks and various blood disorders. All completely unnecessary.

What about the new antipsychotics?

It turned out the new drugs looked great compared to irrational doses of the old ones, but when compared to rational doses there was hardly any difference. The new drugs don't produce the old side effects, but there are a load of new ones: diabetes, sexual dysfunction, weight gain. I'm not saying drugs never work. If you talk to patients, some will tell you that drugs are a lifesaver and others that drugs have made their lives worse. Quite a few patients now on drugs would be better off without. Perhaps the best thing is to encourage patients to try them and let them decide.

How far can you take this? What about when people are forcibly admitted to hospital?

The first question is, do they need to be? In a lot of circumstances it can be avoided by engaging people in the right way. Why do patients get forcibly admitted? Because they refuse treatment. And why do they refuse? Because lots of psychiatric treatment is crap, it is abusive and horrible.

So put the lunatics in charge of the asylum?

Maybe we should! If we had patients helping to manage services, it would guarantee better services. I think patients should protest more and there should be more progressive services, like the one in Bradford where they have patients – “service users” as they call them – sitting on psychiatric team meetings, involved in decisions.

What makes you identify with the patients?

Basically in the space of a few years in my late twenties, my father was killed in a car smash, I got divorced, my brother Andrew committed suicide and I became depressed. People are nervous about the influence of the family: a psychologist once told me my research was dangerous, that I was reviving the idea that families cause psychosis. The thing is, getting from one end of your life to the other is about negotiating a series of obstacles. Some find it more difficult than others. I wanted to get away from the idea that we are a professional elite who have all the answers. It's not how I feel. And to some extent I talk about my own experiences as an illustration of that. But it's deeply difficult to talk about. As I talk I feel this emotional knot.

And did you seek psychiatric help?

Yes. It was an amazing experience. It was scary. I remember sitting in the waiting room. I remember the anxiety of sitting there and wondering what people were thinking of me. They must think I'm mad. Do they think I'm weird? And trying to look normal by holding a big academic textbook! Then I thought: “This is what people go through waiting to see me.”