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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 wouldn't consider gender dysphoria to be a red herring, it's more of a flagship. The most prominent example due to it being deliberately spread and promoted above and beyond what most of the others are, and therefore the most obvious example of this trend.

But yes, it is but one example among many, and probably noncentral given that it has significant opposition and thus culture war effects while the others mostly go unnoticed and unopposed.

To quote my response to @aqouta below:

I suppose I think that compared to depression, anxiety, chronic pain, anorexia, and other issues I see trans as something that doesn't cause nearly as much harm, but generates a disproportionate amount of outrage. It's definitely one of the best examples of a subculture driving mental illness though.

Are you talking about in absolute terms? That is, transgenderism is significantly rarer than most of those conditions, and therefore fixing it would be less significant in total value than fixing one of the others.

Or do you mean per person? Because transgenderism causes significant distress in many of its sufferers, driving many to suicide, social ostracism, and mental anguish up to the point where they are willing to undergo expensive and permanent surgeries, including castration, in an attempt to alleviate it. The more serious cases (people who seek actual physical transition) seem comparable to the more serious cases of depression and anorexia, which also lead to suicide, self harm, and other forms of self-imposed physical harm to otherwise physically healthy people.

A transtrender who dresses up like the other sex and uses a different name for a few years before going back to normal isn't especially suffering, but neither is someone with minor social anxiety or self-diagnosed ADHD.

I think in comparing like to like it's pretty comparable to most of the others, aside from the disproportionate promotion/opposition it receives from each political side.

Yes in absolute quantitative terms. I don't particularly care about whether individual trans people have it worse than depressed or anxious people, I think the question is beyond confused anyway.

When you're looking at societal issues it makes sense to focus it on the aggregate, in my view. Why the heck would anyone talk about a mental illness 100 people had? (Obviously trans is larger but the media massively overplays the numbers.)

This is a reasonable point.

I still think it is appropriate to talk about in disproportion to its prevalence due to the unique nature of its advocacy. That is, it is deliberately being promoted and celebrated and spread, as opposed to incidentally spread via cultural knowledge as the other conditions are. As a result:

  1. It is increasing at a faster rate than the other conditions are. So its prevalence in the future may be greater than theirs even if its current prevalence is not

  2. It is significantly simpler to reduce. Stop digging the hole. Mental health conditions which are treated as mental health conditions and spread via general cultural knowledge of them would require deliberate anti-awareness campaigns or other anti-memetic shenanigans to reduce this way. Transgenderism just requires you to stop celebrating it. Or, it would have, the cat's probably out of the bag now and it's probably going to stick around for a long time even if a consensus were to be reached that it's negative for its sufferers. But at the very least, stopping its increase would improve mental health in the future. So it's possible to create more value per effort, at least in theory, because of its current position in the culture war.