Calling some cases “mild” sounds trivializing. Calling other cases “severe” sounds stigmatizing. Whatever your criteria for a mild case are, there will be someone who fits those criteria, but says the condition ruined their life and you are dismissing their pain. Whatever your criteria for a severe case are, there will be someone who fits those criteria but is thriving and living their best life and accuses you of wanting to imprison them in a hospital 24-7.

Plenty of people hear voices. Some of these people are your typical homeless schizophrenic, but many aren’t. One of my patients was a successful computer programmer who had near-daily auditory hallucinations. He realized they weren’t real, did his best to ignore them, and got on with his successful life - just like he had been doing for the past twenty years.

But if you do insist on unusual experiences as the measure of a valid person, then there will always be a pressure to exaggerate how unusual your experience is.

a better framing might be “in the weird cultural situation of 21st century scientific psychiatry, nobody expects voices to be intelligent and agentic, and they aren’t. In some other weird cultural situation, who knows?”

Alcoholics Anonymous makes an interesting comparison: they’re solving this problem in their own way, by being more conservative and unforgiving than the psychiatric establishment would like. Hearing Voices is more liberal and accepting than the establishment, but the key point is not landing in the exact same place.

If this were true, a maximally compassionate policy would involve both trying to support people who are already transgender, and trying to prevent the switch from being flipped in people who aren’t transgender yet.

[Peer Review] Which Party Has Gotten More Extreme Faster?