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Many people in my family have an autism diagnosis, or autistic traits (genetics!) In fact, I wouldn't be surprised if your sister has autistic traits herself, even if she doesn't meet the "threshold" for diagnosis. Right now, the most common model is the Autism spectrum model. In other words, diagnosing autism isn't a "yes or no" question but rather a "more or less" question. We're all on the spectrum somewhere.

I suspect the spectrum model is equally true with anxiety and restlessness, just as you mentioned in your comment. Or depression, or schizotypal traits, etc. How we express it is cultural, and where we draw the line between normal and disordered is also cultural. When we remove the stigma from autism, like in the neurodiversity community, a lot more edge-case people are willing to get tested or admit that they have it. So then you get into the age old argument- - are autism rates increasing or is diagnostic criteria changing?

And like you said, how useful/helpful is the diagnosis? An autism diagnosis doesn't tell me anything about a person's preferences, personality, experiences, or abilities. But I think it can be very helpful if it helps people access meaningful advice that improves their quality of life.

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F'd up time scale on that obesity chart.

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Wow, I noticed the 20 year discontinuity (to an extrapolated data point) at the end, but looking at it more closely it only levels off in the middle because time went from moving a decade at a time to two years at a time...

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And the 2007/8 point is a smaller number than 2005/6 (which actually says 2005/5006), but is _higher_ on the chart.

If you graph it out properly, the rate is climbing fairly steadily from the end of the 70s onwards.

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The y-axis isn't great either...

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founding

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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But then why did women stop fainting in the 20th century?

I think it's more probable that dramatic fainting was a performative social behavior - sort of like how we cough or clear our throats to attract attention, even though we're not sick.

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They stopped fainting because we started hospitalizing them for malnutrition before they could faint from malnutrition 😎😎😎😎

But really I have no clue

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Or speaking in tongues in certain contexts.

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What makes you think they did? Human females the number of presentations for fainting in general practice and in emergency settings is approximately four times higher for young females than for young males (Olde Nordkamp et al. 2009).

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Wasn't that largely corsets?

If you're looking for anorexia in girls, amenorrhea would be a symptom, though I suppose the Victorians had some euphemism for it and probably there aren't good records.

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My understanding is that corsets weren't more restrictive than modern clothing; the horror stories about tight-lacing were very extreme cases, like a future historian basing their understanding of bras on Lady Gaga's outfits

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Yeah, I fell into a hole in YouTube a while ago (pre-covid) that is full of historical clothing experts getting extremely annoyed that tight-laced corsets are seen as the norm, rather than being a special-occasion garment. It's like, oh, six-inch platform heels. No-one wears those as an everyday shoe, but you see them a lot at very fancy events (there are photos of Olivia Rodrigo at the White House a couple of days ago wearing them). Because published images are much more likely to be of fancy events, we get a distorted image of the past.

The other problem is that corsets have to be fitted to the specific person and off-the-shelf corsets, the ones that almost every modern person that has ever worn a corset has experience with, are much more restrictive than properly-fitted ones.

There was an actress who had done lots of period films who was put in a properly-fitted corset for the first time for a particular film (or maybe TV show?) and was in raptures about how much more comfortable it was and how much less restrictive, and this whole YouTube community were posting up videos of the interview and saying "see, we told you so".

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relevant vid: https://www.youtube.com/watch?v=rExJskBZcW0

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founding

From the same source, on the extent to which those published images were heavily "photoshopped" even a century before the invention of photoshop.

https://youtu.be/gYGUfg_NJzg

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Thanks very much. It's hard to be cynical enough.

Perhaps we know what the dogs looked like.

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I was in Basel, Switzerland, a few years ago and the local toy museum had a temporary exhibit on the history of corsets. (I guess they were the only museum with extra space). It was fascinating, and corroborates this view that most corsets were not extremely restrictive.

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Look at "greensickness" https://en.wikipedia.org/wiki/Hypochromic_anemia

Turns out to be anaemia. Poor diet, overheated/poorly ventilated rooms, heavy clothing and anaemia on top of stress makes for fainting, especially if it's socially acceptable for women to faint. Probably also was an element of "fainting because I am a Delicate Flower and get attention that way" as well, and perhaps women weren't in fact fainting as much as popular novels and plays described them as doing.

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Can we tell a predictive coding story? If your top-down prior is that stress = fainting, and your bottom-up sensory data is giving you stress signals, do you faint?

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Better nutrition and better overall health might have reduced the probability of fainting. Modern women (and men !) rarely push their bodies to the absolute limits of survival on the daily basis. We have weekends and 8-hour workdays at the office, not 24/7 shifts of mining coal or carrying buckets of water over multiple miles.

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But 19th century women who are always fainting, generally belong to the leisured upper class, and certainly not working in coal mines.

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Alternatively, _The Frailty Myth_ has it that early Victorian women were so much discouraged from moving that they had trouble giving birth and so light, ladylike exercise was invented.

It would be interesting to pin down the range of time when fainting was more common. Or, for that matter, to find out something about how common fainting was.

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That's upper class early Victorian women, of course.

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Incorrect. Human women faint at a rate double the rate of men. This is true today as it was then.

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I doubt this is true; extant clothing from the period shows a range of sizes consistent with generally healthy weight.

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Also, in many cultures, for long periods of time, being thin wasn't even seen as attractive: see Rubens and other art from the era, for example. Or ancient art and sculpture from many different places. When food is scarce, voluptuousness is seen as attractive. When food is plentiful, it flips. (I have seen this flip within my lifetime in India, as a consequence of globalization and economic growth.)

Anorexia is unheard-of in societies where most people live at the edge of starvation, for obvious reasons.

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It was performative status signaling, just like today.

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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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Yeah, talk about insensitive. They just had a tsunami! Yeesh.

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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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Scott sort of alluded to this towards the end of his review of "Origin Of Consciousness In The Breakdown Of The Bicameral Mind" https://slatestarcodex.com/2020/06/01/book-review-origin-of-consciousness-in-the-breakdown-of-the-bicameral-mind/

A lot of people have drawn parallels between the spikes in anorectic teenage girls observed in the 1990s and 2000s, and the current spike we are experiencing in transgender teenagers (specifically trans boys). Lisa Littman's research into "rapid onset gender dysphoria" makes the comparison quite explicit and argues that the underlying mechanism in the two cases is basically identical: social contagion via social media and peer groups.

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The other possible example of this "the spectrum".

Presumably in young kids, autism is genuine and not being faked/projected/induced. On the other hand, when I was in Silicon Valley 20 yrs ago, it was definitely a cool disease to be able to say that you had Asperger's.

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Peer group effects can easily occur without social contagion. If some mental status has statistical implications for interests or disposition, it'll exhibit a peer group effect, because people choose their friends based on interests or disposition.

In high school, I had two groups of friends, who didn't interact much. The majority of one group is now gay or bisexual (but mostly weren't out then); the majority of the other group became software developers. It would be *possible* to explain this by peer group effects, but the actual explanation is that my friend groups were preselected for the interests at hand - I was on the robotics team and ate lunch with the theater kids.

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Fair point.

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I wonder about this as well.

I instinctively come down hard against the people who declaratively say "You say that you are X, but actually, you are Y, and also fuck you" and in favor of being whatever you like being; but at the same time it's pretty hard for me to understand what people mean when they describe themselves as feeling like a particular thing.

I've never particularly felt like a male or female or anything particular, so I need this shit explained to me.

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SlateStarCodex had a helpful (for me) post about the concept of being "cis by default": https://slatestarcodex.com/2013/02/18/typical-mind-and-gender-identity/. It included a request for comments about people having strong positive feelings about their gender matching their sex-assigned-at-birth, and got some responses. (Note also that some X -> Y trans people seem to have a stronger visceral sense of "I'm not X" than "I'm Y".)

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People with little experience in the trans community seem to conflate feeling like you're not X with feeling like you are Y pretty often, when really they're related but separate factors and any given trans person seems (to me at least) to differ in how much of each they feel.

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I've listened to some videos about detransition, and how much of I'm not X versus I'm Y *might* be a thing to look into to see whether transition is a good idea. I say might because this is a hypothesis.

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Or you don’t. ;-)

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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 have heard similar from someone I know, as well — that it didn't seem shameful and horrifying until everyone kept saying how ashamed and horrified she must be.

A common thread here might be that in both of these cases, it doesn't appear to have been violent or forceful — I'd wager that in the more awful cases, other people's reactions aren't needed to make it a terrible memory.

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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”)

In Sri Lanka we* also called our 30-year-long ethnic civil war the exact same thing ("The Troubles"). Before reading this review I hadn't previously thought to connect this to a kind of cultural euphemising.

*As a Sri Lankan-descendant born in the UK I thought it was fascinating that both countries had "The Troubles" front-of-mind in the 1980s, and as a child I wondered whether every country had The Troubles as well.

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I'm wondering whether (in either case) calling it anything more specific might not reveal preferences and so be avoided in public.

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I have a kind of mirror version of this where I suspected maybe that I should be upset and freak out, but then upon reflection thought: who gives a fuck? Weirdos gonna weird, no harm no foul? Way worse shit has happened to me? This is of course a profoundly unpopular view that I cannot talk about with anyone, basically.

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As someone who grew up in what was basically still stiff-upper-lip British society long after Britain itself had abandoned this, I thank god every day for doing so.

So much dysfunctionality of the US seems to stem from this high-emoting crap and the baggage that goes along with it. Both at the societal level of the absolute incomprehension of other societies and other times; and at the individual level of "thing has happened and therefore I should freak it and continue freaking out until I have ruined the lives of at least three people around me".

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In the play 'Angels in America', one of the characters refers to AIDS as 'the troubles'. FWIW

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This sounds a bit like the Dawkins thing? People seemed to think that just because he said he wasn't horrifically traumatized and that it ruined his life, that it meant he was *defending* it.

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Consider this. We tell kids to report if they are inappropriately touched (and a bunch of other stuff related to it). They go to the doctor, who tells them that normally they should not allow anyone to do this, but they need to examine them. We create frameworks why this is okay, rules about it, etc., and the kids show their genitals to strangers. We treat this as normal, no big deal, and most importantly, not traumatizing. On the other hand, if a stranger looks at us too long in a public place while fully clothed, we treat that like an invasion. That bothers us, and we tell an authority (adult, maybe police).

Why is the more egregious invasion not traumatizing, while the objectively less invasive experience is? It seems obvious to me that it's cultural expectation. Not all things can be controlled by cultural expectations, but I am confident that we could create a society where we consider it weird for a doctor to see us naked, just as much as for a different kind of stranger. Yet we don't.

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It is very American to read stories like this:

https://www.france24.com/en/20150810-dubai-father-stops-rescue-drowning-daughter-dishonour

(arab girl drowns because male lifeguard not allowed to touch here) and think "OMG those savages".

But I can easily think of equivalent situations in the US. For example suppose I'm out hiking somewhere really cold, there's a severe rainstorm, and I come across an 8 yr old girl. It seems like the most sensible life-saving response would be for us both to get naked (out of cold clothes) and together (share body heat) in a sleeping bag. And perhaps 30 years ago I'd probably have done that unthinkingly. Would I do that today? Hmm. Save the girl and quite possibly ruin my life; or walk away as not my problem...

Of course it's just as American to deny that this second situation has any analogy with the first...

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On the other hand lots of child abuse does seem to have horrible effects independent of “psychologizing it”. Our approach is dumb, but don’t throw out the literal babies with the bathwater! Some people not being affected doesn’t mean some others aren’t.

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Absolutely, though it appears that a lot of how we feel about these situations is related to how society depicts them and treats them. Not everything, by any stretch, but a lot more than we tend to give credit for.

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author

There was a famous study a while ago that found exactly this - that child sexual abuse did not seem to traumatize the child when it happened, only later once it was revealed to be stigmatizing. Needless to say it was very controversial. I've looked for it but I can't find it or remember exactly what it was.

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I don't know how traumatizing child sexual abuse is, but I have wondered for quite a while how much culture is a factor in sexual assault being more traumatizing than regular old physical assault. The problem is that even trying to know what to search for is difficult in itself.

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As other commenter said, child sexual abuse can be anything from “questionable contact once or twice”, which probably is fine in terms of long term harm (although still bad), and regularly happens between young kids themselves, and “brutal rape and beating”, which is really quite bad in the long term, and anything in between. Might be hard to separate those.

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er I meant “which [in some cases] is still” in the first example

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You may be referring to Rind et al. (https://en.wikipedia.org/wiki/Rind_et_al._controversy), a controversial meta-analysis which found that child sexual abuse did not result in significant, long-term negative psychological effects.

I read the literature around it pretty comprehensively about 5 years ago and found myself agreeing pretty heavily with Rind. The Wikipedia article spends a lot of time discussing the "methodological" issues, but Rind was successfully replicated in IIRC 2009, even accounting for those issues.

Fun fact: did you know that both the Senate and the House passed resolutions condemning the study?

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That reminds me of Scott's post on the virtue of silence.

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Same thought came to my mind immediately when I read your post. To begin with, what constitutes "abuse" is already a function of societal norms. Then, whether or not something is labelled as "abuse" contributes very heavily to feelings of having been a victim. This applies to all sorts of abuse" childhood sexual abuse, childhood physical abuse, FGM, adult sexual or otherwise inappropriate behavior, what have you. Even financial things such as, say, not inheriting from your father because you're a female. As long as the person believes this is the norm, they are either not inconvenienced, or accept the inconvenience the same way as we accept childhood illnesses we can't avoid. I always thought that, for example, in rape cases, the ideal would be a dual approach: come down hard on the rapist with the full force of the law, and have a psychologist downplay the whole thing to the victim as if it had been no big deal. Of course that doesn't work too well in America (or generally "The West") where people believe there must be one "Truth" rather than many culturally biased perceptions.

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I worry that the current culture rewards people for being and staying victims. It is *useful* to be able to say your current condition is because you are a victim, and it allows you access to resources for victims. Many people are victims of *something* and may require support and healing, however it is not a healthy mind-set to stay in. People need to be empowered to move on and away from victim status.

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This reminds me of the case of one of Larry Nassar's victims (the pedophile Olympics doctor). She was convinced she had received legitimate medical treatment and even defended him publicly until it was proven beyond a shadow of a doubt that he had touched her inappropriately for his own gratification. After that, she was one of the many who confronted him in court and gave a tearful victim impact statement.

Someone I know was abused over a long period of time and had sketchy memories of the timeline until they confronted their abuser and he filled in some of the details. Those new details gave the victim a new zeal to seek justice, although they certainly had been traumatized already. But the new information brought a new angle to the trauma.

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This is consistent with something I (think I) read in Frank Bures's The Geography of Madness: it is the cultural context of sexual acts with children that causes trauma for the child, not the sexual act itself. He illustrates this with the example of a maturation ritual of the Sambia tribe of Papua New Guinea: it involves the boys performing fellatio on an adult man of the tribe, but it is in the context of growing up and "becoming a man". Because it's public and socially accepted, it is not a cause of trauma for anyone involved.

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Are you sure the Sambia exist?

As far as I can tell they are only attested by a single anthropologist, Gilbert Herdt, who refused to tell anyone else where they were in order to protect their "privacy".

An alternative explanation is he simply made them up.

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Similar rituals are reported from other peoples of east-central New Guinea, such as the Etoro and Kaluli, by other anthropologists. It would have to be a pretty elaborate and coordinated conspiracy for them all to be made up.

Also, the location and identity of the Sambia does not appear to be that much of a secret any more. The Wikipedia page on the Sambia says that "the Sambia people speak Simbari (called Sambia by Herdt)", and the location of the Simbari linguistic group is given in fairly precise terms in Richard Lloyd (1973), The Angan Languages. The evidence for the Sambia-Simbari connection, as given on Wikipedia, comes from a book called "Pacific Homosexualities" published in 2002. I don't have access to this book, but I can see an extract in Google Books which contains the following quote, said to be from a statement issued by "a few Christianized Simbari":

"The people of Simbari in Marawaka, Eastern Highlands province are protesting the actions of the government in allowing an American anthropologist (Gilbert Herdt) to come and study our people's culture in the 1970s and '80s. Books allegedly written by Mr. Herdt and "discovered" in 1984 were against our customs. We also found that he never lodged copies of his books ... Our requests for assistance from Governor Peti Lafanama and Minister Muki Taranupi have fallen on deaf ears. We want compensation for the damage his books have caused to our customs and traditional beliefs."

So in this statement some of the Simbari seem to have acknowledged that they were the "Sambia" people Herdt studied. Admittedly they are also saying that what Herdt wrote was "against their customs", but these are Christianized Simbari who naturally would like to believe that.

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This is called delayed onset PTSD. It doesn't mean she wasn't actually traumatized. A lot of the conversations in response to this thread are extraordinarily minimizing to the biological nature of PTSD. People with that kind of trauma can be dissociated from their body for years without ever realizing it. That doesn't mean the trauma wasn't there, only that they were not aware of it.

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What is the proposed mechanism for delayed onset PTSD as distinct from socially mediated / expectation-based PTSD?

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I think the question here is not necessarily about how bad or "biological" PTSD is — that is, not minimizing how much trauma may be retained once it has occurred/once PTSD has developed — but rather about the cause of the trauma/PTSD in the first place.

If an event is not viewed as traumatic by an individual at the time, and then they're told it is traumatic and subsequently develop PTSD, how do we distinguish between "PTSD was socially inculcated in this individual" vs "they always had it but it was just delayed onset"?

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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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> I don't want to return to negatively stigmatizing mental illness. But I think "normalization", whatever that means, may be a bit too far.

Another possibility is that efforts to normalize mental health issues have no effect either way, and in fact follow an increase in actual mental health issues.

Some diseases like diabetes and myopia, as well as autoimmune disorders such as asthma and allergies, are far more prevalent in developed societies in developing societies. Could PTSD, anxiety, and depression be similar? Perhaps, even though we have great material abundance, we live in a maximally mental illness generating environment?

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> 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.

For what it's worth, I'd say that anyone who primarily describes Inside as a comedy has made a serious genre error (Netflix very much included) - Burnham is a comedian and humor is his tool, but it's first and foremost an exploration of deteriorating mental health in quarantine. One of those cases where a content warning might need a "no seriously, we mean it" re-claimer.

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I think "comedy special" is a genre that originated in an art form that involved standing up and telling jokes, but has changed quite a bit, even though it keeps the same name. Just as "tragedy" originated as a singing competition (oidy) where the winner gets a goat (trag) and gradually changed into something else, but kept the name.

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Huh. I thought tragedy started as goat-fucking humor, like the girls and swans stuff the Emperor Justinian's wife started with.

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Isn't the very assumption "Of COURSE quarantine has led to deteriorating mental health -- now let's just p-hack till we find it" precisely the problem Scott is talking about?

Why is that the correct prior rather than, eg, "Quarantine led to families being much closer and better mental health among most" or even "mental health is almost all genes and biology, and, unsurprisingly, quarantine had no effect since it did not change either genes or biology"?

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Let me try this again: "Inside" is an exploration of *one particular man's* deteriorating mental health during quarantine. I would hope for Burnham's sake that it's mostly artifice, but I get the impression there's a lot of honesty in the emotions there. And it is quite good at getting people to relate to it, which is not *supposed* to be a pleasant thing.

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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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We're probably all suffering from countless small diseases and pathologies that haven't been classified yet. Maybe a person in the year 2200 will read about 2020 and be amazed that anyone survived.

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founding

My mother (who was a doctor) often said that med students will catch every one of the diseases they're learning about, and that's perfectly normal. I should have made the connection to mental health earlier.

Which makes it even more frustrating that every one of the psychiatrists I visited for insomnia insisted that there's underlying depression and anxiety, even though I don't feel at all depressed or anxious.

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Jerome K Jerome, Three Men in a Boat, 1909

It is a most extraordinary thing, but I never read a patent medicine advertisement

without being impelled to the conclusion that I am suffering from the particular

disease therein dealt with in its most virulent form. The diagnosis seems in every

case to correspond exactly with all the sensations that I have ever felt.

I remember going to the British Museum one day to read up the treatment for

some slight ailment of which I had a touch - hay fever, I fancy it was. I got down

the book, and read all I came to read; and then, in an unthinking moment, I idly

turned the leaves, and began to indolently study diseases, generally. I forget which

was the first distemper I plunged into - some fearful, devastating scourge, I know

- and, before I had glanced half down the list of "premonitory symptoms," it was

borne in upon me that I had fairly got it.

I sat for awhile, frozen with horror; and then, in the listlessness of despair, I again

turned over the pages. I came to typhoid fever - read the symptoms - discovered that

I had typhoid fever, must have had it for months without knowing it - wondered

what else I had got; turned up St. Vitus's Dance - found, as I expected, that I had that

too, - began to get interested in my case, and determined to sift it to the bottom, and

so started alphabetically - read up ague, and learnt that I was sickening for it, and

that the acute stage would commence in about another fortnight. Bright's disease, I

was relieved to find, I had only in a modified form, and, so far as that was concerned,

I might live for years. Cholera I had, with severe complications; and diphtheria I

seemed to have been born with. I plodded conscientiously through the twenty-six

letters, and the only malady I could conclude I had not got was housemaid's knee.

I felt rather hurt about this at first; it seemed somehow to be a sort of slight.

Why hadn't I got housemaid's knee? Why this invidious reservation?

After a while, however, less grasping feelings prevailed. I reflected that I had every other known malady in the pharmacology, and I grew less selfish, and determined to do without housemaid's knee.

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founding

For a book from the nineteenth century, I am eternally amazed by how much of it holds up as well as this bit. A wonderful quote. :)

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We love this bit! Jerome K Jerome rocks

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There was an episode of Frasier (who played a call-in radio psychiatrist), who had a patient call in and describe a wide-assortment of mental illnesses they were suffering from in great detail.

Frasier correctly "diagnosed" the caller as a 3rd year psychiatry student.

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Every time I use WebMD, I wind up thinking I have at least one disease that I read about.

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I suspect that this is because the terms used in textbooks don't really make a lot of sense until you've seen them in-person. The first time this clicked with me was when I encountered my first patient going through a mania phase. They'd just learned that they were going to be moving into the apartment unit they wanted. They decided to be proactive by staying up without sleep for 48 hours straight and packing, but doing nothing more than removing all the stuffing from the couch cushions. And then you go "so *that's* what mania looks like" rather than thinking it's being a little restless and trying to cure your insomnia by going for an hour-long walk.

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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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I think most folks get over their dysphoria, but with acceptance instead of rejection, many people are doing things to their life that reduce their wellbeing. However, there a few folks for whom the increase in wellbeing from transitioning is extreme. The question is how do stop mass delusions in teenage girls, while not hurting the actual people who would benefit from acceptance. To me the clear answer is to accept and encourage transitions, but only for adults over 21.

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Hard disagree. I think the problem is that there are a small number of people who are actually trans, and I think the neuroscience needs to develop to the point that early detection and intervention in these few cases becomes tenable

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But what would it mean to be "actually trans"?

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Neurological states matching those of target gender

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But is this theory correct? I was under the impression that the jury was still out there. In particular, i recall reading that the studies did not correct for sexual orientation (It was a commentary by james cantor, but i cannot find it)

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would that have changed the result?

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Someone who wants to change their gender, and does so, and is then happier, is clearly trans whether or not their neurology is similar to the Hypothetical Average Cis (Wo)Man.

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Sounds a bit "no true scotsman"

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Maybe they would have been happier anyway as time passes? How do you even measure happiness here? Seems like there could be a lot of pitfalls with this line of reasoning.

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Facially false - ugly man gender swaps into hot woman, is happier because hot, despite not being trans. Women with untreatable gender specific part pain gender swaps, no longer has pain, is happy.

In general this stuff is a lot more socially determined construct complicated than that suggests. Are tribal shamans “clearly innately tribal shamans” because they participate in a role slash identity in their culture? Personal satisfaction as a 100% metric for truth is unreasonable and ridiculous

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Interesting that a lot of woke people out there think that there aren't significant enough differences between genders when it comes to neurological differences.

Would partially explain why some feminists increasingly are becoming hostile towards trans activists.

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Trans people, even the real ones (whatever that means), don’t really ever share the whole range of “psychological traits” of their target gender in my experience. Even the MtFs who knew they were trans from age five, imagine themselves as women daily to the point of it being crippling until transition, feel strong suicidal urges at thoughts of maleness, etc etc , don’t really have feminine lack of assertiveness, or patterns of general thinking and influence, mode of sexual attraction (immediate and visual vs socially embedded and changing), or whatever else. Also, all the brain studies find pre-trans brains are wayyy more similar to assigned sex brains than target sex brains (if there are even significant smaller scale differences in those structures, and n=20 fMRI etc but whatever) (that subject, like so many others, was the subject of a massive campaign of persistent study misreading and misusing to imply that trans brains are just like their gender identity brains which means trans is real!!!!!) (and if anyone wants my 1000 words about this I’ll dig it up). But if you look at relatively unconscious or supposedly innate psychological attributes, at least all trans people both I know personally, which is a lot, and all the ones I have seen in passing, don’t tend towards being biologicallypsychologically women in any significant sense. Also see the interests of MtFs lining up way more closely with the interests of men than women, especially in areas like programming, tech, guns, and being an autistic contrarian (women sometimes are interested in all of these, but ... not at a 50% rate!). All put together I can’t really see “MtFs have woman brains” as true. None of this really rebuts “no biological influence at all, it’s all a massive mess” though, although there’s gotta be some significant sex psychological differences.

(if this is over any line I’ll delete & shut up)

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I don't trust anecdotal data on this. I think cis people lie to themselves as much as anyone. I also think testosterone and socialization undoubtedly masculinize Trans women (and the converse for Trans men), but that there's no reason to think this wouldn't happen if you subjected cis people to the same conditions. That's a longitudinal question. Also, male interests are more associated with the types of jobs that:

1. Trans people can actually get and maintain

2. You specifically are exposed to

There are a lot of Trans people that work as prostitutes and/or die by their 30s. Just not seeing it, sorry.

Agree current data inadequate of course.

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> I also think testosterone and socialization undoubtedly masculinize Trans women (and the converse for Trans men), but that there's no reason to think this wouldn't happen if you subjected cis people to the same conditions.

... but testosterone masculinizing behavior slash brain would mean you have a masculine brain. And as IIRC testosterone is a primary driver of all sex differentiation in biology (https://en.m.wikipedia.org/wiki/Sexual_differentiation_in_humans - reading the list of syndromes, it seems testosterone issues at various causal points can cause mostly full reversal of apparent sex), while a female brain male body is possible if like the brain doesn’t respond to T but the body does or something, that seems quite tough to pull off mechanically, and doesn’t mesh with I’ve seen. But yes it is tough to figure this stuff out, although I think “anecdotes” can be quite strong in terms of evidence when done correctly, generally that doesn’t work out well. But all of my trans friends were, and continue to be, masculine in ways that just seem weird (strong wills, male style interests, internet autism, very much do not go with the flow, anger issues for some, etc) and idk how to square that with “woman brains slash minds”

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"Masculine and feminine brain" is not enough dimensions to capture the relevant questions. All that needs to be the case for my position to hold is for there to be some non trivial non plastic part of the brain that corresponds statistically and in a yudkowskian thing-space sort of sense to something generally found in opposite sex and not birth sex.

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Like, I'm not arguing that Trans brains are holistically female or male, just that there is some persistent kernel of maleness or femaleness there (not even for sure having anything to do with masculinity or femininity)

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That sounds like a survivorship-bias sort of problem. Wouldn't somebody who lacked a strong will or significant anger, who tended to go along with the flow and blend in socially, but with subjective experience of gender dysphoria held constant, be far more likely to simply hide those feelings? Rather than, say, heroically asserting themselves and overturning their whole life in a quest to resolve the issue.

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"Also, male interests are more associated with the types of jobs that:

"1. Trans people can actually get and maintain

"2. You specifically are exposed to"

The guy I knew in MBA school in 1981 who is now said to be "America's highest paid female CEO" made his first fortune by inventing his own industry. He was among the most willful people I've ever met. He made a similar impression upon his highest paid employee, Howard Stern, who called him Martin Luther Queen.

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I'm not sure why it would be relevant that they do/don't. Should not our standard for transness be:

"Would benefit from gender transition".

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What’s benefit? I’m sure there are numerous practices and massive life choices many take and find beneficial but you disagree are beneficial. Some dislike religious asceticism, some dislike voluntary sexual repression, some dislike hedonism, some dislike conversion therapy, some become eunuchs as a fetish, all of these have many participants who claim they’re awesome. Claiming that, because people find transition good, makes it good, isn’t something you’d claim true for conversion therapy or Islamic repression of women, and is quite odd anyway.

And anyway “MTF brains are significantly F” was both the initial claim here and a common claim to support the idea of trans, so it’s relevant.

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Snake oil medicine, energy healing for cancer, new age religions, The Secret, are more things that lots of people like, but the “it is good because it is well liked by participants” is questionable.

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Not in my opinion no.

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I think there's something about imprinting on social roles-- it's not just about the body.

I was surprised when I realized there's no such thing as "dressing like a woman", there's only dressing like a woman from a particular culture.

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I bet it helps to be assertive if you're weighing whether to transition.

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Is this a theological belief or a rational belief? ie

- is it capable of being falsified?

- what does it rest upon if you concede that neuroscience cannot confirm it?

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Yes, it's capable of being falsified. Just not immediately. It is in roughly the same category of propositions as "it will rain on the first Wednesday of April 2057". In the meantime I trust my own intuitions and reasoning about it based on direct experience more than I trust the reasoning of others, though I don't think that's sufficient to convince others and defer to political conventions of liberty as a stronger argument against encroachments.

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IIRC there actually was adversarial collaboration on SSC which showed significant desistance (i.e. not continuing with dysphoric feelings) after puberty, up to half of the cases (the data is all over the place but that's about the middle point). However, there's the other half too. The complication of course it's not just "acceptance" now, it's either rejection in one tribe, or completely disproportional celebration in the other. Imagine getting some complicated surgical procedure were celebrated as a huge achievement for the person and people who had one would have been treated as a hero. Would that increase the number of people getting it? I think so. Wouldn't deny the cases where people actually need one, either - it's just there would be a lot of cases where they really don't.

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Puberty blockers until 18.

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Yes, the enbyphant in the room.

I was hesitant to bring it up trans issues but that's where my mind went, too. There seems to be far more gender nonconformism now, particularly among young people. The NHS Gender Identity Development Service has seen something like a 3000% increase (not a typo) in referrals over the past decade. Other numbers from around the world are similar.

A common explanation is that dysphoric kids have always existed but hid it in the past. That's plausible if we're talking about kids attending More Country Music High in Cletusville Alabama, I guess.

But look, I was in forums and chat rooms in the early 00s. Places where you could just pick a name and be yourself. I never met an out trans person. I met gay people, but no trans people. They had no reason to hide. They just didn't seem to exist.

This might reflect the social bubble I was in. No doubt people will post replies with differing experiences, which is fair. But there does seem to be an amazing increase in a period of just a few years, and I do wonder about social contagion as an explanation.

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Do you think homosexuality has followed a similar pattern? As in if that chatroom was in 1700 you would be telling me you didn't know of any gay people?

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I looked into this, and the answer seems to be no. The share of US adults identifying as homosexual went from 1.6% in 2008 to 2.4% in 2016, before declining to 1.7% in 2018: https://qz.com/1601527/the-rise-of-bisexuals-in-america-is-driven-by-women/

Interestingly, the share of US adults identifying as bisexual has indeed increased, from 1.1% in 2008 to 3.2% in 2018. This rise is driven entirely by women. Similarly, the rise in transgender women is much faster than the rise in transgender men, so much so that the gender ratio has reversed from 2009 to 2016 among UK teenagers (see my other post). Maybe the the increase in absolute prevalence of gender dysphoria is due to increased acceptance, but why would the sex ratio change so suddenly, for either bisexuality or transgender identity?

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I meant more like maybe it was 0.016% or something in 1700 and it is the same phenomena of a 100 times increase just not as rapidly. Obviously, it would be hard to figure out if this was true.

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I ... don’t think so. There have certainly been changes in the idea of homosexuality, but men have been fucking men for a LONG time, in large numbers, and there’s documentation everywhere proving that. Maybe less, but not one in ten thousand (roughly the chance of being struck by lightning in your lifetime, according to the National Weather Service). It certainly wasn’t seen in the Kinsey Scale exclusive homosexual - bisexual - exclusive homosexual sense though, whether or not that Was. I’d recommend an academic paper written about the social construction of homosexuality in ancient Rome - https://www.academia.edu/544127/The_teratogenic_grid - but apparently it was written by a later convicted CP possessor so ... oh well.

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a lot more people get struck by lightning than I would have guessed!

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Most cases of men fucking men have not been homosexuality but loose standards.

Same thing also causes men to fuck hands, mouths, and any hole that is roughly right size.

This is very different from homosexuality as in preferring same-sex partners, even if same word is used for both.

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Is there any male character in Shakespeare who stands out as almost certainly gay from his traits?

My vague impression is that Shakespeare might not have had the concept of the modern stereotypical gay man in his conceptual repertoire. Foucault argued along these general lines and perhaps he is right in this case. Over a long enough time period, lots of things can change.

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Osric in "Hamlet"? Though he is more a fussy courtier type. Mostly it's boys playing girl parts where the girl is pretending to be a boy, like Olivia in "Twelfth Night" or Rosalind in "As You Like It".

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If memory serves, a significant number of Shakespeare’s love sonnets are written from a male perspective and addressed to a male “youth”

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In the Merchant of Venice, the relationship between Antonio and Bassanio reads like a gay affair. It's not explicit, but once it's pointed out, it becomes pretty hard to read their scenes any other way

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The evolution of the idea of homosexuality as a sexual orientation is intriguing, because up to about the mid 16th century it wasn't really considered in the aspect of character at all as much as it was about behaviour, so sodomy was just another one of the sexual vices.

By the 18th century, at least in London, a distinct sub-culture had evolved with the molly-houses: https://en.wikipedia.org/wiki/Molly_house

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I was under the impression that, among the aristocracy, a man's marital duty was to produce an heir; everything else was unimportant. Sure, salacious gossip is always fun, but a feudal lord (duke, earl, marquise, whatever) could have 100 lovers of various genders on the side, and as long as his official wife produced him an official heir, no one would hold it against him.

I say "man", because historically women were rarely seen as important enough to merit any kind of notice :-(

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I think I would have heard of homosexuality in 1700. In other periods of time, who knows? We're still not sure what causes homosexuality, and there's no reason its frequency should remain steady in time. Anthropologists have found societies where homosexuality apparently doesn't exist (mostly hunter-gatherer ones).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534200/

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You’re right about some hunter gatherer societies not having homosexuality / male-male sex as a recognized concept, at least wrt what I’ve read, although the converse that many *do* is equally interesting. That they had to go looking for ones where it doesn’t exist says something.

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It's nothing I know much about, but I understand that the letters from Renaissance people to each other refer often enough to their own male homosexuality, e.g. Michelangelo's. I mean, it wasn't something you would say out loud in a public place, but it was okay to talk about it with friends.

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Greg Cochran has cited its absence among many hunter-gatherers as evidence for his pathogenic theory.

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The issue with using hunter gatherer societies in discussions like this is that they aren't miraculously preserved simulacra of some early human mode of existence but societies that have evolved away from that mode as much as we have (if not more - I bet their generations are shorter), just in a different direction. So just because some hunter-gatherers don't have homosexually we can't say anything about our ancestral hunter gatherers sexual tendencies.

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Also, male homosexuality is mentioned in both the Old Testament and New Testament, so it couldn't have been that rare in ancient times.

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founding

My pet hypothesis (of which I'm very much not convinced) is that this is mostly an 'Old Testament' thing and is more like modern (U.S.) 'prison homosexuality' in that the anti-homosexuality was directed at relatively powerless males that might be tempted to opt out of trying to find a wife (and then reproduce and raise any children). Part of the temptation would be due to polygyny (by the relatively more-powerful males in one's tribe/clan) and the other to being pastoralists, i.e. many young men not being around women for long periods of time. This would also explain the prohibitions against bestiality.

I am mostly convinced that 'prison homosexuality' isn't the same thing as (modern) 'regular homosexuality'.

And then there's 'homosexuality' among other animals – that _could_ be 'real homosexuality', but it could also be 'opportunistic sexuality' – sexual behavior has to be 'implemented' somehow and given the general chaos that is biological evolution generally, it seems pretty likely that, however it's implemented, it wouldn't be 'perfect' (in the sense of always serving evolutionary fitness, i.e. leading to reproduction).

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Part of the reason that the Jewish and Christian faiths tend to be anti-homosexual behavior is that their institutional memories run all the way back to the Greco-Roman world, in which male homosexual behavior tended to be exploitive, with the powerful having their way with the less powerful (e.g., slaves, youths, etc.)

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Is there reason to believe they'd be concerned about this exploitative power difference in particular?

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I thought the biblical prohibition of gay sex predated Greek influence over the Jews.

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People wouldn't have identified as homosexual in the same sense we understand it. There would be the difference between "men who have sex with men (and women)" and "men who are effeminate and play the woman's part" as they understood it.

In a poem of 1675, Rochester can refer to bisexuality (and what seems like "gay for pay") without it being anything more than the general idea of debauchery; from "The Disabled Debauchee":

"Nor shall our love-fits, Chloris, be forgot,

When each the well-looked linkboy strove t’ enjoy,

And the best kiss was the deciding lot

Whether the boy fucked you, or I the boy."

So the idea of "men who have sex with men" (as distinct from "identifying as homosexual/gay") was around back then as much as it is around today.

I still remember the opening chapters of Cephas Goldsworthy's idiosyncratic biography of Rochester, describing the spirit of the 17th century where two young gentlemen, probably drunk, definitely showing-off, either simulated or actually had sex in public, before a jeering crowd, on the balcony of an inn - and when brought to court the case was dismissed, because the enraged judge who would have loved to sentence them was forced to let them go as there were not any laws about public indecency at the time. Plainly the sporting sprigs of the gentry didn't think it would do their reputations any real or lasting harm to have it bruited about that they were doing gay sex things.

The same is recorded in an anecdote about Mark Antony, that when he was a young rakehell and wanting to piss off his censorious father (or his friend's censorious father), they would pretend to be (actually were?) boyfriends:

"According to the historian Plutarch, Antony spent his teenage years wandering through Rome with his brothers and friends gambling, drinking, and becoming involved in scandalous love affairs. Antony's contemporary and enemy, Cicero, charged that he had a homosexual relationship with Gaius Scribonius Curio."

"There was a rumor that Curio and Mark Antony had an affair when they were young. When the two men had been banned from seeing each other by Curio's father, Curio had smuggled Mark Antony in through his father's roof."

Cicero really had a fun time in his Philippics against Antony, from the Second Philippic:

"44 XVIII. Shall we then examine your conduct from the time when you were a boy? I think so. Let us begin at the beginning. Do you recollect that, while you were still clad in the prætexta [white robe with purple border, worn by Roman boys up to the age of 16-17 and by girls until marriage], you became a bankrupt? That was the fault of your father, you will say. I admit that. In truth, such a defence is full of filial affection. But it is peculiarly suited to your own audacity, that you sat among the fourteen rows of the knights, though by the Roscian law there was a place appointed for bankrupts, even if any one had become such by the fault of fortune and not by his own. You assumed the manly gown, which you soon made a womanly one: at first a public prostitute, with a regular price for your wickedness, and that not a low one. But very soon Curio stepped in, who carried you off from your public trade, and, as if he had bestowed a matron’s robe upon you, settled you in a steady and durable wedlock.

45 No boy bought for the gratification of passion was ever so wholly in the power of his master as you were in Curio’s. How often has his father turned you out of his house? How often has he placed guards to prevent you from entering? while you, with night for your accomplice, lust for your encourager, and wages for your compeller, were let down through the roof. That house could no longer endure your wickedness. Do you not know that I am speaking of matters with which I am thoroughly acquainted? Remember that time when Curio, the father, lay weeping in his bed; his son throwing himself at my feet with tears recommended to me you; he entreated me to defend you against his own father, if he demanded six millions of sesterces of you; for that he had been bail for you to that amount. And he himself, burning with love, declared positively that because he was unable to bear the misery of being separated from you, he should go into banishment.

46 And at that time what misery of that most flourishing family did I allay, or rather did I remove! I persuaded the father to pay the son’s debts; to release the young man, endowed as he was with great promise of courage and ability, by the sacrifice of part of his family estate; and to use his privileges and authority as a father to prohibit him not only from all intimacy with, but from every opportunity of meeting you. When you recollected that all this was done by me, would you have dared to provoke me by abuse if you had not been trusting to those swords which we behold?

47 XIX. But let us say no more of your profligacy and debauchery. There are things which it is not possible for me to mention with honour; but you are all the more free for that, inasmuch as you have not scrupled to be an actor in scenes which a modest enemy cannot bring himself to mention."

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That Cicero quote is awesome :-)

That said though, I could be wrong, but my impression is that the modern idea of "identity" as based on a person's gender/sexual orientation/race is relatively new. From what I can tell, in ye olde days one's identity was pretty much defined by one's allegiance to a country (which, admittedly, did cluster along racial lines), or a quasi-national entity such as a religious order. One's choice of sexual partners was a preference, and perhaps an aspect of one's character, but not an identity as such.

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How long ago did that "allegiance to a country" predominate? My impression is that pre-1815, and even more likely pre-1648, most Europeans didn't particularly identify with the lord who happened to have authority over their territory, and that would have been the closest thing to a modern concept of "country" they had.

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Romans went in for sexual invective, especially for denigrating political rivals and opponents in court cases, in a big way so Cicero as an orator can certainly make the most of what he's laying to Antony's charge.

The picture painted is (probably) intentionally hilarious, to make Antony and his affairs sound even more ridiculous: the stricken father, confined to bed and sobbing with grief and chagrin; the love-stricken son, also weeping and throwing himself histrionically at Cicero's feet to demand he pay that huge debt of Antony's and declaring that he couldn't live without his love; and Cicero as the family friend dragged into this highly emotional scene to sort it all out.

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And it's interesting that while he's painting the young Mark Antony as effeminate, playing the "wife" to his lover, he then turns it around and has the older Mark Antony being disgraceful by his public affair with a courtesan/actress/manumitted slave he made his mistress:

"The tribune of the people was borne along in a chariot, lictors crowned with laurel preceded him; among whom, on an open litter, was carried an actress; whom honorable men, citizens of the different municipalities, coming out from their towns under compulsion to meet him, saluted not by the name by which she was well known on the stage, but by that of Volumnia. A car followed full of pimps; then a lot of debauched companions; and then his mother, utterly neglected, followed the mistress of her profligate son, as if she had been her daughter-in-law. O the disastrous fecundity of that miserable woman! With the marks of such wickedness as this did that fellow stamp every municipality, and prefecture, and colony, and, in short, the whole of Italy.

...You came to Brundusium, to the bosom and embraces of your actress. What is the matter? Am I speaking falsely? How miserable is it not to be able to deny a fact which it is disgraceful to confess! If you had no shame before the municipal towns, had you none even before your veteran army? For what soldier was there who did not see her at Brundusium? who was there who did not know that she had come so many days' journey to congratulate you? who was there who did not grieve that he was so late in finding out how worthless a man he had been following?"

Yeah, I'm not going to think that an army of veterans would be shocked, shocked! that their general was keeping a mistress, even if she was an actress.

"Again you made a tour through Italy, with that same actress for your companion. Cruel and miserable was the way in which you led your soldiers into the towns; shameful was the pillager in every city, of gold and silver, and above all, of wine.

However, we will say nothing of these things, which are acts of a more hardy sort of villainy. Let us speak rather of his meaner descriptions of worthlessness. You, with those jaws of yours, and those sides of yours, and that strength of body suited to a gladiator, drank such quantities of wine at the marriage of Hippia, that you were forced to vomit the next day in the sight of the Roman people. O action disgraceful not merely to see, but even to hear of! If this had happened to you at supper amid those vast drinking-cups of yours, who would not have thought it scandalous? But in an assembly of the Roman people, a man holding a public office, a master of the horse, to whom it would have been disgraceful even to belch, vomiting filled his own bosom and the whole tribunal with fragments of what he had been eating reeking with wine. But he himself confesses this among his other disgraceful acts. Let us proceed to his more splendid offenses.

[Mark Antony buys, or otherwise takes possession of, the estate of Pompey The Great]:

"But, as some poet or other says,—“ “Ill-gotten gains come quickly to an end.”

It is an incredible thing, and almost a miracle, how he in a few, not months, but days, squandered all that vast wealth. There was an immense quantity of wine, an excessive abundance of very valuable plate, much precious apparel, great quantities of splendid furniture, and other magnificent things in many places, such as one was likely to see belonging to a man who was not indeed luxurious but who was very wealthy. Of all this in a few days there was nothing left.

...Actors seized on this, actresses on that; the house was crowded with gamblers, and full of drunken men; people were drinking all day, and that too in many places; there were added to all this expense (for this fellow was not invariably fortunate) heavy gambling losses. You might see in the cellars of the slaves, couches covered with the most richly embroidered counterpanes of Cnaeus Pompeius. Wonder not, then, that all these things were so soon consumed. Such profligacy as that could have devoured not only the patrimony of one individual, however ample it might have been (as indeed his was), but whole cities and kingdoms. And then his houses and gardens!

...I pity even the walls and the room. For what had that house ever beheld except what was modest, except what proceeded from the purest principles and from the most virtuous practice? For that man was, O conscript fathers, as you yourselves know, not only illustrious abroad, but also admirable at home; and not more praiseworthy for his exploits in foreign countries, than for his domestic arrangements. Now in his house every bedchamber is a brothel, and every diningroom a cookshop. Although he denies this:—Do not, do not make inquiries. He is become economic. He desired that mistress of his to take possession of whatever belonged to her, according to the laws of the Twelve Tables. He has taken his keys from her, and turned her out of doors. What a well-tried citizen! of what proved virtue is he! the most honorable passage in whose life is the one when he divorced himself from this actress."

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> They had no reason to hide.

I think that would depend on how they wanted to socialize, explicitly identifying that way would certainly attract (not totally positive) attention in the early 2000s (especially if as you say there weren't other out ones), and on a text based forum it would be easy for them to just present as whatever gender they wanted.

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Wait there were definitely isolated nerdy trans internet folx in the 00s. How many idk but there were

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You did meet them. One was my partner. She went by a female name on forums and chat rooms in the early aughts and nobody was the wiser. Forums and chat rooms offered her a place to be seen as she wanted to be seen, no questions or explanations necessary.

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I mean that figuratively not literally. I have no idea who you are. I'm simply proposing that you could have met one and had no idea.

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I'm sure this was the case.

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I think that a lot of it was down to "if you don't know about it, you don't apply it to yourself". There may well have been many more trans people than the ones who came out about it, but they just thought they were/were classed by society around them as "tomboys" and "masculine women" or as "sissies" and "effeminate men".

As I said elsewhere, I'm sure I've been aro/ace since I was nine and very decisively told my mother I had no interest in marriage or family, but I had no idea of the concepts even existing until much, much later in life. If I'd never encountered those ideas, I'd have gone on thinking "well, I'm just weird and maybe mentally ill/disordered; normal people want marriage, kids, sex and romance".

Though it's true that there is an element of the copycat; teenagers are trying on identities in order to find one that fits, as they are in the process of constructing a self that is now a separate individual and not centred around their parents, and becoming an adult from a child. Transness may seem to make sense, or at least be something concrete, in the midst of the confusion of puberty and adolescence. A bit like the "lesbian till graduation" college girls of fable? Some will go out the other side and discard it but it was useful for a time they needed it; some will continue thinking "this is me", and some will be right.

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People choosing a life of celibacy has been culturally recognized for a very long time.

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I have a friend whose mom had an interesting life trajectory. As a small child in the 1930s, a major movie studio put her forward to the public as their version of Shirley Temple. When her movie career fizzled as a teen, she became a nun at 18. Ten years later, she ran off with a priest, got married and started a family (including my friend).

Lots of big dramatic decisions, but no chemicals or surgeries back then to close off future changes of mind.

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And some will have themselves mutilated and sterilized over a fad.

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Is that 3000% increase in referrals due to an increase in gender nonconformity, or due to an increase in the behavior of referring people to the NHS Gender Identity Development Service?

I "identified" "as" "genderqueer" in, like, 2007 (never mind that the innovation of identity-label discourse was seen as missing the point - from my perspective, the quality of the theory around it has gone steadily downhill, mostly due to its popularization in the media), as did several of my friends. If you'd told us that, in 2021, the Brits would have an NHS service for that, we would've either looked at you like you'd grown a second head or assumed it meant conversion therapy. Probably both - what else could gender nonconformity have to do with *doctors*?

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I was wondering the same thing. There has been a dramatic increase in the number of self-reported trans people, along with a flip in the sex ratio from male-dominated to female-dominated. For example, referals to the Gender Identity Development Service in the UK have gone up from 24 to 426 from 2009 to 2016 for adolescent males, and from 15 to 1071 (!!) for adolescent females. Maybe the growth itself can be explained by greater awareness of either gender dysphoria or the GIDS, but what explains the change in the sex ratio from 1.6 to 0.40?

https://www.researchgate.net/publication/324768316_Sex_Ratio_in_Children_and_Adolescents_Referred_to_the_Gender_Identity_Development_Service_in_the_UK_2009-2016

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Aren't all trans people are self-reported? Is there some alternative evaluation method that reliably identifies a person's internal subjective experience before they divulge it? If so, who invented mind-reading technology and how do I destroy them?

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Yes, it's self reported. Most mental illnesses are self reported, or based on symptoms that are self reported. Psychiatrists don't diagnose depression or anxiety by measuring the patient's brain waves. If there's any point in analyzing the prevalence of any mental illness, there's no reason not to analyze transgender prevalence.

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I think there have always been people, who, if they could just hit a button and switch genders (with no terrible social consequences) - they would. (And, of course, some of them might regret it! Grass is greener and all that.)

Of course it's not that easy, so I think it's a function both of how *badly* they want to switch, and how difficult (medically, socially, financially, etc) it is.

Right now on the social-ostracism front it's gotten dramatically easier. Also on the medical front options have gotten better - mainly young people now have a chance of getting medical treatment before secondary sex characteristics are fully developed, letting them physically get much closer to their preferred gender when they reach adulthood.

So, I think there's been the most obvious change on the reduction-of-obstacles front so that's the most straightforward explanation for the increased numbers.

On the demand side, maybe? I think people are more aware of the option, which may cause them to think about it more, and maybe on the margins that increases the desire of some people to switch enough to cross the threshold to overcome the (still not insignificant) obstacles. On the other hand societal gender roles are less constraining than in the past which you'd think would reduce the pressure to switch some.

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A lot of people would “switch genders at will” who aren’t trans in any way shape or form!

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I'd do it for the weekend. Sounds like fun. Isn't there a Roman parable about a man who gets temporarily transformed into a woman... and then back again? And the gods are having an argument about whether male or female orgasms are better so they ask The Guy Who Was A Woman to resolve their dispute?

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Tiresias who was a Greek seer and the father of Manto, also a prophetess (and her name is related to the word, "mantis" meaning "seer, soothsayer, prophet, diviner" which is why Scott uses pictures of mantises for Mantic Monday).

He struck a pair of copulating snakes with a rod and was turned into a woman as punishment by Hera; he became a priestess of Hera, married and had children; seven years later, (s)he again encountered a pair of copulating snakes and was restored to his male form.

Later on, Zeus and Hera were arguing over who gets more pleasure from sex and Tiresias, as having experienced both sexes, was asked for a judgement: he came down on the side of women getting much more pleasure, so once again a displeased Hera punished him, this time with blindness.

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That's the one! Well now I feel like I betrayed my ancestors by mistaking it for a Roman fable (I suppose Romans could have repeated it), but I originally heard it from my high school Latin teacher (it was a Catholic school), hence the association with Romans.

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> Well now I feel like I betrayed my ancestors by mistaking it for a Roman fable

Maybe as a punishment your username should be changed to Ceres.

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Wait, why was Hera on the side of "men get more pleasure"?

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founding

Her husband was obviously getting a lot of pleasure from his various affairs, and she didn't want to admit to getting any pleasure from him (or any other man). In that family's warped domestic politics, it served her interest for men to be the sex-crazed fiends and women their long-suffering victims.

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Sure, in this case I was imagining the button being a one-time, no reverse sort of deal. So people who hit it should believe they'd be able to live better as the other gender, but they wouldn't need to feel that way to an extreme degree.

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Maybe the development of real and artificial sex hormones as treatments in the mid-20th Century made possible new modes of life, which people then developed an urge to pursue?

For example, as a sort of cross between (reverse) gender dysphoria and (reverse) anorexia, probably more males are obsessed with building huge muscles than ever before, in part because steroids make it possible and provide them with lots of role models (and we have more access to images than ever before).

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I think more along the latter.

What is the optimum response from society? I think something like:

"Oh, you think you might be a woman born in a man's body (or v-v). OK, here are your options..."

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What is interesting is that upper class men in the 17th century where very feminine. In the clothing they wore, and the fact that they had on a thick layer of make up and even fake moles on their face. There was an increasing focus on beauty for men, until apparantly the distinction between masculine and feminine became too small and there was a strong pushback for upper class men becoming more masculine again. I think the Macaroni was especially one step too far towards the feminine for many, and sort of sparked the reversal.

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cf. the anti-emo backlash, which was followed by ultramasculine "bro"/"party rocker" style

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My feeling is that transgenderism has probably always existed. Some percentage of transgender cases might be treatable by therapy (basically, just talking about it); some are not, and may lead to fatal outcomes. However, the number of such cases is quite small, on the order of small fractions of percentage points.

The rising awareness of trans issues had enabled advanced treatment options for body dysphoria sufferers. Unfortunately, rising awareness and rising acceptance also led to some form of trans identity becoming, for lack of a better word, fashionable. The actual number of transgender people had not changed, but the number of people who either want to be transgender (minus the painful side effects), or mistakenly believe themselves to be, had risen by orders of magnitude. Hence the ongoing fractal proliferation of trans-adjacent identities.

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I find it neat to read Matthew 19:12, where Jesus says "12 For there are eunuchs who were born that way, and there are eunuchs who have been made eunuchs by others—and there are those who choose to live like eunuchs for the sake of the kingdom of heaven. The one who can accept this should accept it.”

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Was he referencing the Chinese eunuchs? Or am I being comically ignorant here.

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I think the Middle East was only vaguely aware of China at the time. But there were also eunuchs in the Middle East.

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Probably more towards comically ignorant, but that's okay!

Jesus is talking about divorce, and the comment is his response to the disciples saying that no one getting divorced is a serious dilemma. It's interesting to me that he separates those who "live like" eunuchs from those that are made into eunuchs and also separate from those that are born as such. Plausibly he's talking about those that are asexual (or at least live like they are), as well as those born without genitalia. So it was apparently a known enough thing at the time to reference it.

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My guess would be that a fairly high proportion of people who are sexually attracted to the same sex as their assigned sex have some cross-sex gender feelings, which probably come from the same biological origin as the sexual orientation. How these people get classified and deal with their dysphoria depends on cultural context, sometimes handled entirely within the queer community. In the recent past in the US, many people would have been classified as butch or drag queens who are classified as nonbinary today. Having a butch identity historically could include a lot of the things we consider trans associated now, including binding your breasts, presenting in a completely masculine fashion, and being viewed by others as not really a woman. It’s not clear to me whether the old or new way of classification, where many nonbinary people somewhat socially transition but most don’t take hormones, serves people’s quality of life better.

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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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Definitely 1903 for Misao Fujimura. I wonder if the book went into the context of the Meiji restoration and modernization, which is pretty fascinating as it relates to how Fujimura's suicide was thought about at the time and since. You could make a strong case that Fujimura's teacher, Soseki, created the legend for his own purposes (skepticism of the Meiji program) out of a lovesick teenager. As an aside, his famous carved goodbye poem seems to me (a non-specialist for sure)......strangely good? And the quality of that poem was another driving factor here, for why this became such a well known example of teen death by suicide.

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author

Thanks, fixed.

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founding

What's the source for the expressed emotion measurements?

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This question interested me as well so I did a quick search for the first review I could find-- so caveat that this article is the first time I'd heard of "expressed emotion" and I'm not an expert in the topic.

https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/expressed-emotion-across-cultures/CC598258E8D8F7E0B4EFD9DA141A916C

This focuses more on the association between households with high expressed emotion, and relapse of schizophrenia, but also gives some numbers attributed to Leff & Vaughan 1985 which at first glance do line up with the ones for American and British households from the book (the linked article gives the low-EE %, the quote from the book above is the high-EE %, and they add up to 100%). Despite having a university library access I couldn't find the Leff & Vaughan paper quickly, though-- others might have more success.

Also, I think the definition of "expressed emotion" in the article I linked above helps explain the discrepancy that Scott noted above, that the understood knowledge is that white Americans prefer/demand social environments without big displays of emotion. From what I can tell, "expressed emotion" really is just "expressed emotion (from a schizophrenia patient's household towards a schizophrenic person)". It's a pretty limited definition that's about the ways that people around a schizophrenic person at home, respond to that person. So, it makes a lot of sense that a culture's "way of interacting with schizophrenic people at home" could be very different from their "way of interacting with neurotypical people outside of home".

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I had never heard this phrase before now. It seems to have been the subject of quite a lot of research and to have changed its meaning over time, a weird and fascinating subtheme in the weird and fascinating intellectual history of schizophrenia research, and I hope Scott will revisit it.

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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.

https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate

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https://ourworldindata.org/grapher/suicide-rates-by-country OWID’s data says otherwise - with Japan as much higher - likely due to age structure adjustment? Also suicide rate has been falling for a while in Japan apparently (maybe)

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It's probably because that chart ends in 2005, another from the same site ending in 2016:

https://ourworldindata.org/grapher/suicide-rate?country=USA~DEU~JPN~KOR~RUS~FRA

Those trends seem in line with the 2019 WHO data on the Wikipedia page with Japan now lower than the US.

On the other big statistic Japan is known for (fertility rate) it doesn't stand out much from western countries these days either.

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Here's another article about the suicide rate in Japan:

https://www.nippon.com/en/japan-data/h00381/japan-records-lowest-suicide-rate-since-statistics-were-first-kept-in-1978.html

A huge rise in the 90s, followed by a steep decline starting around 2010.

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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 don't really see the connection here... What's the question — are you positing that intermittent fasting's popularity stems from the same root as anorexia's?

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Yes. Exactly. You put it better than I did.

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It’s fine lol. Intermittent fasting is seen as a nutrition / discipline / weight loss / health thing, and most everyone who does IF, overall, eats a healthy and normal calorie diet. If anything they tend to eat more healthily than most, just out of selection effects. There’s no overall trend at all of malnutrition, or hyper weight loss, or purging and binging, or body image issues on the whole. Many more IFers don’t lose enough weight because they don’t commit than overdo it. You could just as well say Christian or Islamic fasting or many other fasting traditions are related to anorexia. But as the people who do it don’t end up malnutrition or vomiting, it’s fine. That said, IF can certainly participate in the unhealthy relationship an anorexic had with food - an anorexic could intermittent fast unhealthily - and some people have certainly taken IF to extremely unhealthy levels that resemble anorexia and cause serious health issues -but it in no way presents like or interacts with anorexia for the vast majority of intermittent fasters.

That said, IMO itself it doesn’t matter much, might be good but doesn’t seem that useful

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"You could just as well say Christian or Islamic fasting or many other fasting traditions are related to anorexia"

Interestingly, in this context, the mystic St. Catherine of Sienna fasted severely and even at the time people were writing her concerned letters about it which she answered in an irritated fashion.

"TO A RELIGIOUS MAN IN FLORENCE WHO WAS SHOCKED AT HER ASCETIC PRACTICES

In the Name of Jesus Christ crucified and of sweet Mary:

Dearest and most beloved father in Christ sweet Jesus: I Catherine, a useless servant of Jesus Christ, commend me to you: with the desire to see us united and transformed in that sweet, eternal and pure Truth which destroys in us all falsity and lying. I thank you cordially, dearest father, for the holy zeal and jealousy which you have toward my soul: in that you are apparently very anxious over what you hear of my life. I am certain that nothing affects you except desire for the honour of God and for my salvation, which makes you fear the assaults and illusions of devils. As to your special fear, father, concerning my behaviour about eating, I am not surprised; for I assure you, that not only do you fear, but I myself tremble, for fear of devilish wiles. Were it not that I trust in the goodness of God, and distrust myself, knowing that in myself I can have no confidence. For you sent, asking me whether or no I believed that I might be deceived, saying that if I did not believe so, that was a wile of the devil. I answer you, that not only about this, which is above the nature of the body, but about all my other activities also, I am always afraid, on account of my frailty and the astuteness of the devil, and think that I may be deceived; for I am perfectly well aware that the devil lost beatitude, but not wisdom, with which wisdom, as I said, I recognized that he might deceive me. But then I turn me, and lean against the Tree of the Most Holy Cross of Christ crucified, and there will I fasten me; and I do not doubt that if I shall be nailed and held with Him by love and with profound humility, the devils will have no power against me—not through my virtue, but through the virtue of Christ crucified.

You sent me word to pray God particularly that I might eat. I tell you, my father, and I say it in the sight of God, that in all ways within my power I have always forced myself once or twice a day to take food. And I have prayed constantly, and do pray God and shall pray Him, that in this matter of eating He will give me grace to live like other creatures, if it is His will—for it is mine. I tell you, that often enough, when I have done what I could, I enter within myself, to recognize my infirmity, and God, who by most special grace has made me correct the sin of gluttony. I grieve much that I have not corrected that miserable fault of mine through love. I for myself do not know what other remedy to adopt, except that I beg you to pray that Highest Eternal Truth, that He give me grace, if it is more for His honour and the salvation of my soul, to enable me to take food if it please Him. And I am sure that the goodness of God will not despise your prayers. I beg you that if you see any remedy you will write me of it; and provided it be for the honour of God, I will accept it willingly. Also I beg you not to be light in judging, if you are not clearly illumined in the sight of God. I say no more to you. Remain in the holy and sweet grace of God. Sweet Jesus, Jesus Love."

Modern writers tend to go wholesale for the "of course she had anorexia" but that's hard to say; the Wikipedia article (unintentionally) puts a more manipulative slant on it:

"She died on 29 April 1380, exhausted by her rigorous fasting.

...When Catherine was sixteen, her older sister Bonaventura died in childbirth; already anguished by this, Catherine soon learned that her parents wanted her to marry Bonaventura's widower. She was absolutely opposed and started a strict fast. She had learned this from Bonaventura, whose husband had been far from considerate but his wife had changed his attitude by refusing to eat until he showed better manners. Besides fasting, Catherine further disappointed her mother by cutting off her long hair as a protest against being overly encouraged to improve her appearance to attract a husband.

...Her custom of giving away clothing and food without asking anyone's permission cost her family significantly, but she requested nothing for herself. By staying in their midst, she could live out her rejection of them more strongly. She did not want their food, referring to the table laid for her in Heaven with her real family.

...For many years she had accustomed herself to a rigorous abstinence. She received the Holy Eucharist almost daily. This extreme fasting appeared unhealthy in the eyes of the clergy and her own sisterhood. Her confessor, Raymond, ordered her to eat properly. But Catherine claimed that she was unable to, describing her inability to eat as an infermità (illness). From the beginning of 1380, Catherine could neither eat nor swallow water. On 26 February she lost the use of her legs.

Catherine died in Rome, on 29 April 1380, at the age of thirty-three, having eight days earlier suffered a massive stroke which paralyzed her from the waist down."

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Fasting has also been used as a legal remedy, even to the point of death, and the historical background to it provided the impulse for the hunger strike in Irish political activity:

https://stairnaheireann.net/2017/08/11/brehon-law-the-troscad-4/

"A method of exerting authority, available to all members of Celtic society, was the ritual fast, the troscad. As a legal form of redressing a grievance, this act emerged in the Brehon law system. That it was an ancient ritual can be demonstrated by the fact that it bears almost complete resemblance to the ancient Hindu custom of dharna. This custom is not only found in the Laws of Manu but as prayopavesana (‘waiting for death’) it occurs in ancient Vedic sources. The troscad was ‘Identical with the eastern custom, and no doubt it was believed in pagan times to be attended by similar supernatural effects’; that is, that if the one fasted against ignores the person fasting then they would suffer fearful supernatural penalties. The troscad was the means of compelling justice and establishing one’s rights. Under law, the person wishing to compel justice had to notify the person they were complaining against and then would sit before their door and remain without food until the wrongdoer accepted the administration or arbitration of Justice. ‘He who disregards the faster shall not be dealt with by God nor man … he forfeits his legal rights to anything according to the decision of the Brehon.’

The troscad is referred to in the Irish sagas as well as laws and when Christianity displaced the pagan religion, the troscad continued. We find St Colman fasting against Guaire the Hospitable, St Ronan fasting against Diarmuid, even Patrick himself fasting against several persons to compel them to Justice. Some people even fasted against the saints themselves to get them to give justice and wives also fasted against their erring husbands.

It is fascinating, as well as sad, that in the long centuries of England’s sorry relationship with Ireland, the Irish have continued a tradition of the troscad which has become the political hunger strike. One of the most notable Irish political hunger strikes was that of the Lord Mayor of Cork, Terence MacSwiney, also an elected Member of Parliament, who was arrested by the English administration in Cork City Hall and forcibly removed from Ireland to London’s Brixton Prison. He died in Brixton on 24 October 1920, on the seventy-fourth day of his hunger strike. He was, of course, not the first Irish political prisoner to die on hunger strike during this period. Thomas Ashe died as a result of forcible feeding on 25 September 1917. MacSwiney’s sacrifice was said to have inspired Mahatma Gandhi to revive the custom of dharna in India as a moral political weapon. In recent times, and perhaps better known, came the hunger strikes in Long Kesh prison camp, when in 1981, ten Irish political prisoners died on hunger strike in an attempt to force the administration to restore their rights as political prisoners, taken away from them in 1974. Among them was Bobby Sands, elected Member of the British Parliament, and Kieran Doherty, elected Member of the Irish Parliament. But these ten Irish prisoners were not the first to resort to the continuing tradition of the troscad in an attempt to assert their rights during the current struggle in the north of Ireland, nor the first to die on hunger strike. Frank Stagg, for example, died after a sixty day hunger strike in Wakefield Prison on 12 February 1976, trying to compel the reinstatement of recognition of special status withdrawn in 1974. The troscad was never entered into lightly and always with full knowledge of the seriousness of the final intent.

The troscad in ancient times was the effective means of someone of lesser social position compelling Justice from someone of higher social position. Thus Druids could fast against a king, or even a man or woman in the lower order of society could fast against their chieftain."

On Indian dharna: https://www.downtoearth.org.in/coverage/dharna-to-defecation-the-indian-art-of-protest-30999

"The Kathiawar Gazetteer of 1884 states, "If a man had a large claim against a chief or another individual of social importance, and all other means of obtaining his rights failed, he would post himself at the door of his debtor and vow to fast until his claim was satisfied. In extreme cases, the creditor was allowed to starve to death, but generally his importunity was rewarded, as few liked to take upon themselves the odium and discredit of causing their creditor's death."

Dharna was not restricted to credit transactions, alone, nor was it always an individual act. Groups of people -- even an entire village -- would stage a collective hunger strike to protest atrocities inflicted by a tax collector or a rapacious landlord."

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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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The evil spirits and PTSD demons don’t seem to quite fit the idea of “not reifying or idolizing evil”, but maybe hunter gatherers are just postmodern anti essentialist deleuzean spirit mystics who have transcended categorical chains.

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Perhaps "reify these things only in order to other them as external enemies or invaders"?

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Hmm maybe this is the theory behind "demons"

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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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That's basically how my shrink described it. Stuff that is not only normal but necessary in a war zone is bonkers in America.

Hyperawareness, aggression, night terrors, twitchiness around loud noises- survival traits in a world where gunshots at 50 meters are a constant threat. Even flashbacks can have their use; last time I smelled cordite in the air, it meant death, so now the smell of fireworks sets me off. Once I saw a car explode and pelt me with hot frag, and now cars backfiring send me into the gutter for cover.

(fake examples, not applicable to me)

It's only an issue when it comes home with you and you can't shake it off, and it's a only a disorder when it starts disrupting your life. Other than that, it's not a thing to stress about. You were exposed to danger and you're still acting like it, that's all.

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Thanks for the good examples. I think this general idea goes a long way toward explaining the whole "But why don't people in [insert war-torn country here] have more PTSD than veterans living in Pleasantville?" conundrum.

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Another idea: perhaps societies with less rigid work scheduling allow some flexibility for people with PTSD to work it out. Like, I'm picturing a family living in a multi generational household with various members contributing to the household economy. They farm or they labor in some fashion that ultimately meets their needs. It might not be the end of the world if someone shows up late to plant a field because they didn't sleep the previous night, or gets in a shouting match and storms off all emotional when someone mentions how much they enjoyed last week's crucifixion. And if the aforementioned finds that they can't concentrate on anything, that's alright because this bucket of corn needs to be sorted and it requires no thought at all.

But if I chronically show up late to work because I didn't sleep, get into shouting matches because a coworker said something insensitive about small towns that get incinerated by wildfires, forget important details, and fail to solve the most basic problems because I can't think straight, I might end up fired. And if I get depressed and stay at home and fail to get another job and miss my rent, I might end up on the street. And then I'd be one of those poor souls standing line at the DHS because my behavior is way out of alignment with the context in which I live and work, and my neediness would get written up as a big expensive problem because damn the cost of existing in America is high, and at that point pathologizing my experiences and behavior might make sense.

As someone with a PTSD diagnosis (and my therapist was very cautious about it- she never brought up PTSD and reassured me that my experiences were not abnormal for a whole three months before referring me to a trauma specialist for further evaluation), I've been through rough periods where I had some slack and rough periods where I had absolutely none. The working-through-severe-symptoms-with-no-slack experience was so bad I came very close to swallowing a bunch of percoset but was redirected by nice people to urgent care, where they gave me trazodone instead. There were many times when I wished I could just make a day's pay sorting corn.

Standard disclaimer: I'm doing much better now, don't