Quotulatiousness

March 24, 2023

From “railway spine” to “shell shock” to PTSD

Filed under: Health, History, Military, Railways, WW1, WW2 — Tags: , , , , , — Nicholas @ 05:00

At Founding Questions, Severian discusses how our understanding of what we now label “Post-Traumatic Stress Disorder” evolved from how doctors visualized bodily ailments over a century ago:

A shell-shocked and physically wounded soldier in the First World War.

I mentioned “shell shock” yesterday, so let’s start there. Medicine in 1914 was still devoted to the “Paris School,” which assumed nothing but organic etiology for all syndromes. Sort of a reverse Descartes — as Descartes (implicitly) “solved” the mind-body problem by disregarding the body, so the “Paris School” of medicine solved it by disregarding the mind. So when soldiers started coming back from the front with these bizarre illnesses, naturally doctors began searching for an organic cause. (That’s hardly unique to the Paris School, of course; I’m giving you the context to be fair to the 1914 medical establishment, whose resistance to psychological explanations otherwise seems so mulish to us).
They’d noticed something similar in the late 19th century, with industrial accidents and especially train crashes. When a train crashed, the people in the first few cars were killed outright, those in the next few wounded, but the ones in the back were often physically fine. But within a few hours to weeks, they started exhibiting all kinds of odd symptoms. Hopefully you’ve never been in a train crash, but if you’ve ever been in a fender-bender you’ve no doubt experienced a minor league version of this.

I hit a deer on the highway once. Fortunately I was at highway speed, and hit it more or less dead on (it jumped out as if it were committing suicide), so it got thrown away from the car instead of coming through the windshield. The car’s front end was wrecked, naturally, but I was totally fine. I don’t think the seatbelt lock even engaged, much less the airbag, since I didn’t even have time to hit the brakes.

The next few hours to days were interesting, physiologically. It felt like my body was playing catch up. I had an “oh shit, I’m gonna crash!!!” reaction about 45 minutes after I’d pulled off to the side of the road, duct-taped the bumper back on as best I could, and continued to my destination. All the stuff I would have felt had I seen the deer coming came flooding in. Had I not already been where I was going, I would’ve needed to pull over, because that out of the blue adrenaline hit had my hands shaking, and my vision fuzzed out briefly.

The next morning I was sore. I had all kinds of weird aches, as if I’d just played a game of basketball or something. I assume part of it actually was the impact — it didn’t feel like much in the moment, but if it’s enough to crumple your car’s front end (and it was trashed), it’s enough to give you a pretty good jolt. That would explain soreness in the arms, elbows, and shoulders — a stiff-armed, white-knuckle grip on the steering wheel, followed by a big boom. But I was also just kinda sore all over, plus this generalized malaise. I felt not-quite-right for the next few days. Nothing big, no one symptom I can really put my finger on, but definitely off somehow — a little twitchy, a little jumpy, and really tired.

Having done my WWI reading, I knew what it was, and that’s when I really understood the doctors’ thought processes. I really did take some physical damage, because I really did receive a pretty good full-body whack. It just wasn’t obvious to the naked eye. And since everyone has experienced odd physical symptoms from being rattled around, or even sleeping on a couch or sprung mattress, it makes sense — the impact obviously jiggled my spine, which probably accounts for a great many of the physical symptoms. Hence, “railway spine”. And from there, “shell shock” — nothing rattles your back like standing in a trench or crouching in a dugout as thousands of pounds of high explosive go off around you. It must be like going through my car crash all day, every day.

Skip forward a few decades, and we now have a much better physiological understanding of what we now call (and I will henceforth call) Post-Traumatic Stress Disorder (PTSD). There’s a hypothesis that I personally believe, that “shell shock” is also a whole bunch of micro-concussions as well as “classic” PTSD, but let’s leave that aside for now. The modern understanding of PTSD is largely about chemistry. Cortisol and other stress chemicals really fuck you up. They have systemic physical and mental effects. If those chemicals don’t get a chance to flush out of your system — if you’re in a trench for weeks on end, let’s say — the effects are cumulative, indeed exponential.

Returning to my car crash: I was “off” for a few days because my body got a huge jolt of stress chemicals. That odd not-quite-right thing I felt was those chemicals flushing through. Had I gone to a shrink at that moment, he probably would’ve diagnosed me with PTSD. But I didn’t have PTSD. I had a perfectly normal physiological reaction to a big shot of stress chemicals. If I’d gotten into car crash after car crash, though, day in and day out, that would’ve been PTSD. I’d be having nightmares about that deer every night, instead of just the once. And all that would have cumulative, indeed exponential, effects.

He then goes on to cover similar physical reactions to stimuli in modern life, so I do recommend you RTWT.

December 31, 2022

If Hell is “other people”, then the deepest level of Hell must be “other high school students”

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

Tom Knighton on a recent post from FEE about the awfulness of the school experience for a lot of students:

“Leaside High School entrance Toronto Ontario Canada” by ammiiirrrr is licensed under CC BY-NC-SA 2.0 .

I was never a big fan of school. While I always thought education was important, I never liked school itself.

Part of that was because I was the kid most likely to get picked on, but even when that wasn’t happening, I still didn’t like it. Learning boring stuff while not getting to delve deeper into interesting topics just made it a chore to be endured.

Couple with the fact that cruelty is such a part of the “educational experience”, it’s no wonder that I didn’t like it.

Hell, even when everyone was being chill, the fact that I didn’t fit in did a number on me, including a time when I genuinely wanted to end my own life. I don’t talk about that kind of thing much, but it was a stark reality of that time.

[…]

Granted, I always chalked my difficulties at the time — and I’m much better now, I should note — with a number of things besides the structure of school itself. Mostly the fact that it was a small school, I was the weird kid, and while I had friends, I never felt like I really fit in.

Yet I can’t rule out that the structured nature of education at the time contributed greatly to the problem.

As noted in the original piece, the patterns for suicidal behavior in teens don’t match up with adults. That tells us that there’s something at play other than just the weather, the temperature, or whatever.

Regardless, it raises serious questions about our schools as an environment. Teachers and administrators would tell you that they strive to create a nurturing environment for students of all ages. I’m pretty sure most of them mean it, too.

Yet these studies suggest that they’re failing. Miserably.

But let’s not ignore the possibility that much of this may well be because, frankly, kids can be little sociopaths. They’re mean. They’re cruel. Someone will seek out those they perceive as weak and victimize them while others get to enjoy the show, even while being glad they’re not the target.

Then there’s the fact that it’s impossible to hide from any deficiencies you might have, including social deficiencies just as good fortune with finding romantic partners of your preferred sex and that’s going to play a role as well.

June 12, 2019

Men’s mental health and the conflicting demands they face

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

In Psychology Today, Rob Whitley explains the paradoxical demands that men make active efforts to talk about mental health issues and to “check their privilege” and shut up:

Men, Please Talk More

Men experience elevated rates of numerous mental health issues including suicide and substance use disorder while showing low rates of mental health service utilization and a tendency to bottle-up. This has led many scholars to posit a silent crisis of men’s mental health.

Consequently, many mental health organizations and high-profile individuals are sending out an insistent message that men must talk more about their mental health.

Even royalty has endorsed this message, with HRH Prince William stating in a recent documentary that we need to “pass the message onto men everywhere that it’s okay to talk about mental health… and be able to talk about our emotions.”

Fine words indeed.

Men, Please Shut Up

However, other individuals and organizations are sending out a completely different message, namely that men as a group need to remain silent and “check their privilege.” As wryly noted by Bloomberg journalist Ramesh Ponnuru “check your privilege means shut your mouth.”

Such messages can be seen all over the Internet, with pleas for men to shut-up or stop whining. Of note, these pleas come from both men and women. These echo comments men often hear in face-to-face interactions, even from their intimates and their employers.

Indeed, such perspectives can emanate from high places, including the U.S. Senate, with Hawaii Senator Mazie Hirono recently stating, “I just want to say to the men in this country: just shut up and step up. Do the right thing for a change.” For some, male silence is a sign of moral rectitude.

This situation creates a men’s mental health double-bind. On the one hand, men are being told to talk more and open-up; on the other hand, men are being told to check their privilege and be silent. This can only create cognitive and emotional distress.

Interestingly, the men’s mental health double-bind manifests itself beyond the borders of the U.S. As such, examples from the U.K and Canada are given below to illustrate its global nature.

November 12, 2017

BAHFest East 2017 – Olivia Walch: Symbiotic relationship promotes longer lifespans

Filed under: Health, Humour — Tags: , , , — Nicholas @ 02:00

BAHFest
Published on Oct 22, 2017

Watch Olivia Walch discuss her proposal that older individuals who care for younger individuals experience a reduction in mortality because they are protected from heart attacks by regularly occurring, anger-triggered decreases in cortisol levels.

BAHFest is the Festival of Bad Ad Hoc Hypotheses, a celebration of well-researched, logically explained, and clearly wrong evolutionary theory. Additional information is available at http://bahfest.com/

March 28, 2017

QotD: The rise of political correctness in the UK

Filed under: Britain, History, Quotations — Tags: , , , — Nicholas @ 01:00

The philosophy of political correctness is now firmly entrenched over here, too, and at its core is a refusal to look the truth squarely in the face, unpalatable as it may be.

Political correctness is about denial, usually in the weasel circumlocutory jargon which distorts and evades and seldom stands up to honest analysis.

It comes in many guises, some of them so effective that the PC can be difficult to detect. The silly euphemisms, apparently harmless, but forever dripping to wear away common sense — the naivete of the phrase “a caring force for the future” on Remembrance poppy trays, which suggests that the army is some kind of peace corps, when in fact its true function is killing.

The continual attempt to soften and sanitise the harsh realities of life in the name of liberalism, in an effort to suppress truths unwelcome to the PC mind; the social engineering which plays down Christianity, demanding equal status for alien religions.

The selective distortions of history, so beloved by New Labour, denigrating Britain’s past with such propaganda as hopelessly unbalanced accounts of the slave trade, laying all the blame on the white races, but carefully censoring the truth that not a slave could have come out of Africa without the active assistance of black slavers, and that the trade was only finally suppressed by the Royal Navy virtually single-handed.

In schools, the waging of war against examinations as “elitist” exercises which will undermine the confidence of those who fail — what an intelligent way to prepare children for real life in which competition and failure are inevitable, since both are what life, if not liberal lunacy, is about.

PC also demands that “stress”, which used to be coped with by less sensitive generations, should now be compensated by huge cash payments lavished on griping incompetents who can’t do their jobs, and on policemen and firemen “traumatised” by the normal hazards of work which their predecessors took for granted.

Furthermore, it makes grieving part of the national culture, as it was on such a nauseating scale when large areas were carpeted in rotting vegetation in “mourning” for the Princess of Wales; and it insists that anyone suffering ordinary hardship should be regarded as a “victim” — and, of course, be paid for it.

That PC should have become acceptable in Britain is a glaring symptom of the country’s decline.

George MacDonald Fraser, “The last testament of Flashman’s creator: How Britain has destroyed itself”, Daily Mail, 2008-01-05.

May 13, 2016

British doctors and the attraction of moving to Australia

Filed under: Australia, Britain, Health — Tags: , , , — Nicholas @ 03:00

Scott Alexander talks about the dispute between the junior doctors and the British government:

A lot of American junior doctors are able to bear this [the insane working hours] by reminding themselves that it’s only temporary. The worst part, internship, is only one year; junior doctorness as a whole only lasts three or four. After that you become a full doctor and a free agent – probably still pretty stressed, but at least making a lot of money and enjoying a modicum of control over your life.

In Britain, this consolation is denied most junior doctors. Everyone works for the government, and the government has a strict hierarchy of ranks, only the top of which – “consultant” – has anything like the freedom and salary that most American doctors enjoy. It can take ten to twenty years for junior doctors in Britain to become consultants, and some never do. […]

Faced with all this, many doctors in Britain and Ireland have made the very reasonable decision to get the heck out of Britain and Ireland. The modal career plan among members of my medical school class was to graduate, work the one year in Irish hospitals necessary to get a certain certification that Australian hospitals demanded, then move to Australia. In Ireland, 47.5% of Irish doctors had moved to some other country. The situation in Britain is not quite so bad but rapidly approaching this point. Something like a third of British emergency room doctors have left the country in the past five years, mostly to Australia, citing “toxic environment” and “being asked to endure high stress levels without a break”. Every year, about 2% of British doctors apply for the “certificates of good standing” that allow them to work in a foreign medical system, with junior doctors the most likely to leave. Doctors report back that Australia offers “more cash, fewer hours, and less pressure”. I enjoy a pretty constant stream of Facebook photos of kangaroos and the Sydney Opera House from medical school buddies who are now in Australia and trying to convince their colleagues to follow in their footsteps.

Upon realizing their doctors are moving abroad, British and Irish health systems have leapt into action by…ignoring all systemic problems and importing foreigners from poorer countries who are used to inhumane work environments. I worked in some rural Irish towns where 99% of the population was white yet 80% of the doctors weren’t; if you have a heart attack in Ireland and can’t remember what their local version of 911 is, your best bet is to run into the nearest mosque, where you’ll find all the town’s off-duty medical personnel conveniently gathered together. This seems to be true of Britain as well, with the stats showing that almost 40% of British doctors trained in a foreign country (about half again as high as the US numbers, even though the US is accused of “stealing the world’s doctors” – my subjective impression is that foreign doctors try to come to the US despite barriers because they’re attracted to the prospect of a better life here, but that they are actively recruited to Britain out of desperation). Many of the doctors who did train in Britain are new immigrants who moved to Britain for medical school – for example, the Express finds that only 37% of British doctors are white British (the corresponding number for America is something like 50-65%, even though America is more diverse than Britain). While many new immigrants are great doctors, the overall situation is unfortunate since a lot of them end up underemployed compared to their qualifications in their home country, or trapped in the lower portions of the medical hierarchy by a combination of racism, language difficulties, and just the fact that everyone is trapped in the lower portions of the medical hierarchy these days.

If Britain continues along its current course, they’ll probably be able to find more desperate people willing to staff its medical services after even more homegrown doctors move somewhere else (70% say they’re considering it, although we are warned not to take that claim at face value). I work with several British and Irish doctors in my hospital here in the US Midwest, they’re very talented people, and we could always use more of them. But this still seems like just a crappy way to run a medical system.

I don’t know anything about the latest dispute that has led to this particular strike in Britain. Both sides’ positions sound reasonable when I read about them in the papers. I would be tempted to just split the difference, if not for the fact several years of medical work in the British Isles have taught me that everything that a government health system says is vile horrible lies, and everybody with a title sounding like “Minister of Health” or “Health Secretary” is an Icke-style lizard person whose terminal value is causing as many humans to die of disease as possible. I can’t overstate the importance of this. You read the press releases and they sound sort of reasonable, and then you talk to the doctors involved and they tell you all of the reasons why these policies have destroyed the medical system and these people are ruining their lives and the lives of their patients and how they once shook the Health Secretary’s hand and it was ice-cold and covered in scales. I don’t know how much of this is true. I just think of it as something in the background when the health service comes up to doctors and says “Hey, we have this great new deal we want to offer you!”

November 16, 2012

SEC employee stress levels must be down because they’re not surfing for porn during “98% of the workday”

Filed under: Bureaucracy, Government, USA — Tags: , , , — Nicholas @ 09:49

Ah, the hard life of the SEC employee must have gotten a bit less stressful recently. Tim Cushing has the, um, sordid details:

An internal investigative report of the SEC’s Trading and Markets division has been recently been reviewed by Reuters. After reading its rundown of the misdeeds and abuses uncovered, I’m left with the urge to laugh maniacally in the manner of someone having just cleared the tipping point and now sliding irretrievably into insanity. The sheer irresponsibility on display here springs from the sort of irredeemable carelessness that comes with spending other people’s money (taxes) and operating without any credible oversight or accountability (a large percentage of government entities).

Bess Levin at Dealbreaker points out that while the SEC’s internal investigation may have turned up several misdeeds, ranging from the merely stupid to the positively horrendous, it is quite a step up from the insatiable pornhounds that used to populate the Commission:

    If you had asked us two years or two months or two days ago if we thought that there would be a time in the near future when Securities and Exchange employees would not be regularly reprimanded for watching porn on their work-issued computers for 98 percent of the workday, we would have said absolutely not. No judgment, but in our professional opinion, people do not go from, among other things:

    * Receiving “over 16,000 access denials for Internet websites classified by the Commission’s Internet filter as either “Sex” or “Pornography” in a one-month period”

    * Accessing “Internet pornography and downloading pornographic images to his SEC computer during work hours so frequently that, on some days, he spent eight hours accessing Internet pornography…downloading so much pornography to his government computer that he exhausted the available space on the computer hard drive and downloaded pornography to CDs or DVDs that he accumulated in boxes in his office.”

    …to living a porn-free existence at l’office.

Truly a mind-boggling set of employees. One regional staff accountant ran into the “no-porn” wall 1,800 times in a two week period, yet remained undeterred. Those caught accessing porn with ridiculous frequency cited the “stress” of their jobs as the underlying reason for the nearly uninterrupted pornathons.

September 28, 2012

Defending the welfare state … badly

Filed under: Bureaucracy, Europe, Government — Tags: , , , , — Nicholas @ 08:27

At sp!ked, David Clements reviews a new book by Asbjorn Wahl which inadvertently exposes some of the very real problems of the modern welfare state in the process of praising and defending it:

Asbjorn Wahl is a trade unionist, director of the Campaign for the Welfare State and Norwegian. While you shouldn’t judge a book by the biog of its author, far less his nationality, it is fair to say that when I opened his new book, The Rise and Fall of the Welfare State, I wasn’t expecting much.

He begins, as all defenders of the welfare state must, with a bleak account of the public; that is, of the welfare state’s helpless, vulnerable clients and potential clients. There is a ‘feeling of powerlessness and apathy among people’, says Wahl, a feeling of ‘tragic stories’ too numerous to mention. As well as discovering an ‘unexpectedly large number… of victims of workfare’, he finds other people suffering ‘bad health and ever-more demanding work’. He tells us ‘stories of people who struggle with their health, then their self-confidence and their self-image’. As I heard a man on a picket line tell a Sky News reporter recently, everyone is ‘sick and tired of being sick and tired’.

[. . .]

Wahl is critical of both the anti-democratic tendencies of the European Union and the imposition of the ‘economic straitjacket’ resulting from the attack on living standards in the Eurozone periphery countries. But his call for the ‘stimulation of the economy, investment in infrastructure and in productive activities’ can hardly be taken seriously given his doubts about the benefits of economic growth. While attempts by Europe’s governments to counter the financial crisis, and in so doing to create public debt crises, have, as Wahl says, been ‘exploited as an excuse to make massive, intensified attacks on the welfare state’, this does not in itself invalidate the attack. His view that capitalist excess is responsible for all of Europe’s ills is also his blind spot when it comes to seeing the damage done by an increasingly therapeutic welfarism. In truth, the welfare problem is not something dreamt up by neoliberals (whoever they are). Rather, it is symptomatic of a political culture that robs people of their agency, something that you might expect somebody like Wahl to be opposed to. Far from it. ‘Good social security’, he says, ‘gives people that much-needed self-confidence boost that enables them to become active players in society’.

As this back-to-front and patronising rationale makes clear, today’s welfare state infantilises people. It tells them that they are too damaged to function without its official hand-holding and belittling interventions. Any ‘progressive’ movement would surely endorse the contrary view that people should be treated as morally independent beings, responsible for their own actions? But to say as much is to invite the charge that you are horribly right wing and endorse ‘welfare-to-work’ policies (which, incidentally, sound rather more like the unforgiving and austere welfare state envisioned by its founders than that proposed by its supposed critics).

April 14, 2010

Unexpected findings on delaying or avoiding PTSD

Filed under: Health, Military — Tags: , , , — Nicholas @ 08:58

With American troops being deployed so frequently to combat missions over the last few years, efforts to diagnose and treat Post-Traumatic Stress Disorder (PTSD) have become far more urgent. The risk of troops suffering from PTSD goes up the longer they are in combat or combat-like situations. The repeat deployments can’t be avoided, but other things can be done to reduce the risks:

The U.S. Army has found that PTSD (post-traumatic stress disorder) often does not appear immediately after combat, but gradually, over a longer (5-10 year) period. Short term, the army has found that 14 percent of troops on their first combat tour have stress problems. That goes to 18 percent for those on their second tour, and 31 percent for those on their third. But in the longer term (after five years of being in combat), 24 percent of troops who have served 12 months (one tour) in a combat zone will develop some PTSD. That goes to 39 percent for those who serve two tours and 64 percent for those who do three. The army wants to limit the number of troops suffering from PTSD. This is essential if the army is to maintain an experienced combat force.

[. . .]

Once a soldier has PTSD, they are usually no longer fit for combat, and many troops headed for Afghanistan are falling into this category. PTSD makes it difficult for people to function, or get along with others. With treatment (medication, and therapy), you can recover from PTSD. But this can take months or years. In extreme cases, there is no recovery. And while being treated, you stay away from the combat zone.

The army has found that PTSD can be delayed, or even avoided, by providing the troops with what previous generations of soldiers would have considered luxuries. For example, when possible, combat troops sleep in air conditioned rooms, and have access to the Internet and video games, as well as good food and other amenities. The video games and Internet resulted in an unexpected positive effect. The surveys found that troops that spent 2-4 hours a day on the Internet or playing video games (even violent ones) had far fewer stress problems. Having exercise facilities available also helped, despite the physically strenuous nature of combat in Afghanistan. While the combat troops spend most of their time out in the countryside, living rough, their commanders know what even a few days back at a larger base, with all the goodies, makes a big difference in attitudes, morale and combat effectiveness.

March 23, 2010

Post-traumatic stress in soldiers

Filed under: Health, Middle East, Military — Tags: , , , — Nicholas @ 07:35

Strategy Page looks at the rising rate of reported Post-Traumatic Stress Disorder (PTSD) in the forces engaged in Afghanistan and Iraq:

As expected the U.S. Army is beginning to see more widespread effects from PTSD (post-traumatic stress disorder). There are two main indicators. The suicide rate, which has gone from 9 per 100,000 troops in 2001, to 23 last year, gets most of the media attention. The less noticed indicator, which impacts a lot more people, is the use of anti-stress medications. These have gone up 76 percent since 2001. About 17 percent of all troops now take these drugs, including six percent of those in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent.) The impact of these drugs, especially in combination, can be unpredictable. The army is still waiting to see how this increased use of anti-stress medications will play out. This is all unknown territory.

[. . .]

Nearly a century of energetic effort to diagnose and treat PTSD (including much recent attention to civilian victims, via accidents or criminal assault), had made it clear that most troops eventually got PTSD if they were in combat long enough. During World War II, it was found that, on average, 200 days of combat would bring on a case of PTSD for American troops. After World War II, methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). That’s why combat troops in Iraq and Afghanistan often sleep in air conditioned quarters, have Internet access, lots of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This has extended their useful time in combat, before PTSD sets in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.

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