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> Like so many things, PTSD feels self-evident once you know about it. Only from the myopic perspective of people only used to a life of luxury and ease. Thro

• throwanem 7y ago
  The same reasoning, from the same prior, suggests that lead poisoning probably also doesn't exist. After all, the Romans made water pipes out of the stuff, and look how well they did.
  • Filligree 7y ago
    Roman water pipes ended up covered in (substance I don't recall the name of), and so not much lead leeched into the water. Water jugs made of lead were probably more of a problem. The same holds true for modern lead pipes. They work fine, until they don't.
• nyolfen 7y ago
  anthropologist greg cochran has made the same point: https://westhunt.wordpress.com/2018/08/18/ptsd/ https://westhunt.wordpress.com/2018/08/18/ptsd/ then again, from what we can tell about the premodern world it seems much more violent than what we are accustomed to.
  • pjc50 7y ago
    Per his wikipedia he appears to believe that homosexuality is caused by a virus? https://en.wikipedia.org/wiki/Gregory_Cochran https://en.wikipedia.org/wiki/Gregory_Cochran
    • pliny 7y ago
      What's your point?
      • throwanem 7y ago
        "What do we know [about male homosexuality]? We have a lot of indications that there has been some change in the brain. After all, that's the most logical location for the cause of a change in behavior. Simon LeVay and others see differences in hypothalamic nuclei (similar to those seen in sheep). There are associated changes - the lisp, increased neuroticism and depression, etc. Somehow the cause is affecting the brain." [1] I dunno, man. If you want to take seriously some dude who builds a house of cards from incredibly tendentious evo-psych nonsense so he can scale it to the dizzying heights of "this is why all gay men lisp", you do you. [1] https://web.archive.org/web/20081011094900/http://zero.poynt.zero.googlepages.com/home https://web.archive.org/web/20081011094900/http://zero.poynt...
        • nyolfen 7y ago
          i know that invoking evo-psych is a thought-terminating cliche for many people, but saying “there are measurable common traits that could be associated with physical changes in the brain” doesn’t even fall into its realm
          • PhasmaFelis 7y ago
            Someone who thinks that lisping is so common among gay men that it must be genetic rather than social is someone who is reasoning from stereotypes. This is roughly equivalent to claiming a genetic preference for rainbow bumper stickers.
• East-Link 7y ago
  It's adaptive, not maladaptive
• pjc50 7y ago
  On the other hand you could look at this the other way round: catastrophic physical illness was widespread, why not catastrophic mental illness? And if you look at history with the right lens, you can find examples that might support this. There are huge areas of folk psychology around things like "demonic possession" that are usually attributed to what would today be understood as forms of mental illness. Just because someone is surviving and even reproducing doesn't mean they're not psychologically damaged. Even to quite a considerable extent.
  • patrec 7y ago
    Your analogy does not work. The reason people succumbed to widespread and severe physical illness, despite clear evolutionary pressure not to do so, is because there is equal evolutionary pressure on pathogens to successfully bypass host adaptations. Any psychological or physiological damage which doesn't noticeably dent your reproductive fitness, isn't -- at least as far as evolution is concerned. But being a mental wreck along the lines that PTSD is often portrayed very clearly would negatively impact your reproductive success.
    • jplayer01 7y ago
      > But being a mental wreck along the lines that PTSD is often portrayed very clearly would negatively impact your reproductive success. There are plenty of people with PTSD who have families (particularly, kids). Our reproductive age begins really, really, really early and our reproductive drive is incredibly strong. I don't know why mental illness like PTSD would in any way impact our ability to procreate as a species or at an individual level. It might make life more difficult and life might be filled with more suffering, but we're able to procreate under all kinds of bizarrely sub-optimal conditions.
      • patrec 7y ago
        > I don't know why mental illness like PTSD would in any way impact our ability to procreate as a species or at an individual level. One wonders if you could imagine anything that might in any way impact an individual's ability to procreate and have surviving offspring, if you don't see how significantly heightened suicide risk, being volatile and potentially dangerous to be around and restricted in normal functioning might in any way impact an individual's success in having surviving offspring.
• losvedir 7y ago
  Sure, and he makes the same point: > Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens . . . Our evolutionary history should have prepared us incredibly well for all of this; the brain “getting stuck” in fear mode after a particularly bad trauma should be no more likely than the legs “getting stuck” in running mode after a particularly long chase. I took his "self-evident" to be from his point of view as a practicing psychiatrist. Whatever our evolutionary history, lots of people present with it in modern times. For someone who treats such people, once you have the concept for it, it becomes very clear what the disorder is.
  • patrec 7y ago
    He does indeed make the very same point and his review suggest he thinks of the author as more or less a proudly scientifically illiterate witch doctor whose patients' behavior bears not resemblance to that of his own patients. This does however not prevent him from then recommending the book to one of his patient whom apparently is instantly cured by it. Somehow the intro and ending seem at variance with the rest of the piece and I'm not sure your -- plausible -- reading entirely resolves this. Lots of people presenting with a "disorder" is of course an imperfect indicator that the disorder has some objective basis in fact[1], but there is no real suggestion that Alexander thinks this is the case here. I'm not sure what to make of this piece. [1] https://en.wikipedia.org/wiki/Koro_(medicine) https://en.wikipedia.org/wiki/Koro_(medicine) > Local official records indicate genital retraction endemics in Hainan Island and Leizhou Peninsula in Guangdong, China, as early as the late 19th century.
• jallasprit 7y ago
  Intuitively it would seem like PTSD is a result of a traumatic break in expectations, rather than the trauma itself. Now, here's my reasoning for this. The brain is essentially a pattern recognizer in the sense that it will look for danger, and consider ways to avoid the danger.[1] If we think about the nature of trauma in the past, it has been a society where you are told by your surroundings that things like childbirth indeed is a dangerous but necessary undertaking, supported by the idea that your children will be able to take care of you when you're too old to do so yourself. The pre-modern world was a much more dangerous place due to the lack of modern medicine, et cetera. Now, in the modern world, the expectations about childbirth have also changed for the better. WHO states that between 2000 and 2017 maternal mortality dropped by 38% worldwide.[2] Going back to the original argument about PTSD, intuitively it makes sense that if you're subjected to a traumatic experience, your resilience (towards PTSD and other disorders caused by traumatic experiences) are very much affected by the individual's expectation towards the traumatic event. If people go through the event, with the expectation that there is a very probable risk that they will die, it seems there is relief in knowing you survived. On the contrary side, could it be the case that having overly optimistic expectations crushed by trauma, lead to the diagnostic symptoms we associate with PTSD? [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141622/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141622/ [2] https://www.who.int/news-room/fact-sheets/detail/maternal-mortality https://www.who.int/news-room/fact-sheets/detail/maternal-mo...
  • zsz 7y ago
    The brain processes and integrates emotional/instinctive responses, not abstract concepts -- even in situations where said responses are themselves caused by abstract triggers (e.g. stock market crash and subsequent loss of wealth/job/etc.). In fact, the reason why some people are more resilient to the effects of PTSD than others is already well understood: "While the presence or absence of any of these responses are not necessarily predictive, people who take a more active, problem-solving approach to the traumatic event are less likely to develop PTSD, while those who dissociate are more likely to develop PTSD." https://www.voa.org/understanding-ptsd https://www.voa.org/understanding-ptsd
• chrisweekly 7y ago
  "maladaptive... last few millenia" In terms of selective adaptation, isn't the time scale for human evolution more like 40-50,000 years? IOW, biologically, aren't we living humans the result of evolutionary pressures that predominated in our distant ancestors' lives on the savannah?
  • bobcostas55 7y ago
    There's no such "time scale", it all depends on the strength of the selection. Lactase persistence went from zero to ~100% in some populations in less than 3000 years.
    • patrec 7y ago
      Exactly -- Lactose tolerance is a common counter example to the strange notion that evolution in humans has somehow stopped either literally or practically (given supposedly glacial timescales).
      • chrisweekly 7y ago
        You're both right, of course. I was thinking in terms of evolutionary psychology and neuroanatomy -- areas where the timescales are "glacial" compared to the rise in lactose tolerance over a handful of generations.
        • bobcostas55 7y ago
          There's nothing inherently slow about selection on psychological traits. To give just one striking example, there is extremely rapid selection against intelligence in advanced societies going on right now, at a rate of about 0.25-0.3 standard deviations per century. US: https://www.pnas.org/content/suppl/2016/05/25/1523592113.DCSupplemental/pnas.1523592113.sapp.pdf https://www.pnas.org/content/suppl/2016/05/25/1523592113.DCS... (Table S11) Taiwan: https://www.sciencedirect.com/science/article/abs/pii/S0160289616303038 https://www.sciencedirect.com/science/article/abs/pii/S01602... Iceland: https://www.dropbox.com/s/9vq5t6urtu930xe/2017-kong.pdf https://www.dropbox.com/s/9vq5t6urtu930xe/2017-kong.pdf
• vector_spaces 7y ago
  A common misperception about ptsd is that it results from discrete traumatic events or episodes. It doesn't in general. More often it results from discrete or continuous traumatic events or episodes together with one or more of alienation, lack of social support, or ostracization. That is one reason why not everyone who experiences a shared traumatic event will develop PTSD. So what is maladaptive are there breakdown in social ties and cultural/social infrastructure and process for supporting humans going though hell, not, in fact, my PTSD, thanks
  • deleted 7y ago
    [deleted]
  • zsz 7y ago
    1. PTSD is in actuality frequently triggered by a single, discrete, traumatic event. 2. The feelings of ostracization/alienation and general disengagement from social discourse are indeed well known markers -- except, they follow, rather than lead the onset of PTSD. In other words, they manifest as a result of PTSD -- not the other way around. Source: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd https://www.psychiatry.org/patients-families/ptsd/what-is-pt...
  • lfuller 7y ago
    While what you're saying is correct, you're describing CPTSD (complex post traumatic stress disorder) rather than PTSD, which typically results from a single traumatic event.
• currymj 7y ago
  a posteriori, though, it is in fact extremely common for people to suffer from these symptoms after having those experiences.
  • patrec 7y ago
    Sure – I'm just taking issue with the "in retrospect obvious". PTSD might still be real, or it might turn out to be in fact several different phenonema, with possible some more real than others. But there is a lot that's counter-intuitive.
• Nasrudith 7y ago
  > Because that would seem to be extremely maladaptive for almost all of the last few millenia. Malnutrition says hello. If there is any lesson of history it is "That would be extremly non-optimal of society." is not an arguement against it actually happening. Unless it would leave them literally completely non-viable extraordinarily messed up things can wind up winning out in the circumstances. A bunch of malnourished farmers who were several inches smaller than their hunter-gatherer ancestors won out against the bands. Despite the obvious disadvantages. Numbers and potentially emplacements allowed the nutritionally stunted to not only win but essentially wipe out hunter-gatherers to the point where they are mostly found where agrarians weren't there to compete.
  • patrec 7y ago
    No one is making arguments for optimality of society! If your argument is that societies which traded off mental health of their members (almost certainly an individual fitness hit) for other benefits that allowed them to outcompete individuals in other societies to overcompensate that fitness hit (similar to farmers beating hunter gatherers), I'd be curious to hear what these psychologically more idyllic less successful societies far less prone to PTSD would have looked like. You might be correct (and one sibling commenter has for example already blamed a change in the availability of social support networks), but it's certainly not obvious to me what the difference might be that suddenly made PTSD a recent "discovery". So I still think it's everything but "obvious in retrospect" in at least one meaning of that phrase. Maybe it was always with us, and people just failed to recognize it, but naively it would seem that live almost everywhere ought to have been massively more trauma inducing than in the contemporary West.