Review and Science: Thomas Was Alone

Humans have an amazing ability to ascribe intention and emotion when logic tells us there could not possibly be any, a fact demonstrated most succinctly by this clip from Community

but proven somewhat more rigorously by An experimental study of apparent behaviour (PDF), in which experimental subjects were asked to watch and describ a short film showing some shapes moving around.  If you would like to play along at home, I’ve embedded the video below.

The first subject group (n=34 undergraduate women) was given no instruction beyond “describe what happened in the movie.”  Exactly one subject described it in purely geometric terms.  Two others described the shapes as birds, and the rest described them as humans.  19 gave a full story.  The stories people told  (in this treatment and another where subjects were primed to view the shapes as people) had a shocking amount in common, suggesting there was something innate in the interpretation.*

My point is, humans will bond with anything.  In many ways it’s easier to bond with/project onto simple objects than actual humans or almost humans.  This can be used to great effect in art, to evoke desired emotions without all the messiness of using real people.  A simple example is an extremely short, simple game whose name I’m not going to tell you, because it would bias your experience of it.

Did you play it?  The game’s name is Loneliness.  Can you guess why?

I like to think the shunned little square from Loneliness grew up in to be Chris in Thomas Was Alone, a game about rectangles making friends.  Thomas Was Alone‘s premise sounds kinds of dumb: it’s a puzzle platformer with some narration ascribing emotions to the rectangles you solve puzzles with.  But it pulls this off so masterfully I actually bought branded merchandise of it, which is something I can’t say about a single other game.  The story is genuinely sweet, but the real skill is in how the puzzles reinforce it.  Each rectangle has slightly different skills, some more useful than others.  Chris is a shitty jumper whose initial story revolved around resenting the better jumper, and who is nothing but dead weight in the first puzzles (the other rectangles could get through without him, but he could not with them) suddenly becomes indispensable, I felt pride and relief.

TWA starts out a little slow.  If you want to play, finish the first world before deciding whether to continue or quit.  But I highly recommend it both as an interesting example of human psychology, and as a piece of happy art, which I don’t think we see enough of.

Okay, fine, I don’t see enough of because I’m a severe subscriber to the dark and edgy trend.  But that just makes Thomas Was Alone more impressive.

*Attenuated by the fact that women attending college during WW2 is a narrow subset of the population.

Bariatric Surgery

I had a pretty poor opinion of weight loss surgery already, but Health At Every Size all but says any doctor recommending it should lose their license for malpractice.  That claim seems worth investigating.  Luckily, she cites her sources.

First, I feel it’s important to note that bariatric is medical Greek for “obesity related medicine.”  I’m already not thrilled with that because I think excess fat is a symptom of health problems, but rarely a health problem in and of itself.  “Bariatric surgery” is often sold as something that is fixing a problem, the way an appendectomy fixes appendicitis, but it is at best undoing the damage of something else that is making you fat.

That said, let’s start with the immediate death rate.  HAES quotes a study as reporting a 4.6% death rate within the year: what it doesn’t say is that that study was done on Medicare recipients, meaning they were older than 65 or disabled.    Moreover, the 4.6% number is based on death from any cause, not what would be expected above and beyond what is normal for patients’ age and health.  Controlling for age, sex, and likelihood they would have died anyway* the researchers found that surgery increased your risk of death in the 90 days after surgery by somewhere between 90% and 200% (=3 times as likely to die), depending on which demographic you were in.  Inexperienced surgeons make this worse (which they do not back out of their model).  This is not just the stress of surgery: that’s twice the death rate following coronary revascularization or hip replacement, neither of which are minor.

HAES cites another study, published in JAMA as reporting a 6.4% four-year death rate.  This study has a number of problems.  Its only control was matched for age- and sex- but not health status.  A lot of the deaths stem from heart disease, which could plausibly be caused by being fat or having been fat, which is not a case against weight loss surgery.  Worse, that was the death rate only among people considered “at risk” enough to justify four years of follow ups.  The article doesn’t explain what qualified someone as “at risk”, but rarely does that risk mean “at risk of living too long”.  HAES cites a blogger who cites the study as demonstrating a 250%-360% increase in mortality over four years, relative to age- and BMI- matched controls, but I don’t see that anywhere in the original paper.

Meanwhile, the American Society for Metabolic and Bariatric Surgery aka “the people doing the surgeries” is happy to report a mere 0.2%-0.5% mortality rate after the first month of gastric bypass surgery.

That’s everything the book cites on mortality, which I found unsatisfying, so I turned to Dr. Google.  This Swedish study actually bothered to match controls (although surgery was not assigned at random, introducing the possibility that the surgical patients varied on a factor they didn’t think of) and found a 30% reduction in death over 10 years.

But I hate it when people act like death is the only bad thing that could ever happen to you.  What about people who don’t die, but do suffer for the surgery?  HAES cites six studies showing long term nutritional deficiency.  Of the five I was able to find online, all showed serious deficencies and none had a control.  Interestingly they all found a vitamin D deficiency, when vitamin D is primarily produced by your skin in response to sunlight, unless you live in Seattle, in which case you mostly get it through supplements.  Either way, food is not a major source of it, and if bariatric surgery effects vitamin D levels (which these studies have not demonstrated) I am extremely curious as to why.  Given the current controversy as to the efficacy of vitamins even in people with normal stomachs, it’s not clear how much this issue could be fixed with supplementation.

Every study I’ve read agrees that people lose substantial weight after surgery and then gain some of it back, I’m not even bothering looking for citations for this.

CONCLUSION: bariatric surgery has severe risks.  These may be partially compensated for by a skilled surgeon and good nutritional technique.  For extremely obese patients the benefits may outweigh the risks.  We don’t know where the cut off is for “fat enough to benefit.”  The strongest piece of evidence against bariatric surgery is that no one has done the fairly obvious studies that would conclusively demonstrate their effectiveness.

Some of the benefits probably stem from societal approval rather than genuine health issues, and the long term fix for that is for society to stop shaming people for their weight.  Another part of the benefit may be a forcing function, i.e. if patients ate like they’d had the surgery they’d lose weight whether or not they actually had it.  For an individual living in the society they live in and who has already tried dietary changes, this is sad but irrelevant to the decision.

I’m really uncomfortable with this conclusion.  It doesn’t fit my prior model, and I prefer the tribal affiliation of strong weight loss surgery opponents to strong weight loss surgery advocates.  I consider the evidence I’m basing this on somewhat iffy,  but in all honesty if it had come out the way I expected I would be fine with it.  I’m also pretty disappointed in HAES for so blatantly misrepresenting the evidence.

*Risk of death was calculated using the  Charlson Comorbidity Index.   I have no idea if that is a good model, but it appears to be standard.  This doesn’t prevent the researchers from being wrong but it does mean they’re probably not being deliberately manipulative.

Depression in video games

Okay, apparently psychology and video games is my niche and I should just accept that.

If you ask most gamers for a game about depression they’d say Depression Quest*, partly because it has depression right in the name and possibly because one of the designers, Zoe Quinn, has been targeted for massive harassment.  DQ is the world’s most morose choose your own adventure novel.  The descriptions of depression and they choices it leaves you are very accurate, but I left the game thinking “Boy, I am good at fighting depression.  Why don’t actual depressed people do as well as I did on this game?”  Which is of course massively unfair, and I assume not what the developers were going for.  I know other people who have liked it a lot, and it’s short and free, so certainly give it a go if you’re at all interested, but I don’t have much to say about it.

And then there is The Cat Lady.

The Cat Lady is a horror game.  If you hate being scared, or don’t want to see violence, sexualized violence, and gore, you should not play it.  I found it well done, artistically merited, and not exploitative, but it is pretty gruesome.

I like horror video games but no genre misses its mark more often.  Many games are never scary.  Of those that are, most rely purely on jump scares, which make me twitchy but not scared- the opposite of what I want.*  The best part of being scared is when it is over.  Of games that are successfully atmospherically scary at first, most are not by the end. You’re too used to the mechanics, you’ve acclimated to the monsters, your brain has noticed none of this is actually happening.  This can ruin the experience.

BEGIN SPOILERS (not scary)

The tempo of The Cat Lady can roughly be described as spooky-creepy-CREEPY-creepy-TERRIFYING-weird-scary-spooky-….and then every scene is less creepy than the one before.  You could call this a failing, in the pattern of many horror games before it.  Or you could call it a brilliant use of the mechanics of a game to induce a particular psychological state in the user,** in this case with the goal of demonstrating the improvement in the main characters psychological state as the game goes on.  The game starts with her suicide.  It ends with her finding her voice, making a friend, and standing up for what she thinks is right.  It felt very organic.  The player is given a lot of choice in Susan’s dialogue.  At the beginning I chose the most withdrawn and passive options, and at the end I chose the most active and courageous ones, because it felt like that’s what the character would do.  The lessening of terror felt like Susan coming into her own.

END SPOILERS

The negatives are mostly mechanical- for an atmospheric narrative game, the lack of autosave is puzzling.  The inability to manually save during dialogue, which can go 15 minutes at a stretch, is unacceptable.  The lack of even quicksave, meaning I must hit three buttons and then type the name of a new save, and do it compulsively because you never know if I’m about to crash or hit another 15 minute unsavable section, would be unforgivable even if the game hadn’t crashed twice at the same spot.***  The game is very talky, and it’s paced badly.  It was a very poor choice to block saves between chapters, and then start every chapter with a bunch of exposition, because it meant I was leaving the game in medeas res, rather than at natural down beats.  The talky bits were sometimes very interesting but sometimes very painful to get through- a lot of plumbing through dialogue trees to get the option you already know you’re going to use.

Would I recommend this to a person who wanted to know what depression felt like?  Only very a specific person.  You’d have to be a horror fan or you’d never get past the second chapter.  And if you don’t naturally get the genre I’m not sure it would have the same effect.  Would I recommend it to a depressed person looking to see their experiences reflected in art?  Same caveats, with possibly a wider net, since depressed people will more naturally get the depression in the beginning.  The writer/designer apparently has personal experience with depression, and it shows.  Would I recommend it to someone who likes horror games?  Yes, definitely, without reservation.  It is so good.

As a side note, I think is another piece of evidence for my evolving hypothesis about women and horror stories.  I don’t what the statistical distribution is because I watch a very nonrandom subset, but in a world where most major movies don’t even pass the Bedschel test, horror films address a lot of “women’s issues”.  Ginger Snaps and Jennifer’s Body are about female competitiveness as they come into sexual power, Mama is about being raised by a mentally ill parent, and Drag Me To Hell is about an eating disorder.  And now The Cat Lady is about depression, and the way depressed middle aged women are treated by society.

*There is a very slight chance they’d say Shadow of the Colossus, which is an excellent game, but any connection to depression is buried deep in metaphor.

MORE SPOILERS

*I discovered something interesting when I played Condemned.  Originally the contrast on my TV was so  bad I couldn’t see enemies (which, for maximum discomfort, are crazed homeless people) until they’d actually attacked me.  This was startling, but not scary at all.  I then upped the contrast so it was theoretically possible for me to see enemies ahead of time, although they were still mostly hidden.  This was much scarier.  It’s like I don’t feel fear unless something is preventable through my own actions.  Ironically the fact that The Cat Lady is a puzzle game, and thus you are never on a clock and can only die when the story says you’re definitely going to die, makes it easier for me to be scared.

**Papers, Please is the only other game I think of that does this.  It takes the mundanity of a lot of casual games and makes it a manifestation of working a soul crushing job.  I was impressed with them too.

***Non-gamers: I know it sounds like I’m overreacting, but I’m not.  Imagine if you had to walk to another room to save your place in a book on every page.

Book Review: The Child Catchers

I’ve used the words “calling” or “purpose” a few times on this blog now.  I’m not Christian, but I was raised in a Christian home in a Christian culture, and my concept of a calling is clearly steeped in that tradition.

So for me, reading The Child Catchers (Kathryn Joyce) was mostly a cautionary tale about letting a Call override the rest of your brain.  Step by step, Joyce takes you through how a large group of people who fervently believed they were doing not only the right thing, but the best thing, the thing they had been called by their God to do, destroyed the lives of countless children and ripped about whole societies.  Some of it came from privilege/White Man’s Burden beliefs, but some of it was just that they had bad or insufficient information.

On a practical level, non-foster-care adoption seems to have the trouble as the pharmaceutical industry: we wanted something (lifesaving medicine, care for abandoned children) but didn’t want to pay for it, so we handed the bill to the deepest pocket around (pharma companies, adoptive parents), and then we got mad when the system inevitably bent towards their point of view.  A lot of the problems in adoption stem from that most systems match a parent with a specific child and then start verifying if the child is available to be adopted.  Or the adoptive parents start picking up the mother’s expenses before birth.  The very impulse that will make these prospective parents good parents- the belief that this is their child– is incredibly destructive at this stage, and the fact that they’re required to invest a lot of money makes it worse.  It inevitably leads people to view searches for biological extended family as obstacles, or pressure a birth mother to “keep her word” and surrender the infant.  Even if they haven’t bonded with that specific child (which I would find worrying), they may not have the money to try again.  That’s just not fair.

Rwanda has chosen a different tactic.  International families go on a waiting list.  The Rwandan government checks all potentially eligible children, which involves looking for biological family who might take in the child and making sure the birth mother wasn’t coerced, or finding an unrelated local family that would like to adopt.  By the time an international adoptive family is contacted, the chances of something going wrong are minuscule.

Callings are important, but they need to be reality checked.  That might be my new Effective Altruism slogan.

Reality is Broken and how to fix it

I am very into video games.  This does not mean I play many video games- I’m below average for people I know, although that’s a skewed sample.  But I do a lot of reading about video games , because I find economics interesting and the business of video games has a confluence of factors that allow me to understand it.  Plus, it’s going through some interesting transformations on both the monetary and art fronts.  That is why I read Reality is Broken by Jane McGonigal.

Much like researchers of heroin and cocaine before her, McGonical’s approach is to look at something addictive and, rather than declare we’re all weak for liking it, study why it is so addictive/satisfying and what we can do to bring that into our lives in a healthy way.  Her list of things video games provide us- flow, challenge, ownership, accomplishment- read like a list of things my job doesn’t do.  Which I already knew, and has led me to start researching other careers, which led to among other things this blog.  This gave me the idea to start alternating work-type tasks with video games targetted to give the satisfaction of having done work (e.g. Harvest Moon, which is about running your own farm).  For the moment the work type task is “reading books I already wanted to read”, but it nonetheless raised my satisfaction and endurance level significantly, and I’m hopeful it will help when I return to work as well.*

But then McGonigal shifts tacts, and talks about all the ways we can use video games to improve the world.  One example is Foldit, in which players are given the primary structure of a protein and attempt to find the lowest-energy tertiary structure for it.  Scientists actually use these results in their research. **   She also designed World Without Oil, a collaborative fiction game where people brainstormed how to adapt to an oil storage.

She also talked about her prolonged recovery from a concussion.  I identified with this a lot: the lack of tangible progress, the alternation between not having the energy to do what you’re supposed to and being desperate to do something but not knowing what.  In my case there’s also juggling several different problems, and wondering if you’d be happier if you just concentrated on one until it was done, and trying to manage containing the most urgent symptoms and investing in long term solutions.  I responded by writing “this is hard” in my diary.  Jane McGonigal responded by making SuperBetter, a website/service that gamifies convalesence (think fitocracy but for actual health, rather than health-as-codeword-for-skinny).  This was kind of a revelation for me on two levels.  One, it solved a problem I had recently been whining about, and enables me to take better care of myself.  I’ve been using it for a week so far, and while it’s not magic, it is helpful, and it is most helpful when I am least able to act on my own.

Two, it has me thinking about my future.  My volunteer thus far has me very convinced I want to work in adolescent mental health.  I think that is my special talent and while I feel stupid saying it, I genuinely think I could change the world.  I want to do that.  But so far my research has focused on existing career tracks I could jump into (psychiatrist, counselor, etc).  I’d considered programming for a company that made meaningful software but dismissed it, in part because I’d done it before and found it lacking.  But maybe there’s a hybrid.  I could have made SuperBetter.  I mean, the last webpage I made was written in notepad, but I’m capable of learning the skills to make SuperBetter.  Hell, I could probably get a job to pay me to learn the skills to make SuperBetter.  There’s no credential holding me back.  And I think I would be really proud of myself if I did something like that.

MoodGym already exists, so off the top of my head I don’t know what I could create that would add value to the world.  I definitely need more volunteering and reading to find out, and may quite possibly need more formal education.  But my eyes are open to the broader range of possibilities for me to change the world, both now and in the future.

Which is extremely convenient, because the money that would have gone to taking off work and soul searching has gone to taking off work and holding an ice pack to my jaw.  It was a good trade given the circumstances, but it may set formal school back years.  This was an excellent time to acquire hope I can do more in place.

*According to Reality is Broken, this is common strategy among top executives.

**This is how I got through the analytical section of organic chemistry.  I hated all that stuff that was never going to be relevant to me as a behaviorist until I realized it used exactly the same part of my brain as the game Set, which I loved.  I went on to nail that test and enjoyed it more than any other part of orgo.

First Impressions: It’s Not Just Who You Know, by Tommy Spaulding.

I have a long and antagonistic relationship with social skill how-to books, starting with my award winning 8th essay about How to Win Friends and Influence People.  The essay was about how it didn’t teach you how to make friends, it taught you how to suck up to people, and my award was that I got to stop reading the book.*  As an adult I realized that HtWFaIP couldn’t possibly have stayed that popular for that long for no reason and gave it another shot.  The most charitable thing I could say was that it was for incompetent or unconfident extroverts.  I was a profound introvert, and Carnegie genuinely did not seem to get the idea that talking to people could be draining.

This would become a theme with me.  I am eternally grateful to the friend who loaned me Crucial Conversationsbecause it immediately improved my life by 15%, and has never stopped paying dividends.  How to Talk so Kids will Listen and Listen so Kids will Talk and John Gottman’s books on marriage** were not quite as revolutionary, but I enjoyed reading them and knew they would have been useful had Crucial Conversations not gotten there first.  But those were books focused on doing emotional work in deep relationships.  Books about professional networking or making friends tended to leave me just as angry as HtWFaIP, for similar reasons.  They assumed that everyone wanted the things extroverts wanted, and that they could get them by acting like extroverts.  I didn’t need someone to encourage me to speak up at corporate dinners, I needed either a list of tricks to make them less energetically costly for me or a less painful way to get the benefits of attending said dinners.***  Or they imply there’s something wrong/selfish/possibly evil about me not wanting to engage with every person I meet.

Along with the rest of the internet, I went through an introverts rights phase, reading Quiet and Introvert Power.  Those made me feel better about myself, and helped me socially by making me feel more comfortable advocating for my needs.  But they were never intended to be how-to books.

Now I am reading It’s Not Just Who You Know. It’s pitched as “How to Win Friends and Influence Peoplebut for emotionally meaningful relationships.”, which so far has been ragingly inaccurate, but I’m only 30% in, and what it’s been so far has been even better.

So far INJWYK has been a memoir, starting in high school, of how Tommy Spaulding’s social skills and resulting social connections have helped him.  For a while I struggled with jealousy at what Spaulding got through socializing and I thought be “earned.”  What I eventually realized was this:

Tommy Spaulding talks to people the way I read books.

That is, sometimes he has a very explicit goal oriented exchange (like, I don’t know, buying a shirt.  He doesn’t devote much book time to these interactions) just like I sometimes read a technical manual to extract a specific fact.  But mostly, he talks because talking is a thing he enjoys doing.  He does some research to direct his efforts to the people he’s most likely to find most interesting, and he’s worked out techniques to make those conversations as interesting and rewarding as possible.   If nothing useful ever came out of it he would probably change his approach.  But he is not approaching anyone with the idea of what they can do for him, and he’s very conscious of the value of other people’s time.  I am never, ever going to talk to as many people as Tommy Spaulding does.  But I respect and value his approach, in a way I never did Dale Carnegie.

Additionally, this knowledge has helped me stop resenting people who get nice things via social interaction.  Those people benefit from their hours of socializing.  I benefit from my hours of reading.  If I’m going to complain about the unfairness of people benefiting from social connections, I’d better be prepared to give up the advantages I gain from reading.

*That was the year I was homeschooled.  The primary benefit of homeschooling was no longer attending a school where I had a perfectly reasonable fear of being stabbed, but the option to reason my way out of dumb assignments was nice too.

**I have never been married and have no kids, but I’d heard really good things and thought the principles might be useful.  I was right.

***For example, suppose your goal was meet new people and advertise your professional skills, with some thought to advancing your career.  You could go to to industry social events and apply HtWFaIP.  But if you’re a programmer you can get many of the same benefits by contributing to open source projects. Yes, it’s a lot of hours of work for the amount of recognition and networking you achieve.  But if you love programming and hate talking to strangers in crowds, it’s worth considering as a partial replacement.