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Notes -
Scott made a point years ago that I've been thinking about for years. The conventional wisdom in so much of psychiatry is that mental illnesses are "historicist" i.e. caused by a personal experience that the patient in question had. It's not common to hear people state "I have an anxiety disorder as a result of being in an abusive relationship", ascribing a direct causal relationship between a certain series of events and a certain constellation of symptoms. In the case of post-traumatic stress disorder, the historical framing is right there in the name - in order to be formally diagnosed with PTSD, one must have gone through a traumatic experience.
But of course, not everyone who goes through a traumatic experience (or experiences) exhibits PTSD-like symptoms, and many people develop said symptoms who have never gone through a traumatic experience. And it's not so long ago that the received wisdom in the psychiatric community was that autism was a direct result of a child having a cold, emotionally remote mother. Now We Know Better and autism is now understood as a condition primarily determined by genetics, but it's remarkable how little self-reflection the psychiatric community has engaged in when it comes to the historicist paradigm undergirding so many other psychiatric diagnoses. We might soon learn that there's a genetic basis for what we now call PTSD which is only activated in the case of profoundly elevated cortisol levels over an extended period of time, and the idea that someone might suffer from PTSD in the absence of said gene expression will seem as preposterous as the idea of children with emotionally remote mothers invariably developing autism as a result.
Per your twin studies example - because WEIRD people spend most of their time in hermetically sealed antiseptic environments, there's a tendency to conflate "environmental" with "social", and assume that anything which isn't caused by genetics must be caused by social influence in some nebulously defined fashion. But of course, that isn't the only thing that "environmental factors" can refer to. Maybe schizophrenia will eventually turn out to be caused by pesticides that only one twin was exposed to, or a pathogen of some kind (e.g. if one twin is more promiscuous than the other and catches an STD). Maybe the recent surge in PTSD diagnoses will turn out to be a side effect of the fact that we all have microplastics in our balls/breasts. Who can say?
I definitely would not be surprised if your theory turned out to be correct. Quite fittingly, the reason Lovecraft himself was so obsessed with madness and sanity slipping away is that he had to watch both his parents go insane from neuro-syphilis.
Regarding your last point. I suspect that many of the cases of war PTSD are actually caused by TBI from exposure to explosions. Ancient warriors didn’t seem to have much problem with it, and notice that the absolute worst cases of shell shock seem to come out of the Great War, in which indirect exposure to heavy artillery was most common.
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