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F'd up time scale on that obesity chart.

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This might be a side comment, but the possibility that anorexia always existed but was unnoticed might line up with the thing where women were always fainting at the drop of a hat in the past and how this eventually went away. If everyone just thought passing out was normal instead of an anorexia symptom they wouldn't include it in diagnoses, right?

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Awesome review!

>keeping all of their emotions “bottled up”,

Is this a bit too close to a water metaphor?

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I wonder about the psychology of gender identity in relation to this. It's been very strange watching transmedicalist narratives be completely obliterated by weird continental perspectives that seem to allow and encourage a distinct gender identity for every possible permutation of quale. Gender identity disorder has increasingly become a cultural phenomenon believed to be on a continuum rather than a discrete alleged biological category. In that way it is somewhat opposite to trends described here, yet the increase is still occurring. It seems like you can track the taint of medicalization in through at least two directions I guess. The reference point would be cultures with strong non binary or non static gender norms perhaps.

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>(though before you start thinking of this as too exotic, remember that the Irish called their own ethnic violence “The Troubles”)

Yeah, it seems pretty universal to give scary things harmless-sounding euphemisms. People with HIV often refer to it as "the bug" or "high five", for example.

>I was more interested in a sort of sub-thesis that kept recurring under the surface: does naming and pointing to a mental health problem make it worse?

From the department of N=1 studies:

I know a woman who was sexually interfered with as a child. It didn't affect her when it happened. She was old enough to remember it, but the memories weren't painful. It was just a weird person doing stuff. She certainly didn't feel like she'd been victimized.

Only later, when surrounded by friends who talked about how awful CSA is and how it ruins your life forever (etc, etc), did trauma from the event hit her.

This might not be a common experience, but it was unsettling to hear her describe that. She felt a degree of bitterness toward her friends: almost as though they'd caused her to become a victim, not her attacker.

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I had skepticism around this sort of activist push for "mental health awareness" and calls for "normalization." I recall watching the Netflix special by Inside by Bo Burnham and finding the constant discussion of mental illness and suicide very off-putting even though it was made to be humorous. It is not glamorization of mental illness but it seems to be something like treating it lightly.

There is the issue of pathologizing oneself and then saying "this is how a [insert illness] acts. And of course if everyone knows what Borderline Personality/cyclothmia is then maybe people start saying "maybe I have that?" and then maybe doing that makes them think a certain way. Determining how large this phenomena is would be really difficult.

I don't want to return to negatively stigmatizing mental illness. But I think "normalization", whatever that means, may be a bit too far. I imagine we could treat this stuff with a bit of seriousness maybe. Yes, I could imagine spreading information about psychiatric disorders could cause spread. Not sure what to do with this. Scott's humorous world probably isn't it.

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This reminds me of how sometimes I get into a rabbit hole of reading about something like Morgellons disease or those people who are sensitive to electromagnetic radiation from radio signals and things. I'm always a bit worried that I'll develop one of those syndromes after reading about it. But so far my mental health is very robust and things like that don't happen to me.

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My mind goes to gender dysphoria.

We can view this increase in trans awareness as an introduction of a foreign idea. Here is one theory: This causes people to not feel good in their bodies like the spread of the other conditions. Here is another: People who would be happier trans or with a different gender identity have always existed and awareness of transgenderism, body dysphoria, gender identity and so forth has allowed people to discover something about themselves and take steps to improve their life. And social awareness creates social acceptance and improves the quality of transpeople's lives. Or maybe it's both?

What do you guys think?

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> The most embarrassing extreme of this happened in 1906, when some photogenic Japanese youth carved a poem in a tree, went to a beautiful waterfall, and leapt to his death

Looks like this was actually in 1903?

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What's the source for the expressed emotion measurements?

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> Japan - a country where committing suicide is basically the national pastime

That's the stereotype, but Japan actually has a lower suicide rate than the US.


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This was so fascinating! I just finished reading the section on anorexia.

I have a question about the huge popularity of intermittent fasting. It is mostly about when you eat, abd eating relatively unprocessed food (any amount) and Dr. Jason Fung explains it. What do you think about it, considering we live in a culture where anorexia is (I suppose) rampant?

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I feel like a decent prescription, in this and other topics, is: Do Not Reify that which is evil, except where necessary. Contain the reification of potentially damaging concepts to those people who must deal with the handful of real instances (doctors and such), but do not allow such ideas to become well known, even as negatives.

The description of Mental Health Unawareness Campaigns was delightful, thank you.

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Alternate hypothesis for why past and current societies with more violence and less stability would seem to have less PTSD: involuntarily and frequently entering fight/flight/freeze mode is only problematic when everything's actually fine.

If you're living in a violent society where threats are everywhere and violence of all kinds happens all the time, you're likely to have good reasons to sit upright in bed in a blind panic when something goes thump in the night. Perhaps symptoms went unnoticed in ancient Rome because trauma-related behaviors and experiences seemed reasonable?

I've often thought about the fact that my PTSD-related sleep disturbances wouldn't be such a problem if someone actually broke into the house. I'd be the only one prepared for a fight. Granted, I'm glad they're subsiding with treatment, as my life is not full of threats and sitting upright in a panic when someone closes a car door outside is unnecessary and exhausting.

Has this been proposed or delved into before by someone who thought about it in a more formal manner than one who lies awake in bed trying to convince herself she'll be fine?

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With regard to the idea that suicide is a result of depression. I wonder if Watters was framing suicide in Japan as shame-induced rather than depression-induced or guilt-induced? It seems possible to frame suicidal motivation in terms of failure to fulfill your relational role (I let my family down) or guilt (My actions have permanently screwed up my life) rather than (I'm terribly sad and I don't think it will get better).

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Surely a big confounder on anorexia's arrival in Hong Kong in the 90s is the arrival of "western diet," no? It seems natural that an eating issue that's sticky once developed might have some relation to the microbiome.

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I'm a big fan of Crazy Like Us, and I drew on it (particularly the anorexia example) in my piece for Plough on the narrow acceptable ways for women to give voice to pain: https://www.plough.com/en/topics/justice/culture-of-life/let-the-body-testify

I'm curious how you'd extend the lesson of this book to the current approach to gender trouble. Here was my take from the piece.

"With the best of intentions, my middle-school health teachers gravely instructed us that many girls experienced disordered eating, that high-achieving girls might be drawn to calorie-counting as one more thing to excel at, that it could be an exhilarating way of experiencing control if you lacked it elsewhere. It became a tutorial in how to suffer correctly.

Today, a girl who experiences trauma or distress as her body changes, her desires stir, and men sexualize and harass her is more likely to be told that one option from the symptom pool is to not be a woman. In those same health classes, she may be told that discomfort with her changing body is evidence she might belong in a different body."

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I thought I read somewhere that PTSD started in WWI, where it was called "shell-shock", and that this is evidence (along with greater rates found among artillerymen than many close-combat roles, or something like that) that it is actually caused by brain injury from proximity to explosions rather than psychological factors.

I remember seeing something rather convincing along those lines, anyway, but I can't remember where. (Would have thought it was SSC, actually — except surely that would have been mentioned...)

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"Over the course of decades (plus lots of marketing by enthusiastic therapists), PTSD expanded from a Vietnam-only problem, to all wars, to all natural disasters, to abuse and sexual violence, to the modern understanding where people say they got PTSD from a bad boss, a bad roommate, or an insufficiently woke college reading assignment. "

Where is the person who claims PTSD from an "insufficiently woke college reading" assignment?

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"I thought that woke people were talking about how demanding a calm, quiet, low-expressed-emotion environment was white supremacy because only white people cared about that kind of thing. "

Why did you think this? Can you link to an article that makes this claim?

Or are you just signalling against the outgroup?

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Excellent post: interesting, thoughtful, and funny.

There is an error in the sentence ending "(presumably because staff are less emotions)".

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Living in Russia, I can say that ADHD (translated as СДВГ) is less recognized by the psychiatry community here because of its unclear aetiology. Doctors usually refuse to treat the patients in the absence of dangerous symptoms, and state the diagnosis as "organic nervous system disorder", "psychoorganic syndrome" or indeed "neurasthenia". Adderall and Ritalin are illegal drugs here. Patients usually get prescribed nootropics (glycine, racetams) and adrenaline reuptake inhibitors (atomoxetine).

At the same time there are some articles in popular online magazines telling stories about children and adults struggling with ADHD in Russia. (https://translate.google.com/translate?hl=en&sl=ru&tl=en&u=https%3A%2F%2Fwww.the-village.ru%2Fcity%2Fstories%2F285860-adhd) Some people order illegal drugs from nearby countries. Researchers also are aware of it. At the same time, I see some articles talking about US problems with over-medicalization of ADHD with dangerous narcotics driven by profit-seeking pharma companies. (https://translate.google.com/translate?hl=en&sl=ru&tl=en&u=https%3A%2F%2Flenta.ru%2Farticles%2F2019%2F02%2F12%2Fadderallnation%2F)

So if you ever wondered what would happen to ADHD people if stimulants weren't legal, Russia seems like a good test case.

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The idea that psychiatric diseases (at least some of them?) are caused by psychiatry is certainly very intriguing, and a certain totaly-not-a-cult-not-even-close community would be delighted to hear more about it.

As for Mental Health Unawareness Campaigns - the Big Social Media has already perfected the technology of banning any discussion of particular subject, and of anybody - from a lowly peasant to a President - who dares to mention it. So deploying a total ban on mental health discussion would be just a matter of somebody getting the ears of three-four people in charge. Of course, there would be places who don't play ball - like Substack - that will still allow such things and this particular posting may survive (at least until their hosting turns off their servers and the banks refuse to process their payrolls), but the combined power of Google/Twitter/Facebook should be enough to make a noticeable impact. We already have experts ready to go on TV and tell people whatever needs to be told. We already have cultural gatekeepers ready to force everybody to believe whatever the TV experts say. We already know how to ban words and topics and expell anybody who mentions them, in any context and with any intent, from the polite society. As a society, America is basically made for Mental Health Unawareness Campaign now.

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FWIW I suspect important part of the story with how culture-bound anorexia is is that humans are pretty strongly inclined to pick up cultural/moral taboos about what is and isn't food (Leviticus etc. etc.)

It's only on exposure to modern dieting culture where so many things aren't considered food that this turned into people not eating (and I guess this would explain the correlation with OCD)

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Ok since you mentioned it yourself, I have to admit to a dark little secret - there's a part of me which is absolutely certain that this model is the main explanation of why the Bay Area appears to have such *insanely* (pun intended) higher rates of mental health issues than the small town I grew up in.

Back there, sure you could meet a person who's a bit weird sometimes, and there were some people with mental retardation and/or addictions. But things like "depression", "autism" or "anorexia" were stuff from the TV, not the real world. Here everyone either has a mental health issue themselves, or have a partner, close relative or friend who's dealing with it.

Yeah yeah, underdiagnosis, social bubbles, stigma, *I* know. But there's a part of me that doesn't and keeps on feeling like it's those fancy-ass bay area hipsters making up fake problems for themselves because they have no real ones.

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I'm just entertained the notion that Scientology's attitude towards psychiatrists as charlatans might be (somewhat) true.

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Under the theory that formless extreme stress finds an outlet determined by your cultural milieu, it seems like the sudden huge spike of anorexia in Hong Kong ought to have *displaced* other disorders. Did it?

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Everytime someone refers to Northern Ireland as religious or ethnic violence, a small part of me dies inside.

My Dad's half Northern Irish and half Finnish and my Mom from Kerry and outside the Finnish fourth- I have enough runs of homozygosity in my genome to give the Habsburgs a run for their money.

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Young Americans appear to have been undergoing a worsening in mental health since about 2013, roughly the era of the Great Awokening.

The evidence in Haidt and Lukianoff's "The Coddling of the American Mind" points to the second Obama administration as being the era when the national nervous breakdown began.

The authors cite alarming evidence of a recent increase in emotional problems. For example, the percentage of college students who said they suffered from a “psychological disorder” increased among males from 2.7 percent in 2012 to 6.1 percent by 2016 (a 126 percent increase). Over the same four years, the percentage of coeds who saw themselves as psychologically afflicted rose from 5.8 percent to 14.5 percent (150 percent growth).

Haidt and Lukianoff are somewhat impressed by the data assembled in psychologist Jean M. Twenge’s new book "iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy—and Completely Unprepared for Adulthood." Twenge theorizes that the rise of smartphones and social media from 2007 onward has made the teenage years a living hell of status anxiety and call-out culture for kids born from 1995 onward. ...

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If anyone reading this is interested in digging a little deeper into the question of ancient Roman PTSD, they should check out ACOUP's post on the matter. Not sure how to embed links here, but the URL is https://acoup.blog/2020/04/24/fireside-friday-april-24-2020/

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PTSD was recently studied in Turkana warriors in Africa in this PNAS paper. https://www.pnas.org/content/118/15/e2020430118

Highly recommended for an insight into what it probably looked like throughout human history

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On PTSD in wars, is WWI "shell shock" usually regarded as what we would now call PTSD? Because there was a hell of a lot of that and the medical establishment took a while to acknowledge it and it came as big surprise.

Warfare changed a lot in the few decades before WWI. With the exception of sieges, which were always understood to be very wearing on an army (which is why the convention arose that a city would be invested, ie surrounded, and then given the choice between surrender without a sacking or a siege with a sacking, the idea being to try to avoid sieges), most wars before 1900 or so involved set-piece battles lasting a day or two (Leipzig in 1813 was four days and that was regarded as utterly exceptional).

The continuous contact of both armies and the continuous low-level fighting (patrolling, raiding, firing off a few artillery shells, etc) didn't start in WWI - the Russo-Japanese war was like that ten years earlier - but WWI was the first big war to feature it.

So, if there is a discontinuity and PTSD in warfare starts with WWI shell shock, then there is a discontinuity in the experience of warfare itself that takes place at the same time.

This would also suggest that persistent trauma is a bigger deal for PTSD formation than a single big traumatic event; I don't know anywhere near enough about PTSD to know if that is true.

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Re: "The Troubles", we also referred to the Second World War as "The Emergency".

The Zanzibarian expression “an attack of the nerves” seems more like it might be a translation/carried over from when the Portuguese were the main colonial power; the French have the expression "crise de nerfs" and it's common enough among working-class/lower middle-class Irish and British to talk about "being on pills for my nerves", so looking up the Portuguese version, there's (what seems to me) the more modern term "colapso nervosa" (nervous breakdown) and (what seems to me) the older term "crise nervosa" https://blog.psicologiaviva.com.br/crise-nervosa/

"The nervous crisis can be triggered by numerous emotional and physical responses that can aggravate your condition, such as: irritability, crying spells, appetite changes, lack of interest in social life, reactivity, alcohol and drug addiction (way to escape from reality), lack of motivation, extreme anger, violence, isolation from people, insomnia, fear, panic, sweating, pain, fatigue, agitation, among others."

So "I'm having trouble with my nerves" is possibly more a universal explanation (along with "possession by demons/spirits") for such illnesses, until Modern Western Science comes along with a Latin or Greek name for the condition instead.

I don't know if anorexia was "introduced" to Hong Kong by adopting Western ideas, it possibly again is "new description from outside of what we already have in our culture". East Asian beauty ideals for women include being thin (sometimes very thin https://martalivesinchina.wordpress.com/2017/08/07/beauty-standards-in-china/ "Every few months, a new “skinny challenge” appears in Chinese social media to prove how thin you are. The most famous ones are the “waist narrower than a A4 sheet of paper”, the “knees together can be covered by an iPhone” and the “holding coins in your collarbone”), so that natural slimness plus adhering to standards meant that "oh, this girl is severely dieting? well, that's normal!"

European societies also have the idea that "you have to suffer to be beautiful", so introducing the idea that "no, actually, starving yourself until your bones show isn't 'normal'" was a unique idea, and yeah, like a lot of trends, it got adopted by everyone to show how up-to-date and special they were (hence why Sing Lee can say "we didn't have anorexia until it became fashionable").

Again, Western societies have been the same way: the glamorisation of tuberculosis, even though it was a genuine scourge, making the ideal of the pale, delicate, wasting away female character in fiction (and probably real life as well, after all, why have a "fainting couch" unless you can decorously lie there all wan and fragile?) and we can't laugh at the Japanese for adopting German crazes around depression, not from the society which went crazy over "The Sorrows of Young Werther" which also had a European fan following to the extent that Thackeray wrote a satirical poem about it in 1855:

Werther had a love for Charlotte

Such as words could never utter;

Would you know how first he met her?

She was cutting bread and butter.

Charlotte was a married lady,

And a moral man was Werther,

And, for all the wealth of Indies,

Would do nothing for to hurt her.

So he sighed and pined and ogled,

And his passion boiled and bubbled,

Till he blew his silly brains out,

And no more was by it troubled.

Charlotte, having seen his body

Borne before her on a shutter,

Like a well-conducted person,

Went on cutting bread and butter.

I think that there's a definite point about the adoption of Western science, technology and medicine, so that traditional definitions and treatments of conditions are scrapped in favour of "this is called X and the symptoms are A, B, C and sometimes D and you treat it by regular doses of Z" diagnosis. But I don't think "oh, some societies at some times never even had this condition!" holds true. It may not have been called that, it may have been understood as running amok https://en.wikipedia.org/wiki/Running_amok or possession by ghosts/spirits/demons, it may have undergone several changes as fashions in diagnosis changed in Western medicine, but that "people C never had illness until they started importing fashions from people D" doesn't make sense.

I don't think anyone would argue "nobody in Japan ever had diabetes until Western medicine took off" because the human body works the same way, pretty much, wherever you are, so why should the human brain and mind be greatly different?

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One interesting thing that may be related is the "Truman Show Delusion." The Truman Show was a popular movie released in 1998 where the main character is born and raised in an entirely artificial environment. All of the people he interacts with, including his wife and parents, are paid actors and his every move is broadcast to a huge audience. After it was released, a few mentally ill people started claiming that everyone around them was an actor and they were stuck in an artificial world. Nobody knows how many, but it's enough for some psychologists to bring it to the attention of popular media.

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According to memories of an old doctor, there still existed a few cases of "hysterical paralysis" in Czechoslovakia in 1950s when he started his carreer, but they disappeared in later decades.

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It's a very hard thing to distinguish "knowledge creates the phenomena" and "phenomena creates knowledge" in principle. Both frameworks allows to interpret nearly any evidence in their favour. Multiple people have immediately remembered gender issues, but there is much more fundamental case.

How do we know that it's reality that creates our knowledge and not the other way around? It takes people literal years of constant evidence stream in favour of materialism to accept the simple truth of the litany of Gendlin. Is it, in principle, possible to accure as much evidence in cases of mental illnesses, sexual orientation or gender?

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When measuring the "highest-expressed-emotion culture", I think we should distinguish between different kinds of emotions, rather that using "emotions" as a unified whole.

Specifically, I suspect that in safer environments people would feel more free to express emotions of "weakness" (e.g. crying), and in dangerous environments people would perform anger to look more threatening. Similarly, some emotions are more "individualistic" (enjoyment of something), some are more "collectivistic" (admiration of gods or leaders), so different cultures would reward and punish them differently. Depending on how much weight we assign to different types of emotions, we could get opposite conclusions.

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So, the obvious question for an effective altruist is how to design a "mental illness" with positive consequences... and then make an awareness campaign about it, hoping that it would replace some of the traditional ones.

Refusal to drink coke, fear of reading Reddit...

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"Japanese medical students went to Germany, learned psychiatry, came back to Japan, and told everyone they were neurasthenic. Being neurasthenic became first a fashion, then a class marker."

I believe something similar can be stated about melancholia versus depression. At least in a German-type context, and if my cultural Fingerspitzengefuhl is not failing me, to have a bout of Melancholia now and then is cool and a marker of high status. It shows you are a sensitive soul; it is related to Weltschmerz.

While being depressed means you're just an average Joe.

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I wonder how this applies to psychiatric diseases that don't exist in the West, but do exist in the developing world. Would we get mass outbreaks of Koro if we started worrying about it?

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Your articles would be greatly improved if you refrained from injecting random attacks on strawman "woke" people/positions out of nowhere at random intervals. It adds nothing to what you are saying, and makes you sound obsessive. Maybe try imagining a random racist interjection in place of your anti-woke ones if you don't see it.

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What patriarchal beauty standards? The patriarchy wants women to be wide-hipped, big-breasted baby-churning machines, it's the fashion media, which is mostly dominated by women like Anna Wintour, that established the starving waif aesthetic.

I suspect anorexia is a copycat effect, like school shootings post-Columbine, a memetic virus that defies conventional mental health analysis.

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For comparison, there was a review of this book on the sub-Reddit a few months ago:


On anorexia: the thing about the doctor (Sing Lee) inducing it in himself really caught my attention. As the attentive ACX reader knows, it can be induced in animals through similar means (see #14 on https://astralcodexten.substack.com/p/links-for-april)! My guess is that there is something like this going on: "certain individuals are latent anorexics; weight loss / dieting reveals it." (source: I was/am anorexic).

Something else about the book: Watters talks about exporting western psychiatry being equivalent to handing out smallpox blankets. But then he reveals that he's married to a psychiatrist. He's, uh, maybe working through some stuff here?

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quick typo: the post has the incorrect "Abhkazia" instead of the correct "Abkhazia" (k <--> h)

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I’m not a doctor, but anecdotally I have helped people contextualize their mental health sort of like the spirits.

I’ve talked to several people who who were actively in the medical system for depression and explained how I see the brain, not as a fighter pilot (you are alone in there, any screw-up is on you) but as the captain of a ship (you command many parts, each of which may be imperfect).

And this helped them! A lot! This framing changed their outlook from “I am a problem” to “I have a problem”, which is much more productive and much less self-hating. It didn’t change their underlying conditions, of course, but I saw a slow-burn change in behavior. That could be a coincidence (the plural of anecdote is not data!) but I have since not been surprised by the practice of attributing mental health to externalized spirits that one is in contact with; it may not be literally true but it can be a helpful coping mechanism.

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Scott's most Straussian post yet?

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>Meanwhile, “in 1902 n article reported that fully one-third of patients visiting hospitals for consultations were suffering from the new disease.”

Did you mean "an article"?

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I'm presuming Watters has investigated and discounted the possibility that people in the past with (what we now call) PTSD might have got less support and so lived less long - perhaps even ended their own lives, and no-one talked about that either - so statistically there were fewer of them around?

Also some relevant discussion about PTSD in ancient soldiers over on ACOUP: https://acoup.blog/2020/04/24/fireside-friday-april-24-2020/ and https://acoup.blog/2021/02/12/collections-the-universal-warrior-part-iib-a-soldiers-lot/

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I found the trauma section of the book very compelling, in part because it squares with my impression of the United States as a society that is convinced it understands trauma better than any previous society but seems to achieve uniquely poor outcomes. It would be like a land that was convinced it had the best vaccine for polio but you look around and every fourth person is in an iron lung.

I see this most clearly with recent war veterans. 45% of Iraq and Afghanistan veterans file for disability, a large fraction psychological: https://www.bostonglobe.com/news/nation/2012/05/27/almost-half-new-veterans-seek-disability-benefits/sYQAAY00ddXBRoqfsKMheJ/story.html

Perhaps some are outright malingerers, but clearly for a large number (including a friend of mine) this is real. They really are suffering from a set of symptoms consistent with PTSD. And yet, the vast majority of WWI veterans, Holocaust survivors, everyone who lived through WWII in Western Russia etc., a large fraction of people in the Middle Ages etc. experienced as bad or worse stuff and the vast majority could function as adults. It's hard to escape the conclusion that we've created an expectation of disabling trauma and people fulfill it. Crazy Like Us quotes an American soldier who said that he felt like an actor given a script. Here's PTSD, this is what you do next.

I don't think we can create the anti-psychiatry society like in Scott's post, but we can send a message that left to their own devices the vast majority of people who experience terrible things will recover, and they shouldn't expect PTSD.

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Have to go to work and haven't read the whole piece, so apologies if this is raised in the post, but:

> "In the same way, Watters suggests, there probably is some base-level objectively-real mental illness. If you have to think of it as something, you can think of it as formless extreme stress, looking for an outlet. But the particular way the stress finds an outlet is based on the patient's cultural preconceptions."

Suppose we buy this. What would be the best of the already-existing ways that cultures conceive mental illness, in terms of overall human flourishing? How *should* extreme stress manifest pathologically? The best one I've been able to come up with is Japanese Hikikomori, ie withdrawal from society. It causes problems, for sure, and I don't mean to minimize it. But of the known ways that that extreme stress can be channeled, I haven't been able to come up with a *less* harmful one.

Anyone else?

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Good review, but I think it kind of forgets the 'biodiversity' idea? Particularly the section on the Sri Lankan "gaze of the wild" treatment. Western psychiatry clearly still has a lot to learn about PTSD, and if you believe in cultural evolution at all then Sri Lanka could very well have something to teach. Even if their approach isn't better overall, it might get something right that the West missed.

Focusing on whether the expected outcome is better or worse misses the point; the tragedy is in lost value of information.

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ooh excited for the schizophrenia post. I wanna know to what extent https://threadreaderapp.com/thread/1270547158882832387.html is legit or totally made up (cw: racism).

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If all of the brain's functions can be described as some kind of Bayesian inference, then only one thing can go wrong with it.

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> One background part of this chapter which I enjoyed was the section on biological views of mental illness. Westerners tend to spread these in order to reduce stigma - “has a brain chemical malfunction” sounds better than “is possessed by demons”, or even than “is just inexplicably lazy and weird”. But studies generally show that the biological view of mental illness makes people less sympathetic to the mentally ill, more concerned about them being violent, more interested in avoiding them, etc.

> I am skeptical this actually worsens outcomes for schizophrenia; the developed vs. developing world thing is more likely diagnostic differences. Still, oops.

Probably 20 years ago now, I had the pleasure of attending a lecture and Q&A session with the late Dr. Julian Leff, which I found very thought provoking. He did a lot of transcultural research as a psychiatrist, and much of what I remember would seem to agree with Watters observations. In particular, he thought the jury was out as to who was more effective in treating schizophrenia, and mental illness in general, but he thought the edge probably went to traditional (non-western) societies. He observed, like Watters, that the "ill" were better tolerated, integrated, and taken care of by their family and community, than in the west. In "traditional" societies, there is no stigma attached to "is possessed by demons", because that can happen to anyone, so the individual is not blamed and held responsible. The other thing which I found very interesting is that he said in general it is impossible to do western style talking therapies in traditional cultures. The main reason is that there is very little privacy. Everyone knows everyone's business, gossip (news and information) circulates very quickly, it is very difficult to keep secrets. Western style talking therapies crucially rely on privacy and confidentiality, so a client is safe in expressing things it would not do to make public knowledge. That does not work in traditional cultures, thus, the family or community will usually be included in the diagnosis, and treatment, and the "cause" of trouble will be spirits, demons, or malevolent forces which are not the fault of the person, but in fact could afflict anyone.

If anyone is interested, here is a short account of some of Dr. Leff's observations, "The lessons I learned as a psychiatrist from my transcultural work in low and middle-income countries": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520537/

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I recall a story about the "discovery" of hoarding. Some academic psychologist or psychiatrist happened upon someone crippled by hoarding behaviour. And he thought, "Hum, I've never seen this before. I wonder if it's a thing." So he put out a request to the public asking if anyone had heard of this. He came to work Monday to a ton of e-mails from people saying, "Yes! My partner, mother, aunt, cousin, etc. etc. has this." It was a big problem. But for someone reason it just wasn't widely known.

To me that lends credence to the idea that these issues can be widespread but hidden from general professional and public awareness.

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From the opening paragraph, I was expecting something about mental illnesses in other cultures that are dying out. That would be an interesting topic for a post.

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> But studies generally show that the biological view of mental illness makes people less sympathetic to the mentally ill, more concerned about them being violent, more interested in avoiding them, etc.

Heads-up, the link in this paragraph is inaccessible from Germany. (Yes, I know I could VPN.)

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Trying to decide if this is a Straussian post on CW issues.

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You say:

"Of course, the null hypothesis is that there are lots of people suffering in silence until people raise awareness of and destigmatize a mental illness, after which they break their silence, admit they have a problem, and seek treatment. I am slightly skeptical of this, because a lot of mental health problems are hard to suffer in silence - if nothing else, anorexia results in hospitalizations once a patient’s body weight becomes incompatible with healthy life. Still, this is an important counterargument, and one that I hope people do more research into."

I think that the null hypothesis is almost certainly right in this an in many other cases, and the strongest evidence I have for this is childhood sexual abuse. I'm almost certain that we've always been brutally sexually abusing children as a society for as long as humans have been around. Even if that's not the case, I KNOW that the boomers in America were often sexually abused as children. Both my parents were raped / abused as kids. My grandmother was raped. About 75% of my aunts / uncles were abused / raped. Around 20% of the boomer friends I have that I’ve had deep conversations with have shared stories with me of them being raped / sexually abused as children. I think the actual real prevalence based on my own experience is probably somewhere between 20%-50%. Go talk to some of your boomer friends that actually trust you and learn how common it was!

And yet, in 1960s there was total, absolute denial in American society that childhood sexual abuse even existed. From The Body Keeps the score:

(Dr. Van Der Kolk): "In my new job I was confronted on an almost daily basis with issues I thought I had left behind at the VA. My experience with combat veterans had so sensitized me to the impact of trauma that I now listened with a very different ear when depressed and anxious patients told me stories of molestation and family violence. I was particularly struck by how many female patients spoke of being sexually abused as children. This was puzzling, as the standard textbook of psychiatry at the time stated that incest was extremely rare in the United States, occurring about once in every million women. Given that there were then only about one hundred million women living in the United States, I wondered how forty seven, almost half of them, had found their way to my office in the basement of the hospital."

"Furthermore, the textbook said, “There is little agreement about the role of father-daughter incest as a source of serious subsequent psychopathology.” My patients with incest histories were hardly free of “subsequent psychopathology”—they were profoundly depressed, confused, and often engaged in bizarrely self-harmful behaviors, such as cutting themselves with razor blades. The textbook went on to practically endorse incest, explaining that “such incestuous activity diminishes the subject’s chance of psychosis and allows for a better adjustment to the external world.” In fact, as it turned out, incest had devastating effects on women’s well-being."...

"As Roland Summit wrote in his classic study The Child Sexual Abuse Accommodation Syndrome: “Initiation, intimidation, stigmatization, isolation, helplessness and self-blame depend on a terrifying reality of child sexual abuse. Any attempts by the child to divulge the secret will be countered by an adult conspiracy of silence and disbelief. ‘Don’t worry about things like that; that could never happen in our family.’ ‘How could you ever think of such a terrible thing?’ ‘Don’t let me ever hear you say anything like that again!’ The average child never asks and never tells.”"

"After forty years of doing this work I still regularly hear myself saying, “That’s unbelievable,” when patients tell me about their childhoods. They often are as incredulous as I am—how could parents inflict such torture and terror on their own child? Part of them continues to insist that they must have made the experience up or that they are exaggerating. All of them are ashamed about what happened to them, and they blame themselves—on some level they firmly believe that these terrible things were done to them because they are terrible people."

What conclusion can we draw from this? I think the most reasonable one is that psychiatrists (and doctors in general) are EXTREMELY bad at their jobs. They see what they want to see, they are controlled by the prevailing narratives they’ve been taught, and they don’t really listen to their patients. It’s clearly true that if you’re told during medical school to ignore really significant problems that essentially all doctors will happily ignore these problems for their whole career. And society has awesome mechanisms in place that can brutally suppress any stories of abuse or problems from getting out into wider awareness. These mechanisms (which also exist in other cultures) are so strong that I think they mostly invalidate whatever Crazy like Us is trying to say. The author of Crazy like Us would have to have done MUCH more rigorous work to overcome the fact that there are powerful conspiracies in every society that work to obscure and hide all kinds of mental problems / abuse / internal feelings. It doesn’t look to me like he’s done that work.

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Mental Health Unawareness culture sounds like a very good idea.

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> I. Anorexia In Hong Kong

Interesting reading, especially given that I was taught that anorexia was significantly *less* culture-bound than bulimia. Pulling the citation I remembered (1), it looks like they cite 5 articles by S. Lee in their meta-analysis along the way to ultimately concluding that AN doesn't qualify - I'd say that cuts against the specific claim Watters is making depending on his specific citation, but the BN section definitely supports his overall thesis.

1) Keel & Klump, 2003 - https://pubmed.ncbi.nlm.nih.gov/12956542/

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Isn't' PTSD the new name for shell shock?

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Keeping in mind the very well supported (IMHO) lead crime hypothesis - what odds does everyone give that the rise in transgenderism being due to hormone disrupting chemicals in the environment?

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This seems heavily invested in a static model of mental illness as something you either have or don't have. If you instead look at mental illness as self-reinforcing instability in a dynamical system, it seems pretty obvious that environment will influence the rate at which it manifests itself into visible symptoms.

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Well, look at ADHD diagnoses right here in the US-of-A.

Do more people have ADHD today? Maybe. Or have we diagnosed more people with ADHD, whether as a result of increased medicalization or because of something else? Maybe. Or some of both? Maybe. I dunno.

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"Sometimes we apply the same metaphor to the human world, eg “falling linguistic biodiversity" when minority languages get replaced by English or whatever."

Do they, or do they just call it "linguistic diversity"? Searching "linguistic biodiversity" just brings up the usual guff about how indigenous peoples have special ecological knowledge western science is unable to discover or incorporate.

"If you want an objectively real psychiatric illness with no culture-bound component, schizophrenia is as close as you’re going to get."

And this I highly doubt, at least that other people are going to agree with it. The anti-psychiatry movement tends to focus quite a lot on schizophrenia. If you want an uncontroversial mental illness, you go for something like Alzheimer's or brain damage, something with obvious physical effects on the brain, but I don't know if those count as "psychiatric illnesses".

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I'm surprised you're not drawing a connection to the copycat suicide/suicide contagion/Werther effect literature. I think there's also a bunch of projects specifically looking at 13 reasons why?

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re zanzibar: "But they are weirdly blase about this. Their position is that everyone gets possessed by spirits sometimes."

Remember this is the position contended by Hubert Dreyfus (philosopher at UC Berkeley) about the correct way to interpret Bronze Age Europe (and specifically the Illiad). And it was more or less what Julian Jaynes said...

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Anorexia might be a kind of special case, among the other disorders covered in the book. I think there is plenty of anecdotal experience (and maybe even some research but I haven't looked) about the 'contagiousness' of anorexia - especially in settings such as all-girl, boarding schools. This isn't to say that anorexia is solely a role-playing phenomenon but, like hypnosis, it might be very difficult to tell the difference between someone who has the condition and someone who is acting like they have the condition, with death a a possible outcome in both instances.

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"Zanzibari schizophrenics never feel that different from anyone else - everyone gets possessed by spirits sometimes, everyone gets attacks of the nerves sometimes, lots of people never leave their family homes."

How is this different from the western model of "everyone is a little bit mentally ill, it's only a psychiatric problem if it interferes with a normal life"?

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>the few anorexics he was able to find couldn't be less interested in thinness or beauty standards or anything like that. Also (unlike in the West) they weren't delusionally sure that they were fat. They were very aware that they were starving themselves to death, and they were against this. They just felt like they had some sort of nausea or stomach disease which made it impossible for them to eat.

I (an American man) have struggled with this *exact same condition* (laced with emetophobia), peaking mainly in 2016-2017. (Although, while I became quite underweight, I don't believe it severely impeded me functioning or quite reached the extent of being immediately medically dangerous. I'm about 95% over it now.)

The only time, apart from the above post, that I've ever seen mention of such a condition was in a textbook I was flipping through in the psychiatry section of my alma mater's bookstore. The textbook labeled it as, I think, "food avoidant disorder" and was careful to classify it as separate from an actual eating disorder (the book seemed to imply that eating disorders necessarily require a distorted perception of one's body / the risks of eating a certain way).

Does anyone have any familiarity or further knowledge of this disorder? I can't help but feel curious to learn more.

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>I assume there is some sort of inspector who comes around and makes sure you attribute mental illness to demons, and if not, they take away your indigenous society license

I would guess it's something more like various indigenous people describing the various things they believe in to english-speaking Christians, and those English-speakers rounding them all off to 'demons' or 'spirits.'

Certainly they're not all referring to the Christian notion of 'demons', I suspect there's a lot of variance and metaphor in there.

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I came across this article today about the dancing plagues. This is a fun read despite the explanatory just-so stories. None of them seem convincing to me. (BTW, the ergot theory has largely been disproven.) Also, the author's claim that modern raves are multi-day events is mostly bullshit, I think. Having attended a few Raves in the 90's, none of them lasted beyond a single evening. Most of the dancers stumbled home at dawn after our MDMA and LSD highs wore off. Certainly the DJs were exhausted by dawn!


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i was thinking about the point made in your conclusion recently wrt all the talk i've seen recently about adhd. it seems like it's everywhere on twitter recently (chickenpox_plane.jpg), and i've been wondering to what extent it's a "real" phenomenon, and even to what extent that question itself makes sense. i have a few other hypotheses about what might be going on, but i haven't done investigation beyond the surface-level.

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If public awareness of a mental illness increases its prevalence by making the symptoms of already mentally ill people better fit the expected illness, then it might be a good idea to run public awareness campaigns for mental illnesses whose symptoms are relatively harmless.

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I've read a fair number of accounts of anorexia, and the thing that struck me was that a very high proportion started with food restriction in childhood. (Sorry, no records.) What was odd was that it didn't seem to matter whether the food restriction was imposed by parents or chosen by the child.

This argues in favor of an anorexia switch, though I don't have a baseline for how common food restriction in childhood is in general, considering how terrified a lot of people are of being fat or having a fat child.

An argument against an anorexia switch is that anorexia doesn't seem to be a common response to starvation from poverty or imprisonment, though food hoarding is.

I've been reading lately that there's a lot of psychiatric comorbidity with anorexia, and I don't know where that leaves any theories.

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I'm also reminded of the deaf community and its occasional desire to have children *not* receive cochlear implants so they can grow up and join the deaf community.

If a disease, mental or otherwise, is "normalized", sufferers are going to form a community - and a community disproportionately characterized by the most severe and hard-to-treat sufferers, because those are the ones who need it most and have the worst alternatives. Which is good for them. What's not good for them, is for the medical community to develop more effective treatments so that they wind up having their support community die out (literally or otherwise) around them.

So there's a conflict of interest where the community benefits from there *not* being highly effective treatments, or for such treatments not being recognized as effective. And, perhaps relevant here, from marginal sufferers in the broader world being lead to believe that they are going to suffer greatly, that there is nothing to be done about it but to turn to the support community, when really with a finite period of treatment with the right doctors they can live happy, normal lives in the broader community.

Since public discussion of [disease or condition] is going to be dominated by A: the spokesmen of the support community and B: the relevant doctors, we need the doctors to step up and provide realistic guidance against the sometimes perverse evangelism of the support community. If the doctors aren't doing that, if they are instead saying, "Yep, this is real bad and if you feel it might apply to you, you have to come to us and be prepared for the long haul" when that's not necessarily the case, I can see the dynamic Watters describes being reinforced.

Does Watters talk at all about, e.g, the emergence of an "anorexic community" in Hong Kong?

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I've been really enjoying a lecture series by Robert Sapolsky, which is drawn from Stanford's introductory class on human behavioral biology. This is a weak area in my knowledge base and he's a superb lecturer. He has a very good story about encountering a schizophrenic woman among the Masai during his field research.


This sets up a fascinating lecture on the biological underpinnings of religion (not recorded in the most recent iteration, this is an older version) in which he argues that the shamanistic thinking induced by the distantly related schizotypal phenotype is the reason that the genetic basis of schizophrenia persists in human populations and forms the basis of religious ritual & tradition.


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If I hadn't actually read this book myself, just from reading this review I would think the book was about something completely different than what it is actually about. The title of the book, which Scott seems to mistaken to be, "Not Crazy Until We Showed Up", is actually "Crazy Like Us". It's not about the spread of Western mental illnesses via some meme about their existence, it's about the spread of the ways mental illness manifests in western influenced ways. Watters isn't saying people weren't crazy before Western Psychiatry showed up, he's saying they were crazy in different ways and now the ways they are being crazy are becoming Westernized.

Scott also seems to have missed the secondary thesis of the book which is that a/the major way that western diagnostic criteria are unique from many of the alternatives it is replacing is that they are individual(mental)-ontological rather than social-ontological. This might be hard for a western-trained psychiatrist to truly grok but there are cultures and languages in the world that do not even have a word for mind. The existence of a "private inner" world of "thinking" and "knowing" in many tribes in Papua New Guinea for example are subsumed under the activity and label of "hearing"(See Anna Wierzbicka's Semantics. Primes and Universals pg. 197 for a discussion of this). In light of the ways that many cultures(nearly all of the ones Watters cites in the book) have seen what we call "mental illnesses" as more like "social/relational illnesses," he wants us to consider this alternative and the consequences of the way we conceptualize the problem as individual/mental in the first place. If we thought of them more as relationship/social problems would that put us on better tracks towards the treatment of them? I don't know, but that's the question Watters wants us to ask ourselves.

Watters 3rd thesis is summed up by his quoting of psychologist Ken Miller who said, “The meaning of a horrible event has a tremendous impact on the human psyche, and that meaning differs across the world.The meaning matters as much as the event itself.” Watters doesn't prescribe just not talking about "mental illness" as Scott seems to imply throughout his review, he wants us to pay attention to the WAY we talk about it and the MEANING we ascribe to it, to realize their are alternatives, and to consider the consequences of thinking we have identified universal features of human existence when the lens we are looking at them through is in fact culturally specific. He's not saying there isn't SOMETHING universal happening to which our psychiatric diagnosis criteria points. He's just pointing out that the way we conceptualize what is happening is not universal, that should tell us that we haven't nailed down what's happening yet, and that if we do want to identify something universal then paying attention to the differences in how they manifest in different cultures should be an important part in that process.

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Although I really *want* to believe the thesis of the book and plan to read it to see if I'm convinced, I feel compelled to offer a wildly different explanation for the entire slate of phenomena the book is trying to explain. This idea comes courtesy of a friend.

Everywhere, in the past, child death was common. Children got diseases, starved, had gruesome accidents. Mothers died in childbirth not infrequently. How bad can anything else really be when you've grown accustomed to the death of your siblings and later your children? Key word is accustomed. You didn't have a special tragedy. You had the same tragedy as your friend down the road.

Many places, recently, though at varying times, child death has become very, very uncommon. It's possible for something like anorexia to be "the literal worst". It's much more likely that my worst and my neighbor's worst are two different things. We can now imagine seeking to get a handle on special difficulties that in the past would have been completely overshadowed by ordinary life.

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Weird question: Where does the discussion on animal depression fit in Ethan Waters view?


(The fish depression fits less well in my view because they seem to be experiencing withdrawal rather than depression?

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When Scott brings up the apparent social contagion effect of talking about mental illness, I can't help but think of the trans movement in the US the past decade. It went from being a phenomenon more-or-less specific to serial killer movies to a fad ... pretty quickly. I'd be curious if the recent trend of trans teenagers is funging against other, more common psychiatric syndromes like anorexia.

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Two examples of PTSD before it was a thing in the culture: Frodo in Lord of the Rings. Early in the story, he gets a sliver from a Nazgul's sword in his shoulder. He never fully recovers, and is especially haunted by in on anniversaries.

Thorby in Heinlein's _Citizen of the Galaxy_ (1957)-- he was kidnapped into slavery (I think his parents were killed in front of him) when he was a small child. He has nightmares and a triggerable temper as a result.

This is especially striking because it's PTSD which *isn't* from being a soldier in combat.

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One theme running through this book review (that is particularly visible in the discussion of PTSD) is the Western trend to diagnose more and more things as psychiatric illnesses. I think that in turn is mainly caused by a Western philosophy of life where people are individuals entitled to happiness and success, but if they aren't happily achieving success something must be wrong with them. I.e. I am problematic if I don't live up to an unrealistic standard for human beings that is expressed through all kinds of channels including the work-place, the treatment of the unemployed, or the lives of other people we see on TV or social media. Hence there is a large demand to produce diagnoses to address the perceived abundance of personal defects.

I agree with the book that in general the West is very successful in exporting this aspect of its culture overseas. The most harmful aspect of which might be exporting the idea of "There is a problem with me, I am deficient". Once this idea has been successfully implanted somewhere, this will naturally also create a robust demand for Western styles of psychotherapy, apparently justifying the mushrooming of psychiatric diagnoses.

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Sigh. I'd be willing to bet (a small amount of) money that someone will take the last couple paragraphs of this post and use them to claim Scott believes mental illness is a delusion.

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An alternate null hypothesis is that dead mean tell no tales.

Many forms of mental illness were much more likely to be quickly fatal under past conditions (and to a lesser extent, present conditions in the third world and developing world today) than they are in the developed world today.

Before the Vietnam war, there were a lot of well-documented cases of soldiers getting PTSD, but people called it things like "cowardice" or "shell-shock," and their commanders shot them for getting it.

The timeline you discuss for the prevalence of anorexia in Europe lines up almost perfectly with the hypothesis "nobody gets diagnosed with anorexia in countries where people die of starvation that is clearly caused by poverty and insufficient availability of food on a regular basis." The late 1800s saw a temporary end of widespread famine in the West. Famine was really bad all over the world again by the 1930s, and then eliminated again under the green revolution which had fully taken hold in the West by the early 1960s. During a period of famine, everybody knows that practically everyone is undernourished to the point of causing adverse health conditions and premature death unless they are lucky and work really hard not to have that happen. If a relatively small number of people happen to also be undernourished because they are psychologically predisposed to under-eat, they're lost in the crowds of people who are undernourished because there's just not enough food. (Hence, anorexia as a diagnosable condition only exists in settings where there is ample food. Since far more people are psychologically predisposed to overeat to the point of causing adverse health condition than are predisposed to under-eat this way, anorexia as a diagnosable condition exists if and only if obesity is also somewhat prevalent.)

China had famines in the twentieth century a couple decades past when they stopped happening in the West. I don't know about the history of famine specifically in Hong Kong post-WWII, but Hong Kong currently imports over 90% of its food with the majority coming from China, so I suspect food availability in Hong Kong somewhat paralleled its availability in China.

(It's also possible that anorexia as a mental condition regardless of its diagnosability doesn't occur in times of famine. Scarcity of food during people's early childhood is well-documented to have lasting impact on their eating habits -- though it's better-documented in mice. People who had too little to eat as young children have a greater propensity to overeat the rest of their lives. So it seems somewhat likely that being born in or around a time of famine prevents some people who would otherwise have developed anorexia from ever developing it.)

If the end of food scarcity caused the increase in anorexia, the sudden discovery of its prevalence in response to its first high-profile case is not at all surprising. Discovery of prevalence in response to the first high-profile case of something happening are common. (E.g. Many people, including a past version of me, believe(d) that the name "Britney" became massively more prevalent because Britney's fans were naming their children after her. But in reality, Britney was born at the peak of the popularity of her name. It was just that most people heard of her before they had really heard of anyone else Britney, and then shortly thereafter started encountering far more people sharing her name. And names, especially first names, are not conditions that people are generally keeping secret/hiding in the closet.)

Conversely, modern conditions have also eliminated many other types of stressors that could trigger symptoms that were previously diagnosed as mental illness.

I experienced temporary blindness as a teenager. I'd been being fairly active outside on a hot day for several hours without drinking any water. When I stopped being able to see, someone I was with suspected it was induced by heat/dehydration, and led me to the shade and gave me some water, and by the time I finished drinking the water, I could see again. A lot of the symptoms of hysteria are also symptoms of heat exhaustion, heat stroke, CO2 poisoning, dehydration, and/or malnourishment. (The folk remedies for these conditions also tended to treat them like everybody believed this condition was exacerbated by heat and lack of fresh air.) It seems likely to me that people in the 1800s were conditioned to respond to stress by exhibiting these symptoms because they were living in physical conditions that also cause these symptoms, and most things in biology have complicated multifaceted causes. When people in well-ventilated air-conditioned rooms get suddenly stressed, they don't tend to exhibit symptoms of heat exhaustion nearly as often as people in hot, stuffy rooms do when they get stressed. I don't see why this would require any invocation of culture or expectations to explain it.

I don't doubt that culture somewhat affects people's psychology including their mental pathologies and response to stress. But the past is full of people who had a life expectancy of 30 who spent their whole lives subjected to the whim of nature; and the modern third world is not quite as bad off as the past was, but it's still a lot closer to dealing with those sorts of conditions than the present first world. And I suspect that the drastic differences in material conditions between the groups being compared (over time or place to place) have had a much larger impact on responses to stress and diagnoses of such responses than any shifts in culture have had.

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Hard not to notice the parallels between anorexia and gender dysphoria

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“has a brain chemical malfunction” sounds better than “is possessed by demons”, or even than “is just inexplicably lazy and weird”

It kind of really doesn't, given all this context. Meh.

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Our brain is great at pattern matching. No surprise that when we learn about some new pattern we tend to match reality to this. And this can include our own personal experiences. When we learn about some new mental illness we can ask ourselves whether we have it and find some similarities as everything is on the spectrum. On the other hand when we learn about this pattern matching thing we can meta-pattern-match and wonder whether some group of people just pattern match to some condition and doesn't actually have it, or do have it but only due to this pattern matching and otherwise would have a different condition. Once again, this seems as a really difficult problem.

Here is some of my personal experience with such pattern matching. When I was a teenager I identified myself as a man. I thought of it as a meaningful category with which I identified some of my personal qualities and experiences. But later I learned more about sexism and gender. I reevaluated my experiences and figured out that I don't actually mean anything by saying that I am a man. I have some qualities which the society might identify with manliness but it's mostly due to sexism and I don't really care about it. This qualities are not masculine or feminine, they are mine. And this completely explained away my feeling of gender identity. I used to feel something and then I stopped. I can imagine thet if I never learned this information I could have identified myself as a man till the end of my life.

So did feminist propaganda contaminate me and turned me into agender or I have found a better framework to classify my experience? Somewhat both? When I look back I see that I definetely wasn't a typical man. But again my expirience actually changed when I got rid of a "man" label.

Later I became really curious what people actually meant when they claimed to be of a certain gender and that it's super important for them. Could they explain away their gender identity as I did? I talked with such people, I also got a partner who was very into my masculinity and it meant something for her so I tried to understand. And I figured out that gender identity isn't a void idea and that it even have some meaning for myself. My previous position of "I don't even understand what you mean by this gender identity stuff" stopped being true. And there was a period when I thought that it may be valid to consider myself a man again. But then again I learned even more information on the topic, I reflexed and figured that I actually miss some of the things people are talking about. I'm pretty sure that I wouldn't have disophoria in a female body, neither I do in a male one. I used to be not happy with having a beard but I now I accept it. Which actually contrasts very much with some of my man-friends who are very found of having a beard and male body. Once again I came to the conclusion that "man" label doesn't actually fit me. And on every step changing the label affected the way I parse my inner experience.

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Few months ago I came with a thought on modern society feels like we need to interfere with everything and we find it hard to accept that something is going to work better if we leave it alone.

This might be a good case to think about.

Besides I have to complement you for the reviews and articles, I've found this blog few days ago, and your writings are really interesting (also added your podcast to playlist, next long ride I'll listen to you)

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so short version: lots of psychiatric diseases have large social components?

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@Scott you're a great reviewer; please review better books. Your arabian nights review was life-changingly good, and although this one is cool, I just don't feel like it has the meat of something that a classic would. Would love to hear your commentary on idk Blaise Pascal's Pensees or Confucius' Analects or something.

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>I hear woke people talk about how demanding a calm, quiet, low-expressed-emotion environment is white supremacy because only white people care about that kind of thing.

Maybe woke people are extremely-high-expressed-emotion folks who express whatever gripes they have with mainstream American culture by attributing them to white supremacy.

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> Those who jump off a waterfall or throw themselves in front of a train are weak-minded. [...] How useless they are! Such weak-minded people would only cause harm even if they remained alive.

Gotta love how the author seems to have zero interest in preventing suicide and instead just wants to stigmatize them after they're dead. (It's not clear that this attitude would reduce suicide at all; the sentiment "no, suicide doesn't make you hard-working, intelligent, sensitive, or admirable" is more plausibly useful.)

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> The island nation was [insert some term other than “inundated” or “flooded”] with a [insert some term other than “tide”] of counselors, therapists, and psychiatrists

The island nation was slammed again with a wave of counselors, therapists, and psychiatrists.

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1. Hydraulic model of emotions:

in "The cultural animal" (Baumeister 2005)* he compares the hydraulic model of emotions versus a self-inflating feedback model.

the hydraulic model of emotions assume that there is a quantity of emotions and if you don't let it go out the pressure will keep increasing until it explodes. this applies to anger sexual desire trauma etc.

but all the available evidence shows no support whatsoever to the hydraulic model. You do not see that getting angry is reducing one's anger and so on, outside qualified circumstances.

the feedback self-inflating model says is that sometimes using the emotions is actually amplifying and self-perpetuating it. and we do have evidence in anger for example that getting angry or on average makes you more angry. And ruminating about traumatic experience increases the effect of the trauma, and so on.

2. lipostat, obesity and anorexia

assuming that obesity is mostly caused by failure of the lipostat - the body weight management mechanism is faulty, this will directly cause both obesity and anorexia.

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Just read the book, really liked it, thanks Scott for the essay/review!

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People who write about psychogenic pain say that it's culturally "contagious". For example, they claim that the prevalence of back pain in the US is higher than it used to be, due to the claims of experts that the spine is a delicate structure that has to be used in specific ways to avoid pain/injury. This creates fear around using the spine, leading to pain.

Whiplash is one of the chronic pain syndromes that's supposedly culturally contagious. According to Alan Gordon, whiplash doesn't exist in Lithuania, despite frequent car accidents. Pain can occur immediately after an accident, but it resolves in a few days. This is supposedly because there is no cultural awareness of whiplash.

The idea of psychogenic pain "fads" sounds plausible to me but I don't know how strong the evidence is. Here are two citations about whiplash in Lithuania.



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> But nope, according to Crazy Like Us scientists have determined that white Americans are the highest-expressed-emotion culture in the world

Of course they are. Americans invented the "crazy" (note the scarequotes) idea that emotions can matter in the workplace (and thus, e.g., the horrible salesman smile plastered on people, say, telling you you're fired or something). There is the "bottled-up Brit" stereotype, but these are the same Brits that popularized boxing as a way to let their emotions out - not karate or kapoeira, boxing, i.e., the literal "punch the bag" exercise.

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