Highlights From The Comments On Geography Of Madness
Highlights From The Comments On Geography Of MadnessPlus: A case for culture-bound mental disorder skepticism[Original post: The Geography Of Madness] Thomas Reilly (author of Rational Psychiatry) writes:
I responded “Have you ever seen BPS? I almost never have, and was told it was mostly used as a code for new-onset schizophrenia that didn't satisfy the time criterion yet,” and Dr. Reilly wrote:
This is a really good point, and I appreciate his prodding on this matter. I’m trying to remember how often I’ve a boufee delirante/brief psychotic syndrome-like cases, and realizing how hard a question this is. I’ve definitely seen people suddenly become psychotic for no reason, but I usually assume it’s because of drugs. I can’t always establish this right away, because the person might be too psychotic to answer questions, but usually in the end when I’m able to get the full story the assumption about drugs proves true. Does it always? I don’t think my mind keeps track of that statistic, which means that cases of BD could easily slip through my radar. Related: the DSM doesn’t let you diagnose schizophrenia until someone’s been having symptoms for six months. What happens if you see someone one month into what seems likely to be schizophrenia? You provisionally diagnose Brief Psychotic Disorder until the six month mark. But newly psychotic people are often randomly getting better or worse from day to day, and getting shuffled from ERs to inpatient wards to partial programs to at risk programs, and in all of this shuffling it would be hard for an individual psychiatrist to notice someone who actually was just psychotic for one month and then recovered and was completely normal. Given how complicated it is to notice this diagnosis, I now wonder whether the differences between France (where doctors have a low bar for noticing and diagnosing this) and everywhere else (where they have a high bar) require explanation. Steve Sailer writes:
This encouraged me to look into the school shooting statistics further, and I take back my claim that Columbine was a break from trend. This article claims the first mass shooting in US history was in 1949, and that the initiating factor seemed to be advances in gun technology; there have been violent sprees since forever, but semi-automatic weapons raised the death count to levels that made national news. If this is true, I’m not sure what survives of amok as a specifically Malaysian culture-bound illness. Perhaps the victim’s claim to be possessed or amnesiac is uniquely Malay, but surely if Americans could get away with saying a tiger spirit made them do it, they would try that too! In fact, this would be a good place to admit I’m getting very skeptical about pretty much every culture-bound syndrome on the traditional list. Amok and boufee deliriante impress much much less after reading your comments, and the other big famous one is taijin kyofusho, a supposedly a Japanese culture-bound condition where someone is excessively . . . I’m trying not to use the words “socially anxious” so that it can be a big reveal when I say it seems similar to our Social Anxiety Disorder. The culture-bound aspect is supposed to be that it presents differently, with fear of causing offense. But first, many Americans with social anxiety disorder fear causing offense. And second, everyone knows that Japanese culture is more offense-focused than ours; “Americans and Japanese express social anxiety in different ways” feels less mysterious than “they have completely different culture-bound mental disorders!” Another thing going on seems to be a problem of grouping: one sub-aspect of taijin kyofusho is shubo-kyofu, basically body dysmorphic disorder. American psychiatrists would never think of this as a kind of social anxiety, but it kind of fits. Another symptom is jikoshu-kyofu, fear of body odor. I’d never heard of this and thought it might be a genuine Japanese culture-bound condition, but Wikipedia tells me there’s a Western version called olfactory reference syndrome. The International OCD Foundation says that “the prevalence of ORS is not known, but it is certainly more common than generally recognized”. Lochner and Stein find that the prevalence in psychiatric samples (ie people with other mental health conditions) seems to be around 2%. I don’t think it’s at all obvious that more Japanese than non-Japanese have this condition that nobody ever does a good job measuring the prevalence of. The other culture-bound illness I mentioned on the post was shenkui, a Chinese condition where people who believe in yin and yang feel like orgasming depletes them of vitality. But isn’t this pretty similar to r/NoFap? I imagine that before there was Reddit, there were a lot of Westerners individually thinking “I feel worse and sicker every time I masturbate”, but never mentioning it because nobody wants to hear about your masturbation habits. All of this is convincing me that culture bound illness, while real, is much subtler than The Geography of Madness (or my previous views) suggested. Or maybe that the panic type (where they spread in epidemics over the course of a few days) are more culture-bound, but that the long-run normal conditions are less culture-bound than I thought. Morgan writes:
Great find! This study looks at the Turkana people of Kenya. Even though they are a very warlike society (“half of adult male mortality stemm[ed] from combat”), the authors find that many of them had PTSD (they draw a distinction between “learning and reacting symptoms”, which were equally common among Turkana and Americans, and “depressive symptoms”, which were less common in Turkana, but it didn’t seem like a huge effect.) There are a few sentences suggesting they limited their analysis to the Turkana who seemed to have a lot of PTSD, which would be relevant, but they didn’t have much trouble finding them. McChemist writes:
Thanks for this. I’m realizing I have only Ethan Watters’ account of how unknown anorexia was in pre-1994 Hong Kong, and that this is exactly the kind of exciting cultural difference that often people play up and then have to ashamedly back down from later when more dedicated anthropologists show up on the scene. AntiMemeticsDivisionDirector writes:
…and that’s why they became the antimemetics division director! Seriously, there was a very similar episode in The Geography Of Madness. A Chinese school was having a few cases of koro, and:
Teucer writes:
I agree with the first paragraph; I think saying “more people are being socialized into transgender” and “fewer people are being socialized into cisgender” are more or less identical. David Chapman writes about the “choiceless” nature of traditional societies; if you were born in a peasant village in medieval England, you would be straight, cis, Christian, monarchist, and a farmer - neither because you loved those things and chose them voluntarily, nor because evil outsiders forced you to do those things which you secretly hated, but because you couldn’t conceive of doing anything else. Very gradually, that choiceless mode broke down into the package of identity choices people face today; faced with the choice between being cis and trans, some people find that something (maybe biology) gives them an extremely strong pressure towards trans; if they didn’t realize that was a choice, the pressure might come out some other way, or just fizzle out. Maybe this is an argument for gender dysphoria not being like culture-bound mental illness; I don’t think there’s any sense in which, given a choice to believe that a witch stole your penis, some people are going to choose yes. Regarding PMS and PMDD, Aella writes:
If I’m reading that poll right, 39% of ghost believers get PMS, but only 19% of ghost skeptics do. I am boggled by this and Aella is a national treasure - although I look forward to her reporting the more formal investigation of this in her survey. I don’t think it’s obvious that “believes in ghosts” is a proxy for “more likely to develop culture-bound illnesses”, but I can’t think of a better reason why these should be so connected. Aella also has written about her own experience with trauma - and how it changed once she left her culty upbringing, learned what trauma was, and understood that other people expected her to have it - here. Analytic Converter writes:
There is a contingent of people who think of tendonitis, repetitive stress injury, carpal tunnel, etc as somewhere between 50% and 99% cultural. I think it’s probably a mix, but I’ve been told some people with carpal tunnel have benefitted from Unlearn Your Pain and similar books, and I weakly recommend them to such people, as an experiment. Mark writes:
Weird. My source said it came from Flowers of Virtue, 1486, but Flowers was published earlier than that, and Malleus was published in 1486, so maybe it’s confusing these and this is a Malleus illustration? Garald writes:
This is a good point. I had kind of discounted it, because many koro patients say their penis is missing, not just smaller or retracted, and I find it hard to imagine my penis retracting so far that I start believing it’s not there. Maybe I just haven’t been sufficiently afraid. Somebody should watch a horror movie naked, then report back. For science. You're currently a free subscriber to Astral Codex Ten. For the full experience, upgrade your subscription. |
Older messages
Open Thread 265
Sunday, February 26, 2023
...
Announcing Forecasting Impact Mini-Grants
Friday, February 24, 2023
...
Book Review: The Geography Of Madness
Wednesday, February 22, 2023
...
Grading My 2018 Predictions For 2023
Monday, February 20, 2023
...
Open Thread 264
Monday, February 20, 2023
...
You Might Also Like
☕ Great chains
Wednesday, January 15, 2025
Prologis looks to improve supply chain operations. January 15, 2025 View Online | Sign Up Retail Brew Presented By Bloomreach It's Wednesday, and we've been walking for miles inside the Javits
Pete Hegseth's confirmation hearing.
Wednesday, January 15, 2025
Hegseth's hearing had some fireworks, but he looks headed toward confirmation. Pete Hegseth's confirmation hearing. Hegseth's hearing had some fireworks, but he looks headed toward
Honourable Roulette
Wednesday, January 15, 2025
The Honourable Parts // The Story Of Russian Roulette Honourable Roulette By Kaamya Sharma • 15 Jan 2025 View in browser View in browser The Honourable Parts Spencer Wright | Scope Of Work | 6th
📬 No. 62 | What I learned about newsletters in 2024
Wednesday, January 15, 2025
“I love that I get the chance to ask questions and keep learning. Here are a few big takeaways.” ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏
⚡️ ‘Skeleton Crew’ Answers Its Biggest Mystery
Wednesday, January 15, 2025
Plus: There's no good way to adapt any more Neil Gaiman stories. Inverse Daily The twist in this Star Wars show was, that there was no twist. Lucasfilm TV Shows 'Skeleton Crew' Finally
I Tried All The New Eye-Shadow Sticks
Wednesday, January 15, 2025
And a couple classics. The Strategist Beauty Brief January 15, 2025 Every product is independently selected by editors. If you buy something through our links, New York may earn an affiliate commission
How To Stop Worrying And Learn To Love Lynn's National IQ Estimates
Wednesday, January 15, 2025
... ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏
☕ Olympic recycling
Wednesday, January 15, 2025
Reusing wi-fi equipment from the Paris games. January 15, 2025 View Online | Sign Up Tech Brew It's Wednesday. After the medals are awarded and the athletes go home, what happens to all the stuff
Ozempic has entered the chat
Wednesday, January 15, 2025
Plus: Hegseth's hearing, a huge religious rite, and confidence. January 15, 2025 View in browser Jolie Myers is the managing editor of the Vox Media Podcast Network. Her work often focuses on
How a major bank cheated its customers out of $2 billion, according to a new federal lawsuit
Wednesday, January 15, 2025
An explosive new lawsuit filed by the Consumer Financial Protection Bureau (CFPB) alleges that Capital One bank cheated its customers out of $2 billion. ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏