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PaperclipPerfector  2mo ago (text post)   25167 thread views

Culture War Roundup for the week of April 29, 2024

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One wrinkle for me when trying to think about the efficacy of therapy is that the incidence of mental illness has skyrocketed in step with the wide spread adoption of therapy culture. This is supposed to be caused by increased awareness, but then you have things like Scott's Anorexia in South Korea story, that push me towards a different theory. Therapy culture is horrible, and therapy itself is mostly trash (which is why we can't make any meaningful improvements to the practice after over a hundred years), it only works in as much as it is the socially acceptably path to resolve such issues. I imagine if we could check, running amok would have been found to be an effective above placebo 'therapy' as well. Outside of a handful of mental illnesses with consistent cross cultural manifestations, everything else is either conversion disorder with people trying to fit their negative emotional states into a culturally understood framework, or increasingly, excuses for shitty behavior and to avoid accountability. The framework spawned by therapy culture in the west is particularly bad, mental health awareness is bad, stoicism is probably correct.

The framework spawned by therapy culture in the west is particularly bad, mental health awareness is bad, stoicism is probably correct.

I get that you are making a distinction between "therapy culture" and "therapy" proper, but it is worth pointing out that Stoicism's DNA is in CBT by way of REBT's influence on it, with REBT's founder Albert Ellis being influenced by (among other sources) the Stoic philosophers. So Stoicism's influence is part of modern therapy, even if it is not part of modern therapy culture.

incidence of mental illness has skyrocketed in step with the wide spread adoption of therapy culture

That is hopelessly confounded. For most of history, the only treatment for mental illnesses was beatings, blood letting, the asylum, or maybe some mercury if it was syphilitic.

They barely had the conceptual framework to understand mental illness in the first place.

Besides, we know that the stressors of modernity are bad for mental health in of themselves, just look at social media and dating apps for recent examples. Atomization of families, loss of the (false) comfort from religion and so on.

Not everything is a mass psychogenic illness. I would bet a great deal of money that things like depression, BPD, bipolar disorder and the like aren't. And therapy helps, at least when we now recognize and formally diagnose those who could need it.

My own ADHD would certainly have gone undiagnosed, as would so many other conditions (not that therapy does anything there, the drugs help).

therapy itself is mostly trash (which is why we can't make any meaningful improvements to the practice after over a hundred years), it only works in as much as it is the socially acceptably path to resolve such issues. I imagine if we could check, running amok would have been found to be an effective above placebo 'therapy' as well

I feel like my citations speak for themselves here. Is it a good thing that we have the option of paying money to talk to someone in private instead of running about with a machete? I'd be curious to hear how that's not the case.

I'm not defending therapy culture. It's infantilizing to say the least. But actual therapy works well enough that we often consider it the firstline treatment before resorting to the funny drugs. And that's a considered decision made by multiple independent bodies, on the basis of a great deal of evidence.

Wouldn't it be funny if beatings, bloodletting, alcohol and prayer actually worked?

Imagine life in 1300s Europe. There's a 30-50% chance your child will die as an infant. You might have chevauchee Englishmen/Frenchmen/Germans running around looting and killing. Sudden illness could randomly kill you. You likely work long days in the fields, famine is an everpresent danger especially if the lord decides to take your food. You might be drafted to fight in some war where you'll wait between bursts of extremely gorey, personal violence and interminable waiting as disease picks your comrades off. If you sin you face a very real and universally accepted penalty of eternal hellfire. Esoteric doctrinal differences to the church? Welcome to a world of blood and fire, brought to you by your local crusaders. Alternately, if you're in range of the Mongols you can experience blood and fire without needing any heresy. The less said about Meso-America the better.

This is a pretty stressful lifestyle! WEIRD people don't have any of these problems, only social alienation and other such high-Maslow issues. I won't dismiss the psychic damage inflicted by Microsoft PowerPoint but it's on a totally different level to ubuiquitous deaths in childbirth. Yet there's loads of anxiety, depression and so on today.

Prayer probably does work at least a little bit, and beatings can at least straighten out the crowd with a mental illness downstream of refusing to be normal.

We do at least still have beatings and alcohol, and blood letting too, if you're diagnosed with hemochromatosis.

Frankly speaking, while depression might be more prevalent today as a disease exacerbated by modernity, I can't imagine our ancestors weren't anxious or stressed the fuck out.

They barely had the conceptual framework to understand mental illness in the first place.

Are the current year frameworks better or just different?

Unless there's some identifiable treatable organic cause for the anxiety, mood or personality disorder might the patient improve just as well be guarding against and rebuking the demons of pride, envy, sloth, lust, etc? Especially if most of the available therapy interventions perform as well as each other.

Better? As far as I can tell, yes.

Unless there's some identifiable treatable organic cause for the anxiety, mood or personality disorder might the patient improve just as well be guarding against and rebuking the demons of pride, envy, sloth, lust, etc? Especially if most of the available therapy interventions perform as well as each other.

We do have identifiable organic causes for many psychiatric illnesses we did not, within living memory, once have. Subtle and variable ones, but what can other answer can you expect when asking a question that involves most psychiatric diseases under the sun?

I fail to see how the latter follows at all. It's not like therapy is the only tool in the arsenal, psychiatrists are not psychologists, we dole out meds too and once again, they work, even if some of them aren't as effective as could be desired.

Psychiatrists do dole out meds. But the efficacy (and why) is questionable. I read that exercise seems like it results in a better outcome.

Are you a psychiatrist? If so, that obviously gives you special insight but also clearly a bias.

I just went to the trouble of citing a million studies and meta analyses on the matter, what else can I add that isn't anecdotal? Exercise certainly helps, it's far from the only thing that helps. Antidepressants aren't very good drugs, but they beat placebo at the least.

Are you a psychiatrist? If so, that obviously gives you special insight but also clearly a bias.

I've been accepted into psychiatry residency in the UK, starting in a few months. But it's always been my penchant, so consider me the least biased I could possibly be, or at the least I wouldn't have chosen that subject if I felt it was fraudulent.

That is hopelessly confounded.

It is certainly confounded enough that I did not mean to imply that I have some sort of formula that accurately describes the relationship, but are you contesting that the relationship exists at all, or do you think it is not big enough to meaningful inform how we think about the efficacy of therapy? My thought process here, in simple terms, would be that a person who is having a shitty time but does not exist in therapy culture, has a less shitty time than the same person in therapy culture. So, a study that finds that people who show up with depression get better after therapy, has the problem for me, that I do not know if that person would have had an equally bad condition in the counterfactual where they don't know what depression is. Imagine if the anorexia in South Korea story is correct, and previously Korean girls never got anorexia, and now a bunch are getting it. Someone coming along and telling me that therapy does better than a placebo at treating their anorexia with super high-powered top-tier most excellent and well replicated research, is still not offering me a particularly compelling defense, if I think therapy awareness campaigns 'caused' the anorexia in the first place. See also all the stories of, trauma counseling that traumatized someone.

I'm not trying to say that the myriad forms of mental illness have no basis in real human experiences and emotional states. I just think it's possible that therapy, and the (unavoidable?) downstream therapy culture, might actually be a bad way to structure a societal understanding and response to those feelings.

Is it a good thing that we have the option of paying money to talk to someone in private instead of running about with a machete?

Maybe? It isn't easy for me to evaluate the counterfactual. I have no idea exactly how destructive a, the way to deal with bad emotions is to go a little wild and break stuff, society needs to be, the purge is (probably) too far, the way I dealt with stress as a kid (running around yelling), probably healthier than what we do now.

I don't deny the existence of mass psychogenic illness. I agree with Scott that it's the most reasonable explanation for things like bulemia, or even gender dysphoria.

I entirely reject that it covers the majority of psychiatric conditions, especially the ones I mentioned, which also happen to be amenable to therapy.

You'll find that the "incidence" of most diseases sky rocketed in short order over the past century. Mainly because if we don't know a disease like that exists, due to a lack of diagnostic tests or plain awareness, there won't be a diagnosis.

But isn’t this the whole discussion about illness v disease. There are a lot of things we call “diseases” that are diagnosed via the DSM. But is there a blood test for say anxiety? Is there a scan for depression? What about being gay (which prior DSM’s treated as a mental illness).

I know this is veering into Szasz (and Caplan’s points).

It's routine (or at least best practice) to order a whole heap of blood tests when doing a work up for someone with depression. Add on polysomnography too.

Thyroid deficiencies, sleep apnea, neurological issues like Alzheimers or Parkinsons, they all can produce depression, or be comorbid with it.

So while there's no blood test to diagnose depression-in-itself, any decent psychiatrist will figure out if there's something else wrong with the body, and treat accordingly. But in the end, we have no reliable way of pointing an instrument at someone and get DEPRESSED or NOT DEPRESSED back. Hence the whole talking to them and using standardized questionnaires, which does work mind you, even if we don't have anything significantly better once we've ruled out the body fucking with the mind in other ways.

To no one's surprise, Scott has written about this at length and I feel like there's little for me to contribute, yet.

For example, this one https://slatestarcodex.com/2020/01/15/contra-contra-contra-caplan-on-psych/, though he's written more about it on ACX not that long ago.

One thing that is interesting (at least to me) is whether even if the diagnostic tests were useful once upon a time do you run into an observer effect rendering the diagnostic useless?

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