02 Apr 2019

The Flu Preference

Humor 8 Comments

When I describe gastrointestinal illness as “an extreme, socially disapproved preference,” the most convincing counter-example people offer is the flu.  Do I really think people “want to have the flu” or choose the flu as a bizarre alternative lifestyle?

My quick answer: These objections confuse preferences with meta-preferences.

No one chooses to have the gene for cilantro aversion.  Yet people with the cilantro aversion gene are perfectly able to eat this vegetable.  They just strongly prefer not to.

Similarly, when I say that those “with the flu” are people who value blowing chunks more than avoiding grossing out their family, this doesn’t mean that they like having these priorities.  If they could press a button which would eliminate their desire to puke, I bet many with the flu would press it.  But given their actual cravings, they prefer to keep vomiting heavily despite the suffering of their families.

Is this all just a word game?  No.  The economic distinction between preferences and constraints that I’m drawing upon has three big substantive implications here.

First, people with extreme preferences could make different choices.  People with cilantro aversion are able to eat cilantro.  People with the flu are able to stop vomiting.  For example, an adult with the flu usually makes it to the bathroom before puking.

Second, as a corollary, people with extreme preferences can – and routinely do – respond to incentives.  Although it hasn’t been formally tested in the lab, I’m sure the appropriate experiment would find that this “need” to throw up would be postponed more often in cases when the carpet is very expensive–thus proving that vomiting, even when you “have the flu,” is a rational choice in a world of tradeoffs.

Third, as a further corollary, people with extreme preferences can – and routinely do – find better ways to cope.  People reshape their own preferences all the time; perhaps you can do the same.  If you find yourself “with the flu” and feeling miserable, take a bath and a nap. Don’t just wallow in your misery.

* I’m well-aware that many physical symptoms also respond to incentives.  You can pressure a diabetic to lose weight, which in turn reverses his diabetes.  But all of these incentive effects require time to work.  The symptoms of the flu, in contrast, can and often do respond to incentives instantly, because they are choices that are always within your grasp.  “I’m divorcing you unless you stop puking right now” is a viable threat.  “I’m divorcing you unless you stop being diabetic right now” is a silly one.

P.S. If you liked my analysis, you will also enjoy Bryan Caplan’s similar discussion of clinical depression.

8 Responses to “The Flu Preference”

  1. ThomasL says:

    I am not sure the ability to delay something a little while is enough to call something a preference. Breathing and blinking can also be done intentionally right now, or postponed for a period.

    But it would be pretty bizarre to say that someone merely had a strong, social preference for breathing.

    Likewise for using the restroom, vomiting, etc. One is able to constrain or induce them somewhat, but they are not strictly optional in the sense that they are things you can just take or leave.

  2. Denver Hoggatt says:

    I don’t think people with the flu are capable of choosing not to vomit. Though, granted, I’m only claiming that based on introspection. And maybe if I was a severe schizophrenic, I would introspect that I was incapable of choosing not to hear voices.

    So maybe Bryan’s hard-line Szaszian stance is too strong, but I do think he has a point that modern psychiatry undervalues the role incentives play in changing people’s behavior (as well as people’s ability to just choose not to act on their “preferences”).

  3. Harold says:

    Radical freedom!

    I have a preference to drink water and eat food. I am free to exercise my option to refrain from both. People do it all the time. Some are called breatharians. Or more frequently they are called “the deceased, formerly a breatharian.” The inevitable consequence of that choice is that I would die quite soon, but that is my choice if I were to take it.

    Sartre said we always have a choice. Following from a discussion a week or so ago, he was another who did not believe in a self that continues through time -to him there was only the present.

    There are some parallels between Sartre and Mises – doing nothing is itself a choice, for example. Everyone must take responsibility for their actions. It was not society, or your abusive parents that were responsible, it was you!

    Camus wondered, given this reality, why anyone chooses to carry on rather than commit suicide, which nearly all of us could do if we chose. Why do we continue?

    On the opposite pole there is determinism. Everything has a cause, there is no choice, no free will.

    Either of these positions may be true. Neither do I find particularly useful.

    We may have free choice, but we know without doubt that given certain priming and pre-conditioning, almost everyone is more likely to take one choice rather than another. Is that free choice? How can it be? Almost everyone does not choose suicide – is that free? Not completely. We are born with instincts and drives that inevitably dictate some of our preferences, which in turn almostinevitably dictate our actions. It is that almost that makes the difference.

    The will to live is like the bad taste of coriander for those with cilantro aversion. I can do nothing about it, but with sufficient incentive I can change my actual preference and choose to die. However, nearly all of us choose to continue living because of a pre-programmed preference.

    Does my dog have a similar choice? If asked, she will (sometimes) refrain from eating a tasty snack until given permission. Clearly she is choosing to refrain from eating for that period, just as the flu victim is refraining from throwing up until the toilet bowl, sink or bucket is in range. She could in principle simply continue to do so indefinitely until she died. She is just as free as I am, but seems to have even less likelihood to break free from the innate preferences she has.

    To me the “could in principle, if the incentives were high enough” is not that helpful. We know that most people will behave according to their innate preferences, so it is more useful to ask “what can be done to encourage a person from following harmful preferences?”

    Having said that, there is something in it. If mental illness is a massive stigma, people have a huge incentive not to show it or even admit they have it. It is possible that reducing this stigma allows people to “give themselves permission” to be depressed.

    • Tel says:

      Camus wondered, given this reality, why anyone chooses to carry on rather than commit suicide, which nearly all of us could do if we chose. Why do we continue?

      It’s a self contradiction. The “we” described here is already limited to the people who chose not to commit suicide, because everyone who wanted to just give up have already removed themselves (usually some time ago).

      However, if the real question is “What motivates people?” the answer is lots of different things … it depends.

      On the opposite pole there is determinism. Everything has a cause, there is no choice, no free will.

      As an empiricist my argument on determinism is that anyone who wants to demonstrate the ability to predict the behaviour of everyone on Earth all the time is more than welcome to do so. If that happens then I would have to accept determinism. If not, then they probably don’t really know.

      That said, I think you can predict some of the people some of the time, and that kind of thing does get demonstrated, so a watered down weak determinism might be plausible.

  4. Bitter Clinger says:

    I don’t understand either Caplin’s or Dr. Murphy’s posts on meta-preference. My understanding is that a meta-preference is a preference over preferences. I have one. In the early 90’s I went to a executive development program called Personal Peak Performance. Jim Looram PHD developed it. It was about finding your mission, purpose, and meaning in life.

    Looram said that 10% of the people in the US have a purpose and can articulate it. Another 15 to 20% have a purpose but can’t articulate it. The balance of the population has the meta-preference of Harold’s dog, that is to eat, sleep, and procreate. They can be seen at Sanders/Warren rallies howling, “Medicare for all and Climate Change.” Of course there are the ones at the Trump rallies that are barking, “Lock them up.”

    Looram’s book, Your Essential Self is an accurate portrayal of the class but without the Foo Foo exercises in yoga, tree hugging, and meditation; it doesn’t deliver the impact of being there. What he said (and is true) is that less is more. Once you know your meta-preference, that is your mission, meaning, and purpose in life; choosing your preferences is easy. I would never choose to have PTSD (for many years I thought it was Agent Orange though as far as I know I was never exposed) but because I can articulate my mission in life, I can work through the anxieties and depression to accomplish my purpose. I get up in the morning with a preference for beer, ice cream, or exercise; I will choose the one that is most supportive of my mission. Easy, straightforward obviously less is more.

    I believe that all commenters on this blog have a meaning and purpose in their lives, or else they would be on facebook or twitter. Whether they can articulate their purpose is another story. My mission is not flexible enough to encompass attempting to help you discover your missions but at the same time it is flexible enough to let you know that if you can articulate your mission (purpose), i.e. write it down, your life will be better, easier, more meaningful. As you can see, incentives not only effect preferences they can also effect your meta-preference.

  5. Harold says:

    “The balance of the population has the meta-preference of Harold’s dog, that is to eat, sleep, and procreate.” Well, she also wants to please or obey me more than she wants to eat, at least for a while. Fitting in to the pack is very important for dogs and dictates a lot of their behaviour.

    I note that you classify this post as humor, but Caplan’s paper is certainly serious and could affect the way ill people are treated.

    I have been pondering this preference thing. We have likes and dislikes, but these are not preferences. Preferences require two things at least to choose between. Surely we must distinguish between likes and preferences?

    Take cilantro. To those with the aversion gene it tastes of soap. Nearly everyone dislikes the taste of soap. Therefore given a choice between cilantro and most other food, their preference will generally be for the other. If they live in SE Asia, lots of food has cilantro in it and avoiding this is a problem. We could say their meta preference is that they would rather prefer cilantro to other foods, but it would be more accurate to say they would rather cilantro did not taste of soap. The taste of soap is not a preference, it is a state of being dictated by the gene. If cilantro did not taste of soap, it would naturally follow that they would not prefer to avoid cilantro and they could go out to dinner.

    Homosexuals find people of the same sex attractive. Given this attraction, they are just following exactly the same preference as heterosexuals in choosing to have relationships with people they find attractive. In repressive societies, they may want to prefer a different sex, more fundamentally they don’t want to find the same sex attractive, then the preference would inevitably follow.

    Someone with a sprained ankle avoids walking because of the pain. They have a preference for immobility. They may have somewhere to go, and so their meta-preference is for mobility. However, it is a very odd way to put it. We would not usually express this as a preference. What they want is to not have pain. Preferring to avoid walking is an inevitable consequence of the universal human condition of pain avoidance. Heal the sprained ankle and the preference for mobility naturally follows, just as the preference for cilantro and people of the opposite sex in the earlier examples.

    All of the above share a common theme that the underlying condition is pretty much universal – it is hard wired into us. We all share avoidance of particular tastes, following attraction and avoiding of pain.

    Does this ever stop? Does this framing make the whole idea of preferences meaningless? A common illustration of meta preference is a preference for sitting on the couch compared to exercising. We say that the lazy person’s preference is for relaxing, while their meta preference is for exercise; they would rather prefer exercise. However, quite a lot of people feel really good after exercise. If you prefer oranges to apples, then there are lots of people who have the opposite preference. We don’t know what personal sensations these people experience. Maybe there is different way people experience apples and exercise. However, we have no knowledge of these experiences. We simply say that it is a preference.

    So I say that the things discussed by Bob and Caplan are not meta preferences. Because we can pin down the sensation that is pretty much universal, this is not a preference, bit a condition. Homosexuality, sprained ankles, cilantro aversion schizophrenia and depression are not best described as meta preferences, because we don’t have choice about them.

    They are not ““an extreme, socially disapproved preference,” but rather a normal preference to an unusual condition.

    Here is a paper about liking vs preference.

    • guest says:

      “Homosexuality, sprained ankles, cilantro aversion schizophrenia and depression are not best described as meta preferences, because we don’t have choice about them.”

      Here’s an article that makes the case that, while it’s true that homosexuals “can’t help” their attraction, it is nevertheless based on unhelpful and self-damaging perspectives about themselves that then results in same-sex attraction.

      Strong preferences (homosexual preferences, included) are not a barrier to changing those preferences if those preferences are ultimately due to the paradigm one holds:

      The Meaning of Same-Sex Attraction

      “Homosexual acting-out, for these men, is an attempt at restoring psychic equilibrium in order to maintain the integrity of the self-structure.”

      This “integrity of the self-structure” perspective is helpful.

      No, homosexuals can’t help their desires (because the paradigm they hold is part of what makes them who they are); But, yes, their desires can change.

      • Harold says:

        Interesting that you should reference Nicolosi. In an ironic twist, given the tile of this post, from Wikipedia.

        “He died in March 2017 at the age of 70 from complications from the flu.”

        Just exercising his preference, perhaps?

        However, Nicolosi is a very controversial figure, described as a purveyor of pseudo-science and whose theories have been rejected by the scientific community. The American Psychological Association issued a proceeding rejecting the approach in 1998 and again in 2009.


        I find your evidence in this case very unconvincing, so I stick to my original take for now.

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