> Let’s say that based on family stories, you suspect that your great-grandfather had ADHD. (And let’s pretend for the moment that ADHD is real.) He almost certainly would not have been as conscious of his condition as he would today, given that there wasn’t even a shorthand for it. But would he have suspected that something was off? Would he have considered himself different—even less—than others?
> The progress answer says: Yes, he suffered in the shadows of the ignorant society around him. But the solution problem says: Nope, he probably didn’t notice anything at all.
> Remember, the mind must first attend to something, and then classify it as a problem or opportunity, before it tries to solve it. Without much of a mental health infrastructure around him—most notably, without a bona fide diagnosis—your great-grandfather likely had no clue that anything was amiss.
Eh, reading Wikipedia article on History of autism... yeah, autist in the past wouldn't have a concept explaining their issues - they would definitely notice these issues tho.
> [1908AD] Swiss-American psychiatrist August Hoch of the New York State Psychiatric Institute defined the concept of the shut-in personality. It was characterised by reticence, seclusiveness, shyness and a preference for living in fantasy worlds, among other things. Hoch also said they had "a poorly balanced sexual instinct [and] strikingly fruitless love affairs"
or
> A more concise definition of the introverted type was given by Jung in February 1936
> He holds aloof from external happenings, does not join in, has a distinct dislike of society as soon as he finds himself among too many people. In a large gathering he feels lonely and lost. The more crowded it is, the greater becomes his resistance. He is not in the least "with it", and has no love of enthusiastic get-togethers. He is not a good mixer. What he does, he does in his own way, barricading himself against influences from outside. He is apt to appear awkward, often seeming inhibited, and it frequently happens that, by a certain brusqueness of manner, or by his glum unapproachability, or some kind of malapropism, he causes unwitting offence to people...
or
>Autistic attitude. All children in this group remained aloof from their environment, adapt to their environment with difficulty and never fully integrate into it. Cases 1, 2 and 3 immediately become the object of general ridicule among the other children upon admission to school. Cases 4 and 5 had no authority among their classmates and are nicknamed "talking machines", although their general level put them significantly above the rest of the children. Case 6 even avoided the company of children, which traumatized him. The tendency to loneliness and the fear of people can be observed in all of these children from early childhood onwards; they stay apart from the others, avoid playing together, they prefer fantastic stories and fairy tales.
Does it really help to not have a way of conceptualizing such problems coherently?
I think in some cases it does, and in others it doesn't. I've typically used schizophrenia as an example of something that is definitely real and worth knowing about, even though the effectiveness of medication (and especially therapy) is limited. I'd include autism in that list, too, although I suppose the roles of medication and therapy are reversed with autism.
But what about the hundreds of other diagnoses? Probably what we'd end up with is a spectrum of how helpful it is to know about them. On the one end we'd have schizophrenia and autism, and on the other we'd have ADHD, Prolonger Grief Disorder, and maybe some of the sexual and personality disorders. And of course it wouldn't be as simple as that: we'd have to factor in the effectiveness of existing solutions, a person's access to them, and so on.
Hopefully I conveyed in the series that the vast majority of what has happened is good-intentioned. It's just people trying to figure out their own or others' suffering in the good old scientific way. But because the underlying science is murky, profusion is inevitable, and when around 50% of the population is diagnosable at some point in their lives, I think it's fair to say that things have gotten out of hand. Then, add to that that the instinct is turn to a professional for help in these matters, and we're cutting the legs out from many sturdy solutions, such as individual tolerance and community support.
I take your point, though, and do have a draft in the works about the value of the DSM, and what we could be doing with its information, so I ought to finish that up soon :)
i'm from india and mental health issues are relatively scarce here compared to the western world.
i don't exactly know why but maybe some reasons being -
1. mental health issues are still a stigma so maybe people are dissuaded from even trying to find out whether they have a 'problem'.
so majority of indians i'm guessing don't even know that mental health is a problem.
2. india is one of the most socially integrated countries i'm guessing. we have joint families, lots of relatives, lots of friends.
but there is one section of india that is increasingly becoming similar to the western countries and that is priviledged teens. because they have the internet and the time to wander on it and they have started talking about mental health based off of western content.
Always nice to hear about a difference place far from home to see if the argument holds up, so thanks for sharing. This does seem to square with mental illness being a luxury good, or at least a a problem that people in many cases need to be made aware of, because otherwise it wouldn't be apparent. That's not to say increased awareness doesn't improve some outcomes, but just that there's something nice about ignorance.
I'm guessing the social integration also serves to take care of many problems that here in the US we'd refer to a psychologist, yeah?
yes most people here have someone (a family member or a friend) who they can just open up about their problems to. most Indians would be shocked if you told them you go to therapy.
Interesting. I think most people in the US have a friend or family member they can open up to, as well, but the power of the therapy narrative is pushing more and more issues into the domain of therapists or other professionals.
Anyway, thanks for sharing and please feel free to comment on future posts about how the argument applies/doesn't apply in India. It will be a big help to cross-reference with a culture and country much different from the US.
and now the art of creating problems so you can solve them (AKA art practice) has been gifted to LLM generators, their "model collapse" irrupting into our social learning world (as if paranoia, death cult Gnosticism and the generalizing metaphysics of our social categories or 'ontologies' were not enough) is upon us. https://andrewzh112.github.io/absolute-zero-reasoner/ (found after reading this)
I remember you commenting that you were mildly not autistic on one of our earlier posts and not quite knowing what you meant. But it makes sense now, and I think it's is a good way of describing a difference that you notice, but that does not measure up to the difference of, say, your grandfather.
I feel like this analysis ignores how satisfying it is to solve problems. In the case of mental illness, it seems to me the actual issue is that neither therapy nor medication can reliably deliver fixes to the problems they claim to be solving, so you have to continuously put resources into it until the problem is fixed. This is probably part of why people don’t like inequality: it seems to me that it’s actually when other people start solving problems that you recognize in yourself that you become dissatisfied with yourself. Otherwise, shikata ga nai would be sufficient to render the Japanese the happiest people on Earth.
I do love a good solved problem, but my resulting satisfaction is undermined by the fact that another problem will soon present itself, and that I'll never solve all my problems. Totally agree that the situation is made worse in mental health because the solutions of medication, therapy, and so on aren't complete and total fixes like the SnotSucker. Thanks for reading, and appreciate your response.
I wonder to what extent this feeling is correlated with things like not really enjoying food. The fact that I'm going to be hungry again later doesn't really matter to me, because eating itself is enjoyable. Actually, it's an opportunity to have another nice meal again. Same with sleeping.
Right, the fact that we'll never be permanently full ends up being a good thing (assuming we always have food) because we get to eat again and again. I don't deny that some people could feel the same way about problems in general: that it's nice to always have some available to solve.
Anyway, I appreciate this perspective and will take it into account.
I'm curious how much of the DSM inflation is (in)directly due to the way the US healthcare industry functions: that often, insurance companies won't cover people's healthcare without a diagnosis to "justify" the expense.
Yep, totally. There are plenty of pressures to create new disorders, and that's one of them. Another is that as soon as a new disorder exists, medication can be tailored to it. But I also think another pressure is from small, dedicated communities who suffer from something that they want to see legitimized. My point in this series is just that people can suffer from such a wide range of things when it comes to mental health, that the enterprise of defining all mental disorders, or cataloguing every psychic distress, is kind of ridiculous.
Stoicism, either guided by reading the ancients or as self-derived from introspection, was the way that many generations dealt with neuroses. As for my great-grandfather, his ADHD contributed to his eagerness to fill the family pot by hunting in the mountains above his homeplace rather than by hoeing his cornfield. Maybe ADHD was adaptive prior to paid jobs in a fixed spot.
Good to know my fictional great-grandfather has a real-life counterpart :) But, yes, exactly what you said. As for ADHD being adaptive, I would say something like: the range of distractibility found in humans is the adaptive range. In some environments and in some circumstances, having a low threshold for distractibility was good; in others, having a high threshold was better. But anywhere in the range was okay. That's not technically correct, since maladaptive traits (or ranges) can survive, but correct enough, I think.
> Let’s say that based on family stories, you suspect that your great-grandfather had ADHD. (And let’s pretend for the moment that ADHD is real.) He almost certainly would not have been as conscious of his condition as he would today, given that there wasn’t even a shorthand for it. But would he have suspected that something was off? Would he have considered himself different—even less—than others?
> The progress answer says: Yes, he suffered in the shadows of the ignorant society around him. But the solution problem says: Nope, he probably didn’t notice anything at all.
> Remember, the mind must first attend to something, and then classify it as a problem or opportunity, before it tries to solve it. Without much of a mental health infrastructure around him—most notably, without a bona fide diagnosis—your great-grandfather likely had no clue that anything was amiss.
Eh, reading Wikipedia article on History of autism... yeah, autist in the past wouldn't have a concept explaining their issues - they would definitely notice these issues tho.
> [1908AD] Swiss-American psychiatrist August Hoch of the New York State Psychiatric Institute defined the concept of the shut-in personality. It was characterised by reticence, seclusiveness, shyness and a preference for living in fantasy worlds, among other things. Hoch also said they had "a poorly balanced sexual instinct [and] strikingly fruitless love affairs"
or
> A more concise definition of the introverted type was given by Jung in February 1936
> He holds aloof from external happenings, does not join in, has a distinct dislike of society as soon as he finds himself among too many people. In a large gathering he feels lonely and lost. The more crowded it is, the greater becomes his resistance. He is not in the least "with it", and has no love of enthusiastic get-togethers. He is not a good mixer. What he does, he does in his own way, barricading himself against influences from outside. He is apt to appear awkward, often seeming inhibited, and it frequently happens that, by a certain brusqueness of manner, or by his glum unapproachability, or some kind of malapropism, he causes unwitting offence to people...
or
>Autistic attitude. All children in this group remained aloof from their environment, adapt to their environment with difficulty and never fully integrate into it. Cases 1, 2 and 3 immediately become the object of general ridicule among the other children upon admission to school. Cases 4 and 5 had no authority among their classmates and are nicknamed "talking machines", although their general level put them significantly above the rest of the children. Case 6 even avoided the company of children, which traumatized him. The tendency to loneliness and the fear of people can be observed in all of these children from early childhood onwards; they stay apart from the others, avoid playing together, they prefer fantastic stories and fairy tales.
Does it really help to not have a way of conceptualizing such problems coherently?
I think in some cases it does, and in others it doesn't. I've typically used schizophrenia as an example of something that is definitely real and worth knowing about, even though the effectiveness of medication (and especially therapy) is limited. I'd include autism in that list, too, although I suppose the roles of medication and therapy are reversed with autism.
But what about the hundreds of other diagnoses? Probably what we'd end up with is a spectrum of how helpful it is to know about them. On the one end we'd have schizophrenia and autism, and on the other we'd have ADHD, Prolonger Grief Disorder, and maybe some of the sexual and personality disorders. And of course it wouldn't be as simple as that: we'd have to factor in the effectiveness of existing solutions, a person's access to them, and so on.
Hopefully I conveyed in the series that the vast majority of what has happened is good-intentioned. It's just people trying to figure out their own or others' suffering in the good old scientific way. But because the underlying science is murky, profusion is inevitable, and when around 50% of the population is diagnosable at some point in their lives, I think it's fair to say that things have gotten out of hand. Then, add to that that the instinct is turn to a professional for help in these matters, and we're cutting the legs out from many sturdy solutions, such as individual tolerance and community support.
I take your point, though, and do have a draft in the works about the value of the DSM, and what we could be doing with its information, so I ought to finish that up soon :)
i'm from india and mental health issues are relatively scarce here compared to the western world.
i don't exactly know why but maybe some reasons being -
1. mental health issues are still a stigma so maybe people are dissuaded from even trying to find out whether they have a 'problem'.
so majority of indians i'm guessing don't even know that mental health is a problem.
2. india is one of the most socially integrated countries i'm guessing. we have joint families, lots of relatives, lots of friends.
but there is one section of india that is increasingly becoming similar to the western countries and that is priviledged teens. because they have the internet and the time to wander on it and they have started talking about mental health based off of western content.
i say relatively scarce based on my sample space. i might be wrong.
Always nice to hear about a difference place far from home to see if the argument holds up, so thanks for sharing. This does seem to square with mental illness being a luxury good, or at least a a problem that people in many cases need to be made aware of, because otherwise it wouldn't be apparent. That's not to say increased awareness doesn't improve some outcomes, but just that there's something nice about ignorance.
I'm guessing the social integration also serves to take care of many problems that here in the US we'd refer to a psychologist, yeah?
yes most people here have someone (a family member or a friend) who they can just open up about their problems to. most Indians would be shocked if you told them you go to therapy.
Interesting. I think most people in the US have a friend or family member they can open up to, as well, but the power of the therapy narrative is pushing more and more issues into the domain of therapists or other professionals.
Anyway, thanks for sharing and please feel free to comment on future posts about how the argument applies/doesn't apply in India. It will be a big help to cross-reference with a culture and country much different from the US.
and now the art of creating problems so you can solve them (AKA art practice) has been gifted to LLM generators, their "model collapse" irrupting into our social learning world (as if paranoia, death cult Gnosticism and the generalizing metaphysics of our social categories or 'ontologies' were not enough) is upon us. https://andrewzh112.github.io/absolute-zero-reasoner/ (found after reading this)
This is why I tell people I am mildly not autistic. As opposed to my grandfather who was almost non-verbal.
I remember you commenting that you were mildly not autistic on one of our earlier posts and not quite knowing what you meant. But it makes sense now, and I think it's is a good way of describing a difference that you notice, but that does not measure up to the difference of, say, your grandfather.
It's also a dad joke…
Well I'm recently in the market for those :)
I feel like this analysis ignores how satisfying it is to solve problems. In the case of mental illness, it seems to me the actual issue is that neither therapy nor medication can reliably deliver fixes to the problems they claim to be solving, so you have to continuously put resources into it until the problem is fixed. This is probably part of why people don’t like inequality: it seems to me that it’s actually when other people start solving problems that you recognize in yourself that you become dissatisfied with yourself. Otherwise, shikata ga nai would be sufficient to render the Japanese the happiest people on Earth.
I do love a good solved problem, but my resulting satisfaction is undermined by the fact that another problem will soon present itself, and that I'll never solve all my problems. Totally agree that the situation is made worse in mental health because the solutions of medication, therapy, and so on aren't complete and total fixes like the SnotSucker. Thanks for reading, and appreciate your response.
I wonder to what extent this feeling is correlated with things like not really enjoying food. The fact that I'm going to be hungry again later doesn't really matter to me, because eating itself is enjoyable. Actually, it's an opportunity to have another nice meal again. Same with sleeping.
Right, the fact that we'll never be permanently full ends up being a good thing (assuming we always have food) because we get to eat again and again. I don't deny that some people could feel the same way about problems in general: that it's nice to always have some available to solve.
Anyway, I appreciate this perspective and will take it into account.
I'm curious how much of the DSM inflation is (in)directly due to the way the US healthcare industry functions: that often, insurance companies won't cover people's healthcare without a diagnosis to "justify" the expense.
Yep, totally. There are plenty of pressures to create new disorders, and that's one of them. Another is that as soon as a new disorder exists, medication can be tailored to it. But I also think another pressure is from small, dedicated communities who suffer from something that they want to see legitimized. My point in this series is just that people can suffer from such a wide range of things when it comes to mental health, that the enterprise of defining all mental disorders, or cataloguing every psychic distress, is kind of ridiculous.
Stoicism, either guided by reading the ancients or as self-derived from introspection, was the way that many generations dealt with neuroses. As for my great-grandfather, his ADHD contributed to his eagerness to fill the family pot by hunting in the mountains above his homeplace rather than by hoeing his cornfield. Maybe ADHD was adaptive prior to paid jobs in a fixed spot.
Good to know my fictional great-grandfather has a real-life counterpart :) But, yes, exactly what you said. As for ADHD being adaptive, I would say something like: the range of distractibility found in humans is the adaptive range. In some environments and in some circumstances, having a low threshold for distractibility was good; in others, having a high threshold was better. But anywhere in the range was okay. That's not technically correct, since maladaptive traits (or ranges) can survive, but correct enough, I think.
Do I get it right that the reasons we see more mental health diagnoses lately are :
- once you know smth exists you start to notice it everywhere
- once you tried to solve it, you build a new world that has other problems and we get recursive explosion
Yep, precisely, and recursive explosion is a nice phrase.