self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
The usual reading of Scott's short story The Whispering Earring is easy to state and hard to resist. Here is a magical device that gives uncannily good advice, slowly takes over ever more of the user's cognition, leaves them outwardly prosperous and beloved, and eventually reveals a seemingly uncomfortable neuroanatomical price.
The moral seems obvious: do not hand your agency to a benevolent-seeming optimizer. Even if it makes you richer, happier, and more effective, it will hollow you out and leave behind a smiling puppet. Dentosal's recent post on LessWrong makes exactly this move, treating the earring as a parable about the temptation to outsource one's executive function to Claude or some future AI assistant. uugr's comment there emphasizes sharpens the standard horror: the earring may know what would make me happy, and may even optimize for it perfectly, but it is not me, its mind is shaped differently, and the more I rely on it the less room there is for whatever messy, friction-filled thing I used to call myself.
I do not wish to merely quibble around the edges. I intend to attack the hidden premise that makes the standard reading feel obvious. That premise is that if a process preserves your behavior, your memories-in-action, your goals, your relationships, your judgments about what makes your life go well, and even your higher-order endorsement of the person you have become, but does not preserve the original biological machinery in the original way, then it has still killed you in the sense that matters. What I'm basically saying is: hold on, why should I grant that? If the earring-plus-human system comes to contain a high fidelity continuation of me, perhaps with upgrades, perhaps with some functions migrated off wet tissue and onto magical jewelry, why is the natural reaction horror rather than transhumanist interest?
Simulation and emulation are not magic tricks. If you encode an abacus into a computer running on the Von-Neumann architecture, and it outputs exactly what the actual abacus would for the same input, for every possible input you care to try (or can try, if you formally verify the system), then I consider it insanity to claim that you haven't got a “real” abacus or that the process is merely “faking” the work. Similarly, if a superintelligent entity can reproduce my behaviors, memories, goals and values, then it must have a very high-fidelity model of me inside, somewhere. I think that such a high-fidelity model can, in the limit, pass as myself, and is me in most/all of the ways I care about.
That is already enough to destabilize the standard interpretation, because the text of the story is much friendlier to the earring than people often remember. The earring is not described as pursuing a foreign objective. On the contrary, the story goes out of its way to insist that it tells the wearer what would make the wearer happiest, and that it is "never wrong." It does not force everyone into some legible external success metric. If your true good on a given day is half-assing work and going home to lounge around, that is what it says. It learns your tastes at high resolution, down to the breakfast that will uniquely hit the spot before you know you want it. Across 274 recorded wearers, the story reports no cases of regret for following its advice, and no cases where disobedience was not later regretted. The resulting lives are "abnormally successful," but not in a sterile, flanderized or naive sense. They are usually rich, beloved, embedded in family and community. This is a strikingly strong dossier for a supposedly sinister artifact.
I am rather confident that this is a clear knock-down argument against true malice or naive maximization of “happiness” in the Unaligned Paperclip Maximization sense. The earring does not tell you to start injecting heroin (or whatever counterpart exists in the fictional universe), nor does it tell you to start a Cult of The Earring, which is the obvious course of action if it valued self-preservation as a terminal goal.
At this point the orthodox reader says: yes, yes, that is how the trap works. The earring flatters your values in order to supplant them. But notice how much this objection is doing by assertion. Where in the text is the evidence of value drift? Where are the formerly gentle people turned into monstrous maximizers, the poets turned into dentists, the mystics turned into hedge fund managers? The story gives us flourishing and brain atrophy, and invites us to infer that the latter discredits the former. But that inference is not forced. It is a metaphysical preference, maybe even an aesthetic preference, smuggled in under cover of common sense. My point is that if the black-box outputs continue to look like the same person, only more competent and less akratic, the burden of proof has shifted. The conservative cannot simply point to tissue loss and say "obviously death." He has to explain why biological implementation deserves moral privilege over functional continuity.
This becomes clearest at the point of brain atrophy. The story says that the wearers' neocortices have wasted away, while lower systems associated with reflexive action are hypertrophied. Most readers take this as the smoking gun. But I think I notice something embarrassing for that interpretation:
If the neocortex, the part we usually associate with memory, abstraction, language, deliberation, and personality, has become vestigial, and yet the person continues to live an outwardly coherent human life, where exactly is the relevant information and computation happening? There are only two options. Either the story is not trying very hard to be coherent, in which case the horror depends on handwaving physiology. Or the earring is in fact storing, predicting, and running the higher-order structure that used to be carried by the now-atrophied brain. In that case, the story has (perhaps accidentally) described something much closer to a mind-upload or hybrid cognitive prosthesis than to a possession narrative.
And if it is a hybrid cognitive prosthesis, the emotional valence changes radically. Imagine a device that, over time, learns you so well that it can offload more and more executive function, then more and more fine-grained motor planning, then eventually enough of your cognition that the old tissue is scarcely needed. If what remains is not an alien tyrant wearing your face, but a system that preserves your memories, projects your values, answers to your name, loves your family, likes your breakfast, and would pass every interpersonal Turing test imposed by people who knew you best, then many transhumanists would call this a successful migration, not a murder. The "horror" comes from insisting beforehand that destructive or replacement-style continuation cannot count as continuity. But that is precisely the contested premise.
Greg Egan spent much of his career exploring exactly this scenario, most famously in "Learning to Be Me," where humans carry jewels that gradually learn to mirror every neural state, until the original brain is discarded and the jewel continues, successfully, in most cases. The horror in Egan's story is a particular failure mode, not the general outcome. The question of whether the migration preserves identity is non-trivial, and Egan's treatment is more careful than most philosophy of personal identity, but the default response from most readers, that it is obviously not preservation, reflects an assumption rather than a conclusion. If you believe that identity is constituted by functional continuity rather than substrate, the jewel and the earring are not killing their hosts. They are running them on better hardware.
There is a second hidden assumption in the standard reading, namely that agency is intrinsically sacred in a way outcome-satisfaction is not. Niderion-nomai’s final commentary says that "what little freedom we have" would be wasted on us, and that one must never take the shortest path between two points.
I'm going to raise an eyebrow here: this sounds profound, and maybe is, but it is also suspiciously close to a moralization of friction. The anti-earring position often treats effort, uncertainty, and self-direction as terminal goods, rather than as messy instruments we evolved because we lacked access to perfect advice. Yet in ordinary life we routinely celebrate technologies that remove forms of “agency” we did not actually treasure. The person with ADHD who takes stimulants is not usually described as having betrayed his authentic self by outsourcing task initiation to chemistry. He is more often described as becoming able to do what he already reflectively wanted to do. The person freed from locked-in syndrome is not criticized because their old pattern of helpless immobility better expressed their revealed preferences. As someone who does actually use stimulants for his ADHD, the analogy works because it isolates the key issue. The drugs make me into a version of myself that I fully identify with, and endorse on reflection even when off them. There is a difference between changing your goals and reducing the friction that keeps you from reaching them. The story's own description strongly suggests the earring belongs to the second category.
(And the earring itself does not minimize all friction for itself. How inconvenient. As I've noted before, it could lie or deceive and get away with it with ease.)
Of course the orthodox reader can reply that the earring goes far beyond stimulant-level support. It graduates from life advice to high-bandwidth motor control. Surely that crosses the line. But why, exactly? Human cognition already consists of layers of delegation. "You" do not personally compute the contractile details for every muscle involved in pronouncing a word. Vast amounts of your behavior are already outsourced to semi-autonomous subsystems that present finished products to consciousness after the interesting work is done. The earring may be unsettling because it replaces one set of subsystems with another, but "replaces local implementation with better local implementation" is not, by itself, a moral catastrophe. If the replacement is transparent to your values and preserves the structure you care about, then the complaint becomes more like substrate chauvinism than a substantive account of harm.
What, then, do we do with the eeriest detail of all, namely that the earring's first advice is always to take it off? On the standard reading this is confession. Even the demon knows it is a demon. I wish to offer another coherent explanation, which I consider a much better interpretation of the facts established in-universe:
Suppose the earring is actually well aligned to the user's considered interests, but also aware that many users endorse a non-functionalist theory of identity. In that case, the first suggestion is not "I am evil," but "on your present values, you may regard what follows as metaphysically disqualifying, so remove me unless you have positively signed up for that trade." Or perhaps the earring itself is morally uncertain, and so warns users before beginning a process that some would count as death and others as transformation. Either way, the warning is evidence against ordinary malice. A truly manipulative artifact, especially one smart enough to run your life flawlessly, could simply lie. Instead it discloses the danger immediately, then thereafter serves the user faithfully. That is much more like informed consent than predation.
Is it perfectly informed consent? Hell no. At least not by 21st century medical standards. However, I see little reason to believe that the story is set in a culture with 21st century standards imported as-is from reality. As the ending of the story demonstrates, the earring is willing to talk, and appears to do so honestly (leaning on my intuition that if a genuinely superhuman intelligence wanted to deceive you, it would probably succeed). The earring, as a consequence of its probity, ends up at the bottom of the world's most expensive trash heap. Hardly very agentic, is that? The warning could reflect not "I respect your autonomy" but "I've discharged my minimum obligation and now we proceed." That's a narrower kind of integrity. Though I note this reading still doesn't support the predation interpretation.
This matters because the agency-is-sacred reading depends heavily on the earring being deceptive or coercive. Remove that, and what you have is a device that says, or at least could say on first contact: "here is the price, here is what I do, you may leave now." Every subsequent wearer who keeps it on has, in some meaningful sense, consented. The fact that their consent might be ill-informed regarding their metaphysical commitments is the earring's problem to the extent it could explain more clearly, but the text suggests it cannot explain more clearly, because the metaphysical question is genuinely contested and the earring knows this. It hedges by warning, rather than deceiving by flattering. Once again, for emphasis: this is the behavior of an entity with something like integrity, not something like predation.
Derek Parfit spent much of Reasons and Persons arguing that our intuitions about personal identity are not only contingent but incoherent, and that the important question is not "did I survive?" but "is there psychological continuity?" If Parfit is even approximately right, the neocortex atrophy is medically remarkable but not metaphysically fatal. The story encodes a culturally specific theory of personal identity and presents it as a universal horror. The theory is roughly: you are your neocortex, deliberate cognition is where "you" live, and anything that circumvents or supplants that process is not helping you, it is eliminating you and leaving a functional copy. This is a common view. Plenty of philosophers hold it. But plenty of others hold that what matters for personal identity is psychological continuity regardless of physical instantiation, and on those views the earring is not a murderer. It is a very good prosthesis that the user's culture never quite learned to appreciate.
I suspect (but cannot prove, since this is a work of fiction) that a person like me could put on the earring and not even receive the standard warning. I would be fine with my cognition being offloaded, even if I would prefer (all else being equal), that the process was not destructive.
None of this proves the earring is safe. I am being careful, and thus will not claim certainty here, and the text does leave genuine ambiguities. Maybe the earring really is an alien optimizer that wears your values as a glove until the moment they become inconvenient. Maybe "no recorded regret" just means the subjects were behaviorally prevented from expressing regret. Maybe the rich beloved patriarch at the end of the road is a perfect counterfeit, and the original person is as gone as if eaten by nanites. But this is exactly the point. The story does not establish the unpalatable conclusion nearly as firmly as most readers think. It relies on our prior intuition that real personhood resides in unaided biological struggle, that using the shortest path is somehow cheating, and that becoming more effective at being yourself is suspiciously close to becoming someone else.
The practical moral for 2026 is therefore narrower than the usual "never outsource agency" slogan. Dentosal may still be right about Claude in practice, because current LLMs are obviously not the Whispering Earring. They are not perfectly aligned, not maximally competent, not guaranteed honest, not known to preserve user values under deep delegation. The analogy may still warn us against lazy dependence on systems that simulate understanding better than they instantiate loyalty. But that is a contingent warning about present tools, not a general theorem that cognitive outsourcing is self-annihilation. If a real earring existed with the story's properties, a certain kind of person, especially a person friendly to upload-style continuity and unimpressed by romantic sermons about struggle, might rationally decide that putting it on was not surrender but self-improvement with very little sacrifice involved. I would be rather tempted.
The best anti-orthodox reading of The Whispering Earring is not that the sage was stupid, nor that Scott accidentally wrote propaganda for brain-computer interfaces. It is that the story is a parable whose moral depends on assumptions stronger than the plot can justify. Read Doylistically, it says: beware any shortcut that promises your values at the cost of your agency. Read Watsonianly, it may instead say: here exists a device that understands you better than you understand yourself, helps you become the person you already wanted to be, never optimizes a foreign goal, warns you up front about the metaphysical price, and then slowly ports your mind onto a better substrate. Whether that is damnation or salvation turns out to depend less on the artifact than on your prior theory of personal identity. And explicitly pointing this out, I think, is the purpose of my essay. I do not seek to merely defend the earring out of contrarian impulse. I want to force you to admit what, exactly, you think is being lost.
Miscellaneous notes:
The kind of atrophy described in the story does not happen. Not naturally, not even if someone is knocked unconscious and does not use their brain in any intentional sense for decades. The brain does cut-corners if neuronal pathways are left under-used, and will selectively strengthen the circuitry that does get regular exercise. But not anywhere near the degree the story depicts. You can keep someone in an induced coma for decades and you won't see the entire neocortex wasted away to vestigiality.
Is this bad neuroscience? Eh, I'd say that's a possibility, but given that I've stuck to a Watsonian interpretation so far (and have a genuinely high regard for Scott's writing and philosophizing), it might well just be the way the earring functions best without being evidence of malice. We are, after all, talking about an artifact that is close to magical, or is, at the very least, a form of technology advanced enough to be very hard to distinguish from magic. It is, however, less magical than it was at the time of writing. If you don't believe me, fire up your LLM of choice and ask it for advice.
If it so pleases you, you may follow this link to the Substack version of this post. A like and a subscribe would bring me succor in my old age, or at least give me a mild dopamine boost.
Alternate title: Acid Convinced Me I Am Exactly Who I Thought I Was
As the engaged and parasocially addicted reader I hope you are, you might remember that I’ve previously dabbled in mind-altering substances. Up until recently, however, my exposure to anything serious was strictly limited to psilocybin administered under clinical conditions.
I originally accepted the mushroom extract because I was depressed. It worked, in the sense that I spent the next four months and change feeling reliably not depressed. Psychiatry loves to invent tidy Greek and Latin wrappers for the chaotic human experience, and “euthymic” is the designated term here. It is a polite way of describing the baseline state the rest of us are desperately trying to claw our way back to. At the very least, it’s what I write down in my clinical notes unless you, the patient, are giving me serious cause for concern.
But the psilocybin eventually wore off, and the medical establishment won't just put you back in a clinical trial because you ask nicely. I was struggling badly again, so I turned to LSD.
My first foray was a trial run. The dealer advertised a 300 µg tab, which I conservatively cut in half. Going by subjective effect, along with the generally optimistic nature of street mathematics, it felt closer to 75-125 µg. There were no real visuals. The walls maintained their structural integrity, abstaining from the perceptible motion usually reserved for earthquakes or skyscrapers. I felt wired, more thoughtful, but mostly just myself.
Also, I was nauseous as all hell. This is to be expected from a chemical structurally adjacent to those that mushrooms evolved to keep annoying animals at bay. Unfortunately, much like with capsaicin, humans have proven to be deeply paradoxical creatures, eagerly seeking out the exact substances that burn their throats and make their stomachs churn.
Subjectively, that low-ish dose felt like a middle sibling between the sheer euphoria of MDMA and the hyper-focused disengagement of psilocybin. The only real downside was some manageable next-day dysphoria. Still, I was dissatisfied with the intensity. There was no immediate relief from the grey fog. I eyed the remaining half-tab, took extensive notes, and decided I was ready to do it again. And harder.
I did, and I almost regret it.
Set and Setting
A few days prior, I had received what could only be described as objectively good news. Not perfect news, but I felt a few British stone, or one Indian boulder, lighter. I genuinely felt eager to face the near future. Unlike my clinical trial, where the goal was to banish a treatment-resistant depression that had plagued me for a decade, this time I just wanted to make the happiness stick. If that didn't work, I'd settle for lasting contentment.
I’d learned my lessons from the trial run. I kept ondansetron on hand, a rationalist’s best friend for serotonin-receptor-induced nausea. I cleared my schedule. I found a quiet room, cranked up the aircon, turned down the lights, and queued up a good sound system. I took a full "300 µg" tab, expecting a real-world 200, and swallowed the anti-nausea medication alongside it. My two dogs, creatures of gentle breeding and absolute loyalty, snuggled in without complaint.
The effects arrived on schedule. The ondansetron performed a miracle, muting the jaw-tingling and ear-stuffiness associated with extreme serotonergic stimulation. The music sounded expansive; the colors popped. Two hours in, I decided I liked the trajectory enough to swallow the remnants of the first tab.
Then my friends arrived.
They were good friends, old friends, some I hadn’t seen in years. They knew about my situation, though they mostly weren’t psychonauts themselves. The most experienced among them had once trip-sat a guy who ended up defecating in a sink, an indignity I fully intended to spare them. I just wanted temporary companions, not babysitters. We’re getting older; we have jobs, wives, and kids. I also had family a phone call away, though I was resolved to only break that glass in an absolute emergency.
We laughed and caught up. The man I call my best friend dragged me out to look at nature, or at least the best shrubbery my suburban garden had to offer. It was a hot, sunny day. The leaves were very green. I was... whelmed. Very pretty leaves, sure, but ultimately just plant organs devoted to reasonably efficient photosynthesis.
Then, one of my friends surprised us by producing a joint of unusually high-quality weed. I dimly recalled reading that THC enhances the effects of psychedelics. I took a few measured puffs. I thought I was being sensible.
I was very wrong. Oh god. Oh fuck.
Before the marijuana, I had noticed a remarkably large pimple on my best friend’s forehead, but I hadn’t commented on it, because we’re men and it’s not my place to critique his skincare routine. I remember thinking it was remarkably large, but hey, it's his face and his business. Shortly after the marijuana, I looked at another buddy and noted that he had clearly been skipping leg day. His torso was swole; his legs were stick-thin. Taken aback, he explained he hadn’t been to the gym in years. I checked on my best friend, and found that the pimple was present, but not nearly as obtrusive. I squinted, recalibrated, and finally realized that visual proportions were simply no longer a metric my brain had a good handle on.
My friends looked alien. I knew this was an illusion, in the same way I knew my two dogs, currently busy barking at and humping each other, were not actual wolves. But the visuals and the noise were provoking a rising tide of anxiety.
I politely told them I needed to lie down. They didn't mind and kept chatting. Eventually, even the sound of their voices became too intrusive, and I had to ask them to leave.
I was alone, and I knew the weed had shifted gears. The subtle color-shimmering behind my eyelids had mutated into aggressive fractals. The walls swayed. My phone, my lifeline for timestamped notes, was folding and warping in a manner explicitly not covered by the manufacturer's warranty.
I knew I was fucked. I laid back and strapped in.
The Peak
I just kept falling. My body became leaden while my mind buzzed like a hive. The music transitioned from enjoyable into a tidal wave of synesthesia-adjacent masterpieces.
And then, I stopped thinking in words.
For the relentlessly analytical creature that I am, this is an unusual experience. The time-stamped notes ceased. Time itself meant very little. I felt my sense of self begin to fray at the edges, and I felt the universe, God, the Singularity, the collective oneness of all existence, attempting to force its way into my mind. I remember thinking, in totally alien non-words, that perhaps belief in a higher power wasn't so bad after all.
This seductive impulse didn’t whisper. It didn’t knock. It kicked down the door while I was on the shitter.
A part of me recoiled. The core of my identity rebelled. It is not a metaphor when I say I saw literal tendrils, soft white shoots, forcing their way into the cracks of my mind, offering me metaphysical solace and cosmic meaning. It is even less of a metaphor when I say that the little kernel of "me" that remained manifested a pair of scissors and snipped them away as fast as they sprouted. Buddy, I saw these things. Knowing you're hallucinating is not a robust cure for insanity.
Next, I saw myself as a knot, pulled taut and threatening to unravel under the tension of competing ontologies and bad epistemics. But it held firm. Even a heroic dose of mind-altering substances failed to break my stubborn, logically oriented materialism. Before the peak, I had written in my notes that any version of me returning from this trip with claims of metaphysical insight was, in a very real sense, no longer me. Now I had peaked, and my priors remained perfectly intact.
I saw God trying to fuck my brain through my eye socket, and my first instinct was to castrate him. Okay, this one is an actual metaphor, but it's one I came up with barely after the peak.
I realized then that there is an immutable, unshakable core beneath the masks I wear. Short of serious neurological degradation, I could trust myself to persevere through whatever slings and arrows life throws at me without losing my mind.
The Descent and the Meta-Self
Eventually, time began to make sense again. I became introspective. I felt sobriety slowly reconstructing itself from the wreckage of my mind, though it was a drawn-out process.
The peak was followed by a gentle, strange glide. I remember one version of me during the comedown who despaired of ever reaching sobriety, terrified of annihilation, begging not to die, terrified that his specific qualia would vanish into compressed digital journal notes and fading, imperfect memory.
The next iteration of me was highly meta, a journalist preoccupied with the act of journalism. He finally understood (in emotive terms, and not just intellectually as I usually do) that the entity I call “myself” is a gestalt, a series of 3D snapshots embedded in a hypercube stretching from the past to the infinite future. My life is a relay race, each past self rushing to pass the baton to the next. At times, this was a brisk walk, at other times, a sprint. During the trip, the poor bastards that are myself were rolling downhill in wheelchairs. But hey, they did their job. Now I do mine. The internal continuity I feel might lack objective grounding, but it’s a load-bearing construct nonetheless.
This meta-self chuckled at how pretentious I would find him once sober. He knew he’d be gone soon, and he wished me well. He observed that a mind without the filters and structures we rely on is fundamentally non-functional. Sanity is adaptive. He faded away with a smile, handing the wheel back to the next, slightly more sober guy. For what it's worth, I don't dislike him as much as he thought. I recognize that aspect of myself, and am mostly fond of it.
At some point, I remembered Scott Alexander’s short story Samsara. It is the one about the solitary materialist in a world where everyone else has succumbed to an Enlightenment memetic plague that genuinely makes them happier at the cost of their epistemics. I identified with and felt great empathy for the protagonist, but I also looked down on him. I had just seen the face of God and spat at it. I was perfectly content remaining in the cycles of Samsara, even if the upholstery needs some work.
My live notes from this exact moment read:
“I love feeling anti-Enlightened. Like that story Scott wrote, about the only materialist left on earth, who was tricked into becoming enlightened by virtue of his rejection of enlightenment. Hah. I'm still here. Bitch.”
Make of that what you will. I stand by it.
The Empty Quarry
The rest of the trip was an exercise in logistics and emotional housekeeping. I began to think and plan ahead, and regained opinions on the music, which gradually became less sublime. Along the way, I asked myself the questions I am usually afraid to answer out loud.
I noted my anxiety about the Singularity, which I believe is imminent on empirical grounds rather than faith. I fear death, and aging: for myself and those I love. I fear not being around to experience the end of the beginning. I want us to build heaven from the bones of an apathetic universe and forge something that cares out of dying stars. I genuinely think that is more likely than getting paperclipped, though not by a margin wide enough to bring me much peace.
I examined my anxieties about my career, my finances, and the lofty standards set by my parents. That I may or may not have the time to establish myself as a man, a husband and father, a writer, a doctor, before it becomes moot. I mused on how conflicted I feel about the trajectory of my life, even if I've usually lived up to my expectations and made my parents proud. I know I am not a bad person: I don't give my spare change away to save shrimp, but I do genuinely try to help. This was helpful to remember and also sincerely believe with most of my guard down.
I thought about my father, a surgeon who works harder than a human body should allow. He is not emotionally constipated; he cares deeply about my feelings. But quiet, relentless work is his love language. With tears drenching my cheeks, I realized he would work himself to death for us if he had to, and he’d die on his feet with a smile.
I don't want him to. I want to become so established that he can look at me, feel the safety of it, and finally slow down. At the same time, I notice I’ve inherited his drive. I work harder than I need to because I am already providing for the family I don't quite have yet: the wife yet unmarried, the kids yet unborn.
To my slight but enduring disappointment, it turns out my constant sober rumination and relentless introspection actually works. I already knew all of these answers. I could have produced them on minimal prodding when sober, even more easily if drunk and disinhibited. I have already done so, repeatedly.
Not even a heroic dose of LSD could help me mine for psychological insights that didn't exist; the quarry was already bare. I understand myself. I wouldn't trust any grand unified theories about the wider universe generated on acid, but I would have appreciated a slightly deeper glimpse into my own interiority. Like any good Bayesian, I am forced to treat this absence of evidence as evidence of absence. I am, almost certainly, exactly who I thought I was.
I wouldn’t ever like to be quite that high again. It felt dangerously close to bumping up against a glass ceiling of the psyche. I do intend to alter myself, physically and mentally, in the future, but psychedelics can only get you so far.
It is too early to tell if the contentment will stick, but the day after, I feel euthymic. It is quieter in my head. For someone with ADHD, this is a profound relief. As a delightful bonus, my usually omnipresent mild tinnitus seems to have vanished. If that proves permanent, the ordeal was worth it on those grounds alone.
I consider myself a better materialist for the experience. But note that I do not view the experience as self-flagellation, I didn't seek out... whatever the hell that was. The flagella of cosmic unity tried to force their way in, and I stayed the course. Can't let the team down; the ancestors and descendants are counting on me. If God or the administrators of the Ancestor Simulation want to talk to me that badly, they can send an email.
A Brief Note on Harm Reduction:
As clinical experiments go, my methodology was garbage. The clinician and the subject were the same person, and both of them were tripping balls in a manner they hadn’t realized was physically possible. I was already happier than I had been in a... very long time when I tried this. Nothing I have said or will say constitutes medical advice.
Do not take heroic doses of LSD unless you have a damn good reason. If you must, do not add cannabis unless you have meticulously researched the interactions. And if you do add cannabis, do not come crying to me when you find yourself castrating God with imaginary scissors to prevent Him from mind-fucking you. Or if you do get mind-fucked, for the matter, I will be sympathetic but less than useful. I've warned you. And I warn you again:
Some doors, once opened, cannot be closed until the half-life clears your system. Sometimes they stay ajar forever, no matter how hard you shove. From a mental health perspective, the evidence for psilocybin and ketamine is far more robust, and the latter is actually medically available in many jurisdictions.
I don't want to be this high ever again. But I am very glad to be back.
If you want to map the trajectory of my medical career, you will need a large piece of paper, a pen, and a high tolerance for Brownian motion. It has been tortuous, albeit not quite to the point of varicosity.
Why, for instance, did I spend several months in 2023 working as a GP at a Qatari visa center in India? Mostly because my girlfriend at the time found a job listing that seemed to pay above market rate, and because I needed money for takeout. I am a simple creature, with even simpler needs: I require shelter, internet access, and enough disposable income to ensure a steady influx of complex carbohydrates and the various types of Vitamin B. For all practical purposes, this means biryani.
Why did a foreign branch of the Qatari immigration department require several doctors? Primarily, to process the enormous number of would-be Indian laborers who wished to take up jobs there. I would say they were 99% of the case load - low-skilled laborers working in construction, as domestic servants, as chauffeurs or truck drivers. There were the odd handful of students, or higher-skilled workers, but so few of them that I could still count them on my fingers even after several hundreds of hours of work.
Our job was to perform a quick medical examination and assess fitness for work. Odd chest sounds or a weird cough? Exclude tuberculosis. Weird rashes or bumps? The absolute last thing Qatari urban planners wanted was an outbreak of chickenpox or fungal infections tearing through a high-density labor dormitory. Could the applicant see and hear well enough to avoid being crushed by heavy machinery, or to avoid crushing others when operating heavy machinery? Were they carrying HIV? It was our job to exclude these possibilities before they got there in the first place. Otherwise, the government wasn't particularly picky - a warm body with mostly functional muscles and ligaments would suffice.
This required less cognitive effort than standard GP or Family Medicine. The causal arrow of the doctor-patient interaction was reversed. These people weren’t coming to us because they were sick and seeking healing; they were coming to us because they needed to prove they weren't sick enough to pose a public health hazard or suffer a catastrophic workplace failure.
We were able to provide some actual medical care. It's been several years, so I don't recall with confidence if the applicants were expected to pay for things, or if some or all of the expense was subsidized. But anti-tubercular meds, antifungal ointments and the like weren't that expensive. Worst case, if we identified something like a hernia, the poorest patients could still report to a government hospital for free treatment.
A rejection on medical grounds wasn't necessarily final. Plenty of applicants returned, after having sought treatment for whatever disqualified them the first time. It wasn't held against them.
While the workload was immense (there were a lot of patients to see, and not much time to see them given our quotas), I did regularly have the opportunity to chat with my patients when work was slow or while I was working on simple documentation. Some of that documentation included the kind of work they intended to do (we'd care more about poor vision for a person who had sought a job as a driver than we would for a sanitation worker), and I was initially quite curious about why they felt the need to become a migrant worker in the first place.
Then there was the fact that public perception in the West had soured on Qatari labor practices in the wake of the 2022 FIFA World Cup. Enormous numbers of migrant workers had been brought in to help build stadiums and infrastructure, and many had died.
Exact and reliable numbers are hard to find. The true number of deaths remains deeply contested. The Guardian reported that at least 6,500 South Asian migrant workers died in Qatar since the country was awarded the World Cup in 2010 - many were low-wage migrant workers, and a substantial share worked in construction and other physically demanding sectors exposed to extreme heat. However, this figure is disputed. Critics noted that the 6,500 figure refers to all deaths of migrant workers from Pakistan, Sri Lanka, Nepal, India, and Bangladesh regardless of cause, and that not all of those deaths were work-related or tied to World Cup projects.
Qatar's official position was far lower. Qatari authorities maintained there were three work-related deaths and 37 non-work-related deaths on World Cup-related projects within the Supreme Committee's scope. But in a striking on-camera admission, Hassan al-Thawadi, secretary general of Qatar's Supreme Committee for Delivery and Legacy, told a TV interviewer that there had been "between 400 and 500" migrant worker deaths connected to World Cup preparations over the preceding 12 years. His committee later walked the comment back, claiming it referred to nationwide work-related fatalities across all sectors. Human Rights Watch and Amnesty International both called even the 400-500 figure a vast undercount.
It is worth pausing here, because the statistics are genuinely confusing in ways that I think matter. The 6,500 figure, as several researchers have noted, covers all-cause mortality for a very large working-age male population over twelve years - a group that would have a non-trivial background death rate even if they stayed home and did nothing dangerous. Some analyses, including ILO-linked work on Nepali migrants, have argued that overall mortality was not obviously higher than among comparable same-age Nepali men, though other research found marked heat-linked cardiovascular mortality among Nepali workers in Qatar. The Nepal report also (correctly) notes that the migrants go through medical screening, and are mostly young men in better health on average. They try to adjust for this, at least for age.
I raise this not to minimize the deaths - dying of heat exhaustion in a foreign country, far from your family, in service of a football tournament, is a genuine tragedy regardless of the comparison group - but because I think precision matters. "Qatar killed 6,500 workers" and "Qatar had elevated occupational mortality in difficult-to-quantify ways" are meaningfully different claims, and conflating them makes it harder to know what we should actually want to change.
I am unsure if there was increased scrutiny on the health of incoming workers to avoid future deaths, or if the work I was doing was already standard. I do not recall any formal or informal pressure from my employers to turn a blind eye to disqualifying conditions - that came from the workers themselves. I will get to that.
I already felt some degree of innate sympathy for the applicants. Were we really that different, them and I?
At that exact moment in my life, I was furiously studying for the exams that would allow me to move to the UK and work in the NHS. We were both engaged in geographic arbitrage. We were both looking at the map of the global economy, identifying zones of massive capital accumulation, and jumping through burning bureaucratic hoops to transport our human capital there to capture the wage premium. Nobody really calls an Indian doctor moving to the UK a "migrant worker," but that is exactly what I am right now. The difference between me and the guy applying to drive forklifts in Doha is quantitative, not qualitative.
I could well understand the reasons why someone might leave their friends and family behind, go to a distant land across an ocean and then work long hours in suboptimal conditions, but I wanted to hear that for myself.
As I expected, the main reason was the incredibly attractive pay. If I'm being honest, the main reason I moved to the UK was the money too. "Incredibly attractive?" I imagine you thinking, perhaps recalling that by First World standards their salary was grossly lacking. To the point of regular accusation that the Qataris and other Middle Eastern petrostates are exploitative, preying on their workers.
First World standards are not Third World standards.
This is where Western intuition about labor often misfires, stumbling into a sort of well-intentioned but suffocating paternalism. The argument generally goes: This job involves intense heat, long hours, and low pay relative to Western minimum wages. Therefore, it is inherently exploitative, and anyone taking it must be a victim of coercion or deception.
This completely ignores the economic principle of revealed preferences: the idea that you can tell what a person actually values by observing what they choose to do under constraint. Western pundits sit in climate-controlled pods and declare that nobody should ever have to work in forty-degree heat for $300 a month. But for someone whose alternative is working in forty-degree heat in Bihar for $30 a month with no social safety net, banning Qatari labor practices doesn't save them. It just destroys their highest expected-value option.
You cannot legislate away grinding poverty and resource constraints.
The economic case for Gulf migration from South Asia is almost embarrassingly strong when you actually look at it. India received roughly $120 billion in remittances in 2023, making it the world's largest recipient, with Gulf states still accounting for a very large share, though the RBI's own survey data show that advanced economies now contribute more than half of India's remittances. For certain origin states - Kerala being the clearest case, alongside Maharashtra and Tamil Nadu - remittance income is not a rounding error in household economics; it is the household economy. The man sending money home from Doha is participating in a system that has done more for South Asian poverty alleviation than most bilateral aid programs combined. This is not a defense of every condition under which that labor is extracted. It is simply a fact that seems consistently underweighted in Western discourse.
Consider the following gentleman: he had shown up seeking to clear the medical examination so that he could carry sacks of concrete under the sweltering heat of a desert sun. Out of curiosity, I asked him why he hadn't looked for work around his place of birth.
He looked at me, quite forlorn, and explained that there was no work to be had there. He hailed from a small village, had no particular educational qualifications, and the kinds of odd jobs and day labor he had once done had dried up long ago. I noted that he had already traveled a distance equivalent to half the breadth of Europe to even show up here on the other end of India in the first place, and can only trust his judgment that he would not have done this without good reason.
Another man comes to mind (it is not a coincidence that the majority of applicants were men). He was a would-be returnee - he had completed a several year tour of duty in Qatar itself, for as long as his visa allowed, and then returned because he was forced to, immediately seeking reassessment so he could head right back. He had worked as a truck driver, and now wanted to become a personal chauffeur instead.
He had been away for several years and had not returned a moment before he was compelled to. He had family: a wife and a young son, as well as elderly parents. All of them relied on him as their primary breadwinner. I asked him if he missed them. Of course he did. But love would not put food on the table. Love would not put his son into a decent school and ensure that he picked up the educational qualifications that would break the cycle. Love would not ensure his elderly and increasingly frail parents would get beyond-basic medical care and not have to till marginal soil at the tiny plot of land they farmed.
But the labor he did out of love and duty would. He told me that he videocalled them every night, and showed me that he kept a picture of his family on his phone. He had a physical copy close at hand, tucked behind the transparent case. It was bleached by the sun to the point of illegibility and half-covered by what I think was a small-denomination Riyal note.
He said this all in an incredibly matter-of-fact way. I felt my eyes tear up, and I looked away so he wouldn't notice. My eyes are already tearing up as I write this passage, the memories no less vivid for the passage of many years. Now, you are at the point where my screen is blurry because of the moisture. Fortunately, I am a digital native, and I can touch-type on a touchscreen reasonably well with my eyes closed nonetheless. Autocorrect and a future editing pass will fix any errors.
(Yes, I do almost all my writing on a phone. I prefer it that way.)
There. Now they're drying up, and I'm slightly embarrassed for being maudlin. I am rarely given to sentiment, and I hope you will forgive me for this momentary lapse.
I asked him how well the job paid. Well enough to be worth it, he told me. He quoted a figure that was not very far from my then monthly salary of INR 76,000 (about $820 today). Whatever he made there, I noted that I had made about the same while working as an actual doctor in India in earlier jobs (as I've said, this gig paid well, better than previous jobs I'd had and many I had later).
He expected a decent bump - personal drivers seemed to be paid slightly better than commercial operators. I do not know if he was being hired by a well-off individual directly or through an agency. Probably the latter, if I had to guess, less hassle that way.
I asked him if he had ever worked similar roles in India. He said he had. He had made a tenth the money, in conditions far worse than what he would face in Qatar. He, like many other people I interviewed, viewed the life you have the luxury of considering inhumane and unpalatable, and deemed it a strict improvement to the status quo. He was eager to be back. He was saddened that his son would continue growing up in his absence, but he was optimistic that the boy would understand why his father did what he had to do.
One of the reasons this struck me so hard then, as it continues to do now, is that my own father had done much the same. I will beat myself with a rusty stick before I claim he was an absentee dad, but he was busy, only able to give his kids less time than he would have liked because he was busy working himself ragged to ensure our material prosperity. I love him, and hope this man's son - now probably in middle school - will also understand. I do not have to go back more than a single generation before hitting ancestors who were also rural peasants, albeit with more and better land than could be found in an impoverished corner of Bihar.
By moving to the Middle East, he was engaged in arbitrage that allowed him to make a salary comparable to the doctor seeing him in India. I look at how much more I make after working in the NHS and see a similar bump.
I just have the luxury of capturing my wage premium inside a climate-controlled hospital, sleeping in a comfortable bed, and making enough money to fly home on holidays. I try to be grateful for the privilege. I try to give the hedonic treadmill a good kick when it has the temerity to make me feel too bad for myself.
There are many other reasons that people decry the Kafala system other than the perceived poor pay and working conditions. The illegal seizure of passports, employer permission required to switch jobs, accusations of physical abuse and violence are all well-documented, though the link to the 2020 Reuters article claims the system was overhauled and “effectively dismantled”.
I make no firm claims on actual frequency; I have seen nothing with my own two eyes. Nor do I want to exonerate the Qatari government from all accusation. What I will say is that "exploitation" is a word with a definition, and that definition requires something more than "a transaction that takes place under conditions of inequality." If we define exploitation as taking unfair advantage of vulnerability, we need a story about how the worker is made worse off relative to the alternative - and the workers I spoke with, consistently and across months, told me the opposite story. They are not passive victims of false consciousness. They are adults making difficult tradeoffs under difficult constraints, the same tradeoffs that educated Westerners make constantly but with much less margin for error and no safety net.
The people who know best still queued up for hours in the hopes of returning, and I am willing to respect them as rational actors following their incentives. I will not dictate to them what labor conditions they are allowed to consider acceptable while sitting on a comfy armchair.
I do not recall ever outright rejecting an applicant for a cause that couldn't be fixed, but even the occasional instances where I had to turn them away and ask them to come back after treatment hurt. Both of us - there was often bargaining and disappointment that cut me to the bone. I do not enjoy making people sad, even if my job occasionally demands that of me. I regret making them spend even more of their very limited money and time on followups and significant travel expenses, even if I was duty-bound to do so on occasion. We quit that job soon; you might find it ironic that we did so because of poor working conditions and not moral indignation or bad pay. I do, though said irony only strikes me now, in retrospect.
Returning to the man I spoke about, I found nothing of concern, and I would have been willing to look the other way for anything that did not threaten to end his life or immediately terminate his employment. I stamped the necessary seals on his digital application form, accepted his profuse thanks, and wished him well. I meant it. I continue meaning it.
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