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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.

The fact that chronic pain is so well correlated with aging suggests that for the majority of people there is some underlying physical degeneration coupled with a culturally/psychologically mediated experience of pain. It's possible we're spreading cultural memes about aging that causes old people to hyperfixate on minor and aches and pains but the cultural universality of old people's body's hurting makes that seem iffy to me. It could be that technological advances of having pain treatments available primes people to fixate on total pain alleviation and medical treatments while past generations would simply learned to tolerate the unchangeable pain.

I know an old hippie lady who had chronic back pain that kept her in bed a lot. She loves to tell the story of how she 'cured' it by meditating intensely, talking to the pain in the form of a wol, and fully internalizing the idea that it was a part of her body trying to protect her not a sign she was being harmed. She's relatively mobile in day to day life and in some sense was healed, but she's still an old lady and moves gingerly and there's no way she could work in a warehouse or something. That's to say that there's substantial mobility and pain reduction to be gained through psychologically and culturally mediating pain like that but, not infinite improvement in most cases. Even when pain has identifiable biological causes there's still a lot of reduction that can be accomplished through psychological means.

The fact that chronic pain is so well correlated with aging suggests that for the majority of people there is some underlying physical degeneration coupled with a culturally/psychologically mediated experience of pain.

Not necessarily. Perhaps it suggests that "everyone knows" chronic pain is well correlated with ageing, so only old people can overcome the subconscious suspension of disbelief and delude themselves that they have it.

In the same way that no Malaysian-Chinese women worry about penis theft. It's all in their heads, but the scenario in their heads has boundaries.

Maybe with the propagation of gender theory Malaysian-Chinese women start worrying about that. After all, if you can become a woman just by declaring it, why can't you identify as a woman whose penis has been stolen? Moreover, the same ideology would require the doctors, on the pain of being fired and de-licensed, to treat such cases as the actual disappearance of the actual penis. You can't contradict somebody's living experience!