Most active commenters
  • seethedeaduu(3)
  • const_cast(3)

←back to thread

540 points drankl | 13 comments | | HN request time: 0.786s | source | bottom
Show context
parpfish ◴[] No.44485690[source]
Decades ago in my first abnormal psych course, the prof warned us that there was an almost iron-clad law that students will immediately start self diagnosing themselves with “weak” versions of every disorder we learn about. In my years since then, it has absolutely held true and now is supercharged by a whole industry of TikTok self-diagnoses.

But there are a few things we can learn from this:

- if you give people the chance to place a label on themselves that makes them feel unique, they’ll take it.

- if you give people the chance to place a label on themselves to give a name/form to a problem, they’ll take it.

- most mental disorders are an issue of degree and not something qualitatively different from a typical experience. People should use this to gain greater empathy for those who struggle.

replies(21): >>44485765 #>>44485973 #>>44486164 #>>44486176 #>>44486614 #>>44486756 #>>44486800 #>>44486816 #>>44486909 #>>44487348 #>>44487570 #>>44487609 #>>44487864 #>>44488239 #>>44488655 #>>44488855 #>>44489328 #>>44490389 #>>44490808 #>>44508689 #>>44518726 #
1. EGreg ◴[] No.44486909[source]
The word “disorder” is loaded, but it is interesting to also look through the lens of the Social Theory of Disability. For the rise in diagnoses for autism, ADD, gender dysphoria, eating disorders such as anorexia nervosa, bulimia etc.

Just as we now view the historical labeling of women as suffering from “hysteria” as a systemic failure, not a personal pathology, we should interrogate whether current diagnostic regimes will look just as crude and institutionally convenient in 50 years

Many social and health-related challenges we label today as “disorders” may in fact be downstream responses to structural issues in how society is organized — education, labor, healthcare, media, food, and housing. It’s worth asking: what if we’re pathologizing reactions to a sick system?

Generations identifying as trans:

  Gen Z: 2.8%
  Millennials: 1.0%
  Gen X: 0.3%
  Baby Boomers: 0.2%
  Silent Generation: <= 0.05%
A lot of it has to do not with the label itself but with the industry. Where someone in the past would be called a “tomboy” or “femboy” today they would have a different diagnosis, the DSM-5 would be consulted, etc.

Similarly with ADHD if a kid would have been called “rambunctious”, today they might be labeled as having a “disorder” and medicated with literal amphetamines, instead of for instance reforming public schools. (To be clear, I am talking not about exteme/acute cases but overdiagnosis of relatively mild cases.)

We can look at other examples (eg Finland’s schools where children can climb trees and have much lower ADHD diagnosis rate) as one way to compare.

Or in the past, anorexia and eating disorders were a form of body dysmorphia, and some such images were actually promoted by industries such as fashion modeling or ballet performance. And when I say promoted - I mean also heavily enforced within the industry itself.

Industry in USA works with government, together. For example the factory farms (overusing antibiotics, abusing animals) and ag-gag orders, criminalizing whistleblowing and exposing them. Or monsanto and intellectual property enforcement. Or pistachio farmers in CA and water shortages. Or bottling companies and clothing companies putting out metric tons of plastics and microplastics, while regular people are told they can’t have a straw or a bag, and must recycle (itself revealed to be mostly a govt+industrial scam, shipped to China etc.)

This is across the board. Obesity and diabetes are a major epidemic in USA but instead of questioning high fructose corn syrup, highly processed starches and sugars in everything, people are told they can fix things themselves with diet and exercise. Actually it has been shown that obesity and disabetes in mothers is correlated with autism in their children. It has been shown that there was a serious correlation between obesity, diabetes and covid morbidity but the latter was taken extremely seriously but the former is not.

Same with plastic recycling, etc. or going vegan. Or buying free range. Or whataver. The individual is kept distracted.

In USA medicating things downstream is the default. One in five middle aged women is on antidepressants. Teenage girls have the highest levels of “sadness” (most outlets don’t want to say depression) etc.

Of course when it comes to depression and gender dysphoria we get extra political sensitivity due to activism around those issues. Of the usual character: the INDIVIDUAL is the one that has to make all the downstream adjustments and cope with the SYSTEMIC upstream issues, which are not questioned much. The individual is even told to embrace their label and tell others it is great (eg “big is beautiful” for obesity, celebrating the result instead of reforming the system).

Until AI takes the jobs, the social compact has become: both parents have had to work for corporations, to afford the expenses that could previously be paid by one “breadwinner” in the family working for corporations. And they stick their kids in public schools and elderly parents into nursing homes. And then medicate them if they don’t like it, because the DSM 5, school administrators or nursing homes staff say that this is the best way. Everyone is afraid to speak up against the system, they would rather perpetuate it and cover their own ass.

There was a time when people derided USSR people for drinking a lot to cope with the failures of their economic system. But now with men on opiates, women on antidepressants, high rates of teen suicide ideation, elderly and kids being medicated — perhaps we should rethink our own economic system. There are a lot of “problems” that people are experiencing and it may be from upstream systemic causes. But they are kept distracted by govt and corporations with the idea that they can fix it by their individual actions, which include recycling, dieting, and placing a label on themselves that the industry then helpfully gives them medications to manage it.

replies(4): >>44488277 #>>44489198 #>>44494030 #>>44518124 #
2. ◴[] No.44488277[source]
3. seethedeaduu ◴[] No.44489198[source]
> Generations identifying as trans:

Is this surprising? 20 years ago in many parts of the world the only way to survive as a trans person was through prostitution. You would be forced to live as an outcast, far away from "normal people". There were barely any legal protections, you could often not change your legal sex, finding any information about what this is or its treatments (not a fetish, something that millions experience, can't be "converted away", hormones exist, etc) was nearly impossible. Most people would see you as a freak.

> A lot of it has to do not with the label itself but with the industry. Where someone in the past would be called a “tomboy” or “femboy” today they would have a different diagnosis, the DSM-5 would be consulted, etc.

This is not true. Trans people don't go to a doctor and ask them if they are trans. Rather trans people generally arrive at the realization of what they are by themselves, usually before seeking any professional help about it. The DSM is not consulted (and if it is, it's done post-facto by someone acting as a gatekeeper and trying to fill boxes).

Many people who called themselves femboys in the past ended up transitioning after becoming more informed about the whole topic and realizing that transitioning their sex and living as their true self is an option rather than something they had to do in secret.

replies(2): >>44490274 #>>44491833 #
4. EGreg ◴[] No.44490274[source]
If we want to reduce the incidence of distress in people and families, we need approach all these issues with compassion and an open mind. The open mind means considering various possibilities, while still being rational.

Yes, one theory is that everything “just happens to be” innate from birth, and unchangeable, and we simply discover it later. This essentialist type of theory may in fact be the best one for extreme cases of any condition. But we have to be very careful applying essentialism across the board — is it true for even mild, increasinly widespread cases? Could we also not investigate the factors upstream of the issue? Not just before birth, but also in the environment, in the socialization, culture, economics, etc. And if we find factors that heavily seem to affect it, should we not consider trying to fix the problems upstream such that the “disorders” downstream become reduced in many cases?

In the case of gender dysphoria, and to a lesser extent of depression being caused by serotonin, is too politically charged to start with. Many extremely creative people we know were born biologically male - the Wachowskis, Justine who made redbean, etc. transitioned their identity. They are adults who make a decision to live in ways they feel are more authentic to themselves amid the current culture and technology and that is their choice, as it should be. But we have to be careful not to therefore say there are no major issues in society upstream of millions of people who are experiencing distressing conditions, and try to embrace and normalize those conditions as opposed to trying to reduce the incidence of them.

Let’s look rationally and scientifically at every other example with similar conditions but without the charged atmosphere, to get a feeling for what the Social Theory of Disability and similar approaches would say. The key is to think systemically, and to accept that an identity is socially constructed and reinforced, that people are nudged all the time by culture around them, while they and the people around them are coerced by economics into stable behaviors and arrangements that may lead to distress (eg both parents working for corporations and neglecting their children and parents, to afford the rent because they have been made to expect and enforce a certain level of decadent spending that their ancestors never afforded).

1. Obesity. Now, to be sure there have also been attempts, with varying degrees of success, to normalize being obese and even celebrating this condition and some encouraging others to embrace the lifestyle. Yet we know that there are real public health issues upstream of the condition, including but not limited to unprecedented processed sugar and starches in everything, high fructose corn syrup, overuse of antibiotics on factory farms etc. the reduction of minerals in our vegetables etc. in short massive changes on an industrial scale that affect millions of Americans.

Imagine we were to ignore this and simply be content with embracing obesity as a “identity” to be accepted and was always around, but finally people were willing to become their true selves, would be scientifically and socially derelict. It would also be defeatist and lazy from the point of view of public health and social reform, would it not? And yet there have been serious attempts to normalize the Big and Beautiful identity as something we should embrace have more of in USA. The thing is, both can be true: “fat shaming” can be bad, while simultaneously it also bad to not have a public health investigation for upstream causes of obesity — yes treating it as a disorder to be reduced.

2. Eating disorders like Anorexia Nervosa and Bulimia. On the surface, they share many characteristics with Gender Dysphoria, namely a distressing mismatch between the body you have and the identity of how you wish it to be and how you want to be perceived. In fact there have been entire industries promoting and enforcing body standards for their participants to enter and keep participating, such as fashion models and ballerinas etc. But in these cases when a person comes to the doctor and admits that they are indeed looking to be thinner, the doctor is told by their industry to so the opposite thing than in the case of gender dysphoria. The doctor does NOT tell them to embrace their anorexia as an identity, and modify their body, but instead tries to get them to how much of their identity is actually socially constructed by others around them, and this is true not just for young and impressionable kids but also adults. When it comes to eating disorders, or some issuss of body dysmorphia, the distressing body-rejecting condition is managed in a completely opposite different way, and it is considered correct to point out the social and economic factors.

In fact, human body modification has a rich history going back thousands of years, and using all kinds of technology available to tribes. Some tribes and cultures embrace it as an identity. (As one small example, lip disks in some African cultures.) The people who choose to practice these modifications may be embraced with a special status and identity. But we looking from the outside can clearly see the societal and cultural constructs behind nudging and reinforcing the identity. So what I am saying is, look systemically, when you analyze public health issues.

3. Clinical depression. Many people here on HN have experienced clinical depression and I remember they have insisted for years that people should just “let it go” and it’s “just how things are”, and medications like SSRIs are the only real way to manage it. Over a decade ago people said Tom Cruise was a dangerous idiot, after his interview with Matt Lauer where he warned against overprescribing amphetamines, opiates etc. to treat these conditions. But once again, while the pharma industry and our US society at large has normalized this sort of overdiagnosis, “medicalization and treatment” of conditions, it was not always the case.

In 2022 studies and meta-studies came out in reputable scientific and medical journals questioning the efficacy of SSRIs at all vs placebo, and throwing into question the whole theory of serotonin being the main factor behind depression, and whether or not it is really preventable or manageable through changes in lifestyle, diet, mindfulness. But again, perhaps far and away the biggest questions were not systemically investigated: what is it upstream in culture and economics that systemically causes more Americans to be clinically depressed?.

More to the point, teenage depression and suicidal ideation is extremely high. Almost as high in the wider teen population as it is in the trans community! (I was shocked at the statistics.) So if something distressing rises so much, then it absolutely behooves us to look at what changed in society upstream of them. For example, the rise of tiktok and instgram and other social media as used by teens, for their body image and other things. Surveillance capitalism pushing certain things not just to teens but all of us (outrage, clickbait, echo chambers, even adults are more tribak and angry than ever, thanks to algorithms). Notifications that pop up at any time and distract us.!Instead of having the political will to address these issues and incentives, we accept them as a normal part of life. We are about to accept AI and robots that way, letting the industry “disrupt” anything and everything about culture, and leaving out-of-work men and women to figure it out (wringing our hands about usage of opiates and antidepressants while pharma industries gladly generate steady recurring revenues).

3. ADHD. I would call it the modern “hysteria” except for boys instead of women. We know hysteria was just a lazy catch-all to medicate women downstream of societal issues. In 50-100 years we may say the same about ADHD, as we have done with lobotomies etc. Do you see where I am going with this? I will leave the rest as an exercise for the reader for the sake of space here.

4. Autoimmune disorders on the rise as microplastics build ip in our bodies, while clothing companies put it in our clothes and bottling companies put out metric tons into bottles we drink from, but we throw up our hands and say there’s nothing we can do. While our ancestors reused glass bottles and washed forks, we discard plastic forks shipped from somewhere, into a landfill. Day after day without a thought to the next generation. Species are plummeting. One third of arable land is desertified. Our generation is living on an ecological credit card, that our children would have to pay. But we are told to shut up and work. Embrace and medicalize the conditions. We really have no time to organize against this stuff anymore. (Maybe we will once AI takes out jobs?)

Whether it’s obesity, diabetes, autoimmune disorders, eating disorders, depression, autism, and yes gender dysphoria etc. we can just stop at theories that essentialize new types of identities or we can actually take a public health approach where we look at them as “disorders” (word use by OP) that we want to minimize by gradually changing society. Not just for kids, but especially for them.

Lest you think I am just pontificating without actual solutions, here are some:

1. Gradually phase in a UBI for all US Americans. This will increase their disposable income and let them purchase goods made by startups (good for YC) as well as corporations. Let the money trickle up into the economy and tax the corporations. Our country is untold trillions in debt, it’ll have to print trillions to service that debt. May as well be like Alaska and give the first hop to each citizen equally. Then increasingly tax the corporations and their AI / robots / automation, and use that to pay down the debt over 30 years — after it has helped everyday Americans! PS: Alaska has had among the lowest Gini index of all states since it started this.

2. Reduce the 40 hour workeweek protections to 30 hours, as some countries did, or even 20 hours. Free up people from the hamster wheel so they can spend more quality time with their children and elderly parents, rather than school administrators and nursing home attendants (and their AIs). Stop normalizing this: https://www.youtube.com/watch?v=xNzXze5Yza8

3. Gradually phase out factory farm practices, be more like Europe. Go after corporations that pollute. Make the corporations switch to using biodegradeable materials rather than plastics and forever chemicals, rather than trying to forcing individuals dat the end of the production line to do that.

4. Consider implementing public health programs in schools like John F Kennedy did, modeled on the La Sierra high school. Same with math and STEM. Shorten the school day and let kids run around. Let children climb trees like in Finland.

5. HK-NC ◴[] No.44491833[source]
Why is this specific thing completely unquestionable for self diagnosis without any kind of test? It seems to be treated as if no child could possibly feel slightly less than the ideal representation of their sex and end up embracing the trans identity just like someone might embrace ADHD or autism because of some minor common personality trait. The difference being one annoyingly reminds people theyre ADHD every time they do something untoward, and the other could be rendered infertile due to hormones pr castration.
replies(2): >>44494060 #>>44494611 #
6. const_cast ◴[] No.44494030[source]
I think comparing LGBTQ+ identifications with mental illness is dangerous. Not too long ago we were quick to lump homosexuality in with these, despite the fact homosexuality is more of a state of being evidenced by real-life actions people willingly take. That being, sex with the same sex.

Transgender people often suffer gender dysphoria. You're correct that it's possible that gender dysphoria might be a downstream effect of society. Namely, we are an extremely gender-segregated society. There's truly only one way to be a man, although there are multiple ways to be a woman. People feel forced and confined to a very small subset of behavior and self-expression.

Existing between genders is, unfortunately, untenable. Society is just not built for that. But existing as the opposite gender seems to be perfectly doable. I'm not saying that it's that simple and all transgender people would disappear if we live in a society with no gender roles or expectations, but certainly they heavily feel the pressure of those gender roles and expectations.

replies(1): >>44494229 #
7. const_cast ◴[] No.44494060{3}[source]
We don't view it as unquestionable, we question it quiet a bit. Like, a lot actually. And people do change course if they want, that happens sometimes.

And on the topic of infertility, it's complicated. Many people have no desire to have children, and many people are infertile anyway. I'm infertile due to cancer, and little did I know this was pre-determined at birth. I didn't even make it to my mid twenties before that chicken came to roost.

But I face a lot less stigma and questioning about that. Everyone is quick to accept I'm infertile and that's that, and there's nothing anyone could have done. If this happened in my 50s this would make more sense. But, I didn't. I became infertile around the same time many people choose to transition. And yet, my infertility isn't a topic of discussion.

8. trealira ◴[] No.44494229[source]
> Transgender people often suffer gender dysphoria.

That's the definition of it.

> You're correct that it's possible that gender dysphoria might be a downstream effect of society. Namely, we are an extremely gender-segregated society. I'm not saying that it's that simple and all transgender people would disappear if we live in a society with no gender roles or expectations, but certainly they heavily feel the pressure of those gender roles and expectations.

I don't think this is the case. Strict gender roles might make trans people's dysphoria worse, but it's primarily about a strong desire to be the other sex and not have your current sexual characteristics. Even in a world where everything is unisex, a trans person would still feel that discomfort - for a trans girl/woman, that you wish your voice were higher and not like a man's, that your face seems alien, that your genitals are wrong, literally anything sexed about the human body. It's orthogonal to whether a man can wear a dress or makeup. Not all trans women are even that feminine. And if it were about gender roles, then you'd expect more trans women to exist than trans men, given "there's truly only one way to be a man, although there are multiple ways to be a woman."

replies(2): >>44494368 #>>44494879 #
9. const_cast ◴[] No.44494368{3}[source]
There's really two components to gender identity: the socially constructed stuff, which is most of it, and the biological stuff. Usually changing the biological stuff just lends itself to better socially constructed stuff.

Most trans people I know, for example, have no desire to change their genitals. Probably, I'm guessing, because nobody sees that. So their genitals have pretty much no relation to their gender identity. Which makes sense when you think about it. I mean, I gender everyone in my life, including people I see only for a few seconds. But I see very, very little genitals. I'm really just guessing, and everyone is.

It's very complicated. Of course men can wear dressed and makeup and such, but that is a very high-friction activity, borderline dangerous. Women can do that, however. So then I question if there are transwomen out there who would be satisfied in a world where anyone can wear anything. Such a world does not exist, so we don't know.

replies(1): >>44494754 #
10. seethedeaduu ◴[] No.44494611{3}[source]
There are no tests that can show if someone is trans or not.

> the other could be rendered infertile due to hormones pr castration.

With the alternative of being mutilated forever due to testosterone and being forced to waste decades of your life existing in limbo.

Although I should note that the claim that trans people become permanently infertile due to hormones is questionable.

11. trealira ◴[] No.44494754{4}[source]
> So then I question if there are trans women out there who would be satisfied in a world where anyone can wear anything.

So long as they look in the mirror and see a woman. There are trans women already who just wear jeans and t-shirts and other unisex wear in their everyday lives. There are also trans women who will never come close to passing even after a long time on HRT and surgery and wearing the most feminine clothing, and it's just tragic.

12. seethedeaduu ◴[] No.44494879{3}[source]
> That's the definition of it.

I have seen multiple competing definitions.

- People who are transitioning socially

- People who are transitioning medically (hrt)

- People who have transitioned surgically (depends what surgeries the person that says it considers necessary)

- Using some biological distinguisher (this lets you refer to people who are currently repressing as trans, and makes it an inherent property of a person that was predetermined)

- People who want to transition (socially, hormonally, surgically)

- People who have dysphoria

- People who have an f64 diagnosis

Etc

13. ryuker16 ◴[] No.44518124[source]
Double blind testing has been done on this so none of what your essay is saying has not been tested or studied.

Putting adhd or depressed people in a paradise situation does not make them not adhd or depressed.

Ive lived in a few different countries. Societies that dont label or believe in psychology just outcast the mentally ill as weirdos and encourage them to drink away their troubles.