Bryan Caplan  

Howard Hughes and the Economics of Mental Illness

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I finally saw The Aviator, and it's hard not to scream "Scorsese was robbed!" Larry White has already done a great job of analyzing the bread-and-butter economics of the story. What's fascinating to me, however, is the exploration of Hughes' eccentricity/mental illness.

I am a big fan of psychiatrist Thomas Szasz (pronounced like the statistical program SAS). Szasz is notorious for his view that "mental illness is a myth" - which of course does not mean that self-destructive and anti-social behavior does not exist, but that "diagnoses" of mental illness are covert ethical judgments rather than scientific diagnoses.

In one of my favorite papers, "The Economics of Szasz", I argue that microeconomics and Szasz have a natural affinity. As he puts it in Insanity:

Do we want two types of accounts about human behavior – one to explain the conduct of sane or mentally healthy persons, and another to explain the conduct of insane or mentally ill persons? I maintain that we do not need, and should not try, to account for normal behavior one way (motivationally), and for abnormal behavior another way (causally). Specifically, I suggest that the principle, "Actions speak louder than words," can be used to explain the conduct of mentally ill persons just as well as it can the behavior of mentally healthy persons.

Move over, Gary Becker! In economic terms, I argue that the best way to model mental illness is as "extreme preferences" rather than literal incapacity. Rather than give you my big theoretical case, I'm going to apply it to Hughes' bizarre behavior, and let you see if the shoe fits. (Aside: I don't know how factually accurate The Aviator is, though all the license taken by A Beautiful Mind makes me wonder).

What's so odd about Hughes? His biggest foible, which drastically increases during the story, is germophobia. No doubt today he'd be diagnosed with Obsessive-Compulsive Personality Disorder. I say, however, that this is just name-calling. Hughes worried a lot more about germs than I do. A lot more. But I don't see why this makes him less of a rational economic agent than me. My dad can spend 10 hours a day watching sports, which seems like a complete waste of time to me. Why should I judge a man who fights germs 10 hours a day any differently?

In "The Economics of Szasz", I argue that a key test of my position is responsiveness to incentives:

Can we change a person's behavior purely by changing their incentives? If we can, it follows that the person's was able to act differently all along, but preferred not to; their condition is a matter of preference, not constraint. I will refer to this as the "Gun-to-the-Head Test." If suddenly pointing a gun at alcoholics induces them stop drinking, then evidently sober behavior was in their choice set all along.

So what do we see in the movie? Even when he seems awfully "crazy," Hughes pulls himself together for the sake of his airline. He hates to risk getting someone's germs from shaking hands, but he shakes the hand of the senator he wants to win over. He hates to go out in public, but he testifies before Congress to defend himself from accusations of "war profiteering." Sometimes he obsessively repeats catch phrases to himself. "Show me all the blueprints. Show me all the blueprints. Just show me all the blueprints." But when he has to win over the American people with his Congressional testimony, he is suddenly articulate and charming.

Call him OCD if you must. The Howard Hughes of The Aviator recognized and responded to incentives just like homo economicus is supposed to.


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COMMENTS (10 to date)
Jonathan Brown writes:

Scorcese was robbed? Baloney - Million Dollar Baby actually had a well told story and more than one talented actor.

Danno writes:

As a warning: I have not had the time to read your essay, it's a bit late, but I wanted to respond to the gist of it, so you may have already addressed my points.

A diabetic suffers from extreme blood sugar levels to the point that it affects the rest of their general health.

In that case, I don't see why extreme levels of certain neurotransmitters or reuptake inhibitors or what have you shouldn't be treated as a disease when it affects the general health of a person as can often be the case with schizophrenics or OCD sufferers. (Anecdotally, I have heard of germaphobe OCD sufferers going to such lengths as boiling their hands to attempt to stay clean).

To summarize, why would an extreme variation in blood chemistry be acceptable as a disease but one in brain chemistry would not?

Ronnie Horesh writes:

Perhaps the incentives for rich people, kings or dictators are different. When they are surrounded by sycophantic flunkies or courtiers, odd behaviour that would otherwise be subject to subtle disapproval is regarded as a charming or lucrative eccentricity.

Randy writes:

I think there are both causal and motivational elements in normal and abnormal behavior. Those whose business is with people (managers, judges, etc.) recognize both, and incorporate both in their decisions.

Bill Stepp writes:

I've not yet read Bryan's paper, but as a devoted Szaszian, I would respond to Danno's extreme blood chemistry point above by noting that this may (or may not, I am no physician) be evidence of a physical illness, but why muddy the water by calling it evidence of a "mental illness"?
As Ssasz points out in several places, an illness has a physiological manifestation, such as a lesion.
The brain can have a lesion (e.g., a tumor), which perhaps can cause incomprehensible and abnormal behavior (action?) that might be labeled "mental illness," but it has a physical cause. Calling a possible symptom (weird behavior) "mental illness" is unhelpful at best.

Jon writes:

Modern physiology and research on the relationship between mind and body makes a joke out of the Szazs viewpoint. The only difference between mental and physical illness is that the former is harder to diagnose as brain chemistry is much less accessible and more complicated then blood chemistry. The difference between diabetes and "normal" is the point at which the blood chemistry reaches the point where we believe it will impair the quality of life. Similarly the difference between "normal" and "mentally ill" is the point where the quality of life is impaired by the reaction of the mind to the environment.

The debate really becomes symantec at some point. If a medecine or therapy works to improve someone's life it should be used.

Jon writes:

The Szasz concept really originates from the discomfort many people have with "shades of gray". Szasz prefers to deal with the problem of separating mental illness from preference by defining it away. This does little to help us improve anyone's life.

The "gun to the head" analogy does not deal with the issue. The person who requires an incentive as strong as a "gun to the head" to alter destructive behavior clearly suffers quite a bit of anguish; just as much as someone with a painful disease may require a gun to the head to endure the pain of walking up a flight of stairs.

The "extreme preference" theory would state that the man who jumped into the tiger cage at the zoo was merely exhibiting an "extreme preference"; this is a useless tautology and only helps obtain some greater enjoyment from abstract theories of homo economus by stretching them beyond their useful limits.

The concept of mental illness allows us to recognize that he was at risk for that behavior and appy treatment to prevent it. Most of the people (and their friends and families) who have benefited from such treatment would consider the mental illness concept extremely useful.

Bernard Yomtov writes:

Thank you, Jon.

Yes. Szasz's ideas have proven wrong. Just as wrong as the notion that being a rational economic agent is proof of the absence of mental illness (or just illness, if Bill Stepp prefers).

Debi writes:

Mental illness is in the eye of the beholder. If Hughes was content to piss in a different mason jar each time he had to empty himself, then what's the big deal? If, however, he wanted desperately to stop and didn't know how, that becomes a major deal.

Of course, if the entire event was entirely made up, that's a different debate.

Debi

Miss_ill writes:

all mental illness is not created equally.

thanks for the article. much enjoyed.

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