11 ms·

It's Not All In Your Head

115 points by notagain 5y ago

no-dr-onboard 5y ago
> “The dream of a fully frictionless existence, a world of highly efficient cyborgs. Because if you’re not perfectly productive, if you let up for even a moment, you must be sick: The forces of decay will swallow you whole.“ Alas, the author reaches a mountain of a question (as a side note, at that): why are we so dissatisfied with human imperfections?
- slx26 5y ago
  Well, the problem with human imperfection is that you have to be aware of its many faces, because some of them make our societies more miserable. When imperfection affects only yourself as an individual, or those around you only slightly, it doesn't seem like a big problem. And if it's not a big problem, hey, why do we even make a problem of it at all? Right? But it turns out imperfections reach much further. I want a society that doesn't let anyone sink, that is built to be resilient, that is in control of human wellness. And we are still too imperfect to reach that. Though it's not about imperfection per se, it's about doing better as a tool to make our societies what we would like them to be. Maybe if we reached such equilibrium we could allow ourselves to go back to be much more imperfect again.
  - sokoloff 5y ago
    > I want a society that doesn't let anyone sink, that is built to be resilient, that is in control of human wellness. Who decides what is “sinking”? I don’t mean in the sense of “is a teenager given an iPhone X who wanted a 13 ‘sinking’?” but rather: What if some people have a genuine desire to do something that other people (people who are in charge) have decided is “sinking”? Should we abide the will of the former or latter group?
    - slx26 5y ago
      I meant "sinking" as "needing / asking for help and not receiving it". I think the broader point I was trying to make is reasonably clear. We could of course go deeper into philosophy territory... but this is "just" a comments section.
    - mistermann 5y ago
      An easy first step would be to simply ask each person if they are content, feel like they are sinking, have any general grievances (or ideas/perspectives) they'd like to share, etc.
- a_e_k 5y ago
  For your specific question, I really like the take from Walter M. Miller Jr.'s "A Canticle for Leibowitz" (one of my favorite novels): > The closer men came to perfecting for themselves a paradise, the more impatient they became with it, and with themselves as well. They made a garden of pleasure, and became progressively more miserable with it as it grew in richness and power and beauty; for then, perhaps, it was easier to see something was missing in the garden, some tree or shrub that would not grow. When the world was in darkness and wretchedness, it could believe in perfection and yearn for it. But when the world became bright with reason and riches, it began to sense the narrowness of the needle's eye, and that rankled for a world no longer willing to believe or yearn.
  - vga805 5y ago
    Hadn't heard of this book, I'll have to check it out. It vaguely reminds of something Dostoevsky's Underground Man might have said when he was railing against the utopian rationalists. edit: typo
    - qohen 5y ago
      https://en.wikipedia.org/wiki/A_Canticle_for_Leibowitz https://en.wikipedia.org/wiki/A_Canticle_for_Leibowitz
    - a_e_k 5y ago
      Consider yourself one of today's lucky 10,000, then (https://xkcd.com/1053/ https://xkcd.com/1053/). It does help if you have some knowledge of the ways of the Catholic Church when reading the novel. I don't think I could have fully appreciated the richness of "Canticle" if I'd read it at a younger age when I'd had no experience with the Church. But I'll also say that it's one of those books that I love but don't reread too often since it always leaves such an impression. But yes, I would say that the dangers of pure rationalism (without the wisdom to temper it) is something of a theme throughout "Canticle".
- causi 5y ago
  Satisfaction does not breed improvement.
  - andi999 5y ago
    And vice versa.
- Apocryphon 5y ago
  As valid as that pondering is, and as much as I cherish A Canticle for Leibowitz as one of my faves, I must too scoff at this chestnut like so: "Ah, yes, I too have watched The Eternals."
Apocryphon 5y ago
Former VICE journalist, dirtbag left guy, and one time Something Awful poster Sam Kriss is reviewing a Tao Lin novel in the conservative Catholic journal First Things? The future truly is strange.
- jlos 5y ago
  I'm not familiar with Kriss or Tao Lin, but First Things, while predominantly Catholic, is ecumenical. They have regular columns from protestants, Jews, Muslims, and even Peter Thiel. I've found they will print some authors from outside their normal milieu if they offer some insight that would benefit the high brow literary conservatism that characterizes the magazine.
  - V-2 5y ago
    "First Things, while predominantly Catholic, is ecumenical. They have regular columns from protestants, Jews, Muslims" For what it's worth, "ecumenical" means promoting Christian unity. So if Catholics carry dialogue with protestants, it may be ecumenical in nature, but with Jews or Muslims (as commendable and fruitful as it may be, but that's not the point) it can't be called that.
    - niea_11 5y ago
      I'm not a native english speaker. First time I encountered the word ecumenical in a tv show (Frasier) and understood it in the same way it was used by gp. Maybe it's specific to american english. I checked cambridge dictionary and it confirms that definition : tending to support and encourage unity among different religions Merriam-webster has a similar definition : Worldwide or general in extent, influence, or application Also collins dictionary : interreligious or interdenominational https://dictionary.cambridge.org/dictionary/english/ecumenical#cacd-1 https://dictionary.cambridge.org/dictionary/english/ecumenic... https://www.merriam-webster.com/dictionary/ecumenical https://www.merriam-webster.com/dictionary/ecumenical https://www.collinsdictionary.com/dictionary/english/ecumenical#ecumenical__4 https://www.collinsdictionary.com/dictionary/english/ecumeni... Link to the Frasier clip :) https://www.youtube.com/watch?v=QfrFkxDzpLU https://www.youtube.com/watch?v=QfrFkxDzpLU
deckplecksetter 5y ago
This was funny, a few paragraphs in: "For Freud, this was just another confirmation of his theories. He wrote in a letter to Fliess: THIS IS THE FIRST OF YOUR THREE FREE ARTICLES FOR THE MONTH."
- watwut 5y ago
  Freud was well ahead of time. Trying to monetize the modern way.
PaulKeeble 5y ago
This has happened over and over. Multiple Sclerosis was a psychological disease until we found the cause. Medically unexplained simply means we don't know the cause and a lot of conditions are very hard to diagnose, especially since doctors tend to stop after their first test for the problem fails and they then try the depression route. I am convinced depression will become a physical biological condition that is treatable once we investigate its causes. There has been a flurry of papers around long covid, ME/CFS and Fibromylgia (and maybe chronic Lyme and Gulf War Syndrome) over the past 2 months. They show a core dysfunction in oxygenation of tissue caused by micro-clots and capillary narrowing, the red blood cells can't adjust their shape properly among other aspects. This came after a German researcher found that H.E.L.P. Apheresis helped long covid patients, now everyone is testing the various aspects and finding real problems in all these patients. It is the sort of breakthrough that I think in a few months will lead to treatments and eventually cures after 80 years of the condition being considered and treated psychologically. This month NICE in the UK changed its guidelines to remove the psychological explanation and remove the treatments patients said were harming, they were removed after the evidence was reviewed and found to be of low quality. This is happening the world over since covid has proven post viral conditions that lead to long covid and other conditions are obviously very real and debilitating. It looks like 2% of our population will become severely disabled by covid unless we solve it. But there is finally a test that is showing microclots in these patients and not in controls. So we might finally have a good diagnostic test and a treatment all in the space of months. So I think its badly timed that this articles suggest at the end this is maybe psychological condition given the enormous progress made in the past couple of months, that come about because of just how many millions of long covid patients there are suffering badly with the conditions. Medicine has a problem, it leaves people to suffer without researching at all the cause and misses diagnoses. It has consistently failed to research conditions that we have known about for 100s of years. If a patient says they are ill odds are they are right and its not just in their head given just how often medicine has proved to be wrong and how many millions it continues to leave in suffering for issues that are already treatable. Psychology in time is going to disappear, none of its results in time has proven repeatable, none of its treatments seem to work very well and its diagnoses are not consistent. It is the place where bad medicine goes when it doesn't have an answer, which is fine we don't know the causes but we ought not waste yet more money into the pit of something proven to be wrong and not work. We can do something about these conditions if we reallocate that funding.
Gravityloss 5y ago
I love that this text goes into multiple places. It's not advocating a too simplified picture of the world.
smeej 5y ago
I think doctors aggravate this problem of people believing they're ill even when the clinical evidence doesn't support it. I can't tell you how many doctors I've had tell me, explicitly, within 15 minutes of having met me that they know my body, symptoms, and experience better than I do. It used to come much later in the process, after I'd spent months following their instructions to the letter and having my symptoms only get worse because they had completely overlooked or ignored some important piece of information I'd given them, so now I just ask in the very first appointment before I consider hiring that doctor to help me. I think I understand why they do it. I have to imagine the overwhelming majority of people they see have only a grade school-level understanding of science, and a social media-level understanding of research. And doctors are used to being assumed to be the smartest person in the room (by themselves and everybody else, fairly or not). But the complete failure to consider the possibility that I might also be intelligent, educated, and able to understand the applicable research just because my day job isn't in medicine immediately disqualifies a doctor for me. I remember well my classmates who became doctors. A few of them were brilliant. Most of them were very good at repeating back information and not terribly good at forming their own insights. That's fine in many contexts. I just don't assume someone in a white coat is smarter than I am, much less knows me "better than I know myself," just because they got their advanced degree in a different field than I did.
- guerrilla 5y ago
  > I just ask in the very first appointment before I consider hiring that doctor to help me. Ask what?
  - lupire 5y ago
    > [if] they know my body, symptoms, and experience better than I do.
  - sumtechguy 5y ago
    Maybe that is the question (doubt it). Think about it. Its brilliant. You say 'I always ask this one question to my doctors' then ramble off on some other tangent. See if they come back to that question. It means they are paying attention and are inquisitive.
deleted 5y ago
[deleted]
civilized 5y ago
> It's Not All In Your Head (firstthings.com) I was certain that this was going to be an essay from Ross Douthat about his struggles with chronic Lyme. "All in your head"? The premier Catholic public intellectual magazine? What else could it possibly be? But I was wrong. It's a review of Ross Douthat's book about his struggles with chronic Lyme. A review that begins with several paragraphs of trashing Freud, including compelling and little-known historical detail of Freud's horrific diagnostic mistakes rooted in his turn-of-the-century scientific sexism. Followed by a flash-forward to the 1980s satanic ritual child abuse panic, concluding with a Scott Alexander-tier bit of jerking the reader around: "what if Freud was right after all?" Alright. Alright. I'm here for this.
Madmallard 5y ago
A huge issue with doctor patient relationships in 2021 is that modern health conditions that heavily lack research are exploding in incidence. Take patients with allergic presentations and intolerances that don't register with IgE testing. I know probably two dozen people with this issue, including myself. The immunologist and PCP can recognize what's going on as a problematic immune response but cannot explain the origin from current lab findings. Imagine the frustration and difficulty.
rpaddock 5y ago
I've lost count of the number of doctors that told my late wife the headaches were all in her head (Mentally to be clear here). When she laid down, she had no headache. When she would be upright the headache would return. This is frequently, and incorrectly, called "An Afternoon Migraine". After nearly two decades, because the Medical Establishment had written her off as a mental case, she figured out what she had herself, which was Intracranial Hypotension due to Cerebrospinal Fluid (CSF) Leaks. CSF Leak detection is still a developing area of medical research. We desperately need better imaging technology than we have today. CSF Leak detection is still in the "Stone knives and Bearskins" category. Hopefully the brilliant people that hang out here can help with that... Karen eventually killed herself because of what had become constant pain from the CSF Leak and poisoning by the Fluoroquinolone antibiotic Levaquin (Cipro is in the same drug class; the FDA itself says to only use this class of Meds as the last resort yet the doctors give it out like candy). Karen's Journal was part of a FDA hearing in 2015 about the damage these antibiotic cause. Her whole messy saga became one of the featured stories in the documentary Pain Warriors which is free to watch on Amazon Prime and TubiTV. It can be found other places as well. It is NOT a warm and fuzzy thing to watch. The bottom line is be responsible for your own health and NEVER blindly trust what anyone in the Medical Establishment tells you. Do your own research on your condition etc...
- sterlind 5y ago
  I'm sorry for your loss. Fluoroquinolones are indeed scary. I was saved from them in college by my hypochondria, when I developed a UTI and my doctor prescribed one to me. I googled, found tendon damage issue and asked for a different Rx. Years later, I was diagnosed with Ehlers-Danlos syndrome and told never to take this class of antibiotics, since our faulty collagen triggers this side effect and can cause arteries to rupture.
  - rpaddock 5y ago
    I'm up to 47 people that have told me that their own CSF Leak started after taking a FQ based antibiotic. I spoke about this subject at the first ever Spinal CSF Leak conference to the worlds leading doctors for the condition. They are well aware of the issues. The EDS docs are also well aware of the dangers posed by these drugs. Sadly few others are. Dr Schievink, at the top of the CSF Leak food chain (After him there is no places else to go) has stated "that just slightly less than 100% of the people with CSF Leaks, have some type of connective tissue disorder".
alan-crowe 5y ago
The article portrays a simple dichotomy: mental versus physical. But there is something interesting going on with psycho-social explanations. Given the epistemological difficulties one rather expects extended fights between the proponents of rival psycho-social theories. But the tendency is for one such theory to win and obliterate its rivals. Consider ME/CFS. The human body has remarkable powers of recuperation. Feel ill with a cold? Just take two weeks off to rest and you will recover. Broken bone? That will need splinting, but again it will heal up in six weeks. Ah! Now we come to the difficulty. There are standard times, two weeks, six weeks; what happens if something goes wrong and healing takes a lot longer? One psycho-social explanation of ME/CFS is that patients aren't patient. Something nasty has happened, bio-medically, and they need to take two year out of their hectic life to recover. After six months they cannot take resting and pacing any more and do too much, too soon, provoking a major relapse. That restarts the clock on two years to recover. Rinse and repeat indefinitely. Call that "trying too hard". The rival psycho-social explanation is that patients are deconditioned due to too much rest and need to exercise and build up their stamina on a "normal" schedule. Call this "not trying hard enough". This doesn't really work as an explanation because some of the patients are ex-athletes and familiar with training and building back up systematically after time off for an injury or illness. They are going to the doctor because they have done what always worked in past, because it hasn't worked this time. The rival psycho-social explanation isn't relevant to the actual problem. It is worse than that. NASA attempts to study the effects of weightless on the ground, in gravity, by having people lie in bed and get deconditioned. Deconditioning is a rather delicate effect. It depends on a rigid discipline of lying down all the time. The effects wear off rather quickly. Crucially the effect wears off monotonically. It is not like ME/CFS with its key symptom of Post-Exertional Malaise: sufferers think they are getting better, but a day or two later, wallop, they have a flare up of symptoms. The natural expectation is for a fight between psychologists. "Trying to hard" versus "not trying hard enough". One expects it to be a one-sided fight. "not trying hard enough" is a much worse fit to what the patients experience. Back in the real world "not trying hard enough" has won a total victory. When patients are angry about the "not trying hard enough" explanation, that is understood as anger about the psycho-social model, as if there were only one. The important question is "Why prefer the implausible psycho-social model over the plausible one?". And that question is difficult to ask. The article manages to skip over the central issue with popular "all in your head" explanations. It is not that they compare unfavourably with "physical illness" explanations. The problem is that they compare unfavourably with less popular "all in your head" explanations. What is going on there?
bckr 5y ago
Half way through -- this is so far an ideal essay (dare I say Platonic?) It has everything: 1) a series of reversals that leave you wondering what the conclusion will be 2) late modern, contemporary, and personal histories that make you feel more informed as well as touched and entertained, and 3) that timeliness that makes you feel like you've written this essay yourself in the spare moments between thoughts, over the last 7 years
mariodiana 5y ago
The article talks about "the values and structures and injustices," but I think what's really behind the author's sentiment is, to put it in Judeo-Christian terms, man being driven from the Garden of Eden. I say this because, as the author notes, "demonic possession" has been around for a long time. Call it what you will, but it's found across cultures and across time. I think what he's talking about is fundamentally human. In the past, and to put things in more secular terms, I've made two jokes on the subject. The first is: Evolution operates as if the work is being done by government contractors chosen because they've put in the lowest bid. The second is: Our brains are wired like the lights in a Christmas tree. So, imagine Christmas tree lights being strung up by government contractors! What I'm getting at is that we don't have the "luxury" of the animals, who simply go about their lives more or less moment by moment, dealing with the immediate. We're self-aware, socially aware, and most importantly temporally aware. Because of these things, we have conquered the world. The downside is that's all work done by the lowest bid has allowed for. Our brains work according to spec — and nothing more. Now and then, some of us simply crack from the strain. That's the bug. What I'm saying is that to think hysteria — or, again, whatever you want to call it — isn't real is simple hubris. All of human history makes mention of it.
legerdemain 5y ago
This is a review of two books about living with chronic illness: a memoir by columnist Ross Douthat and a novel by Tao Lin, the Ted Chiang of literary trolling.
- deleted 5y ago
  [deleted]
- thyrsus 5y ago
  Please elucidate. The article's author thinks Mr. Lin is being ironic, but says others he's proposed that to believe the opposite. Has Poe's law taken over every field of communication?
  - jmeister 5y ago
    This interview might help: https://brightestyoungthings.com/articles/tao-lin-literary-troll https://brightestyoungthings.com/articles/tao-lin-literary-t...
hoseja 5y ago
I've seen a recent theory for chronic pain where the spinal/brain neurons get into a maladaptive feedback loop and report continual pain where none is coming from the periphery. I'll see if I can find the source.
- civilized 5y ago
  The NYT has been doing a whole series about the neurological underpinnings of chronic pain. Apparently nervous system cells called "glia", which are not neurons but are deeply involved with neurons, play an important role. https://www.nytimes.com/2021/11/09/well/mind/glial-cells-chronic-pain-treatment.html https://www.nytimes.com/2021/11/09/well/mind/glial-cells-chr...
- codingdave 5y ago
  Are you thinking of central sensitization? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/
- throwaway2331 5y ago
  I'm liable to agree that there is something there. It's probably the reason placebo works so well with chronic pain management (surgeries, spinal fusions, knee/hip-replacements, chiropractors, acupuncture, injections of any sort), i.e. the nerves are programmed to keep on "firing" until they receive a stop signal (e.g. mental/physical attention). I've blown out my back before with a herniated disc. The initial pain was god awful, and an MRI confirmed it. But, after about a year and a half, it seems to be on-and-off of periods of discomfort (but never like the initial pain) that feel like the nerves in my back are all twisted up. The thing I've focused on for long-term relief is stretching and mentally focusing on the area. It seems to give me months of relief, until I (safely) pick up a ladder and then the sensations comes back. Have my nerves' sensitivity been upregulated to scream and shout when, otherwise mild or very small strain, is put on that area of the body? I'm suspicious that they have.
Borrible 5y ago
The moment the mind, a mere tool for the survival of the body, declared itself extremely important. From then on, any imperfection means that death is lurking in the shadows. Entropy eats up everything. You can run away, but you can't hide. The extreme narcissism of our time is only the most refined form. Sharpened and promoted by the extreme free-market competition of individuals. Whereby, this did not create it, it only took up the theme and perfected it. Allthough, or better because, for the most time, there is nothing really substantial in them, they yell: Me, me, me. So, they don't have much else, but they want to be something. Sell it to them. Illusion. The priest knew it, the shrink knows it. Every good con man, spin doctor and the whole culture industry knows it. There is a buck to be made, feeding the ego. But every time this Illusion of being something substantial is shattered, the crack threatens to show the truth, the abyss. The abyss of death. The place the ego doesn't.exist.
- ganzuul 5y ago
  I think the source of the maladaption lies in the use of money to make people do things they would never otherwise do. Asking ourselves who we would be to others if we had money at least somewhat insulates us from the effect of this mental wildfire.
  - Borrible 5y ago
    I don't think that the origin of the problem is this or that social structure. I think that these structures bind it in one way or another to make this basic human condition bearable. Both for the individual and for society. But they determine to a large extent who benefits from the dichotomy of being and consciousness. Nor do I believe it can be overcome or cured. To be human is not just to have knowledge of and insight into the world and knowledge of and insight into oneself. It means knowing that this knowledge gives agency. An extremely powerful tool for survival, something special. But this tool is at the same time an instrument of torture of itself. It reflects also its transience and insignificance. You may survive today because you are the cunning hunter, but one day you will die. And nothing, what ever you've done or knew will change that. And another day, everyone who remembers that you and your kind ever existed will be gone. And nothing, what ever you've done or knew will change that. In the end, it even will seem like there never was anything at all. And nothing, what ever you've done or knew will change that. Facing that and dealing with it is the basic premise of human consciousness. Most of the time we have coped with rituals, religion and rules. Recently we have science, technology, entertainment industry and consumption. Art and Drugs have always played a role in escaping the torment. Most can't face it without the help of the above, some even flee the terror of consciousness through suicide.
hnarn 5y ago
https://archive.md/2021.11.13-023640/https://www.firstthings.com/article/2021/12/its-not-all-in-your-head%23 https://archive.md/2021.11.13-023640/https://www.firstthings...
theobeers 5y ago
Kriss mentions Freddie deBoer’s review of Douthat’s book. Some of you might be interested in reading that. In fact, it’s probably more up HN’s alley, in terms of directly addressing the controversy surrounding chronic Lyme. https://freddiedeboer.substack.com/p/review-ross-douthats-the-deep-places https://freddiedeboer.substack.com/p/review-ross-douthats-th...
- nkurz 5y ago
  Wow, that's a fantastic review. Thanks for linking it. To others: If you are someone who is interested in this topic, even if you've previously been put off by deBoer's politics or reputation, you should definitely read it.

115 points by notagain 5y ago

> “The dream of a fully frictionless existence, a world of highly efficient cyborgs. Because if you’re not perfectly productive, if you let up for even a moment, you must be sick: The forces of decay will swallow you whole.“ Alas, the author reaches a mountain of a question (as a side note, at that): why are we so dissatisfied with human imperfections?

slx26 5y ago
Well, the problem with human imperfection is that you have to be aware of its many faces, because some of them make our societies more miserable. When imperfection affects only yourself as an individual, or those around you only slightly, it doesn't seem like a big problem. And if it's not a big problem, hey, why do we even make a problem of it at all? Right? But it turns out imperfections reach much further. I want a society that doesn't let anyone sink, that is built to be resilient, that is in control of human wellness. And we are still too imperfect to reach that. Though it's not about imperfection per se, it's about doing better as a tool to make our societies what we would like them to be. Maybe if we reached such equilibrium we could allow ourselves to go back to be much more imperfect again.
- sokoloff 5y ago
  > I want a society that doesn't let anyone sink, that is built to be resilient, that is in control of human wellness. Who decides what is “sinking”? I don’t mean in the sense of “is a teenager given an iPhone X who wanted a 13 ‘sinking’?” but rather: What if some people have a genuine desire to do something that other people (people who are in charge) have decided is “sinking”? Should we abide the will of the former or latter group?
  - slx26 5y ago
    I meant "sinking" as "needing / asking for help and not receiving it". I think the broader point I was trying to make is reasonably clear. We could of course go deeper into philosophy territory... but this is "just" a comments section.
  - mistermann 5y ago
    An easy first step would be to simply ask each person if they are content, feel like they are sinking, have any general grievances (or ideas/perspectives) they'd like to share, etc.
a_e_k 5y ago
For your specific question, I really like the take from Walter M. Miller Jr.'s "A Canticle for Leibowitz" (one of my favorite novels): > The closer men came to perfecting for themselves a paradise, the more impatient they became with it, and with themselves as well. They made a garden of pleasure, and became progressively more miserable with it as it grew in richness and power and beauty; for then, perhaps, it was easier to see something was missing in the garden, some tree or shrub that would not grow. When the world was in darkness and wretchedness, it could believe in perfection and yearn for it. But when the world became bright with reason and riches, it began to sense the narrowness of the needle's eye, and that rankled for a world no longer willing to believe or yearn.
- vga805 5y ago
  Hadn't heard of this book, I'll have to check it out. It vaguely reminds of something Dostoevsky's Underground Man might have said when he was railing against the utopian rationalists. edit: typo
  - qohen 5y ago
    https://en.wikipedia.org/wiki/A_Canticle_for_Leibowitz https://en.wikipedia.org/wiki/A_Canticle_for_Leibowitz
  - a_e_k 5y ago
    Consider yourself one of today's lucky 10,000, then (https://xkcd.com/1053/ https://xkcd.com/1053/). It does help if you have some knowledge of the ways of the Catholic Church when reading the novel. I don't think I could have fully appreciated the richness of "Canticle" if I'd read it at a younger age when I'd had no experience with the Church. But I'll also say that it's one of those books that I love but don't reread too often since it always leaves such an impression. But yes, I would say that the dangers of pure rationalism (without the wisdom to temper it) is something of a theme throughout "Canticle".
causi 5y ago
Satisfaction does not breed improvement.
- andi999 5y ago
  And vice versa.
Apocryphon 5y ago
As valid as that pondering is, and as much as I cherish A Canticle for Leibowitz as one of my faves, I must too scoff at this chestnut like so: "Ah, yes, I too have watched The Eternals."

Apocryphon 5y ago

Former VICE journalist, dirtbag left guy, and one time Something Awful poster Sam Kriss is reviewing a Tao Lin novel in the conservative Catholic journal First Things? The future truly is strange.

jlos 5y ago
I'm not familiar with Kriss or Tao Lin, but First Things, while predominantly Catholic, is ecumenical. They have regular columns from protestants, Jews, Muslims, and even Peter Thiel. I've found they will print some authors from outside their normal milieu if they offer some insight that would benefit the high brow literary conservatism that characterizes the magazine.
- V-2 5y ago
  "First Things, while predominantly Catholic, is ecumenical. They have regular columns from protestants, Jews, Muslims" For what it's worth, "ecumenical" means promoting Christian unity. So if Catholics carry dialogue with protestants, it may be ecumenical in nature, but with Jews or Muslims (as commendable and fruitful as it may be, but that's not the point) it can't be called that.
  - niea_11 5y ago
    I'm not a native english speaker. First time I encountered the word ecumenical in a tv show (Frasier) and understood it in the same way it was used by gp. Maybe it's specific to american english. I checked cambridge dictionary and it confirms that definition : tending to support and encourage unity among different religions Merriam-webster has a similar definition : Worldwide or general in extent, influence, or application Also collins dictionary : interreligious or interdenominational https://dictionary.cambridge.org/dictionary/english/ecumenical#cacd-1 https://dictionary.cambridge.org/dictionary/english/ecumenic... https://www.merriam-webster.com/dictionary/ecumenical https://www.merriam-webster.com/dictionary/ecumenical https://www.collinsdictionary.com/dictionary/english/ecumenical#ecumenical__4 https://www.collinsdictionary.com/dictionary/english/ecumeni... Link to the Frasier clip :) https://www.youtube.com/watch?v=QfrFkxDzpLU https://www.youtube.com/watch?v=QfrFkxDzpLU

deckplecksetter 5y ago

This was funny, a few paragraphs in: "For Freud, this was just another confirmation of his theories. He wrote in a letter to Fliess: THIS IS THE FIRST OF YOUR THREE FREE ARTICLES FOR THE MONTH."

watwut 5y ago
Freud was well ahead of time. Trying to monetize the modern way.

PaulKeeble 5y ago

This has happened over and over. Multiple Sclerosis was a psychological disease until we found the cause. Medically unexplained simply means we don't know the cause and a lot of conditions are very hard to diagnose, especially since doctors tend to stop after their first test for the problem fails and they then try the depression route. I am convinced depression will become a physical biological condition that is treatable once we investigate its causes. There has been a flurry of papers around long covid, ME/CFS and Fibromylgia (and maybe chronic Lyme and Gulf War Syndrome) over the past 2 months. They show a core dysfunction in oxygenation of tissue caused by micro-clots and capillary narrowing, the red blood cells can't adjust their shape properly among other aspects. This came after a German researcher found that H.E.L.P. Apheresis helped long covid patients, now everyone is testing the various aspects and finding real problems in all these patients. It is the sort of breakthrough that I think in a few months will lead to treatments and eventually cures after 80 years of the condition being considered and treated psychologically. This month NICE in the UK changed its guidelines to remove the psychological explanation and remove the treatments patients said were harming, they were removed after the evidence was reviewed and found to be of low quality. This is happening the world over since covid has proven post viral conditions that lead to long covid and other conditions are obviously very real and debilitating. It looks like 2% of our population will become severely disabled by covid unless we solve it. But there is finally a test that is showing microclots in these patients and not in controls. So we might finally have a good diagnostic test and a treatment all in the space of months. So I think its badly timed that this articles suggest at the end this is maybe psychological condition given the enormous progress made in the past couple of months, that come about because of just how many millions of long covid patients there are suffering badly with the conditions. Medicine has a problem, it leaves people to suffer without researching at all the cause and misses diagnoses. It has consistently failed to research conditions that we have known about for 100s of years. If a patient says they are ill odds are they are right and its not just in their head given just how often medicine has proved to be wrong and how many millions it continues to leave in suffering for issues that are already treatable. Psychology in time is going to disappear, none of its results in time has proven repeatable, none of its treatments seem to work very well and its diagnoses are not consistent. It is the place where bad medicine goes when it doesn't have an answer, which is fine we don't know the causes but we ought not waste yet more money into the pit of something proven to be wrong and not work. We can do something about these conditions if we reallocate that funding.

Gravityloss 5y ago

I love that this text goes into multiple places. It's not advocating a too simplified picture of the world.

smeej 5y ago

I think doctors aggravate this problem of people believing they're ill even when the clinical evidence doesn't support it. I can't tell you how many doctors I've had tell me, explicitly, within 15 minutes of having met me that they know my body, symptoms, and experience better than I do. It used to come much later in the process, after I'd spent months following their instructions to the letter and having my symptoms only get worse because they had completely overlooked or ignored some important piece of information I'd given them, so now I just ask in the very first appointment before I consider hiring that doctor to help me. I think I understand why they do it. I have to imagine the overwhelming majority of people they see have only a grade school-level understanding of science, and a social media-level understanding of research. And doctors are used to being assumed to be the smartest person in the room (by themselves and everybody else, fairly or not). But the complete failure to consider the possibility that I might also be intelligent, educated, and able to understand the applicable research just because my day job isn't in medicine immediately disqualifies a doctor for me. I remember well my classmates who became doctors. A few of them were brilliant. Most of them were very good at repeating back information and not terribly good at forming their own insights. That's fine in many contexts. I just don't assume someone in a white coat is smarter than I am, much less knows me "better than I know myself," just because they got their advanced degree in a different field than I did.

guerrilla 5y ago
> I just ask in the very first appointment before I consider hiring that doctor to help me. Ask what?
- lupire 5y ago
  > [if] they know my body, symptoms, and experience better than I do.
- sumtechguy 5y ago
  Maybe that is the question (doubt it). Think about it. Its brilliant. You say 'I always ask this one question to my doctors' then ramble off on some other tangent. See if they come back to that question. It means they are paying attention and are inquisitive.

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civilized 5y ago

> It's Not All In Your Head (firstthings.com) I was certain that this was going to be an essay from Ross Douthat about his struggles with chronic Lyme. "All in your head"? The premier Catholic public intellectual magazine? What else could it possibly be? But I was wrong. It's a review of Ross Douthat's book about his struggles with chronic Lyme. A review that begins with several paragraphs of trashing Freud, including compelling and little-known historical detail of Freud's horrific diagnostic mistakes rooted in his turn-of-the-century scientific sexism. Followed by a flash-forward to the 1980s satanic ritual child abuse panic, concluding with a Scott Alexander-tier bit of jerking the reader around: "what if Freud was right after all?" Alright. Alright. I'm here for this.

Madmallard 5y ago

A huge issue with doctor patient relationships in 2021 is that modern health conditions that heavily lack research are exploding in incidence. Take patients with allergic presentations and intolerances that don't register with IgE testing. I know probably two dozen people with this issue, including myself. The immunologist and PCP can recognize what's going on as a problematic immune response but cannot explain the origin from current lab findings. Imagine the frustration and difficulty.

rpaddock 5y ago

I've lost count of the number of doctors that told my late wife the headaches were all in her head (Mentally to be clear here). When she laid down, she had no headache. When she would be upright the headache would return. This is frequently, and incorrectly, called "An Afternoon Migraine". After nearly two decades, because the Medical Establishment had written her off as a mental case, she figured out what she had herself, which was Intracranial Hypotension due to Cerebrospinal Fluid (CSF) Leaks. CSF Leak detection is still a developing area of medical research. We desperately need better imaging technology than we have today. CSF Leak detection is still in the "Stone knives and Bearskins" category. Hopefully the brilliant people that hang out here can help with that... Karen eventually killed herself because of what had become constant pain from the CSF Leak and poisoning by the Fluoroquinolone antibiotic Levaquin (Cipro is in the same drug class; the FDA itself says to only use this class of Meds as the last resort yet the doctors give it out like candy). Karen's Journal was part of a FDA hearing in 2015 about the damage these antibiotic cause. Her whole messy saga became one of the featured stories in the documentary Pain Warriors which is free to watch on Amazon Prime and TubiTV. It can be found other places as well. It is NOT a warm and fuzzy thing to watch. The bottom line is be responsible for your own health and NEVER blindly trust what anyone in the Medical Establishment tells you. Do your own research on your condition etc...

sterlind 5y ago
I'm sorry for your loss. Fluoroquinolones are indeed scary. I was saved from them in college by my hypochondria, when I developed a UTI and my doctor prescribed one to me. I googled, found tendon damage issue and asked for a different Rx. Years later, I was diagnosed with Ehlers-Danlos syndrome and told never to take this class of antibiotics, since our faulty collagen triggers this side effect and can cause arteries to rupture.
- rpaddock 5y ago
  I'm up to 47 people that have told me that their own CSF Leak started after taking a FQ based antibiotic. I spoke about this subject at the first ever Spinal CSF Leak conference to the worlds leading doctors for the condition. They are well aware of the issues. The EDS docs are also well aware of the dangers posed by these drugs. Sadly few others are. Dr Schievink, at the top of the CSF Leak food chain (After him there is no places else to go) has stated "that just slightly less than 100% of the people with CSF Leaks, have some type of connective tissue disorder".

alan-crowe 5y ago

The article portrays a simple dichotomy: mental versus physical. But there is something interesting going on with psycho-social explanations. Given the epistemological difficulties one rather expects extended fights between the proponents of rival psycho-social theories. But the tendency is for one such theory to win and obliterate its rivals. Consider ME/CFS. The human body has remarkable powers of recuperation. Feel ill with a cold? Just take two weeks off to rest and you will recover. Broken bone? That will need splinting, but again it will heal up in six weeks. Ah! Now we come to the difficulty. There are standard times, two weeks, six weeks; what happens if something goes wrong and healing takes a lot longer? One psycho-social explanation of ME/CFS is that patients aren't patient. Something nasty has happened, bio-medically, and they need to take two year out of their hectic life to recover. After six months they cannot take resting and pacing any more and do too much, too soon, provoking a major relapse. That restarts the clock on two years to recover. Rinse and repeat indefinitely. Call that "trying too hard". The rival psycho-social explanation is that patients are deconditioned due to too much rest and need to exercise and build up their stamina on a "normal" schedule. Call this "not trying hard enough". This doesn't really work as an explanation because some of the patients are ex-athletes and familiar with training and building back up systematically after time off for an injury or illness. They are going to the doctor because they have done what always worked in past, because it hasn't worked this time. The rival psycho-social explanation isn't relevant to the actual problem. It is worse than that. NASA attempts to study the effects of weightless on the ground, in gravity, by having people lie in bed and get deconditioned. Deconditioning is a rather delicate effect. It depends on a rigid discipline of lying down all the time. The effects wear off rather quickly. Crucially the effect wears off monotonically. It is not like ME/CFS with its key symptom of Post-Exertional Malaise: sufferers think they are getting better, but a day or two later, wallop, they have a flare up of symptoms. The natural expectation is for a fight between psychologists. "Trying to hard" versus "not trying hard enough". One expects it to be a one-sided fight. "not trying hard enough" is a much worse fit to what the patients experience. Back in the real world "not trying hard enough" has won a total victory. When patients are angry about the "not trying hard enough" explanation, that is understood as anger about the psycho-social model, as if there were only one. The important question is "Why prefer the implausible psycho-social model over the plausible one?". And that question is difficult to ask. The article manages to skip over the central issue with popular "all in your head" explanations. It is not that they compare unfavourably with "physical illness" explanations. The problem is that they compare unfavourably with less popular "all in your head" explanations. What is going on there?

bckr 5y ago

Half way through -- this is so far an ideal essay (dare I say Platonic?) It has everything: 1) a series of reversals that leave you wondering what the conclusion will be 2) late modern, contemporary, and personal histories that make you feel more informed as well as touched and entertained, and 3) that timeliness that makes you feel like you've written this essay yourself in the spare moments between thoughts, over the last 7 years

mariodiana 5y ago

The article talks about "the values and structures and injustices," but I think what's really behind the author's sentiment is, to put it in Judeo-Christian terms, man being driven from the Garden of Eden. I say this because, as the author notes, "demonic possession" has been around for a long time. Call it what you will, but it's found across cultures and across time. I think what he's talking about is fundamentally human. In the past, and to put things in more secular terms, I've made two jokes on the subject. The first is: Evolution operates as if the work is being done by government contractors chosen because they've put in the lowest bid. The second is: Our brains are wired like the lights in a Christmas tree. So, imagine Christmas tree lights being strung up by government contractors! What I'm getting at is that we don't have the "luxury" of the animals, who simply go about their lives more or less moment by moment, dealing with the immediate. We're self-aware, socially aware, and most importantly temporally aware. Because of these things, we have conquered the world. The downside is that's all work done by the lowest bid has allowed for. Our brains work according to spec — and nothing more. Now and then, some of us simply crack from the strain. That's the bug. What I'm saying is that to think hysteria — or, again, whatever you want to call it — isn't real is simple hubris. All of human history makes mention of it.

legerdemain 5y ago

This is a review of two books about living with chronic illness: a memoir by columnist Ross Douthat and a novel by Tao Lin, the Ted Chiang of literary trolling.

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thyrsus 5y ago
Please elucidate. The article's author thinks Mr. Lin is being ironic, but says others he's proposed that to believe the opposite. Has Poe's law taken over every field of communication?
- jmeister 5y ago
  This interview might help: https://brightestyoungthings.com/articles/tao-lin-literary-troll https://brightestyoungthings.com/articles/tao-lin-literary-t...

hoseja 5y ago

I've seen a recent theory for chronic pain where the spinal/brain neurons get into a maladaptive feedback loop and report continual pain where none is coming from the periphery. I'll see if I can find the source.

civilized 5y ago
The NYT has been doing a whole series about the neurological underpinnings of chronic pain. Apparently nervous system cells called "glia", which are not neurons but are deeply involved with neurons, play an important role. https://www.nytimes.com/2021/11/09/well/mind/glial-cells-chronic-pain-treatment.html https://www.nytimes.com/2021/11/09/well/mind/glial-cells-chr...
codingdave 5y ago
Are you thinking of central sensitization? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/
throwaway2331 5y ago
I'm liable to agree that there is something there. It's probably the reason placebo works so well with chronic pain management (surgeries, spinal fusions, knee/hip-replacements, chiropractors, acupuncture, injections of any sort), i.e. the nerves are programmed to keep on "firing" until they receive a stop signal (e.g. mental/physical attention). I've blown out my back before with a herniated disc. The initial pain was god awful, and an MRI confirmed it. But, after about a year and a half, it seems to be on-and-off of periods of discomfort (but never like the initial pain) that feel like the nerves in my back are all twisted up. The thing I've focused on for long-term relief is stretching and mentally focusing on the area. It seems to give me months of relief, until I (safely) pick up a ladder and then the sensations comes back. Have my nerves' sensitivity been upregulated to scream and shout when, otherwise mild or very small strain, is put on that area of the body? I'm suspicious that they have.

Borrible 5y ago

The moment the mind, a mere tool for the survival of the body, declared itself extremely important. From then on, any imperfection means that death is lurking in the shadows. Entropy eats up everything. You can run away, but you can't hide. The extreme narcissism of our time is only the most refined form. Sharpened and promoted by the extreme free-market competition of individuals. Whereby, this did not create it, it only took up the theme and perfected it. Allthough, or better because, for the most time, there is nothing really substantial in them, they yell: Me, me, me. So, they don't have much else, but they want to be something. Sell it to them. Illusion. The priest knew it, the shrink knows it. Every good con man, spin doctor and the whole culture industry knows it. There is a buck to be made, feeding the ego. But every time this Illusion of being something substantial is shattered, the crack threatens to show the truth, the abyss. The abyss of death. The place the ego doesn't.exist.

ganzuul 5y ago
I think the source of the maladaption lies in the use of money to make people do things they would never otherwise do. Asking ourselves who we would be to others if we had money at least somewhat insulates us from the effect of this mental wildfire.
- Borrible 5y ago
  I don't think that the origin of the problem is this or that social structure. I think that these structures bind it in one way or another to make this basic human condition bearable. Both for the individual and for society. But they determine to a large extent who benefits from the dichotomy of being and consciousness. Nor do I believe it can be overcome or cured. To be human is not just to have knowledge of and insight into the world and knowledge of and insight into oneself. It means knowing that this knowledge gives agency. An extremely powerful tool for survival, something special. But this tool is at the same time an instrument of torture of itself. It reflects also its transience and insignificance. You may survive today because you are the cunning hunter, but one day you will die. And nothing, what ever you've done or knew will change that. And another day, everyone who remembers that you and your kind ever existed will be gone. And nothing, what ever you've done or knew will change that. In the end, it even will seem like there never was anything at all. And nothing, what ever you've done or knew will change that. Facing that and dealing with it is the basic premise of human consciousness. Most of the time we have coped with rituals, religion and rules. Recently we have science, technology, entertainment industry and consumption. Art and Drugs have always played a role in escaping the torment. Most can't face it without the help of the above, some even flee the terror of consciousness through suicide.

hnarn 5y ago

https://archive.md/2021.11.13-023640/https://www.firstthings.com/article/2021/12/its-not-all-in-your-head%23 https://archive.md/2021.11.13-023640/https://www.firstthings...

theobeers 5y ago

Kriss mentions Freddie deBoer’s review of Douthat’s book. Some of you might be interested in reading that. In fact, it’s probably more up HN’s alley, in terms of directly addressing the controversy surrounding chronic Lyme. https://freddiedeboer.substack.com/p/review-ross-douthats-the-deep-places https://freddiedeboer.substack.com/p/review-ross-douthats-th...

nkurz 5y ago
Wow, that's a fantastic review. Thanks for linking it. To others: If you are someone who is interested in this topic, even if you've previously been put off by deBoer's politics or reputation, you should definitely read it.