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Culture War Roundup for the week of February 27, 2023

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Some of you may have read Scott Alexander’s recent post, Book Review: The Geography of Madness. The couple of paragraph summary is:

A culture-bound mental illness is one that only affects people who know about it, and especially people who believe in it. Often it doesn’t make sense from a scientific point of view (there’s no such thing as witches, and the penis can’t retract into the body). It sometimes spreads contagiously: someone gets a first case, the rest of the village panics, and now everyone knows about it / believes in it / is thinking about it, and so many other people get it too.

Different cultures have their own set of culture-bound illnesses. Sometimes there are commonalities - many cultures have something related to the penis or witches - but the details vary, and a victim almost always gets a case that matches the way their own culture understands it.

THESE PEOPLE ARE NOT MAKING IT UP. I cannot stress this enough. There are plenty of examples of people driving metal objects through their penis to pull it out of their body or prevent the witches from getting it or something like that. There is no amount of commitment to the bit that will make people drive metal objects through their penis. People have died from these conditions - not the illness itself, which is fake, but from wasting away worrying about it, or taking dangerous sham treatments, or getting into fights with people they think caused it. If you think of it as “their unconscious mind must be doing something like making it up, but their conscious mind believes it 100%,” you will be closer to the truth, though there are various reasons I don’t like that framing.



The thrust of Scott’s argument is that humans have an amazing propensity to change their subjective experience based on their beliefs. Here, I'm not talking about rationally held or carefully reasoned beliefs, but deep-seated beliefs that aren’t easy to change, even if you know for a fact they're irrational. Typically, these beliefs seem to be formed through social or cultural channels, and once formed, they can be very difficult to change unless your cultural narrative also changes.

This idea ties into other work on the placebo effect and the ways it shaped our culture, for instance, John Vervaeke’s take on shamanism. The basic idea being that shamanism was highly advantageous from an evolutionary perspective because it allowed groups of humans to harness the placebo effect to overcome illness and manage social problems.

In short, despite the rational pretensions our culture has, our irrational beliefs have extremely strong effects on our perception of pain and other subjective experiences. However, an important nuance is that no cultural disorder is 100% ‘in your head;’ on the contrary, these disorders are very real and can have strong physical effects.

Some of the big examples that Scott gives, and some I think might be (mostly) culturally mediated, are:

  • Anorexia

  • Post-traumatic stress disorder

  • Anxiety

  • Depression

  • Gender dysphoria

  • Chronic pain

  • TikTok Tourettes

  • Long Covid

Now, based on the bent of this forum, many people might be tempted to jump on the gender dysphoria issue. While it’s certainly a loud and vibrant battle in the culture war, I’d ask that we instead focus on other problems. In my opinion, if this thesis holds true, then gender dysphoria is a red herring.

The evidence clearly suggests that we are inflicting massive amounts of pain and suffering on ourselves through our cultural beliefs and practices. The fact that so many of our cultural problems - from overdose deaths and suicides to chronic pain and crippling anxiety - are unforced errors is truly shocking.

Think about it - one fourth of the adult U.S. population experiencing chronic pain? That's a staggering number, and it seems largely due to the fact that we have been conditioned to believe that our pain must have an acute physical cause. We've been taught to view pain as something that must be cured with medication or surgery, when in fact many cases of chronic pain can be alleviated by simply changing our beliefs about it.

The truly shocking revelation here is that so many of our cultural problems - massive amounts of overdose deaths, suicides, one fourth of the adult population experiencing chronic pain, crippling anxiety causing young people to retreat from society, and many more issues - are clear unforced errors. We are inflicting this pain on ourselves.

If this theory is true it may very well be one of the most important and impactful frameworks with which to view the issues of post modernity. We wouldn’t need endless medications or miraculous scientific breakthroughs - we could already have the power to end massive amounts of truly pointless suffering.

ETA: is another perfect example of this type of illness.



From a personal perspective, I can attest that this theory confirms my priors. I’ve dealt with chronic pain for a decade and have long suspected that it was mostly psychosomatic. Even with this realization, it is a difficult battle to fight. Ironically, support groups where people confirm and commiserate seem to make the issue worse. In fact, many modern studies on pain recommend not even using the word "pain" and replacing it with something else to trick your mind into understanding that your pain doesn’t have an acute physical cause.

So many of us in the rationalist community focus on object-level reasons as to why our society may be stagnating or why we have so many cultural problems. At the end of the day, it turns out that our beliefs themselves may be throwing us into a twisted, absurd, and horrific self-fulfilling prophecy.

It may be time to stop assuming that the causes of our problems originate directly from the outside world and update to a view that many more major problems could be solved if we simply change our cultural beliefs.

I've long believed something that rhymes with this and becoming more familiar with modern psychiatry has done nothing but increase the feeling that we're both pathologizing normal human variance and create more extreme cases by creating identity molds for people to slot themselves into. I could have made a case for having many different issues, depression, anxiety, and attention defeciet, ect. It would be easy, maybe some of them at some points of my life would be even true.

I was diagnosed with dyslexia in childhood, to this day I am not sure if that is a diagnosis that just means nearly nothing or if it was a miss diagnosis. I do indeed read slower than many peers, but I'm not even sure how cleanly I can separate cause and effect there, perhaps the diagnosis gave me an excuse and in fact a neat little special marker that overcoming or discarding the diagnosis would actual rob me of. I'd just be a normal.

Anyways I mostly forgot about the whole thing for years but recent it's resurfaced in my consciousness as some excuse for some behavior and in resurfacing I now really do seem to be finding it relevant more and more. I find myself even more preferring audio to text, even more not putting in the effort to improve. On the other hand without the diagnosis I might have thought I was dimmer than I otherwise am, the identity package included strengths with the weaknesses and might have cause dme to lean more into math and engineering subjects than I otherwise would have.

I know you see the trans question as a red Haring but this is another reason I find the topic impossible to ignore. It's the meme equivalent of a bullet with my name on it. There but for the grace of God go I as it is exactly the kind of thing I might have been susceptible to.

Crystallizing this further, I think particularly in the case of depression / anxiety / ADHD, what happens is that a cultural meme develops that some common facet of the human experience is caused by some specific disease, and that the appropriate way to fix this is to obtain treatment.

Examples:

  • Alice notices that she does not enjoy things that she's "supposed" to enjoy. She's heard that this can be a symptom of depression. She looks up "how to tell if you have depression", and reads that common symptoms include apathy, lack of interest, excessive sleepiness, and insomnia. Now, every time she has trouble falling asleep, she thinks "wow, this depression sucks" and not "I am having trouble falling asleep". She looks up "what to do if you have depression", and sees the usual suggestions about sunlight / therapy / medication. She thinks "well, they were definitely right about my symptoms, so they're probably right about the treatment as well", and gets a therapist and a sunlamp.

  • Bob notices that he's having a lot of trouble focusing on his job as Senior Manipulator of Boring Numbers. He has heard that trouble focusing can be indicative of ADHD. He looks up "symptoms of ADHD", sees fidgeting, absent-mindedness, difficulty focusing, and forgetfulness. Now, the next time he is introduced to a room full of people and has trouble remembering their names, he thinks "wow, ADHD sucks" and not "wow, I'm bad at names". He obtains some amphetamines, which is what you do when you have ADHD.

  • Carol notices that her heart rate is elevated and her muscles are tense before her board meeting. This has happened before the last three board meetings too. She googles "elevated heart rate tense muscles" and sees that, according to WebMD, she either has anxiety or lupus. She knows that WebMD is strangely likely to say that people have lupus, but the description of anxiety is on-point. Additionally, there are some new ones on there, like "difficulty concentrating", which she didn't think were caused by the same thing as the thing where she gets way too nervous before important meetings, but maybe it is after all. She talks to a therapist, and learns that indeed, all of her problems are because she has a disease called "Anxiety", but with the proper therapy schedule and medications, she can probably live some semblance of a normal life.

  • Dan notices that he's been having trouble with his sexual performance. He goes to the friendly neighborhood elder, who informs him that this is a common symptom of being cursed by witches. When you are cursed by witches, lots of bad things can happen, including livestock death, sudden inexplicable vomiting, and impotence, and in extreme cases, your penis sometimes even disappears! The next day, one of Dan's chickens keels over and dies for no apparent reason, and what's worse, he starts violently vomiting after eating the dead chicken. And oddly his penis feels smaller than usual. What was it that elder said he should hang above his door again?

Hypothesis if this is a usefully predictive model of the world: People who read their horoscope on a daily basis are more likely to experience chronic pain than those who don't, even when controlling for all of the obvious confounding factors. I expect that this would be the case because I expect "reads the horoscope daily" to be a reasonably good proxy for both "is searching for an overarching narrative of why things are they way things are" and also "is prone to confirmation bias", and I expect that "you have chronic pain" is one of those things you're more likely to believe if you're searching for an overarching explanation and tend to look for evidence under streetlamps.

Crackpot theory time: It would be possible to significantly reduce the burden on chronic pain by doing something like the following:

  1. Experienced debilitating, chronic pain for some period of time

  2. Changed something plausible about their lives

  3. Immediately after making the change, noticed something that was an obvious consequence of making the change

  4. Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

and then loudly broadcast the existence of this group of people at people who have chronic pain. I expect that this intervention would work even if people knew you were doing it, as long as you (correctly, I think) pointed out that your narrative is more plausible than the narrative of "sometime in the recent past, a phenomenon started happening where otherwise-healthy people started experiencing significant pain for no apparent reason, and found themselves unable to live their lives normally due to that pain, and found that, though the pain might sometimes temporarily improve, it always comes back". Because "I do sometimes experience pain, but it's not continuous" and "I sometimes experience a reduction in pain to the point where it's not noticeable, but the pain always comes back" in fact describe exactly the same set of experiences.

Crackpot theory time: It would be possible to significantly reduce the burden on chronic pain by doing something like the following:

*Experienced debilitating, chronic pain for some period of time

*Changed something plausible about their lives

*Immediately after making the change, noticed something that was an obvious consequence of making the change

*Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

I don't really understand this - can you give a concrete example?

For some examples, see the comments of the link posted upthread. For example, pjeby's comment on that LW post:

1. Experienced debilitating, chronic pain for some period of time

I used to have wrist pain a lot, and tried a ridiculous number of things to deal with it

2. Changed something plausible about their lives:

until I discovered the trigger point concept. Over time I've learned to identify which trigger points produce what symptoms for me, and what postures or behaviors set off the trigger points. [...]

3. Immediately after making the change, noticed something that was an obvious consequence of making the change

My dentist referred me to an oral surgeon twice for things that later turned out to be trigger points: my teeth had gotten sensitive after dental work, but it turned out that I developed trigger points from having my mouth open for hours during the procedure. Now I know where to massage my neck and jaw to prevent tooth sensitivity from arising in certain areas of my mouth after dental work

4. Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

Anyway, my prior now for "mysterious chronic pain" is "check for trigger points creating referred pain". Most often this consists of following the nearest muscles, nerves, or blood vessels in the direction of the spine or brain, checking for tenderness. A sharply sensitive spot is likely a trigger point, so I press deeply on it for a minute (as in 60 seconds) and see if the original pain is made worse or better. If nothing happens to it, it's probably not the trigger point. (Pressing on a trigger point can make the pain temporarily worse, but the pain will reduce again when the trigger point releases or un-knots.)

So pjeby mostly reconceptualized what the pain meant. If you have a job that involves a lot of typing, and your wrist starts hurting, a natural hypothesis might be "the typing caused the wrist pain", which suggests the action of "reduce the amount of typing you do until the pain goes away". The idea of "trigger points" gives an alternative hypothesis of "I am feeling referred pain", and suggests the action of "look at the chart and massage the indicated areas until the pain recedes".

Now obviously, if the "trigger points exist, and pressing them causes the pain signals to diminish" model of the world is just factually correct, that would explain why pjeby saw such good results. But even if the world-model is not fully correct, it might still be less wrong than the original world-model where pain was caused by strain and should be solved by using rest. And in the case of chronic, debilitating pain where the sufferer has rested for an extended period and the pain is not improving, there is fairly strong (not insurmountable, but fairly strong) evidence that the "rest will make the pain go away" model is not helpful, and replacing it with a different plausible model is likely to be a good idea.

For the sake of clarity, there is a thing which sounds a lot like what I am saying, but is emphatically not what I am saying. That thing is "trigger points are bullshit placebos, and they only appear to work because chronic pain is fake". If that is what you are getting from my post, please let me know and I'll try to come at it from a different angle.

Think of a certain sort of televangelist.

  1. Find someone with debilitating but nonvisible illness

  2. Loudly invoke the power of the LORD

  3. Patient experiences one of the socially expected consequences, like speaking in tongues or collapsing

  4. wow pain is gone

And then there’s step 5: televise this for awareness and/or profit.

It doesn’t have to be religious, but that’s probably the most visible narrative that deals with life transformation. I guess you could make a similar narrative for gender dysphoria…

I will note that it is an important part of my world model that people with chronic pain, or with gender dysphoria, are in fact experiencing sensations which they interpret as aversive. And, while there exist humans who can execute the mental motion of "recontextualize your experiences such that the pain is not suffering", I don't think telling people to do that directly is likely to be a winning strategy.

"There is no such thing as an unmediated experience" is a true fact about the world (one that people in our particular corner of the internet are particularly bad at acknowledging - see all of the "I didn't fall for that optical illusion" types). In isolation, is is not usually a helpful fact about the world. However, rephrasing it as "here are some different lenses you can view your experiences through, keep trying out different lenses until you find one you like" is an approach that I expect will work more often.

Crackpot theory

See also: Duplex’s tithing experience in the Friday thread.