Quotulatiousness

April 16, 2025

The “medicalization” or “syndromization” of aspects of the normal human condition

Filed under: Health, Media, USA — Tags: , , , — Nicholas @ 05:00

On his Substack, Freddie deBoer wonders why we can’t be honest about the rise of bespoke “mental disorders” that look remarkably like typical human reaction to stimuli:

I just found a cost-free way to farm sympathy and attention 😊

I will never not be fascinated by those issues or arguments or perspectives that are studiously ignored by the media generally and the New York Times in particular. I’ve whinged about this many times when it comes to education, as the NYT is simply not going to consider the notion that different individual people have fundamentally different levels of academic potential in its pages, not even in an attempt to rebut the idea. I suppose that notion is just too challenging to the elite meritocratic liberalism that the Times epitomizes; the idea that we are all ultimately capable of achieving academic and professional greatness flatters the high-achievers who read and write the paper, and the “anyone can be anything” ethos is pleasant and unchallenging. It’s also destructive, which is the point. Bad ideas grow like weeds in the shade, or whatever the saying is. Disability issues are another place where the Grey Lady is very picky about what ideas to consider, and as usual they set the rhythm for many other publications.

This weekend the Times released a long piece looking at the ever-escalating rates of ADHD diagnoses and what exactly they tell us. What’s in the piece is fine — of course, the ADHD activist class doesn’t like it — but what’s remarkable is what isn’t in it. Once again, there’s just about zero consideration of ADHD as a social contagion, any recognition that there is now a vast and deeply annoying ADHD culture online that acts as a kind of evangelical movement for a neurodevelopment disorder. There are millions of people on ADHD TikTok and ADHD Tumblr and ADHD Twitter. There’s a vast universe of facile memes, dubious statistics, and self-flattering nostrums about ADHD floating around out there, and increasingly they’re penetrating into broader internet culture. (I am genuinely unaware of a subculture that is more directly and shamelessly self-celebrating than the online ADHD community, and I’ve read the comments at LessWrong.) Unsurprisingly, a big subsidiary industry has sprung up, with all kinds of products and services for sale, books and apparel and tchotchkes and conferences and boutique forms of therapy and exclusive members-only Discords … Whether neurodevelopmental disorders should have merch is an open question. What’s not subject to questioning is that this is happening. Five minutes of cursory searching would reveal the remarkable scope of online ADHD culture.

And yet the piece’s author, Paul Tough, is just about totally silent on this glaring reality. I find it genuinely bizarre. In a long and rambling (in a good way) piece where he kicks the various rocks of ADHD and asks good-faith questions about how diagnostic rules and social perception of the disorder influence medical practice, he still somehow fails to ever refer to the large, influential, and growing online movement that has raised the profile of the disorder even beyond its prior notoriety and in doing so injected a ton of money into the equation. You can dismiss that community as an online sideshow if you choose, but of course the online world has become profoundly influential on real life, and in other contexts neither the New York Times specifically nor the elite media generally has any problem acknowledging that fact. Why not here?

This tendency extends beyond ADHD. Recently Holden Thorp, editor in chief of the prestigious journal Science, wrote an essay for the NYT that explores the rise of autism diagnoses, which have expanded at truly ludicrous rates. To the extent that it’s referenced at all, the idea of social contagion is dismissed without argument. A couple years ago the Times published a piece by Azeen Ghorayshi about the absurd case of Tourette’s spreading (or “spreading”) among too-online adolescent girls via TikTok; though Ghorayshi is admirably clear that those young women did not in fact have Tourette’s, her piece is also slavishly, almost comically sympathetic to them, never bothering to suggest that maybe these were just bored teenagers who engaged in a frivolous and offensive bit of minstrelsy. (Imagine, judging teenagers for doing something stupid!) The idea that anyone could ever have unserious and wrongheaded motivations for adopting a disability seems to be one of those stories that the New York Times absolutely refuses to tell.

But why? People make up fake illnesses all the time, both consciously and unconsciously. Factitious disorders are real; we have references to what we might now call psychosomatic illnesses that stretch back to antiquity. Munchausen by internet is real. Hypochondria, factitious illness, Munchausen’s, the worried well … these have represented a major challenge for psychiatry for as long as the field has been formalized and integrated into the larger medical project. Why does no one ever talk about this stuff in our stuffy elite publications? Why do so many people in our media dance and shuffle rather than ask direct questions like “How many of these diagnoses are fundamentally faulty?” Why can’t anyone point out that saying you have a medical disorder is a shortcut to getting sympathy and attention, and that human beings crave sympathy and attention the way they crave water and air? We’ve lived through something like a “vibe shift,” and previously-unchallengeable social justice pieties are increasingly challenged, in good ways and bad. Yet under the broad umbrella of disability rhetoric, it’s always 2018, with both traditional and social media operating under a cloud of fear of giving offense. As I’ve said many times, the number of people who privately agree with me about all this is legion. The number who are willing to say so publicly are very few indeed. Nobody wants to paint that target on their back, I suppose. But why do these issues make people feel like targets at all?

April 8, 2025

QotD: The sad plight of the modern day “radical”

Filed under: Humour, Politics, Quotations — Tags: , , — Nicholas @ 01:00

Many are opposed to faith, family, industrious habits, common decency and public order. The “radical” will not be able to articulate reasons for his bitter opposition, but one look at his face should make everything clear. Here in Parkdale, we have a lot of Leftists. Perhaps they had unhappy childhoods. I hope gentle reader will not think me a bigot, but I have noticed that they are almost all white people.

Whatever the cause, they cannot “smoak a jest”, recognize other forms of humour, or distinguish the parts of speech. This makes them appear batty (in the old sense, when it would have attracted institutional attention). They are frequently convulsed with anger, then sullen when they have exhausted themselves. Alas, they cannot be left in normal company, for they will immediately and raucously demand a “safe space”, and then not go away. They will accuse the normal person of “racism”, “fascism”, “sexism”, and “microaggressions”. Their spittle represents a health hazard.

It is hard to know what to do with these people, in the absence of the traditional arrangements. When world markets open again, we could sell them into slavery. But in the meantime, I suppose, we must keep them in group homes, ideally under armed guard. Maybe feed them okra; surely there is a surplus, and I’m told it has calming properties.

But that’s just me, always looking for solutions.

David Warren, “Keeping one’s peace”, Essays in Idleness, 2020-04-18.

March 26, 2025

QotD: Therapy that works for women doesn’t necessarily work for men

Filed under: Health, Quotations — Tags: , , — Nicholas @ 01:00

The most important thing I’ve learned about human psychology in the last five years: therapy for depression in men is usually mistargeted and ineffective because therapists think men are like women, who become depressed because they don’t feel loved.

This is completely wrong. Men cope with feeling unloved relatively easily. What destroys them is feeling powerless.

So yeah. Swing a sword. Restore a steam engine. Climb a rock. Do something — anything — that asserts your competence and control over your environment.

For men, this is much better therapy than talking about feelings.

ESR, Twitter, 2024-05-06.

March 1, 2025

“There were always scapegoats … and they were always driven out one way or another”

Filed under: Britain, Health, Politics — Tags: , , , , , — Nicholas @ 05:00

The second part of Nigel Biggar‘s look at the culture war in Britain includes a look at how the professional approach to young peoples’ gender issues became monomaniacal because nobody involved stopped to think for fear of being ostracized (or fired):

On the gender front, there’s plenty of reason to doubt the intellectual coherence of transgender-self-identification. When a biological male believes that his inner, authentic self is female, what exactly does he think being ‘female’ is? I’m still waiting for someone to persuade me that this doesn’t trade on gender stereotypes that feminists rightly taught us to throw overboard decades ago.

    Observe how that has nothing at all to do with the care of patients, and how it has everything to do with the self-regard and political standing of the managers.

There’s even more reason to doubt that the well-being of young people is well served by taking their asserted genders at face value and allowing them to align their bodies by making irrevocable physical changes. According to Hannan Barnes’ shocking chronicle of the scandal at the Gender Identity Development Service (or GIDS) at the Tavistock Institute here in London, there was widespread doubt among clinicians about young people’s claims of “an inborn ‘trans’ nature”, awareness that these were sometimes correlated with eating disorders and self-harm, and suspicion that they might be caused by abuse or trauma. Furthermore, the long-term effects of using puberty-blockers were “largely unknown”, there was considerable uncertainty about which patients would benefit from them, and the health of some young patients actually seemed to worsen while on them.

Notwithstanding all this, “the clinical team … never discussed as a group what it even understood by the word ‘transgender'”, clinicians “never dream[t] of telling a young person that they weren’t trans”, and they always prescribed puberty-blockers unless the patient actively refused them. What’s more, expressions of doubt by staff were discouraged. “Someone would raise concerns, and someone else would move in to shut it down”, writes Barnes. “Those who persisted in asking difficult questions were not received well … those who spoke out were labelled troublemakers. [According to one witness,] ‘There were always scapegoats … and they were always driven out one way or another'”. “Junior staff looked on and learnt”.

Note the chilling effect.

The Tavistock Institute in London

Barnes’ book bears the title, Time to Think, because she identifies the general problem at GIDS as that of “not stopping to think”. That, of course, raises the question, Why? Barnes gives several reasons. One was the fact that the GIDS was propping up the Tavistock financially and that senior managers had a material interest in not disturbing its assumptions. Another was the unwillingness to offend transgender lobby groups such as Mermaids for “fear of a backlash”. But, most important of all was concern for the ‘progressive’ reputation of the management. According to David Bell, consultant adult psychiatrist at the Trust and whistleblower, “The senior management regarded [GIDS] as a star in our crown, because they saw it as a way of showing that we weren’t crusty old conservatives; that we were up with the game and cutting-edge. That was very important to the management to show we were like that”. Observe how that has nothing at all to do with the care of patients, and how it has everything to do with the self-regard and political standing of the managers. Not for the first time, the basic narcissism of progressive virtue-signaling is exposed.

Update: Added missing URL.

December 9, 2024

“… liberalism has become a political ideology that is utterly incapable of policing itself for its own worst excesses”

Filed under: Media, Politics, USA — Tags: , , , , , — Nicholas @ 03:00

Freddie deBoer patiently explains why outrageous over-the-top emoting isn’t a useful or productive way to argue for your political views:

I’ve written several times about the phenomenon of adolescent women on TikTok pretending to have dissociative identity disorder for social media clout and attention. I’ve focused on it not because I necessarily think the issue itself is particularly important, but rather because it’s so emblematic of what liberalism has become: a political ideology that is utterly incapable of policing itself for its own worst excesses, a collection of well-intentioned people who mistake the responsibility to fight discrimination for a broad, vague duty to shield certain groups of people from any criticism.

For the book I’m currently writing, I’m talking to a ton of people in the broad world of mental health — psychiatrists, therapists, researchers, policymakers, journalists, fellow patients — and I’ve brought up the TikTok DID community over and over again. Remarkably, not one person defends the phenomenon as a true expression of genuine illness, not even a few disability rights activists I’ve talked to, who usually have an ethic of never questioning a disability claim. Countless normie liberals I’ve chatter with, over the past several years, have also accepted my basic position that these young women don’t actually have dissociative identity disorder. But, also, almost no one is willing to affirmatively say anything about this dynamic themselves. Indeed, The Verge reported that many experts have decided that the costs of speaking out about that whole culture just aren’t worth it. And so you have a set of behaviors that no one defends but that no one feels comfortable criticizing, thanks to the pathologies of 21st century liberalism and online rage. That’s what I’m really here to talk to you about today.

I don’t, of course, want to be too harsh on the individual young women who have turned a debilitating and controversial disorder into an opportunity to put on vertical video fashion shows; they’re just kids and kids do stupid shit, sometimes even genuinely offensive shit. What you usually have, or used to have, is the ability to tell someone doing stupid shit to knock it off. Not oppress anyone, not humiliate anyone, not permanently shun anyone. But just to say, “You don’t have dissociative identity disorder, pretending you do is unhealthy and offensive towards people who actually have serious mental illnesses, knock it off“. I find that very easy to say. But clearly a lot of people don’t, and the reasons are fairly obvious. First, despite whatever vibe shift we may be living through, it remains the case that in progressive discursive spaces, saying the wrong thing is still very fraught and can result in accusations of bigotry that are personally and professionally damaging. Second, liberals have trained themselves to avoid any position at all that might be construed as siding with the enemy, as a matter of in-group identification. Take it from me: “A lot of people in Gen Z appear to be lacking in emotional resilience, in a way that’s unhealthy for them” has become, in the internet-soaked mind, “Gen Z is a bunch of snowflakes”, and so a ton of liberals recoil at that idea. Can’t appear to make a concession to the enemy! I’m afraid we do not have a vocabulary for critical solidarity anymore.

All of this is bad, and you only have to look at how incredibly harsh certain slices of “queer fandom” can be to see what I’m talking about.

November 20, 2024

QotD: The Chads, the Staceys, and the Incels

Filed under: Health, Media, Politics, Quotations — Tags: , , , , — Nicholas @ 01:00

I have spent some time in the twilight reaches of the manosphere researching a new book, a world of depressing forums, full of hatred and despair, where young men gather to focus on the absence of sex in their lives. There are two broad categories: The Incels hate women because they won’t sleep with them. The Men Go Their Own Way (MGTOW) guys won’t sleep with women because they hate them.

These boys have their own vocabulary and belief systems. Pretty girls (Staceys) all sleep with the same few Alpha men (Chads). The Staceys ride the Cock Carousel, ie, have sex with the same few Chads. All this sluttish behaviour gives the Staceys something called A Thousand Cock Stare.

It is a grim world, in which women are evil and manipulative, and hated both for being sluts and for being virgins. It is a world in which pictures of pretty girls with their pet dogs are unbelievably sinister. These boys choose to live in this bleak world. They are culpable. But, if you tell all young, white boys that they are damned, why should they not behave as if they are damned?

A society which does not allow for people to atone, to be redeemed, and to be judged on their intent and actions is a miserable place. Most people interact with each other without antagonism most of the time. We should start being a bit more forgiving to each other, ditch the Puritanism and learn to cherish the well-meaning stumble towards decency. Even if, sometimes, we fall.

Antonia Senior, “Identity politics is Christianity without the redemption”, UnHerd, 2020-01-20.

November 1, 2024

QotD: J.D. Vance, a Führer for the rest of us

Filed under: Health, Media, Politics, Quotations, USA — Tags: , , , , — Nicholas @ 01:00

    Expert: JD Vance’s selection as Trump’s running mate marks the end of Republican conservatism

Quoted for the lulz. Ol’ JD, a Führer for the rest of us.

But since we’re here … a fascinating footnote in Jaynes informs us that schizophrenics, who Jaynes thinks might be throwbacks to the “bicameral mind”, have no problem with “diffused identity” or whatever the term was. Jaynes hypothesizes that ancient, preconscious peoples didn’t see images of their gods in cult objects; they saw the actual, physical gods. We unicameral people can’t wrap our heads around it, since there are lots of statues and they can’t ALL be god — even if we grant that the biggest statue in the best temple can be god, or if we allow that the black meteorite or whatever is really god to them, still, god can’t be diffused like that: Either your statue is god or mine is; or neither of them are, but they can’t both be.

Schizophrenics, at least according to Jaynes, would be down with that. He notes that you can put two guys who think they’re Napoleon in the same padded cell, and you don’t get a schizo bum fight, you get complete agreement: They’re both Napoleon, somehow. The law of the excluded middle, personal identity version, simply doesn’t apply.

And since my hypothesis is that smartphones are re-decameralizing (it’s a word) us at Ludicrous Speed, well … here you go. Donald Trump is Hitler, but J.D. Vance is somehow also Hitler. It’s not like the real, historical Hitler lacked for shitty, evil underlings — J.D could easily be Heinrich Himmler or somebody. But no, he’s gotta be Hitler, the same way Trump has to be Hitler, and if that means they’re somehow both Hitler, well … there it is. Bicamerality for the win.

Severian, “Catching Up With the Crazies”, Founding Questions, 2024-07-29.

October 1, 2024

TikTok’s Dissociative Identity Disorder (DID) community

Filed under: Health, Media — Tags: , , , , , , — Nicholas @ 05:00

The more we experience the joys of widespread social media, the more people seem to discover ways to bring attention to themselves for genuine or dishonest reasons. Freddie deBoer looks at the DID-sufferers on TikTok and assesses the chance that such a rare disorder can have had so many newly discovered sufferers:

Let me turn back to the TikTok “systems”, the strange, maybe-shrinking world of adolescent women on social media who pretend to have an incredibly rare and debilitating mental illness and treat it as a fun and quirky alternative lifestyle.

This piece from The Verge, though a little misguided, is a good jumping off point for this topic. The basic story is pretty simple. Dissociative identity disorder (DID), long referred to as multiple personality disorder, is a remarkably controversial diagnosis that has long captured the public imagination. It’s not hard to see why; the idea of someone who switches from one personality to the other is lurid and dramatic, making it easy fodder for television. (The number of episodes of legal dramas about DID is immense.) The condition also invites a particularly stark consideration of the question of individual agency and culpability for bad deeds. As you can imagine, pretending to have “alters” can be very convenient; a notorious case involved an embezzler whose only defense for his crimes was that he had multiple personalities and one of them stole the money. There have long been researchers and clinicians in psychiatry who doubt the very existence of DID, and even among those who are friendlier to the concept, the disorder is known to be incredibly rare. Many prominent cases of DID have proven in time to be fraudulent. The most famous American case, that of “Sybil“, was particularly tragic. The woman who supposedly suffered from the disorder, who faced a childhood of abuse and neglect, would go on to admit to her psychiatrist that she had made the alternate personalities up. (We know because we have the letters.) But the doctor, who had been made wealthy and famous thanks to her work with Sybil, threatened to withdrawn her financial support if Sybil did not recant that confession. Having no other choice, she did.

What DID TikTok asks us to believe is that, in the span of maybe half a decade, tens of thousands of adolescent women developed DID, an exceedingly rare disorder marked by symptoms entirely unlike those on your For You page. The Verge article, written by Jessica Lucas, is typical of the media’s take on this issue, to the degree that they’ve written about it at all: relentlessly sympathetic to the DID TikTok adolescents even when grudgingly admitting that there’s a lot of fakery. And admit that she does, as it would be essentially impossible to pretend otherwise. Even the wokest wokie couldn’t help but look at this shit and conclude that a lot of it is bullshit.

The cases of DID that are considered to be particularly valid or believable are very few, and the people who have suffered in them have been people living absolutely wasted lives, lives filled with abuse and instability and addiction and misery; the overwhelming majority of DID TikTokers appear to be living perfectly stable and successful adolescent lives. Those with DID have almost never professed to be able to switch from one alter to another on command; many DID TikTokers playact that exact behavior for their viewers. Alters are notoriously uncooperative towards each other; TikTok DID videos routinely feature alters happily participating in “roll calls” in which they switch from one identity to the next, conveniently timed for the creation of #content. (The DID people claim that really they’re just opportunistically capturing organic switches, but a) it’s very clear that many of these videos are filmed in one day and b) that would still require alters to willingly turn the camera on and get into the costume etc, which is not at all how alters have traditionally acted.) In the DID literature alters are almost never aware of what’s happening when another alter is “fronting”; on DID TikTok they almost universally are, justified with the convenient idea of “co-consciousness,” which is one of many evolutions of DID these people have implemented to allow their little pageant to continue. Most people with DID diagnosis, historically, have not been photogenic women with an interest in getting more followers. I could go on.

Lucas’s piece is particularly useful for the remarkable, remarkably depressing story of Dr. Matthew Robinson, a clinician and researcher from Harvard Medical School’s McLean Hospital. (The site of Girl, Interrupted, among other things.) Like a lot of people in psychiatry, Robinson noted with alarm that his hospital had “been inundated with referrals and requests from schools, parents, and our own adolescent treatment and testing services to assess for symptoms of what [patients] call DID.” He proceeded to discuss the difficulties this sort of situation provokes in an already-overtaxed mental health system, and spoke frankly about the fact that a considerable number of the people presenting with this disorder obviously do not in fact have it. He stated plainly that which many are too circumspect to say, which is that these TikTokers are faking. The consequence, of saying this in a lecture with his professional peers, was review-bombing of the hospital online, threats, a call to have Robinson’s medical license revoked, and sufficient harassment that McLean pulled online videos of the lecture. The online mob engaged in the typical social justice-vocabulary freakout campaign, McLean folded, and as stated in the piece, most researchers are now too scared to publicly comment on this absurd situation. If someone tells you that there is no such thing as a social justice-inflected cancellation campaign, you can point to this exact scenario and to the vicious and vengeful disability rights movement in general.

To be clear, I think that probably literally zero of the people who perform DID on TikTok have the disorder. Zero. I imagine that a significant portion of them have deluded themselves into thinking they do. But I’m quite confident that most of them are very well aware that they’re faking.

August 15, 2024

QotD: The bitter fruit of deinstitutionalization

Filed under: Health, History, Law, Liberty, Quotations, USA — Tags: , , , — Nicholas @ 01:00

In 1963, JFK signed the Community Mental Health Act. Its order to close the state psychiatric hospitals was followed, and hundreds were shuttered; the community mental health centers that were meant to replace them were never built. With far fewer beds for a growing patient population it should not have surprised anyone that the streets gradually filled with the severely ill. But somehow, we were surprised. The state governments were mostly just grateful to save money that had once gone to mental healthcare. The passage of Medicaid two years later deepened the problem. Medicaid’s funding structure presented states with an opportunity to further offload costs, this time onto the federal government. Unfortunately, the private institutions that filled with Medicaid patients were no better than the state facilities that had been closed; often they were worse. And maintaining access to Medicaid funding for such care, in practice, was more complicated and less certain than staying in a state institution. In 1975, the Supreme Court’s O’Connor v. Donaldson decision established a national standard that the mentally ill could only be involuntarily treated if they represented an immediate threat to themselves or others. This completely removed actual medical necessity from the equation, and the standard directly incentivized hospitals to discharge very ill patients, many of whom leave these useless emergency room visits and immediately abuse drugs, self-harm, commit crimes, attack others, or commit suicide. In 1990 the passage of the Americans with Disabilities Act further empowered treatment-resistant patients and created legal incentives that led hospitals to release severely ill people rather than face the burden of litigation. Various state reforms in recent decades have almost uniformly pushed the severely ill out of treatment rather than into it, under the banner of “autonomy”. For sixty years we’ve done everything in our power to make it harder to treat people who badly need care. And here we are.

Freddie deBoer, “We Closed the Institutions That Housed the Severely Mentally Ill and We Made It Dramatically Harder to Compel Them to Receive Care”, Freddie deBoer, 2024-05-14.

July 21, 2024

QotD: There’s no recovery mode from being a Basic College Girl

Filed under: Education, Health, Quotations, USA — Tags: , , , , , — Nicholas @ 01:00

    Do you have any examples of BCGs recuperating?

Sadly, very few. Part of this is just in the nature of the biz — I don’t see too many former students out and about, since they all leave College Town for the big wide world — but I do know this: Scratch a Karen, find a BCG. In fact, you could go so far to say that “Karen” simply IS the BCG after she hits The Wall. The faster the impact, the bigger the Karen (this is a testable hypothesis — given that our gal Taylor Swift is currently impacting The Wall at about Mach 3, if I’m right, she’ll soon unleash the kraken of Karens on an unsuspecting world).

I also strongly suspect that BCGs can’t recover. As any shrink will tell you, Narcissistic and Borderline Personality Disorders are almost impossible to treat. For one thing, treatment requires believing that you have a problem, and believing you don’t have a problem is pretty much diagnostic of those two syndromes. And while I’m not sure the BCG is clinically diagnosable with either of those, what they actually are is close enough that I’m betting whatever therapies “work” on actual clinical cases would “work” on them … but see above.

Finally, I guess I can’t really blame the BCG for not realizing she’s got a problem, because she obviously doesn’t have a problem. Look around — society rewards this shit. AOC, for example, is going to be La Presidenta por Vida de los Estados Unidos here in a decade or so; if that’s a problem, I can’t really blame them for not fixing it. Eventually, of course, reality will intrude, and your BCG will be screaming for a real man to come save her … but, thanks to her BCG antics, there won’t be any real men around. Or, you know, we’ll all be in the OPFOR, so good luck with that, beeyatch.

Severian, “Friday Mailbag /Grab Bag”, Rotten Chestnuts, 2021-06-25.

July 3, 2024

QotD: Mental health and social media

Filed under: Media, Politics, Quotations, USA — Tags: , , , , , — Nicholas @ 01:00

I question the idea that modern life has increased the total amount of lunacy in the world. Thanks to the Internet in general, and social media in particular, the volume of the world’s lunatic population has been amped well past 11 … but I think this is less a case of “Twitter creating lunatics” than “online anonymity letting people fly their freak flags openly”. Deliberately avoiding sex and politics, an example: On a road trip recently, I started flipping channels in my hotel room, and I came across a show called Dr. Pimple Popper. I swear, this is absolutely a real thing that exists. Here’s this woman, a dermatologist I guess, rooting around in cysts and boils and tumors and whatnot for the cameras, and … that’s it.

Not only is there an audience for this — which I never would’ve believed — there’s enough of an audience for it that it’s on basic cable. See what I mean? Somehow, the marketing guys determined that yes, there are enough people out there who want to see cysts being cauterized that we can make an entire show out of it. How could they figure it out? Beats me, but unless some suits at TLC had a contest to see what’s the silliest, grossest thing they could actually get broadcast, I’m betting that there was a group of Internet weirdos out there discussing it, and the marketing boys just ran with it.

Applying that to the topic at hand, my guess is that, since it’s so easy for people to be Massively Online these days, the kind of folks with that particular type of mental problem pretty much live on Twitter, where — as anyone who has waded into that cesspit for more than five minutes knows — the Twitterati absolutely cannot distinguish “talking about doing something” from “actually doing something”.

Severian, “Friday Mailbag”, Rotten Chestnuts, 2021-06-04.

June 10, 2024

The FDA has a jaundiced view of psychotherapy involving the use of MDMA (aka “Ecstasy”)

Filed under: Bureaucracy, Government, Health, USA — Tags: , , , — Nicholas @ 03:00

Colby Cosh indulges in a minor “I told you so” after the FDA’s expert panel recommended against the agency permitting any medical use of MDMA, despite some experiments indicating it does have therapeutic value:

Ball-and-stick model of the 3,4-methylenedioxy-methamphetamine molecule, also known as MDMA, or ecstasy, a well-known psychoactive drug. Based on the crystal structure of MDMA hydrochloride, as determined by X-ray diffraction.
Color code: Carbon, C: black, Hydrogen, H: white, Oxygen, O: red, Nitrogen, N: blue.
Image by Jynto via Wikimedia Commons.

Hopes for research into therapeutic uses of psychedelic drugs received a setback last week, one that your correspondent saw tripping (geddit?) up the road in advance. An expert panel published its official advice to the United States Food and Drug Administration (FDA) on permitting medical use of MDMA, the synthetic nightclub enhancer that we’re afraid the kids probably still aren’t calling “ecstasy” or “molly”.

There is long-recognized potential for MDMA to be combined with classical psychotherapy in treating emotional disorders, notably post-traumatic stress (PTSD), and now there are some small, limited studies showing evidence of positive effects.

But the FDA’s scientists weren’t very impressed with this evidence, and they voted almost unanimously against creating a therapeutic exception to the illegality of ecstasy, which the U.S. Controlled Substances Act classifies as a “Schedule 1” drug, right next to heroin. The panel’s advice isn’t binding on the agency, which is crawling in somewhat good faith toward recognizing the understudied medical potential of psychedelics. But the vote emphasizes the inherent problems that drugs face, once they are defined in law as “recreational”, in winning over skeptical scientists.

Reason magazine’s great drug-war correspondent Jacob Sullum has a thorough discussion of the issues. The existing research, despite some impressive headline results, has garden-variety issues with dropout rates, follow-ups and occasional researcher shenanigans. But the big problem, which defies easy technical solution, is with scientific blinding of the research subjects.

Scientific trials of the modern kind are predicated upon separating illusory placebo effects from genuine treatment effects. Researchers expect that a high-quality study will have a control group that receives sham treatment or none at all, and good practice requires that experimenters and their guinea pigs are both blind to who is in what group.

News flash: most people can tell whether they’ve been really given a psychedelic drug. Indeed, most doctors can tell whether they’ve given a patient a genuine psychedelic drug, and how much of it. Many placebo-controlled trials on psychoactive drugs, perhaps most of them, thus suffer from an alleged problem of broken blinding. (Have a glance, for example, at Table 2 in this review of blinding procedures in psychedelic studies.)

June 5, 2024

QotD: Mental health at “Flyover State”

Filed under: Education, Humour, Politics, Quotations, USA — Tags: , , , , , — Nicholas @ 01:00

As y’all undoubtedly know, mental illness is something of a badge of honor in the ivory tower. Screw HIPAA; most people in academia are willing, indeed eager, to tell you all about their mental problems. The students mostly do it to get out of classwork, of course — the minute you get the letter from Student Services, you can go ahead and start filing the “incomplete” paperwork with the registrar — but grad students and professors collect DSM diagnoses and SSRI prescriptions like the Japanese collect Pokemon and used panties.

Given that, and given how lunatic professors’ actual beliefs are, there’s pretty much nothing you can’t get away with saying in the ivory tower if you play your cards right. In much the same way Jon Stewart rode his “clown nose on / clown nose off” act to adulation from the smart set, you can say whatever you want if you keep it ambiguously crazy. (You know how it goes — if you agree with Stewart, he’s doing straight political commentary; but if you disagree with him to the point where he might lose sponsors, c’mon man, he’s just a tv comedian).

I’ll give you an example. Back in 2008, during the Democratic primaries, it was all the rage on campus to be anti-Obama. You’ll just have to trust me on that, I guess, but if you believed my previous “inside the ivory gulag” posts, I’m sure you’ll understand why that fad existed — everyone’s playing the “more radical than thou” game, and what’s more radical than being against the black guy, because his positions are such weak sauce Liberal boilerplate? The real People’s Candidate back then was Dennis Kucinich, and if normal people remember anything about him, it’s that he was more than a little Fox Mulder-y on the question of extraterrestrial life.

Anyway, whenever anyone asked me who I was voting for, I’d give Obama both barrels, always from the most extreme conservative position … but when I noticed the SJW I was talking to had finally cottoned to that, I ended with something like “And what’s worst is that unlike some candidates, Obama refuses to take the saucer people menace seriously!!”

Severian, “Friday Mailbag”, Rotten Chestnuts, 2021-06-04.

May 22, 2024

Scott Alexander reviews The Others Within Us

Filed under: Books, Health — Tags: , , — Nicholas @ 05:00

At Astral Codex Ten, Scott Alexander discusses teh new hawtness in psychotherapy as expounded in Robert Falconer’s new book The Others Within Us:

Internal Family Systems, the hot new1 psychotherapy, has a secret.

“Hot new psychotherapy” might sound dismissive. It’s not. There’s always got to be one. The therapy that’s getting all the buzz, curing all the incurable patients, rocking those first few small studies. The therapy that was invented by a grizzled veteran therapist working with Patients Like You, not the out-of-touch elites behind all the other therapies. The therapy that Really Gets To The Root Of The Problem. There’s always got to be one, and now it’s IFS.

Sufficiently new and popular therapies are hard to get. Therapist training starts slow – the founder has to train the second generation of therapists, the second generation has to train the third generation, and so on. IFS says they have a 10,000 person wait list for their training program. So lots of people have heard great things about IFS, maybe read a manual or two, but never tried it or met anyone who has.

What I gather from the manuals: IFS is about working with “parts”. You treat your mind as containing a Self — a sort of perfect angelic intellect without any flaws or mental illnesses — and various Parts — little sub-minds with their own agendas who can sometimes occlude or overwhelm the Self. During therapy, you talk to the Parts, learn their motives, and bargain with them.

For example, you might identify a Part of you that wants to sabotage your relationships. You will visualize and name it — maybe you call her Sabby, and she looks like a snake. You talk to Sabby, and learn that after your first break-up, when you decided you never wanted to feel that level of pain again, you unconsciously created her and ordered her to make sure you never got close enough to anyone else to get hurt. Then you and the therapist come up with some plan to satisfy Sabby — maybe you convince her that you’re older now, and better able to deal with pain, and you won’t blame her if you get close to someone and have to break up again. Then you see a vision of Sabby stepping aside, maybe turning off the Windmill Of Relationship Sabotage or something like that, and then you never sabotage your relationships again. It’s more complicated than that, but that’s the core.

All of this is the classic version everyone learns from the manual. Before we get to the secret, let’s examine two big assumptions in more detail.

First, this isn’t supposed to be just the therapist walking you through guided imagery, or you making up a story you tell yourself. The therapist asks you “Look inside until you find the part that’s sabotaging your relationship”, and you are supposed to discover — not invent, discover — that your unconscious gives it the form of a snake called Sabby. And you are supposed to hear as in a trance — again, not invent — Sabby telling you that she’s been protecting you from heartbreak since your last breakup. When you bargain with Sabby, it’s a two-way negotiation. You learn — not decide — whether or not Sabby agrees to any given bargain. According to Internal Family Systems (which descends from normal family systems, ie family therapy where the whole family is there at once and has to compromise with each other), all this stuff really is in your mind, waiting for an IFS therapist to discover it. When Carl Jung talked about interacting with the archetypes or whatever, he wasn’t being metaphorical. He literally meant “go into a trance that gives you a sort of waking lucid dream where you meet all this internal stuff”.

(After reading the IFS manuals, I tried most of their tricks for initiating this sort of trance and meeting Sabby or whoever. I got nothing. I notice most of the patients with great results are severely traumatized borderlines, ie the same people who often get multiple personality disorder after the slightest hint from a therapist that this might happen. We’ll get back to this analogy later.)

The second assumption is that everything inside your mind is part of you, and everything inside your mind is good. You might think of Sabby as some kind of hostile interloper, ruining your relationships with people you love. But actually she’s a part of your unconscious, which you have in some sense willed into existence, looking out for your best interests. You neither can nor should fight her. If you try to excise her, you will psychically wound yourself. Instead, you should bargain with her the same way you would with any other friend or loved one, until either she convinces you that relationships are bad, or you and the therapist together convince her that they aren’t. This is one of the pillars of classical IFS.

The secret is: no, actually some of these things are literal demons.

    1. Some people object to me calling it “new” – it was developed in the 1980s, and has been popular since the early 2010s. Still, the therapy landscape shifts slowly, and even an exponentially-growing therapy takes a long time to get anywhere.

April 30, 2024

TikTok for Tots (and Instagram, and Facebook, and Twitter, and …)

Filed under: Britain, Health, Media, Technology — Tags: , , , , — Nicholas @ 05:00

Ted Gioia has some rather alarming information on just how many kids are spending a lot of time online from a very early age:

The leader in this movement is TikTok. But the other major platforms (Instagram, Twitter, Facebook, YouTube, etc.) are imitating its fast-paced video reels.

My articles have stirred up discussion and debate—especially about the impact of slot machine-ish social media platforms on youngsters.

So I decided to dig into the available data on children and social media. And it was even worse than I feared.

30% of children ages 5 through 7 are using TikTok — despite the platform’s policy that you can’t sign up until age 13.

The story gets worse. The numbers are rising rapidly — usage among this vulnerable group jumped 5% in just one year.

By the way, almost a quarter of children in this demographic have a smartphone. More than three-quarters use a tablet computer.

These figures come from Ofcom, a UK-based regulatory group. I’ll let you decide how applicable they are to other countries. My hunch is that the situation in the US is even worse, but that’s just an educated guess based on having lived in both countries.

What happened in 2010?

One thing is certain — the mental health of youths in both the US and UK is deteriorating rapidly. There are dozens of ways of measuring the crisis, but they all tell the same tragic story.

Something happened around 2010, and it’s destroying millions of lives. […]

As early as age 11, children are spending more than four hours per day online.

Here’s a comparison of time spent online by age. Even before they reach their teens, youngsters are spending more than four hours per day staring into a screen.

Here’s what a day in the digital life of a typical 9-year-old girl looks like.

I don’t find any of this amusing. But if you’re looking for dark humor, I’ll point to the four minutes spent on the Duolingo language training app at the end of the day. This provides an indicator of the relative role of learning in the digital regimen on the rising generation.

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