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Notes -
Some of you may have read Scott Alexander’s recent post, Book Review: The Geography of Madness. The couple of paragraph summary is:
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.
And, to add a button to this dynamic, the mode of therapy for these kinds of issues seems to have changed from correcting them -- aiming to help the patient reconcile their delusions with reality -- to normalizing the delusions, including cultural reinforcement of this normalization.
Is that true?
I assume you’re thinking of trans issues. That’s the only thing on OP’s list where I’ve seen treatment focused on bringing the physical in line with the mental. Well, there’s physical therapy and prosthetics, but that’s beside the point. Anxiety, depression, et cetera…the intent is to mitigate them.
Source. The last couple options on that page lean away from coping strategies, but they still aren’t normalizing the symptoms.
It might also be worth noting that the response to mental illness isn’t exactly coordinated. Political slogans, softball media coverage, and Twitter—avenues of cultural reinforcement—don’t fall in line with therapists. Arguably, it’s the other way around, since motivated patients can select their way to a sympathetic therapist.
I'm not sure exactly what the modes of mitigation are, and if they're applied consistently. I guess I'm reacting more to the "pop psychology" reaction to these issues that you see in the media, and the effusive affirmations that now greet announcements of mental illness.
For anxiety and depression, my assumption is that the treatment for these has at least shifted from a "get over it" approach to a "this is very normal and valid" approach, even if the latter was originally intended as a way to end-run around the obvious objections to "get over it" while still helping them get over it. Now, the mode seems to be helping the patient feel better about their affliction rather than removing the affliction, as if the stigma of a mental health problem is more important than the mental health problem.
I'm wondering if it might also depend on the demographics of the patient. I have a hard time imagining that the treatment approach (across a broad swath of therapists) would be the same for a middle-aged white man who feels paranoid anxiety over romantic issues with women and a young black woman who feels paranoid anxiety over racial discrimination. Is one more likely to be asked to look for internal causes/solutions to their predicament while the other is tasked with better coping skills in the face of injustice? Is a profession that has fallen almost completely in-line with a radically progressive approach to trans issues not going to see that same context start to inform their other treatments?
hasn't it mostly transitioned to therapy and maybe prescribing antidepressants?
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