It's Not All In Your Head | Hacker News Reader

It's Not All In Your Head

firstthings.com

115 pointsnotagain92 comments

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.

> I just ask in the very first appointment before I consider hiring that doctor to help me.

Ask what?

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.

I had to read 3 times to get it: They’re asking within 15 minutes of meeting the doctor about their symptoms and providing their personally identified cause and seeing what the doctor does. Whereas before they would go through the long drawn out process of following the doctors recommendations and getting no progress because the doctor misdiagnosed them.

I think it's too much to ask that every doctor (or any professional in any field, really) make an accurate individual judgement on who of their clients are able to do their own research or not. That's a luxury you might be able to afford if you're offering high-end (and thus expensive) services, but not when serving a large amount of customers.

The issue is we’re not “customers”, it’s a regulated profession so you don’t get to pick and choose ad infinitum, and it’s also not like you could bypass them and directly receive treatments you think you need.

If you’ve done your homework when coming to them, I don’t think it’s too much to expect to have them at least pay attention to what you bring to the table.

I think it is, actually - especially if 90% of people who "do their homework" actually end up with the wrong conclusions, and 50% of those are too stubborn to admit that they are wrong. It can be a massive waste of trained professionals' time.

“Doing their homework” means learning enough about a subject to be able to explain in details what they are seeing/feeling and understanding what the doctor has to say about it.

It’s the difference between “my poo is weird” and “here’s my temperature during the last three days and each feces according to the Bristol scale”. A doctor just telling you to shove your observations in indecent places isn’t sparing anyone’s time. They might be missing the mark or unreliable, but that’s not what the parent was talking about.

On patients that think they know what they need and won’t budge an inch, you’ll have them anyway. Recognizing and properly dealing with these cases is part of being a doctor. You won’t see many 6 yo kid naturally sold on getting intramuscular injections.

The trope that doctors are very smart isn't one Ive ever understood.

A funny story was my shop teacher (Electrician class in high school) told us after he was sued by a customer who's doctor son attempted to rectify a "mistake" the electrician made. I forget the details but the doctor wound up blowing out or damaging something in his botched attempt to play electrician. Doctors father sues electrician for doing a faulty job when it was clearly his idiot "doctor" son who blew it all up. The mans argument in all this was summed up by his plea to the judge to understand why he thought the electrician was wrong: "Your honor, my son is a doctor." The judge laughed and dismissed the case.

That seems more like a demonstration of arrogance and lack of wisdom than lack of intelligence.

But on the flip side of this, you don't know your internal workings better than they do.

Just because you live in your body doesn't mean you know how it works. I drive a Civic, it doesn't make me a mechanic.

Diagnosis is tricky. Especially in a system as complicated and interconnected as the human body. People often have a bad tendency to misattribute effects to recent events.

And let's say your conjecture of why they dismiss you is true. That it's because everyone else is an idiot and they're not accustomed to dealing with the brilliance that is you. Everyone thinks like that. Everyone thinks they're the bright shining star who knows medicine better than the doctor. You were not the first person and you won't be the last who walks in with reams of printed out papers on the very thing they're sure is the problem.

They have no way of knowing if you actually know what you're talking about unless they put in the work of figuring out what's up with you. So yes, you could be right, but you could also be wrong. And the work is the same either way.

> and the work is the same either way

I think I that’s the issue. Not all doctors are the same. I’ve been to many that just gave me a surface level amount of thought and sent me on my way. I’ve been to others that took time to really dig in and try to solve the problems. People resort to self research because (for whatever reason, some valid) too many doctors are the former.

Operating in a system where regression to the mean is so prevalent rewards doing the bare minimum with the added benefit of generally reducing your liability.

> Everyone thinks like that. Everyone thinks they're the bright shining star who knows medicine better than the doctor.

This seems more truthy than True.

It may be an exaggeration for effect, but in any walk-in clinic, you're going to get at least one of those a day.

"at least one of those a day" sounds like a vast minority rather than "everyone" though doesn't it?

That's why we call it an exaggeration for effect.

At the time you said it, didn't you believe it to be actually true? I mean, there is a fair amount of truth to it in my experience.

I think there was a fair enough number of people who act that way that I didn't think the exaggeration would require this level of explanation.

I am directly challenging the notion that you considered it an exaggeration at the time you wrote the comment. Considering you were criticizing the judgment of others in the comment, it seems a bit rich to play off examination of yours as somehow unfair or weird.

Cognition is often a group activity (comments on social media have effects upon the beliefs of others), and some of us actually take that very real phenomenon seriously.

Then you are simply wrong.

It's certainly plausible, but considering your epistemic track record I am skeptical.

Only if you are coming into the discussion in bad faith to try and score points on what you see as technicalities.

There can be no other way than bad faith? Not something you may not have thought of or perhaps never encountered before?

An old guy once told me how veterinarians were often better doctors than medical doctors because their patients couldn't confuse the diagnosis with bad input.

But, I've also met simply belligerent doctors before, that simply couldn't be wrong no matter what the evidence said...

There's human error on both sides to take into account.

Which is really my point here.

The person I responded to is laying the fault completely with doctors. But doctors see patients like him all the time. And they're often wrong.

The cases where they're not wrong is survivorship bias at work. It makes "patient knows better than doctor" feel more common than it is.

But if you are the kind of person very conscience of your health (or lack of it) and know very, very well what is going on. Your experience will be "most doctors ignore my (the patient) input".

So it's easy to see how skewed this can get based on perspective.

I have been told once by a doctor that he flatly refused to see me anymore if I didn't do exactly what he said, but he was just wrong.

I’m not sure if the work is the same either way (I feel ambivalent on this question). If you know that no diagnosis is possible you have to simply alleviate the symptoms as best is possible (I wish therapy was thought more of in this way, maybe it’s not all in your head but we can’t figure it out so let’s help you deal with it), if there is a possible silver bullet you need to keep chasing that even if that chasing increases the symptoms.

But thinking this over that’s a false dichotomy, even if your doctors have exhausted their theories it doesn’t mean that some other doctor might not have an idea or there’s some variation on one of the existing theories that might explain things.

Likewise, even if an exact diagnosis is found, few treatments are 100% effective in all cases, and most diagnosis have special cases which complicate things in sometimes baffling ways.

Realistically, people usually need to both address symptoms directly and seek underlying causes to some degree when dealing with illness. That exact degree depends on the exact situation but it’s typically not 0% in either case.

I would add something else, ultimately, especially with vague complicated symptoms which occur both in firmly physiological and firmly psychological disorders, the primary goal is typically to return function to ones life. Whether or not the mechanism to do so is real or not is of secondary importance especially if it doesn’t cause much harm relative to its benefit (which is not a simple matter to evaluate in cases like long term antibiotics for chronic pain, but I think is easier to evaluate for things like exercise (it might not cure the underlying cause, but it is likely to be indirectly helpful and unlikely to harmful so…))

True, but you know which noises are normal for your Civic much better than your new mechanic (or even your old one). If you know there's a new sound, your mechanic has to take that as truth and find the (a) problem. Works the same for a body.

Incidentally this problem is what is stopping me from going to a doctor right now. I'm having headaches recently which are not normal for me, but are still in the realm of "normal". I'm putting off a visit to the doctor because I'm afraid they'll say it's normal. It is not, for me.

Also, always search a second opinion. I wouldn't be born if my parents went for the "absolute truth" of the doctor they had at the time.

I find that doctors are somewhat like a frustrating computer form, making patients jump through the procedural hoops to finally get to anything of value. There’s no way around it, patients can tell them what’s been tried before, their family history, what else is going on, but they will always defer to the simplest most common condition without fail, and ignore any association. That’s because that’s what they’re trained to do and it will work in many situations. However, when someone has something that is not a simple condition they fail to piece together the multiple conditions and other circumstances which tell them that a nose bleed may be more serious than dry air.

There’s also the complication of overdiagnosis. I’ve had a doctor not refer me to others because he believed that if I am referred to certain doctors and tested, they will find something wrong with me, but that condition may have not been serious and caused many problems, but the treatment could be worse. I don’t think this “ignorance is bliss” philosophy is unique to my doctor.

I think a corollary to this is that no one will CARE as much about your health than you, even your doctor. It is perhaps scary to realize it fully, but no one is as invested in getting to the root cause of your issues, and no one has as. much intimate information about how it feels/manifests itself etc. than you. I think taken together this surely spells out that you ought to have a much more active role in your care than you may otherwise think to do, especially in situations where those factors may be more pronounced.

I speak from experience. I was born with serious congenital issues which are non-evident from looking at me or a simple examination. Switching doctors, for instance, is quite the ordeal, and it is always a few sessions before I get someone to be "leveled" up to where I need them to.

My parents have a remarkable story related to me being born that ties into this as well. Apparently my mother suffered from severe pain later acknowledged to be polyhydramnios. They went to several doctors, did many ultrasounds, etc. From the first to the forth doctor, she got anything from needing to stress, to rest, to this is normal, etc. But luckily one hinted just slightly that he thought there MIGHT be something, and suggested she go see this other specialist who was at the tail end of his career. Apparently a minute or two into the ultrasound, he apparently mentioned it with utter certainty: It could be one of two things, either anencephaly or esophageal atresia; I'd either be stillborn or would need surgery shortly after birth. Guess there's not much suspense for the reader for which one of these it turned out to be, but I always remember that story -- and my parents relentless pursuit to find someone until they were convinced they had it "right" -- whenever folks bring up searching for medical advice.

I agree, but this has happened less and less as I have gotten older. I'm not sure if there is newer training, or they just give me the benefit of the doubt because I'm a decade older than them. Either way, I have found that older doctors are more likely to talk down to me, even when they clearly do not know what they're talking about.

This is an overgeneralization, but I’ve experienced this most often with affluent baby boomers, across all disciplines. I don’t think it’s purely an age gap issue, as I generally don’t get that sense from generations older than baby boomers. It could have less to do with your age and more to do with baby boomers aging out of the workforce.

The most arrogant and least approachable managers, teachers, doctors, etc I’ve encountered always seem to be from that generation.

Maybe I’m just a “spoiled millennial”… this kind of generational generalization is almost definitely unproductive, but I can’t help myself from thinking it has some validity.

> 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.

To my eye, this reads quite a bit like the same sort of thing anti-vaccine and Flat Earther types think. Just because you think you're smart in some area, or even in general, doesn't mean you've got a natural aptitude for anything else. Maybe you're the exception to the rule, (probably not) but you can't blame other people for not taking your layperson confidence as gospel truth that you're smart and not at all being misled by your own or others hubris.

It’s not that doctors think you unintelligent, but you are not a doctor. It doesn’t matter how many YouTube videos you’ve watched on a subject or how many hours you’ve spent reading about your current symptoms to convince yourself that your special intellect justifies doctors paying closer attention to your opinion, if you haven’t gone through the 7 years of education and passed the exams, then you are not a doctor and you will not be treated as one. Patients should be more accepting of this fact. It does not make sense in general to have doctors ask their patients to self-diagnose, even if their patients are intelligent, it doesn’t add value.

The problem is that every gambler will tell a statistician that actually their odds are abnormally high. And it’s true, if you pull 5 cards from a deck, the odds of getting exactly the cards you drew are incredibly small… no matter what you draw, so when you try to post rationalize events that have already occurred you even feel that statistics will back up your claim, but that’s not how it works, you can’t do that, just like patients being correct occasionally does not mean they should be treated as doctors because they don’t have the required education and experience.

The average doctor is an expert in memorising text books but has no ability to think.

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."

Freud was well ahead of time. Trying to monetize the modern way.

> 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.

> “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?

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.

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

https://en.wikipedia.org/wiki/A_Canticle_for_Leibowitz

Consider yourself one of today's lucky 10,000, then (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".

Satisfaction does not breed improvement.

And vice versa.

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."

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.

> 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?

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.

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.

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-th...

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.

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.

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.

Thiel identifies as Catholic.

Does he? I got the impression he was an unorthodox Protestant. He's a Christian, but I've never seen him identify as Catholic.

I think you are right. David Perell has a great article titled "Peter Thiel's Religion" (https://perell.com/essay/peter-thiel/) which doesn't even mention the word "Catholic". This would seem unlikely if he identified as such.

"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.

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/ecumenic...

https://www.merriam-webster.com/dictionary/ecumenical

https://www.collinsdictionary.com/dictionary/english/ecumeni...

Link to the Frasier clip :) https://www.youtube.com/watch?v=QfrFkxDzpLU

"Merriam-webster has a similar definition : Worldwide or general in extent, influence, or application"

Yes, but that's the broader understanding, not related to religion. You can even find somewhat bizarre (to my ear at least) examples like "ecumenical meal of German, Italian, and Chinese dishes", but it's a turn of phrase, and not necessarily applicable in the religious context.

In the religious context the very same Merriam-Webster you just quoted defines ecumenism as:

"a : of, relating to, or representing the whole of a body of churches

b : promoting or tending toward worldwide Christian unity or cooperation"

It's kind of like you can have a coding or eating marathon... because in broad sense it's defined as any "long-lasting or difficult task or activity"... but then you still shouldn't call a 10-mile run "marathon".

https://www.oxfordlearnersdictionaries.com/definition/englis...

"involving or joining together members of different branches of the Christian Church"

https://dictionary.cambridge.org/dictionary/english/ecumenic...

"encouraging the different Christian Churches to unite"

The same in encyclopedias:

https://www.britannica.com/topic/ecumenism

"ecumenism, movement or tendency toward worldwide Christian unity or cooperation. The term, of recent origin, emphasizes what is viewed as the universality of the Christian faith and unity among churches."

https://en.wikipedia.org/wiki/Ecumenism

"Ecumenism (/ɪˈkjuːmənɪzəm/), also spelled oecumenism, is the concept and principle in which Christians who belong to different Christian denominations work together to develop closer relationships among their churches and promote Christian unity."

("Not to be confused with Interfaith dialogue", correctly points out the article).

But maybe I'm just a purist. (Not a native English speaker either, if that matters, although the term is rather universal and not really exclusive to English).

Maybe you're just focusing on the fact that it's a christian journal. I think the fact that it's a christian journal doesn't mean that the word can't be used in its broader sense in this context.

I wasn't aware of the christian specific meaning of the word before reading your first comment. Thanks

FWIW as someone who is both a native English speaker and who grew up in a community where 90% of residents went to church every Sunday, the only usage of "ecumenical" that I'm familiar with would be "open to all religions" or "including people of all faiths", not Christian only.

It's not a super commonly used word, so I'm unsurprised that the definition you were taught is not how it's contemporarily used in middle America. Probably a case where if enough people use a word "wrong" then the "wrong" definition becomes a valid usage.

Ecumenical, in common use in the Catholic Church in the US at least, typically means "unity among religions" and is not exclusive to Christian/Christocentric religions.

For example, a page explicitly outlining an ecumenical relationship with Muslims from the Archdiocese of Chicago: https://eia.archchicago.org/muslim-catholic-relations/about-...

The header of this website clearly says "ECUMENICAL AND INTERRELIGIOUS AFFAIRS".

Now, if "ecumenical" and "interreligious" were really a potato/potahto thing, would there be a reason for using both side by side... I'm sure you see my point.

The event is called "Muslim-Catholic Interfaith Iftar Dinner". Interfaith, not "ecumenical".

I didn't watch the video itself. Does the bishop call this relation "ecumenical"?

I don't argue with what the common use is, or seems to be (let alone in the US, where I don't live).

I'd only insist that this particular common use - however widespread - is kind of incorrect, or at least inaccurate, misleading.

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.

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.

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.

That defeatist philosophy was an excruciating read. I wonder about your purpose sharing it.

Keep your tools of torture. If we all die in the end why take them into our hands. You don't make sense to me.

Gotcha.

You write that? Nice.

Yeah everything is for survival, construction of ego and neuroticism. Depression too.

No, not everything is for survival. There is no teleology. Some things survive, others not. Some things stay for a long time, some barely blink in existence before they're gone.

The ego construct did survive so far for a few million years, depending on which organisms you concede the development of an ego before humanity.

Neuroticism is a pointed variant of the ego. It may or may not survive in greater numbers for the next 50 years. For now it is a profitable market.

Depression is another variant of consciousness, based on a variant brain metabolism. Often associated with a shorter life expectancy and, since it can be lethal in younger years, probably at disadvantage to procreate. Which probably was not the case in times humans procreated at a much younger age than today and had less time to indulge in its quirks.

On the other side, if you survive depression, it may give you a much deeper insight in the human condition. Which for sure is nothing for faint-hearted happy fools.

... Oh, just in case some HN kitchen psychology rears its head. I'm not depressed, I'm just outright evil.

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.

Are you thinking of central sensitization?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/

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.

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-chr...

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.

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.

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...

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.

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".

This obscure FDA document prepared by the FDA itself for the 2015 hearing says that for UITs, Sinusitis and Bronchitis, the three most common things docs give FQs for, work no better than placebos.

This document also gives the damage caused by FQs the name Fluoroquinolone-Associated Disability or FQAD.

The EU equivalent of the FDA says FQs should be removed from the market due to their devastating side effects.

"FDA Briefing Document Joint Meeting of the Antimicrobial Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee

November 5, 2015 The Benefits and Risks of Systemic Fluoroquinolone Antibacterial Drugs for the Treatment of Acute Bacterial Sinusitis (ABS), Acute Bacterial Exacerbation of Chronic Bronchitis in Patients Who Have Chronic Obstructive Pulmonary Disease (ABECB-COPD), and Uncomplicated Urinary Tract Infections (uUTI)."

https://web.archive.org/web/20170113234645/http://www.fda.go...

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.

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?

This interview might help:

https://brightestyoungthings.com/articles/tao-lin-literary-t...

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

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

https://archive.md/2021.11.13-023640/https://www.firstthings...

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.

> I am convinced depression will become a physical biological condition that is treatable once we investigate its causes.

From a materialist perspective, all psychological issues necessarily have a physical manifestation. That doesn't mean it needs to be a specific pathology. Placebos do have a real effect, does that mean there is some hitherto unidentified substance in Placebos, doing all the work? Of course not.

The problem with people that reject "psychosomatic" as a diagnosis is that they're hopeless in case their condition actually is psychosomatic. If you demand your condition be found under a microscope and treated with a pill, medicine will most likely disappoint. If your condition is not psychosomatic, but invisible to current methods of screening, you are screwed either way. If we look into all directions for something like CE/MFS, surely we will find something. That doesn't mean it will reproduce. It's a long way to go.

Of course, many doctors are quick to dismiss difficult-to-diagnose pathologies as psychosomatic. That probably means you're not making them enough money. Other doctors will gladly mislead you into an expensive and potentially dangerous placebo treatment. Either way, the doctor most likely to diagnose you properly is not necessarily the one that tells you what you wanted to hear.

> 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.

You have to consider that the field faces significant practical challenges when it comes to applying the scientific method. Nevertheless, I wouldn't be so quick to dismiss it, cognitive behavioral therapy does show results on par with commonly prescribed medications.

>You have to consider that the field faces significant practical challenges when it comes to applying the scientific method. Nevertheless, I wouldn't be so quick to dismiss it, cognitive behavioral therapy does show results on par with commonly prescribed medications.

Yet any sort of talk therapy is almost as good as CBT, and psychiatric medications lose effectiveness over years since their development. The former leads me to suspect that the therapy isn't the point, it's a psychological connection with one's therapist. The latter leads me to suspect that most psychiatric medication isn't "fixing the problem" so much as re-rolling a few stats such that the user can feel different for a bit, and hopefully thereby pull up from their metaphorical depressive nosedive.

> Nevertheless, I wouldn't be so quick to dismiss it

An interesting psychological phenomenon in its own right, the human mind's ability to know (or, inability to not know) the future.

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?

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