I understand there has been a negative article about me in the New York Times and that patients will reasonably be concerned. This page is my general response. If you have more specific questions that you want responses to, feel free to email me.
Like many people in the early 2000s, I started a blog when I was in college. To stay anonymous, I wrote it under my first and middle names – Scott Alexander – while leaving out my last name. I continued writing in it through medical school, residency, and until the present. Although I’ve never personally been involved in the tech industry, my blog became very popular among people in tech because it discussed ideas centering around scientific and technological progress, especially artificial intelligence.
In early 2020, I learned the New York Times wanted to write an article about me. They had discovered my real name and wanted to reveal it to the world. Their original pitch – and I don’t know if it was true or not – was that they were interested in how I predicted the coronavirus pandemic very early and urged people to wear face masks before this was standard advice.
I was grateful for the interest, but still objected that I didn’t want my real name revealed to everyone. I think patients having too personal a relationship with their psychiatrist interferes with care. Patients being able to read my daily thoughts about everything – including medicine and psychiatry – would inevitably cause this sort of inappropriately personal relationship. This is the standard consensus in the psychiatric profession – see this Scientific American article for more information, and it was the advice I received from various past mentors and other psychiatrists I consulted about this. The article also made me concerned for my safety, since there are some scary stories about Internet-famous people whose identities get revealed getting stalked or attacked or something.
When I discussed this with the New York Times, they said they were going to reveal my real name anyway. As a protest and an attempt to prevent this from happening, I deleted my blog and replaced it with a page condemning the New York Times for this. The post “went viral”, 513,000 people read it, thousands of people cancelled their New York Times subscriptions in protest, and it was a major scandal. There were some news stories about it at the time – you can read some of them eg here or here. Some other psychiatrists, including some who were leaders in the American Psychiatric Association, also came out in support of me, something for which I am deeply grateful. I was also proud to get support from voices as diverse as Harvard professor Steven Pinker, Wikipedia founder Larry Sanger, social psychologist Jonathan Haidt, science broadcaster Liv Boeree, and Atlantic editor Yascha Mounk.
The New York Times backed off briefly as I stopped publishing, but I was also warned by people “in the know” that as soon as they got an excuse they would publish something as negative as possible about me, in order to punish me for embarrassing them. I didn’t want to spend the rest of my life in hiding, so I took various steps to make this more surviveable, including quitting PCPA so that they would not get embroiled in my problems, and taking some steps to improve my personal safety. After doing all these things, I started blogging again, this time under my real name since I knew NYT would reveal it anyway. Predictably, the NYT piece came out soon after, and predictably, it was very negative. I want to respond to four main negative claims in the article – there are more, but these should give a general sketch of why I feel it was unfair:
1. The article states that in one post, I “aligned myself” with Charles Murray, famous for his racist views on IQ. I This is true only insofar as I expressed agreement with an unrelated article of his about how saying “learn to code” was not a compassionate or appropriate response for dealing with poverty. The Times’ attempt to insinuate that I praised his racist views on IQ is completely false. I realize it is bizarre to accuse a major newspaper of lying this brazenly, but this is the position I find myself in, and part of the reason I think it was retaliatory rather than a fair attempt at journalism.
2. The article states that I compared “some feminists” to Voldemort. This is true only in the sense that I applied this comparison to a specific group of feminists who were bullying and taunting people in a way that drove them to suicide. Lots of other feminists are great, and I continue to support gender equality.
3. They also presented a more general case that I was a bad ally to women in tech. I deny this claim. I have repeatedly blogged about studies suggesting that women are underrepresented in tech not because of explicit discrimination on the part of tech companies, but because women lose interest in tech very early, at least by high school (high school computer science classes are something like 80% male, the same as big tech companies). I continue to believe these studies are true, I’ve spoken with some of the researchers who have performed them, and the New York Times itself has previously written positively about these same studies. I think understanding the reasons behind gender imbalances in tech is vital towards figuring out how to address them better than we’re addressing them now. There is no evidence that women are inherently any less intelligent or any worse at math than men, and I have tried to make this very clear in all of my posts on the subject.
4. They further presented a more general case that I am six-degrees-of-Kevin-Bacon-style linked to far-right and pro-Trump figures in Silicon Valley like Peter Thiel. I assume this is true – it’s a small world, and I know enough people that I’m sure I’m friends with someone who is friends with Peter Thiel. In fact, I actually met Peter Thiel once, kind of unexpectedly, at a party, long before Trump was in the news, and exchanged about two sentences of conversation with him (I don’t think he had the slightest idea who I was, nor was there any reason he should have). I have never personally met the other right-wing figures named in the article. I wrote a condemnation of one of them on my blog a few years ago, and had a brief email exchange with him about whether the condemnation was unfair; I received a sympathetic email from another about the Times article; others I have had literally no contact with. Again, it would not surprise me if I was a few degrees of social separation from some of these people. I don’t feel like this means I have done anything wrong, and I assume most people are a few degrees of social separation away from a Republican or Trump supporter. I myself am a Democrat (although I continue to work productively with Republican patients, respect them and their beliefs, and I try not to make my political affiliations get in the way of my job).
Other people in journalism share my concerns. British journalist Mary Harrington called it “a startlingly partial and falsehood-adjacent hit-piece”. GMU professor and Bloomberg View columnist Tyler Cowen – himself a former New York Times contributor – said that “I can’t recall the last time I saw such near-unanimous and bipartisan and also highly reasoned condemnation of a feature profile.” I think these views are the consensus and that most people in journalism and the intellectual world think I was treated unfairly.
I understand that some of my political views, including on the future importance of AI, on the importance of a more aggressive response to the coronavirus, and on the origins of gender inequalities in tech, are well outside the mainstream. I try hard not to let any of my unusual views affect how I interact with patients. The only exception is that I am strongly opposed to the current health care system, which I think creates an intolerable cost burden for poor and marginalized people, and started Lorien Psychiatry partly to explore alternative models – in particular, providing care regardless of health insurance status at affordable prices. I have not been especially secretive about this being my goal, and I plan to continue working towards it.
If this article makes you concerned about being my patient, you’re welcome to quit with no hard feelings; I can recommend Pacific Coast Psychiatric Associates as an excellent alternative provider, and if you want I will work with you to make sure you don’t experience an interruption of care as you transfer. If you have very specific questions, I am happy to answer them by email. I am going to strongly avoid anything that feels like a long conversation about politics, or a discussion of the details of my life, for the reasons I mentioned above.
Thank you for your patience during this complicated situation.