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What would be your biological / cultural breakdown on "demonic possession"?

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"Gender dysphoria shares some resemblance to culture-bound illnesses; I would put it around the same level as anorexia."

I agree with this, but I think, given the physical and emotional cost of dysphoria and associated treatment, this implies we should try to *turn the culture knob down* so that we're not steering more people into dysphoria.

In practice, I think this is one of the strongest case for *not* doing awareness campaigns, especially for young kids. Encouraging little kids, to cultivate sensitivity to sensitivity seems like it has the potential to elevate a number of manageable discomforts to dysphoria.

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I wonder, have you ever seen Woody Allen's "mockumentary" called "Zelig (the chameleon man)"?



Periodically wonder whether that might be part of the explanation for transgenderism, a case of imprinting:


In any case, I kinda think that your use of "sex-change surgery" should be deprecated if not anathematized. Unless you're going to argue, contrary to standard biological definitions, that penises and vaginas -- or reasonable facsimiles thereof -- constitute the necessary and sufficient conditions for sex category membership 🙂

"Gamete competition, gamete limitation, and the evolution of the two sexes" (Lehtonen & Parker [FRS]):


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Just from the first couple paragraphs I can already tell this is gonna be a classic.

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In my freshman year of college, my roommate, who was a violin major, got crippling tendonitis in her forearm, presumably from suddenly playing the violin vastly more hours of the day. (Eventually she changed majors.) Guess who ALSO got crippling forearm tendonitis, despite no corresponding lifestyle change? Me. I'm like 99% sure this was social contagion, but the tendonitis was real.

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Anorexia strikes me as a particularly bad culture-bound mental illness to have, since after patients psychologically recover their metabolisms are frequently still messed up, sometimes forever. Amok damages lots of bystanders, people get killed in kuru-panics etc. etc.

Is there like, a harm-reductive culture-bound mental illness we could import? Hikikomori seems relatively harmless and reversible, if very bleak. "Workaholism" is rather pro-social but doesn't feel like a real mental illness.

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> The patient was uncooperative - he was only visiting MDs because the local bishop wouldn’t call in an exorcist until he got a psych exam - and eventually left against medical advice.

I take it you never found out what happened to him?

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This is an all-time great blog post, start to finish.

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I kept reading and reading waiting for the reference to Morgellon's disease. Yes, you had to get to gender dysphoria, that was a given. And there is at least a mention of chronic lyme. But the two most striking instances of this phenomenon to my mind are the remarkable upsurge in diagnoses (in some quarters of the culture) of different versions of neuro-atypicality, especially autism, and Morgellon's, which makes people sure they are discovering whisps of cotton-like fibers coming out of their body. Still, I don't want to be churlish. This is a great review, especially as half of a diptych with the one on Watters' book.

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Relevant anecdote for once. So I was nineteen years old, first summer working in the sawmill between college and got sent out to replace a length of chain on one of the many chutes that moves sawdust from the mill to the chip pile. Working that day with a guy from West Virginia named Big John. He’s the millwright and I’m the lowly fire watch.

We drive across the shipping yard and he almost runs us straight into a fork lift. I grab my chest and say “Jesus John, I thought we were ghosts there for a second.”

He laughs but gets a distant look in his eye.

We don’t say anything on the rest of the drive out.

We replace the chain. No big deal. He lights a cigarette because no one ever goes through that part of the mill and I have a hose right there anyway. Without preamble he says:

“A ghost touched my honker when I was a young man. Ghosts are very loving creatures. You don’t have to be afraid of ghosts.”

I ask him “what?”

He tells me he worked a year in a logging camp when he was a young man. Him and another guy shared a room. It was summer and super hot so he’d just sleep under a sheet. The ghost would come into his room at night and just hold his honker then leave.

He tells me this over like ten minutes and I start to ask questions about his roommate. No the roommate didn’t have a girlfriend, never said anything about girls, just wanted to hang out with Big John.

I very politely and compassionately suggest to Big John that he was sexually assaulted by his roommate.

He goes, “nah, he was a Presbyterian.”

He goes back to the machine shop. Had to be reminded he told me this later because it was no big deal.

I just sit out there for two hours with my hose. I go back to the lunchroom when my time is up. I try to tell my friend Dude about the story. A guy named TJ overhears and insists that it happened to him too.

At this point I’m sure they’re fucking with me and it’s all an elaborate ruse, and say so. TJ who usually doesn’t care about anything gets really emotional and says he knows what happened.

Then Aaron the apprentice millwright comes in and TJ tells him to tell his story about being molested by a ghost and Aaron just leaves because it’s too much.

Big John, TJ, and Aaron all also had no teeth due to tobacco use and were the only ones with that affliction so in the course of a day I suddenly knew three people with no teeth who believed they were molested by a ghost.

Over the course of two summers I became satisfied they legitimately believed this all happened. This is also why I don’t fully trust any weird experience I ever have no matter how profound.

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PTSD might be confounded by the fact that war has genuinely gotten more horrible in the modern era - a Roman soldier only had to worry about the guy in front of him trying to stab him, while the modern soldier has to worry about suddenly being exploded by a drone five miles up, or by an artillery unit 20 miles away, or by a cleverly hidden landmine, or... well, there's a lot of things that can suddenly and randomly explode you in modern warfare and I think that would lead to a lot more stress and fear.

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"Myalgic encephalomyelitis" and "long covid" (are these the same thing?) are good examples too.

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Lindybeige has a good video about PTSD ("Battle Fatigue") in the Ancient world.

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As someone who has had mild issues with anxiety I can sense that the anxiety exists outside of anything to be anxious about. It’s there and it tries to find a way to manifest itself. I’m assuming this is something similar. The “crazy” exists and will find something to latch on to.

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Doesn't the trope also show up in the Odyssey? I'm almost positive Ulysses is wary of sleeping with Circe less because he's worried about being unfaithful to his wife, and more because he's afraid of, well, you know the drill by now.

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Well, i saw the gorilla and counted the right passes and had no prior knowledge, so i must be a superior human right?

However in all my years reading Scott never have I once spotted one of his double thes. Its a life goal of mine. I will snap into enlightenment the moment it happens. One of these days, Scott. you cant quit writing until i get it okay?

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Regarding school shootings, I once went through the entirety of https://en.wikipedia.org/wiki/List_of_school_shootings_in_the_United_States_(before_2000) article and it turns out that there were literally zero school shootings before Charles Whitman in 1966. The article lists a lot of shootings _in_ schools, sure, an eight grader accidentally shot a classmate while showing off his new revolver, that kind of stuff, but it took having a brain tumor to come up with an idea of shooting a bunch of schoolchildren to get back at the society. And then twenty-some years of gradually increasing number of copycats to popularize the idea that this is what some people upset at the society do.

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I wonder if there weren't significant differences in people's behavior in the past that make them basically unrecognizable, psychologically, to us today.

The example I think of sometimes is Beatlemania -- where, by all reports, people were literally fainting and collapsing and having other strange hysterics about the Beatles playing in the 60s. I wonder if back then lots of people had such different backgrounds, e.g. having grown up with no exposure to mass media, that they really did have hysterical reactions to things we find more mundane today. (There are many other possible stimuli that would have been dramatically changing around the 60s -- fewer traditional/highly-repressive cultures than behavior; relaxed codes of dress and interactions, whatever modern psychology was at the time...) And that's not even that long ago.

Basically I wouldn't be surprised to learn that, if I met somehow met someone from ~1800, their reactions to things would be completely unintelligible to me, but along axes that I have trouble imagining precisely because they're so unintelligible. So perhaps people really did get 'hysteria', but they mostly don't anymore, simply because "times have changed"?

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Two anecdotes:

1. Earlier today I was reading an article about Impostor Syndrome in the most recent New Yorker. I don't have Impostor Syndrome, I was just looking for something to read during dinner. But near the end of the article one random sentence clicked for me, something about the way it described the fear of being revealed as not knowing something, and this dread started rising in me, a feeling like when you have to give a presentation in front of a bunch of people that you didn't properly prepare for.

Naturally I suppressed the feeling right away. Just like you would suppress the desire to kill your boss. No good thoughts come from that direction.

Maybe I narrowly avoided contagion with impostor syndrome.

2. I may have written this in the comments before, but German doesn't have a word for "anxiety". Instead you use different words depending on what's happening. Like stage-fright or shyness or fear or nervousness or dread or panic or uncertainty or 'under pressure' or stress or homesickness or sorrow or 'feeling tense' or concern or phobia. I think it's part of American culture to mix a lot of these things together. Sure they have some similarities, but they're also clearly different. Like hunger and thirst are similar but clearly different.

E.g. you might be unable to act because you're shy or because you're uncertain. Americans might just say they're "anxious" in both cases. I can see how if you're both shy and uncertain, then their effects build on each other and you have a stronger combined feeling. But that doesn't make them the same thing. If you're both hungry and thirsty, their effects also build on each other. (and excuse me if I got my example wrong and "shyness" or "uncertainty" are not actually examples of "anxiety". As I said I still don't fully know what the word means)

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Fainting used to be fashionable, but has undisputed biological causes. Struck me as a very obvious example.

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Really interesting post with a lot of food for thought.

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I wonder to what degree loneliness is a cultural contagion.

Anecdotally, there have been years-long periods in my life when I've had friends and relationships, and years-long periods where I've lived like a hermit- and I've actually mostly found myself to be happier in the latter. When I've made an effort to be social, it's been motivated mostly by a feeling that living like a hermit is embarrassing, and out of a desire not to disappoint people wanting to form relationships. But there's a freedom that comes with being entirely alone for long periods of time, which is often enough to motivate me to avoid all of that. I don't think I've ever felt something that matches what people describe as loneliness, even after spending weeks with no social interaction whatsoever.

Since I was diagnosed with Asperger's at a young age, I've always attributed that lack to my being psychologically unusual. But from a quick look at the data (https://ourworldindata.org/social-connections-and-loneliness#loneliness-and-aloneness-are-not-the-same), it seems that the loneliest countries aren't necessarily the ones where the most people live alone. So I have to wonder: is it possible that loneliness has some large cultural component which my self-image as someone psychologically unusual has sort of inoculated me against? Could it be that it's not something I experience because I never really expected to experience it?

And if that's the case, could that suggest that the high level of loneliness in the U.S. might be helped by more cultural acceptance of less social lifestyles?

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This post really gives me ~2018 Scott vibes, great content.

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Men *don’t* get proprioceptive impulses from their penises. (Proprioception is only associated with skeletal muscles, isn’t it?)

Normally you can figure out what your penis is doing based on what you can feel (“the left side is touching skin, the right sight is touching cloth”) combined with what you know about what you’re wearing and assumptions about what direction gravity would be pulling it given your body position. But in situations where that doesn’t work (eg, skinny dipping), you’ll find that you can’t actually tell what direction your penis is pointing without looking at or touching it.

(I assume the same thing would apply to breasts?)

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Fascinating review... can’t wait to re-read tomorrow.

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Absolutely stellar post. Deserved a better title.

I'm also strongly reminded of something Aella said in her recent interview on Lex Fridman's podcast. She recounted how she was confused when she told people about her childhood and they said things like "Oh I'm so sorry, that must have been so traumatic". Because she had been going around with a framing and a worldview that such things were unpleasant but not unexpected - so they were not traumatic. But then she got out into a different culture and adopted a different worldview - and suddenly those childhood experiences *became* traumatic.

(I highly recommend the podcast to anyone who hasn't listened to it yet, here: https://lexfridman.com/aella/)

And all of this combines to paint the picture that the kind of culture and expectations we choose to adopt is very important!

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I find your stance in the following passage a bit perplexing:

"But he quickly moves on to a long section that tries to establish the reality of “voodoo death”, ie the thing where if you believe you are going to die hard enough, you actually die. I think most arguments for voodoo death are pretty bad, and I didn’t find Bures’ convincing....

"Is it weird to stay on the crazy train long enough to agree that cultural effects are strong enough to make you think witches are stealing your penis, and then get off it once people start talking about voodoo death? I think no - these are very different situations. Believing in koro can make you hallucinate that your penis is shrunken or gone, but no belief, however strong, can (directly) remove your penis itself. Culture → beliefs is fine; culture → reality is a step I’m not willing to take."

It doesn't require any ride on the crazy train to explain "voodoo death". I haven't read Bures's book (and hadn't even heard of it before reading your post). Hoeever, if "voodoo death" were observed, it would be much simpler to explain than a lot of what you've written about here. Each of us continuously engages in small acts of self-preservation, each of which decreases our likelihood of dying in some near interval. A person who believes strongly that they will die soon could conclude as a corollary that these acts are futile. So they may do these acts with less care and may omit some of them. At some point this repeated (and possibly even compounding) carelessness may indeed kill them.

That wasn't so difficult or mysterious, was it?

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This doesnt detract from the message, but i would point out that sparta had no written records and everything we know about them was written by people who at some point had the shit kicked out of them by Sparta

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A couple items:

1) My wife was a teenager growing up in Hong Kong in 1994, and she says she (and presumably her classmates) had known what anorexia was before this schoolgirl died. She posits that the ensuing rush of cases was a function of diagnosing an existing disease, not of a cultural idea getting implanted. Single data point and all that, make of it what you will.

2) After reading, I immediately ran to Uniprot to see if there really was a sodium channel named BLRG2? There's enough weird ion channels out there that I'm kind of saddened that this wasn't a real one.

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The first Columbine-style school shooting I am aware of was at the U. of Texas around 1966. The next was a young woman shooting up a school outside of San Diego around 1978. When asked why she did it, she said, "I don't like Mondays." Bob Geldof of the Boomtown Rats wrote a catchy tune about that shooting, which likely helped make school shootings more of a Thing in American culture.

In contrast, some things that used to be bigger Things in America seem to have receded somewhat, such as serial killings, political assassinations, bombings, kidnappings, and skyjackings.

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I read this book a while back and got curious about PMS. Here's a twitter poll that showed a decent correlation between believing in ghosts, and getting PMS: https://twitter.com/Aella_Girl/status/1589509446837075970 (tho I'm slightly more wary of twitter polls that I can't include 'see results' options in)

I then also added in a question about PMS to my big kink survey, asked to biological females only. I'm in transit (and my dataset got too huge so can't rerun it until I figure out how to run it from a hosting service) rn but can share any correlations with that soon.

(edit: Just tweeted another one: https://twitter.com/Aella_Girl/status/1628263635285086208)

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Re: anorexia, the most plausible-seeming explanation I've seen for the cross-cultural differences in presentation is that we've got the causality all wrong.

The theory is basically that the pathological drive to starve oneself is *caused by* rapid weight loss. All of the explicit conscious thoughts people use to justify self-starvation are either post-hoc rationalizations or amped-up versions of whatever caused the initial weight loss.

So in one society, dutiful daughters might refuse to eat out of grief over their father's death; in another, devout Christians might fast excessively out of religious devotion; in another, high achievers might starve themselves to demonstrate their self-control or achieve the perfect body. (Worth noting that these are all similar personality types.)

If this theory is correct, we'd expect to see something that looks like social contagion: whenever there's a trend of severe food restriction, especially among adolescent girls, we'd expect to see a few who don't seem to be able to stop. But in between the waves of contagion, we'd also see sporadic cases among people (mostly adolescent girls) who stop eating independently for idiosyncratic reasons.

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Penises don't disappear or retract into the body –– but men are subject to hormonal fluctuations, which can be induced by psychological states (I'm not talking about arousal but sort of its opposite) and produce visible bodily effects. These states are plausibly subject to placebo (or, in this case, nocebo) effects. It wouldn't be shocking if some traditional witchcraft worked on this mechanism.

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And there I thought my penis had shriveled just because I am old. I much prefer the new diagnosis. Burn, witch, burn!

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This paper found widespread PTSD symptoms among warriors in a pastoral African society, suggesting that it's not culture-bound. .

From the abstract:

"It is unclear whether combat-related PTSD is a universal evolutionary response to danger or a culture-specific syndrome of industrialized societies. We interviewed 218 Turkana pastoralist warriors in Kenya, who engage in lethal cattle raids, about their combat experiences and PTSD symptoms. Turkana in our sample had a high prevalence of PTSD symptoms, but Turkana with high symptom severity had lower prevalence of depression-like symptoms than American service members with high symptom severity. Symptoms that facilitate responding to danger were better predicted by combat exposure, whereas depressive symptoms were better predicted by exposure to combat-related moral violations. The findings suggest that some PTSD symptoms stem from an evolved response to danger, while depressive PTSD symptoms may be caused by culturally specific moral norm violations."


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autocthonous > autochthonous

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Do we know the Spartans actually acted like that?

There is a concept in classics of the "Spartan mirage", almost everything written about Sparta was written by Athenians vilifying or praising them, almost no sources about the Spartans were written by them so we get an extreme and exaggerated impression of them.


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When I was stressed at a certain point in my life, I read about people in the past who had “nervous breakdowns“ and were sent by their families to the South of France for six months to recover. I remember thinking that I wanted a nervous breakdown too, it seemed like a good way of escaping. But how would people know it was a nervous breakdown I was having and not just being a bad and lazy person? The question is what cultural position do you have to be in to justify your emotions?

I read somewhere that a lot of what used to be called hysteria (in the 19th century at least) may have been temporal epilepsy which apparently can involve a feeling of something rising up from the lower abdomen. Maybe this is just a retrospective interpretation.

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Great book review. I can't help but think of Korean Fan Death, which seems analogous to Voodoo Death.

I got the Dalmatian and the cow instantly, whatever that signifies. Unfortunately Scott's text had primed me for the gorilla before I had parsed the instruction not to go further, which might be related.

The transgender ideology bit is confusing, giving the previous context: I can't tell if Scott is proposing a real phenomenon of penis-stealing witches made flesh via academia, or examining the people who are afraid of them.

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I would like to raise awareness of St. Vitus' Dance https://en.wikipedia.org/wiki/Dancing_mania

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I want to interrupt here for an importnt cultural touchstone: The Carpenters

Maybe you are too young (<30) to have heard of The Carpenters, or just never really heard them, or long ago dismissed their music as simple-minded treacle-y pap, un-hip, simple, maybe vaguely icky-Christian or cultlish. Maybe the idea of a brother and sister singing love songs *to each other* weirded you out on some fundamental level. but if so, you need to stop in your cultural tracks and listen to them again. REALLY. NOW. BECAUSE:

Karen Carpenter's voice was absolutely glorious, she was one of the greatest female singers ever recorded. Plus, those recordings were at the Golden Age of Los Angeles studio musicians, and recording technology, even the few bad songs stilll have a magical golden shimmer about them, and ... My God that voice.

I can elaborate below, but you owe it to yourself to hear this.


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Feb 22·edited Feb 22

Well, I found a Middle English translation of the Fiore di Virtu.

(https://quod.lib.umich.edu/e/eebo/A16439.0001.001?view=toc) Seemingly no penis theft. But sounds like Die Blumen der Tugend is this plus its own additions, so maybe they added it in.

According to Google Translate, the German word for 'penis' is 'penis', so you can maybe word search it.

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You could have easily stepped into the cultural disease called "Climate Crisis." But that disease is far too early in it's course for most people to stand outside and measure it's breadth.

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Feb 22·edited Feb 22

Lin'guo > Lin'gao

(Also, "regular Chinese" is a bit of a strange phrase in the context you use it. It feels a bit like saying "Basque is not at all related to regular Spanish" - it isn't like there is some kind of "irregular Spanish" that it is related to.)

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I'm not sure I completely follow the section on PMS. Even if it were 100% cultural, your wife would still feel the very real symptoms. I don't understand how her mother's ability to diagnose PMS would change based on its position on the cultural-biological spectrum.

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I don’t think Bouffée délirante is a culture bound syndrome - it’s just the French equivalent of brief psychotic disorder (DSM), acute and transient psychotic disorder (ICD), or Brief Limited Intermittent Psychotic symptoms (CAARMS).


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After reading the text I realised I had completely misinterpreted that first picture. I didn't initially notice the penis in her hand or the basket of previously-stolen penises next to her. So I assumed that the penis theft had already happened, and now the guy is sitting there looking dejected, while his female partner is consoling him and assuring him that she still loves him -- in other words, a typical ad for erectile dysfunction treatment! So I guess that counts as another example of culture-mediated interpretation of an ambiguous image.

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Data point:

When I read about Scott's ants and his itches, I myself had an itch (because social contagion, or just suggestibility - is this the same thing?) but I didn't assume it was ants (because I have no prior on ants).

No immediate conclusion, but I wonder, having read this and had this thought, whether when I have another itch whether I will then assume ants.

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I get the impression that you're working with an understanding of culture-bound illness that is limited to "cultural belief -> psychosomatic condition". Is there anything ruling out the possibility of "cultural belief -> internal mental processes affecting real physical processes -> physical condition (possibly in addition to some strange psychological reaction which may not be itself directly caused by the cultural beliefs, ie someone from another culture would feel the same way if they were affected by the physical condition, but they aren't so they don't)"? I feel like that pathway could explain some scenarios.

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Leah Libresco Sargeant (above) mentions "...the physical and emotional cost(s) of [gender] dysphoria and associated treatment..." My question, and one that I see very much avoided, is:

-- What about the $$$$ cost?

-- Who is paying for all of these surely $X00,000+ treatments?

-- Where is this money coming from, and why are there suddenly more than 100 "gender" clinics in the US now, when there were zero ten years ago?

Given that insurance, both private and public, dictates and/or causes the vast majority of treatment decisions in the US, surely something suddenly changed ~7-10 years ago and now "gender transition" is booming. I don't think that change was a sudden grass-roots upswell of concern for and about actual LBGT+? issues and kids. I strongly suspect the difference is that suddenly, almost overnight, "gender transitioning" became very, very lucrative.

Do you or any commenter have knowledge of how this industy is financed? I am especially curious that "at-risk" and poor youth, by definition "charity" patients, are a major percentage of gender referrals, government programs or grants must be paying the doctors running these brand-new clinics.


The late David Foster Wallace, in a great deep-dive into political Talk Radio circa 2004, reminded us that it's always informative to follow the money:

"Whatever the social effects of talk radio or the partisan agendas of certain hosts, it is a fallacy that political talk radio is motivated by ideology. It is not. Political talk radio is a business, and it is motivated by revenue. The conservatism that dominates today's AM airwaves does so because it generates high Arbitron ratings, high ad rates, and maximum profits."

I think that the Occam's Razor perspective in the above paragraph should be uppermost in people's mind when thinking about the intersection of media, social-media, culture, and a US healthcare industry that now consumes 17% of our GDP.

Very much worth reading, BTW. Most of it still incredibly spot-on, even almost 20 years later:




Also, Wallace's troubling description of home morgatge financing companies' being like 50% of the ads on the radio in March 2004, seems a disturbing parallel to how 100+ Gender Transition practices have appeared since 2016:

"As of spring '04, though, the most frequent and concussive ads on KFI are for mortgage and home-refi companies—Green Light Financial, HMS Capital, Home Field Financial, Benchmark Lending. Over and over. Pacific Home Financial, U.S. Mortgage Capital, Crestline Funding, Advantix Lending. Reverse mortgages, negative amortization, adjustable rates, APR, FICO … where did all these firms come from? What were these guys doing five years ago? Why is KFI's audience seen as so especially ripe and ready for refi? Betterloans.com, lendingtree.com, Union Bank of California, on and on and on."

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Feb 22·edited Feb 22

"Okay, so which of our mental disorders are culture-bound?"

My first thought upon reading this was, "Am I *really* sure that during the endless hours I (and everyone else affected by this culture) spends staring at the glowing rectangles, that I'm not just hallucinating that there's meaningful content being communicated to me?" From the outside, it would probably look like it, an ever-expanding trend of people spending more and more time sitting and staring at the things.

(No, this idea does not actually hold up unless one posits some *serious* mental dysfunction about everything remotely related to our activity on the glowing rectangles, which now underlies basically every element of life.)

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Wow, what an amazing article! It explains so much in such a convincing way! It is a great framework to understand the expression of all these conditions.

And I am also amazed by the way you write your demonstration: your ideas are presented so efficiently that I thought "oh but this is a predictive processing like mechanism" just a few sentences before you explained that it is.

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In the case of running amok, it sounds like the culture has a special sort of acceptance/forgiveness for it. I bet that is an active ingredient in the presentation of the condition, as it creates an incentive to channel one's anger into this presentation specifically.

It makes me wonder how important these sorts of things are for the conditions. For instance, has penis-stealing witches just been random accusations, or have they been linked to long-standing conflicts between people?

Or beyond the case of conflicts, I know obesity has increased in a lot of places; how sure are we that anorexia isn't linked to this? (more obesity -> essence of beauty becomes being thin -> more anorexia)

In the case of gender dysphoria, there is a cultural distinction between those who think it is important for men to be masculine/women to be feminine, and those who don't (or who think gender-atypicality is admirable, and that you can choose your gender). Gender issues are disproportionately reported by the latter: https://surveyanon.wordpress.com/2022/10/12/towards-a-comprehensive-study-of-potential-psychological-causes-of-the-ordinary-range-of-variation-of-affective-gender-identity-in-males/

This is commonly discussed in the trans community (under the label of "repression", which was discussed even decades ago), and our culture has become much more gender progressive over time, which probably accounts for a big change in the presentation of gender dysphoria.

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Feb 22·edited Feb 22

I genuinely had an experience like this recently. I'd been putting off going to the dentist for far too long, because it's something I'm anxious about, and felt a cavity with my tongue. This caused me to both make an appointment, and start having a lot of unhealthy thoughts about what the dentist would discover. During this period I didn't look at the tooth visually, all I could do was feel it with my tongue.

I genuinely, unambiguously felt the tooth becoming so weak that it folded in on itself and collapsed. I could move the thinnest wall around it back and forth with my tongue. Clearly the enamel was so thin, it had become flimsy and malleable, there was nothing but enamel left. It was a disaster, how could I have been so neglectful?

Except, of course, it wasn't. And sometimes in that week waiting for the appointment, once I woke up, it didn't feel malleable. It felt like a tooth that happened to have a cavity right next to an old filling, which happens a lot. I went back and forth through these clear, physical perceptions going up and down over the course of several days. Of course once I went to the dentist it turned out to be a run-of-the-mill (though rather bad) cavity, and the physical perceptions completely stabilised. Until it was fixed, it felt like just a tooth with a hole in it, which is what it is.

I still remember the perception of it moving an collapsing so vividly I'm not quite sure how to process at. I also remember thinking AS IT HAPPENED that it wasn't actually happening, that it was a perception driven by anxiety, and yet that not quite getting through to most of my brain. When I read about the men whose penises are retracting, I can't help but think about that damn tooth, so decayed it was collapsing in my mouth, except it wasn't.

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>What if transphobia is our culture’s version of the penis-stealing witch panic? Wise but evil women (gender studies professors) are using incomprehensible black arts (post-modernism) to make people lose their penises.

I realise this passage is tongue-in-cheek, but I wouldn't describe this narrative as transphobic. One could frame it as such: "I treat trans people with respect and compassion, but gender dysphoria seems like a debilitating and distressing condition which no one would choose to have if they could help it. If it does spread (partly) via social contagion, it's irresponsible for gender studies professors to promote it or glamorise it."

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Pedantic comment from a Queenslander living in Tasmania now. There have been a few claims of Tasmanian tiger sightings in Cape York, the pointy northern bit of Queensland, as there have been in all sorts of other places in mainland Australia (home of the somewhat similar dingo), and one group of local scientists did go have a look. But the wilds of western and northeast Tasmania are where most of the claimed sightings are, and also where dingoes aren’t, and so that’s where the hopeful spotters mostly go.

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A different take on psychological trauma in the ancient world:


Basically, the people who had symptoms that resembled today's trauma reactions tended to be people who felt they had committed some kind of moral violation (such as fighting against other Romans) rather than the much larger group of people that participated in and/or were exposed to violence.

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I'm surprised by jikoshu-kyofu. Not that it exists and has a name, but that it's not more widespread. I know I am very worried about my body odor, and expected many people (maybe not most, but at least a sizable minority) to be paranoid about it as well.

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I'm surprised that nobody has mentioned an obvious contributor to that-witch-stole-my-penis: testicles do retract, and penises do shrink, as an unconscious response to fear! Not all the way into the body cavity, obviously, but they do retract and shrink to a very clear effect. (It's a reflex that is probably there to, well, safeguard our balls.) You can see how this works now: if you get really afraid of an imaginary penis-stealing witch in the neighborhood, your bits will noticeably retract, thereby confirming your fear of the penis-stealing witch. The very real sensations you perceive as a result of the cremaster actually doing its work will be amplified and interpreted by your witch-believer brain in the way you'd expect.

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I read a while ago that a certain mental illness (Cotard's syndrome, I believe?) used to be fairly common in France (as in, everybody who had worked in a mental hospital knew some cases), and then became much rarer, at least in its classic presentation, within a generation or two (beginning of the 20th century? I can't locate my (printed, French) source). A doctor reminisced and asked: but what happened to this sweet, philosophical sort of deluded person?

The "classic presentation": Doctor, I have lost my soul. I have no soul.

There were other beliefs associated to that: I am dead and somehow go on living; my insides are hollow... Apparently, the syndrome is more associated to these beliefs nowadays (though there are still religiously tinged cases - upon being taken to South Africa to recover, a Scotsman who was in a motorcycle accident came to believe that he was in hell, guided by his mother's spirit). The standard guess now is that there is an underlying neurological problem (the patient's brain loses the ability to react emotionally to the patient's own face, or else there is something messed up with proprioception) which gets interpreted by the mind in terms of beliefs that are culturally important; it is this interpretation that gets diagnosed.

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I think Aella's piece on Trauma might be of interest here, I also think that modern examples of the trauma caused by CSA, likely have a large cultural component as demonstrated by the seeming lack of trauma in many different cultures throughout history. Although it's important to note that historic adult-child relationships seem typically very different from their modern equivalent, probably due to such relationships being pushed out to the fringes of society, where such relationships used to be common among high status individuals in farming societies, they now attract "less desirable" pursuers.

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Echoing what many say here, really great post, Scott!

Some thoughts about getting off the crazy train:

"Is it weird to stay on the crazy train long enough to agree that cultural effects are strong enough to make you think witches are stealing your penis, and then get off it once people start talking about voodoo death? I think no - these are very different situations. Believing in koro can make you hallucinate that your penis is shrunken or gone, but no belief, however strong, can (directly) remove your penis itself. Culture → beliefs is fine; culture → reality is a step I’m not willing to take."

I think I don't understand the line you're drawing there.

First, if dying from a broken heart (or, if you want to sound fancier and slightly less precise, Takotsubo cardiomyopathy) is something that really happens, why not voodoo death? If I hear a shaman saying that I'll die, and I *really* believe in that shaman's powers, I'd probably get a pretty strong emotional response from that at the very least. That by itself could plausibly lead to serious downstream effects.

Second, and this is a broader point, do we need to draw any lines here at all? "Culture → beliefs" type of effect is already a "culture → reality" type of effect. (And what is meant by "reality" here?) Just to be clear, subjective idealism and social constructionism are cool and all, shout out to Berkeley, but I definitely don't want to say something like "your (cultural) beliefs determine your reality" or anything like that. At the same time, they are a part of it and because of that they do affect it. I wouldn't argue that there are no constraints on how much beliefs can affect reality, but how well do we know what those constraints are, especially when for humans biological and cultural is so intertwined?

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I haven't been reading this blog long enough to know better, but this feels like an all-time classic post.

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The thing is, I know people who transitioned long before it was popular. It's quite possible that culture makes a difference to frequency.

In some ways, culture shapes mental disorders. There are people with OCD who are tormented with the idea that they've run someone over with their car. This presumably was only possible after cars were invented, and possibly only happened after cars were common.

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I feel like my model of anorexia isn't "telling people about anorexia gives them anorexia", it's "exposing people to Western dieting culture gives them anorexia?"

like, moral/purity prohibitions about what food is good and bad to eat are a cultural universal and i think people are wired to be good at internalising them -- I pretty successfully did this to become vegetarian

and if your prohibition is "don't eat anything with calories" this is going to run into problems

I guess if this has any historical precedent it's fasting/ascetic traditions in various religions (eg in India)

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I consider PMS/PMDD to be basically a weaker form of postpartum depression (which everyone agrees is real and caused by the effects of hormones).

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I'm Malaysian so I was so confused when I got to the koro part. This is the first time I have heard of it. The nearest term to koro in Malay is kura which is half of kura-kura meaning turtle.

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Obvious examples of culture-bound psychosomatic conditions: sugar rush/children becoming hyperactive after being given sugar and some (but I think not all?) of the "coffee as stimulant" stuff.

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Feb 22·edited Feb 22

I guess at one point, do we collapse back into social constructionism or even some Foucault with this sort of thing?

One can really feel or empathize with the earlier wave of ‘culture-strong’ thinkers as they were struck by such stark comparatively different or culture-specific instances across societies.

In some ways, your post seems to implicitly paints a similar “picture of smart people genuinely trying their best in epistemically treacherous situations” of those culture-specific theories.

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I just realized that, while there is a small proportion of people who detransition who could say "A witch stole my penis", what we're mostly seeing is people saying "Witches stole *their* penises".

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If anyone wants to try to translate the “Flowers Of Virtue” poem, here it is:


Also featuring a hilarious penis with legs missing from the image in the post.

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About the ol-german poem "by" Hans Vitler 'flowers of virtue" - that was a translation of an Italian original form 1320* Hans Vitler's famous translation was rather "free", but I guess he would not have added a penis-theft. - Now I found one commented reprint of "Blumen der Tugend" , well actually "Pluemen der Tugent" - it is oooold: https://archive.org/details/diepluemendertu00maxigoog/page/n381/mode/1up no such story there, it seems Vitler considered believe in witchcraft even: sinful superstition. Witch-hunt was NOT a middle-age thing, but came big in (early) modern times. Prof. Marvin Harris has some theories as for "why then": Cows, Pigs, Wars, and Witches: The Riddles of Culture (tl;dr: both big churches THEN felt the need to proof they were "indispensable" - before: the one church just obviously was. Witch-hunts: ON.)

* seems one can find here - it translated automatically(?) on my chrome at least (into a strange kind of modern German) : https://it.wikisource.org/wiki/Fiore_di_virt%C3%B9/I

tl;dr: speed reading it; i saw no witch or penis-theft, though the beginning of the text starts rather misogynistic

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The division of culture bound delusion seems too vague an interpretation of how beliefs function to be anything but useful. What about the origins of potential beliefs in ancestors trauma or the potential to novel creations like Schreber which go on to become in some species useful behaviours?


The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind



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I am seriously disturbed that many people who are not under the influence cannot instantly make out a Dalmatian and cow.

How do all of you drive at night?

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I really wanted you to end your list of made up diseases around the world with "in America, sometimes people think they have a disease called "Restless Leg Syndrome", and are kept up all not thinking that their legs need to move.

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Just a kindof crazy idea, but I'm curious if there is a correlation between being able to 'see' Cube 1 as either Cube 2 or Cube 3 and being able to see the reasoning behind opinions you disagree with (i.e. to the point where you can empathize with them and/or make a coherenet logical arguement for that position)

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I think you can almost factor out culture from this explanation.

If you take the view that raw sense data/brain activity is a mess of "blooming and buzzing confusion" which we then build something resembling a consciousness/ego/self out of, then psychological conditions come from one of two places. One is weird raw materials (the brain receives sense data that's wrong, or a part of the brain that's responsible for conveying/processing raw sense data screws up the signal). The other is a badly constructed consciousness (sense data/pre-conscious brain activity gets classified in weird ways, or biological urges get routed into weird motivations/weird motivations are created ex nihilo).

A huge part of constructing a consciousness must be linguistic (I'm not sure it's coherent to talk about having a non-linguistic sense of self) and transmitted from others, although there are presumably parts that are more-or-less hard wired biologically for evolutionary reasons; I doubt you could raise someone to have a consciousness radically different from the norm (no ego, no persistent objects etc). Given it's parents/peers, this will vary markedly by culture; the upper layers of it will be explicit knowledge that changes over the course of a lifetime, which is where some of the more obvious culture-bound stuff is sitting. The lower levels of the consciousness being mal-formed are probably things like personality disorders. Some psychotic illnesses are presumably broken sense-data processing at a pre-conscious level.

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>an area in Virginia where the government enforces a ban on electromagnetic transmissions for secret military reasons

an area in *WEST VIRGINIA* and Virginia. A keen eye will note that the Wikipedia page doesn't list any points of relevant interest in the Virginia half of the area.

As fun as it is to say 'secret military reasons,' the government is open about some of the reasons: Sugar Grove Station in WEST VIRGINIA (https://en.wikipedia.org/wiki/Sugar_Grove_Station) is an NSA listening station, and Green Bank Observatory in WEST VIRGINIA (https://en.wikipedia.org/wiki/Green_Bank_Observatory), which has the world's largest steerable radio telescope and they offer quite informative tours. All electronics have to be turned off, of course, though the gift shop will provide disposable cameras.

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One thing about “running amok” (both the original Malay version and the American active shooter version) seems to me to be distinct relative to koro and anorexia: while it’s clearly culturally influenced, it’s not (locally) contagious.

The man who runs amok doesn’t generally spark a bunch of copycats in his immediate community, while koro seems to spread in panicked waves that rapidly “infect” lots of socially connected individuals. (There are things that are more like “spontaneous mob violence” or “small military group goes berserker in the face of impossible odds” - but that’s not what we’re talking about here)

I do think this still fits into Scott’s overall model. Maybe there is a “going amok” condition that is pretty rare but is mostly biological. However the exact form it takes is culturally defined in a “choose the form of the destructor” sort of way (catch a demon and go on machete rampage followed by amnesia among the Malays, jihad inspired suicide bombing among the Arabs, Columbine copycats among the Americans, etc.). It’s not really a social contagion, more like a meme that only certain people are vulnerable to.

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For the last two years, I've experienced an undiagnosed medical illness with symptoms a bit similar to CFS/long covid symptoms.

Two primary symptoms:

1. when doing cardio exercise (ie running), after a certain level of exertion (significantly lower than where it should be) , my heart rate will spike and my body will start feeling enough stress to force me to stop.

2. I feel fatigued/bad more frequently than I used to

I actually had a ~6 month period where I fully recovered but then the symptoms came back.

Since these symptoms started appearing, I've become hyper conscious of how I'm feeling and various health metrics (ie heart rate when running, overnight resting heart rate).

I've been told that by being hyper sensitive to how one is feeling/recording data can make these symptoms worse as the mind will pattern match.

Given the concerns outlined in this post, does anyone have any suggestions on how they can experiment with trying to psychologically overcome this?

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To add to the calibration-dependent-phantom-sensations bucket:

phantom notifications.

I don't think it's uncommon to hallucinate a phone vibrating in one's pocket, even when it isn't present.

Curiously though, I don't recall if this is dependent on my wearing pants - but I doubt this is a phenomenon that existed 20 years ago (outside of maybe the pager/beeper crowd).

I also recall hallucinating voices in a specific shower at one point, primarily limited to short instances of vocative address.

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"Before anyone gets too excited about this, I want to stress a version of the point Bures got right earlier: there is no neutral culture. Having lots of transgender people is downstream of cultural choices. But having lots of cisgender people is also downstream of cultural choices. There isn’t infinite flexibility - evolution ensures a bias towards heterosexuality, for obvious reasons. But there’s a lot of flexibility - Spartan men married and had sex with women, but they thought this was a dumb annoying thing they had to do to have children, and sex with young boys was the obvious enjoyable satisfying option. Even within evolution’s constraints, culture can do some pretty weird stuff. I think you could probably have a culture where 99% of people were transgender, where it was generally accepted that everyone transitioned on their 18th birthday, and where only a few people (disproportionately schizophrenic) would object or see anything wrong with this."

I have always thought that sexual orientation must be at least in part cultural/environmental, unless someone could point me to a special genotype that ancient Spartans and modern Pashtuns had.

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I wonder if there's a better explanation of gender dysphoria's cultural-bound-ness: that discomfort with appearing as the gender you don't identify as is cultural. Most men in the United States, if forced by hand-of-god to spend a day appearing exactly as a woman, and not being able to explain what was happening, so that everyone would assume they were a woman, would feel terribly uncomfortable for the entire day. Though I don't have much knowledge about how people would feel about this in other cultures, I expect (I'm not sure why I expect this) that, in a lot of other cultures, people would feel much better about that: people wouldn't be nearly as terribly uncomfortable in this hypothetical.

So, when people in another culture don't feel like the gender that they would be assigned based on their physical sex characteristics, it doesn't really bother them as much. In American culture, the idea that you might want to dress or act differently from the gender that matches your physical sex characteristics is seen as very shameful: so, people feel terribly uncomfortable. In a culture that doesn't have such a strong idea about how one _should_ act or dress might not feel nearly as uncomfortable, simply because the idea they have (that they might want to dress or act differently from the gender that matches your physical sex characteristics) isn't seen as nearly as shameful.

In other words, the cultural idea of shame surrounding crossdressing and transvestism and whatever else people were thinking of it as previously might be what causes gender dysphoria.

With that said, I've not 100% thought this through. I might not agree with this if I thought about it in more detail.

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Rather than questioning whether gender dysphoria is a culture bound affliction, isn't it simpler to recognize that there is no objective reason to suppose that 'gender' is anything distinct from biological sex?

I mean 'I have a real self that is not my biological self.' is an inherently religious or at the very least metaphysical belief that our society has decided to treat as a reality.

It's funny that I didn't realize until Scott was explicit that this was about gender, which is funny since 'penis stealing witches' would actually be a pretty awesome invective to use on the 'groomers'. I thought that this was going to be about the pandemic related collective delusions because I had just seen that the NYT had a column this morning about masking being useless, something we all knew in 2019 but forgot recently.

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"The French suffer from bouffée délirante, where a perfectly healthy person suddenly becomes completely psychotic, with well-formed hallucinations and delusions - then recovers just as suddenly, sometimes over hours or days. This is not how psychosis works anywhere except France and a few former French colonies."

Not completely French-bound: King George III of England, who had sudden hallucinatory episodes (famously talking to trees etc.), then would wake up one day completely fine. Admittedly his episodes lasted longer than "days".

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Great column as usual. But I was hoping you might mention Havana Syndrome, which is quite fascinating -- dozens of cases of government and military personnel convinced that vague symptoms are the result of a Russian sonic-beam weapon of some sort, which no one has proven even exists. Social contagion but with some unusual aspects

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Tinnitus is another example of an ailment that in many cases only becomes one if you ... pay attention to it.

Of course, like all this stuff, it's a spectrum.

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Is this not metaphor, like stolen manhood?

Who doesn't know a man who once said 'that witch has taken what shred of manhood I had left?'

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"Before anyone gets too excited about this, I want to stress a version of the point Bures got right earlier: there is no neutral culture. Having lots of transgender people is downstream of cultural choices... I think you could probably have a culture where 99% of people were transgender, where it was generally accepted that everyone transitioned on their 18th birthday, and where only a few people (disproportionately schizophrenic) would object or see anything wrong with this."

I don't think this is technically wrong, but it feels... stretched? Like here's a bunch of stuff that had to happen for the disproportionately trans stuff to happen here:

1. A certain (large) amount of sexual-liberation stuff had to happen around the more "normal feeling", easier to justify LGBT issues to garner momentum around "Good people of X political alignment support stuff that 'feels gay' as part of their package deal of political and cultural beliefs"

2. Trans lobby had to convert the people who were reflexively in-tune with 1., starting small with stuff like "use my pronouns - it's a polite fiction but it will make me more comfortable, and don't you want to be polite?". In my (possibly wrong) telling this is where they got you - i.e. Emperor Norton "why not, it's kind" tactics.

3. They had to move from "polite fiction" to "you have to actually believe we are in some substantial way a different sex, and treat it that way" stances, where "women were women" and were to be treated so in every possible way they desired. If you didn't meet this expansion, you'd run afoul of 1-2.

4. They had to move from "Don't you want to be polite and nice?" stances to more forceful tactics - utilizing preexisting legal structures and leveraging their more enthusiastic supporters to get you fired from jobs, blacklisted from academia, etc. If you didn't adopt 1-3, to the point now where you basically have to be anonymous to push back on them or make a career of pushing back on them to be "safe" in doing so.

This is trans lobby, granted, and not necessarily every trans person. But the practical upshot is something like us having a mostly enforceable framework in which:

1. Some small percentage of people think trans women are women, full stop

2. Some larger percentage don't think trans women are women, full stop, but do fancy linguistic stuff to indicate that they are in line with party demands and feel good about doing so, and wish they could think it for reals.

3. Some (probably) even larger percentage doesn't think trans women are women and doesn't feel good about saying they are, but know they have to do something between "Give them everything they want, say whatever they want, or else do a damn good job hiding".

All this to say that there might not be a cultural neutral we can pin down, but an awful lot of shit had to happen here to get to where we are. And we can imagine a culture where 99% of everyone is trans and that's just normal, but the stuff that would have to happen to "bend the average" that far would be astronomical. It's a nitpick, but it's really, really hard to look at a system that can only exist when you've leveraged a ton of stuff into completely shutting down any questioning at all at risk of firing/unhirability as "just as normal" as the usual default of "there's a few trans people, and everyone thinks they are at least kind of weird".

I think this matters here because *every single thing about "manufacturing" more trans people is negative.* This sounds harsh, but consider this pretty accurate rewording of general trans lobby positioning as it exists today:

>>> Transness is a thing, we don't call it an illness, but usually the thing about transness is that you have to go on these really clearly unhealthy hormonal treatments from an early age and get massive surgeries to the reproductive system that are pretty dehabilitating to normal sexual function. And the reason you have to do this is that if you don't you will almost for sure kill yourself.

Yes, they deny any possible downside to massive hormone treatments and stopping puberty and roughly redefining sexual organs as approximations of other sexual organs or removing body parts completely.

So there's this thing where, like, say there's some baseline amount of trans people, and you can't do anything about that no matter what you do, and you want to maximize utility in that situation. That's one thing - you do a certain set of stuff under that. Like maybe you all decide to try your best to believe the polite fiction and make it as real as possible, and you all commit to publically only saying things that assume the polite discourse is true.

But that's not the situation we are dealing with, where it's becoming increasingly clear we are making a social contagion of sorts. In that case, you have to grapple with the negative utility of the social contagion, and the balance of forcing everyone at gunpoint to toe a party line changes an awful lot.

In this case it looks like we would have gotten an awful lot of utility out of something like "not joining or working to stop the active, years-long campaign to get people to pretend along with something, or else to threaten them with as much force as we can muster that we will commit serious harm on them if they don't at least shut up and fall in line". Like a lot of people who might have just been furries instead and wouldn't have actively destroyed the function of their bodies, etc.

So that's sort of my pushback, is that there's no "cultural neutral" in the sense that you can't point at the one pure society all other societies are variations of, but it's a much bigger stretch to look at a pretty extreme outlier culture that's producing pretty extreme outlier results only after an extended campaign to use pretty extreme force to muffle what appears to be the usual general reaction to a thing and institute a sort of fiction most people are only at best playing along with even now, and say "But understand there's no cultural neutral - this is about as normal as anything else". Especially when the upshot of that pretty significant downsides.

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It seems to me like gender dysphoria is more similar to something like left-handedness (the body producing the "wrong" hormones in utero, leading to stuff being built in the "wrong" way) than to something like penis-stealing witches.

Gender is clearly a structural neurological phenomenon. Furthermore, I know plenty of trans people who have a certain set of childhood symptoms of gender dysphoria before they were aware of the existence of trans people. Personally, while I was aware of trans people's existence, I hadn't honestly considered if I was trans, but I still had a lot of fairly common symptoms of gender dysphoria. I find it difficult to believe that I almost exclusively enjoyed socializing with women (and a few effeminate men) and constantly felt bad about the masculine traits of my body because of social contagion. I think a far more likely explanation is that I was simply exposed to more estrogen in the womb and my brain took that as a sign to develop in a feminine-structured way.

Now, certainly my choice to *describe* my female-structured central nervous system as me "being a woman" is socially based, but only insofar as my culture believes that the brain is more important to someone's identity than the rest of their body.

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I'm very weirded out by this discussion-- it's a very outside view of transness. It's plausible that my social circle might include more trans people than most (there is (was?) a medical center doing transitions in Baltimore) and I'm in fandom, but am I the only person here who knows any trans people? I can see why a trans person might not want to join this discussion.

From another angle, I've got one friend who thinks that m to f tends to work out better than f to m, and I'll note that most of the trans people I know are trans women. Any thoughts about whether both directions work out about equally well?

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This will sound weird, but the penis retraction thing happened to me at about 11 years old.

One night, a bit of foam comes out, and it shrinks to near nothing.

Was very concerned but kept it to myself, and it resolved after a few days.

No clue how this works.

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Minor aside: the National Radio Quiet Zone isn't just for military use. It's also one of the few places in the county you can operate a radio telescope without getting a bunch of background interference. It's a hotspot for pulsar research, and probably other astrophysics stuff.

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I wonder if penis-stealing is more prevalent in tropical countries where men have never jumped in a cold lake in winter and had their penis actually retract into their body.

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Would people care to take a crack at the sense of rightness or wrongness that people can feel about their bodies or perhaps their lives?

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Minor nitpick: you said in the illustration accompanying “Flowers Of Virtue” that the box of penises is to her right- it would be her *left*, our right.

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Did Oliver Stones "Natural born killers" sensitized folks to do school shootings? Maybe, see very fine book review by whimsi.


(Whimsi nearly won an ACX book review contest with a George Orwell review - and

Oh, and I grossly over-simplify a very fine and long post. Still "3. Exposure to an ideology that serves to ‘explain’ the state of humiliation, ... This can be ready-made or handed down from a formal organization for propaganda, or patchworked from multiple sources by an amateur idealogue with little connection or even a clear understanding of the actual sources of the ideology.

4. Role models that exemplify said ideology are sought and emulated to a greater and greater degree. This will affect the manner of dress, speech, etc.

5. The role models are emulated, and the ideology actuated in steadily more serious infractions against the hated world order. A social unit of some form and scale reinforces the acceptability of said infractions and insulates participants from the social consequences (I feel I have to inject here that DK and EH planned ‘missions’ in the months leading up to the shooting, wherein they vandalized houses, set off small bombs, and even shot young trick-or-treaters with BB guns)."

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>Wise but evil women (gender studies professors) are using incomprehensible black arts (post-modernism) to make people lose their penises.

>Western civilization turns other culture’s myths into reality... Now we’ve finally gotten around to penis-stealing witches.

This whole post was an excuse to make that joke at the end, wasn't it?

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Is there any good breakdown of where the rise in LGB identity is coming from (that is, mostly a rise in L/G identity, or mostly a rise in B identity)? A Gallup survey says that most (57%) of LGBT people are bisexual, but I don't know if that's a historical shift.

My hypothesis is that a lot of the change is coming from Kinsey scale 2s (say, a dude who exclusively dates women but would totally make out with Channing Tatum if given the opportunity). A generation ago, this guy would say he's straight on a survey (since being bi would lead to ridicule/oppression/lowered social status), but now is saying he's bi (because being LGBT is brave, increased status in left-wing social groups, he can still take women to the towny bar where he might get called a fag if takes a man).

Similarly with the rise in trans identity: is the increase mostly in people who want hormones/surgery, or in AFAB non-binary folk who certainly feel closer to the "woman" identity than the "man" identity but who don't appreciate being saddled with the expectations of womanhood?

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I'm one of the few that correctly saw the sensitization tests without checking the answer.

Also I'm pretty sure the redline on the dog has its hind legs wrong: https://imgur.com/a/PRwO8no

Fascinating read.

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> The Columbine shooters seem to have been autocthonous American cases... before their fame inscribed amok onto the US collective consciousness

Don't be too sure of this. They weren't the first such shooters, and their actions came after American culture had started to unravel. Compare suicide in Greenland - yes, there may well have been a memetic effect there, but the epidemic occurred after their values had been undermined by exposure to modernity.

It makes more sense to say that some cultures are robust, and others are vulnerable to these kinds of behavioral contagions. If so, we should predict that problems like school shootings will be exacerbated in America as the culture becomes more sick, and alleviated when it is more healthy. I have a test for this...


...YES! School shootings declined noticeably in the aftermath of September 11th, when a shocking narrative of evil enemies Threatening Our Freedoms (TM) galvanized the American people into a patriotic fervor, staving off the creeping cultural anomie and rootlessness for a year.

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Lacan’s notion of the symbolic order might actually help provide some kind of answer for why there are culturally coded mental health disorders. Lacan is sort of justly neglected by the anglophone world because he purposefully wrote in an obscure way. But his idea of the symbolic order makes sense. Granted it's more philosophical than most therapists would probably be comfortable with, but it can be expressed in a way that should make sense to people.

Namely it is that people are sometimes unconsciously determined by language, particularly the language of their culture.

You can find examples in the literature of people who are stuck on some issue (this is what Freud's hysteria described), who only get over it by putting it into words, the words of their own particular culture. See this example of a contemporary case:


On Lacan's picture, texture of the symbolic in each place is different, has different weights and emphases, with different consequent eruptions of madness, different forms the ultimately insufficiency of the symbolic take different forms.

So, even if we are only *somewhat* conditioned by the symbolic order, by language (that is, this worldview doesn't have to throw the free will baby out with the bathwater), then we should expect different psychological disorders to obtain in different cultures, because the symbolic order in different cultures itself differs—in fact, it differs down to the level of individuals as well.

The symbolic is neither wholly individual or idiosyncratic or truly transcultural and objective. The moon is coded feminine in most cultures, but not all of them. Our own symbolic chain also has its "man in the moon," where a Chinese person might first think "rabbit in the moon." And some individual might associate the moon with his or her father or mother depending on idiosyncratic personal experience. Etc.

I think the whole penis stealing syndrome thing is also very, very psychoanalytic. One of the core concepts in both Freud and Lacan is castration, and while admittedly both sort of play games with the word such that it's difficult to hammer out a concrete, simple, sciencified concept which would be palatable to the anglo mind (although anglophones like Bruce Fink and Stephanie Swales, Darian Leader etc. do *try* to make it make more sense)—the fact remains that in clinical practice (particularly among schizophrenics), a delusion clustered around or somehow making reference to castration (really, strictly speaking, emasculation) is relatively commonplace.

All of which is to say that such theories could be on to something or could help us think about these things and thus help people.

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How should trans people who share your belief that gender dysphoria is largely cultural behave? If you have a painful mental health condition, the only treatment for which is expensive, invasive, and leads to sterility and social ostracization; don't you have a moral responsibility not to spread it? Do you have a moral obligation not to share your experiences on the chance that people would begin to experience ambiguous dissatisfaction as gender dysphoria and become trapped that way?

I just feel like you dropped an enormous "black pill" on trans people and the suggestion that "actually societies can tolerate lots of different default sexualities, like, Greek pederasty" (great example) is cold comfort. If it's possible for a lot of people to avoid the painful experience of gender dysphoria and transition, shouldn't we strive towards that? If you were a trans person who shared your own beliefs about the nature of gender dysphoria, how would you behave?

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I remember when I was in middle school there was a big awareness campaign around cutting. Assemblies, guest speakers, special sessions of health class, material sent home to parents, etc. Immediately, the number of (predominantly) young women cutting went way up - or at least the number cutting in highly visible locations did. The next year things were mostly back to "normal". Of course there's no way to know for sure, it's entirely possible that those people prominently displaying scars would have been self harming in some other way without the campaign, but it was striking to 7th grade me.

Don't misunderstand me, I don't mean to imply that cutting didn't exist before or stopped existing afterward. And I'll grant that middle schoolers may not be the most representative population. But from an early age I observed that

a. While mental illness has always existed, the specific ways in which it manifests can be extremely malleable, and

b. When you make it clear to people - especially awkward, insecure young people - that compulsive behavior X will result in receiving large amounts of sympathy and positive attention, expect rates of compulsive behavior X to go up. To be clear that doesn't necessarily mean people are *faking* behavior X (although in hindsight I suspect some of those scars were drawn on), but when social incentives are powerful and sudden people will alter their behavior in surprisingly radical ways.

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Great. I broke down and gave you a heart.* Reading this I kept thinking that whatever it is, it seems like its adjacent to the placebo effect. (Which I don't understand either.)

*When you wrote that you liked getting hearts. I said to myself, "OK I'm not sure that is a good incentive, no more hearts."

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I think you've got the etiology of the rise in trans identities more or less backwards, but your note that there is no neutral culture rescues you from actually saying anything false. I think we're not so much seeing a result of a stronger cultural sense of being the wrong gender (that probably peaked in the 80s), as we are a weakening of our culture's ability to assign gender at all.

Sex is biologically real. Intersex people are a small, but not statistically negligible, fraction of the population, and the rest of us do fall into two categories with regard to our outward sexual characteristics. But what traits do those sexual characteristics assign?

In 21st-century America, women are less enthusiastic about sex, often unsatisfied by it; therefore, it's only natural that men initiate most sexual encounters. In ancient Athens, women, the irrational sex, were slaves to their desires, and part of the humor of the Lysistrata was the idea that the women took their protest so seriously that they could restrain their sexual appetites.

In 21st-century America, mentioning that a man writes whiny poetry is a great way to call his masculinity into question. In 12th-century England, Richard the Lionheart was the epitome of manliness, and was especially praised for being a warrior poet. Only one of his poems survives (Ja Nus Hons Pris) and it's pretty whiny.

Anthropologists who study gender find gender categories like that in every culture, with anywhere from two to five genders. America right now has two, but its ability to assign those two is breaking down.

Weak prediction (call it 40%, with a very low chance that our current systems hold and a decent chance of something I don't foresee happening instead): in 2073, American culture will have three gender categories that are pretty well respected, with most trans people born after 2048 being in the middle gender (currently called "non-binary", which isn't just one thing now but is seen as one thing then) rather than being AFAB trans men or AMAB trans women. 20%: any attempt to explain what it is to be male in 2073 seems kinda nonsensical; 90%: any such attempt remains very controversial.

(Disclosure of biases: I'm a cis man that's also comfortable with neutral pronouns.)

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Regarding PTSD, could its virtual absence in the past be due to the reporting problem ? Until relatively recently, the world was pretty much in a constant state of war; and for most people, survival was a chancy proposition even in peacetime. In such an environment, some level of (what we now call) PTSD would be expected, and not reported as anything unusual. Today, most of us lead the kinds of lives that would be considered incredibly sheltered and pampered by medieval standards; thus, PTSD is rare and stands out enough to be remarked on.

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Feb 23·edited Feb 23

I realize even as I type it that this comment is likely to be part of an inevitable system of you getting it coming and going, and I also realize that as a Bay Aryan you have to do it to some extent to not get broken on the wheel, but still: I feel like you're really burying the lede here WRT transgenderism, Scott. First all that hedging, and *then* you admit you think transgenderism is about as cultural as anorexia, which you just made a huge deal about how it's super cultural?

I would just own it, man.

PS: I saw the gorilla, and it stole my penis.

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I find it telling that your guesses about which DSM conditions are biological vs cultural line up neatly with.the order in which they are socially perceived in our culture as making one a villain vs a victim, with schizophrenia being the most villainous/biological and PTSD being the most victimous/cultural. It suggests that in fact they're all cultural, but that your desire to believe in the rationality and thus morality of your own actions (such as getting people locked up against their will for being labeled as part of a socially designated scapegoat group) makes you want to believe some DSM diagnoses are more biological (read: real).

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I find it telling that your guesses about which DSM conditions are biological vs cultural line up neatly with.the order in which they are socially perceived in our culture as making one a villain vs a victim, with schizophrenia being the most villainous/biological and PTSD being the most victimous/cultural. It suggests that in fact they're all cultural, but that your desire to believe in the rationality and thus morality of your own actions (such as getting people locked up against their will for being labeled as part of a socially designated scapegoat group) makes you want to believe some DSM diagnoses are more biological (read: real).

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> Some see it as a giant Jewish conspiracy, others as being guided by the hand of God

The most parsimonious explanation is that the hand of God is guiding the giant Jewish conspiracy.

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I'd wager that this is the best ACT post so far!

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As nobody else has mentioned it yet (I think), I think it would be worth mentioning that 1997 Pokemon episode which caused seizures [0]. A guardian article from last year [1] says

"What Radford and Bartholomew discovered was that the vast majority of affected children had become ill after hearing about the programme’s effects."

From the article, it sounds like there was an actual effect from the episode, but most of the cases appeared after the patients heard about the other cases.

[0] https://en.wikipedia.org/wiki/Denn%C5%8D_Senshi_Porygon

[1] https://www.theguardian.com/tv-and-radio/2022/dec/16/pokemon-explosion-tv-japan-children-hospital

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I wonder how much this applies to long covid... It was certainly an enormously publicised illness.

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>PTSD: 20% biological, 80% cultural

I somewhat cast doubt on this from personal experience. I have never been diagnosed with PTSD, but I have been diagnosed with schizophrenia. After my schizophrenic/psychotic episodes I have been tormented with flashbacks, nightmares and such about it even years after the event itself, and after my almost miraculous complete recovery. I am certain I met the criteria for clinical PTSD as the flashbacks made me visibly flinch in public when as little as a lamppost reminded me of my episodes wandering the streets at night with a frayed mind.

The fear reflex felt way too fast and natural to be learned behaviour, although I can't exclude the possiblity in total, basically something set my mind to wander, a memeory of the traumatic event intruded, and then I was hit by a heavy wave of fear and stress.

I cured it by accident, as I came upon a podcast by Dr. Jordan Peterson and Dr. John Delony where they talked shop about how they treat PTSD patients, and I went and applied some of these routines to myself (basically convince the conscious with a sound narrative of why the unconscious does not have to remind you of your past anymore, as failsafes against fallbacks are in place), and voila, the flashbacks and nightmares reduced 95%, effectively stopped.

I think the romans may have had PTSD, but maybe they didn't have it related to war. If PTSD is indeed a fear mechanism trying to guide your mind away from recreating a pattern that could be devastating for it (i.e. bring a soldier back to Vietnam, bring me back into psychosis) as Peterson/Delony implied, and if the Romans had a culture that glorified war and saw it as a honorous place to be, then it makes sense that PTSD was not connected to war. Why should your mind warn you from going back into war, if the siege of carthago is a great place to be?

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In a lecture in Munich in 1913, Carl Gustav Jung said he was led to distinguish between two types, extraverted and introverted, by observing characteristic differences between two groups of his patients, those suffering from hysteria and those suffering from dementia praecox. The latter means schizophrenia (I think), which you judge to be the most biological, non-cultural of your examples.

So perhaps, in a sense, the original meaning of „extraverted“ is „potentially susceptible to the kind of cultural contagion discussed in this post“. Only potentially, of course; he says that hysteria and dementia praecox are extreme cases, where something has gone wrong. And a decade later, in „Psychological Types“ (the book), he does not follow up on this much and instead refers much more to similar (he argues) distinctions in the literature, e.g. Nietzsche‘s „Dionysian“ and „Apollonian“, etc.

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1. Bouffé delirante: I remember researching this for a journal club, and the feeling was that it was the French version of another forgotten diagnosis, psychogenic psychosis.

2. We have seen conditions, then classified as 'monosymptomatic hypochondiacal delusions' that resemble the cultural psychoses, except with the contagious aspect. I recall one poor chap who was convinced he had a strange tasting fluid (not saliva or reflux) appearing in his mouth. After seeing lots of docs he was referred to our psychiatric day hospital but nothing made any difference, so my boss (a psychiatrist who made his name quite cynically by picking an understudied area - gambling) did what psychiatrists always do: he blamed the patient for not getting better, at which point the patient took offense and self-discharged.

3. I got to sit in on a couple of gynae clinics with Katerina Dalton at the Obstetric Hospital across Huntley Street behind the old UCH building when I was a student. What a sensible, down-to-earth woman she was. At the time she was into treating PMS (or PMT as we called it then) with progesterone suppositories.

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Prediction: This is the post that will be cited up and down as evidence that "SCOTT ALEXANDER IS AN EVIL PSYCHO TRANSPHOBE PLOTTING TRANS GENOCIDE"

which may or may not lead to a follow up article in the NYT saying things like "Accusations of Transphobia have been made towards..."

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Someone has to ask this question about Scott's dismissal of Voodoo Death:

Does this mean that if you die in Canada, you don't die in real life?

Until next time...

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This all seems reminiscent of the Sapir Whorf Hypothesis or those stories/magic systems where giving something a name gives it power (perhaps telling stories of a demon really does, in a sense, give it power).

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"What if transphobia is our culture’s version of the penis-stealing witch panic?"

Unlike koro, in the trans panic penises are actually vanishing, everyone can observe this to be the case. How can the man who wrote "Is Everything A Religion?" elide the significance of whether the alleged physical symptoms are real? This is a bullshit comparison and you should know better!

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This post keeps touching on "psychosomatic problems are real", but I think it's important to expand on that because there's an important sense in which they're not.

A few years ago I fell and seriously injured my arm. I didn't break it, but for a couple days I couldn't move it at all without debilitating pain. Six months later I still had a reduced range of motion in my arm, if I tried to hold my arms out in a T-pose the right arm was noticeably less extended than the left. I'm pretty sure this was psychosomatic, some lingering "for god's sake don't move your arm"" impulse written into my muscle memory. Because if I grabbed my right arm with my left I could move it around just fine: no pain, and if I let go the muscles could hold the position I left it in, I just couldn't consciously flex the muscles into that position.

Now my reduced range of motion was real, I had some difficulty opening cupboards and so on. But if you just say "Ninety-Three's arm problem is real" then one might conclude my arm remained physically injured and that would be important because I eventually saw a physiotherapist who prescribed exercises based on assumption about what was wrong with me. A cocaine addict with delusional parasitosis has a condition that is more real than his socially-contagioned roommate, and this is important because one of them can probably be treated with CBT or something while the other should be told to stop doing cocaine.

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My only concern, and it's an "Old Man Yells At Cloud" concern, is that "culture" is becoming increasingly disjointed and fractal. Like I don't mind that we have a much higher rate of transgenderism in the U.S. because I don't care about that (and don't understand why 550 comments worth of folks do). It has nothing to do with me, and the transgender folks I know who were able to transition socially and medically have had massively improved QoL as a result. I can't consider that bad, and only really consider that "good" to the extent that it lets them do other interesting things with their lives. If calling my friend by a different name and pronoun makes them able to succeed in their chosen careers, show more kindness to others, be a better friend and partner, etc., etc. then I don't have to understand why they need that to do it.

But I do care that there are now full "cultures" defined entirely by being transgender, or having multiple personalities, or really really hating Infinite Jest. Not because you shouldn't be transgender or have multiple personalities or hate Infinite Jest. But because you're building an incredibly narrow version of both yourself and the world that will be impossible to escape as you grow.

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I went through two years of depression that made me miss half of my bachelor's degree and that I still barely recovered from 8 years later due to "hearing someone expressing a wrong opinion during a college class" repeatedly.

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"National Radio Quiet Zone, an area in Virginia where the government enforces a ban on electromagnetic transmissions for secret military reasons)"

Several corrections here.

The NRQZ is centered and mostly located in West Virginia, but does extend into Virginia and Maryland

While it does protect the Sugar Grove NSA facility it also protects the Green Bank Observatory, an NSF-funded radio astronomy observatory and home to the world's largest fully steerable telescope.


There isn't a complete ban on electromagnetic transmissions. Within the NRQZ fixed transmitters have to meet power and directionality requirements. Mobile transmitters are unregulated. The regulations are stricter within 10 miles of the Observatory but there are still ways of mitigating transmitters (e.g. the microwaves at the Observatory are all inside Faraday cages), and exceptions are made for things like emergency communications.

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I also can't believe you went the whole article without mentioning Lorena Bobbitt:


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I'm pretty sure I have asymptomatic long covid.

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"There is no amount of commitment to the bit which will make people drive metal objects through their penis. "


Apparently sex-cult adjacent San Fran is a completely different set of experiences than demi-monde Austin.

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> (there’s no such thing as witches, and the penis can’t retract into the body).

Are you saying Seinfeld lied to us? Like a frightened turtle I say!

> And how come knowing about anorexia makes it spread so quickly?

Innate desire for increased attention? The death was widely publicized and people do crazy shit for fame and attention.

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Am I the only one who immediately saw the dalmation and the cow without looking at the answers? I kept searching for a second image, since I assumed that the trick was that there were two possible images.

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The comment about overreacting to parental death reminds me of my rage at a manager back ~10 years ago where they were hired to be my new boss at a small ~15 person firm despite me *clearly deserving* (IMO) the position (except I was too young and didn't have the right educational background).

The new manager proceeded to be absolutely horseshit at her job, get absolutely nothing done, then ~6 months in her mother died. This was used as an excuse to get nothing done for another 3+ months and miss many weeks of work (which she didn't have leave for). Then when she came back there were constant comments about how impossible it was to work under the conditions of their 90+ year old parent being dead.

I called bullshit and was pretty rude about it, and left to start my own thing (which went great!). She got fired anyway as soon as was seemly, and the place ended up brining me back off and on in a consulting basis at ~4X the hourly I had been making before, while I also worked for their competitors.

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Articles like this make me so glad I subscribe. I asked my wife is PMS really exists, and she said... yeah I think so, aren't I sometimes moodier than others?

So... no evidence there :)

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> delusional parasitosis - the false belief that you are infested with parasites and can feel them crawling in your skin - is actually an especially interesting case. Two groups are disproportionately represented among patients: menopausal women and cocaine addicts. Relatedly, two biological conditions that can sometimes cause weird skin sensations that feel like crawling insects are . . .

Tangential, but I'm curious how the term "delusional parasitosis" might relate to an experience of mine.

For a period of many months, my house contained a large number of ants. At any given point, it was pretty likely I'd have one or two ants crawling around somewhere on me.

The ants frequently gave me the sensation that I had something on me, as evidenced by perfectly normal events such as 1. feeling a crawly skin sensation, 2. reaching over to it, and 3. coming up with an ant.

However, the sensation became much more decoupled from the actual ants than I would have liked. It was very frequent that I would experience the sensation of ants crawling on my skin where there were obviously no ants. And while this is harder to prove, I tend to suspect that my sensitivity to actual ants went down, that sometimes they'd be crawling on me and I just wouldn't notice.

I chalked up the false crawling sensations to, essentially, overstimulation. I didn't like the sensation and I didn't like that it was frequently provoked by no direct cause. At no time did I believe that the ants (real or spurious) were a danger to me, or that a sensation that occurred in the absence of an ant must indicate that the ant was really there but somehow difficult to observe.

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> In our society, it’s commonly believed that War Is Hell, and if you enjoy it too much, you might be a bloodthirsty psychopath. Relatedly, estimates of what percent of veterans get PTSD range from 15% to 85%. I’m not sure the 85% number is accurate, but if it was, and I was a veteran, and I wasn’t getting PTSD, I might start worrying that this was starting to signal negative things about me.

I think there's a major confounder here, which is that, in our society, if you say you have PTSD, the government will give you a bunch of free money and compel other people to change their behavior on your behalf.

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Feb 24·edited Feb 25

Sketching a stylized but potentially helpful model here, consider 4 categories of potential trans people by how their dysphoria is mediated by social contagion:

0. The inevitables. The ones who in a world where 'transgender' is not a concept at all, personally decide that they are the wrong sex, spend the first part of their lives asking how they can change sex or what they need to do be a member of whatever gender, and get told by everyone that it's impossible and made up and they'd have to figure out a way to be happy as they were; then they do their level best cut ties with everyone, get some new clothes, and move somewhere under their target identity.

1. The inevitably weird. The ones who'd go around asking how they can change sex, and, on being told it's impossible, make unhappy faces and ask if you're really really sure? then sigh and work on 'figuring out a way to be happy as they are,' whatever that means. Probably crossdressing. Maybe religion. Maybe they meet a trans person and suddenly understand they're not unique.

2. The inevitably sad. The ones with confusing discomfort with gender and sex and society. The ones who hit puberty (edit: or otherwise encounter gender) and realize they don't like where life is going, but in ways that are complicated and confusing and might take a long time to follow to any particular conclusion. Or, come to a quicker and less confusing time when re-considered with a framework of gender dysphoria.

3. The otherwise fine. The ones who learn about gender dysphoria, and find confusion and discomfort in their experiences with gender and sex and society, and follow patterns of gender dysphoric behavior to try to resolve it.

To be clear all categories can include non-binary people, and cis people / people who don't recognizably transition.

0's semi-hypothetical because anyone who tried that hard and can be reached for comment at this point probably knows that gender dysphoria exists. Group 3 is also semi-hypothetical because it's just 2 with a secret untestable uncondition.

There is no real way, in a world aware of gender dysphoria, to distinguish between 2&3. And there's no external distinction (and no certain internal distinction) between 1&2. That is, please assume that there aren't going to be ways to 'test' or 'screen' people into GID-I -II -III and alter approach accordingly. (Trans communities regularly try to do this, when people feel like some in-fighting.)

Anyone who transitions and probably all of groups 0 and 1 get enormous benefit from social normalization of gender variance, in pure practical payoff of 'allowed into respectable society.' There can still be drawbacks, like for all the people who were happier as 'androgyne' and are now 'trans,' or the ones who were 'transvestites' and now have to pick pronouns about it. The precise syndrome associated with 'transgender' might be a worse time than whatever transgression of gender people would have done otherwise, but at least fewer people will think you're just a pervert.

Group 1 contains a lot of people who are pretty obviously so much better off transitioning, and making that harder for them is cruel. This group is not going to get normal outcomes even without a socially defined conception of gender dysphoria, and on average would probably suffer a lot more.

Group 2&3 people seem increasingly likely to transition younger these days, and get to do it while people question their legitimacy. Some of these people are saving a lot of time by transitioning without spending 20 years figuring it out from first principles. Some of them are missing out on a life that was basically the same except they were cis.

I see people express a lot of concern over group 3. That's the group unhappier because they're in a world where gender dysphoria is an option. They are that by construction, because that's the imaginary line I'm drawing between 2&3. Group 2 looks entirely identical to 3, only the cultural accessibility of gender dysphoria has a more ambiguous impact on them. They already had gender-related issues. They might have eventually resolved them without a dysphoria framework, or been more able to push them aside to a tolerable point. Honestly I don't know whether they win here on net. But I guess generally I'd build for 'suffering with a map' over 'suffering without a map.' Maybe it's worth trying to make it a decent map.

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