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naraburns  nihil supernum  1yr ago (text post)   33348 thread views

Culture War Roundup for the week of February 27, 2023

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Some of you may have read Scott Alexander’s recent post, Book Review: The Geography of Madness. The couple of paragraph summary is:

A culture-bound mental illness is one that only affects people who know about it, and especially people who believe in it. Often it doesn’t make sense from a scientific point of view (there’s no such thing as witches, and the penis can’t retract into the body). It sometimes spreads contagiously: someone gets a first case, the rest of the village panics, and now everyone knows about it / believes in it / is thinking about it, and so many other people get it too.

Different cultures have their own set of culture-bound illnesses. Sometimes there are commonalities - many cultures have something related to the penis or witches - but the details vary, and a victim almost always gets a case that matches the way their own culture understands it.

THESE PEOPLE ARE NOT MAKING IT UP. I cannot stress this enough. There are plenty of examples of people driving metal objects through their penis to pull it out of their body or prevent the witches from getting it or something like that. There is no amount of commitment to the bit that will make people drive metal objects through their penis. People have died from these conditions - not the illness itself, which is fake, but from wasting away worrying about it, or taking dangerous sham treatments, or getting into fights with people they think caused it. If you think of it as “their unconscious mind must be doing something like making it up, but their conscious mind believes it 100%,” you will be closer to the truth, though there are various reasons I don’t like that framing.


The thrust of Scott’s argument is that humans have an amazing propensity to change their subjective experience based on their beliefs. Here, I'm not talking about rationally held or carefully reasoned beliefs, but deep-seated beliefs that aren’t easy to change, even if you know for a fact they're irrational. Typically, these beliefs seem to be formed through social or cultural channels, and once formed, they can be very difficult to change unless your cultural narrative also changes.

This idea ties into other work on the placebo effect and the ways it shaped our culture, for instance, John Vervaeke’s take on shamanism. The basic idea being that shamanism was highly advantageous from an evolutionary perspective because it allowed groups of humans to harness the placebo effect to overcome illness and manage social problems.

In short, despite the rational pretensions our culture has, our irrational beliefs have extremely strong effects on our perception of pain and other subjective experiences. However, an important nuance is that no cultural disorder is 100% ‘in your head;’ on the contrary, these disorders are very real and can have strong physical effects.

Some of the big examples that Scott gives, and some I think might be (mostly) culturally mediated, are:

  • Anorexia

  • Post-traumatic stress disorder

  • Anxiety

  • Depression

  • Gender dysphoria

  • Chronic pain

  • TikTok Tourettes

  • Long Covid

Now, based on the bent of this forum, many people might be tempted to jump on the gender dysphoria issue. While it’s certainly a loud and vibrant battle in the culture war, I’d ask that we instead focus on other problems. In my opinion, if this thesis holds true, then gender dysphoria is a red herring.

The evidence clearly suggests that we are inflicting massive amounts of pain and suffering on ourselves through our cultural beliefs and practices. The fact that so many of our cultural problems - from overdose deaths and suicides to chronic pain and crippling anxiety - are unforced errors is truly shocking.

Think about it - one fourth of the adult U.S. population experiencing chronic pain? That's a staggering number, and it seems largely due to the fact that we have been conditioned to believe that our pain must have an acute physical cause. We've been taught to view pain as something that must be cured with medication or surgery, when in fact many cases of chronic pain can be alleviated by simply changing our beliefs about it.

The truly shocking revelation here is that so many of our cultural problems - massive amounts of overdose deaths, suicides, one fourth of the adult population experiencing chronic pain, crippling anxiety causing young people to retreat from society, and many more issues - are clear unforced errors. We are inflicting this pain on ourselves.

If this theory is true it may very well be one of the most important and impactful frameworks with which to view the issues of post modernity. We wouldn’t need endless medications or miraculous scientific breakthroughs - we could already have the power to end massive amounts of truly pointless suffering.

ETA: is another perfect example of this type of illness.


From a personal perspective, I can attest that this theory confirms my priors. I’ve dealt with chronic pain for a decade and have long suspected that it was mostly psychosomatic. Even with this realization, it is a difficult battle to fight. Ironically, support groups where people confirm and commiserate seem to make the issue worse. In fact, many modern studies on pain recommend not even using the word "pain" and replacing it with something else to trick your mind into understanding that your pain doesn’t have an acute physical cause.

So many of us in the rationalist community focus on object-level reasons as to why our society may be stagnating or why we have so many cultural problems. At the end of the day, it turns out that our beliefs themselves may be throwing us into a twisted, absurd, and horrific self-fulfilling prophecy.

It may be time to stop assuming that the causes of our problems originate directly from the outside world and update to a view that many more major problems could be solved if we simply change our cultural beliefs.

We wouldn’t need endless medications or miraculous scientific breakthroughs - we could already have the power to end massive amounts of truly pointless suffering.

You think changing culture is easier than making a pill? I'm not sure it's the case. It may be possible to change the culture by the pill (e.g. - oral contraceptives?), but if somebody gave me two options of achieving the same goal - either by inventing the pill or by figuring out how to change the culture - I'd go for the pill. I think semaglutide has a better chance to make the dent in the obesity epidemic than 1000 public awareness campaigns.

Ahh yes, you might like Scott’s older post Society is Fixed, Biology is Mutable.

The problem with this model is that if these illnesses are truly caused from cultural issues, there can’t be a pill that fixes them. Sure we can try to use the placebo affect but doctors already do that by prescribing Gabapentin or other weak drugs for everything.

If it's culture+biology, then we still can attack the biology part. We have a choice then which part to concentrate on, I'm just saying biology may be easier.

P.S. read Scott's post - yeah, he pretty much says all what I meant. Haven't seen it before, thanks for pointing it out.

The fact that chronic pain is so well correlated with aging suggests that for the majority of people there is some underlying physical degeneration coupled with a culturally/psychologically mediated experience of pain. It's possible we're spreading cultural memes about aging that causes old people to hyperfixate on minor and aches and pains but the cultural universality of old people's body's hurting makes that seem iffy to me. It could be that technological advances of having pain treatments available primes people to fixate on total pain alleviation and medical treatments while past generations would simply learned to tolerate the unchangeable pain.

I know an old hippie lady who had chronic back pain that kept her in bed a lot. She loves to tell the story of how she 'cured' it by meditating intensely, talking to the pain in the form of a wol, and fully internalizing the idea that it was a part of her body trying to protect her not a sign she was being harmed. She's relatively mobile in day to day life and in some sense was healed, but she's still an old lady and moves gingerly and there's no way she could work in a warehouse or something. That's to say that there's substantial mobility and pain reduction to be gained through psychologically and culturally mediating pain like that but, not infinite improvement in most cases. Even when pain has identifiable biological causes there's still a lot of reduction that can be accomplished through psychological means.

The fact that chronic pain is so well correlated with aging suggests that for the majority of people there is some underlying physical degeneration coupled with a culturally/psychologically mediated experience of pain.

Not necessarily. Perhaps it suggests that "everyone knows" chronic pain is well correlated with ageing, so only old people can overcome the subconscious suspension of disbelief and delude themselves that they have it.

In the same way that no Malaysian-Chinese women worry about penis theft. It's all in their heads, but the scenario in their heads has boundaries.

Maybe with the propagation of gender theory Malaysian-Chinese women start worrying about that. After all, if you can become a woman just by declaring it, why can't you identify as a woman whose penis has been stolen? Moreover, the same ideology would require the doctors, on the pain of being fired and de-licensed, to treat such cases as the actual disappearance of the actual penis. You can't contradict somebody's living experience!

I’ve dealt with chronic pain for a decade and have long suspected that it was mostly psychosomatic.

I guess you know this post?

https://www.lesswrong.com/posts/BgBJqPv5ogsX4fLka/the-mind-body-vicious-cycle-model-of-rsi-and-back-pain

There are some (strange? common?) testimonials about miracle curing chronic pain.

Woah I had not seen this! Bookmarked, thanks for sharing.

It’s a 50 episode series attempting to build a framework for meaning and consciousness. It’s actually quite good although it takes a while to build.

I agree but there's an elephant in the room in the form of subsidies and welfare.

If the Romans had welfare programs specifically for ex-legionaries who were traumatized, there'd be a lot more of them! This isn't to say that all PTSD is made up but that it's surely magnified by incentives. Same with chronic pain, anxiety and some others. That helps normalize it as a concept, something that people can have.

All kinds of students have 'fluctuating conditions' or 'anxiety' since it gets them more favorable conditions in exams (at least in my country). I highly doubt that they do that in China or South Korea where they'd probably laugh at you if you said you were anxious about studying 12 hours a day. In many countries you can get welfare for these conditions. If you pay for something, you get more of it.

I recall reading veteran comments about having some PTSD but never seeking any treatment for it, because when they did, and it was some group therapy, they realised 80% of those in the room were faking it and walking away from it in disgust.

Sometimes I will start thinking that I'm stressed and my heart rate will increase as I start to feel miserable and sort of "lose agency" in the sense that I will begin to engage in mildly self-destructive behaviors such as playing a videogame when I should be working. These periods are generally caused by real stressors, but without fail I can introspect a bit and notice that most of my behavior comes because I am pretending to be stressed. When I simply ignore it and deny that I'm stressed at all, the stress generally goes away and I just get back to work, no harm done.

I wouldn't necessarily call this a cultural illness, though culture certainly has an effect. It's more that I think our brains don't perfectly record their own thoughts, so we as humans are particularly bad at interpreting and explaining our own emotions, memories, behaviors, etc. in ways that can compound on themselves. I have noticed this in myself in many different areas. Basically any time I seem to be making bad choices, I can reason through why those choices are being made and come to the conclusion that I seem to be emulating what I think someone else would do, e.g. I feel like I must be stressed out so I'm emulating a stressed person, or same for someone who is angry or sad.

That said, I have experienced chronic pain (but do not currently) and that was definitely 100% real. Certainly it can be psychosomatic for some people but let's be clear that it often has a purely physical cause.

That said, I have experienced chronic pain (but do not currently) and that was definitely 100% real. Certainly it can be psychosomatic for some people but let's be clear that it often has a purely physical cause.

It can absolutely have a physical cause, but more than a few months and I'd be willing to bet it's mostly psychosomatic. My understanding is that most chronic pain starts with an acute injury and spirals from there. The brain feels the body get hurt, tenses up, and a vicious cycle ensues.

At the end of the day the line between the two is blurry.

As far as I am aware one leading explanation isn't that it really is psychosomatic in the regular sense but rather than the system for sending pain signals from the spinal cord to the brain gets messed up by and self triggering from having some sort of long term pain, which leads to it continuing sending signals to the brain despite the injury healing.

The brain isn't at fault, it receives real signals, it's just that the signals doesn't have a injury as a cause (any more).

Eh, I think this one is genuinely real. As for other types of chronic pain, I'd be willing to believe they're mostly psychosomatic, but it's hard to know for sure without having experienced it. Sorry to be the "well acktually" guy but there really are real sources of chronic pain.

Hah you’re fine. I think the terminology here is mostly to blame, “real” and “psychosomatic” don’t really map onto what we’re getting at. Maybe culturally-induced vs mechanical?

Sure, IDK if it's really "cultural" though, psychosomatic seems more accurate. I think even if you were a hermit with absolutely no culture you could still fool yourself into a lot of these things.

Ironically, support groups where people confirm and commiserate seem to make the issue worse. In fact, many modern studies on pain recommend not even using the word "pain" and replacing it with something else to trick your mind into understanding that your pain doesn’t have an acute physical cause.

And, to add a button to this dynamic, the mode of therapy for these kinds of issues seems to have changed from correcting them -- aiming to help the patient reconcile their delusions with reality -- to normalizing the delusions, including cultural reinforcement of this normalization.

Is that true?

I assume you’re thinking of trans issues. That’s the only thing on OP’s list where I’ve seen treatment focused on bringing the physical in line with the mental. Well, there’s physical therapy and prosthetics, but that’s beside the point. Anxiety, depression, et cetera…the intent is to mitigate them.

DBT was developed for people who experience extreme emotional responses to certain situations. “It’s essentially about learning how to think in a way that calms you down in moments of crisis,” explains Johnsen. “The goal is to center yourself so that you can get back to rational thought and behavior more quickly. Eventually, you should be able to catch yourself and learn to curb overreaction before it occurs.”

DBT is a “gold standard” in treating conditions like borderline personality disorder (a chronic behavior pattern that may include mood instability, difficulty with interpersonal relationships, and self-injury) and histrionic personality disorder (which entails constant attention-seeking, emotional overreaction, and seductive behavior) but can be used to treat anyone who experiences over-reactivity in certain scenarios. “It’s an in-the-moment technique that a person can use to regulate super-strong emotions, and get to a place where those emotions are bearable and surmountable.”

Source. The last couple options on that page lean away from coping strategies, but they still aren’t normalizing the symptoms.

It might also be worth noting that the response to mental illness isn’t exactly coordinated. Political slogans, softball media coverage, and Twitter—avenues of cultural reinforcement—don’t fall in line with therapists. Arguably, it’s the other way around, since motivated patients can select their way to a sympathetic therapist.

Anxiety, depression, et cetera…the intent is to mitigate them.

I'm not sure exactly what the modes of mitigation are, and if they're applied consistently. I guess I'm reacting more to the "pop psychology" reaction to these issues that you see in the media, and the effusive affirmations that now greet announcements of mental illness.

For anxiety and depression, my assumption is that the treatment for these has at least shifted from a "get over it" approach to a "this is very normal and valid" approach, even if the latter was originally intended as a way to end-run around the obvious objections to "get over it" while still helping them get over it. Now, the mode seems to be helping the patient feel better about their affliction rather than removing the affliction, as if the stigma of a mental health problem is more important than the mental health problem.

I'm wondering if it might also depend on the demographics of the patient. I have a hard time imagining that the treatment approach (across a broad swath of therapists) would be the same for a middle-aged white man who feels paranoid anxiety over romantic issues with women and a young black woman who feels paranoid anxiety over racial discrimination. Is one more likely to be asked to look for internal causes/solutions to their predicament while the other is tasked with better coping skills in the face of injustice? Is a profession that has fallen almost completely in-line with a radically progressive approach to trans issues not going to see that same context start to inform their other treatments?

hasn't it mostly transitioned to therapy and maybe prescribing antidepressants?

And even create them. Modern therapeutic culture absolutely creates the preconditions for getting a mental illness. We teach through culture that you’re supposed to be happy and healthy and successful and that failure to achieve a life like that is a failure mode of life. And expectations are absurdly high. You have been told to get rich doing a job you love, to find a soul mate, and hobbies you’re passionate about, lots of friends, and be absolutely authentic all the time. Nobody actually has a life like that, or at least not anyone born into the leisure class. And worse, when the failures come and you feel bad, the general message is to focus on that one thing that’s broken. Incels are doing exactly what the culture has taught them, in a sense. They are supposed to have a wife, or at least date. But, for various reasons it isn’t working. So they focus on it. And they focus on how bad it feels to not only not date, but how bad it feels to feel that bad. If I wanted to create a toxic brew for mental illness, this is how I’d do it. Create absurdly high expectations, blame the victim for failures, and tell them to focus on their failures and how bad they feel as a failure. If I could do that, I guarantee I can create anxiety and depression.

Incels are doing exactly what the culture has taught them, in a sense. They are supposed to have a wife, or at least date. But, for various reasons it isn’t working. So they focus on it. And they focus on how bad it feels to not only not date, but how bad it feels to feel that bad. If I wanted to create a toxic brew for mental illness, this is how I’d do it.

How would this square with the fact that polygamous societies are less stable due to the issues caused by unhappy, unmarriageable young men?

Are lower-class Somali men steeped in the over-ruminating logic of (bad) Western psychiatry?

Man, that reminds me of an exchange I got into on Discord. I probably should have known better, but for whatever reason this discord about funny youtube videos devolved into everyone talking about their mental illnesses and describing their therapy and self help books.

I said mine was "Shut The Fuck Up" By Dr Denis Leary. Nobody got the joke. People said they'd never heard of it, so I posted the bit. It was a joke. I was making a joke. This being a discord for funny youtube videos and all.

It.... did not go well. One person was especially triggered, accusing me of attacking them and wanting them to die. The mods eventually had to step in and make peace.

I don't understand the neurotic wound picking that seems to have become the predominant culture on nearly every web based community I traverse.

I would assume something like that was an attack, to be quite honest. The alternative interpretation is that you were trying to change the subject to funny youtube videos when people want to wallow (already a faux pas), and just by accident picking the one that looks exactly like an attack on the wallowing people. Unless I knew you to be extremely socially unaware I wouldn't assume such an unlikely scenario.

That might be a more effective response than my go to, which is “uh…y’all having fun in here?”

For some reason the people who want to broadcast their home/romance/gender struggles in #offtopic don’t tend to take that hint.

It seems to me that there could easily be two separate and sometimes overlapping things going on here.

There could be one group with the underlying physical cause and then the usual neurotic demographics that develop the same condition psychosomatically after it gets promoted for some reason (or people sorting their own different physical condition in under whatever label is hip or gets them resources and/or sympathy).

Or people have some more or less severe physical condition but the consequences of it gets magnified psychosomatically by the cultural understanding of the (or a similar) condition.

I wouldn't consider gender dysphoria to be a red herring, it's more of a flagship. The most prominent example due to it being deliberately spread and promoted above and beyond what most of the others are, and therefore the most obvious example of this trend.

But yes, it is but one example among many, and probably noncentral given that it has significant opposition and thus culture war effects while the others mostly go unnoticed and unopposed.

To quote my response to @aqouta below:

I suppose I think that compared to depression, anxiety, chronic pain, anorexia, and other issues I see trans as something that doesn't cause nearly as much harm, but generates a disproportionate amount of outrage. It's definitely one of the best examples of a subculture driving mental illness though.

Are you talking about in absolute terms? That is, transgenderism is significantly rarer than most of those conditions, and therefore fixing it would be less significant in total value than fixing one of the others.

Or do you mean per person? Because transgenderism causes significant distress in many of its sufferers, driving many to suicide, social ostracism, and mental anguish up to the point where they are willing to undergo expensive and permanent surgeries, including castration, in an attempt to alleviate it. The more serious cases (people who seek actual physical transition) seem comparable to the more serious cases of depression and anorexia, which also lead to suicide, self harm, and other forms of self-imposed physical harm to otherwise physically healthy people.

A transtrender who dresses up like the other sex and uses a different name for a few years before going back to normal isn't especially suffering, but neither is someone with minor social anxiety or self-diagnosed ADHD.

I think in comparing like to like it's pretty comparable to most of the others, aside from the disproportionate promotion/opposition it receives from each political side.

Yes in absolute quantitative terms. I don't particularly care about whether individual trans people have it worse than depressed or anxious people, I think the question is beyond confused anyway.

When you're looking at societal issues it makes sense to focus it on the aggregate, in my view. Why the heck would anyone talk about a mental illness 100 people had? (Obviously trans is larger but the media massively overplays the numbers.)

This is a reasonable point.

I still think it is appropriate to talk about in disproportion to its prevalence due to the unique nature of its advocacy. That is, it is deliberately being promoted and celebrated and spread, as opposed to incidentally spread via cultural knowledge as the other conditions are. As a result:

  1. It is increasing at a faster rate than the other conditions are. So its prevalence in the future may be greater than theirs even if its current prevalence is not

  2. It is significantly simpler to reduce. Stop digging the hole. Mental health conditions which are treated as mental health conditions and spread via general cultural knowledge of them would require deliberate anti-awareness campaigns or other anti-memetic shenanigans to reduce this way. Transgenderism just requires you to stop celebrating it. Or, it would have, the cat's probably out of the bag now and it's probably going to stick around for a long time even if a consensus were to be reached that it's negative for its sufferers. But at the very least, stopping its increase would improve mental health in the future. So it's possible to create more value per effort, at least in theory, because of its current position in the culture war.

People being depressed don’t gain access to facilities they would otherwise be barred from.

I've long believed something that rhymes with this and becoming more familiar with modern psychiatry has done nothing but increase the feeling that we're both pathologizing normal human variance and create more extreme cases by creating identity molds for people to slot themselves into. I could have made a case for having many different issues, depression, anxiety, and attention defeciet, ect. It would be easy, maybe some of them at some points of my life would be even true.

I was diagnosed with dyslexia in childhood, to this day I am not sure if that is a diagnosis that just means nearly nothing or if it was a miss diagnosis. I do indeed read slower than many peers, but I'm not even sure how cleanly I can separate cause and effect there, perhaps the diagnosis gave me an excuse and in fact a neat little special marker that overcoming or discarding the diagnosis would actual rob me of. I'd just be a normal.

Anyways I mostly forgot about the whole thing for years but recent it's resurfaced in my consciousness as some excuse for some behavior and in resurfacing I now really do seem to be finding it relevant more and more. I find myself even more preferring audio to text, even more not putting in the effort to improve. On the other hand without the diagnosis I might have thought I was dimmer than I otherwise am, the identity package included strengths with the weaknesses and might have cause dme to lean more into math and engineering subjects than I otherwise would have.

I know you see the trans question as a red Haring but this is another reason I find the topic impossible to ignore. It's the meme equivalent of a bullet with my name on it. There but for the grace of God go I as it is exactly the kind of thing I might have been susceptible to.

Crystallizing this further, I think particularly in the case of depression / anxiety / ADHD, what happens is that a cultural meme develops that some common facet of the human experience is caused by some specific disease, and that the appropriate way to fix this is to obtain treatment.

Examples:

  • Alice notices that she does not enjoy things that she's "supposed" to enjoy. She's heard that this can be a symptom of depression. She looks up "how to tell if you have depression", and reads that common symptoms include apathy, lack of interest, excessive sleepiness, and insomnia. Now, every time she has trouble falling asleep, she thinks "wow, this depression sucks" and not "I am having trouble falling asleep". She looks up "what to do if you have depression", and sees the usual suggestions about sunlight / therapy / medication. She thinks "well, they were definitely right about my symptoms, so they're probably right about the treatment as well", and gets a therapist and a sunlamp.

  • Bob notices that he's having a lot of trouble focusing on his job as Senior Manipulator of Boring Numbers. He has heard that trouble focusing can be indicative of ADHD. He looks up "symptoms of ADHD", sees fidgeting, absent-mindedness, difficulty focusing, and forgetfulness. Now, the next time he is introduced to a room full of people and has trouble remembering their names, he thinks "wow, ADHD sucks" and not "wow, I'm bad at names". He obtains some amphetamines, which is what you do when you have ADHD.

  • Carol notices that her heart rate is elevated and her muscles are tense before her board meeting. This has happened before the last three board meetings too. She googles "elevated heart rate tense muscles" and sees that, according to WebMD, she either has anxiety or lupus. She knows that WebMD is strangely likely to say that people have lupus, but the description of anxiety is on-point. Additionally, there are some new ones on there, like "difficulty concentrating", which she didn't think were caused by the same thing as the thing where she gets way too nervous before important meetings, but maybe it is after all. She talks to a therapist, and learns that indeed, all of her problems are because she has a disease called "Anxiety", but with the proper therapy schedule and medications, she can probably live some semblance of a normal life.

  • Dan notices that he's been having trouble with his sexual performance. He goes to the friendly neighborhood elder, who informs him that this is a common symptom of being cursed by witches. When you are cursed by witches, lots of bad things can happen, including livestock death, sudden inexplicable vomiting, and impotence, and in extreme cases, your penis sometimes even disappears! The next day, one of Dan's chickens keels over and dies for no apparent reason, and what's worse, he starts violently vomiting after eating the dead chicken. And oddly his penis feels smaller than usual. What was it that elder said he should hang above his door again?

Hypothesis if this is a usefully predictive model of the world: People who read their horoscope on a daily basis are more likely to experience chronic pain than those who don't, even when controlling for all of the obvious confounding factors. I expect that this would be the case because I expect "reads the horoscope daily" to be a reasonably good proxy for both "is searching for an overarching narrative of why things are they way things are" and also "is prone to confirmation bias", and I expect that "you have chronic pain" is one of those things you're more likely to believe if you're searching for an overarching explanation and tend to look for evidence under streetlamps.

Crackpot theory time: It would be possible to significantly reduce the burden on chronic pain by doing something like the following:

  1. Experienced debilitating, chronic pain for some period of time

  2. Changed something plausible about their lives

  3. Immediately after making the change, noticed something that was an obvious consequence of making the change

  4. Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

and then loudly broadcast the existence of this group of people at people who have chronic pain. I expect that this intervention would work even if people knew you were doing it, as long as you (correctly, I think) pointed out that your narrative is more plausible than the narrative of "sometime in the recent past, a phenomenon started happening where otherwise-healthy people started experiencing significant pain for no apparent reason, and found themselves unable to live their lives normally due to that pain, and found that, though the pain might sometimes temporarily improve, it always comes back". Because "I do sometimes experience pain, but it's not continuous" and "I sometimes experience a reduction in pain to the point where it's not noticeable, but the pain always comes back" in fact describe exactly the same set of experiences.

Crackpot theory time: It would be possible to significantly reduce the burden on chronic pain by doing something like the following:

*Experienced debilitating, chronic pain for some period of time

*Changed something plausible about their lives

*Immediately after making the change, noticed something that was an obvious consequence of making the change

*Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

I don't really understand this - can you give a concrete example?

For some examples, see the comments of the link posted upthread. For example, pjeby's comment on that LW post:

1. Experienced debilitating, chronic pain for some period of time

I used to have wrist pain a lot, and tried a ridiculous number of things to deal with it

2. Changed something plausible about their lives:

until I discovered the trigger point concept. Over time I've learned to identify which trigger points produce what symptoms for me, and what postures or behaviors set off the trigger points. [...]

3. Immediately after making the change, noticed something that was an obvious consequence of making the change

My dentist referred me to an oral surgeon twice for things that later turned out to be trigger points: my teeth had gotten sensitive after dental work, but it turned out that I developed trigger points from having my mouth open for hours during the procedure. Now I know where to massage my neck and jaw to prevent tooth sensitivity from arising in certain areas of my mouth after dental work

4. Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

Anyway, my prior now for "mysterious chronic pain" is "check for trigger points creating referred pain". Most often this consists of following the nearest muscles, nerves, or blood vessels in the direction of the spine or brain, checking for tenderness. A sharply sensitive spot is likely a trigger point, so I press deeply on it for a minute (as in 60 seconds) and see if the original pain is made worse or better. If nothing happens to it, it's probably not the trigger point. (Pressing on a trigger point can make the pain temporarily worse, but the pain will reduce again when the trigger point releases or un-knots.)

So pjeby mostly reconceptualized what the pain meant. If you have a job that involves a lot of typing, and your wrist starts hurting, a natural hypothesis might be "the typing caused the wrist pain", which suggests the action of "reduce the amount of typing you do until the pain goes away". The idea of "trigger points" gives an alternative hypothesis of "I am feeling referred pain", and suggests the action of "look at the chart and massage the indicated areas until the pain recedes".

Now obviously, if the "trigger points exist, and pressing them causes the pain signals to diminish" model of the world is just factually correct, that would explain why pjeby saw such good results. But even if the world-model is not fully correct, it might still be less wrong than the original world-model where pain was caused by strain and should be solved by using rest. And in the case of chronic, debilitating pain where the sufferer has rested for an extended period and the pain is not improving, there is fairly strong (not insurmountable, but fairly strong) evidence that the "rest will make the pain go away" model is not helpful, and replacing it with a different plausible model is likely to be a good idea.

For the sake of clarity, there is a thing which sounds a lot like what I am saying, but is emphatically not what I am saying. That thing is "trigger points are bullshit placebos, and they only appear to work because chronic pain is fake". If that is what you are getting from my post, please let me know and I'll try to come at it from a different angle.

Think of a certain sort of televangelist.

  1. Find someone with debilitating but nonvisible illness

  2. Loudly invoke the power of the LORD

  3. Patient experiences one of the socially expected consequences, like speaking in tongues or collapsing

  4. wow pain is gone

And then there’s step 5: televise this for awareness and/or profit.

It doesn’t have to be religious, but that’s probably the most visible narrative that deals with life transformation. I guess you could make a similar narrative for gender dysphoria…

I will note that it is an important part of my world model that people with chronic pain, or with gender dysphoria, are in fact experiencing sensations which they interpret as aversive. And, while there exist humans who can execute the mental motion of "recontextualize your experiences such that the pain is not suffering", I don't think telling people to do that directly is likely to be a winning strategy.

"There is no such thing as an unmediated experience" is a true fact about the world (one that people in our particular corner of the internet are particularly bad at acknowledging - see all of the "I didn't fall for that optical illusion" types). In isolation, is is not usually a helpful fact about the world. However, rephrasing it as "here are some different lenses you can view your experiences through, keep trying out different lenses until you find one you like" is an approach that I expect will work more often.

Crackpot theory

See also: Duplex’s tithing experience in the Friday thread.

Thanks for your perspective. Dyslexia is another good example of one of these potentially culturally bound illnesses.

I know you see the trans question as a red Haring but this is another reason I find the topic impossible to ignore. It's the meme equivalent of a bullet with my name on it. There but for the grace of God go I as it is exactly the kind of thing I might have been susceptible to.

I suppose I think that compared to depression, anxiety, chronic pain, anorexia, and other issues I see trans as something that doesn't cause nearly as much harm, but generates a disproportionate amount of outrage. It's definitely one of the best examples of a subculture driving mental illness though.

I do agree that Trans in of itself generates less harm, but the sheer massive correlations with other mental illnesses seems to be indicative of an issue.

It’s pretty clear that it is much, much worse to be trans than cis, so it would be a pretty central example of a subculture driven mental illness really hurting people.

I suppose I think that compared to depression, anxiety, chronic pain, anorexia, and other issues I see trans as something that doesn't cause nearly as much harm

I find this difficult to understand. Just on a trivial metric transgendered people seem to have a higher suicide rate than depressed people. You may be right on chronic pain but that does seem less memetically contagious and much less identity forming so it Amy make up in pure volume what chronic pain has in raw level of misery caused. I can't say which I would choose if I had to make such a choice, but it is far from obvious to me that transgendered is the least of the options on that list.

Fair! I suppose I thought depression/anxiety etc were much more broadly diagnosed and well known in society.

Then again, I'm also a bit tired of all the constant debates about trans on here. ;)

simply

Ay, there’s the rub.

How would you implement such a change in perspective? How could you do so without significant change in the outside world?

I’m reminded of the teen pregnancy discussion a couple weeks back. It didn’t go down because everyone decided to make a societal change. Instead, the confluence of social signaling, costs, new technology, and coordinated efforts shifted the calculus.

One of the early touchstones of the community was raising the sanity waterline. Getting people, in general, to believe true things and avoid bias. This was rightly recognized as rather hard. Quite a bit of the early rationalist canon was dedicated to actually changing your mind. (Also, wow, the community was so much more vocally atheist back then.) Sociogenic mental illness fits right in: just get people to stop thinking in the bad way.

It’s also…kind of the steelman for therapy? Back in Freud’s day the strategy was digging up whatever had stunted emotional development in hopes that it would be resolved. Today we’re a little more sophisticated and try to teach strategies and mental patterns to redirect the mind. CBT, DBT, IFS…at least there’s some effort to measure and test their effectiveness.

But that’s the bar for changing people’s minds. At best, you’re operating in the same regime as modern therapy with all its pitfalls. At worst, you’ve got to rebuild a large chunk of culture to accommodate the new idea. It ain’t simple.

How would you implement such a change in perspective? How could you do so without significant change in the outside world?

I’m reminded of the teen pregnancy discussion a couple weeks back. It didn’t go down because everyone decided to make a societal change. Instead, the confluence of social signaling, costs, new technology, and coordinated efforts shifted the calculus.

I'm skeptical that you necessarily need to change everyone's sanity at once. Effective Altruism is a good example of a movement that can get a lot of narrow work done without making everyone involved significantly smarter. You get smart people at the top directing others, and build a hierarchy that (hopefully) selects for competence.

Now EA may be in troubled times, but it has certainly had a massive impact. If we could make this sort of awareness into a cause area I think we'd get significant movement. At least better than a counterfactual without some sort of movement.

I would add Long Covid to this list of illnesses. Of course, post-viral symptoms from a nasty viral infection are a real thing that impact some non-trivial number of people, but the distribution of Long Covid doesn't make much sense if it's that. We have a disease that can't be identified with reliable physical markers; per the CDC:

A positive SARS-CoV-2 viral test (i.e., nucleic acid amplification test (NAAT) or antigen test) or serologic (antibody) test can help assess for current or previous infection; however, these laboratory tests are not required to establish a diagnosis of post-COVID conditions. SARS-CoV-2 RT-PCR and antigen testing are not 100% sensitive. Further, testing capacity was limited early in the pandemic so some infected and recovered persons had no opportunity to obtain laboratory confirmation of SARS-CoV-2 infection. Finally, some patients who develop post-COVID conditions were asymptomatic with their acute infection and would not have had a reason to be tested.

Even more strikingly, Long Covid correlates with belief in having Covid rather than positive tests:

Conclusions and Relevance The findings of this cross-sectional analysis of a large, population-based French cohort suggest that persistent physical symptoms after COVID-19 infection may be associated more with the belief in having been infected with SARS-CoV-2 than with having laboratory-confirmed COVID-19 infection. Further research in this area should consider underlying mechanisms that may not be specific to the SARS-CoV-2 virus. A medical evaluation of these patients may be needed to prevent symptoms due to another disease being erroneously attributed to “long COVID.”

The CDC demographic breakdown of who says they've had Long Covid is fascinating - women report it much more frequently than men, but transgendered people more still, bisexuals report Long Covid much more than straight or gay people, and there doesn't look like any correlation between races and states that makes sense with infection rates or severity of illness. Other work shows much higher rates among people with self-reported histories of anxiety.

As Scott suggests, I'm not saying that these people aren't experiencing something quite unpleasant, but I am saying that it's often not a product of a strictly viral or immunologic cause.

I would add Long Covid to this list of illnesses. Of course, post-viral symptoms from a nasty viral infection are a real thing that impact some non-trivial number of people, but the distribution of Long Covid doesn't make much sense if it's that.

Good call, added to the list.

Highly recommend reading Ian Hacking's Making Up People which was a decade ahead of The Geography of Madness in describing this phenomenon.

Around 1970, there arose a few paradigm cases of strange behaviour similar to phenomena discussed a century earlier and largely forgotten. A few psychiatrists began to diagnose multiple personality. It was rather sensational. More and more unhappy people started manifesting these symptoms. At first they had the symptoms they were expected to have, but then they became more and more bizarre. First, a person had two or three personalities. Within a decade the mean number was 17. This fed back into the diagnoses, and became part of the standard set of symptoms. It became part of the therapy to elicit more and more alters. Psychiatrists cast around for causes, and created a primitive, easily understood pseudo-Freudian aetiology of early sexual abuse, coupled with repressed memories. Knowing this was the cause, the patients obligingly retrieved the memories. More than that, this became a way to be a person. In 1986, I wrote that there could never be ‘split’ bars, analogous to gay bars. In 1991 I went to my first split bar.

This story can be placed in a five-part framework. We have (a) a classification, multiple personality, associated with what at the time was called a ‘disorder’. This kind of person is now a moving target. We have (b) the people, those I call ‘unhappy’, ‘unable to cope’, or whatever relatively non-judgmental term you might prefer. There are (c) institutions, which include clinics, annual meetings of the International Society for the Study of Multiple Personality and Dissociation, afternoon talkshows on television (Oprah Winfrey and Geraldo Rivera made a big thing of multiples, once upon a time), and weekend training programmes for therapists, some of which I attended. There is (d) the knowledge: not justified true belief, once the mantra of analytic philosophers, but knowledge in Popper’s sense of conjectural knowledge, and, more specifically, the presumptions that are taught, disseminated and refined within the context of the institutions. Especially the basic facts (not ‘so-called facts’, or ‘facts’ in scare-quotes): for example, that multiple personality is caused by early sexual abuse, that 5 per cent of the population suffer from it, and the like. There is expert knowledge, the knowledge of the professionals, and there is popular knowledge, shared by a significant part of the interested population. There was a time, partly thanks to those talkshows and other media, when ‘everyone’ believed that multiple personality was caused by early sexual abuse. Finally, there are (e) the experts or professionals who generate (d) the knowledge, judge its validity, and use it in their practice. They work within (c) institutions that guarantee their legitimacy, authenticity and status as experts. They study, try to help, or advise on the control of (b) the people who are (a) classified as of a given kind.

This banal framework can be used for many examples, but roles and weights will be different in every case. There is no reason to suppose that we shall ever tell two identical stories of two different instances of making up people. There is also an obvious complication: there are different schools of thought. In this first instance, there was the multiple movement, a loose alliance of patients, therapists and psychiatric theorists, on the one hand, who believed in this diagnosis and in a certain kind of person, the multiple. There was the larger psychiatric establishment that rejected the diagnosis altogether: a doctor in Ontario, for example, who, when a patient arrives announcing she has multiple personality, demands to be shown her Ontario Health Insurance card (which has a photograph and a name on it) and says: ‘This is the person I am treating, nobody else.’ Thus there are rival frameworks, and reactions and counter-actions between them further contribute to the working out of this kind of person, the multiple personality. If my sceptical colleague convinces his potential patient, she will very probably become a very different kind of person from the one she would have been had she been treated for multiple personality by a believer.

I would argue that the multiple personality of the 1980s was a kind of person previously unknown in the history of the human race. This is a simple idea familiar to novelists, but careful philosophical language is not prepared for it. Pedantry is in order. Distinguish two sentences:

A. There were no multiple personalities in 1955; there were many in 1985.

B. In 1955 this was not a way to be a person, people did not experience themselves in this way, they did not interact with their friends, their families, their employers, their counsellors, in this way; but in 1985 this was a way to be a person, to experience oneself, to live in society.

As I see it, both A and B are true. An enthusiast for what is now called Dissociative Identity Disorder will say, however, that A is false, because people with several ‘alter personalities’ undoubtedly existed in 1955, but were not diagnosed. A sceptic will also say that A is false, but for exactly the opposite reason: namely, that multiple personality has always been a specious diagnosis, and there were no real multiples in 1985 either. Statement A leads to heated but pointless debates about the reality of multiple personality, but in my opinion both sceptics and enthusiasts can peacefully agree to B. When I speak of making up people, it is B that I have in mind, and it is through B that the looping effect occurs.

Multiple personality was renamed Dissociative Identity Disorder. But that was more than an act of diagnostic house-cleaning. Symptoms evolve, patients are no longer expected to come with a roster of altogether distinct personalities, and they don’t. This disorder is an example of what in my book Mad Travellers (1998) I called a ‘transient mental illness’. ‘Transient’ not in the sense of affecting a single person for a while and then going away, but in the sense of existing only at a certain time and place. Transient mental illnesses can best be looked at in terms of the ecological niches in which they can appear and thrive. They are easy cases for making up people, precisely because their very transience leads cynics to suspect they are not really real, and so could plausibly be said to be made up.

MPD makes sense to me. People already engage in various forms of "mask-wearing": if you're a performer, you're consciously putting on a very elaborate mask of the character you're portraying. But even outside the world of theatre, consciously or unconsciously, you're wearing one mask in front of your parents, the other in front of your partner, the third one in front of your friends, the fourth one in front of your coworkers, the fifth one in front of a cop, the sixth one on The Motte and so on. Some people narrate their internal monologue as a dialogue.

It's not a huge leap to get from putting a mask on unconsciously, to putting one on consciously, to deliberately crafting and enhancing such a mask, to treating an advanced mask as a person, especially when you have learned that treating masks as separate people is something people do.

That's not what MPD is though. Like, the way I talk on this site vs 4chan are wildly different, and it's sorta plausible to say they're different "masks" or "personalities", even though they both come from the same goals / values / etc. But that's just 'purposeful action that depends on context and conditions', not 'different people'. Your 'thinking' or 'ideas' aren't fixed into one mask or context, you can remember something that happened in a seriouspost and make a joke about it later. And sometimes you make a seriouspost on rdrama, sometimes you tell a joke here. (And I'd personally prefer a motte where bizzare enraging shitposts are mixed with the seriousposts, but am aware it wouldn't work, both because they don't want to see the shitposts and they'd bait them away from making interesting posts.)

But someone with MPD claims to have 'fully separate' personalities that they 'can't control' - you'll switch semi-uncontrollably between one and another, you can't remember things on one personality that another can. They'll have different 'traits' in the same contexts, depending on what "person" they claim is fronting at the moment. This isn't just - sometimes you act silly and other times serious - which is entirely normal and unremarkable. It's saying that "Serious You" is "Joe" and joe is extraverted and likes doing math and watching cartoons, but "Silly You" is "Sally" and sally is introverted and likes moodboards and Harry Potter. This is just weird. Why not be ""extraverted"" about harry potter or ""introverted"" about math, depending on the circumstance? (and it really is that dumb - 'Having DID is wild [...] or a certain song will come on and suddenly I'm wearing different clothes and it's two hours later and I'm like "oh right"'). There's no use for that - each of those things can be engaged in independently. And the 'can't remember stuff from one personality in another one' isn't at all biologically plausible. They're just larping.

There’s a bit of motte and bailey going on. Or maybe sanewashing, I don’t know.

The defensible example is what you’re saying—everyone does social adaptation, some probably do it via dialogue, the long tails of that distribution could look like multiple personalities. There’s long-standing rationalist blogposts about having such dialogue, fiction with characters who use it, along with a general credulousness when talking about weird mental states. It’s also what Scott defends in his post:

For example, the person might be kind of a pushover, and then one time after they watched Star Wars ten times in a row, someone bossed them around particularly badly, and they imagined Darth Vader telling them to give into their anger and fight back…They emphasize that it really feels like Vader is in their head giving them advice, or that they sometimes “become” Vader - and in particular they emphasize that this is different from just asking themselves “what would Darth Vader do in this situation?”. They understand that most people learning about their situation would expect that they’re exaggerating a much more boring “just ask yourself what Vader would do” situation, and they’re fine with people believing that if they want, but insist that it’s actually something different and more interesting than that.

Something weird but comprehensible, plausibly an exaggeration, plausibly as “real” as anything else going on in one’s head. More importantly, it’s easy to empathize if one can relate it to the very normal dynamics of acting, role playing, whatever.

Now start adding accommodations.

This is the spicier claim: that the other personalities are, on their own, valid persons. That they may (or should) be addressed separately. That memories may not be shared, and any inconsistencies are framed as personality differences rather than a mercurial disposition. Perhaps that different pronouns are appropriate, since communities which buy into this dynamic are much, much more likely to be deeply and passionately aware of gender.

I don’t mean this as an attack. I’m really conflicted about the phenomenon, in part because it has such a reasonable motte. Also in part because one of my best friends has been diving headfirst into this community, and I’m worried about her. There is clearly a complex of social obligations which entangles the community with trans issues and transhumanist issues alike.

I could say the same thing about other possible incidences of fake science.

A. There were no flying saucers in the 1900s. There were many in the 1950's.

B. In the 1900s, people did not interpret mysterious things in the sky to be flying saucers and in the 1950s they did.

A is only true if by "flying saucers" you mean an observational phenomenon. And that's a motte and bailey, because when people say that flying saucers, or multiple personalities exist, they are not trying to communicate "this phenomenon exists", they are trying to communicate a particular claim about the underlying reality behind that phenomenon. If all you mean by A is is that the phenomenon exists, A and B are true, but not very interesting, because nobody cares about that.

I think this distinguishing between, say, the brute facts (or underlying reality) of some phenomena X and a socio-cultural narrative about X is exactly what Hacking is trying to get at with his distinction. Further in the paper he writes of autism:

Now let’s try out A and B for high-functioning autism:

A. There were no high-functioning autists in 1950; there were many in 2000.

B. In 1950 this was not a way to be a person, people did not experience themselves in this way, they did not interact with their friends, their families, their employers, their counsellors, in this way; but in 2000 this was a way to be a person, to experience oneself, to live in society.

As I said, A in my view is true for multiple personality. But it is absolutely false for high-functioning autism. It is almost as absurd as saying that autism did not exist before 1943, when Kanner introduced the name. But B, I believe, is true. Before 1950, maybe even before 1975, high-functioning autism was not a way to be a person. There probably were a few individuals who were regarded as retarded and worse, who recovered, retaining the kinds of foible that high-functioning autistic people have today. But people didn’t experience themselves in this way, they didn’t interact with their friends, their families, their employers, their counsellors, in the way they do now.

I think if Hacking were applying his model to your A and B he'd come to the same conclusion as with autism, that your (A) is false but (B) is true. Whatever phenomena we see with the naked eye that we interpret as being "flying saucers" almost certainly existed before we had the socio-cultural narrative of "flying saucers." I take Hackings point to be that having certain kinds of socio-culutural or medical narratives can both change the way we interpret some observed phenomena (as in the case of autism, or flying saucers) but also can give rise to entirely new phenomena (as in multiple personality disorders).

You can say all you want that you're talking about the sociocultural narrative, but everyone else isn't. You know, or should know, that the other people who claim that multiple personalities exist (or don't exist) aren't talking about a narrative. Saying "sure they exist" in reference to a narrative is a way to be the motte to their bailey by pretending to agree with them, but really agreeing with a much easier to defend version that misses the point.

Fascinating write-up - thanks for sharing. I wonder how many critiques of psychology (and other fields) like this are lost because of the fact that the current narrative doesn't support them.

I wish someone would write a counterfactual history where the mythopoetic Jungian psychologists stayed in power and kept developing their narratives into the mainstream. I feel like we might be in a better spot regarding mental health. Psychology has a lot to answer for....

This sounds like a plausible Orson Scott Card novel.

This topic hit way closer to home than I had anticipated. I have been experiencing my own type of delusional paranoia that is remarkably similar to the topic you explain. I had an acid trip around New Years that turned very bad, and long story short I then became extremely paranoid about my health, and particularly my heart and lungs. I've regularly vaped for more than five years and I became anxious to exercise because i believed that it would inflame my cardiovascular system. It got to the point where I had my first panic attack at 26 years old because of it, ambulance and all. I became convinced that I had some type of congenital defect or some vaccine related myocarditis. I got a full check up, EKG, X-rays, blood tests, you name it. Everything came out fine. 177 cm, 165 Ibs. My doctor told me that my health was immaculate. It was literally all in my head. But it was so real. I literally felt like I was going to collapse and die at any moment, I was convinced of it. I felt every heartbeat, and every bed pain from sleeping wrong was misinterpreted as a coming disaster. It turns out that all it really boiled down to was that I was spending a little too much time by myself in my apartment, and consumed a little too much nicotine and caffeine that elevated my heart rate. It is incredible what your mind can convince itself of in the right circumstances.

I’m going through…almost an identical situation to you. No psychedelics, but similar height, weight, age, and newly developed fear of my heart/lungs giving out. It’s so obviously anxiety—but that doesn’t help in the moment, not when the symptoms of a panic attack include all the vague signs of my vascular system losing it. Lately it’s been a sudden awareness of my heart pounding, especially if I dare try to sleep on my left side, even when I’m at a nice 70 BPM.

SSRIs help, and it’s gotten me to start exercising for the first time since the pandemic. Knowing has helped keep me from throwing myself at the medical system. But it fucking sucks.

Sorry to hear you've been through that. I've never experienced anything quite so acute, but I've had my fair share of harrowing moments that later turned out to be nothing.

But it was so real. I literally felt like I was going to collapse and die at any moment, I was convinced of it. I felt every heartbeat, and every bed pain from sleeping wrong was misinterpreted as a coming disaster.

I relate to this so much more than I can express here. I try not to refer to these episodes as "panic attacks" because of the aforementioned issues, but have definitely been there.

It's a type of experience that I think is uniquely difficult to put into words. People who haven't gone through that sort of thing literally just cannot grasp the magnitude of it I find, and I don't blame them. But over time the meaningless platitudes people spout when you open up really drives you to others who understand.

Then of course a whole subculture forms, and the problem reinforces itself. It's a nasty spiral.

A lot of the examples you mention, besides the “you hear about it and then convince yourself you have it,” mechanism, seem to go further and have communities dedicated to actively spreading the condition and making sure people who have the condition keep having it. This often seems to be exacerbated by the architecture of modern social discourse: Victims of the disease congregate online and can wall themselves off from opposing viewpoints, meanwhile there’s kind of a “recruiting” community (e.g., /r/egg_irl) which sources new members. Illnesses whose communities build these recruiting hubs are more successful in spreading. Some are even so successful that the hijack public institutions.

These are literal meme (in the old sense of a self-replicating idea) mental viruses that compete and thrive in the 21st century social lattice. Put that way it seems like no surprise whatsoever that societies with less developed communication infrastructure have a lower prevalence of these diseases.

I guess the question is how to minimize the effect of these on a population. Is there some kind of immunizing treatment? Alternatively does the same mechanism that tends to make “real” illnesses become less severe also exist here?

I wonder if a society with much more restrictive communication like China has less of this. I would support “internet mask wearing” to combat this but at least in the west I’m pretty sure the people in control of making these decisions already have the disease.

At least to some types of people, those communities are extremely dangerous. I fell for the old 'me_irl' memes of old during a few years when I spend a lot of time at home due to illness. I've never really been one to be tricked into believing things when speaking to people in the real world, however those kind of reddit communities manages to warp my mind a lot. Despite never even commenting. Some combination of being tired, agreeable and a bit neurotic?

I see so many people in real life everyday suffering from similar things and I just want to shake them and tell them to throw the phone away. But I don't know how. I wonder what will be said in the future about this time period.

I don't think it's possible to have nothing occupy the memetic vacuum of social media, perhaps we can fill it useful identity memes instead? I'd suggest traditional ones like maternal or paternal but I'm not necessarily against modern versions so long as they're healthy. We destroyed the traditional gender roles people fit into and replaced their with nothing. To paraphrase a meme on /r/theschism, one person's cage is another's frame to build on. If given no frame many people will poorly build something themselves and it won't be as tested as ones we've lived with for all of human history.

I guess the question is how to minimize the effect of these on a population. Is there some kind of immunizing treatment?

I’ll go with the boring classical libertarian answer and say that the answer to free speech is more free speech.

Encouraging a culture in which people are able to freely and publicly criticize these memes would cause them to lose a lot of their contagious force. Becoming trans would be a lot less appealing if the average reaction in polite society was “uh, you know that you’re still a dude, right?” instead of “please tell me your preferred pronouns so I can affirm your identity”.

I think we have seen the consequence of that. The free marketplace of ideas ends up just like the free market. With government interventions, monopolies and all the other fun stuff.

I am not sure I see how it follows from allowing more speech to the median reaction to trans people being to deny their identity. My impression is most people (myself included) who affirm trans people's identities do so for reasons other than fear of social censure. I am not trans myself but it is also my impression there is no lack of media or content which they can be exposed to that denies their preferred identity, often including quite popular and mainstream publications depending on their location.

Any culture that exists gets identified. Once it has been identified it can be mocked. Once it gets mocked those who stand on the outside of that process will steer away from it and look for new cultures that have not been identified yet and are therefor free of mockery. Until we repeat the cycle.

Emo, scene, hipster, goth, metal head, jock, nerd, car guy, metrosexual or whatever other 'culture' that exists within a population.

Now imagine if we had enshrined some of the cultures with an inordinate amount of media and political power. Being emo is actually a medically recognized thing. There are special news stories every week about the emo suicide rate and how emo kids are bullied in school and how that is a giant social problem and how society as a whole has to come together and fix these issues that afflict this very special group. There are support groups and specific institutions and outlets dedicated to the group specifically.

How about instead of media mocking the whole emo thing as being a phase for insecure teenage girls who lack personality and are looking for attention and an excuse to use excessive amounts of make up whilst pretending their PMS is chronic suicidal ideation, we rather make laws that outlaw such verbiage.

Regardless of anything else, I'm sure being emo would still exist today if it had been sanctified in victimary discourse instead of having been mocked. Let alone if it was a pathway to some form of power or social capital.

Now, I think there are reasons outside of all of this that contribute much more to the survivability of LGBTQ stuff compared to things like being emo. But I do think it's an important element. If the words to describe what you see are removed from your brain, all attempts to discuss it will be in vain.

I'm sure being emo would still exist today

It does, I see dozens of these kids every day. It's like 2007 all over again, except they use vapes and smartphones rather than rollies and Nokias.

In Western news media, emos, goths, juggalos etc. are presented in at best a neutral light and at worst a very negative one, and yet all three still exist in some capacity. Some subcultures can apparently withstand decades of mockery and belittlement and survive. There might even be an oppositional component, where being mocked by the mainstream causes people to dig deeper into their subculture more than they would have otherwise.

I don't know if it's the same. It might be the 'next generation of the neurotype' for a lack of a better term, but when I think of emo I think of things like this: https://youtube.com/watch?v=GaNFqd5eTX0 or this https://youtube.com/watch?v=s1o8WpTXfCY

Where the group identity itself is known as being something more than just a fashion trend, where there is an obvious ingroup and outgroup dynamic going on. Where you distinguish yourself as being something through your expression, i.e. makeup and clothing, and are recognized as being different by other groups.

But maybe it is the same where you live, I would not know.

I think of things like this: https://youtube.com/watch?v=GaNFqd5eTX0 or this https://youtube.com/watch?v=s1o8WpTXfCY

I understand, and I see teenagers dressed exactly like that every day. Granted, it was in remission for a few years, but now it's back with a vengeance.

Maybe it is my cultural milieu but my impression is basically every culture you list ("Emo, scene, hipster, goth, metal head, jock, nerd, car guy, metrosexual") all still exist. I think it is likely some marginal people who may have become members of those groups didn't because of that mockery, but my impression is certainly not that these cultures are totally failing to attract new members. Searching for things like "#goth" or "#emo" on TikTok bring up videos with collectively billions of views. Most of those videos seem, at a glance, to be people in the appropriate subculture rather than being mocked as well. It is also not clear to me that "being trans" is more like "being goth" or "being emo" as compared to "being gay."

You are reading into 'existing' too literally. The 'look' still exists, but emo as an identity exists today the same way being trans existed in 2001. In other words it's people putting on a costume in isolation. Outside of that every culture I listed still exists and I never said they didn't.

It is also not clear to me that "being trans" is more like "being goth" or "being emo" as compared to "being gay."

What's the difference? As groups there's no distinction. Gays have always existed but not as a group like we see today.

I am not sure I see how it follows from allowing more speech to the median reaction to trans people being to deny their identity. My impression is most people (myself included) who affirm trans people's identities do so for reasons other than fear of social censure.

One plausible mechanism I could see is that those other reasons are often downstream from forms of social censure. The social milieu I inhabit is almost exclusively people who affirm trans people's identities, out of a genuine belief that the affirmation is the right thing to do. And that genuine belief is formed in an environment in which the idea that anything other than such affirmation could be acceptable is censured harshly. As you write, media that put forth such an idea isn't in short supply, but such things only exist in this environment as objects of derision, a target of a Two Minute Hate at best. As such, I think if such censure didn't exist and people were left free to argue that sometimes affirmation might not be the only acceptable thing, then fewer people would genuinely believe that it's the only acceptable thing, and a higher proportion of people would respond with the "uh, you know that you’re still a dude, right?" instead of "please tell me your preferred pronouns so I can affirm your identity."

No idea if the numbers would shift enough to make the former the average reaction, though. Given the massive incentive for preference falsification in this subject, I'm not sure it's possible to make any meaningful estimates.

  • Anorexia

  • Post-traumatic stress disorder

  • Anxiety

  • Depression

  • Gender dysphoria

  • Chronic pain

I guess the question is how to minimize the effect of these on a population.

I mean, my first impulse would be to remove them from the K-12 curriculum, but that's just me. I don't buy into this learned helplessness. The federal government should not be actively propagating mental illnesses, at a minimum. After this most basic of steps has been taken, we can agonize over echo chambers and misinformation on the internet.

Edit: Jeeze, I really fucked up the formatting on that list, apologies, but I can't seem to find a way to make it work.

I guess the question is how to minimize the effect of [literal memes] on a population.

I think there is also a question of determining which memes are harmful, which on the edges is fuzzier than it sounds. There are plenty of positive memes (the notions of democratic governance and enlightenment liberalism come to mind), and some negative ones like suicide clusters are pretty universally seen as harmful -- barring a crowd of unironic nihilists out there. But the more nuanced memes tend to draw disagreement, often becoming fodder for the Kulturkampf. Is organized religion a harmful meme? Personally, not in most cases, but many arguments to the contrary have been made earnestly.

Even if there were a mechanism for minimizing memes (beyond the simple "countermeme harder" which just raises the temperature), I'd be concerned about exactly what you'd choose to target with it.

From a personal perspective, I can attest that this theory confirms my prior beliefs. I’ve dealt with chronic pain for a decade and have long suspected that it was mostly psychosomatic. Even with this realization, it is a difficult battle to fight. Ironically, support groups where people confirm and commiserate seem to make the issue worse. In fact, many modern studies on pain recommend not even using the word "pain" and replacing it with something else to trick your mind into understanding that your pain doesn’t have an acute physical cause.

So many of us in the rationalist community focus on object-level reasons as to why our society may be stagnating or why we have so many cultural problems. At the end of the day, it turns out that our beliefs themselves may be throwing us into a twisted, absurd, and horrific self-fulfilling prophecy.

It may be time to stop assuming that the causes of our problems originate directly from the outside world and update to a view that many more major problems could be solved if we simply change our cultural beliefs.

You know another common thread? Neuroticism. That inability to just tune out something negative and get on with your fucking life. Extrapolating every bad thing that has ever happened to you or which you've ever experienced into infinity and beyond. And by and large, I believe our therapy culture, our support group culture, our subreddit for everything echo chamber culture just encourages this.

Go work with your hands. Or touch grass. Or something. Get out of your head, and especially stay away from people who just want to wallow in their own misery.

My wife and I have been talking about this quite a bit lately with regard to physical pain and suffering. What do other people experience? Of course, we can never know that for sure, but it's interesting to ponder. One place this came up is in the context of footraces, where the expected norm for anyone that cares even a little bit is deliberately incurring a large amount of cardiovascular stress and suffering, sometimes to the point of collapsing and vomiting after finishing. I have some reasonable degree of confidence that in this context I'm significant tougher than someone that isn't trained at all, but how could I have any idea whether I'm tougher than the guy that I'm racing against on a given day? I suspect that the difference isn't large, but I don't know, I might be gutting by someone strictly because I'm more willing to hurt than they are, but it might also be true that I'm a total pussy and they were able to drain their tank a lot more to even keep a race even. In any case, I know that people that habitually run as fast as they are physically capable of for a few miles will have more ability to tolerate this sort of suffering than people that get winded from going up a flight of stairs.

So how does that translate to the rest of life? When someone says that their back is sore or that they're feeling under the weather, are they experiencing something different than me? It seems to me that they must be, based on the way they react to illness. The number of times per year that I'm too ill to pull up a computer and work is maybe a couple days per year, but I've talked to other people that think it's completely unreasonable that a given company (with strictly non-physical work) only allows a couple weeks per year of sick time. We must be feeling quite different, right? I ultimately don't know, but I suspect that these differences in tolerance translate to differences in experience and result in part of the gap between people that allow setbacks to wreck them long-term relative to bouncing back and getting right. Treating everything as massively damaging seems like a form of anti-resilience that will lead to continually diminished physical and mental capacity to deal with future insults. Sub-cultures that treat these insults and corresponding diminished capacity as an identity unto themselves seem likely to spiral this further, possibly to the point where you have people lying in bed, convinced that they can't do anything, and they're actually correct.

RE: Illness, as I've gotten older, the brain fog I get from even a simple cold has gotten worse. To the point where there isn't much sense in me logging into work to sling some code, when I know I'm running at maybe 50% speed, and most of the code I write won't work either.

Doesn't help that I get sicker, more often, on account of having a kid in school who drags home everything and insist on sharing/stealing my breakfast every morning. I could say no... and sometimes I do when she's especially booger faced. But giving her half my bagel and egg in the morning is a nice daddy/daughter ritual I'd rather not give up. Plus it's one of the surest ways to get food in her before school.

At least she's not eating chocolate frosted sugar bombs.

The number of times per year that I'm too ill to pull up a computer and work is maybe a couple days per year, but I've talked to other people that think it's completely unreasonable that a given company (with strictly non-physical work) only allows a couple weeks per year of sick time. We must be feeling quite different, right?

I think part of this might be, as you say, subjective differences regarding the experience of the same illness, but this could also be just a difference in immune systems/health in general.

That is to say, I wouldn't be surprised if the gap there may be doubly influenced by your running- first in just being healthier and getting sick less/getting less sick and second by then being better at coping with whatever level of discomfort you get from that sickness.

Edit: There is also the noted vicious cycle for chronic illness (real or perceived) where feeling like shit makes you less likely to practice the habits which make you less likely to feel like shit, which then causes you to feel like shit even more/more often. Once again to some extent this applies mentally, but is also a very real thing physically.

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