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Culture War Roundup for the week of October 10, 2022

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They really are, subjectively, suffering as much as someone with locked-in syndrome or constant physical pain.

There's really no way to know this from outside of that person's perspective. Depression is often characterized by depressive delusions. I see no reason to take them at their word that they are suffering any more than we should take them at their word that the universe is a dismal joke.

I also don't accept that being really sad all the time is nearly as bad as being in agonizing pain.

I also don't accept that being really sad all the time is nearly as bad as being in agonizing pain.

Obviously no one truly knows what someone else is feeling. But if you think major depression is just "being sad all the time," you have probably not known someone who dealt with major depression. The fact that it's all in their head (literally) does not mean the suffering isn't real.

True, but it also doesn't mean the suffering is real, or at least that it is comparable to living with actual chronic pain.

True, but it also doesn't mean the suffering is real, or at least that it is comparable to living with actual chronic pain.

Clearly the suffering is real unless you believe they are outright lying. As for whether it's comparable, what's the difference between telling someone living with chronic pain "it's not that bad" and telling someone with depression "it's not that bad"? How do you ajudge that someone with depression isn't "really" suffering as much as someone in chronic physical pain? It's not as if chronic physical pain is any more objectively measurable outside the head of the person suffering it. (Hence skepticism about things like fibromyalgia.)

Most of us have no trouble believing in physical pain because we've all experienced it, but if we haven't experienced mental anguish like chronic depression, it's easy to think "They're just sad all the time, that's not comparable to real pain."

I do not think people who claim to suffer from depression are any less reliable reporters of their own subjective experiences than people claiming to suffer from physical pain. In both cases, there are certainly people who exaggerate their suffering or for whom the pain is literally "all in their head," but the fact that the suffering may come from something other than stimulation of pain nerves doesn't make it less real.

Clearly the suffering is real unless you believe they are outright lying.

No, there's a third possibility, which is that they're sincere but deluded. Which we know is the case on many other axes, since depressive delusions arrive in the box with depression.

Most of us have no trouble believing in physical pain because we've all experienced it

There's also a mechanism that makes sense. Nerves send a pain signal to the brain, and brains translate that signal into the qualia of pain. Pain that originates within the brain is much harder to understand. Dysfunctions of the brain present a malfunctioning mind, as opposed to a properly functioning mind responding to a malfunctioning body. If the mind is compromised, we have every reason to treat its claims with suspicion.

No, there's a third possibility, which is that they're sincere but deluded. Which we know is the case on many other axes, since depressive delusions arrive in the box with depression.

I'm not sure there is a meaningful difference between "You are experiencing psychological pain" and "You suffer from a delusion that you are experiencing psychological pain."

I'm not saying we should encourage people with depression to kill themselves, obviously. Just that if you accept that some people experience so much suffering that suicide is a rational option, I don't think you can draw a hard line between "people suffering from physical pain" and "people suffering from psychological pain" and say the suffering of the former is real but the suffering of the latter is not.

OK, here's my effortpost. I have a few minutes, and I haven't given this topic the treatment it deserves.

Partly because I follow Andrew Sullivan and Chris Rufo on Twitter, I've seen a lot of detransitioner stories. These are usually natal women who transitioned to become boys in their adolescence, and then ended up regretting it. What strikes me about it is how many of them report having been depressed, having been introduced to the world of transgender ideology through the usual very online spaces, and then seizing onto it for three specific reasons: (1) because gender dysphoria is elastic enough to be a plausible cause of their unhappiness, (2) because it is a salient transgressive ideology and therefore permits them to scapegoat their families and culture for their misery, and (3) because transitioning is a big project that they can start one step at a time and work slowly toward along a well-lighted path, with social support and a feeling of accomplishment at each step along the way.

There has been a boom in adolescent girls transitioning, and this is a population known for booms in various sociogenic mental health illnesses: eating disorders, self harm, even sociogenic Tourettes, the last of which pretty squarely indicates its sociogenic fingerprints.

Now, many of these sociogenic illnesses are no joke. Eating disorders, self harm, and medically assisted gender transition have potential lifelong consequences. But the Tourettes thing! The reports indicate that somehow its sufferers get "stuck" in their sociogenic Tourettes -- who can fathom what that feels like "from the inside," but it is a clear case of girls suffering from some kind of delusion, where neurology conclusively rules out the usual Tourettes etiology, where they nonetheless insist they are unable to stop their tics even while they protest that they wish they could. There is no known neurological basis for their disorder, but they swear they are unable to stop their tics. Do you believe them? It's hard for me to really commit to a clear yes or no on that question. The best I can say is that there is a real disorder there, but it's hard to know where the disorder stops and the mind starts. Probably the self and the behavior, via the borrowed identity that the behavior is premised upon, have become conjoined. It isn't a meaningful question to ask whether they are capable of stopping, because doing so assumes the distinct identity of a rational mind that can observe the behavior from outside of it, in the way that someone with a broken arm can observe the source of the pain -- or even that someone with classical Tourettes can observe the source of the errant neurological signals, because they show up on the relevant diagnostic tests. I think there's an analogy to depression here, a meaningful analogy which at least requires us to raise an eyebrow to any sort of confident equivalency between depressive misery and physical pain. How unlike do we think they are, really? Is a clinically depressed person more or less able to get out of bed, shower, and have a productive day than a sufferer of sociogenic Tourettes is to stop exhibiting tics? Intuitively they seem to be in a similar category.

Anyway, imagine that we broadly accept the concept of medically assisted suicide as a treatment for severe depression. We'll put in lots of checks and balances, lots of consultations, require doctors to line up and swear on their souls that there's no alternative: pick your policy suite. What occurs to me is that we started with the same policy suite of checks and balances to avoid premature transgender HRT and surgery. And those checks and balances weren't enough. Arguably the checks and balances contributed to the problem, in the sense that they engendered online spaces dedicated to guiding people through the process, and presented a neat and exciting problem for depressive people looking for social affirmation and a sense of accomplishment in breaking down a big challenge into bite sized chunks and overcoming them step by step.

So whatever procedural safeguards you set up around medically assisted suicide for mental illness, as soon as that pathway is open legally, a subculture will spring up to guide people through it. They will study the criteria and share stories about meeting or not meeting the criteria, about their experience with this doctor or that, which will cumulatively provide a series of beacons for passing through all of the checkpoints that you've established. It will become a project for exactly the population of adolescent girls who are currently transitioning.

And the worst part is that these girls, the ones who fall prey to sociogenic Tourettes, sociogenic transgenderism, sociogenic eating disorders and sociogenic self-harm behaviors -- they usually grow out if it if they can be kept safe for a few years. They are usually fine in the long run! So the result of legally assisted suicide for depressed people, no matter how hard you try to prevent it, will be a lot of dead girls who would have grown up to be healthy and well adjusted women, and a lot of bereaved families who could perhaps be forgiven for believing that society murdered their little girl.

What we need to do, IMO, is to find alternative ways for girls in this group to try on some new and transgressive identity that does not cause lasting harm. Bring back the goth subculture. Have them try out being a lesbian. Let them practice witchcraft, or voodoo, or satan-worship. Maybe try being a Christian to rebel against particularly new-age parents who can't be shocked by the old ways: have them sneak out to attend church when they're supposed to be at volleyball practice, furtively study a bunch of catechisms, discreetly get baptized, and have their shocking and tearful coming-out announcement to their parents. The trick will be in setting up the subculture and making sure that it all feels properly transgressive. Maybe these Tourettes influencers on Tiktok are the answer to all of these problems, and by boosting their signal we'll be able to crowd out all of the other avenues of harm. But for fuck's sake, don't help them kill themselves.

they usually grow out if it if they can be kept safe for a few years

grouping tiktok tourettes, which is more like 'an emo phase', and being trans together in the 'they usually grow out group' is justified how? Your twitter feed evidence is selected for detransitioners, because they're the best way to make being anti-trans seem like a progressive 'saving the vulnerable girls' narrative as opposed to right-wing.

grouping tiktok tourettes, which is more like 'an emo phase', and being trans together in the 'they usually grow out group' is justified how?

They're both epidemiologically sociogenic.

Your twitter feed evidence is selected for detransitioners

It's dicey to rely on academic scholarship in an area as ideologically captured as transgender issues, but nonetheless my impression had been that desistance rates for transgender-identifying children who do not begin puberty blockers to be in the vicinity of 80% -- judged from surveys, not Twitter anecdotes. We should expect the rate to grow dramatically given the recent explosion in teenage natal girls expressing transgender identification in the past five years. Basically, trans teenage (natal) girls fit the cluster of other sociogenic teenage girl afflictions (self harm, eating disorders, tourettes) so well that we should expect them to follow the rest of this cluster in growing out of it, assuming they haven't been allowed to pass any points of no return on their journey (including puberty blockers, which seemingly interfere with the development process that causes them to grow out of such phases).

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