(1) I've read that some believe that combat PTSD actually could have been due to, for some people, actual lesions in the brain due to being regularly exposed explosions. I don't know if that's true, but it would explain the lack of PTSD in the past.
(2) Also, a disproportionately large number of people with PTSD have sleep apnea, which is a disease of modernity (jaw sizes have shrunk and tongue sizes have grown). Some people theorize a connection between sleep disorders and an inability to overcome past trauma.
A similar thought on ADHD:
(1) Several studies have found a large number of children with ADHD have sleep disorders. Several find that a slight majority have sleep apnea. Also, note that sleep apnea, being connected to facial structure, is very genetic. If there are cultures that don't recognize ADHD or something very much like it, I would think it is because they don't have much it, which may make sense if it is, at least partially, caused by modern sleep disorders.
re PTSD (1), Acoup notes: “The issue has been brought up, so I do want to note that I am, by the by, unconvinced by the suggestion that these WWI-era mental wounds were purely or principally the product of concussions from heavy artillery or the like.”
Yes, I guess I need to look into why exactly ACOUP is unconvinced. TBI definitely can mess you up. I personally wouldn't be surprised if the causality was something like TBI->"sleep disorder" and "sleep disorder + trauma"->PTSD. I am a fan of the idea that sleep has something to do with processing trauma properly.
1. Exploding shells are 10% explosive and 90% steel. Having your body riddled with jagged bits of fast-moving steel will mess you up way more than TBI, and if you're close enough to develop chronic psychological symptoms from the explosion, you're likely close enough for those to be rendered moot by the acute deadness from the steel. So it's probably not a coincidence that we started noticing TBI when we started cladding our soldiers in Kevlar.
2. Artillery is not omnipresent. Lots of doctors from World War I on have been observing and documenting symptoms of shell shock / battle fatigue / operational exhaustion / PTSD in soldiers that they knew perfectly well were never near an exploding shell. And in WWI, diagnosing this as "shell shock" because that was the official magic word that got the poor SOB the treatment he needed and that was more important than holding a pedantic debate on medical terminology.
Maybe some of the ones who were near exploding shells, did have TBIs. But Occam's razor suggests that if you've got a bunch of people in roughly the same environment suffering roughly the same symptoms, they're coming from one common cause so look for what they all have in common.
I really think you'd be interested in reading through the article I linked above. mTBI is incredibly common and it's not just from being blasted at. Also, as I said above, it could be that the direct cause of the PTSD is the trauma/distress linked with a sleep disorder. TBI is probably only one of many causes of sleep disorders, similar to how war is only one of many causes of trauma/distress.
Change of diet leading to us eating softer foods. Less need to chew hard means less stress on the jawbone means smaller bone. I don't know about the tongue, though.
I don't think it's meant to be a *genetic* change. It's just that if from birth through your childhood you always eat soft foods, then the jaw doesn't develop as much; like a muscle that's neglected.
As Thomas Kehrenber said it's not genetic. Regular exercise changes your body. Not only the muscles but the tendeons, cartilage and bones as well.
Look at the hands of black smiths, witch are often huge. Or the changes people that shoot Warbows report. Or for a more anecdotal example I lost two shoe sizes after I started rock climbing, because my foots changed with the new challenge.
I was going to say that evolution could only do this if the pressures are great enough that people either (i) die young or (ii) breed less, both of which seem unlikely in this case.
Then I realise I misread; this is about how your bones grow into adulthood, which could be affected by how you use them.
Soft foods is the most popularly known possible explanation for smaller bones, but I definitely think it's only part of a larger picture.
Allergies are also increasing which encourage children to mouth breath which causes smaller jaw development.
There are also a lot more preterm babies that are surviving and it is the end of pregnancy during which the babies orofacial muscles properly develop, so preterm babies are more likely to have issues with jaw development. One study even found something like 70% of preterm babies having sleep apnea, which is pretty huge.
Also, breastfeeding isn't done for as long as it may have been done in the past, and the action of breastfeeding develops the child's jaw in a way that bottle feeding does not.
A crazy theory that I've not read about, but I think could also be the case is that certain endocrine disrupting chemicals that may be building up in the environment could also be affecting in utero development so that orofacial muscles are weaker leading to poorer jaw development.
These are just theories with different levels of evidence behind them. It could end up being mostly just one or two of them or something else entirely (though probably not entirely).
Also, I don't know that these are all completely unrelated and I don't know that they are all having a similar effect around the same time.
Maybe increased hygiene (the hygiene hypothesis) or EDCs cause the allergies and preterm birth. Maybe the breastfeeding and soft foods are less important than some people think. Also, note that breastfeeding may be more difficult with preterm babies because poor orofacial development and tongue tie.
You would benefit tremendously from listening to Mike Mew, who does research on and treats facial structure and sleep apnea without any surgery. Facial structure is entirely fixable in any modern child and largely comes from a veritable avalanche of baby products and new feeding techniques over the last 70 years. Stories of tribes found and photographed with perfect teeth, 50 years of modernity later the young in that tribe were all crooked and degenerate.
I highly recommend him, he is about to publish something along the lines of "jaw structure causes all modern deseases".
To let you know, Mike Mew doesn't do meaningful research (he's written a couple of articles, but not real research from what I've seen) and most probably doesn't effectively treat sleep apnea. Probably any change in facial structure that he causes with his techniques are dentoalveolar rather than skeletal (although I've heard he started using MARPE now which completely goes against his whole "Mewing works in children, teens and adults" theory).
Also, jaw structure can cause issues, but surely not "all modern diseases"! There's a lot going on besides jaw structure and a lot of people with perfect jaws that have modern diseases. But, I do think that Mew is right that the importance of orofacial development to good health is not fully understood by lots of people.
One thought on the PTSD subject -- is this fully explained by "Blast induced trauma" (AKA shell shock) as the source of PTSD in soldiers? I'm not sure how many blasts soldiers in the 19th century were subjected to, but I'd guess it's much less than in modern warfare with high explosives, and it's possible it could be effectively zero exposure if cannonballs don't cause this kind of concussion on impact. Certainly if you go back before gunpowder there was no blasts.
Acoup notes: “The issue has been brought up, so I do want to note that I am, by the by, unconvinced by the suggestion that these WWI-era mental wounds were purely or principally the product of concussions from heavy artillery or the like.”
Re ADHD vs anorexia - wait, you think being bad at concentrating/executive function/prefrontal cortex type stuff feels closer to the hardware level than being bad at the desire/urge/motivation to eat, which is a very primal thing that exists in some of the simplest brains?
That's a fair point. As mentioned in the last post, I think anorexia is a combination of a psychological and a physiological thing, certainly with psychological triggers.
Others in the comments are asking whether it's a physical consequence of blasts or explosions. My question is whether it isn't simply the psychological effect of that: in modern warfare there are constant blasts, artillery, explosions, grenades, and the possibility of instant death at any time. This also puts you in the peak state of stress much longer. You're at the mercy of sudden incidents that you can't control or see coming.
I sifted through the comments on the blog post, and found at least one other person speculating about the same.
"[T]he circumstances that cause the most fear not necessarily those that are objectively the most dangerous. Artillery shells and mortars, as we have seen, cause by far the most casualties–and the soldiers themselves generally know that (Holmes 1985: 209-10)–but the greatest difficulty in combat performance is in confronting small-arms fire at the forward edge of the combat zone. Some surveys show relatively high fear of being killed by bayonet and knife, events rare to the point of fantasy but indicating the quality of soldiers’ imagery about what they feel is in front of them. Nor do persons in highly dangerous situations all show the signs of incapacitating fear that affects frontline troops (Grossman 1995: 55-64): navy personnel are subject to the same dangers as army soldiers of being blown apart by enemy shells–the largest source of ground combat casualties–in addition to prospects of drowning, but data on long-term breakdown from combat stress–which is one measure of combat fear–shows much lower rates of breakdown for sailors in combat zones. Similarly for civilians under bombardment, including long-term blitzes such as the German attack on England, or the Allied bombings of German cities; casualties included being burned alive or sustaining extreme bodily mutilations resulting from burns. Nevertheless, civilian psychiatric casualties were low in these areas compared to army troops."
Supporting anecdotal evidence: My mother, who as a girl of 13 was digged out of a lot of rubble after witnessing her mother dying beside her got along alright and lived a good life of nearly 90 years. She did really dislike the sound of sirens and was addicted to sedatives in her forties, though. Her Uncle was a sailor on SMS Koenig in the Battle of Jutland, which was bad shit, and seemed to be alright for a long life afterwards, too. The autistic traits in my family are on that line. Maybe there is some resilience connected with what is behind autism genetically.
My speculation wasn't so much that they find explosions scary, but that they are disorienting, instantaneous, and the threat of unexpected / instant death persists over long periods of time. The navy example might be a fair counterpoint to that idea--assuming it's robust and based on combat situations...
But if it's not *something* about modern warfare, what is it? The post floats this idea of social contagion. That probably explains something, but at the time of WW1 people recognized shell shock symptoms before there was any cultural meme about "trauma," or any expectation that it would occur. I don't see how that jibes with the theory.
"But in WWI, we heard a lot about ‘shell shock’. Later, in WWII, ‘combat fatigue’ or ‘battle neurosis’. Artillery wars. I would guess that what actually happened was a combination of people finding a way to avoid getting killed, and brain damage due to nearby explosions. After experience in Iraq and Afghanistan, plus football and boxing, people are thinking seriously about those explosions as a cause of PTSD."
"We (the US) listened to psychologists telling us how to deal with combat fatigue: the Nazis and Soviets didn’t, and had far less trouble with it than we did."
This is pretty much my understanding. Getting mortared has no precedent in human warfare, the only precedent is... serious natural disasters such as tsunamis and volcanic eruptions which render a human being *helpless*. The helplessness to even attempt to protect yourself, the complete subordination to sheer dumb luck/fate/the will of the gods, is the source of shell shock/combat fatigue/PTSD, which is why people getting fucked up by war only seems to emerge circa the Thirty Years' War. Shanking somebody on the other hand is one of the root human instincts, we're killers. Tiny little children play-fight. Give two five-year-olds sticks and they'll be using them as swords within 30 seconds. It's not traumatic. You don't feel powerless when you stab your enemies to death, you feel powerful. It's *supposed* to feel great. We're evolved to rejoice in vanquishing our enemies; not so much in being hit by lightning.
Somehow I missed the original thread of this which is too bad. Peter Levine’s somatic experiencing has a lot to say about this. So does Charles Hoge (military psychiatrist who has also deployed), who has published a variety of research as well as “Once a warrior, always a warrior.” So does Resmaa Menakem.
The US culture-at-large is not known for grieving well, releasing emotion, and with very few somatic grief skills, people are walking into dangerous situations with their energy already stuck. Wailing, drumming, singing, staying awake for days at a time, gathering in large groups to celebrate loudly regardless of how “bad” things are, behaviors like this train the spirit to remain present, release stress and intentionally enact feelings. So people have more skills for rebalancing when challenging things happen and they can nip Ptsd in the bud more often.
Much of modern employment is very brain - centric, so memory and thought issues become evident which were less clear when throwing hay bales was the main activity for many a veteran. Also, people now survive experiences that killed prior generations if military, due to medical and transportation advances. So survivors may have more long term health issues now because they are surviving things which no one used to survive.
See also moral injury. There is a lot more to say but I’ll stop here.
Also, whoever thought “white people” don’t express emotion at home has not spent much time with Mediterranean cultures. Expressing emotion is not the same as releasing it though. Expressing and still holding can be epically toxic.
I wanted to add my own wondering about whether we see more DSM-diagnosable things now because our institutions (schools, workplaces) and culture (US, western?) have an ever-narrowing tolerance range for what is considered "normal" combined with expanding language/awareness/focus on medical model pathologizing of DSM-adjacent things.
There is more focus on the small and medium-sized ways that people fall short of being optimized for efficiency and performance at school and work, and more demand to intervene when that falling short is noted.
Variation in human behavior and adaptations to stress used to get called things like quirky, spirited, up-tight, eccentric, vague, artsy, dreamy, dramatic, neurotic, or "not the same since X happened." I can remember all these words being used to describe various extended family members in the 1960s and 70s by the generation before me. A few decades later, those same family members would describe themselves as having panic attacks, anxiety, ADHD, PTSD, OCD, post-partum depression, etc.
And then my favorite explanation for everything these days is stress. My memory of the PTSD in soldiers research is that earlier trauma/adversity in a soldier's life is a better predictor of whether they will develop PTSD from combat experiences than the nature of the combat experiences themselves. PTSD seems to be the destination for a person who layers life-threatening stress on top of earlier adversity. It may be that we've always had the earlier adversity, but that the increased background stress all around us may predispose more people to developing PTSD from a difficult experience later on.
"New research on posttraumatic stress disorder in soldiers challenges popular assumptions about the origins and trajectory of PTSD, providing evidence that traumatic experiences in childhood - not combat - may predict which soldiers develop the disorder."
On the smaller level, Levine also talks about the value of going off and shaking after a traumatic experience-- much more feasible for a gazelle which barely escaped a predator than spending hours drumming.
If he's right, part of what gives people PTSD is that either that the trauma is so continuous that there's no opportunity to go off and shake, or that a lot of people think that holding themselves together (that is, not permitting shaking) is the right thing to do.
"I am sympathetic to this based on an experience I had, where I was pretty bad at tolerating noise, but kind of within the normal human spectrum and never thought much of it, and then I lived with a noisy roommate who characterized my distaste for noise as freakish and psychiatric-level, and after that, every time I heard a noise I started panicking and questioning whether I was going to have some sort of freakish and psychiatric-level reaction to it, and this became so unpleasant that now I do have a freakish and psychiatric-level noise intolerance - or at least this is how I remember it."
Does this mean the piece about Nodrumia was influenced by personal experience? Sounds very much like it!
"Crimkadid is also responsible for this long twitter thread on variance in schizophrenia, which is poorly-supported, bizarre, and racist, but otherwise excellent"
What an absurdly nuanced way to describe something.
I also wonder about the role of medicine in increasing the prevalence of PTSD. I recently listened to an excellent Rough Translation podcast series about a solider with PTSD from having lost three limbs in Afghanistan. A century ago he would not have had PTSD; he would have died. (I see the Globe article makes this point as well.)
The Globe article about 45% of veterans receiving benefits reminds me of the This American Life episode Trends with Benefits, which explored how disability rates are rising overall as disability is one of very few viable welfare programs accessible to many struggling Americans: https://www.thisamericanlife.org/490/trends-with-benefits
Yeah, I was thinking about that during the 'medieval war' section - Scott mentions that different types of wars and different weapons will cause different types of damage, but I think it should be emphasized that medieval warfare is just orders of magnitude different from any modern war than any modern war is from any other modern war. No concussive weapons (which do their own type of brain trauma), no death from above or from a concealed rifle half a kilometer away, fewer surviving injured, etc etc.
People always make that wounding argument, but there's no way you get to 45% on that basis.
I'll try to do the math here. In pre-Vietnam wars, the typical killed to wounded ratio was something like 1:3. In Iraq and Afghanistan (for Americans) it is something like 1:10. So let's be generous and say that for every person who died in Iraq or Afghanistan, there are 2 who would have died in WWII but are alive because of modern medical technology (change 1:10 to 3:8). There were 8,500 fatalities in Iraq and Afghanistan, so let's say about 17000 people are walking around today after wounds that would have been lethal in WWII. 45% of 1.6 million is 720,000. The orders of magnitude are off.
Also, better medical technology means that some people who would have been permanently mangled in older wars are now pretty normal.
The threshold for receiving disability benefits is not very high. A 10% rating i 2021 only gets you $114 a month (see https://www.va.gov/disability/compensation-rates/veteran-rates/). The full rating schedule can be found here (https://www.benefits.va.gov/warms/bookc.aspv), but getting to 10% is not difficult even if you've never seen any sort of combat at all, let alone incurred an acute injury in combat. Many of the conditions are chronic and widespread, in particular functional loss in the knees and lumbar spine and hearing loss. The former are often caused just by carrying around 90 pounds of gear all over the place, or training events like spur rides where you're carrying telephone poles and LMTV tires 12 km through rolling hills at 1 AM in the morning, pretty much just for the hell of it because it's part of the cavalry tradition. Hearing loss is often just due to gunnery, personal rifle qualification, and working around loud vehicles and aircraft daily in your installation motorpools and airfields.
As for why the claim rates are so much higher now compared to Vietnam and earlier, out-processing from the military today involves undergoing a comprehensive physical and VA claims agents are there as part of the TAPS courses to help you file an initial claim for every claimable condition you're found to have that you did not have when you in-processed. Contrast this with Vietnam when servicemembers often weren't even told they were eligible for benefits at all. The increased rates of disability claims don't necessarily reflect increased rates of disability so much as outreach letting disabled people know they are eligible for benefits and helping them to make the claims.
>One theme running through this book review (that is particularly visible in the discussion of PTSD) is the Western trend to diagnose more and more things as psychiatric illnesses.
I think this has a lot to do with us living in a capitalist/authority-based/scientismist society where if you have any problem of any kind, you are expected to pay a professional to deal with it rather than seeking any otehr type of solution, and for many problems you cannot possibly afford treatment unless your health insurance will cover it, and your health insurance will not cover it unless you have a formal diagnosis relating to it.
I strongly suspect that if medical and psychological care were freely available for anyone who wanted help with something even if they had no diagnosis, and meds could be prescribed without a formal diagnosis, the overall rates of diagnosis would go down like 80%.
I think this conflated two different things which is that "having a diagnosis" has a social role in indicating to others that your problem is sufficiently bad to be allowed access to additional resources to deal with it. Vs the descriptive role of using a diagnosis in describing someone. Eg people self diagnose, or dwxribe other people as having "undiagnosed x".
Agree with this. There is a "type" of patient who the normal system doesn't diagnose with anything (besides maybe anxiety or psychosomatic conditions) who gets deeper and deeper into wacky alternative health stuff, constantly collecting fake diagnoses that help them "understand" themselves. Maybe this is downstream of other things about our society, but it makes me doubt that insurances wanting diagnoses to cover things (while real) is the main root of the problem.
The TED talk https://www.ted.com/talks/sebastian_junger_our_lonely_society_makes_it_hard_to_come_home_from_war/transcript?language=en gives more evidence that PTSD is very much rooted in social stories and reactions, and posits that a significant part of PTSD is alienation. An interesting statistic: 50% of US veterans file for PTSD compensation even though only about 10% of US veterans have seen combat. By contrast, the rate of PTSD in the Israeli army is 1% (the TED talk suggests that this is because, unlike in the US, everyone in Israel knows what it's like to be in the army because participation is mandatory).
It seems like PTSD might either be a result of not knowing how to integrate your experiences with the social role you're expected to play (or perhaps in particularly perverse cases, experiencing PTSD is part of the social role you're expected to play)?
I'd like to see a source for that claim about rates of filing for PTSD. That is extremely high if the Boston Globe report that roughly 45% of veterans receive disability compensation of any kind. If more than that are applying just for PTSD, that is an awfully large number of denied claims. The VA reports that somewhere between 10-20% of veterans from the 90s on have actually been diagnosed with PTSD: https://www.ptsd.va.gov/understand/common/common_veterans.asp. You can try to make a claim without having a diagnosis, but you'd need to get the diagnosis before the claim could be approved.
I can't figure out what's supposed to be excellent about that Crimkadid twitter thread. It looks like a pile of just-so stories with a light sprinkling of science, designed to justify irrational prejudices.
...this isn't the first time I've had this reaction to something you've posted. Not even the first time I've had it to something you've linked from a reactionary. With all due respect, I think you're much too tolerant of people making up plausible-sounding semi-scientific explanations for already-known facts. Reality offers endless degrees of freedom; it's always easy to come up with a story explaining how x y and z are all natural consequences of your pre-existing beliefs.
I'm guessing this is based on the "Rule thinkers in not out" philosophy that Scott takes to a pretty real extreme. If you post a bunch of totally wild stuff that sounds semi-plausible and like you worked hard on it, Scott will commend you, is basically my understanding of how that works
This would be nice if it were true, but I don't really think that we have the evidence for this. In his review of David Harvey's work Scott Alexander went out of his way to be uncharitable (and even admitted as such). And in Scott's review of Singer on Marx, Scott didn't seem to understand Marx's position, as I have documented here:
Of course, these are books written by left wing authors, as opposed to random twitter threads written by right-wingers, so Scott may ideologically feel more attracted to one political position over the other.
At some point I'll post a longer essay on cross-group variance in schizophrenia which will hopefully explain where I'm coming from and why things are weird enough that we need an explanation approximately that weird to make sense of them.
I don't remember where I read this, but I remember a reading about a hypothesis that in the past there might have been fewer post-battle mental health issues because soldiers would need to walk back home, which might have taken weeks. In this time, they might have talked with eachother about the terrible things that happened, and integrated the experience somewhat.
In contrast, now they might be flown back and be home in days, ripped from the social group that understands their experience and thrown back into regular society.
Ancient armies had neighbors fighting alongside one another, so you didn't have just a few weeks to talk about what happened; you had the rest of your life.
I think this was on ACOUP, but I forget which post.
Okay, I have opinions on PTSD both from a professional perspective, experiential practice, and an interest in warfare and combat.
I first came across this problem when at a ward round. My consultant asked the junior doctors a general question about PTSD. None of them answered. As the nurse present, being newly qualified and over excited at my first ever ward round ever I piped up and gave an answer, which impressed the consultant and probably embarrassed the junior doctors. My bad.
Anyway, to get to the point; the difference centers around the weight you give to the confounding variables: TBI from shock blasts, drug abuse (Vietnam veterans mediated their feelings with a wide range of drugs, plus the military issues amphetamines or equivalents too), and finally, the point I raised the training has changed.
Back in the good old days (insert date of choice) training was based around generic targets, and studies should that in combat men would choose to fire high, rather than shoot to kill another person. After WW2 Skinner was got involved with training to try and overcome this problem.
The results of this were first seen in the Korean War, and further improved by the time of the Vietnam war. Today a Western military will see approximately 98% of its soldiers shoot to kill compared to the WW2 rate of approximately 2%.
Okay, this doesn't account for for pre-industrial armies and antiquity, but one could make an argument that those suited to the task of killing were self chosen, being those men and women who would see fighting and killing as their calling. Arguable, but it is a theory that fits the evidence and provides a tool for understanding the problem.
"Back in the good old days (insert date of choice) training was based around generic targets, and studies should that in combat men would choose to fire high, rather than shoot to kill another person."
This is based on the works of S.L.A. Marshall, a notoriously controversial figure to this. Wikipedia gives a positive view of him but that's because like many other articles it's being squatted in by an editor with a positive view of him.
That made me curious about what David Gerard is doing recently on Wikipedia. Apparently he is removing information about who financed which tech companies, because the information comes from CrunchBase, which for some reason is a bad thing. I have no horse in that race.
Above I linked to a post mostly excerpting from Randall Collins' book on violence, which cited Marshall (and Dave Grossman), so I've fallen for that too. It wasn't until reading Cochran on the subject that I stopped accepting it uncritically: https://westhunt.wordpress.com/2014/12/28/shoot-to-kill/
I think we've had this conversation in one of the book reviews, but it'd be great if you could link a more substantiative source than one that just says "this is bullshit, he didn't have evidence, obviously most soldiers tried to kill the other side and enjoyed doing it".
Because WP does such a bad job explaining why S.L.A.M. is complete fraud (even according to his grandson), I put together what seem to be the core links: https://www.gwern.net/Replication#slam
I'd be skeptical of the claim that pre-gulf war and certainly pre-industrial soldiers were self-selected for comfort with killing, given many if not most of them were forcibly conscripted.
One way in which militaries have changed quite a bit is in the sheer proportion composed of support personnel. A modern army ships with entirely self-contained units for performing vehicle and aircraft maintenance, IT support, HR and legal support, basic services like laundry and food, construction. They make up far more of the total headcount than people explicitly there to fight, and though they are still required to be professional soldiers, that really just consists of maintaining bare minimum standards for physical fitness and qualification with a personal weapon. The training experience is quite different from being in the infrantry, where you day to day life for as long as you're in consumed with learning how to kill and not be killed.
In pre-Vietnam conventional wars, these support personnel would have been comparatively safe, well behind the front lines in territory that had been claimed and cleared of enemy presence. In a counterinsurgency, there is no safe territory at all. Sometimes the very people you're working with on a daily basis are disguised enemy who activate and murder you one day. I don't know if anyone has studied it, but I would certainly imagine the rates at which support personnel are injured and traumatized is much higher in a counterinsurgency and anti-terrorism type forever wars than in conventional wars that involved taking and claiming land and then getting out once the enemy leadership was killed or surrendered.
A counterpoint to the ACOUP post: Is today's PTSD the same phenomenon as "being haunted by ghosts" in the past?
> Cross-cultural psychologists have observed that, regardless of cultural background, people who suffer persistent emotional disturbances in the wake of a traumatic event exhibit intrusive memory symptoms in some form. Here in the US, these are closely related to what we commonly call "flashbacks." For the Romans, people experiencing intrusive memories were said to be haunted by ghosts. These individuals show up in historical, philosophical, and even medical texts. Josephus, who was an outsider to Roman culture, also describes this phenomenon in his history of The Great Revolt. Those haunted by ghosts are constantly depicted showing many symptoms which would be familiar to the modern PTSD sufferer. Insomnia, depression, mood swings, being easily startled, frequent eye movement, alertness all day and night, paranoia, avoidance of crowds, suicidal thoughts/attempts, loss of appetite, shaking/shivering, self-hatred, and impulsive violence have all turned up in association with these individuals. Since in almost every case the person experiencing these things had made himself an object of public shame, the "ghosts" in question often came in the form of those he had killed or wronged in the past. These would either appear spontaneously to the sufferer, or would come in the form of vivid, frightening nightmares. The key component to these experiences, as with modern cases of PTSD, was that the sufferer had no control over his own symptoms. Thoughts or vivid memories would occur unexpectedly and uncontrollably. It is easy to see why the Romans, who were religiously superstitious to begin with, would attribute such things to the foul play of malicious spirits.
(I'm posting this here, copy+pasting from a comment on ACOUP, which copied from a comment on Hacker News, which copied from the AskHistorians thread. Blog comments are like medieval letters.)
This makes me think of Shakespeare's Macbeth. Specifically where he's haunted by the ghost of Banquo. The audience at the time would probably have thought of that as an entirely literal phenomenon of a ghost haunting the character. While modern productions often treat it as a manifestation of his guilt
Is it? I'm highly dubious of any claim that makes blanket statements about child sexual abuse, especially obviously ridiculous ones such as a claim that there was total denial of it occuring before the 1980s.
I'll also note that the current Western narrative on child sexual abuse seems incapable of understanding that people can genuinely hold beliefs that go against its narrative.
Regarding child sexual abuse and how it was regarded up until the 60s or so, I think we can blame Freud's influence here. He was hearing from so many of his female patients that they had been abused as children that he freaked out about it and revised his opinion from "this is a terrible thing that is happening" and hence his development of the seduction theory to "it can't possibly be happening at these rates, that would mean nearly every woman in Vienna has been abused by her father!" and abandonment of the same.
Because he was the 800 Pound Gorilla of Psychoanalysis and Psychiatry, that naturally influenced those who came after him, especially in the area of pop psychology where the half-informed "knew" that if you claimed your father had abused you, then "really" it was your Electra Complex at work.
"On the evening of April 21, 1896, Sigmund Freud presented a paper before his colleagues at the Society for Psychiatry and Neurology in Vienna, entitled "The Aetiology of Hysteria". Using a sample of 18 patients—male and female—from his practice, he concluded that all of them had been the victims of sexual assaults by various caretakers. The cause of the patient's distress lay in a trauma inflicted by an actor in the child's social environment. The source of internal psychic pain lay in an act inflicted upon the child from outside. This led to his well-known ‘seduction theory’.
...Freud's clinical methodology at the time, involving the symbolic interpretation of symptoms, the use of suggestion and the exerting of pressure to induce his patients to "reproduce" the deeply repressed memories he posited, has led several Freud scholars and historians of psychology to cast doubt on the validity of his findings, whether of actual infantile abuse, or, as he later decided, unconscious fantasies.
Freud did not publish the reasons that led to his abandoning the seduction theory in 1897–1898. For these we have to turn to a letter he wrote to his confidant Wilhelm Fliess dated 21 September 1897.
First, he referred to his inability to “bring a single analysis to a real conclusion” and "the absence of complete successes" on which he had counted.
Second, he wrote of his “surprise that in all cases, the father, not excluding my own, had to be accused of being perverse" if he were to be able to maintain the theory; and the "realization of the unexpected frequency of hysteria… whereas surely such widespread perversions against children are not very probable."
Third, Freud referred to indications that, he argued, the unconscious is unable to distinguish fact from fiction. In the unconscious there is no sign of reality, so one cannot differentiate between the truth and the fiction invested with feeling.
Fourth, Freud wrote of his belief that in deep-reaching psychosis, unconscious memories do break through to the conscious, "so the secret of childhood experiences is not disclosed even in the most confused delirium." (In the same letter Freud wrote that his loss of faith in his theory would remain known only to himself and Fliess, and in fact he did not make known his abandonment of the theory publicly until 1906.)
The collapse of the seduction theory led in 1897 to the emergence of Freud's new theory of infantile sexuality. The impulses, fantasies and conflicts that Freud claimed to have uncovered beneath the neurotic symptoms of his patients derived not from external contamination, he now believed, but from the mind of the child itself."
I can't blame Freud or others for their wish to bury the inconvenient conclusions; when the sex abuse scandals in the Catholic Church first broke, I had the same reactions: it can't possibly be true, or at least not on the scale they are claiming.
"These papers indicate that the patients did not relate stories of having been sexually abused in early childhood; rather, Freud used the analytic interpretation of symptoms and patients' associations, and the exerting of pressure on the patient, in an attempt to induce the "reproduction" of the deeply repressed memories he posited"
Since this sounds a lot like repressed memory therapy, where memories are created rather than brought out, it was probably preferable that Freud abandoned it compared to inducing such false but traumatic memories in his patients.
I think Freud alone was probably not enough to create such a massive cultural change that is sort of implicitly claimed to have happened.
Remember, moral panics about child sexual abuse pre-date any big revelations about child sex abuse, so opinions on the morality of the act itself can't have much to do with a desire to protect the powerful etc.
So, that many people simply aren't fucking their kids. Maybe the rise of incest/torture/rape porn is going to change that, but no, even a sobbing patient in denial of the sex abuse that didn't happen, isn't proof it actually happened.
Its understandable that catholic preists rape kids. They're selected from the rejects of catholic society, gays, asexuals etc. So catholics have a place for them in priesthood. You have a bunch of sexually repressed men together what happens? They develop an atypical taste for males which they may have desired beforehand or been more likely to, and they've got easy access to boys and so it happens.
Father's on the other hand, don't enter fatherhood with the desire or inclinations to fuck their dsughters. So the widespread incest thing is probably just garbage.
I've read that one risk of father-daughter incest is that the daughter gets to an age where she looks the way her mother did when her father was courting.
Sure, it happens at times, but people really need to either prove a causal mechanism for it to be so widespread or stop spreading silly delusions like every few of your male neighbors and coworkers is screwing his own children. If it is really that widespread the let everyone come out and show how society functioned through the decades with it! But it's not happening .
I'll grant that something like this can start happening if incest porn increases. Porn does seem to influence sexual behavior. Anal sex in practice rose after it became popular on porn and so did choking and now according to orgs like Fight the New Drug, porn is becoming more incestuous. If 2 million men out of a billion fathers in the past had a predilection towards incest fantasies then itd possible 1 percent of them actually commit it. This is just an example. Now let's say porn manages to spread it to those beyond the 2 million in a billion that naturally have the fantasy and make it 20 million. If the rate of those who act on it is constant, this is a tenfold increase. Or 9fold increase but you get my point.
One method to deal with this is encourage men who are having this fantasy to remember to keep it in their head and never act on it. Another is ask them to not have any daughters themselves only sons. A third is to have government interventions banning incest porn along with powerful viruses sent to porn websites to force it underground. As recent years have shown. Censorship in the modern era really does seem to shut things down. Finally we can start raising the penalty for those who act on it. One case stuck in my head is the man caught raping his 12 year old girl and the judge gave him a few weeks after his church backed him up and said hes a reformed guy....I would say the utilitarian method is to publicly and brutally execute such people to eliminate the threat and spread fear into the hearts of those who could be willing.
But I bet you 90% of these "cases" from back then are probably fake and most of these are just women who want some extra sympathy and care in their therapy sessions.
"Retrospective data were entered anonymously by 1,521 adult women using computer-assisted self-interview. Nineteen were classified as victims of father-daughter incest, and 241 were classified as victims of sexual abuse by an adult other than their father before reaching 18 years of age. The remaining 1,261 served as controls. Incest victims were more likely than controls to endorse feeling damaged, psychologically injured, estranged from one or both parents, and shamed by others when they tried to open up about their experience. They had been eroticized early on by the incest experience, and it interfered with their adult sexuality. Incest victims experienced coitus earlier than controls and after reaching age 18 had more sex partners and were more likely to have casual sex outside their primary relationship and engage in sex for money than controls. They also had worse scores on scales measuring depression, sexual satisfaction, and communication about sex than controls."
Note that father-daughter incest is rare in general and also rare compared to sexual abuse by other men. Also note that the study leaves out males younger than 18, even though they are capable of sexual assault, and some of them are family members.
I don't know what you've been seeing, but a lot of accounts of sexual assault, statutory rape, etc. are *not* father-daughter rape, and I'm wondering whether you're conflating anger about the whole situation with father-daughter rape.
Maybe I got mixed up i was just referring to father daughter rape in my comment. There is simply no way it was common back then.
That being said caretaker abuse in general could have happened a lot. Step parents or byofriends who moved in are extraordinarily more likely to abuse young girls in the house so it wouldn't be surprising to me if some polls show something like 240/1500 girls are victims of this.
>a claim that there was total denial of it occuring before the 1980s.
When an older person talks about how the world worked "back in the day", they're usually talking about how things were in their house, or street, or part of town. Social bubbles.
Greg Cochran once spoke to an old woman who assured him that single mothers had it much easier back in the old days. "Back then, you'd have a servant cooking and cleaning for you, you see."
I don't buy it either. Maybe people talked about child sex abuse less in the past, but I don't think it's true that nobody was aware of it. One of the great scandals of the Victorian era involved an expose of child prostitution, for example.
I know that older psychiatrists confirm that this was how things worked when they were young, so I'm more likely to believe it. There also seem to be a lot of stories (eg Catholic priests, etc) of the form "huh, this kind of sexual abuse has been going on for decades and we never paid attention to it before, seems bad".
Well that's the claim, but I've never heard people actually say "yeah we knew this was going on, but we didn't think it was a problem". Now obviously there's a lot of incentive to present things a certain way for them, but the reactions of the Catholic Church at the time, even if they did tend towards the cover-up, indicate a belief that it being public knowledge that priests were engaging in sexual activity with children would produce a strongly negative reaction.
"a lot of the educated opinion has switched over to crimkadid’s view (see eg McGrath 2008), which calls the uniformity hypothesis a “dogma”."
I'm interested in this, because Ireland allegedly has a high incidence of schizophrenia. Or allegedly had. Looking up online I can't access the full text of various studies but there does seem to be a ding-dong going on about this ("your study figures are crap" "come outside and say that to my face").
From the scraps I can glean, this seems to be due to:
(1) Irish emigrants turning up in America were hospitalised for schizophrenia at a high(?) rate
(2) Irish schizophrenia was seen to be a rural, rather than urbanised, illness (not surprising there) particularly elevated in the West of Ireland
(3) Revision on this later claims it was because patients first treated/hospitalised for it were using the medical services afterwards as a replacement social support scheme, so they were turning back up to be re-admitted to hospital (I'm torn on this one, as Irish hospitals are not a luxury experience but on the other hand if you're an Irish bachelor farmer in your 60s living up a mountain with nobody but the ghosts and the sheep for company, even an Irish hospital is better than that)
(4) Summation seems to be that Ireland does *not* have an unduly high rate but it's in line with other countries, which would seem to be on the side of uniformity rather than cultural difference?
Unless the "rural support system" hypothesis is true, and countries elsewhere also have people using the medical system as an ersatz community, so the actual incidence of schizophrenia is pretty much the same all over, but hospitalisation rates differ due to "the doctors said I needed aftercare so here I am, please admit me".
On the other hand, this report from 2019 tells a different story? Or at least, that hospitalisation figures remain high in Ireland:
"One-third of all in-patients on census night had a primary admissions diagnosis of schizophrenia, 16% had a diagnosis of depressive disorders, 10% had a diagnosis of organic mental disorders and almost 8% had a diagnosis of mania. Patients with a diagnosis of schizophrenia had the highest rate of hospitalisation, at 16.0 per 100,000, followed by depressive disorders, at 7.9, organic mental disorders, at 4.7 and mania, at 3.6.
Males had a higher rate of hospitalisation for schizophrenia than females, at 20.2 per 100,000 for males and 11.9 for females. Similarly, males had a higher rate of hospitalisation for organic mental disorders, at 5.6 compared with 3.9 for females. In contrast, females had a higher rate of hospitalisation for depressive disorders than males, with a rate of 9.2 for females and 6.6 for males.
Those with a diagnosis of schizophrenia had the highest rate of hospitalisation amongst all age groups in the 20–74 years age range, with rates ranging from 37.5 for the 65–74 years age group to 9.5 for the 20–24 years age group. Both schizophrenia and eating disorders had the highest rate of hospitalisation amongst the 18–19 years age group, at 5.9 each respectively. Organic mental disorders had the highest rate of hospitalisation amongst the 75 and over age group, at 52.6 per 100,000.
Schizophrenia also had the highest rate of hospitalisation in six of the ten socio-economic groups (farmers, agricultural workers, non-manual, manual skilled, semi-skilled and unskilled), while depressive disorders had the highest rate amongst higher professionals, lower professionals, employers and managers and own account workers.
...Schizophrenia continues to be the predominant diagnosis in adult units and hospitals, accounting for one-third of all patients resident, while depressive disorders was the predominant diagnosis amongst the under 18s, accounting for 37% of all under 18s. The proportion of in-patients with a primary diagnosis of schizophrenia remained at a similar level (34%) in 2010 compared to 33% in 2019 while the proportion of in-patients with intellectual disability declined from 6% in 2010 to 4% in 2019."
If we assume that survivor's guilt is some kind of game-theoretic mechanism to prove your innocence, then we could expect that this only kicks in for very taboo things. If you did not know that what happened to you is taboo, then there is no need to prove your innocence with survivor's guilt (of course, getting survivor's guilt is not a *conscious* process, but I hope you get what I mean). But once you learn about how horrified everyone is of your experience, the survivor's guilt starts.
The idea is, in part, that people evolved to be traumatized when raped so that other people wouldn't blame *them* for what happened. Similarly with survivor's guilt - "If everyone else dying was what I *intended* to happen, would I be so miserable right now?"
> Other commenters bring up related arguments - doctors sometimes examine children’s genitals in ways that aren’t obviously different from what goes on in some child sex abuse cases; some tribes have rituals where adults do weird things to children’s genitals - in all these cases, because it’s socially accepted and people aren’t “supposed to” feel traumatized, they usually don’t.
I feel compelled to bring up a counter example. The first time I ever had sex, it was not consensual. I felt powerless and upset, but it was with my first boyfriend and it was not scary, and it didn't map to my expectation of what rape would be like, so I quietly accepted it and did my best to accept that my life now included this activity. I even came to kind of enjoy sex with him, sometimes.
I only went to a gyno much later, after we'd broken up for entirely unrelated reasons. And then, while they did the pap smear, I felt completely violated and vulnerable. The weight of every unwanted touch I'd ever had from my boyfriend seemed to come crashing down on me. It felt much more traumatizing than all of these previous experiences, even though the doctor was perfectly nice and as far as I can tell did everything right.
My reactions don't really make sense to me, but they don't really track with the view that going to the doctor is not traumatic either. I can easily be convinced that if I had no history of sexual assault, then the doctor visit would have gone way more smoothly, and I guess it was just a trigger and not its own trauma per se. But it feels like it was its own trauma anyway.
I haven't had sex since then, even though it's been years and I've had the opportunity several times. After realizing I actually had the choice to say no, it has always felt more compelling to exercise this choice, even though I am aware people seem to enjoy sex a lot and I might too if it was actually under my control.
And I haven't gone to the gyno again, even though I know I should, but it just feels unbearably scary.
All of that said, I don't think I have meaningful PTSD symptoms right now. Looking back, I do think I experienced them while I was dating that first boyfriend, but I attributed them to a previous sexual abuse experience that felt much more terrible and scary, even though it was not under the umbrella of what is normally called rape.
"Phobia" is an overstatement, but I avoid going to the doctor as much as possible and generally seem to feel more of an aversion than most people do, despite having a mild tendency to worry about my health. Part of the trouble might be that I do have a genuine phobia of needles, and obviously those come up a lot in medical contexts.
I'm sorry to hear about what happened to you. I don't think it contradicts my point in that section, which is that absent some context, most people don't seem to interpret exams by doctors in that way. It sounds like you had a lot of especially scary context, and the exam was the trigger for it to activate.
On the second paragraph of the last entry: incentives create results. If there are (monetary) benefits of being sick, people will make themselves believe they are sick (psychologically or otherwise). Obviously this is not the case for everyone.
I am always amazed how many people in my country (the Netherlands) are on semi permanent sickleave so to speak: 817.000, 6.6 % of the working population. And this in a country with a very good, in practice free, healthcare system.
Other benefits are: getting attention and not having to take responsibility.
A country clearly gets as much sick leave as it's ready to pay for. Sweden had a sick leave rate of 5.5%, and more than halved it through some simple, fairly moderate reductions and checks in the 90's.
Disability rates in rural white America seem to be the same kind of thing.
> it’s strange that the PTSD symptoms associated with details of modern combat (ie a “soldier who doesn’t know when the next enemy might appear in a crowd of civilians”) so closely resemble the symptoms modern people get after natural disasters, sexual violence, etc.
A commonality I see with those three cases is a traumatizing event happening at an unpredictable moment in an environment you can't escape.
Your mind will work very hard to protect you from experiencing the enormous event again, so will pattern match even the tiniest details as possible warning signs. There is no such sign, but your mind will not take any chances, those rustling leaves might be a tiger after all.
But that clear lack of warning signs will also cause you to relive the event; the definitive signs haven't been found, so we must keep looking.
All the while you have a list of candidate signs, so every time one of those signs pop up: better safe than sorry, let's get that fight-or-flight going.
Wouldn't it be fascinating to test which Western psychiatric interventions work cross-culturally, and which don't? Presumably medication would be better at it than psychotherapy, for instance? Then we will have data on which interventions are just our own witch-doctor treatments.
Discussion of war previously as a positive good and the lack of connection to PTSD has me thinking about how it may influence groups ('cultures,' but not really) that have similar worldviews today, whether that be terrorist organizations, rebel groups, militias, etc. I'm sure research into PTSD and associated trauma rates in those populations is exceedingly difficult, but maybe there's something out there?
Your explanation of child sex abuse sometimes not causing trauma definitely makes sense, but curious about an alternate theory... It does cause underlying trauma, but in ways that do not manifest directly in a person's life until it's directly discussed as taboo. In that case, couldn't it be seen as a positive that it's brought to the surface (making some kind of treatment possible) rather than unconsciously dealt with?
Maybe? An alternate theory is that it stays a background thought that doesn't interfere with daily activities or major life goals, and the person lives the rest of their life without experiencing the significant trauma. Treatment isn't always a distinct positive, if the alternative is never needing treatment. If there is an ongoing psychological distress that's never dealt with, and it can be successfully dealt with and the patient has no further distress, then bringing it to the surface makes sense. I am highly doubtful that scenario plays out very often. Most of the people I know who seek psychiatric care never get to a point where they can say "I was cured of my X!" Instead, they learn coping mechanisms and the trauma impacts their lives less. Isn't that where we started before we told them they were traumatized and made them deal with it?
That sounds like you really want there to be trauma to find. Which from reading the review, this article and both comment sections happens frequently when westerners are in a foreign context, so I'm not blaming you.
The story above of a western woman in an african village encountering someone recalling "attempted rape" while they and the village were laughing about it and the known "perpetrator". There's nothing to diagnose and nothing to treat there. If you, however, spend significant time as an authority (psychiatrist) insisting that there is a trauma there, I'd be very careful with the eventual - noteworthy parallel! - confession. If it wouldn't hold in court, maybe it shouldn't hold as diagnosis.
There's politician's from the green/alt/hippie crowd who on-the-record said some thirty years ago that we should legalize pedophilia because their own experiences were fine and this all just hysteria. These politicians are still in office/voted to this day and those comments resurfacing recently caused a scandal:
There were a few anti-age of consent etc. groups like the Pedophile Information Exchange who gained a bit of support among some leftist groups during the 1970s, but wider public opinion was always strongly against them. Probably part of it can be blamed on things like the legalisation of homosexuality and a general wave of sexual liberation encouraging people to take a more negative view of formerly sacroscant ideas about sex. To characterise this as being about "elites" is almost certainly highly misleading.
R.e. Kentler, this is an issue where there's a lot of hindsight bias, and the current narrative on child sexual abuse denies any possibility other than that Kentler knowingly and deliberately sacrificed children to pedophiles.
Growing up, I was taught that one of the important differences between Judaism and Christianity is that Judaism teaches that you should do right things and right thinking will follow, whereas Christianity teaches that you should believe right things and right actions will follow. And that this leads directly back to the central directives of each religion; “keep the mitzvot” and “believe in Jesus”, respectively.
Regardless of whether these ideas are prevalent in the West because of their respective religious teachings, it really feels to me like the field of psychology presupposes that right actions can only come from right thoughts. Perhaps they have to; it might be a very different field otherwise. I personally think they’re wrong and one of the themes I see in this Crazy Like Us discussion is pushing back and suggesting that in fact, contrary to what psychology teaches, right thoughts lead to right actions.
My experience with CBT is the opposite of this. A lot of it is about doing behaviors that are not natural until they become a habit, and the positive effect of that habit
I'm confused "presupposes that right actions can only come from right thoughts" and "contrary to [this[, right thoughts lead to right actions" seem to mean the same thing - was one of them meant to be in the opposite order?
I don't know how so many great psychologists being Jewish would fit into this model.
Sorry for the confusion! Serves me right for attempting to operate a keyboard while not under the influence of coffee. The last line should read "suggesting that ... right actions lead to right thoughts", as you probably guessed.
I do think "actions lead to thoughts" has less error with the cases being discussed than "thoughts lead to actions", but on reflection the case for the pure statement isn't as strong as I made it sound.
On the one hand, I think it may have a strong explanatory component for the differences in soldier traumas in modern wars. Not only did the circumstances of those wars change, as you quoted, but the training changed with it. For example, after WW2 the US Army felt that soldiers in the war had acted with insufficient aggression and initiative under fire, and changed basic training to more of a vigilant and aggressive mentality now dubbed the "warrior" mentality. (Out of combat American forces showed far more initiative than, say, highly regimented German or Japanese forces.)
Now, it's not like ambush or surprise was invented in Iraq or Afghanistan or even Vietnam. War has always contained situations only partially in soldiers' control. And while the Germans often followed the laws of war, the Japanese most certainly did not. But is it surprising that the guys trained to maintain vigilance and act aggressively have more vigilant and aggressive trauma than the guys trained to dive for cover and stay in it? I can't speak to the subtleties of the training that, say, hoplites got, but the modern case feels like it could easily follow from the actions as much as the mindsets.
The pure "actions lead to thoughts" model gets harder to square with, say, the cases of CSA that became traumatizing later. In those cases there is a clearer argument that actions and a meta level of thoughts together lead to traumatic feelings. A "how should I feel about myself given what happened" layer, if you will, which can not only change but apply retroactively. And that layer would seem to be highly social and prone to reprogramming.
Perhaps it's slight of hand with both simplistic models that they presume a singular notion - their own - of right thoughts and right actions.
As to why the Jewish teaching wouldn't be more prevalent in psychology despite a prevalence of Jews in psychology ... I don't know! It's a fair question and I don't yet have a good answer. Perhaps it's not actually a widespread Jewish teaching. Perhaps the Jews who go into psychology are unusually interested in how the mind works, and predisposed to the notion that right thinking leads to right actions.
@Randomstringofcharacters
Yeah, behavioral therapy really does run with the idea that right actions lead to right thoughts. I had the impression that CBT was still not really the mainstream, and that the "you have bad thoughts that cause you to do bad actions so let's give you drugs" was the more established orthodoxy. Is that not so?
America and Britain vary. Britain (apart from the blow-back from invested psychiatric and psychological practices) is largely pro-CBT. Behaviours affect thoughts is a core tenet of change.
However, if you have the time and skill, then examining schemas by breaking down thoughts, underlying assumptions, and core beliefs can also affect change.
T&CA, E&OE: my anecdotal experience tends to favour behavioural change as easier to implement and efficacious. YMMV.
Regarding creating trauma, one thing I *think* I've noticed by hanging out with some not-large-but-not-trivial number of Asian families is that how they handle bodyweight issues with kids seems better. If the kid is putting on weight, mom says "Hmm, you're getting a little fat so I made you a smaller plate". That's it. In contrast, American parents (or the stereotype of them at least) is to talk between themselves for a while to figure out how to approach the child gently about their weight, and when they finally do manage to say something, preface it as if they're preparing to tell them all the puppies in the world died, causing the kid to think their weight is a serious world issue and to subsequently experience anxiety about it.
Interesting! although I disagree re: American parents trying to be nice about it, usually one of the two reaches straight for the shame and goes to TOWN.
Re: "I wouldn’t expect there to be enough people witnessing each other’s interactions with schizophrenic family members for this to spread across a culture. Maybe this is downstream of biological views of mental illness or something?"
I don't know, but best guess for the "Crazy Like Us" viewpoint is that a culture-bound "response to mental illness" role could spread through a society in a similar way to how a culture-bound "mentally ill" role spreads. So the depiction of John Nash in "A Beautiful Mind" influences how mental illness expresses as schizophrenia, just as the depiction of his wife Alicia influences how companionship expresses as a particular caretaker/illness-adjacent role within a family?
But, if you follow this idea, you would expect to see a change in this caretaker role accompany changes in the cultural expression of the illness, if the two are related. Maybe it would be easier to see for low-stakes common ailments like "how the rest of the family reacts to one of them getting a cold". Is there a lot of variation in this too, world-wide? And is that influenced by e.g. a character on an American TV show getting a cold, which is broadcast in Europe?
Also, culturally a lot of parents globally could be in the unique situation where right now is the best and maybe only time to get a child into college and therefore the english-speaking elite. That leads to immense pressure on an entire generation in that country where every child not destined to go to college or speak 3 languages by 15 is a disappointment.
Extrapolate to anywhere inbetween or after to get to the US now. Accruing college funds and a third mortgage only for the ADHD / depressed child to fail after 2 years... There's gonna be some expressed emotion in some households for sure!
About natural disasters and PTSD: I wonder if the abundance of information about natural disasters is contributing to duration and severity of anxiety etc people experience afterward.
I'm working off my own experience so I'll try to keep my example brief and dispassionate:
Talent/Phoenix, Oregon last September:
-We had no warning about the Almeda fire, the emergency alert system was not activated, and everyone evacuated at the last second. Three people were killed and 2500 structures burned.
-After the fire, everyone was distraught over the lack of information, so people turned to sharing their own information on Facebook: countless videos of burned neighborhoods, false reports of new fires, pictures of actual fires popping up all over the place.
-Residents also tuned into the police FB page, the fire department FB page, the police scanner, and ever-updating county evacuation maps.
-A major wildfire burned in the Rogue National Forest nearby, inundating the whole valley in thick smoke, and details of this fire were continuously posted/updated.
Given all this information, the residents of Talent and Phoenix lived with a sense of "nowhere is safe" for an extended period post-fire. Some people ended up with PTSD diagnoses, others didn't, and whether they lost a house didn't seem to matter. The people who I saw showing continuous signs of stress and anxiety happened to be those who continued to believe that nowhere is safe.
Of course, the *feeling* that nowhere is safe is a symptom of PTSD, and one that I've experienced. But as I notice my unsafe feelings abating with time/exposure/therapy, I'm seeing people who experienced far less trauma in the wake of the fire display more anxiety about fire season.
I wonder if the exposure to fire-related information is exacerbating their anxiety.
How this relates to the article and discussion: high exposure to information about what is happening in the world this very moment is a modern phenomenon.
My recent ADHD diagnosis has radically rocked my worldview even though it's been consistently suggested since I was in kindergarten to explain various issues. Some deeply un-rigorous thoughts:
1) I have really resented the outpouring of support and kindness from my "progressive" friends - the underlying sentiment appears to be that now I am no longer responsible for anything I do, and that attempts at self improvement or management (other than taking Adderall) are delusional in some way.
2) As Scott suggested, a mental disorder for which 5-10% of people meet the criteria is not a mental disorder. It's just "a way some people are." If we have built a society in which 5-10% of people need to be medicated in order to function, that strikes me as a dysfunctional society, not a society with a lot of dysfunctional people.
3) On the other hand, if Adderall is really as safe and effective as claimed I don't see any reason why 100% of people shouldn't be on it. :P
4) Scott also points out the obvious: a huge part of my struggle was navigating a career I'm bad at. Billing hours makes incentives run precisely backwards. Legal culture is obsessed with stereotypical "lawyerly image" over productivity.
There is limited room in the legal world for a person who is useless from 7-10AM every morning but can knock out an excellent brief at 10pm after a shower thought leads to a new idea for argument. That doesn't project a lawyerly "image" and costs the firm money - If most of your "work" gets done as a background process while you're faffing about, is that billable time?
tl;dr: "Being a bad lawyer" is not a mental disorder. Most people would make bad lawyers.
But more than that, my ADHD diagnosis is cultural in more ways than just "my society has more psychiatrists, and they need something to do." It's also a consequence of society being more global - I need to sell myself to strangers whose incentives include fast, System 1 judgments, and for whom taking a while to evaluate my unique strengths and weaknesses would be an unconscionable waste of time and energy. I am expected to have very set on-hours and off-hours and to conform to the appearance of productivity, even if that's not how my natural cycle works. My usefulness is measured in ways that fail to show me in a good light.
And, yes, perhaps most importantly, I expect to self-actualize as a lawyer/mathematician/rocket scientist/fitness guru/polymath instead of as a sustenance farmer who survives past 25 years old.
I'm inclined to treat all these things as negatives because they exclude me, even though most are decidedly not - set work hours are a win for most people. Performance metrics *should* overtake personal feelings that are often prone to bias. The availability of multiple life paths and resources to pursue them is a mostly unqualified good.
And yet these almost entirely positive things gave me ADHD :P.
Having just recently watched a video from an attorney who hates working for billable hours (has only done it once in his career), I would note that if you start your own firm and work on contingency, you don't have to. May or may not be possible for you, but something to consider.
I agree that medicalizing common behavioural and psychological traits is one of the things that is problematical with modern medicine. Don't allow a diagnosis to control who you are, only use it as a tool to make the best of your life.
I tend to think of myself as scatterbrained, not ADHD, for exactly this reason. In a pre-modern culture I'd just do my thing and nobody would notice.
I noticed that bullshitting your way into an appearance of productivity is the #1 skill of high-functional ADHD people, myself included. Nobody needs to know 90% of the work gets done in a few hours per week.
Billable hours are ridiculous. People pay for an outcome, not the time it took you to get it. Fee for service is the future.
Also, speaking as a lawyer with ADHD, the number I know with it is very high. It may not be particularly compatible with large-scale corporate law. That's not the same thing as it being incompatible with law.
Also also, the fact that people with ADHD often have non-attention related symptoms that respond to medication that they also share with others suggests it is a real disorder, rather than just a way people are. Or, more likely IMO, a collection of disorders with similar symptoms.
Besides that, 23% of adults have arthritis. Still not how things are supposed to work. ADHD may not be particularly unusual. That doesn't make it how things should work.
I've had several positive reactions to medication that aren't attention-related:
1) A decrease in obsessive thoughts and anxiety
2) A decline in taking very casual criticism way too seriously
3) Building consistent priorities instead of changing them every 18 seconds
4) An increase in planning and execution ability.
5) A more consistent sleep schedule for a 9-5 work schedule.
I agree this is a life improvement - I disagree that it would be a life improvement in all societies. In a world where smaller communities live and die by their shared contributions, my unique strengths (which are numerous) would be discovered over time while the weaknesses would be compensated for.
That society isn't better. It's probably worse. And I'm not saying ADHD folks shouldn't be medicated. Medication has improved, and potentially even saved my life. But unlike arthritis treatment - which is our fight against the breakdown of the body, ADHD is innate and not entirely destructive. That, ADHD's prevalence, and a social philosophy that there is a "correct" way to be a person, makes me wonder if we are engineering people to fit a society when the society should serve the people.
An ADHD individual cannot autonomously perform all the functions we require from office workers. But they can be part of a powerful team. There are organizations that take advantage of this, and they are winning. Probably even in law. But not in law in my locality, where the profession is fairly conservative and old-school.
A tangent (in this post about ADHD, lol), but I notice this a lot in Scott's blog circle. The assumption is that people who are not "The Correct" kind of person still have a place in every profession in every location, as long as they have value to add. But in most of the country, the culture is stronger than the market. And in most of the country, the culture does not like having preconceptions about how they do things challenged.
I second the finding that PTSD was virtually unheard of in ancient soldiers. I also looked through the examples people usually cite, and they're thoroughly unconvincing. For example, one was that Roman slave sellers had to inform buyers if the slave had ever been attacked by a bear. The reasoning goes that if the buyer is worried about physical impairments from the attack, he can easily see them himself, so he must be worried about PTSD.
This is even more surprising because of how common war was for ancient people. In Rome, the gates of the Temple of Janus were open in wartime and closed in peacetime. The gates were open continuously from 225 BC to 29 BC. Also, it was standard for Rome to fight with two consular armies of two legions each, for a total of 20,000 men, half of which were Roman and the other half Italian allies. The population of Rome in c. 200 BC was maybe 500,000 people, so this was 4% of the male population under arms at any one time. Since there was no professional army and levies were conducted annually, the percentage of the male population with military experience is probably >15%. In comparison, modern USA has 0.8% of its male population under arms, and most of those have never been near an active combat zone.
"In Rome, the gates of the Temple of Janus were open in wartime and closed in peacetime. The gates were open continuously from 225 BC to 29 BC." Indeed; and not only that, the Res Gestae Divi Augusti claims that before the reign of Augustus they were only ever closed *twice* – the first time by the semi-mythical (or perhaps entirely mythical, but this I doubt) second king of Rome, Numa Pompilius.
Here's an experiment: Let's make up an entirely new form of mental illness with realistic sounding symptoms, and then try and spread awareness of it somewhere. If the ideas in "Crazy Like Us" are correct, maybe we'll see an epidemic of this new mental illness.
What if we invented a mental disorder that was secretly all positives? WE ARE WORRIED ABOUT AN OUTBREAK OF ALTRURISMITIS, AN ALARMING MENTAL DISORDER WHERE PEOPLE GIVE ALL THEIR MONEY TO EFFECTIVE CHARITIES. WE ARE DEPLOYING THERAPISTS TO TREAT IT AT ONCE.
Let's design a catalogue of easy to spot, largely harmless disorders and symptoms for all possible underlying stresses. Then treat those for all eternity.
If we truly have that power then we have to recognise that any and all current catalogues are made up nonesense, in part by patients and in part by doctors without any intent from either party. We would have decided to just cement the status quo, however bad it is, onto paper. Let's change that, then!
re sexual abuse and cultural expectations: this reminds me of an anthropology paper about how people in different cultures experience rape differently because of their beliefs about its severity
From Christine Helliwell's "'It's Only a Penis': Rape, Feminism, and Difference" (CW is self-explanatory):
"In 1985 and 1986 I carried out anthropological fieldwork in the Dayak community of Gerai in Indonesian Borneo. One night in September 1985, a man of the village climbed through a window into the freestanding house where a widow lived with her elderly mother, younger (unmarried) sister, and young children. The widow awoke, in darkness, to feel the man inside her mosquito net, gripping her shoulder while he climbed under the blanket that covered her and her youngest child as they slept (her older children slept on mattresses nearby). He was whispering, "be quiet, be quiet!" She responded by sitting up in bed and pushing him violently, so that he stumbled backward, became entangled with her mosquito net, and then, finally free, moved across the floor toward the window. In the meantime, the woman climbed from her bed and pursued him, shouting his name several times as she did so. His hurried exit through the window, with his clothes now in considerable disarray, was accompanied by a stream of abuse from the woman and by excited interrogations from wakened neighbors in adjoining houses."
"I awoke the following morning to raucous laughter on the longhouse verandah outside my apartment where a group of elderly women gathered regularly to thresh, winnow, and pound rice. They were recounting this tale loudly, and with enormous enjoyment, to all in the immediate vicinity. As I came out of my door, one was engaged in mimicking the man climbing out the window, sarong falling down, genitals askew. Those others working or lounging near her on the verandah - both men and women - shrieked with laughter."
"When told the story, I was shocked and appalled. An unknown man had tried to climb into the bed of a woman in the dead, dark of night? I knew what this was called: attempted rape. The woman had seen the man and recognized him (so had others in the village, wakened by her shouting). I knew what he deserved: the full weight of the law. My own fear about being a single woman alone in a strange place, sleeping in a dwelling that could not be secured at night, bubbled to the surface. My feminist sentiments poured out. "How can you laugh?" I asked my women friends; "this is a very bad thing that he has tried to do." But my outrage simply served to fuel the hilarity. "No, not bad," said one of the old women (a particular friend of mine), "simply stupid.""
"I felt vindicated in my response when, two hours later, the woman herself came onto the verandah to share betel nut and tobacco and to broadcast the story. Her anger was palpable, and she shouted for all to hear her determination to exact a compensation payment from the man. Thinking to obtain information about local women's responses to rape, I began to question her. Had she been frightened? I asked. Of course she had - Wouldn't I feel frightened if I awoke in the dark to find an unknown person inside my mosquito net? Wouldn't I be angry? Why then, I asked,
hadn't she taken the opportunity, while he was entangled in her mosquito net, to kick him hard or to hit him with one of the many wooden implements near at hand? She looked shocked. Why would she do that? she asked - after all, he hadn't hurt her. No, but he had wanted to, I replied. She looked at me with puzzlement. Not able to find a local word for rape in my vocabulary, I scrabbled to explain myself: "He was trying to have sex with you," I said, "although you didn't want to. He was trying to hurt you." She looked at me, more with pity than with puzzlement now, although both were mixed in her expression. "Tin [Christine], it's only a penis," she said. "How can a penis hurt anyone?""
I'm quite surprised that women in any pre-modern society wouldn't see rape as a serious form of harm simply because of the associated risk of unwanted pregnancy, particularly in a context without reliable contraception and where childbirth was life-threateningly dangerous.
(I remember reading about a disturbing provision in a medieval Serbian legal code which specified the compensation to be paid by a man who raped someone else's female slave, impregnated her, and caused her to die in childbirth. The fact that this apparently happened often enough that they had to make a *law* dealing with it really says something.)
" About 75% of my aunts / uncles were abused / raped. Around 20% of the boomer friends I have that I’ve had deep conversations with have shared stories with me of them being raped / sexually abused as children. I think the actual real prevalence based on my own experience is probably somewhere between 20%-50%.
[...]
This was puzzling, as the standard textbook of psychiatry at the time stated that incest was extremely rare in the United States, occurring about once in every million women. Given that there were then only about one hundred million women living in the United States, I wondered how forty seven, almost half of them, had found their way to my office in the basement of the hospital."
Taken together, Robert McIntyre seems to be implying 20-50% of boomer women were raped by their immediate family. I won't say I don't believe it, but I will say that extraordinary claims require extraordinary evidence, and this is definitely an extraordinary claim.
Re Holocaust survivors: here in Israel it's accepted as common knowledge that Holocaust survivors suffer from some type of ongoing trauma response, and moreover that their behavior inflicted trauma on their children. Saying that your parents survived the Holocaust is tantamount to saying that you were traumatized by your parent's response to their Holocaust experience. I'm sure there are studies on this.
Although perhaps the point is that most of the survivors and their children were and are productive member of society and therefore not "disabled"?
A really interesting but understudied-for-obvious-reasons property of lots of disruptive social movements of the post-war era is that they were founded and driven mainly entirely by Jewish people born during or just after WWII (I originally wrote "born to Jewish people whose lives were disordered by WWII" but then realized this was pretty much tantamount to all of them, a nonsense distinction). It's extremely hard to discuss this, of course, since the immediate assumption is that the speaker is some sort of armwaving antisemitic kook, but nevertheless it's factual and easy to substantiate.
Feminism is a particularly clear example, with nearly all prominent "second-wave" (a.k.a. actual, since the first wave didn't call itself feminism and had no social or intellectual connections to the second, in fact the suffragettes were typically at odds with the feminists) feminists fitting this bill. Abzug, Firestone (Feuerstein until her father felt the need to anglicize the surname), Friedan, Koedt (whose parents were part of the Danish Resistance), Sarachild (Amatniek until her feminist convictions led her to adopt a matronymic), Steinem (actually born a couple years before the war proper, but on the other hand her paternal grandmother is noted for successfully saving many members of their extended family from the Holocaust)... Germaine Greer, oddly enough, was born to Catholic parents but *wanted* to be Jewish to a bizarre and unusual extent which just makes the whole situation even stranger (she openly admits to having learned Yiddish and exclusively dated Jewish men during a period of her life, for example). Even feminists seen as part of a later generation, like Susan Faludi (whose father was a Holocaust survivor), match the pattern to a much higher degree than chance would predict.
To cut a long story short, I think there's probably a great deal in the idea of the Holocaust as a disruptive, alienating intergenerational trauma.
Later generations of Jews are still disproportionately involved in social movements. And since you just refer to the Holocaust/WW2 as having affected them all, you have no control group.
I had not heard that the suffragists were typically at odds with the feminists.
"Later generations of Jews are still disproportionately involved in social movements. And since you just refer to the Holocaust/WW2 as having affected them all, you have no control group."
I agree that this is a problem, but I think that if you compare them to *previous* generations, you might be able to cobble together something resembling a control group.
"I had not heard that the suffragists were typically at odds with the feminists."
Here's a brief anecdote told by Barbara "Definitely Not Jewish" Mehrhof (from an article by Susan Faludi on Shulamith Firestone, on the occasion of the death of the latter from mental-illness-induced self-starvation, allegedly in the middle of a kabbalistic diagram on the floor of her apartment):
In January, 1969, on a trip to Washington, D.C., Firestone and a couple of other women knocked on the door of Alice Paul, who had written the original Equal Rights Amendment, in 1921, and who was then in her eighties. She ushered them into a dark parlor, where old National Woman’s Party literature was spread out on the tabletops. “She was very suspicious of us,” Barbara Mehrhof, one of the visitors, recalled. Paul pointed to a wall of framed oil portraits of formidable-looking women—all suffragist leaders—and demanded that they identify them. “We didn’t have any idea,” Mehrhof said. “Which was just emblematic of the whole problem: how can we pass the torch when we don’t even know who we are?”
This story is pretty typical of the interactions between feminists and surviving suffragettes; the suffragettes felt that the feminists were ignorant, respectless and especially, spineless – trying to eke out special considerations and advantages, rather than demanding strict equality of rights, a perfectly even playing field; effectively, from the suffragette point of view, admitting to being the weaker sex. The feminists, for their part, felt the suffragettes were stuck in an outdated mentality of what equality and liberation meant, and (especially in the US) were appalled by their racism. Here's Stanton, for example:
"If woman finds it hard to bear the oppressive laws of a few Saxon Fathers, of the best orders of manhood, what may she not be called to endure when all the lower orders, natives and foreigners, Dutch, Irish, Chinese, and African, legislate for her daughters"
And Anna Shaw:
"You have put the ballot in the hands of your black men, thus making them political superiors of white women. Never before in the history of the world have men made former slaves the political masters of their former mistresses!"
IIRC Shaw was also the one who bitterly remarked in a private letter to another suffragette on the occasion of the 15th Amendment: "There – that shows you what men think of us: lower than niggers". Needless to say (I hope), this stuff did not go over extremely well with the feminists.
This whole discussion (and review) kind of surprised me, I have to admit, because I always assumed that it was sort of obvious and uncontroversial that all this stuff like anorexia and transsexualism are conversion disorders. Basically, conversion disorders used to be simple, obvious physical things like turning blind or hysteric paralysis, but then we developed tools to test these (e.g. reflex hammers) which showed that they were entirely psychologically induced, so then the disorders gradually shifted toward vague, hard-to prove conditions like anorexia, fibromyalgia and gender dysphoria, where the doctor couldn't just look at your tongue or something and say "nope, no trace of that here, your body is working perfectly normally as we've just proved, so it's all in your head".
This entire book + review + the above seems like the start of an entirely new thing.
If we have indeed produced these current disorders by elimination of all else, that immediately suggests that psychology as a field could set the goal of "designing a catalogue of easily diagnosed and largely harmless outlets for various underlying stresses".
Instead of trying to fence in a disorder pudding with "I can't confirm your symptoms" nails, how about building a proper funnel into a bowl and then treating that?
I doubt that would work. Looking at the history of conversion disorders it seems obvious that part or even all of the *point* is to dodge classification of one's problems as a mental issue -- the "conversion" is that of a mental issue into a physical one, and whenever the physical issue is shown to be somehow bogus, it disappears, whereas popularizing specific conversions spreads them. In other words these disorders are perverse in the sense of actively defying being pinned down or defined: herding them into some sort of funnel will just get people to convert to issues outside the funnel.
I see this as an argument for designing the perfect conversion disorders.
As soon as you dismiss one, another pops up randomly. So why not design a harmless and easy-to-spot one, raise "awareness" for that and tell doctors to not dismiss them, but diagnose them immediately for the underlying issue. People don't switch conversion disorder symptoms because they've been discovered, but because those symptoms didn't get them treatment! Let's fix that before the symptoms become cutting and starving and such!
Oh, also: "A second counterargument might be that if Western psychiatry only works because we think it does, we would probably want to know that, and then once we figure it out, it would stop working" – isn't this exactly what you yourself have written about in the past, the mysterious fact that Freudian therapy used to work great, and then it stopped working? And the same thing happened to CBT?
Further bolstered by large parts of the Placebo research.
We have to assume that once people are in a professional's medical office for the first time while spending huge amounts of money they immediately believe that they have the diagnosis and whatever's prescribed helps. Anything else would be a sign of incredible mental fortitude combined with stupid amounts of wealth, of which most patients almost per definition have neither. It's like a horrible funnel and we have to at least consider this as a possible problem.
(I'm not against psychology or doctors in any way, this just seems obvious)
With all due respect, Freudian psychotherapy never really worked because it had no real evidence base for its theoretical framework. The fact that it can provide solace is a separate matter, and I'd largely agree it's for the wealthy worried well.
As for CBT, it does have a theoretical base that is supported by evidence. However, I would be the first to agree that while some practitioners describe themselves as working within a CBT model, what the say and what they do is another matter.
Having seen the transformation of CBT by well meaning healthcare professional enticed by political support, I can fully sympathize with your perspective, because it's the right answer, but for the wrong reasons.
To be totally clear, I'm not presenting a personal thesis here – I'm referring to one Scott wrote about in an old post on SSC. I don't think I have the knowledge necessary to debate the issue myself, so I won't. I was solely remarking on what seemed to me a clear and direct parallel.
"I have a vivid memory of reading a study that basically argued this - victims of child sexual abuse don’t think or care about it much until people tell them that it’s taboo and traumatic, and which point they are duly traumatized - but I can’t find it now. [...]"
...and:
"I am sympathetic to this based on an experience I had, where I was pretty bad at tolerating noise, but kind of within the normal human spectrum and never thought much of it, and then I lived with a noisy roommate who characterized my distaste for noise as freakish and psychiatric-level, and after that, every time I heard a noise I started panicking and questioning whether I was going to have some sort of freakish and psychiatric-level reaction to it, and this became so unpleasant that now I do have a freakish and psychiatric-level noise intolerance - or at least this is how I remember it."
This reminded me of my fictional (vaguely anarcho-monarchist) micronation's definition of treason, which in summary was something like "you're committing treason if you systematically attempt to convince people that other people are out to get them". It was seen as a supreme memetic threat, because they considered it so insidiously difficult to disprove and a comfortable thought for the person(/people) who had been declared a victim. How can sudden displeasure be 'comfortable'? Well, if your social circle tells you that you're a victim, they're on some level signalling their desire to protect you, possibly even give you free stuff in apology for the thing that happened to you. It's mentally very tempting to just accept that narrative; that this can result in you feeling emotionally much worse than you previously did doesn't necessarily stop this effect.
That said, this *is* a fictional micronation we're talking about, and the effort that went into world-building was limited to what seemed like a fun thought at the time, so I don't expect this to hold up against any rigorous scrutiny whatsoever. I'm not a psychologist and the way this nation thought about this phenomenon (= that something becomes horrible once people have convinced you that it is a horrible thing), in ascribing it to social convenience for the victim, is almost surely wrong.
What it *does* tell you is that the author (i.e. me) did observe this phenomenon - largely in verself, actually! This happened a few times. The most striking time was when my mum went over my finances with me back when I was studying and convinced me I was actually poor. It was total bullshit (I was comfortable paying rent, eating, and even taking my primary out to restaurants occasionally), but it seemed *really* compelling at the time and I bought it (pun... half intended?) and cried about it. Thankfully I was lucid enough that I also kicked myself out of that false belief a few hours later.
>A responsible treatment of this would have to discuss the history of traditional societies around the world that have something vaguely similar to our concept of transgender (like “third gender” roles in certain tribes), then move on to transvestism in the 1980s, and come up with some position on how these relate to modern transgender. One interpretation might be that there is some biological substrate for gender nonconformity (eg some evolved part of the brain that is supposed to tell you what gender you are can misfire in some way), and then the way that people feeling vague anxiety about their gender deal with it varies based on the local cultural milieu.
'Traditional society' to '1980s' is missing a few steps, innit?
Anyway, you may find food for thought in the 1918 memoir _Autobiography of an Androgyne_, by "Jennie June". It's not an easy book to read, partly because it describes a depressing amount of abuse, violence, and rape, and partly because the sexual content is all in Latin. But I think it makes a very strong case that sexual nonconformity is both mutable in its expression (as was common at the time, June does not distinguish between 'homosexual' and 'transgender', preferring the term "passive invert"; his life has both features suggestive of modern transgender female identity and strong parallels with modern gay male culture) and fixed in its presence (June suffered pretty much every punishment short of execution for the crime of wanting to consensually suck cock, and yet could not be dissuaded).
"June does not distinguish between 'homosexual' and 'transgender', preferring the term 'passive invert'" – could you clarify this? I'm completely unfamiliar with the book, but just reading this line it doesn't seem obvious that there's *any* transsexuality involved, he's just what contemporary gay culture would call a bottom. Isn't this just an instance of the thing where olde-tyme people figured it was *inherently* feminine to be a bottom (and thus inadvertently conflated transsexuals with the LGB despite the modern "progressive" understanding of these phenomena being worlds apart)?
Sorry, I could have been clearer. June consistently emphasizes his girlishness in both sexual and nonsexual contexts; the "features suggestive of ... female identity" I mention include calling himself a girl as a child, fighting with his parents over being brought up as a boy, wishing to have a girl's body (and a girl's genitalia), being horrified by puberty, doing his intimate socializing under a female name and female pronouns, suggesting that "sex should be determined by the psychical constitution rather than the physical form", and eventually having himself castrated.
(I have left out the gay male parallels, since you take them as read, so this list appears rather one-sided; in context each point of similarity with the modern understanding of transgender is more nuanced—for example, he describes both praying to be made physically a female and praying to be made mentally a man. I use the male pronoun because he does.)
No doubt June's sexual expression, like others' of that era, was influenced by contemporary ideas about gender and sexuality (as well as enforcement of contemporary morals). But he definitely seems to illustrate an overlap between phenomena regarded as separate today; is it accurate to call that a 'conflation', or does it merely privilege the modern progressive understanding? (Certainly arguing whether June 'really' was, or would today have been, a gay man or a trans woman seems unlikely to be productive.)
Oh, yes, that's much clearer now. Thanks. (And sure, I think I see what you mean there at the end, many gay/lesbian, and even some straight!, people seem to argue that if they'd been in their early teens today they would have taken for granted that they were trans, considering their childhood experiences – experiences which did not stop them from being integrated adults of their respective sexual preferences today.)
I've commented this elsewhere before, but it baffles me to see someone as otherwise thorough and thoughtful as Scott assert that ADHD is just being on the low end of the bell curve of ability to concentrate. It comes off like he hasn't done any research at all, which is bizarre from a psychiatrist.
ADHD is an entire neurotype, and it has way more symptoms than just "inability to concentrate." There's hyperfocus, hyperfixations, rejection-sensitive dysphoria, and an inverse reaction to stimulants, among others! A non-ADHD person who was just absentminded probably wouldn't fall asleep after three cups of coffee or need to fidget in order to think. There's no such thing as "primarily hyperactive type inability to concentrate."
ADHD is a lot more like autism (of which it's sometimes considered a cousin condition, because their symptoms overlap) than it is like being unusually clumsy or unusually tall. It's like a brain running on Linux instead of Windows. Reducing it to one single trait is inaccurate.
I think Scott has expressed doubts about rejection-sensitive dysphoria as an ADHD symptom - since this originated as one random doctor's hypothesis, and hasn't been widely accepted in the ADHD literature.
Talking about it as "inability to concentrate" might be oversimplifying, but ADHD does seem to be a person on the low end of executive function, which relates to all the other symptoms you cited.
He has, since he found that when he put it in the reader survey it didn't show up as a majority thing. It DID show up more with ADHD than anything else, and did show up a lot, though.
Now, if he'd put in "and it responds to being medicated" I think he might have gotten further.
> I think the evidence strongly suggests that ancient combatants did not experience PTSD as we do now. [...] The more interesting potential question is why. Considering all of the competing theories for that, I think, would take its own collections post. But for my part, I tend to think the difference lies in part on the moral weight placed on warfare
Interesting. My first instinct is that their lives were just so much harder leading up to being a soldier, that they're just better at coping with emotional and physical hardship, and so they don't actually get traumatized.
Consider that by the time a person reaches maturity, they probably would have already lost a few siblings, they were used to slaughtering animals and possibly even killing other people or seeing them hanged, and they're accustomed to very hard physical labour. Their whole life up to that point was trauma resistance training.
We're fairly pampered by comparison, both emotionally and physically. So maybe PTSD partly results from the fact that we're too safe to have built up the necessary resistance to the horrors of war.
> I remember one that clearly made the connection to being traumatized after you’re informed it’s taboo. Does anyone know what I’m thinking of?
I remember reading one about adult female victims that reached a similar conclusion, ie. that they became more traumatized after seeing how horrified other people were over their experience, and only then did the victims feel shame over what happened to them.
This may seem obvious but I think it's worth saying: it sounds like the presence or lack of childhood trauma as a result of early sexual contact comes down to consent, and I don't see any evidence to convince me that the alternate hypothesis (it's solely a result of parents'/society's expectations or reactions) is remotely tenable (although I can understand how a big dramatic reaction to a non-traumatic event would make the event feel traumatic).
Legal definitions aside, I think most would agree that children are capable of either consenting or not consenting to things. They can be convinced by perpetrators to participate in sexual activity voluntarily, in which case it seems plausible that some would not be traumatized by those experiences until someone makes a big deal out of it much later. Especially if prepubescent sexual activity is culturally acceptable (e.g. Massai culture, at least in Tanzania).
But the existence of individuals who weren't traumatized by early sexual contact does not constitute evidence to support a claim that the enduring distress resulting from childhood sexual abuse is a cultural phenomenon that arises only when the person discovers they violated a taboo. This idea conflicts with every single instance I know of, including my own (I know a lot of women who were assaulted before they ever learned that assault was a thing, and their distress existed before anyone knew enough to react).
The sole concept here that rings true is that our cultural expectations around trauma have the potential to worsen affected children's prospects when it comes to recovery. That, I would believe.
I'm also curious who wrote the mystery paper mentioned above and how they justified it.
Perhaps sexual assault isn't only bad because of potential "trauma" but other things too. In honor cultures a woman will feel her honor is being attacked and her sexual purity defiled by a filthy rapist. May be no trauma involved unless getting angry and wanting revenge against someone who violated your honor is now considered trauma
Konversiyon Bozukluğu nedir? Anksiyete, panik atak, fobiler ve obsesif kompulsif bozukluklar dahil olmak üzere çeşitli zihinsel sağlık koşullarının bir kombinasyonu olarak sınıflandırıldığından, dönüşüm bozukluğunun ne olduğu sorusu karmaşıktır. Bu bozukluğun gerçek nedeni bilinmemektedir ve yalnızca geniş bir şekilde tanımlanmıştır. Bazı uzmanlar, beynin stresli olaylara tepki verme şekliyle veya geçmiş travmatik deneyimleri nasıl hatırladığıyla ilgili olabileceğine inanıyor. Spesifik neden ne olursa olsun, dönüşüm bozukluğunun bir parçası olan ezici kaygı duygusu, hastalar arasında yaygındır.
A comment that I'm very surprised no one has yet brought up is the one that linked to this fascinating study showing a high prevalence of PTSD among Turkana warriors. It would seem to strongly support the 'universalist' view that PTSD has occurred at roughly equal rates among combat veterans throughout history.
Note that the study did find that *depressive* PTSD symptoms were significantly less common among the Turkana, which it attributed to different cultural attitudes toward killing in battle. But hypervigilance, nightmares, and flashbacks were actually *more* common among Turkana warriors than contemporary US combat veterans.
"I didn’t bring up trans issues because I think they’re a better match for another post I hope to write about related issues in the future, but I agree it sounds like an interesting match for something like this - a psychiatric condition which seems to exists at vanishingly low levels until people work to “raise awareness” of it, after which it becomes very common."
I know this is DEFCON 1 level culture war stuff, but there is a radical feminist blog called "culturally bound gender" that talks about exactly what the title says. That includes a whole post on "traditional" non-binary or "two-spirit" genders, and makes a hypothesis that they're doing something very different from what the modern world thinks they are. I'm not an expert in the area and the post doesn't cite sources I could check, but the author has certainly looked into the topic more than I have.
I deliberately won't link to it here, but if you wish, search engines will find it quickly enough.
(For what it's worth, I myself feel like I match some definitions of "trans" and not others, I'd say I have less of a gender identity than a self-identity where gender is not that big of a thing. I found reading the CBG post on the matter helpful rather than hurtful, your experience may vary.)
"That includes a whole post on "traditional" non-binary or "two-spirit" genders, and makes a hypothesis that they're doing something very different from what the modern world thinks they are."
This is certainly the case for the various Asian/Pacific "third gender" categories – just for one thing, the name alone ought to be indication enough that they don't at all match up to the Western transsexual activists' idea that transsexuals meaningfully belong to their desired sex, and it's bigotry to say otherwise.
This article lists out several source examples describing historical PTSD symptoms. I'm _totally_ open to the hypothesis that telling people their experiences are traumatic makes those experiences traumatic and that could increase incidences of PTSD in modern times, but I'm fairly skeptical that a PTSD-like thing didn't exist.
The comment on concussion trauma should be qualified by the difference in combat before gunpowder when a head injury would not have been caused by generally locating the head near an explosive event. Head injuries from any source have only recently been studied in parallel with the PTSD category. A simple skateboarding accident for a young person, for example, can have a life-long, debilitating result which may not be well-classified as a syndrome or disorder given the biology and centralized location of the injury but rather may be better-classified as other local and biological injuries, albeit one that does not heal in the same way.
The Epic of Gilgamesh, one of the first pieces of literature extant and dating back to the third millennium Mesopotamian kingdom of Sumer, details the adventures of the Sumerian king, Gilgamesh, and his warrior companion, Enkidu (Birmes, Hatton, Brunet & Schmitt, 2003). The parallel between Gilgamesh’s post-combat experience and those of modern veterans with the “numbing” and “dissociative” aspects of the modern PTSD diagnosis is striking. On witnessing Enkidu’s death in battle, Gilgamesh is beset by recurrent and intrusive recollections of his friend’s death. A once proud and valiant warrior, Gilgamesh is haunted by these dreams and wanders numb through his kingdom, rendered incapable of regaining his once unassailable martial prowess.
Likewise, in Homer’s Iliad (850 B.C.), the immortal Greek hero, Achilles, is tormented by recurrent nightmares of battle, the death of his companion, Patroclus, and visits in his dreams from the hundreds of men slain by him in combat (Shay, 1994). The impact of these recurrent traumatic dreams and fragmented sleep, which are today recognized symptoms of PTSD, devastated even the great Achilles.
Comparing my friend circles in Poland and larger US-centric communities on Discords I frequent, people from the US seem very focused on their fragile mental health. Might be all sorts of selection effects, of course.
There's also some kind of huge doom wave sweeping over the internet over recent years, where saying anything optimistic seems almost out of place... I'm worried that the world is becoming an echo chamber where suffering people amplify other people's suffering and the only way to stay sane is to disconnect from the narrative as much as possible. In fact, that is what most of my friends I'd consider mentally stable are already doing!
I agree that saying anything positive can seem out of place in some venues. I'll add that disgust with the human race or some large fraction of it is also common and I think that's part of the problem.
Re: Ivan's comment on PTSD claims among recent veterans. It would be a mistake to not attribute the vast portion of those claims to "malingering". Well, not malingering so much as following obvious incentives in an arguably fraudulent (but easy to justify) manner.
You have to understand that these 45% of vets making these claims are not all people making claims of total disability. They are people who are filing claims because both while you are still in the military and especially with respect to your pension when you retire, you are paid extra for any combat damage. Claiming to have more damage literally results in more money in your paycheck. So the incentive is obvious.
My husband retired last year after 25 years in the military. He has been on many combat tours in the Middle East and has been "blown up", as they say, a few times. He does not have PTSD. He does have damage that required surgery to his spine and wrist from explosions. Retirement from the military is a very lengthy process where you go through a bunch of medical and mental exams and do all kinds of paperwork and how much you will be paid each month on your life-long pension is determined partially based on how much physical/emotional damage you have incurred.
While he was going through the process, ALL of his veteran buddies were constantly calling him and giving him advice on all the ways he could maximize his pension by playing up little problems and claiming to have various medical issues. They advised him to get a sleep study and claim to have sleep apnea. They had all kinds of advice. This is a game that they all play to see how much they can ramp up their pensions. He was not willing to fraudulently pretend he had any problems that he doesn't have, though frankly, he was left feeling somewhat like a sucker when his other retired friends laughed at him and told him how much they were being paid for their "PTSD" and sleep apnea and stuff like that.
The incentives are there for soldiers to say they have problems, and PTSD is a lot easier to fake than most other medical issues. So I would look at that 45% figure with extreme suspicion. Obviously no one is going to admit this, or they would get in a lot of trouble. But I witnessed plenty of these conversations ,and it seems like SOP is to exaggerate every "disability" one can, to maximize one's pension. I would be curious to know what year it was that the military started paying extra money to soldiers with PTSD, and my prediction is that you will see a rapid rise in such claims once the monetary incentive was there.
I think if we look at many other types of apparent trauma and mental illness, we will see similar incentives for one to obtain a diagnosis. Everything from extra time to take tests to getting out of class to obtaining sympathy and deference from peers. I don't know exactly what all the incentives are, but clearly there are some major ones among young women/teenagers these days, because they all seem to be off the rails in competing with each other to be the most traumatized and disabled.
Some of the conversations I see on social media amongst them are truly bizarre and there is very obviously a social status system whereby being the most "disabled" confers the highest status. I was once shouted out of a forum by hundreds of hysterical, furious young women for suggesting that being literally blind or having no legs because they were blown off in a war was a relatively worse disability, and more warranted of having a service dog for assistance, than having social anxiety. Apparently that statement is "ablist" and "toxic" and equivalent to attending KKK rallies. Now, to my mind, it is morally reprehensible and one should be ashamed to act as if social anxiety is equally worthy of social resources and sympathy as someone having no legs because they were blown off in combat. How self-pitying can you get?? But that idea was unthinkable and way out of bounds to these young women, who consider every "disability" to be exactly as serious as every other.
I think this stuff about PTSD relates to an even larger point. I feel like there's a certain psychological defense mechanism that we've eschewed as a society in the West - a sort of denial or suppression or diversion which says "Yes, this isn't pleasant, I'll suck it up and not think about it very much."
Instead we've accepted the dual tenets that:
1) *Fragility*. Any kind of harmful thing (traumatic experience, injury, or in the extreme: verbal offense, feeling of unease, being outside your comfort zone) will cause psychological damage. This is why there are calls to limit speech, not use certain non-PC words, have safe spaces, shield children from playing outside alone, etc.
2) *Active Treatment*. The cure to these psychological damages is not ignoring them and keeping busy with other things, but instead carefully opening the wound (delicately) and trying to disinfect it. We are less inclined to say "Yeah, break-up is difficult, get a job and keep busy. Then pick yourself up and start dating again." Instead we ecourage people to mourn, become aware of their feelings and needs, and so on. I feel like my parents' generation were much more inclined to not reveal their feelings and just move on.
For PTSD there is growing evidence that both of these are false and harmful. But this might be harmful in other domains as well.
A couple comments on PTSD:
(1) I've read that some believe that combat PTSD actually could have been due to, for some people, actual lesions in the brain due to being regularly exposed explosions. I don't know if that's true, but it would explain the lack of PTSD in the past.
(2) Also, a disproportionately large number of people with PTSD have sleep apnea, which is a disease of modernity (jaw sizes have shrunk and tongue sizes have grown). Some people theorize a connection between sleep disorders and an inability to overcome past trauma.
A similar thought on ADHD:
(1) Several studies have found a large number of children with ADHD have sleep disorders. Several find that a slight majority have sleep apnea. Also, note that sleep apnea, being connected to facial structure, is very genetic. If there are cultures that don't recognize ADHD or something very much like it, I would think it is because they don't have much it, which may make sense if it is, at least partially, caused by modern sleep disorders.
re PTSD (1), Acoup notes: “The issue has been brought up, so I do want to note that I am, by the by, unconvinced by the suggestion that these WWI-era mental wounds were purely or principally the product of concussions from heavy artillery or the like.”
Yes, I guess I need to look into why exactly ACOUP is unconvinced. TBI definitely can mess you up. I personally wouldn't be surprised if the causality was something like TBI->"sleep disorder" and "sleep disorder + trauma"->PTSD. I am a fan of the idea that sleep has something to do with processing trauma properly.
This article gives some scary numbers on TBI in vets https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482689/
1. Exploding shells are 10% explosive and 90% steel. Having your body riddled with jagged bits of fast-moving steel will mess you up way more than TBI, and if you're close enough to develop chronic psychological symptoms from the explosion, you're likely close enough for those to be rendered moot by the acute deadness from the steel. So it's probably not a coincidence that we started noticing TBI when we started cladding our soldiers in Kevlar.
2. Artillery is not omnipresent. Lots of doctors from World War I on have been observing and documenting symptoms of shell shock / battle fatigue / operational exhaustion / PTSD in soldiers that they knew perfectly well were never near an exploding shell. And in WWI, diagnosing this as "shell shock" because that was the official magic word that got the poor SOB the treatment he needed and that was more important than holding a pedantic debate on medical terminology.
Maybe some of the ones who were near exploding shells, did have TBIs. But Occam's razor suggests that if you've got a bunch of people in roughly the same environment suffering roughly the same symptoms, they're coming from one common cause so look for what they all have in common.
I really think you'd be interested in reading through the article I linked above. mTBI is incredibly common and it's not just from being blasted at. Also, as I said above, it could be that the direct cause of the PTSD is the trauma/distress linked with a sleep disorder. TBI is probably only one of many causes of sleep disorders, similar to how war is only one of many causes of trauma/distress.
Wait, have jaw sizes shrunk and tongue sizes grown within the past century? What would be the cause of such rapid change?
Change of diet leading to us eating softer foods. Less need to chew hard means less stress on the jawbone means smaller bone. I don't know about the tongue, though.
Do you have a source for this? It seems like less stress could lead to weaker bones, but wouldn't affect the overall shape of the jaw.
Okay, should have just checked myself first. It seems to be supported by various sources that I can't get full access to, but there seems to be a study on different human populations (https://www.pnas.org/content/early/2011/11/15/1113050108) and an experiment on animals (https://pubmed.ncbi.nlm.nih.gov/15183669/) that both say the same thing.
A century sounds a bit short timescale, but in the long run, I thought it is the reason why many people have their wisdom teeth removed.
I don't think it's meant to be a *genetic* change. It's just that if from birth through your childhood you always eat soft foods, then the jaw doesn't develop as much; like a muscle that's neglected.
As Thomas Kehrenber said it's not genetic. Regular exercise changes your body. Not only the muscles but the tendeons, cartilage and bones as well.
Look at the hands of black smiths, witch are often huge. Or the changes people that shoot Warbows report. Or for a more anecdotal example I lost two shoe sizes after I started rock climbing, because my foots changed with the new challenge.
Or the hands of rock climbers! Or just their fingers
I think you need to get bigger climbing shoes.
I was going to say that evolution could only do this if the pressures are great enough that people either (i) die young or (ii) breed less, both of which seem unlikely in this case.
Then I realise I misread; this is about how your bones grow into adulthood, which could be affected by how you use them.
Soft foods is the most popularly known possible explanation for smaller bones, but I definitely think it's only part of a larger picture.
Allergies are also increasing which encourage children to mouth breath which causes smaller jaw development.
There are also a lot more preterm babies that are surviving and it is the end of pregnancy during which the babies orofacial muscles properly develop, so preterm babies are more likely to have issues with jaw development. One study even found something like 70% of preterm babies having sleep apnea, which is pretty huge.
Also, breastfeeding isn't done for as long as it may have been done in the past, and the action of breastfeeding develops the child's jaw in a way that bottle feeding does not.
A crazy theory that I've not read about, but I think could also be the case is that certain endocrine disrupting chemicals that may be building up in the environment could also be affecting in utero development so that orofacial muscles are weaker leading to poorer jaw development.
Doesn't it seem like a surprising coincidence for multiple unrelated factors to all be having a similar effect around the same time?
These are just theories with different levels of evidence behind them. It could end up being mostly just one or two of them or something else entirely (though probably not entirely).
Also, I don't know that these are all completely unrelated and I don't know that they are all having a similar effect around the same time.
Maybe increased hygiene (the hygiene hypothesis) or EDCs cause the allergies and preterm birth. Maybe the breastfeeding and soft foods are less important than some people think. Also, note that breastfeeding may be more difficult with preterm babies because poor orofacial development and tongue tie.
Also, tongue sizes have grown because obesity, but there are plenty of non-obese people with sleep apnea, so it's not just an obesity disease.
You would benefit tremendously from listening to Mike Mew, who does research on and treats facial structure and sleep apnea without any surgery. Facial structure is entirely fixable in any modern child and largely comes from a veritable avalanche of baby products and new feeding techniques over the last 70 years. Stories of tribes found and photographed with perfect teeth, 50 years of modernity later the young in that tribe were all crooked and degenerate.
I highly recommend him, he is about to publish something along the lines of "jaw structure causes all modern deseases".
To let you know, Mike Mew doesn't do meaningful research (he's written a couple of articles, but not real research from what I've seen) and most probably doesn't effectively treat sleep apnea. Probably any change in facial structure that he causes with his techniques are dentoalveolar rather than skeletal (although I've heard he started using MARPE now which completely goes against his whole "Mewing works in children, teens and adults" theory).
Also, jaw structure can cause issues, but surely not "all modern diseases"! There's a lot going on besides jaw structure and a lot of people with perfect jaws that have modern diseases. But, I do think that Mew is right that the importance of orofacial development to good health is not fully understood by lots of people.
One thought on the PTSD subject -- is this fully explained by "Blast induced trauma" (AKA shell shock) as the source of PTSD in soldiers? I'm not sure how many blasts soldiers in the 19th century were subjected to, but I'd guess it's much less than in modern warfare with high explosives, and it's possible it could be effectively zero exposure if cannonballs don't cause this kind of concussion on impact. Certainly if you go back before gunpowder there was no blasts.
It seems there's some research backing up this link, e.g. https://pubmed.ncbi.nlm.nih.gov/18234750/.
Acoup notes: “The issue has been brought up, so I do want to note that I am, by the by, unconvinced by the suggestion that these WWI-era mental wounds were purely or principally the product of concussions from heavy artillery or the like.”
Re ADHD vs anorexia - wait, you think being bad at concentrating/executive function/prefrontal cortex type stuff feels closer to the hardware level than being bad at the desire/urge/motivation to eat, which is a very primal thing that exists in some of the simplest brains?
That's a fair point. As mentioned in the last post, I think anorexia is a combination of a psychological and a physiological thing, certainly with psychological triggers.
Others in the comments are asking whether it's a physical consequence of blasts or explosions. My question is whether it isn't simply the psychological effect of that: in modern warfare there are constant blasts, artillery, explosions, grenades, and the possibility of instant death at any time. This also puts you in the peak state of stress much longer. You're at the mercy of sudden incidents that you can't control or see coming.
I sifted through the comments on the blog post, and found at least one other person speculating about the same.
Large overlap between mTBI and PTSD symptoms.
Most casualties in modern war are from such explosions, but people don't find them as scary.
https://entitledtoanopinion.wordpress.com/2009/10/14/nearfar-violence/
"[T]he circumstances that cause the most fear not necessarily those that are objectively the most dangerous. Artillery shells and mortars, as we have seen, cause by far the most casualties–and the soldiers themselves generally know that (Holmes 1985: 209-10)–but the greatest difficulty in combat performance is in confronting small-arms fire at the forward edge of the combat zone. Some surveys show relatively high fear of being killed by bayonet and knife, events rare to the point of fantasy but indicating the quality of soldiers’ imagery about what they feel is in front of them. Nor do persons in highly dangerous situations all show the signs of incapacitating fear that affects frontline troops (Grossman 1995: 55-64): navy personnel are subject to the same dangers as army soldiers of being blown apart by enemy shells–the largest source of ground combat casualties–in addition to prospects of drowning, but data on long-term breakdown from combat stress–which is one measure of combat fear–shows much lower rates of breakdown for sailors in combat zones. Similarly for civilians under bombardment, including long-term blitzes such as the German attack on England, or the Allied bombings of German cities; casualties included being burned alive or sustaining extreme bodily mutilations resulting from burns. Nevertheless, civilian psychiatric casualties were low in these areas compared to army troops."
Supporting anecdotal evidence: My mother, who as a girl of 13 was digged out of a lot of rubble after witnessing her mother dying beside her got along alright and lived a good life of nearly 90 years. She did really dislike the sound of sirens and was addicted to sedatives in her forties, though. Her Uncle was a sailor on SMS Koenig in the Battle of Jutland, which was bad shit, and seemed to be alright for a long life afterwards, too. The autistic traits in my family are on that line. Maybe there is some resilience connected with what is behind autism genetically.
My speculation wasn't so much that they find explosions scary, but that they are disorienting, instantaneous, and the threat of unexpected / instant death persists over long periods of time. The navy example might be a fair counterpoint to that idea--assuming it's robust and based on combat situations...
But if it's not *something* about modern warfare, what is it? The post floats this idea of social contagion. That probably explains something, but at the time of WW1 people recognized shell shock symptoms before there was any cultural meme about "trauma," or any expectation that it would occur. I don't see how that jibes with the theory.
"But in WWI, we heard a lot about ‘shell shock’. Later, in WWII, ‘combat fatigue’ or ‘battle neurosis’. Artillery wars. I would guess that what actually happened was a combination of people finding a way to avoid getting killed, and brain damage due to nearby explosions. After experience in Iraq and Afghanistan, plus football and boxing, people are thinking seriously about those explosions as a cause of PTSD."
https://westhunt.wordpress.com/2018/08/18/ptsd/
"We (the US) listened to psychologists telling us how to deal with combat fatigue: the Nazis and Soviets didn’t, and had far less trouble with it than we did."
https://westhunt.wordpress.com/2014/10/20/the-experts/
This is pretty much my understanding. Getting mortared has no precedent in human warfare, the only precedent is... serious natural disasters such as tsunamis and volcanic eruptions which render a human being *helpless*. The helplessness to even attempt to protect yourself, the complete subordination to sheer dumb luck/fate/the will of the gods, is the source of shell shock/combat fatigue/PTSD, which is why people getting fucked up by war only seems to emerge circa the Thirty Years' War. Shanking somebody on the other hand is one of the root human instincts, we're killers. Tiny little children play-fight. Give two five-year-olds sticks and they'll be using them as swords within 30 seconds. It's not traumatic. You don't feel powerless when you stab your enemies to death, you feel powerful. It's *supposed* to feel great. We're evolved to rejoice in vanquishing our enemies; not so much in being hit by lightning.
Somehow I missed the original thread of this which is too bad. Peter Levine’s somatic experiencing has a lot to say about this. So does Charles Hoge (military psychiatrist who has also deployed), who has published a variety of research as well as “Once a warrior, always a warrior.” So does Resmaa Menakem.
The US culture-at-large is not known for grieving well, releasing emotion, and with very few somatic grief skills, people are walking into dangerous situations with their energy already stuck. Wailing, drumming, singing, staying awake for days at a time, gathering in large groups to celebrate loudly regardless of how “bad” things are, behaviors like this train the spirit to remain present, release stress and intentionally enact feelings. So people have more skills for rebalancing when challenging things happen and they can nip Ptsd in the bud more often.
Much of modern employment is very brain - centric, so memory and thought issues become evident which were less clear when throwing hay bales was the main activity for many a veteran. Also, people now survive experiences that killed prior generations if military, due to medical and transportation advances. So survivors may have more long term health issues now because they are surviving things which no one used to survive.
See also moral injury. There is a lot more to say but I’ll stop here.
Also, whoever thought “white people” don’t express emotion at home has not spent much time with Mediterranean cultures. Expressing emotion is not the same as releasing it though. Expressing and still holding can be epically toxic.
No one specified "white people" in the context of emotional expressivity. The statistic mentioned here was for white Americans.
Yes to what you say here.
I wanted to add my own wondering about whether we see more DSM-diagnosable things now because our institutions (schools, workplaces) and culture (US, western?) have an ever-narrowing tolerance range for what is considered "normal" combined with expanding language/awareness/focus on medical model pathologizing of DSM-adjacent things.
There is more focus on the small and medium-sized ways that people fall short of being optimized for efficiency and performance at school and work, and more demand to intervene when that falling short is noted.
Variation in human behavior and adaptations to stress used to get called things like quirky, spirited, up-tight, eccentric, vague, artsy, dreamy, dramatic, neurotic, or "not the same since X happened." I can remember all these words being used to describe various extended family members in the 1960s and 70s by the generation before me. A few decades later, those same family members would describe themselves as having panic attacks, anxiety, ADHD, PTSD, OCD, post-partum depression, etc.
And then my favorite explanation for everything these days is stress. My memory of the PTSD in soldiers research is that earlier trauma/adversity in a soldier's life is a better predictor of whether they will develop PTSD from combat experiences than the nature of the combat experiences themselves. PTSD seems to be the destination for a person who layers life-threatening stress on top of earlier adversity. It may be that we've always had the earlier adversity, but that the increased background stress all around us may predispose more people to developing PTSD from a difficult experience later on.
Possibly this.
https://www.sciencedaily.com/releases/2012/11/121119140625.htm
"New research on posttraumatic stress disorder in soldiers challenges popular assumptions about the origins and trajectory of PTSD, providing evidence that traumatic experiences in childhood - not combat - may predict which soldiers develop the disorder."
On the smaller level, Levine also talks about the value of going off and shaking after a traumatic experience-- much more feasible for a gazelle which barely escaped a predator than spending hours drumming.
If he's right, part of what gives people PTSD is that either that the trauma is so continuous that there's no opportunity to go off and shake, or that a lot of people think that holding themselves together (that is, not permitting shaking) is the right thing to do.
Makes so much sense….
"I am sympathetic to this based on an experience I had, where I was pretty bad at tolerating noise, but kind of within the normal human spectrum and never thought much of it, and then I lived with a noisy roommate who characterized my distaste for noise as freakish and psychiatric-level, and after that, every time I heard a noise I started panicking and questioning whether I was going to have some sort of freakish and psychiatric-level reaction to it, and this became so unpleasant that now I do have a freakish and psychiatric-level noise intolerance - or at least this is how I remember it."
Does this mean the piece about Nodrumia was influenced by personal experience? Sounds very much like it!
"Crimkadid is also responsible for this long twitter thread on variance in schizophrenia, which is poorly-supported, bizarre, and racist, but otherwise excellent"
What an absurdly nuanced way to describe something.
"Astral Codex Ten: Describing things in absurdly nuanced ways since January 2021"
Sounds like the Confederate Army.
This is excellent.
"Apart from that Mrs Lincoln how did you enjoy the play?"
I also wonder about the role of medicine in increasing the prevalence of PTSD. I recently listened to an excellent Rough Translation podcast series about a solider with PTSD from having lost three limbs in Afghanistan. A century ago he would not have had PTSD; he would have died. (I see the Globe article makes this point as well.)
The Globe article about 45% of veterans receiving benefits reminds me of the This American Life episode Trends with Benefits, which explored how disability rates are rising overall as disability is one of very few viable welfare programs accessible to many struggling Americans: https://www.thisamericanlife.org/490/trends-with-benefits
Yeah, I was thinking about that during the 'medieval war' section - Scott mentions that different types of wars and different weapons will cause different types of damage, but I think it should be emphasized that medieval warfare is just orders of magnitude different from any modern war than any modern war is from any other modern war. No concussive weapons (which do their own type of brain trauma), no death from above or from a concealed rifle half a kilometer away, fewer surviving injured, etc etc.
People always make that wounding argument, but there's no way you get to 45% on that basis.
I'll try to do the math here. In pre-Vietnam wars, the typical killed to wounded ratio was something like 1:3. In Iraq and Afghanistan (for Americans) it is something like 1:10. So let's be generous and say that for every person who died in Iraq or Afghanistan, there are 2 who would have died in WWII but are alive because of modern medical technology (change 1:10 to 3:8). There were 8,500 fatalities in Iraq and Afghanistan, so let's say about 17000 people are walking around today after wounds that would have been lethal in WWII. 45% of 1.6 million is 720,000. The orders of magnitude are off.
Also, better medical technology means that some people who would have been permanently mangled in older wars are now pretty normal.
The threshold for receiving disability benefits is not very high. A 10% rating i 2021 only gets you $114 a month (see https://www.va.gov/disability/compensation-rates/veteran-rates/). The full rating schedule can be found here (https://www.benefits.va.gov/warms/bookc.aspv), but getting to 10% is not difficult even if you've never seen any sort of combat at all, let alone incurred an acute injury in combat. Many of the conditions are chronic and widespread, in particular functional loss in the knees and lumbar spine and hearing loss. The former are often caused just by carrying around 90 pounds of gear all over the place, or training events like spur rides where you're carrying telephone poles and LMTV tires 12 km through rolling hills at 1 AM in the morning, pretty much just for the hell of it because it's part of the cavalry tradition. Hearing loss is often just due to gunnery, personal rifle qualification, and working around loud vehicles and aircraft daily in your installation motorpools and airfields.
As for why the claim rates are so much higher now compared to Vietnam and earlier, out-processing from the military today involves undergoing a comprehensive physical and VA claims agents are there as part of the TAPS courses to help you file an initial claim for every claimable condition you're found to have that you did not have when you in-processed. Contrast this with Vietnam when servicemembers often weren't even told they were eligible for benefits at all. The increased rates of disability claims don't necessarily reflect increased rates of disability so much as outreach letting disabled people know they are eligible for benefits and helping them to make the claims.
>One theme running through this book review (that is particularly visible in the discussion of PTSD) is the Western trend to diagnose more and more things as psychiatric illnesses.
I think this has a lot to do with us living in a capitalist/authority-based/scientismist society where if you have any problem of any kind, you are expected to pay a professional to deal with it rather than seeking any otehr type of solution, and for many problems you cannot possibly afford treatment unless your health insurance will cover it, and your health insurance will not cover it unless you have a formal diagnosis relating to it.
I strongly suspect that if medical and psychological care were freely available for anyone who wanted help with something even if they had no diagnosis, and meds could be prescribed without a formal diagnosis, the overall rates of diagnosis would go down like 80%.
I think this conflated two different things which is that "having a diagnosis" has a social role in indicating to others that your problem is sufficiently bad to be allowed access to additional resources to deal with it. Vs the descriptive role of using a diagnosis in describing someone. Eg people self diagnose, or dwxribe other people as having "undiagnosed x".
Agree with this. There is a "type" of patient who the normal system doesn't diagnose with anything (besides maybe anxiety or psychosomatic conditions) who gets deeper and deeper into wacky alternative health stuff, constantly collecting fake diagnoses that help them "understand" themselves. Maybe this is downstream of other things about our society, but it makes me doubt that insurances wanting diagnoses to cover things (while real) is the main root of the problem.
The TED talk https://www.ted.com/talks/sebastian_junger_our_lonely_society_makes_it_hard_to_come_home_from_war/transcript?language=en gives more evidence that PTSD is very much rooted in social stories and reactions, and posits that a significant part of PTSD is alienation. An interesting statistic: 50% of US veterans file for PTSD compensation even though only about 10% of US veterans have seen combat. By contrast, the rate of PTSD in the Israeli army is 1% (the TED talk suggests that this is because, unlike in the US, everyone in Israel knows what it's like to be in the army because participation is mandatory).
It seems like PTSD might either be a result of not knowing how to integrate your experiences with the social role you're expected to play (or perhaps in particularly perverse cases, experiencing PTSD is part of the social role you're expected to play)?
I mean, "particularly perverse" seems like an underestimation.
Because, y'know, PTSD is definitely socially expected of rape victims, and there are a lot of those.
I'd like to see a source for that claim about rates of filing for PTSD. That is extremely high if the Boston Globe report that roughly 45% of veterans receive disability compensation of any kind. If more than that are applying just for PTSD, that is an awfully large number of denied claims. The VA reports that somewhere between 10-20% of veterans from the 90s on have actually been diagnosed with PTSD: https://www.ptsd.va.gov/understand/common/common_veterans.asp. You can try to make a claim without having a diagnosis, but you'd need to get the diagnosis before the claim could be approved.
What's the source on the 1% Israel statistic? A. It sounds like bullshit B. Googling הלם קרב אחוז got me numbers more like 16%
All of the statistics I'm giving come from the linked TED talk. I wish TED had citation lists...
I can't figure out what's supposed to be excellent about that Crimkadid twitter thread. It looks like a pile of just-so stories with a light sprinkling of science, designed to justify irrational prejudices.
...this isn't the first time I've had this reaction to something you've posted. Not even the first time I've had it to something you've linked from a reactionary. With all due respect, I think you're much too tolerant of people making up plausible-sounding semi-scientific explanations for already-known facts. Reality offers endless degrees of freedom; it's always easy to come up with a story explaining how x y and z are all natural consequences of your pre-existing beliefs.
I'm guessing this is based on the "Rule thinkers in not out" philosophy that Scott takes to a pretty real extreme. If you post a bunch of totally wild stuff that sounds semi-plausible and like you worked hard on it, Scott will commend you, is basically my understanding of how that works
This would be nice if it were true, but I don't really think that we have the evidence for this. In his review of David Harvey's work Scott Alexander went out of his way to be uncharitable (and even admitted as such). And in Scott's review of Singer on Marx, Scott didn't seem to understand Marx's position, as I have documented here:
https://astralcodexten.substack.com/p/book-review-global-economic-history#comment-1795464
Of course, these are books written by left wing authors, as opposed to random twitter threads written by right-wingers, so Scott may ideologically feel more attracted to one political position over the other.
At some point I'll post a longer essay on cross-group variance in schizophrenia which will hopefully explain where I'm coming from and why things are weird enough that we need an explanation approximately that weird to make sense of them.
I look forward to it.
Why did the commenter above get banned for the following?
(Just out of interest)
"(Banned)Jul 21
User was banned for this comment. Hide
Mistaking just-so stories for science is kind of the basic move in rationalism, so this isn't exactly a surprise."
I don't remember where I read this, but I remember a reading about a hypothesis that in the past there might have been fewer post-battle mental health issues because soldiers would need to walk back home, which might have taken weeks. In this time, they might have talked with eachother about the terrible things that happened, and integrated the experience somewhat.
In contrast, now they might be flown back and be home in days, ripped from the social group that understands their experience and thrown back into regular society.
This seems not unreasonable to me.
Ancient armies had neighbors fighting alongside one another, so you didn't have just a few weeks to talk about what happened; you had the rest of your life.
I think this was on ACOUP, but I forget which post.
https://acoup.blog/2020/05/15/collections-the-battle-of-helms-deep-part-iii-the-host-of-saruman/
Okay, I have opinions on PTSD both from a professional perspective, experiential practice, and an interest in warfare and combat.
I first came across this problem when at a ward round. My consultant asked the junior doctors a general question about PTSD. None of them answered. As the nurse present, being newly qualified and over excited at my first ever ward round ever I piped up and gave an answer, which impressed the consultant and probably embarrassed the junior doctors. My bad.
Anyway, to get to the point; the difference centers around the weight you give to the confounding variables: TBI from shock blasts, drug abuse (Vietnam veterans mediated their feelings with a wide range of drugs, plus the military issues amphetamines or equivalents too), and finally, the point I raised the training has changed.
Back in the good old days (insert date of choice) training was based around generic targets, and studies should that in combat men would choose to fire high, rather than shoot to kill another person. After WW2 Skinner was got involved with training to try and overcome this problem.
The results of this were first seen in the Korean War, and further improved by the time of the Vietnam war. Today a Western military will see approximately 98% of its soldiers shoot to kill compared to the WW2 rate of approximately 2%.
Okay, this doesn't account for for pre-industrial armies and antiquity, but one could make an argument that those suited to the task of killing were self chosen, being those men and women who would see fighting and killing as their calling. Arguable, but it is a theory that fits the evidence and provides a tool for understanding the problem.
"Back in the good old days (insert date of choice) training was based around generic targets, and studies should that in combat men would choose to fire high, rather than shoot to kill another person."
This is based on the works of S.L.A. Marshall, a notoriously controversial figure to this. Wikipedia gives a positive view of him but that's because like many other articles it's being squatted in by an editor with a positive view of him.
I've often thought that Wikipedia would benefit from a "50% of this article's edits come from a single account" warning flag of some kind.
That made me curious about what David Gerard is doing recently on Wikipedia. Apparently he is removing information about who financed which tech companies, because the information comes from CrunchBase, which for some reason is a bad thing. I have no horse in that race.
Above I linked to a post mostly excerpting from Randall Collins' book on violence, which cited Marshall (and Dave Grossman), so I've fallen for that too. It wasn't until reading Cochran on the subject that I stopped accepting it uncritically: https://westhunt.wordpress.com/2014/12/28/shoot-to-kill/
I think we've had this conversation in one of the book reviews, but it'd be great if you could link a more substantiative source than one that just says "this is bullshit, he didn't have evidence, obviously most soldiers tried to kill the other side and enjoyed doing it".
Because WP does such a bad job explaining why S.L.A.M. is complete fraud (even according to his grandson), I put together what seem to be the core links: https://www.gwern.net/Replication#slam
Thank you, that looks a lot more credible.
https://historynewsnetwork.org/article/1356
I'd be skeptical of the claim that pre-gulf war and certainly pre-industrial soldiers were self-selected for comfort with killing, given many if not most of them were forcibly conscripted.
One way in which militaries have changed quite a bit is in the sheer proportion composed of support personnel. A modern army ships with entirely self-contained units for performing vehicle and aircraft maintenance, IT support, HR and legal support, basic services like laundry and food, construction. They make up far more of the total headcount than people explicitly there to fight, and though they are still required to be professional soldiers, that really just consists of maintaining bare minimum standards for physical fitness and qualification with a personal weapon. The training experience is quite different from being in the infrantry, where you day to day life for as long as you're in consumed with learning how to kill and not be killed.
In pre-Vietnam conventional wars, these support personnel would have been comparatively safe, well behind the front lines in territory that had been claimed and cleared of enemy presence. In a counterinsurgency, there is no safe territory at all. Sometimes the very people you're working with on a daily basis are disguised enemy who activate and murder you one day. I don't know if anyone has studied it, but I would certainly imagine the rates at which support personnel are injured and traumatized is much higher in a counterinsurgency and anti-terrorism type forever wars than in conventional wars that involved taking and claiming land and then getting out once the enemy leadership was killed or surrendered.
A counterpoint to the ACOUP post: Is today's PTSD the same phenomenon as "being haunted by ghosts" in the past?
> Cross-cultural psychologists have observed that, regardless of cultural background, people who suffer persistent emotional disturbances in the wake of a traumatic event exhibit intrusive memory symptoms in some form. Here in the US, these are closely related to what we commonly call "flashbacks." For the Romans, people experiencing intrusive memories were said to be haunted by ghosts. These individuals show up in historical, philosophical, and even medical texts. Josephus, who was an outsider to Roman culture, also describes this phenomenon in his history of The Great Revolt. Those haunted by ghosts are constantly depicted showing many symptoms which would be familiar to the modern PTSD sufferer. Insomnia, depression, mood swings, being easily startled, frequent eye movement, alertness all day and night, paranoia, avoidance of crowds, suicidal thoughts/attempts, loss of appetite, shaking/shivering, self-hatred, and impulsive violence have all turned up in association with these individuals. Since in almost every case the person experiencing these things had made himself an object of public shame, the "ghosts" in question often came in the form of those he had killed or wronged in the past. These would either appear spontaneously to the sufferer, or would come in the form of vivid, frightening nightmares. The key component to these experiences, as with modern cases of PTSD, was that the sufferer had no control over his own symptoms. Thoughts or vivid memories would occur unexpectedly and uncontrollably. It is easy to see why the Romans, who were religiously superstitious to begin with, would attribute such things to the foul play of malicious spirits.
Origin: https://www.reddit.com/r/AskHistorians/comments/1j6ssm/are_there_any_indications_of_combat_ptsd_in/cbbvfib/
(I'm posting this here, copy+pasting from a comment on ACOUP, which copied from a comment on Hacker News, which copied from the AskHistorians thread. Blog comments are like medieval letters.)
This makes me think of Shakespeare's Macbeth. Specifically where he's haunted by the ghost of Banquo. The audience at the time would probably have thought of that as an entirely literal phenomenon of a ghost haunting the character. While modern productions often treat it as a manifestation of his guilt
"This is a great point and a great example."
Is it? I'm highly dubious of any claim that makes blanket statements about child sexual abuse, especially obviously ridiculous ones such as a claim that there was total denial of it occuring before the 1980s.
I'll also note that the current Western narrative on child sexual abuse seems incapable of understanding that people can genuinely hold beliefs that go against its narrative.
Regarding child sexual abuse and how it was regarded up until the 60s or so, I think we can blame Freud's influence here. He was hearing from so many of his female patients that they had been abused as children that he freaked out about it and revised his opinion from "this is a terrible thing that is happening" and hence his development of the seduction theory to "it can't possibly be happening at these rates, that would mean nearly every woman in Vienna has been abused by her father!" and abandonment of the same.
Because he was the 800 Pound Gorilla of Psychoanalysis and Psychiatry, that naturally influenced those who came after him, especially in the area of pop psychology where the half-informed "knew" that if you claimed your father had abused you, then "really" it was your Electra Complex at work.
https://en.wikipedia.org/wiki/Freud%27s_seduction_theory
"On the evening of April 21, 1896, Sigmund Freud presented a paper before his colleagues at the Society for Psychiatry and Neurology in Vienna, entitled "The Aetiology of Hysteria". Using a sample of 18 patients—male and female—from his practice, he concluded that all of them had been the victims of sexual assaults by various caretakers. The cause of the patient's distress lay in a trauma inflicted by an actor in the child's social environment. The source of internal psychic pain lay in an act inflicted upon the child from outside. This led to his well-known ‘seduction theory’.
...Freud's clinical methodology at the time, involving the symbolic interpretation of symptoms, the use of suggestion and the exerting of pressure to induce his patients to "reproduce" the deeply repressed memories he posited, has led several Freud scholars and historians of psychology to cast doubt on the validity of his findings, whether of actual infantile abuse, or, as he later decided, unconscious fantasies.
Freud did not publish the reasons that led to his abandoning the seduction theory in 1897–1898. For these we have to turn to a letter he wrote to his confidant Wilhelm Fliess dated 21 September 1897.
First, he referred to his inability to “bring a single analysis to a real conclusion” and "the absence of complete successes" on which he had counted.
Second, he wrote of his “surprise that in all cases, the father, not excluding my own, had to be accused of being perverse" if he were to be able to maintain the theory; and the "realization of the unexpected frequency of hysteria… whereas surely such widespread perversions against children are not very probable."
Third, Freud referred to indications that, he argued, the unconscious is unable to distinguish fact from fiction. In the unconscious there is no sign of reality, so one cannot differentiate between the truth and the fiction invested with feeling.
Fourth, Freud wrote of his belief that in deep-reaching psychosis, unconscious memories do break through to the conscious, "so the secret of childhood experiences is not disclosed even in the most confused delirium." (In the same letter Freud wrote that his loss of faith in his theory would remain known only to himself and Fliess, and in fact he did not make known his abandonment of the theory publicly until 1906.)
The collapse of the seduction theory led in 1897 to the emergence of Freud's new theory of infantile sexuality. The impulses, fantasies and conflicts that Freud claimed to have uncovered beneath the neurotic symptoms of his patients derived not from external contamination, he now believed, but from the mind of the child itself."
I can't blame Freud or others for their wish to bury the inconvenient conclusions; when the sex abuse scandals in the Catholic Church first broke, I had the same reactions: it can't possibly be true, or at least not on the scale they are claiming.
Unhappily, it's true.
"These papers indicate that the patients did not relate stories of having been sexually abused in early childhood; rather, Freud used the analytic interpretation of symptoms and patients' associations, and the exerting of pressure on the patient, in an attempt to induce the "reproduction" of the deeply repressed memories he posited"
Since this sounds a lot like repressed memory therapy, where memories are created rather than brought out, it was probably preferable that Freud abandoned it compared to inducing such false but traumatic memories in his patients.
I think Freud alone was probably not enough to create such a massive cultural change that is sort of implicitly claimed to have happened.
Remember, moral panics about child sexual abuse pre-date any big revelations about child sex abuse, so opinions on the morality of the act itself can't have much to do with a desire to protect the powerful etc.
So, that many people simply aren't fucking their kids. Maybe the rise of incest/torture/rape porn is going to change that, but no, even a sobbing patient in denial of the sex abuse that didn't happen, isn't proof it actually happened.
Its understandable that catholic preists rape kids. They're selected from the rejects of catholic society, gays, asexuals etc. So catholics have a place for them in priesthood. You have a bunch of sexually repressed men together what happens? They develop an atypical taste for males which they may have desired beforehand or been more likely to, and they've got easy access to boys and so it happens.
Father's on the other hand, don't enter fatherhood with the desire or inclinations to fuck their dsughters. So the widespread incest thing is probably just garbage.
I've read that one risk of father-daughter incest is that the daughter gets to an age where she looks the way her mother did when her father was courting.
Sure, it happens at times, but people really need to either prove a causal mechanism for it to be so widespread or stop spreading silly delusions like every few of your male neighbors and coworkers is screwing his own children. If it is really that widespread the let everyone come out and show how society functioned through the decades with it! But it's not happening .
I'll grant that something like this can start happening if incest porn increases. Porn does seem to influence sexual behavior. Anal sex in practice rose after it became popular on porn and so did choking and now according to orgs like Fight the New Drug, porn is becoming more incestuous. If 2 million men out of a billion fathers in the past had a predilection towards incest fantasies then itd possible 1 percent of them actually commit it. This is just an example. Now let's say porn manages to spread it to those beyond the 2 million in a billion that naturally have the fantasy and make it 20 million. If the rate of those who act on it is constant, this is a tenfold increase. Or 9fold increase but you get my point.
One method to deal with this is encourage men who are having this fantasy to remember to keep it in their head and never act on it. Another is ask them to not have any daughters themselves only sons. A third is to have government interventions banning incest porn along with powerful viruses sent to porn websites to force it underground. As recent years have shown. Censorship in the modern era really does seem to shut things down. Finally we can start raising the penalty for those who act on it. One case stuck in my head is the man caught raping his 12 year old girl and the judge gave him a few weeks after his church backed him up and said hes a reformed guy....I would say the utilitarian method is to publicly and brutally execute such people to eliminate the threat and spread fear into the hearts of those who could be willing.
But I bet you 90% of these "cases" from back then are probably fake and most of these are just women who want some extra sympathy and care in their therapy sessions.
There's a range between really common and so rare as to be negligible.
https://pubmed.ncbi.nlm.nih.gov/22452300/
"Retrospective data were entered anonymously by 1,521 adult women using computer-assisted self-interview. Nineteen were classified as victims of father-daughter incest, and 241 were classified as victims of sexual abuse by an adult other than their father before reaching 18 years of age. The remaining 1,261 served as controls. Incest victims were more likely than controls to endorse feeling damaged, psychologically injured, estranged from one or both parents, and shamed by others when they tried to open up about their experience. They had been eroticized early on by the incest experience, and it interfered with their adult sexuality. Incest victims experienced coitus earlier than controls and after reaching age 18 had more sex partners and were more likely to have casual sex outside their primary relationship and engage in sex for money than controls. They also had worse scores on scales measuring depression, sexual satisfaction, and communication about sex than controls."
Note that father-daughter incest is rare in general and also rare compared to sexual abuse by other men. Also note that the study leaves out males younger than 18, even though they are capable of sexual assault, and some of them are family members.
I don't know what you've been seeing, but a lot of accounts of sexual assault, statutory rape, etc. are *not* father-daughter rape, and I'm wondering whether you're conflating anger about the whole situation with father-daughter rape.
Maybe I got mixed up i was just referring to father daughter rape in my comment. There is simply no way it was common back then.
That being said caretaker abuse in general could have happened a lot. Step parents or byofriends who moved in are extraordinarily more likely to abuse young girls in the house so it wouldn't be surprising to me if some polls show something like 240/1500 girls are victims of this.
>a claim that there was total denial of it occuring before the 1980s.
When an older person talks about how the world worked "back in the day", they're usually talking about how things were in their house, or street, or part of town. Social bubbles.
Greg Cochran once spoke to an old woman who assured him that single mothers had it much easier back in the old days. "Back then, you'd have a servant cooking and cleaning for you, you see."
I don't buy it either. Maybe people talked about child sex abuse less in the past, but I don't think it's true that nobody was aware of it. One of the great scandals of the Victorian era involved an expose of child prostitution, for example.
https://en.wikipedia.org/wiki/The_Maiden_Tribute_of_Modern_Babylon
I know that older psychiatrists confirm that this was how things worked when they were young, so I'm more likely to believe it. There also seem to be a lot of stories (eg Catholic priests, etc) of the form "huh, this kind of sexual abuse has been going on for decades and we never paid attention to it before, seems bad".
Well that's the claim, but I've never heard people actually say "yeah we knew this was going on, but we didn't think it was a problem". Now obviously there's a lot of incentive to present things a certain way for them, but the reactions of the Catholic Church at the time, even if they did tend towards the cover-up, indicate a belief that it being public knowledge that priests were engaging in sexual activity with children would produce a strongly negative reaction.
"a lot of the educated opinion has switched over to crimkadid’s view (see eg McGrath 2008), which calls the uniformity hypothesis a “dogma”."
I'm interested in this, because Ireland allegedly has a high incidence of schizophrenia. Or allegedly had. Looking up online I can't access the full text of various studies but there does seem to be a ding-dong going on about this ("your study figures are crap" "come outside and say that to my face").
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/496670
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/496674
From the scraps I can glean, this seems to be due to:
(1) Irish emigrants turning up in America were hospitalised for schizophrenia at a high(?) rate
(2) Irish schizophrenia was seen to be a rural, rather than urbanised, illness (not surprising there) particularly elevated in the West of Ireland
(3) Revision on this later claims it was because patients first treated/hospitalised for it were using the medical services afterwards as a replacement social support scheme, so they were turning back up to be re-admitted to hospital (I'm torn on this one, as Irish hospitals are not a luxury experience but on the other hand if you're an Irish bachelor farmer in your 60s living up a mountain with nobody but the ghosts and the sheep for company, even an Irish hospital is better than that)
https://journals.sagepub.com/doi/abs/10.1177/002076408703300302?journalCode=ispa
(4) Summation seems to be that Ireland does *not* have an unduly high rate but it's in line with other countries, which would seem to be on the side of uniformity rather than cultural difference?
https://link.springer.com/article/10.1007/BF00782963
Unless the "rural support system" hypothesis is true, and countries elsewhere also have people using the medical system as an ersatz community, so the actual incidence of schizophrenia is pretty much the same all over, but hospitalisation rates differ due to "the doctors said I needed aftercare so here I am, please admit me".
On the other hand, this report from 2019 tells a different story? Or at least, that hospitalisation figures remain high in Ireland:
https://www.hrb.ie/fileadmin/2._Plugin_related_files/Publications/2019_Publication_files/2019_HIE/NPIRS/Census/Irish_Psychiatric_In-patient_Census_2019_Main_Findings.pdf
"One-third of all in-patients on census night had a primary admissions diagnosis of schizophrenia, 16% had a diagnosis of depressive disorders, 10% had a diagnosis of organic mental disorders and almost 8% had a diagnosis of mania. Patients with a diagnosis of schizophrenia had the highest rate of hospitalisation, at 16.0 per 100,000, followed by depressive disorders, at 7.9, organic mental disorders, at 4.7 and mania, at 3.6.
Males had a higher rate of hospitalisation for schizophrenia than females, at 20.2 per 100,000 for males and 11.9 for females. Similarly, males had a higher rate of hospitalisation for organic mental disorders, at 5.6 compared with 3.9 for females. In contrast, females had a higher rate of hospitalisation for depressive disorders than males, with a rate of 9.2 for females and 6.6 for males.
Those with a diagnosis of schizophrenia had the highest rate of hospitalisation amongst all age groups in the 20–74 years age range, with rates ranging from 37.5 for the 65–74 years age group to 9.5 for the 20–24 years age group. Both schizophrenia and eating disorders had the highest rate of hospitalisation amongst the 18–19 years age group, at 5.9 each respectively. Organic mental disorders had the highest rate of hospitalisation amongst the 75 and over age group, at 52.6 per 100,000.
Schizophrenia also had the highest rate of hospitalisation in six of the ten socio-economic groups (farmers, agricultural workers, non-manual, manual skilled, semi-skilled and unskilled), while depressive disorders had the highest rate amongst higher professionals, lower professionals, employers and managers and own account workers.
...Schizophrenia continues to be the predominant diagnosis in adult units and hospitals, accounting for one-third of all patients resident, while depressive disorders was the predominant diagnosis amongst the under 18s, accounting for 37% of all under 18s. The proportion of in-patients with a primary diagnosis of schizophrenia remained at a similar level (34%) in 2010 compared to 33% in 2019 while the proportion of in-patients with intellectual disability declined from 6% in 2010 to 4% in 2019."
>She felt a degree of bitterness toward her friends: almost as though they'd caused her to become a victim, not her attacker.
(warning: what follows is non-nuanced speculation about sexual abuse)
Given these arguments about guilt: https://www.lesswrong.com/posts/CZnBQtvDw33rmWpBD/guilt-another-gift-nobody-wants , I think this makes some sense.
If we assume that survivor's guilt is some kind of game-theoretic mechanism to prove your innocence, then we could expect that this only kicks in for very taboo things. If you did not know that what happened to you is taboo, then there is no need to prove your innocence with survivor's guilt (of course, getting survivor's guilt is not a *conscious* process, but I hope you get what I mean). But once you learn about how horrified everyone is of your experience, the survivor's guilt starts.
What does survivor's guilt have to do with child sexual abuse? You're not making any sense.
The idea is, in part, that people evolved to be traumatized when raped so that other people wouldn't blame *them* for what happened. Similarly with survivor's guilt - "If everyone else dying was what I *intended* to happen, would I be so miserable right now?"
> Other commenters bring up related arguments - doctors sometimes examine children’s genitals in ways that aren’t obviously different from what goes on in some child sex abuse cases; some tribes have rituals where adults do weird things to children’s genitals - in all these cases, because it’s socially accepted and people aren’t “supposed to” feel traumatized, they usually don’t.
I feel compelled to bring up a counter example. The first time I ever had sex, it was not consensual. I felt powerless and upset, but it was with my first boyfriend and it was not scary, and it didn't map to my expectation of what rape would be like, so I quietly accepted it and did my best to accept that my life now included this activity. I even came to kind of enjoy sex with him, sometimes.
I only went to a gyno much later, after we'd broken up for entirely unrelated reasons. And then, while they did the pap smear, I felt completely violated and vulnerable. The weight of every unwanted touch I'd ever had from my boyfriend seemed to come crashing down on me. It felt much more traumatizing than all of these previous experiences, even though the doctor was perfectly nice and as far as I can tell did everything right.
My reactions don't really make sense to me, but they don't really track with the view that going to the doctor is not traumatic either. I can easily be convinced that if I had no history of sexual assault, then the doctor visit would have gone way more smoothly, and I guess it was just a trigger and not its own trauma per se. But it feels like it was its own trauma anyway.
I haven't had sex since then, even though it's been years and I've had the opportunity several times. After realizing I actually had the choice to say no, it has always felt more compelling to exercise this choice, even though I am aware people seem to enjoy sex a lot and I might too if it was actually under my control.
And I haven't gone to the gyno again, even though I know I should, but it just feels unbearably scary.
All of that said, I don't think I have meaningful PTSD symptoms right now. Looking back, I do think I experienced them while I was dating that first boyfriend, but I attributed them to a previous sexual abuse experience that felt much more terrible and scary, even though it was not under the umbrella of what is normally called rape.
Do you have a phobia about doctors/formal medicine outside of gynecology?
"Phobia" is an overstatement, but I avoid going to the doctor as much as possible and generally seem to feel more of an aversion than most people do, despite having a mild tendency to worry about my health. Part of the trouble might be that I do have a genuine phobia of needles, and obviously those come up a lot in medical contexts.
I'm sorry to hear about what happened to you. I don't think it contradicts my point in that section, which is that absent some context, most people don't seem to interpret exams by doctors in that way. It sounds like you had a lot of especially scary context, and the exam was the trigger for it to activate.
On the second paragraph of the last entry: incentives create results. If there are (monetary) benefits of being sick, people will make themselves believe they are sick (psychologically or otherwise). Obviously this is not the case for everyone.
I am always amazed how many people in my country (the Netherlands) are on semi permanent sickleave so to speak: 817.000, 6.6 % of the working population. And this in a country with a very good, in practice free, healthcare system.
Other benefits are: getting attention and not having to take responsibility.
A country clearly gets as much sick leave as it's ready to pay for. Sweden had a sick leave rate of 5.5%, and more than halved it through some simple, fairly moderate reductions and checks in the 90's.
Disability rates in rural white America seem to be the same kind of thing.
> it’s strange that the PTSD symptoms associated with details of modern combat (ie a “soldier who doesn’t know when the next enemy might appear in a crowd of civilians”) so closely resemble the symptoms modern people get after natural disasters, sexual violence, etc.
A commonality I see with those three cases is a traumatizing event happening at an unpredictable moment in an environment you can't escape.
Your mind will work very hard to protect you from experiencing the enormous event again, so will pattern match even the tiniest details as possible warning signs. There is no such sign, but your mind will not take any chances, those rustling leaves might be a tiger after all.
But that clear lack of warning signs will also cause you to relive the event; the definitive signs haven't been found, so we must keep looking.
All the while you have a list of candidate signs, so every time one of those signs pop up: better safe than sorry, let's get that fight-or-flight going.
Wouldn't it be fascinating to test which Western psychiatric interventions work cross-culturally, and which don't? Presumably medication would be better at it than psychotherapy, for instance? Then we will have data on which interventions are just our own witch-doctor treatments.
I don't think psychiatric practices in the West have been generally validated as working even there.
Discussion of war previously as a positive good and the lack of connection to PTSD has me thinking about how it may influence groups ('cultures,' but not really) that have similar worldviews today, whether that be terrorist organizations, rebel groups, militias, etc. I'm sure research into PTSD and associated trauma rates in those populations is exceedingly difficult, but maybe there's something out there?
Your explanation of child sex abuse sometimes not causing trauma definitely makes sense, but curious about an alternate theory... It does cause underlying trauma, but in ways that do not manifest directly in a person's life until it's directly discussed as taboo. In that case, couldn't it be seen as a positive that it's brought to the surface (making some kind of treatment possible) rather than unconsciously dealt with?
Maybe? An alternate theory is that it stays a background thought that doesn't interfere with daily activities or major life goals, and the person lives the rest of their life without experiencing the significant trauma. Treatment isn't always a distinct positive, if the alternative is never needing treatment. If there is an ongoing psychological distress that's never dealt with, and it can be successfully dealt with and the patient has no further distress, then bringing it to the surface makes sense. I am highly doubtful that scenario plays out very often. Most of the people I know who seek psychiatric care never get to a point where they can say "I was cured of my X!" Instead, they learn coping mechanisms and the trauma impacts their lives less. Isn't that where we started before we told them they were traumatized and made them deal with it?
That sounds like you really want there to be trauma to find. Which from reading the review, this article and both comment sections happens frequently when westerners are in a foreign context, so I'm not blaming you.
The story above of a western woman in an african village encountering someone recalling "attempted rape" while they and the village were laughing about it and the known "perpetrator". There's nothing to diagnose and nothing to treat there. If you, however, spend significant time as an authority (psychiatrist) insisting that there is a trauma there, I'd be very careful with the eventual - noteworthy parallel! - confession. If it wouldn't hold in court, maybe it shouldn't hold as diagnosis.
Indonesia, not Africa.
Re: widespread pedophilia, I just read this article:
The German Experiment That Placed Foster Children with Pedophiles https://www.newyorker.com/magazine/2021/07/26/the-german-experiment-that-placed-foster-children-with-pedophiles
And the subsequent twitter thread that argues that pedophilia was popular among certain elites in the 70s https://twitter.com/razibkhan/status/1417548833593217042
There's politician's from the green/alt/hippie crowd who on-the-record said some thirty years ago that we should legalize pedophilia because their own experiences were fine and this all just hysteria. These politicians are still in office/voted to this day and those comments resurfacing recently caused a scandal:
https://de.wikipedia.org/wiki/P%C3%A4dophilie-Debatte_(B%C3%BCndnis_90/Die_Gr%C3%BCnen)
There were a few anti-age of consent etc. groups like the Pedophile Information Exchange who gained a bit of support among some leftist groups during the 1970s, but wider public opinion was always strongly against them. Probably part of it can be blamed on things like the legalisation of homosexuality and a general wave of sexual liberation encouraging people to take a more negative view of formerly sacroscant ideas about sex. To characterise this as being about "elites" is almost certainly highly misleading.
R.e. Kentler, this is an issue where there's a lot of hindsight bias, and the current narrative on child sexual abuse denies any possibility other than that Kentler knowingly and deliberately sacrificed children to pedophiles.
Growing up, I was taught that one of the important differences between Judaism and Christianity is that Judaism teaches that you should do right things and right thinking will follow, whereas Christianity teaches that you should believe right things and right actions will follow. And that this leads directly back to the central directives of each religion; “keep the mitzvot” and “believe in Jesus”, respectively.
Regardless of whether these ideas are prevalent in the West because of their respective religious teachings, it really feels to me like the field of psychology presupposes that right actions can only come from right thoughts. Perhaps they have to; it might be a very different field otherwise. I personally think they’re wrong and one of the themes I see in this Crazy Like Us discussion is pushing back and suggesting that in fact, contrary to what psychology teaches, right thoughts lead to right actions.
Robin Hanson discusses some of the modern implications of an emphasis on orthodoxy vs orthopraxy here:
https://www.overcomingbias.com/2020/07/beware-righttalkism.html
My experience with CBT is the opposite of this. A lot of it is about doing behaviors that are not natural until they become a habit, and the positive effect of that habit
I'm confused "presupposes that right actions can only come from right thoughts" and "contrary to [this[, right thoughts lead to right actions" seem to mean the same thing - was one of them meant to be in the opposite order?
I don't know how so many great psychologists being Jewish would fit into this model.
@Scott
Sorry for the confusion! Serves me right for attempting to operate a keyboard while not under the influence of coffee. The last line should read "suggesting that ... right actions lead to right thoughts", as you probably guessed.
I do think "actions lead to thoughts" has less error with the cases being discussed than "thoughts lead to actions", but on reflection the case for the pure statement isn't as strong as I made it sound.
On the one hand, I think it may have a strong explanatory component for the differences in soldier traumas in modern wars. Not only did the circumstances of those wars change, as you quoted, but the training changed with it. For example, after WW2 the US Army felt that soldiers in the war had acted with insufficient aggression and initiative under fire, and changed basic training to more of a vigilant and aggressive mentality now dubbed the "warrior" mentality. (Out of combat American forces showed far more initiative than, say, highly regimented German or Japanese forces.)
Now, it's not like ambush or surprise was invented in Iraq or Afghanistan or even Vietnam. War has always contained situations only partially in soldiers' control. And while the Germans often followed the laws of war, the Japanese most certainly did not. But is it surprising that the guys trained to maintain vigilance and act aggressively have more vigilant and aggressive trauma than the guys trained to dive for cover and stay in it? I can't speak to the subtleties of the training that, say, hoplites got, but the modern case feels like it could easily follow from the actions as much as the mindsets.
The pure "actions lead to thoughts" model gets harder to square with, say, the cases of CSA that became traumatizing later. In those cases there is a clearer argument that actions and a meta level of thoughts together lead to traumatic feelings. A "how should I feel about myself given what happened" layer, if you will, which can not only change but apply retroactively. And that layer would seem to be highly social and prone to reprogramming.
Perhaps it's slight of hand with both simplistic models that they presume a singular notion - their own - of right thoughts and right actions.
As to why the Jewish teaching wouldn't be more prevalent in psychology despite a prevalence of Jews in psychology ... I don't know! It's a fair question and I don't yet have a good answer. Perhaps it's not actually a widespread Jewish teaching. Perhaps the Jews who go into psychology are unusually interested in how the mind works, and predisposed to the notion that right thinking leads to right actions.
@Randomstringofcharacters
Yeah, behavioral therapy really does run with the idea that right actions lead to right thoughts. I had the impression that CBT was still not really the mainstream, and that the "you have bad thoughts that cause you to do bad actions so let's give you drugs" was the more established orthodoxy. Is that not so?
America and Britain vary. Britain (apart from the blow-back from invested psychiatric and psychological practices) is largely pro-CBT. Behaviours affect thoughts is a core tenet of change.
However, if you have the time and skill, then examining schemas by breaking down thoughts, underlying assumptions, and core beliefs can also affect change.
T&CA, E&OE: my anecdotal experience tends to favour behavioural change as easier to implement and efficacious. YMMV.
Regarding creating trauma, one thing I *think* I've noticed by hanging out with some not-large-but-not-trivial number of Asian families is that how they handle bodyweight issues with kids seems better. If the kid is putting on weight, mom says "Hmm, you're getting a little fat so I made you a smaller plate". That's it. In contrast, American parents (or the stereotype of them at least) is to talk between themselves for a while to figure out how to approach the child gently about their weight, and when they finally do manage to say something, preface it as if they're preparing to tell them all the puppies in the world died, causing the kid to think their weight is a serious world issue and to subsequently experience anxiety about it.
Interesting! although I disagree re: American parents trying to be nice about it, usually one of the two reaches straight for the shame and goes to TOWN.
While overweight themselves?
Also, re: Expressed Emotion in the US, this seems to be an argument for that?
Glad to hear my comment was helpful!
Re: "I wouldn’t expect there to be enough people witnessing each other’s interactions with schizophrenic family members for this to spread across a culture. Maybe this is downstream of biological views of mental illness or something?"
I don't know, but best guess for the "Crazy Like Us" viewpoint is that a culture-bound "response to mental illness" role could spread through a society in a similar way to how a culture-bound "mentally ill" role spreads. So the depiction of John Nash in "A Beautiful Mind" influences how mental illness expresses as schizophrenia, just as the depiction of his wife Alicia influences how companionship expresses as a particular caretaker/illness-adjacent role within a family?
But, if you follow this idea, you would expect to see a change in this caretaker role accompany changes in the cultural expression of the illness, if the two are related. Maybe it would be easier to see for low-stakes common ailments like "how the rest of the family reacts to one of them getting a cold". Is there a lot of variation in this too, world-wide? And is that influenced by e.g. a character on an American TV show getting a cold, which is broadcast in Europe?
Also, culturally a lot of parents globally could be in the unique situation where right now is the best and maybe only time to get a child into college and therefore the english-speaking elite. That leads to immense pressure on an entire generation in that country where every child not destined to go to college or speak 3 languages by 15 is a disappointment.
Extrapolate to anywhere inbetween or after to get to the US now. Accruing college funds and a third mortgage only for the ADHD / depressed child to fail after 2 years... There's gonna be some expressed emotion in some households for sure!
About natural disasters and PTSD: I wonder if the abundance of information about natural disasters is contributing to duration and severity of anxiety etc people experience afterward.
I'm working off my own experience so I'll try to keep my example brief and dispassionate:
Talent/Phoenix, Oregon last September:
-We had no warning about the Almeda fire, the emergency alert system was not activated, and everyone evacuated at the last second. Three people were killed and 2500 structures burned.
-After the fire, everyone was distraught over the lack of information, so people turned to sharing their own information on Facebook: countless videos of burned neighborhoods, false reports of new fires, pictures of actual fires popping up all over the place.
-Residents also tuned into the police FB page, the fire department FB page, the police scanner, and ever-updating county evacuation maps.
-A major wildfire burned in the Rogue National Forest nearby, inundating the whole valley in thick smoke, and details of this fire were continuously posted/updated.
Given all this information, the residents of Talent and Phoenix lived with a sense of "nowhere is safe" for an extended period post-fire. Some people ended up with PTSD diagnoses, others didn't, and whether they lost a house didn't seem to matter. The people who I saw showing continuous signs of stress and anxiety happened to be those who continued to believe that nowhere is safe.
Of course, the *feeling* that nowhere is safe is a symptom of PTSD, and one that I've experienced. But as I notice my unsafe feelings abating with time/exposure/therapy, I'm seeing people who experienced far less trauma in the wake of the fire display more anxiety about fire season.
I wonder if the exposure to fire-related information is exacerbating their anxiety.
How this relates to the article and discussion: high exposure to information about what is happening in the world this very moment is a modern phenomenon.
I recommend A Collection of Unmitigated Pedantry in general.
Especially https://acoup.blog/category/collections/siege-of-gondor/ where I learned about some things that I missed despite repeated rereads - because I had no knowledge necessary to appreciate it.
Also, I learned a lot about real history from it.
Series about Sparta, about ancient farming, all of that is really interesting and I recommend it.
My recent ADHD diagnosis has radically rocked my worldview even though it's been consistently suggested since I was in kindergarten to explain various issues. Some deeply un-rigorous thoughts:
1) I have really resented the outpouring of support and kindness from my "progressive" friends - the underlying sentiment appears to be that now I am no longer responsible for anything I do, and that attempts at self improvement or management (other than taking Adderall) are delusional in some way.
2) As Scott suggested, a mental disorder for which 5-10% of people meet the criteria is not a mental disorder. It's just "a way some people are." If we have built a society in which 5-10% of people need to be medicated in order to function, that strikes me as a dysfunctional society, not a society with a lot of dysfunctional people.
3) On the other hand, if Adderall is really as safe and effective as claimed I don't see any reason why 100% of people shouldn't be on it. :P
4) Scott also points out the obvious: a huge part of my struggle was navigating a career I'm bad at. Billing hours makes incentives run precisely backwards. Legal culture is obsessed with stereotypical "lawyerly image" over productivity.
There is limited room in the legal world for a person who is useless from 7-10AM every morning but can knock out an excellent brief at 10pm after a shower thought leads to a new idea for argument. That doesn't project a lawyerly "image" and costs the firm money - If most of your "work" gets done as a background process while you're faffing about, is that billable time?
tl;dr: "Being a bad lawyer" is not a mental disorder. Most people would make bad lawyers.
But more than that, my ADHD diagnosis is cultural in more ways than just "my society has more psychiatrists, and they need something to do." It's also a consequence of society being more global - I need to sell myself to strangers whose incentives include fast, System 1 judgments, and for whom taking a while to evaluate my unique strengths and weaknesses would be an unconscionable waste of time and energy. I am expected to have very set on-hours and off-hours and to conform to the appearance of productivity, even if that's not how my natural cycle works. My usefulness is measured in ways that fail to show me in a good light.
And, yes, perhaps most importantly, I expect to self-actualize as a lawyer/mathematician/rocket scientist/fitness guru/polymath instead of as a sustenance farmer who survives past 25 years old.
I'm inclined to treat all these things as negatives because they exclude me, even though most are decidedly not - set work hours are a win for most people. Performance metrics *should* overtake personal feelings that are often prone to bias. The availability of multiple life paths and resources to pursue them is a mostly unqualified good.
And yet these almost entirely positive things gave me ADHD :P.
I’m kind of progressive so I’ll resist the urge to offer support. Oh to hell with it. I hope things work out for you. :)
Having just recently watched a video from an attorney who hates working for billable hours (has only done it once in his career), I would note that if you start your own firm and work on contingency, you don't have to. May or may not be possible for you, but something to consider.
I know a neurologist who researches ADHD. He's fond of observing that "everyone can focus better on Adderall; that's what a stimulant does".
I agree that medicalizing common behavioural and psychological traits is one of the things that is problematical with modern medicine. Don't allow a diagnosis to control who you are, only use it as a tool to make the best of your life.
I tend to think of myself as scatterbrained, not ADHD, for exactly this reason. In a pre-modern culture I'd just do my thing and nobody would notice.
I noticed that bullshitting your way into an appearance of productivity is the #1 skill of high-functional ADHD people, myself included. Nobody needs to know 90% of the work gets done in a few hours per week.
Billable hours are ridiculous. People pay for an outcome, not the time it took you to get it. Fee for service is the future.
Also, speaking as a lawyer with ADHD, the number I know with it is very high. It may not be particularly compatible with large-scale corporate law. That's not the same thing as it being incompatible with law.
Also also, the fact that people with ADHD often have non-attention related symptoms that respond to medication that they also share with others suggests it is a real disorder, rather than just a way people are. Or, more likely IMO, a collection of disorders with similar symptoms.
Besides that, 23% of adults have arthritis. Still not how things are supposed to work. ADHD may not be particularly unusual. That doesn't make it how things should work.
I've had several positive reactions to medication that aren't attention-related:
1) A decrease in obsessive thoughts and anxiety
2) A decline in taking very casual criticism way too seriously
3) Building consistent priorities instead of changing them every 18 seconds
4) An increase in planning and execution ability.
5) A more consistent sleep schedule for a 9-5 work schedule.
I agree this is a life improvement - I disagree that it would be a life improvement in all societies. In a world where smaller communities live and die by their shared contributions, my unique strengths (which are numerous) would be discovered over time while the weaknesses would be compensated for.
That society isn't better. It's probably worse. And I'm not saying ADHD folks shouldn't be medicated. Medication has improved, and potentially even saved my life. But unlike arthritis treatment - which is our fight against the breakdown of the body, ADHD is innate and not entirely destructive. That, ADHD's prevalence, and a social philosophy that there is a "correct" way to be a person, makes me wonder if we are engineering people to fit a society when the society should serve the people.
An ADHD individual cannot autonomously perform all the functions we require from office workers. But they can be part of a powerful team. There are organizations that take advantage of this, and they are winning. Probably even in law. But not in law in my locality, where the profession is fairly conservative and old-school.
A tangent (in this post about ADHD, lol), but I notice this a lot in Scott's blog circle. The assumption is that people who are not "The Correct" kind of person still have a place in every profession in every location, as long as they have value to add. But in most of the country, the culture is stronger than the market. And in most of the country, the culture does not like having preconceptions about how they do things challenged.
Perhaps the takeaway here is that, psychologically speaking, a lot more people are subject to the nocebo effect than we realized.
Per Greg Cochran, the placebo effect is just regression to the mean: https://westhunt.wordpress.com/2016/03/31/medicine-as-a-pseudoscience/
I think he is mostly right but wrong in certain specific situations - see https://slatestarcodex.com/2018/01/31/powerless-placebos/ for more and some evidence.
I second the finding that PTSD was virtually unheard of in ancient soldiers. I also looked through the examples people usually cite, and they're thoroughly unconvincing. For example, one was that Roman slave sellers had to inform buyers if the slave had ever been attacked by a bear. The reasoning goes that if the buyer is worried about physical impairments from the attack, he can easily see them himself, so he must be worried about PTSD.
This is even more surprising because of how common war was for ancient people. In Rome, the gates of the Temple of Janus were open in wartime and closed in peacetime. The gates were open continuously from 225 BC to 29 BC. Also, it was standard for Rome to fight with two consular armies of two legions each, for a total of 20,000 men, half of which were Roman and the other half Italian allies. The population of Rome in c. 200 BC was maybe 500,000 people, so this was 4% of the male population under arms at any one time. Since there was no professional army and levies were conducted annually, the percentage of the male population with military experience is probably >15%. In comparison, modern USA has 0.8% of its male population under arms, and most of those have never been near an active combat zone.
Incidentally, I read a NYTimes article a while back that said drone pilots also get PTSD, even though they're completely safe. The article ascribes it to "moral injury". Not sure what to make of it: https://www.nytimes.com/2018/06/13/magazine/veterans-ptsd-drone-warrior-wounds.html
"In Rome, the gates of the Temple of Janus were open in wartime and closed in peacetime. The gates were open continuously from 225 BC to 29 BC." Indeed; and not only that, the Res Gestae Divi Augusti claims that before the reign of Augustus they were only ever closed *twice* – the first time by the semi-mythical (or perhaps entirely mythical, but this I doubt) second king of Rome, Numa Pompilius.
Here's an experiment: Let's make up an entirely new form of mental illness with realistic sounding symptoms, and then try and spread awareness of it somewhere. If the ideas in "Crazy Like Us" are correct, maybe we'll see an epidemic of this new mental illness.
I propose a ban on gain-of-function research on mental disorders.
That got a chuckle from me.
What if we invented a mental disorder that was secretly all positives? WE ARE WORRIED ABOUT AN OUTBREAK OF ALTRURISMITIS, AN ALARMING MENTAL DISORDER WHERE PEOPLE GIVE ALL THEIR MONEY TO EFFECTIVE CHARITIES. WE ARE DEPLOYING THERAPISTS TO TREAT IT AT ONCE.
Too late.
http://www.davidbrin.com/fiction/givingplague.html
I propose this from the opposite direction:
Let's design a catalogue of easy to spot, largely harmless disorders and symptoms for all possible underlying stresses. Then treat those for all eternity.
If we truly have that power then we have to recognise that any and all current catalogues are made up nonesense, in part by patients and in part by doctors without any intent from either party. We would have decided to just cement the status quo, however bad it is, onto paper. Let's change that, then!
re sexual abuse and cultural expectations: this reminds me of an anthropology paper about how people in different cultures experience rape differently because of their beliefs about its severity
From Christine Helliwell's "'It's Only a Penis': Rape, Feminism, and Difference" (CW is self-explanatory):
"In 1985 and 1986 I carried out anthropological fieldwork in the Dayak community of Gerai in Indonesian Borneo. One night in September 1985, a man of the village climbed through a window into the freestanding house where a widow lived with her elderly mother, younger (unmarried) sister, and young children. The widow awoke, in darkness, to feel the man inside her mosquito net, gripping her shoulder while he climbed under the blanket that covered her and her youngest child as they slept (her older children slept on mattresses nearby). He was whispering, "be quiet, be quiet!" She responded by sitting up in bed and pushing him violently, so that he stumbled backward, became entangled with her mosquito net, and then, finally free, moved across the floor toward the window. In the meantime, the woman climbed from her bed and pursued him, shouting his name several times as she did so. His hurried exit through the window, with his clothes now in considerable disarray, was accompanied by a stream of abuse from the woman and by excited interrogations from wakened neighbors in adjoining houses."
"I awoke the following morning to raucous laughter on the longhouse verandah outside my apartment where a group of elderly women gathered regularly to thresh, winnow, and pound rice. They were recounting this tale loudly, and with enormous enjoyment, to all in the immediate vicinity. As I came out of my door, one was engaged in mimicking the man climbing out the window, sarong falling down, genitals askew. Those others working or lounging near her on the verandah - both men and women - shrieked with laughter."
"When told the story, I was shocked and appalled. An unknown man had tried to climb into the bed of a woman in the dead, dark of night? I knew what this was called: attempted rape. The woman had seen the man and recognized him (so had others in the village, wakened by her shouting). I knew what he deserved: the full weight of the law. My own fear about being a single woman alone in a strange place, sleeping in a dwelling that could not be secured at night, bubbled to the surface. My feminist sentiments poured out. "How can you laugh?" I asked my women friends; "this is a very bad thing that he has tried to do." But my outrage simply served to fuel the hilarity. "No, not bad," said one of the old women (a particular friend of mine), "simply stupid.""
"I felt vindicated in my response when, two hours later, the woman herself came onto the verandah to share betel nut and tobacco and to broadcast the story. Her anger was palpable, and she shouted for all to hear her determination to exact a compensation payment from the man. Thinking to obtain information about local women's responses to rape, I began to question her. Had she been frightened? I asked. Of course she had - Wouldn't I feel frightened if I awoke in the dark to find an unknown person inside my mosquito net? Wouldn't I be angry? Why then, I asked,
hadn't she taken the opportunity, while he was entangled in her mosquito net, to kick him hard or to hit him with one of the many wooden implements near at hand? She looked shocked. Why would she do that? she asked - after all, he hadn't hurt her. No, but he had wanted to, I replied. She looked at me with puzzlement. Not able to find a local word for rape in my vocabulary, I scrabbled to explain myself: "He was trying to have sex with you," I said, "although you didn't want to. He was trying to hurt you." She looked at me, more with pity than with puzzlement now, although both were mixed in her expression. "Tin [Christine], it's only a penis," she said. "How can a penis hurt anyone?""
Very interesting!
I'm quite surprised that women in any pre-modern society wouldn't see rape as a serious form of harm simply because of the associated risk of unwanted pregnancy, particularly in a context without reliable contraception and where childbirth was life-threateningly dangerous.
(I remember reading about a disturbing provision in a medieval Serbian legal code which specified the compensation to be paid by a man who raped someone else's female slave, impregnated her, and caused her to die in childbirth. The fact that this apparently happened often enough that they had to make a *law* dealing with it really says something.)
Still, this doesn't say a lot about the effects of rape as opposed to attempted rape.
" About 75% of my aunts / uncles were abused / raped. Around 20% of the boomer friends I have that I’ve had deep conversations with have shared stories with me of them being raped / sexually abused as children. I think the actual real prevalence based on my own experience is probably somewhere between 20%-50%.
[...]
This was puzzling, as the standard textbook of psychiatry at the time stated that incest was extremely rare in the United States, occurring about once in every million women. Given that there were then only about one hundred million women living in the United States, I wondered how forty seven, almost half of them, had found their way to my office in the basement of the hospital."
Taken together, Robert McIntyre seems to be implying 20-50% of boomer women were raped by their immediate family. I won't say I don't believe it, but I will say that extraordinary claims require extraordinary evidence, and this is definitely an extraordinary claim.
"extraordinary claims require extraordinary evidence"
Yup
Re Holocaust survivors: here in Israel it's accepted as common knowledge that Holocaust survivors suffer from some type of ongoing trauma response, and moreover that their behavior inflicted trauma on their children. Saying that your parents survived the Holocaust is tantamount to saying that you were traumatized by your parent's response to their Holocaust experience. I'm sure there are studies on this.
Although perhaps the point is that most of the survivors and their children were and are productive member of society and therefore not "disabled"?
A really interesting but understudied-for-obvious-reasons property of lots of disruptive social movements of the post-war era is that they were founded and driven mainly entirely by Jewish people born during or just after WWII (I originally wrote "born to Jewish people whose lives were disordered by WWII" but then realized this was pretty much tantamount to all of them, a nonsense distinction). It's extremely hard to discuss this, of course, since the immediate assumption is that the speaker is some sort of armwaving antisemitic kook, but nevertheless it's factual and easy to substantiate.
Feminism is a particularly clear example, with nearly all prominent "second-wave" (a.k.a. actual, since the first wave didn't call itself feminism and had no social or intellectual connections to the second, in fact the suffragettes were typically at odds with the feminists) feminists fitting this bill. Abzug, Firestone (Feuerstein until her father felt the need to anglicize the surname), Friedan, Koedt (whose parents were part of the Danish Resistance), Sarachild (Amatniek until her feminist convictions led her to adopt a matronymic), Steinem (actually born a couple years before the war proper, but on the other hand her paternal grandmother is noted for successfully saving many members of their extended family from the Holocaust)... Germaine Greer, oddly enough, was born to Catholic parents but *wanted* to be Jewish to a bizarre and unusual extent which just makes the whole situation even stranger (she openly admits to having learned Yiddish and exclusively dated Jewish men during a period of her life, for example). Even feminists seen as part of a later generation, like Susan Faludi (whose father was a Holocaust survivor), match the pattern to a much higher degree than chance would predict.
To cut a long story short, I think there's probably a great deal in the idea of the Holocaust as a disruptive, alienating intergenerational trauma.
Later generations of Jews are still disproportionately involved in social movements. And since you just refer to the Holocaust/WW2 as having affected them all, you have no control group.
I had not heard that the suffragists were typically at odds with the feminists.
"Later generations of Jews are still disproportionately involved in social movements. And since you just refer to the Holocaust/WW2 as having affected them all, you have no control group."
I agree that this is a problem, but I think that if you compare them to *previous* generations, you might be able to cobble together something resembling a control group.
"I had not heard that the suffragists were typically at odds with the feminists."
Here's a brief anecdote told by Barbara "Definitely Not Jewish" Mehrhof (from an article by Susan Faludi on Shulamith Firestone, on the occasion of the death of the latter from mental-illness-induced self-starvation, allegedly in the middle of a kabbalistic diagram on the floor of her apartment):
In January, 1969, on a trip to Washington, D.C., Firestone and a couple of other women knocked on the door of Alice Paul, who had written the original Equal Rights Amendment, in 1921, and who was then in her eighties. She ushered them into a dark parlor, where old National Woman’s Party literature was spread out on the tabletops. “She was very suspicious of us,” Barbara Mehrhof, one of the visitors, recalled. Paul pointed to a wall of framed oil portraits of formidable-looking women—all suffragist leaders—and demanded that they identify them. “We didn’t have any idea,” Mehrhof said. “Which was just emblematic of the whole problem: how can we pass the torch when we don’t even know who we are?”
This story is pretty typical of the interactions between feminists and surviving suffragettes; the suffragettes felt that the feminists were ignorant, respectless and especially, spineless – trying to eke out special considerations and advantages, rather than demanding strict equality of rights, a perfectly even playing field; effectively, from the suffragette point of view, admitting to being the weaker sex. The feminists, for their part, felt the suffragettes were stuck in an outdated mentality of what equality and liberation meant, and (especially in the US) were appalled by their racism. Here's Stanton, for example:
"If woman finds it hard to bear the oppressive laws of a few Saxon Fathers, of the best orders of manhood, what may she not be called to endure when all the lower orders, natives and foreigners, Dutch, Irish, Chinese, and African, legislate for her daughters"
And Anna Shaw:
"You have put the ballot in the hands of your black men, thus making them political superiors of white women. Never before in the history of the world have men made former slaves the political masters of their former mistresses!"
IIRC Shaw was also the one who bitterly remarked in a private letter to another suffragette on the occasion of the 15th Amendment: "There – that shows you what men think of us: lower than niggers". Needless to say (I hope), this stuff did not go over extremely well with the feminists.
This whole discussion (and review) kind of surprised me, I have to admit, because I always assumed that it was sort of obvious and uncontroversial that all this stuff like anorexia and transsexualism are conversion disorders. Basically, conversion disorders used to be simple, obvious physical things like turning blind or hysteric paralysis, but then we developed tools to test these (e.g. reflex hammers) which showed that they were entirely psychologically induced, so then the disorders gradually shifted toward vague, hard-to prove conditions like anorexia, fibromyalgia and gender dysphoria, where the doctor couldn't just look at your tongue or something and say "nope, no trace of that here, your body is working perfectly normally as we've just proved, so it's all in your head".
This entire book + review + the above seems like the start of an entirely new thing.
If we have indeed produced these current disorders by elimination of all else, that immediately suggests that psychology as a field could set the goal of "designing a catalogue of easily diagnosed and largely harmless outlets for various underlying stresses".
Instead of trying to fence in a disorder pudding with "I can't confirm your symptoms" nails, how about building a proper funnel into a bowl and then treating that?
I doubt that would work. Looking at the history of conversion disorders it seems obvious that part or even all of the *point* is to dodge classification of one's problems as a mental issue -- the "conversion" is that of a mental issue into a physical one, and whenever the physical issue is shown to be somehow bogus, it disappears, whereas popularizing specific conversions spreads them. In other words these disorders are perverse in the sense of actively defying being pinned down or defined: herding them into some sort of funnel will just get people to convert to issues outside the funnel.
I see this as an argument for designing the perfect conversion disorders.
As soon as you dismiss one, another pops up randomly. So why not design a harmless and easy-to-spot one, raise "awareness" for that and tell doctors to not dismiss them, but diagnose them immediately for the underlying issue. People don't switch conversion disorder symptoms because they've been discovered, but because those symptoms didn't get them treatment! Let's fix that before the symptoms become cutting and starving and such!
Oh, also: "A second counterargument might be that if Western psychiatry only works because we think it does, we would probably want to know that, and then once we figure it out, it would stop working" – isn't this exactly what you yourself have written about in the past, the mysterious fact that Freudian therapy used to work great, and then it stopped working? And the same thing happened to CBT?
Further bolstered by large parts of the Placebo research.
We have to assume that once people are in a professional's medical office for the first time while spending huge amounts of money they immediately believe that they have the diagnosis and whatever's prescribed helps. Anything else would be a sign of incredible mental fortitude combined with stupid amounts of wealth, of which most patients almost per definition have neither. It's like a horrible funnel and we have to at least consider this as a possible problem.
(I'm not against psychology or doctors in any way, this just seems obvious)
How much of that placebo uses a control group of people who get no treatment at all?
With all due respect, Freudian psychotherapy never really worked because it had no real evidence base for its theoretical framework. The fact that it can provide solace is a separate matter, and I'd largely agree it's for the wealthy worried well.
As for CBT, it does have a theoretical base that is supported by evidence. However, I would be the first to agree that while some practitioners describe themselves as working within a CBT model, what the say and what they do is another matter.
Having seen the transformation of CBT by well meaning healthcare professional enticed by political support, I can fully sympathize with your perspective, because it's the right answer, but for the wrong reasons.
To be totally clear, I'm not presenting a personal thesis here – I'm referring to one Scott wrote about in an old post on SSC. I don't think I have the knowledge necessary to debate the issue myself, so I won't. I was solely remarking on what seemed to me a clear and direct parallel.
AskHistorians has a number of answers on ptsd in history, this one could be a starting point: https://www.reddit.com/r/AskHistorians/comments/457idw/did_people_in_ancientmedieval_times_suffer_from/
This psychology blog also has a lot of detail. I recommend.
https://insanpsikolojisi.com/dunden-bugune-iletisim-araclari/
Regarding:
"I have a vivid memory of reading a study that basically argued this - victims of child sexual abuse don’t think or care about it much until people tell them that it’s taboo and traumatic, and which point they are duly traumatized - but I can’t find it now. [...]"
...and:
"I am sympathetic to this based on an experience I had, where I was pretty bad at tolerating noise, but kind of within the normal human spectrum and never thought much of it, and then I lived with a noisy roommate who characterized my distaste for noise as freakish and psychiatric-level, and after that, every time I heard a noise I started panicking and questioning whether I was going to have some sort of freakish and psychiatric-level reaction to it, and this became so unpleasant that now I do have a freakish and psychiatric-level noise intolerance - or at least this is how I remember it."
This reminded me of my fictional (vaguely anarcho-monarchist) micronation's definition of treason, which in summary was something like "you're committing treason if you systematically attempt to convince people that other people are out to get them". It was seen as a supreme memetic threat, because they considered it so insidiously difficult to disprove and a comfortable thought for the person(/people) who had been declared a victim. How can sudden displeasure be 'comfortable'? Well, if your social circle tells you that you're a victim, they're on some level signalling their desire to protect you, possibly even give you free stuff in apology for the thing that happened to you. It's mentally very tempting to just accept that narrative; that this can result in you feeling emotionally much worse than you previously did doesn't necessarily stop this effect.
That said, this *is* a fictional micronation we're talking about, and the effort that went into world-building was limited to what seemed like a fun thought at the time, so I don't expect this to hold up against any rigorous scrutiny whatsoever. I'm not a psychologist and the way this nation thought about this phenomenon (= that something becomes horrible once people have convinced you that it is a horrible thing), in ascribing it to social convenience for the victim, is almost surely wrong.
What it *does* tell you is that the author (i.e. me) did observe this phenomenon - largely in verself, actually! This happened a few times. The most striking time was when my mum went over my finances with me back when I was studying and convinced me I was actually poor. It was total bullshit (I was comfortable paying rent, eating, and even taking my primary out to restaurants occasionally), but it seemed *really* compelling at the time and I bought it (pun... half intended?) and cried about it. Thankfully I was lucid enough that I also kicked myself out of that false belief a few hours later.
>A responsible treatment of this would have to discuss the history of traditional societies around the world that have something vaguely similar to our concept of transgender (like “third gender” roles in certain tribes), then move on to transvestism in the 1980s, and come up with some position on how these relate to modern transgender. One interpretation might be that there is some biological substrate for gender nonconformity (eg some evolved part of the brain that is supposed to tell you what gender you are can misfire in some way), and then the way that people feeling vague anxiety about their gender deal with it varies based on the local cultural milieu.
'Traditional society' to '1980s' is missing a few steps, innit?
Anyway, you may find food for thought in the 1918 memoir _Autobiography of an Androgyne_, by "Jennie June". It's not an easy book to read, partly because it describes a depressing amount of abuse, violence, and rape, and partly because the sexual content is all in Latin. But I think it makes a very strong case that sexual nonconformity is both mutable in its expression (as was common at the time, June does not distinguish between 'homosexual' and 'transgender', preferring the term "passive invert"; his life has both features suggestive of modern transgender female identity and strong parallels with modern gay male culture) and fixed in its presence (June suffered pretty much every punishment short of execution for the crime of wanting to consensually suck cock, and yet could not be dissuaded).
"June does not distinguish between 'homosexual' and 'transgender', preferring the term 'passive invert'" – could you clarify this? I'm completely unfamiliar with the book, but just reading this line it doesn't seem obvious that there's *any* transsexuality involved, he's just what contemporary gay culture would call a bottom. Isn't this just an instance of the thing where olde-tyme people figured it was *inherently* feminine to be a bottom (and thus inadvertently conflated transsexuals with the LGB despite the modern "progressive" understanding of these phenomena being worlds apart)?
Sorry, I could have been clearer. June consistently emphasizes his girlishness in both sexual and nonsexual contexts; the "features suggestive of ... female identity" I mention include calling himself a girl as a child, fighting with his parents over being brought up as a boy, wishing to have a girl's body (and a girl's genitalia), being horrified by puberty, doing his intimate socializing under a female name and female pronouns, suggesting that "sex should be determined by the psychical constitution rather than the physical form", and eventually having himself castrated.
(I have left out the gay male parallels, since you take them as read, so this list appears rather one-sided; in context each point of similarity with the modern understanding of transgender is more nuanced—for example, he describes both praying to be made physically a female and praying to be made mentally a man. I use the male pronoun because he does.)
No doubt June's sexual expression, like others' of that era, was influenced by contemporary ideas about gender and sexuality (as well as enforcement of contemporary morals). But he definitely seems to illustrate an overlap between phenomena regarded as separate today; is it accurate to call that a 'conflation', or does it merely privilege the modern progressive understanding? (Certainly arguing whether June 'really' was, or would today have been, a gay man or a trans woman seems unlikely to be productive.)
Oh, yes, that's much clearer now. Thanks. (And sure, I think I see what you mean there at the end, many gay/lesbian, and even some straight!, people seem to argue that if they'd been in their early teens today they would have taken for granted that they were trans, considering their childhood experiences – experiences which did not stop them from being integrated adults of their respective sexual preferences today.)
I've commented this elsewhere before, but it baffles me to see someone as otherwise thorough and thoughtful as Scott assert that ADHD is just being on the low end of the bell curve of ability to concentrate. It comes off like he hasn't done any research at all, which is bizarre from a psychiatrist.
ADHD is an entire neurotype, and it has way more symptoms than just "inability to concentrate." There's hyperfocus, hyperfixations, rejection-sensitive dysphoria, and an inverse reaction to stimulants, among others! A non-ADHD person who was just absentminded probably wouldn't fall asleep after three cups of coffee or need to fidget in order to think. There's no such thing as "primarily hyperactive type inability to concentrate."
ADHD is a lot more like autism (of which it's sometimes considered a cousin condition, because their symptoms overlap) than it is like being unusually clumsy or unusually tall. It's like a brain running on Linux instead of Windows. Reducing it to one single trait is inaccurate.
I think Scott has expressed doubts about rejection-sensitive dysphoria as an ADHD symptom - since this originated as one random doctor's hypothesis, and hasn't been widely accepted in the ADHD literature.
Talking about it as "inability to concentrate" might be oversimplifying, but ADHD does seem to be a person on the low end of executive function, which relates to all the other symptoms you cited.
He has, since he found that when he put it in the reader survey it didn't show up as a majority thing. It DID show up more with ADHD than anything else, and did show up a lot, though.
Now, if he'd put in "and it responds to being medicated" I think he might have gotten further.
> I think the evidence strongly suggests that ancient combatants did not experience PTSD as we do now. [...] The more interesting potential question is why. Considering all of the competing theories for that, I think, would take its own collections post. But for my part, I tend to think the difference lies in part on the moral weight placed on warfare
Interesting. My first instinct is that their lives were just so much harder leading up to being a soldier, that they're just better at coping with emotional and physical hardship, and so they don't actually get traumatized.
Consider that by the time a person reaches maturity, they probably would have already lost a few siblings, they were used to slaughtering animals and possibly even killing other people or seeing them hanged, and they're accustomed to very hard physical labour. Their whole life up to that point was trauma resistance training.
We're fairly pampered by comparison, both emotionally and physically. So maybe PTSD partly results from the fact that we're too safe to have built up the necessary resistance to the horrors of war.
> I remember one that clearly made the connection to being traumatized after you’re informed it’s taboo. Does anyone know what I’m thinking of?
I remember reading one about adult female victims that reached a similar conclusion, ie. that they became more traumatized after seeing how horrified other people were over their experience, and only then did the victims feel shame over what happened to them.
This may seem obvious but I think it's worth saying: it sounds like the presence or lack of childhood trauma as a result of early sexual contact comes down to consent, and I don't see any evidence to convince me that the alternate hypothesis (it's solely a result of parents'/society's expectations or reactions) is remotely tenable (although I can understand how a big dramatic reaction to a non-traumatic event would make the event feel traumatic).
Legal definitions aside, I think most would agree that children are capable of either consenting or not consenting to things. They can be convinced by perpetrators to participate in sexual activity voluntarily, in which case it seems plausible that some would not be traumatized by those experiences until someone makes a big deal out of it much later. Especially if prepubescent sexual activity is culturally acceptable (e.g. Massai culture, at least in Tanzania).
But the existence of individuals who weren't traumatized by early sexual contact does not constitute evidence to support a claim that the enduring distress resulting from childhood sexual abuse is a cultural phenomenon that arises only when the person discovers they violated a taboo. This idea conflicts with every single instance I know of, including my own (I know a lot of women who were assaulted before they ever learned that assault was a thing, and their distress existed before anyone knew enough to react).
The sole concept here that rings true is that our cultural expectations around trauma have the potential to worsen affected children's prospects when it comes to recovery. That, I would believe.
I'm also curious who wrote the mystery paper mentioned above and how they justified it.
Perhaps sexual assault isn't only bad because of potential "trauma" but other things too. In honor cultures a woman will feel her honor is being attacked and her sexual purity defiled by a filthy rapist. May be no trauma involved unless getting angry and wanting revenge against someone who violated your honor is now considered trauma
Konversiyon Bozukluğu nedir? Anksiyete, panik atak, fobiler ve obsesif kompulsif bozukluklar dahil olmak üzere çeşitli zihinsel sağlık koşullarının bir kombinasyonu olarak sınıflandırıldığından, dönüşüm bozukluğunun ne olduğu sorusu karmaşıktır. Bu bozukluğun gerçek nedeni bilinmemektedir ve yalnızca geniş bir şekilde tanımlanmıştır. Bazı uzmanlar, beynin stresli olaylara tepki verme şekliyle veya geçmiş travmatik deneyimleri nasıl hatırladığıyla ilgili olabileceğine inanıyor. Spesifik neden ne olursa olsun, dönüşüm bozukluğunun bir parçası olan ezici kaygı duygusu, hastalar arasında yaygındır.
https://insanpsikolojisi.com/konversiyon-bozuklugunun-nedenleri-ve-belirtileri/
A comment that I'm very surprised no one has yet brought up is the one that linked to this fascinating study showing a high prevalence of PTSD among Turkana warriors. It would seem to strongly support the 'universalist' view that PTSD has occurred at roughly equal rates among combat veterans throughout history.
Note that the study did find that *depressive* PTSD symptoms were significantly less common among the Turkana, which it attributed to different cultural attitudes toward killing in battle. But hypervigilance, nightmares, and flashbacks were actually *more* common among Turkana warriors than contemporary US combat veterans.
https://www.pnas.org/content/118/15/e2020430118
"I didn’t bring up trans issues because I think they’re a better match for another post I hope to write about related issues in the future, but I agree it sounds like an interesting match for something like this - a psychiatric condition which seems to exists at vanishingly low levels until people work to “raise awareness” of it, after which it becomes very common."
I know this is DEFCON 1 level culture war stuff, but there is a radical feminist blog called "culturally bound gender" that talks about exactly what the title says. That includes a whole post on "traditional" non-binary or "two-spirit" genders, and makes a hypothesis that they're doing something very different from what the modern world thinks they are. I'm not an expert in the area and the post doesn't cite sources I could check, but the author has certainly looked into the topic more than I have.
I deliberately won't link to it here, but if you wish, search engines will find it quickly enough.
(For what it's worth, I myself feel like I match some definitions of "trans" and not others, I'd say I have less of a gender identity than a self-identity where gender is not that big of a thing. I found reading the CBG post on the matter helpful rather than hurtful, your experience may vary.)
"That includes a whole post on "traditional" non-binary or "two-spirit" genders, and makes a hypothesis that they're doing something very different from what the modern world thinks they are."
This is certainly the case for the various Asian/Pacific "third gender" categories – just for one thing, the name alone ought to be indication enough that they don't at all match up to the Western transsexual activists' idea that transsexuals meaningfully belong to their desired sex, and it's bigotry to say otherwise.
https://www.history.com/topics/inventions/history-of-ptsd-and-shell-shock
This article lists out several source examples describing historical PTSD symptoms. I'm _totally_ open to the hypothesis that telling people their experiences are traumatic makes those experiences traumatic and that could increase incidences of PTSD in modern times, but I'm fairly skeptical that a PTSD-like thing didn't exist.
The comment on concussion trauma should be qualified by the difference in combat before gunpowder when a head injury would not have been caused by generally locating the head near an explosive event. Head injuries from any source have only recently been studied in parallel with the PTSD category. A simple skateboarding accident for a young person, for example, can have a life-long, debilitating result which may not be well-classified as a syndrome or disorder given the biology and centralized location of the injury but rather may be better-classified as other local and biological injuries, albeit one that does not heal in the same way.
Re ptsd
First hit on search term "Homer ptsd"
http://www.caffreycounseling.com/articles/combat-stress-warriors-a-historical-perspective/
The Epic of Gilgamesh, one of the first pieces of literature extant and dating back to the third millennium Mesopotamian kingdom of Sumer, details the adventures of the Sumerian king, Gilgamesh, and his warrior companion, Enkidu (Birmes, Hatton, Brunet & Schmitt, 2003). The parallel between Gilgamesh’s post-combat experience and those of modern veterans with the “numbing” and “dissociative” aspects of the modern PTSD diagnosis is striking. On witnessing Enkidu’s death in battle, Gilgamesh is beset by recurrent and intrusive recollections of his friend’s death. A once proud and valiant warrior, Gilgamesh is haunted by these dreams and wanders numb through his kingdom, rendered incapable of regaining his once unassailable martial prowess.
Likewise, in Homer’s Iliad (850 B.C.), the immortal Greek hero, Achilles, is tormented by recurrent nightmares of battle, the death of his companion, Patroclus, and visits in his dreams from the hundreds of men slain by him in combat (Shay, 1994). The impact of these recurrent traumatic dreams and fragmented sleep, which are today recognized symptoms of PTSD, devastated even the great Achilles.
Comparing my friend circles in Poland and larger US-centric communities on Discords I frequent, people from the US seem very focused on their fragile mental health. Might be all sorts of selection effects, of course.
There's also some kind of huge doom wave sweeping over the internet over recent years, where saying anything optimistic seems almost out of place... I'm worried that the world is becoming an echo chamber where suffering people amplify other people's suffering and the only way to stay sane is to disconnect from the narrative as much as possible. In fact, that is what most of my friends I'd consider mentally stable are already doing!
I agree that saying anything positive can seem out of place in some venues. I'll add that disgust with the human race or some large fraction of it is also common and I think that's part of the problem.
Re: Ivan's comment on PTSD claims among recent veterans. It would be a mistake to not attribute the vast portion of those claims to "malingering". Well, not malingering so much as following obvious incentives in an arguably fraudulent (but easy to justify) manner.
You have to understand that these 45% of vets making these claims are not all people making claims of total disability. They are people who are filing claims because both while you are still in the military and especially with respect to your pension when you retire, you are paid extra for any combat damage. Claiming to have more damage literally results in more money in your paycheck. So the incentive is obvious.
My husband retired last year after 25 years in the military. He has been on many combat tours in the Middle East and has been "blown up", as they say, a few times. He does not have PTSD. He does have damage that required surgery to his spine and wrist from explosions. Retirement from the military is a very lengthy process where you go through a bunch of medical and mental exams and do all kinds of paperwork and how much you will be paid each month on your life-long pension is determined partially based on how much physical/emotional damage you have incurred.
While he was going through the process, ALL of his veteran buddies were constantly calling him and giving him advice on all the ways he could maximize his pension by playing up little problems and claiming to have various medical issues. They advised him to get a sleep study and claim to have sleep apnea. They had all kinds of advice. This is a game that they all play to see how much they can ramp up their pensions. He was not willing to fraudulently pretend he had any problems that he doesn't have, though frankly, he was left feeling somewhat like a sucker when his other retired friends laughed at him and told him how much they were being paid for their "PTSD" and sleep apnea and stuff like that.
The incentives are there for soldiers to say they have problems, and PTSD is a lot easier to fake than most other medical issues. So I would look at that 45% figure with extreme suspicion. Obviously no one is going to admit this, or they would get in a lot of trouble. But I witnessed plenty of these conversations ,and it seems like SOP is to exaggerate every "disability" one can, to maximize one's pension. I would be curious to know what year it was that the military started paying extra money to soldiers with PTSD, and my prediction is that you will see a rapid rise in such claims once the monetary incentive was there.
I think if we look at many other types of apparent trauma and mental illness, we will see similar incentives for one to obtain a diagnosis. Everything from extra time to take tests to getting out of class to obtaining sympathy and deference from peers. I don't know exactly what all the incentives are, but clearly there are some major ones among young women/teenagers these days, because they all seem to be off the rails in competing with each other to be the most traumatized and disabled.
Some of the conversations I see on social media amongst them are truly bizarre and there is very obviously a social status system whereby being the most "disabled" confers the highest status. I was once shouted out of a forum by hundreds of hysterical, furious young women for suggesting that being literally blind or having no legs because they were blown off in a war was a relatively worse disability, and more warranted of having a service dog for assistance, than having social anxiety. Apparently that statement is "ablist" and "toxic" and equivalent to attending KKK rallies. Now, to my mind, it is morally reprehensible and one should be ashamed to act as if social anxiety is equally worthy of social resources and sympathy as someone having no legs because they were blown off in combat. How self-pitying can you get?? But that idea was unthinkable and way out of bounds to these young women, who consider every "disability" to be exactly as serious as every other.
I think this stuff about PTSD relates to an even larger point. I feel like there's a certain psychological defense mechanism that we've eschewed as a society in the West - a sort of denial or suppression or diversion which says "Yes, this isn't pleasant, I'll suck it up and not think about it very much."
Instead we've accepted the dual tenets that:
1) *Fragility*. Any kind of harmful thing (traumatic experience, injury, or in the extreme: verbal offense, feeling of unease, being outside your comfort zone) will cause psychological damage. This is why there are calls to limit speech, not use certain non-PC words, have safe spaces, shield children from playing outside alone, etc.
2) *Active Treatment*. The cure to these psychological damages is not ignoring them and keeping busy with other things, but instead carefully opening the wound (delicately) and trying to disinfect it. We are less inclined to say "Yeah, break-up is difficult, get a job and keep busy. Then pick yourself up and start dating again." Instead we ecourage people to mourn, become aware of their feelings and needs, and so on. I feel like my parents' generation were much more inclined to not reveal their feelings and just move on.
For PTSD there is growing evidence that both of these are false and harmful. But this might be harmful in other domains as well.