This is a thought experiment I wrote to encourage discussion of ethical issues in medical science, particularly in the field of psychiatry in the treatment of personality disorders. I have worked in this field in different capacities of direct patient care for years now, and will for the rest of my life, so I feel my development of this thought experiment is based on genuine ethical issues I have observed.

The 9 analysis questions following the thought experiment relate to Ethics of Medicine, as well as Philosophy of Science topics such as theories of mind.

This thought experiment intends to argue that novel conceptual frameworks in the theory of mind are needed to understand the experience of mental illness, before sound ethical decisions can be made.

I hope this is appropriate for submission to this sub, but if not, please let me know, and I'll remove it.

What really struck me was that Moloch and Hannibal are one and the same; Moloch being essentially a large mask. People truly can become their masks, they become inextricable. Perhaps Hannibal really would have been unable to be removed alive once he had fully inhabited the giant anyways...

I appreciate the included analysis at the end. I understand your point much better through the story and analysis and i think it’s well considered and written.

I’m reading Cormac McCarthy’s The Passenger right now. I’m not quite half through but the girl has “imaginary friends” and the electro shock treatment she receives burns her friends. The pills she takes makes them disappear and she missed them.

Your point is important to consider, I think.

Interesting! My doctorate is in Pharmaceutical Sciences, not Psychiatry, but I found this an engaging thought experiment anyway. I did not read your analysis because I’d prefer to come to my own conclusions but I will ask this: did Hannibal spend so much time becoming Moloch that he actually BECAME Moloch? It seems like he ultimately identified as the giant he was pretending to be. I’ve heard a saying that if one wears a mask long enough it ceases to be a mask. Obviously, Hannibal’s hypothesis was more or less proven the moment the healer enthusiastically offered aid, so why continue to his own self destruction?

Thanks for the post!

Sorry this is long and not sure what you wanted but the story and questions set my mind racing.

I really enjoyed thinking about this. The questions were really interesting.

I often wonder about doctors and/or therapists. Do they trust what the patient says? How can they be sure the patient is saying true things? Do they think people are self-destructive because they can’t extricate themselves from family, jobs, partners, practices that are unhealthy? Does the doctor or therapist want to ask more questions of people on this subject but feel it might damage a sensitive system set up by the patient just to survive? They may not want to rock the boat? Or they don’t have TIME to go that deep? Or they already know that some humans are going to be this way? The doctor is more clinical and wants numbers: BP cholesterol etc.. but needs to know also if patients are safe in their house or depressed? All this takes time to gather and the patient may not be able to think fast enough to be truthful about any of it, if they are in a bad situation. Obviously, Hannibal had his mind set when he went in as monster. Most patients see a doctor once a year or less and are not thinking what questions will be asked. Or what help can be obtained. They are just not self-aware. They want help with one issue.

The therapist still has limited time but how deep does he/she want to explore? They both see plenty of humans and know that humans don’t always follow nutritional and exercise advice, many humans don’t take their meds. Do doctors or therapist really ever get answers to these questions? Can the patient ever really explain the why of it? Does the patient think they know when they will die? Do they already have a sense of how they will die and are comfortable with that? They will die like grandma died…. When it comes time to die, will they have regrets?

I was interested in the guilt of the healer. He thought the voice sounded like his friend but he didn’t ask? He didn’t question the monster more? Did he try hard enough to diagnose the situation? Since he didn’t know Hannibal was the puppeteer: If it had been me I would have been sad and angry. Guilty. I think guilt is inevitable in this situation because a person died. Why would my friend trick me like that? I would have wondered if he got tired of being a hermit yet couldn’t make himself give up the title and go back to living with others. Was it ego? Did he use the healer to commit suicide? That would make me/healer angry too. With suicide there are no answers. All you are left with is questions. Why don’t humans ask deeper questions? I wonder this all the time. I try to devise better questions, myself.

Thanks for the thought provoking experiment.

This is such a well-written and engaging thought experiment. Thanks for sharing.

I’ll also add my two cents and say that I think maybe Hannibal, himself, was positioned as the “monster” which the loving community might not accept. Because Moloch, despite his large stature, actually seemed to conform perfectly with the happy, loving little society that the town had created. He was a kind and open-hearted giant; just like them, only a little bigger.

But the parasite was also a living creature, and it was the parasite who was truly seen as the monster. The parasite did not conform. The parasite was not like the townspeople— the parasite was selfish and destructive toward the existence of others. The parasite was a monster; and it had to go.

So maybe Hannibal’s experiment served as a way to draw the line between that which a “loving” society was willing to look past, and that which it was not.

And I think that the connection to mental health is really interesting because of that. Was Hannibal actually self-destructive? Or was he just ashamed of some of his own selfish thoughts, his own needs and desires, and he feared that if he expressed his actual truth then he would be treated like the parasite— dangerous, unfit to be among the townspeople, and better to be eradicated.

When people are afraid that their truth will not be accepted, that their truth will make people turn against them, are they more likely to hide it? I think so. They may even become a mental/emotional hermit, refusing to let anyone see their inner truth. And when they do re-enter society, they wear a mask, or a giant suit, and pretend to be just like everyone else. They pretend that they don’t see themselves as a toxic parasite.

But being a hermit for too long will eventually get to them, because believing yourself to be a parasite to that extent I believe will lead them to one of two possible conclusions: self-destruction (if they have given up the possibility of being seen as anything other than a parasite), or a push for acceptance (if they have enough hope that they’re willing to take the chance that someone will look out for them even if they are a parasite). And so I think this is where Hannibal found himself; he chose to take the chance and trust in this loving society, but their own thinking was not quite nuanced enough, not quite understanding enough, to recognize that the parasite, too, was a living thing that may be sentient, and that may be worth keeping alive itself. Arwen killed the parasite without a second thought— without even determining what kind of parasite that it was. And that, I think, was the folly— he never stopped to question whether there was a way to save them both.

I think that integration, rather than eradication, must be the key. Moloch did not know what his problem actually was— despite his claim, it was actually untrue that Moloch would die if the parasite were left as it was. Perhaps what Moloch actually needed was a sort of counseling and therapy— a means of keeping himself alive and well without removing the parasite at all. Maybe the parasite would not seem so inevitably destructive if the proper workaround could be implemented.

Regardless, it’s definitely an interesting thought experiment. Thanks again for sharing it.

I feel this way a lot these days. My own specific case is, I'm what you might call a "forever" lover. By which I mean, when I fall in love with someone, it basically lasts forever. I can't just "turn it off", the way that other people seem to be able to. I know that there's got to be something neurologically different about me, and others like me. But I've had to destroy certain parts of myself, because the common perception is that if someone stops loving you, you're expected to stop loving them and "get over it" eventually.

I've been forced to basically "cut out" certain parts of myself, emotionally, because my manner of loving is deemed pathological to most people. And, to me, they were some of my best aspects, my biggest strengths. It felt like killing a major part of myself. Like having to take your dog in to be put down. Except I've been through it multiple times over.

I think about this strongly in the domain of LGBTQ+ acceptance. Decades ago, homosexuality was seen as a "mental illness" by psychologists, and conversion therapy was the norm. Anything that didn't fall under cis/het rules was deemed a problem to get rid of.

The minority group wasn't seen as a group deserving its own validation, but a collection of sick (or "evil") people.

For me, well, we all know that people routinely say such things to their partner such as, "I'll love you forever, no matter what"--and while it's nice to hope for the best, in reality, when the vast majority of people say those things, they're being hopeful, romantic, and/or metaphoric.

And those people, in the majority, think that that's the case for all others as well. They're not aware that there's a smaller group of people who literally can say "I'll love you forever, no matter what" and have that be a factual statement, not just wishful thinking.

So, the people who are more "mood-based" or conditional lovers end up screwing over the lives of people who are "forever" lovers. And people do die as a result--it's one of the bigger reasons for suicides. (edit: and depression, which can cut years off of life expectancy, same with drugs.)

I guess it might not tie in that strongly to this thought experiment. But we do ask people to injure certain parts of themselves simply because "that's what works for most people". But most people aren't all people. Certain "medicines" are poisonous, or even deadly to us.

And the people in my life, like the Healer, really do want the best for me. That's definitely part of what makes it so frustrating, even maddening. It's just like being gay in a conservative community that doesn't tolerate it, and feeling like there is something wrong with you for not being "normal". Even your loved ones can't understand, and want you to change.

If this makes perfect sense to anyone, I consider you "my people". :)

I work in psychiatry and I also have 10 years experience working in a SICU. There should be no personal guilt involved in the health Practitioner when they provided informed consent (including potential risks, benefits, etc) and offered the current best practice to resolve an ailment. We often look back in time and cringe at the medical procedures that used to be performed, but those interventions were developed based on past experience. We only got where we are today due to the medical interventions performed in the past. We learn through past experience. Hannibal seemed to be of sound mind when he made the decision to undergo the procedures. Awen did well, and if he uses this experience to improve his practice then he will continue to do well. I don't always know if my psych patients are malingering or have alternative motives when they provide me their symptoms (I work in child psychiatry and there are times it seems my patients are trying to avoid school or home), however, I need to trust them because there is no other choice. If I choose to not believe my patient then I am risking the possibility that I will provide poor treatment to someone who truly needs it.

Edit: I didn't spell Awen's name correctly.

1. Play stupid games, win stupid prizes -hannibal did an experiment, it could've gone worse, like the towns people rioting, he is lucky that they want to help

2. Fuck around, find out

• this where i salute hannibal, he fucked around, and stuck to finding out, even if it meant his death

3. Asymmetric information (a lot of unknowns) -awen was presented with the giant, not knowing hannibal is the puppeteer, the giant told a narrative, and that narrative is what awen has to work with. I think he did his doctor duties and gave moloch/hannibal dignity and agency in choosing the treatment

4. God's point of view -compared to tge olden times, our current tech is like God's eyes, CT scan, MRI, Ultrasound, even bloodwork can reveal a lot -so if awen did see moloch as a puppet and hannibal as the puppeteer, i think they will address hannibal instead of moloch, disregarding moloch as a "mask"/puppet

The biggest thing that strikes me here is the problem of serving multiple masters.

There are two identities in the hermit and the giant and it's morally complex to try and serve both, especially if those interests are competing...

A similar debate occurs in treatments where the interests of a mother and unborn baby don't align, and are probably similar again for multiple personalities...

Another fascinating one is that psychiatrists can serve the interests of the state/community (harm prevention) or the interests of the patient...

As far as I know any legal principles in this domain, where there is a physical codependency, are at best grey. Does consent need to be unanimous or is majority rule ok? Can some entities be disenfranchised through mental fitness, are these thresholds different from a single entity? If the principle of integration of multiple personalities within one physical entity is seen as morally sound does that have implications for the treatment chosen for a person (or parts of a person) given they need to integrate with society writ large?

Another area I haven't looked at but would have some bearing is conjoined twins, especially situations where separation is impossible (physically, ethically, or both)?

If a healer chooses to bear guilt beyond what society asks they do I think it's a personal decision, if they've fulfilled their duties to the best of their ability, and society has deemed them capable of executing those duties based on a reasonable burden of information what more can we ask for?

This strikes me as more of a parable than a thought experiment. It's a story, and there are some sorts of lessons in the story, but the language is flowery, designed to make you feel something, and the main downfall is Hannibal having fallen too deep into character, which is hardly a philosophical issue, more of an issue internal to the plot.

It's vaguely reminiscent of the Chinese Room, but the Chinese room is not 95% story and 5% question, it's a simple hypothetical designed to evoke a focused question.

Any story can be framed as a thought experiment, but a true thought experiment is focused on debating a specific question, rather than focusing on motivations of characters and the bonds of friendship and stuff like that.

This hits close to home, is well written, and from my perspective asks questions other philosophical ideals haven’t or aren’t able to answer.

My most pressing questions regarding the issues presented relate to the identity of the mind as a whole: is it entirely the conscious, subconscious, or unconscious; or a blend of the three? With the latter most likely being the case, is Hannibal essential to Moloch, and is Moloch essential to Hannibal? If the conscious motivates action in one direction, but the subconscious motivates action in the opposite, is the individual as a whole responsible, or are others responsible for making a decision towards one or the other? In summation, how many different entities lie within one mind, and whose mind has the right or responsibility to determine which entities get preference?

In regard to the idea of having a novel framework and understanding the experience of mental illness before ethical action, is waiting unethical, even if the experience isn’t understood? I would argue that our society has said yes, treatment of some kind is better than no treatment, even if one harms more than the other unknowingly.

Like the start, nice writing.

I mean wouldn't the take away here be that withholding treatment to a degree is reasonable? While it may be cruel to do so taking intermediate measures to observe the patient/moloch would I imagine greatly alter the treatment and dialogue needed. And, even after doing so if the physician fails I would argue a change in methodology would be prompted to be better following the example if a better disguised giant came not fully trusting the patient.

Moloch/Hermit were unreliable narrators of their own condition and like all other medicine should take their opinions in stride not disregarded or ignoring them but exploring and verifying. Disregarding the giant killing him and bringing out the hermit is wrong for it will crush him in their lack of empathy for something different, as for pure compassion well we see how it played out.

I do believe the Healer was wrong in his methodology, however feeling guilt/quitting would only prevent helping someone else and shouldn't need to, mistakes happen it is up to them to grow and learn from it.

If a perfect giant came and you tried to explore what was wrong with them but couldn't trust your conclusions then its by your digression by risk assessment. How will the treatment help? Will it kill them? Is it permanent? The healer may have informed the giant of the risks but he himself wasn't sure of the outcome for a giant or if the risks were correctly portrayed due to his unfamiliarity which was overall bad practice of wanting to help and doing more harm then good.

Ultimately blind compassion and a distrust of the patient are the wrong answers and finding a fine line between them seems right to me. rant over ggs

From what I understood, Awen knew Hannibal before the experiment on a personal level. The experiment Hannibal concocted made Awen an accomplice in his suicide plan and basically left him with eternal guilt for killing his friend unknowingly when he was trying to help. I think that's key because that was a really shitty thing to do and something you should never do to someone. If we were to consider that Awen did not know Hannibal at all and this occured, he could remain in good faith that he tried his best even though he was unaware of the exact circumstances that created Moloch.

Reading the analysis provided, I see the path that you are trying to question. As a person suffering from a dissociation disorder and having therapy and counselling for it, I can relate to Hannibal and Moloch quite a lot. That's why it's more unacceptable to me that he did that to someone that knew him. I don't think Awen is to blame and all we can hope from the people we seek help from is that they understand the language by which we speak and show our struggles - especially in my case stories and metaphors. And that they understand and can sympathize a bit with it in good faith to help us. I have met some who are like that and who really didn't care what I said if only to use it to mould it into doing what they wanted. No one can understand 100% what someone else is struggling with especially internally. All a therapist/counsellor can do is keep trying to help them, apologize when you realise you have done something wrong even later down the line and build a bond and be there for them as long as your allowed/can to.

I have type I bipolar disorder, and enjoyed this thought experiment quite a bit. (Note: I am 60 years old, and thanks to Seroquel haven't had a full-blown psychotic episode in over a decade. I've also done DBT. I actually turned down ECT, and from what you have to say I'm glad I did.)

Upon reading your comments, I thought you might like the existential question I live with: If I am not my mind, what am I?

Also, I do not and would not lie to my psychiatrist. That would be counterproductive, and a waste of time and resources.

Thank you for writing this story. It made me look at my own (8 years long) therapy experience differently, and also see my therapist differently — the dilemmas she’s facing as a professional are just as profound as my own.

its not easy to find the relevant elements here. science is finding the dependencys of the things - their social interactons & self-constructions. So to understand the dependencys of the mind and body, u have to use all sciences youve got! So science and specially sociology includes all fields of existence. many things need more then one science to find the truth. for all biological things, u need a lot to understand it correctly & find out all movements. thats the way of science, to create the dependencys of the things to represent/reproduce and transform it correctly/efficient. So, to understand the psychology, u need philosophy, sociology, biology, neuroscience, history... u must understand how all the goals & dependencys get created and work out in the end. A consciousness isnt really the same as a puppet. so there is a lack of dependencys here. Then there are numerous problems u adress & u need to order it more, specially in a more psychoanalytic & functional way. anyway, lets learn...

1. Yes it is possible, as it is possible to evaluate many other dispositions. But it only works, if u realize, that their is a possibility to be so. So the first problem of the doctor in the tale is, that he doesnt see the possibility that the giant is a puppet, controlled by a (maybe) self-destrcutive men. So the help can turn out to be bad because his diagnostic is bad.
2. so here u get a bit metaphysical or should i say, chaotic. First of all, its not sure in which sense exactly Hannibal is self-destructive. So i think there is a good self-destructiveness & a bad one & u must find out how strong this drive is. u must differentiate here a bit more i think. And the problem that a puppet isnt a consciousness is very present here. If hannibal is self-destrucive, moloch is part of this structure, and its not the consciousness itself, its onyl a part of the actual consciousness, which is operating in a priority/fixiation to the unconscious wish to self-destruct. so why should there by another giant? because hannibal got another disposition (to life) and/or because the self-destrcution is bad? Why should a better constructed giant should help hannibal? the giant isnt his problem i guess. the conscoiusness is not the problem at first, its the material dependency that isnt working & leads to a disfunctional mind (un- & consciousnes isnt working properly or the whole social system isnt working properly (anymore) or he wants to find out what happens after death or maybe he isnt really self-destructive, only asocial and stupid). So, here u make a lot of premises that arent really included in the experiment at first. Moloch (as seen as consciousnes) is as conscious about hannibal as the consciousness is consciouss about our unconsciousness. u must be clear here in which way Moloch is really a consciousness or u get unprecise in the experiment. Our consciousness can be aware of our unconsciouss drives, but that doesnt mean, it can influence it to act differently. Of course you have to understand the precise interactions & contraactions of un - & consciousness. This is basic psychoanalytics. so its not very helpful to draw unclear lines here. The question if Awen should act differently with another giant & after finding out the truth about the first giant, is quite obvious & a part of the first question
3. this is also a question of the dependencys. as moloch cant life without hannibal, it should be quite obvoius that both are depending on each other very closely & to the basics of their whole strucutre and so can be seen as one person. so their is only one dead, as hannibals core functions get damaged, all other parts of hannibal, including moloch die too. but only as a very close depending reaction. so the problem of moloch is not the real problem (of hannibal), if he really got one beside stupidity. Privacy is a matter, u must analyse alone. as privacy is nothing that really is important in the end. specially not if u want to help somebody to transform himself (heal him). as every transformation is a death of personality & a rebirth of a new personality and privacy (parts of it). Privacy is only important, if someone want to hide something from others. this is of course not helpful if u want to understand the whole beings. so privacy/secrets (from society) are part of the problem here! as we have structures, that prevent us to transform ourselfs & help us in the end to adapt to all social things. you must analyze, how privacy is part of the problem! But well sometimes, its just natural & part of getting old. As u getting old, u want to have secrets and u want to die, because nothing else makes u happy. its nothing wrong with that. only, when it depends on some failure, u can and want to transform differently. but u must be clear here. the action here dont have to be disfucntional or as symbolic as u think.
4. Awen did everythig he was able to to help him. Its not a new problem, that help can turn out into non-help because of mistreatment. Moloch is hannibal, so hannibal/molochs death was indeed caused by a misleading helpful action & maybe set up as suicide (with a little help from his friends). thats all. for the cause, it doesnt matter why hannibal was doing it. it only matters what Awen knew. Awen knew not very much. Thats his and our all guilt, all the time with everything. But if everything is determined, its not a question of guilt, its a question of how to making it better the next time!
5. What makes u think this is non-ethically? Because of the sucicide or the help to suicide or because the stupid idea of a curious idiot & the unwanted death & killing by his friends? Suicide is ethical if everbody thinks its good. And the unwanted death by the friends is also not unethical, because they dont know what they are doing so they dont act amoral. The only one that acts amoral, is (a part of) hannibal if he really wants to be killed by his friends. As he maybe knows, that they dont want to kill him. Maybe he also thinks, that some would help him to kill him, even if they dont want it. So the moral breach isnt big here i htink. Not really the big problem here. An 100% ethical version could be, to inform all of the experiment but make em act as they would not know. but in the end, its an ambivalent situation, where u must confront yourself with the a) wanted death, b) the wrong outcome of the experiment or/and c) the unfullfilled expectations of the townfolk. u cant make it really 100% ethical i guess, when you dont share/normalize the goals between all actors.

... continue reading down under in the reply section, due to wrong character count by reddit. The whole text is under 10000 characters but i could not post it.

The healer had no business calling appointing themselves a specialist in a field that was new or alien to them. Arwen's compassion while virtuous and seemingly noble is akin to my dog's friendliness and eagerness to cheer me up. His specialty in this thought experiment should be limited only to what he knows to be true and work effectively and the rubbish about him speaking a verbal handshake disclaimer to moloch is where the problem lies. The allegory begs the question that if people's experiences are inherently different works only if we cannot rule out yhat human anatomy and brain chemistry isn't more close to uniform than an alien monster dialogue.