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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.
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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