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Comment by MichaelCollins | Hacker News Reader

It feels as though our society has collectively forgotten that mental illness can be socially transmissible. I remember in 00s there seemed to be mainstream acknowledgement and concern that anorexia and distorted perception of one's body can be socially transmissible, ripping through teen social cliches particularly, and could be spread through the internet by "pro-ana" websites and chat groups. I don't hear much about it these days though. Instead, internet media promoting mental illness seems more common than ever and with few exceptions (threads like this) I rarely see anybody express concern about it. What happened?

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There's still a lot of discussion of this in the political discourse here in Norway, in fact I'd argue it's become increasingly more discussed as social media have taken over. Just recently, a law was passed requiring advertising that is edited to significantly change the physical appearance of people, to marked as such. One of the most common practices is editing to make a model's boobs look bigger, or her figure more hourglass-like. Removing skin blemishes is another. Details in the requirements are being ironed out right now, but I think this is a good example of a fairly simple regulation that should help improve things. It will become too expensive to try to do this kind of editing within the limits due to red tape, and the practice should go away almost completely in time. There's a lot more to be done in the ad, modelling, cosmetics, fashion, entertainment and tech(social media) industries to combat this though. But this kind of photoshopping practice is very harmful because it serves to amplify all of the other harmful signalling.

> Just recently, a law was passed requiring advertising that is edited to significantly change the physical appearance of people, to marked as such.

This makes so much sense, I can't believe I've never thought of it. We do this on boxes of breakfast cereal, why not fashion magazines too?

The iPhone selfie camera changes the physical appearance of the user to appear more attractive. I wonder if every selfie will have to have a notifier.

That's not advertising though -- the commenter stated that the scope of the law was for edited photos in advertisements.

No, that would be a a clear violation of freedom of speech.

Advertising is an act of speech, but it is also an act of trying to get someone to buy something, and that act can be constrained by law.

If you wanted to regulate the iPhone camera issue, I suppose regulating Apple would be the only way to go about it, though I'm not sure if that's a good idea or not.

> It feels as though our society has collectively forgotten that mental illness can be socially transmissible

I mean, that's what religion is. It's a shared delusion that functions as a mind virus, where the conceptualization of deities that are on your side (but not the other side's) is mistaken for there actually being such a thing. The fact that it's normalized doesn't change the fact that it's a delusion.

> I mean, that's what religion is. It's a shared delusion that functions as a mind virus,

I don't believe in anything super human or God like, but that's a very strong assumption

People do know that God might and probably does not exist I mean, ancient Greeks knew that gods did not exist, it was never intended literally.

Religion is simply a set of rule that defines the identity of a community.

I don't like or follow them, but if religion was really a threat for humanity, we would be all dead by now.

Most religious people, the vast majority of them, are perfectly capable of living a normal life.

Religion is a contemplation of free will, e.g. it’s a central ethos of Christianity.

If free will is an illusion, none of this matters anyway :)

What happened is that as we have understood eating disorders better focus on anorexia specifically has been replaced by a much broader class of eating disorders.

In addition what people have learnt is that focusing on illness prevention isn’t the best approach. Focusing instead on more positive alternatives works better. Hence the rise of the body positivity movement.

Finally, anorexia and other eating disorders are much better known so parents and children receive information and education about them through normal channels. Their doctors and school teachers. So discussing it through news media isn’t as important.

Fashion has moved on, so the anorexic has been largely replaced with bikini fitness. This is not a joke. You will also find that among bikini fitness athletes, you will find a lot who have been previously anorexic.

https://nutrition.org/eating-disorders-are-on-the-rise/

>It feels as though our society has collectively forgotten that mental illness can be socially transmissible. I remember in 00s there seemed to be mainstream acknowledgement and concern that anorexia and distorted perception of one's body can be socially transmissible

In the 90s, there was a study done on "sensitivity to environmental toxins," where people would complain about sickness and headaches and similar things from new carpet or new paint in offices.

IIRC, the study found that the reported cases were in a kind of "line of sight," i.e. one person would complain about it to another person, and before long it had passed all the way through the weird social groupings in cube farms, passed from person to person.

It's odd, but important to remember, that humans are still just smarter than average herd animals.

because the mental illnesses being promoted today are deemed socially acceptable by the few percent of the Western population with disproportionate amount of power over our mass and social media.

The drug industry does the same thing. Has anyone else watched a anti-depression medicine commercial and suddenly felt they are depressed?

https://www.youtube.com/watch?v=twhvtzd6gXA

I mean watch this and tell me you don't want what they're selling.

I don't want what they're selling. I don't feel exhausted, hopeless, and anxious. And I don't want dry mouth, insomnia, sexual side effects, diarrhea, nausea, and sleepiness.

Banning advertisements for prescription-only drugs makes quite a bit of sense for reasons like that.

A meme is a memetic virus, people just forgot it can cut both ways because of the funny cat pictures in the early 00s.

You bring an interesting point and it's absolutely true that mental reality is very relative.

And considering the shallowness and speed of socnets... It seems a very bad combo.

Old world may be what it is but there were some natural brakes.

The bar also got a lot lower than back then.

You jump over the gaps in the tiles on the road? You must have OCD. You broke up with your bf/gf.. you must have depression. You're happy a bit? Bipolar disorder. You're a guy and play with a barbie... trans. Less horny, asexual. And let's not forget a bunch of adhd/autism and other disorders, when a kid gets bored in school.

On the other hand, we have professionals (doctors, etc.) reinforcing this, by (eg.) giving pills to kids who can't sit still for 8 hours in school without any physical excercise during that time, and parents give their kids pills,because it's easier than actually parenting that kid.

The language has shifted as well.

You’re not sad, you’re depressed.

You don’t worry, you have anxiety.

Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience.

If you don’t ever worry or get sad about anything there’s probably something else wrong with you.

In terms of diagnoses, the DSM-4 included a “bereavement exclusion” from the depression diagnostic criteria. Thinking being if someone close to you dies a normal person almost should feel the symptoms of depression for some period of time. You don’t have depression, you’re mourning.

It was (controversially) removed in DSM-5:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/

The “slap a medical diagnosis on a normal feeling” described in the article seems to have entered society across the board.

It made us feel so insulted and betrayed that when my wife would cry in the NICU for any reason the nurses would tattle on her and she’d get a call from the pill pushers trying to prescribe her psych meds.

It’s like look, my kid has literally been in the NICU for 6 months now (it ended up being 9 months total) and you’re strongly pressuring us to get her a tracheostomy (let’s not use medical euphemism here though, they wanted to put a tube into our babies throat which would make her unable to cry and necessitate round the clock nursing care) as the “standard of care” (bullshit, it would have made her quality of life worse). But she’s a little upset, better prescribe her happy pills!

For anyone wondering, this was 2019 and my daughter is right this moment peacefully sleeping in her bed with no external breathing aids necessary aside from a wedge pillow to help with her sleep apnea. My blood boils when I think of what we were forced through (especially my wife) dealing with the medical establishment after our daughter was born, but the psych meds being dangled in front of us is a particularly sore spot.

I’m sorry for this entire experience that you’ve had. It sounds like a waking nightmare.

I’m curious, did any doctor bring up therapy?

I have major depressive disorder and I take antidepressants to help manage it. There was a landmark study a few years ago indicating that, while SSRIs/SNRIs are beneficial for people like me, they are no more effective than the placebo for people experiencing transient depression.

Therapy, however, would’ve been a sound recommendation for her. In this case it would have given her a place to vent and taught her some tools to cope.

Finally, you should consider whether you and your wife experience any post-traumatic stress from this experience. Your experience meets the qualifications for one that can lead to PTSD in DSM V. There are extremely effective therapy approaches that can put PTSD in complete remission.

Crying when sad has been helpful for a very long time. I’m not saying therapy is never helpful, but as a parent I’m also annoyed by the medical folks in wincy’s story for pushing pills when they faced a tougher situation than any I have ever experienced and crying was certainly a very normal response. And venting to friends and receiving hugs probably helped even though the expected ache might remain while the baby was struggling. There are too many pills in the USA where people need a lot more compassionate friends and acknowledgment that feeling bad is actually not so bad.

Are you an able bodied person? Because when someone says people in America take “too many pills” it sounds like a very able bodied mindset.

I take 8 daily prescription medications to cope with chronic pain and chronic mental health issues. Removing any of them would diminish my quality of life in some way.

How are compassionate friends going to help me manage depression which is endemic to my brain and has no cause in my perceived reality?

Life comes in many perspectives. Before you prescribe how the disabled should live, please at least imagine walking a mile in our shoes.

Trust me, I'm not saying I've walked any miles in your shoes. I have relatives who have been disabled. I also have relatives who have taken many pills, and I have no doubt that many are necessary. As an American who grew up partly abroad, I have a desire to see increased relational commitment and support and believe that for many people, so many pills would not be necessary. I don't know you, I mean you no offense, and I don't believe I'm talking about someone in your situation. Based on news reports for the past several years, it's no secret that there are too many pills in the USA that are often being given to people who probably don't need them, and instead need something else. Medicate first and actually deal with it later (or never deal with the underlying problem) is not always the best course of action for many people.

> she’d get a call from the pill pushers trying to prescribe her psych meds

If your only tool is a hammer....

This is part of why I avoid the medical establishment.

> My blood boils

Better get some prescription for that. ;)

That’s wildly wrong. The medical community adopted depression and anxiety from general use dating back to the 1500’s rather than the other way around.

“The meaning "dejection, state of sadness, a sinking of the spirits" is from early 15c. (as a clinical term in psychology, from 1905);” https://www.etymonline.com/word/depression

“anxiety (n.) 1520s, "apprehension caused by danger, misfortune, or error, uneasiness of mind respecting some uncertainty, a restless dread of some evil," from Latin anxietatem (nominative anxietas) "anguish, anxiety, solicitude," noun of quality from anxius "uneasy, troubled in mind” https://www.etymonline.com/search?q=anxiety

I think we’re talking past each other here?

The medical diagnoses are generalized anxiety disorder and major depressive disorder (with a variety of variations). Both of which, in common usage, have meaning.

The average person with their arm in a cast doesn’t say they “have a compound fracture of the radius and ulna”. They say they broke their arm or MAYBE fractured their arm. In this case the simple language and medical diagnosis is fracture.

Just like people with SERIOUS, life ruining disabling and debilitating depression don’t say they “have non-psychotic major depressive disorder”. They say they have depression. I’m not gatekeeping, just being extreme for the purposes of discussion.

To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry.

To me (again) the issue comes in when you apply a diagnosis to a feeling. When you bump your funny bone you don’t tell people your arm is fractured.

> To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry.

You are contradicting your own examples:

> You’re not sad, you’re depressed. You don’t worry, you have anxiety.

It's possible the people are expressing they are feeling depressed or having anxiety in a colloquial way without confusing the emotion for the diagnosis. Your prior examples indicated that to use those words is problematic, yet you now say that "you can be depressed about something" and that "you can be anxious about something."

You missed the sarcasm/jest on my first examples. I should have tagged them or been clearer.

On the later the separation is:

“I’m depressed” = Sad or a variation of it.

“I have depression” = Diagnosis of a disorder

I really don’t believe people are casually using self-diagnosing language over using the variation that simply indicates their mood. Perhaps feeling depressed or anxious are more intense versions of feeling sad or worried, as they indicate persistence of negative feeling. But given all that has happened over the last couple of years, it is arguable that society as a whole is more susceptible to intense feelings.

I've always wondered what it means that Germans say "I have hunger" instead of "I'm hungry".

Maybe they think hunger is a disorder to be cured by prescribing food, instead of a feeling to be satisfied by eating. ;)

French is the same: j’ai faim, and Italian is too: ho fame. Both mean “I have hunger”. I wonder if English is in the minority of languages that use “I am” instead of “I have”? Interestingly, German doesn’t use the same construction for thirst. Ich bin durstig.

I think you have been reading to much into this. Less formal language get’s odd when you take it literally.

People casually describe emotions in a silly number of ways. Sometimes it’s possessive like “I got (hungry, depressed)” Other times it’s a state like “I am (hungry, depressed).” Sometimes it’s a transformation “That makes me so (hungry, depressed, happy, angry).” etc

Most people aren’t suggesting a medical diagnosis any more than “I have a crush” suggests you physically caught someone.

Also, “I broke my arm” doesn’t always imply someone broke a bone. Ex-pitchers for example sometimes use the phase to refer to a lack of functionality, though busted is more general.

Just because it is a "normal" thing doesn't mean it isn't something that medicine can address. Many of the unpleasant things our bodies go through are "normal" reactions to events.

The fact that bereavement may be different than other causes of depression may be a reason to treat it differently, but not a reason to ignore it.

But should we be treating those kinds of things with a medication or should we be treating it with education? Should we be more forgiving to people and allowing them the space they need to process life events instead of worrying about money or their jobs or all this crap.

The difference is handing someone a bottle and saying "here this will go away quick!" Vs just generally having a better more emotionally aware society.

Some processes that are brains go through should be allowed and it should be accepted that they run their full natural course given that the human that has the brain is also being cared for and guided in some sort of way during this process and not just isolated and shunned away.

No, just because something is diagnosable doesn’t mean the treatment is a pill.

It is perfectly reasonable to address concerns about the bereavement process with therapy.

I strongly disagree. I think most people I know are careful to not throw around the word "depression" when they talk about being sad. They are keenly aware of the difference. And they know the difference between "being anxious" or "having anxiety" and having an actual anxiety disorder. Of course, a lot of times the lines are blurred. Whole most medical professionals are forced to draw a stark line in order to make an actionable diagnosis, actual people realize that these are all on a spectrum. Some of us may have occasional OCD tendencies or mild body dysmorphia without needing medical intervention. Though self-awareness and discussing the issue with friends and a therapist always seem to help, even if meds or more involved therapy aren't needed.

No offense but if most people around you are throwing around the word "depression," I would personally consider that a red flag (unless you're in the medical profession). Either your friend circle are unusually showing symptoms of depression or they're misusing the term/self-diagnosing themselves.

I clearly stated that "most people I know are careful to not throw around the word "depression". The rest of what I wrote syncs with this perspective. Not sure what you read.

I think the main point of removing this exclusion is that you can be depressed and bereaved at the same time. Or you could be so depressed due to bereavement that you still need treatment. In DSM-V it's left to the clinician to distinguish between clinically significant depression and a healthy, transitory reaction to bereavement. The reason for this is to avoid cases where people who need treatment are dismissed too easily because they happen to be bereaved. There is still a distinction drawn, it's just that it's not currently easy to make that distinction in a standardised way, and so it was decided to remove it from the DSM, which is meant to be as rigorous and statistically grounded as possible.

As the other comment with his wife and the NICU situation noted, the point here is people should be left to deal with life if they’re going through some shit.

IIRC the bereavement exclusion was six months? This made sense to me, if you had some terrible event in your life and you’re not back to something resembling your baseline mood and function after roughly that time period there’s probably something going on that needs to be looked at.

To me this is the mental health equivalent of “Sorry you sprained your ankle and it hurts a little, here’s a month of OxyContin and what could very well be a lifelong addiction”. We don’t do that anymore - today you’ll get ibuprofen and ice.

Even with more serious injuries you’re more likely to get lifestyle suggestions, physical therapy, etc than opioids.

In many cases we’re throwing pills that change mood and brain chemistry at people suffering from what is basically “life”. I’m not saying people shouldn’t be treated, I’m saying general practitioners throwing SSRIs at someone and diagnosing them with depression after talking to them for literally five minutes doesn’t seem right to me.

But it is easier and faster than hours and hours of therapy.

What comes first? An irresponsibly written anti-depressant prescription because someone said they have depression, or someone says they have depression because someone irresponsibly wrote them a prescription for an anti-depressant?

The point is that it's non-trivial to determine whether someone is simply bereaved. Or depressed, and bereaved. If someone is already depressed, bereavement is one of those things that can push them over the edge into attempting suicide. The exclusion criterion was too simplistic to cover the nuance of the differential diagnosis, so it was removed. It is a non-sequitur to say that the removal from the DSM is an endorsement of diagnosing MDD in all bereaved people. Some doctors might be doing that, but then the problem is that those doctors are doing the wrong thing, and whatever societal pressures might have affected them to do so. There is still disagreement about it in the field, and if the consensus shifts again it could very well end up being added back in, but probably I think it will evolve into a more specific diagnostic procedure to tell the cases apart.

> Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience.

Why? In what sense are they "normal"? They're unpleasant and they leave you worse off than you were before you experienced them. It's also becoming clearer that frequently experiencing them has harmful physical effects from stress responses. Over-diagnosis with depression and anxiety is bad because the treatments have such a wide array of potential side effects and limited evidence for efficacy, but it makes no sense to not categorize something as a disease just because we can't treat it.

I think most doctors aren't eager to prescribe the pills, but they have to treat the parents like any other drug-seeking population. It's impossible to get medication to people who need it while denying it to people who don't need it but are determined to get it and know all the right things to say, so you accept there will be some abuse.

> You're a guy and play with a barbie... trans. Less horny, asexual.

Setting aside, for now, the fact that these are things that people realize about themselves and not things people are diagnosed with by others... Why are you bringing them up in response to a comment about mental illness?

Because boys are allowed to play with dolls. And shouldn't think it indicates they are trans or have gender dysphoria. It's not a sign of anything.

Please don't misinterpret the comment.

*Edit: removed the word diagnosed as wasn't in the original comment.*

> Because boys are allowed to play with dolls. And shouldn't be diagnosed as being trans or having gender dysphoria. It's not a sign of anything.

Yep, I meant exactly this.

I mean... take the clothes away, and Action Man and (barbie's) Ken are practically the same doll.

What you actually implied is trans skepticism, which is a form of transphobia, questioning its legitimacy, implying that a lot of trans kids aren't actually trans, that they're being labeled that because they "play with dolls" - and this shouldn't be the case.

No kid is diagnosed with gender dysphoria for playing with dolls.

Another weird trend of this is that these self-diagnoses are brought up as if they're personality traits. From what I've seen, Gen Z is much more likely to introduce themselves to others by saying things like "My name is [xyz] and I'm bipolar transfluid asexual with depression" or similar

Nobody has ever said this to you in your entire life

They actually have. Meeting my significant other's family, her niece came up to me and specifically introduced herself as her father's son

That's kinda different, bud.

No it isn't

> parents give their kids pills,because it's easier than actually parenting that kid.

And then you have threads like this, where people call for mass censorship because some believe it's easier to ban "bad" topics than to actively parent their kids.

Your generalization OCD is very, very wrong. I can sadly speak from all-too-close experience that OCD is an absolutely crippling mental illness our society still does not take seriously enough. It’s still largely used as a punchline in popular culture and in social interactions.

Edit: I’m being told I misunderstood the parent comment but it appears to be claiming the bar is much lower now than in the past. Certainly skipping over sidewalk cracks isn’t OCD. The point of my comment is that when someone is diagnosed with OCD in 2022 by a professional, it’s generally for very serious reasons.

I think you may have misread the comment you replied to.

The claim being made, is that in times past, the bar for being diagnosed with something like OCD was much lower than today, causing people to consider mundane things as symptoms.

“The bar also got a lot lower than back then.”

It appears GP is saying the bar for being diagnosed with a mental illness is lower today (“got a lot lower”). I am pushing back, at least where OCD is concerned.

I'm not talking about official diagnosis by trained professionals, i'm talking about tiktok and self diagnosis.

Kids today think they have OCD because they jump over the gaps in tiles, and promote that on social networks. Other kids claim they have it too, because they jump over the gaps too. And in the end... social vmedia (tiktok videos) leave teens thinking they have rare mental disorders (like 'real' OCD)... as the title of this post says.

from the same GP: “ we have professionals (doctors, etc.) reinforcing this”.

If you’re talking about merely kids self-mis-diagnosing, then sure I’ll grant that, it’s unclear to me that GP was solely talking about that though.

You are replying directly to GP.

Whoops. You're right. I thought you had misread the comment, but instead, I had misread the comment.

I had read "The bar also got a lot lower back then." and missed a critical word. Sorry!

I heard that Obamacare changed the way insurers are paid to more of a cost plus model. So they actually have an incentive to not push back against anything.

Don't know if that's true. But if it is, who is pushing back against treatments? Doctors? Insurance companies? Government? Parents?

> You're a guy and play with a barbie... trans.

This literally does not happen.

Depends on which bubble you live in.

Simple objective reality. Nobody is diagnosing boys as trans or having gender dysphoria simply because they play with Barbies. People in a certain bubble may believe it's happening, but in the real world it takes a lot more than "plays with barbies" to get that diagnosis.

What makes you think you have more access to objective reality than others ?

What makes you think anyone can have access to objective reality? What makes you think a first assertion holds more weight than a second? What makes you think bubbles are not a thing? What makes you think certain phrases don't immediately betray how little someone knows about people outside of their bubble?

I know enough people outside of the heteronormative experience to know that nothing about playing with Barbies pushes people toward being trans. It's reminiscent of the classic "violent games make kids violent" line. That's not the case at all -- rather violent kids are attracted more to violent games. The causality is completely incorrect and displays an obvious naivete paired with a pre-existing ideological bias.

>What makes you think anyone can have access to objective reality?

Because independent people agree, when independent sources of data agree on something, that means the thing they are agreeing on is (plausibly) larger than them, and that's what we call 'reality'.

>What makes you think a first assertion holds more weight than a second?

I don't.

>What makes you think bubbles are not a thing?

That's literally the opposite of what I said.

>I know enough people outside of the heteronormative experience to know that nothing about playing with Barbies pushes people toward being trans.

Cool, but you're missing the point that nobody claims that playing with Barbies, by itself, makes people trans. But rather what's being claimed is that certain people push the people who play Barbies into being trans, which is an entirely different thing.

>obvious naivete paired with a pre-existing ideological bias

You say this as if you don't have an obviously ample supply of those yourself.

Your right. Obviously we can't be sure birds are real, because some people say (without evidence) bird's aren't real and how can we say we have a better grasp of objective reality than them? Obviously, based on their absurd and evidence-less claims, we should forever question if birds are actually flying creatures and not government drones, regardless of our own experiences with birds and information provided by people who study birds for a living.

But by all means, provide me one documented case of a biological male being diagnosed with gender dysphoria by an actual medical professional based on nothing but the fact he plays with Barbies and burst my "bubble".

The comparison to birds is bizarre because they are a public phenomena that anyone can see and study, gender transitions aren't.

>our own experiences with birds

Which is none in the case of gender transitions, or very little for some people. But certainly nowhere near the experience of an average person with birds.

>information provided by people who study birds for a living

Which is not reliable in the case of gender transitions, because those who "study them for a living" have proven themselves to be unreliable and value-laden communicators who either has an ideology to push or are too timid to challenge those who do have an ideology to push. Don't forget the substantial material incentive for diagnosing people with gender dysphoria (months and possibly years of consultation and medical appointments, services and products), if ornithologists were similarly ideological and have reasons to benefit from denying that birds are drones, I would be skeptical of their claims too, until I see lots of birds and study them myself at any rate.

>provide me one documented case of a biological male being diagnosed with gender dysphoria

Diagnosis is medical data that is mostly non-public, so this is an impossible demand for rigor. And yet, here's[1] the next best thing, a celebrated psychologist with a long career in sex and gender research, editor for several journals, slandered and fired because activists are outraged he tries to encourage gender-non-conforming kids to be comfortable in their assigned gender instead of transitioning them immediately. So anybody who doesn't diagnose a barbie-playing boy with dysphoria and transition them is at risk of being slandered and fired no matter what their contribution or position is. I consider this pretty solid evidence for the original claim.

[1] https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-r...

> I consider this pretty solid evidence for the original claim.

Which is odd, because neither the physiologist nor the activists decided anyone was trans for "just playing with Barbies".

It's hilarious that the first "answer" to the Quora question "How do you stop a boy from playing with dolls?" is a targeted ad saying "Ad by Amazon Web Services (AWS): AWS is how. AWS removes the complexity of building, training, and deploying machine learning models at any scale." ;)

They're "Action Servers", not "Doll Models"!

https://www.quora.com/How-do-you-stop-a-boy-from-playing-wit...

> You're a guy and play with a barbie... trans.

That's...not how anyone realizes they're trans or is diagnosed as having gender dysphoria. Your comment is very moral-panicky and transphobic.

There are lots of money to be made from more diagnoses,

This and the parent’s statement is almost entirely wrong.

Given 2 statements: 1) Americans don’t seek/receive enough mental healthcare 2) Americans seek/receive too much mental health care

no one (other than the old school types who think mental health is simply something for weak people) would pick (2) as true.

Americans don’t receive enough HEALTH care. Period. When they do it’s a yearly 10 minute appointment with a primary care physician.

The physician breezes in, looks at some lab work, asks a few questions, writes a prescription or two (hey they have to “treat” something), and heads to the next patient because they do not have time.

80% of anti-depressants are prescribed by general practitioners, not psychiatrists:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473964/#Sec1ti...

I know many, many people who were going through something in their life and mentioned being “a little down” to their primary care doctor. They were handed a prescription for an SSRI on the spot. So now they have depression.

General practitioners do not have the time or the training to be diagnosing and treating mental health disorders. This isn’t a case of “look at a rash for 2 seconds and prescribe a topical steroid”. Psychiatrists schedule hour long appointments and many of them will want to see you a few times before they attempt to diagnose or treat anything.

You can receive not enough health care and too much at the same time. It’s a matter of the right quality and appropriate type of health care.

Healthcare costs are equal to the amount of healthcare used multiplied by the cost per use.

Big picture, Americans use a bit less healthcare and an other parts of the world, but they tend to spend about five times as much which is where the costs come in.

You can have mental health care without over prescribing pills. Some people can really benefit from being asked "how does that make you feel" in a place where they can be honest and not have to provide an answer they think is being sought.

This is a counterargument to something I didn't say.

The social transmission is obvious in clusters to youth becoming trans.

It’s willful blindness

I've spoken to a mother whose school-aged daughters' circle of friends, five biological girls, all identify somewhere between trans and nonbinary. The teachers encourage and reward it. So do most of the parents. Among these girls it's uncool to accept the body and sex you were born with. I've read stories of similar clusters in other deep-blue cities and school districts.

I believe we're seeing a massive Clever Hans effect among children whose mentors have deep moral anxiety. They grew up during the final battles and ultimate victory of the LGB rights movement, and desperately wish to avoid being seen "on the wrong side of history." Driven by this anxiety, they aggressively pursue gender-affirming care for their children. They do this even in cases where the child's discomfort may more likely result from depression, autism spectrum disorders, the normal effects of puberty, or other conditions unrelated to gender dysphoria. Their children will bear this moral panic's lasting fallout. The effects of puberty blockers are lifelong and largely unknown. The effects of mastectomies and testosterone injections are irreversible.

The real shame will be felt by those who knew, but said nothing, because they didn't want to lose their personal comfort or social networks. The evidence of most trans children desisting in adulthood is clear. "For decades, follow-up studies of transgender kids have shown that a substantial majority-- anywhere from 65 to 94 percent-- eventually ceased to identify as transgender":

https://www.kqed.org/futureofyou/441784/the-controversial-re...

The detransitioner phenomenon has been covered since 2017 (this article got Katie Herzog harassed and fired from The Stranger; she now runs a successful podcast with writer Jesse Singal):

https://www.thestranger.com/features/2017/06/28/25252342/the...

Small correction: while the 2017 Stranger article did lead to Herzog receiving harassment, death threats, and social ostracization, she did not leave The Stranger as a direct result of the article. She was furloughed in 2020 and then laid off during COVID.

The edit timer on my original comment expired, but I didn't want to leave that error hanging out there.

It’s child abuse.

Allowing teens to spread mental illness on social media was less profitable in the 00s. There was a low cost to shutting down pro-ana tumblr accounts.

Now, those sites are worth hundreds of billions of dollars. Can't afford to do the right thing.

> Now, those sites are worth hundreds of billions of dollars. Can't afford to do the right thing.

Which sites?

Tumblr was started in 2007 - it wasn't very big until 2009. I'm not sure why it's even in your comparison.

The only company worth hundreds of billions of dollars remotely relevant is Facebook and - possibly - TikTok. Are you implying that the majority of their business is promoting teen mental illness and eating disorders? Because it's not - especially Facebook. Most of the tweens have moved to TikTok.

Facebook's audience is like ~3% teens & tweens. And of that a small percentage is getting sucked into this strange & toxic echo chamber.

The reason this is mostly a TikTok problem is because Facebook can easily and did do things to prevent this. They could do more, and TikTok can certainly afford to do something about it. The impacts on the top and bottom line would be irrelevant.

I'll end by saying I find it odd we seem to be talking about this being a children only problem. Every time there's a new allergy in the buzz or a new condition - I have at least 100 contacts talking about how they're convinced they have it. This is just typical human behavior - trying to always be the center of attention. Should we be surprised kids want to special? No.

Facebook was one of the websites being criticized for hosting pro-ana content in the late 00s and early 2010s. Facebook, Myspace, Tumblr, Xanga, Livejournal all caught criticism for this; of those only Facebook remains and has arguably lost the demographic of users most susceptible to pro-ana propaganda.

The new 2010s-present wave of social media seems to have largely avoided this sort of controversy. All the focus is now on the way these websites/apps can indoctrinate people into political extremism, but little attention seems to be given to [other sorts of] socially transmissible mental illness.

> Are you implying that the majority of their business is promoting teen mental illness and eating disorders?

These websites will do anything to prevent teens from migrating to a new platform. The majority of content, even teen content, isn't the unhealthy trends, but they will do nothing to curb it if it risks nudging that cohort to a competitor.

> These websites will do anything to prevent teens from migrating to a new platform.

Facebook didn't do much to prevent tweens from migrating to TikTok.

There's not much money to be made from tweens, and now it's a regulatory nightmare.

They can just get you when you're more easily monetizable and want to brag about going to Ibiza for Spring Break in college.

Didn't facebook / instagram have to testify before congress only a couple of years ago about what they were doing to fight the body image issues that their platforms were causing in underage users?

Anorexia has a body count, these TikTok disorders do not.

It's taboo to criticise such movements because by extension you criticise those that actually have the illness. And some movements have grown quite powerful politically. If you allude that it's problematic to let children change sex, you are painted as anti lgbtixxxx. Activism has won against science.

It was never taboo to criticize pro-ana groups.

Being lgbt isn’t a mental illness. Not medically speaking, anyway. Maybe they were considered such in the past. Go far enough back and we used bloodletting as a common treatment, our understanding generally improves with time. I have no desire to go back to an era where lgbt people were persecuted.

With respect to your other point. “Children” is a broad category. Pre-pubescents are not “changing sex”. Instead we are being encouraged to respect their gender identity, and not reject gender-non conforming behaviors [1]. Teens may take puberty blockers to buy time, this also isn’t “changing sex”. Perhaps HRT is what you mean by changing sex, and yes some teenagers are able to access the HRT of their preferred gender. The science on this is pretty clear, that suicide rates of trans people is drastically lowered when in a gender-supportive environment, and their mental well-being is infinitely better.

[1] I implore you to watch this video: https://youtu.be/h60YLGDJ6n0

Edit: despite what a child comment I cannot reply to is saying, while over-medicalization and misdiagnosis is definitely something to watch out for (being gender-nonconforming is not the same as being trans and this is why education about lgbt issues is important), the vast majority of transgender youth do not suffer from an overabundance of societal and medical acceptance for their issues.

Puberty blockers are indeed not a drug to prescribe lightly. Same with SRS, it should not be handed out like candy. People who have only had gender dysphoria for a short time may indeed be better served by a “wait and see” approach. All of these things I can agree with.

If you are under the impression that being trans isn’t stigmatized enough and all the kids might turn trans if we aren’t careful, I’m simply going to disagree with you. There’s no evidence of this.

> Being lgbt isn’t a mental illness. Not medically speaking, anyway.

Medically defining what an "illness" is can get into a lot of squirrely philosophical questions that aren't really scientifically or objectively answerable. We basically just define a mental illness as something that significantly impairs your ability to function happily in life. If society, in general, is intolerant and hostile to you due to that orientation it's not far off to think maybe that's something people might want to take a pill to fix if that was actually possible.

We do recognize, now, that pathologizing being LGBT didn't really do the people with those orientations much good and attempts to reverse or suppress the impulses tended to just lead to worse mental and emotional outcomes. It turned out that simply carving out space in society to accommodate it worked a lot better than turning it into an individual problem to be "solved." And, it turns out, it wasn't that big of a deal to let people live like that after all.

But I'm not sure to what extent a lot of stuff we think of as mental "illnesses" aren't like that as well. Like perhaps a lot of ADHD or anxiety disorders are actually fairly reasonable responses to sociological stressors, but we just treat them as individual problems to fix rather than wide-scale issues to address at a higher level.

ADHD I have some experience with and can agree with you. I think it is mostly just a different mode of thinking that simply isn’t very compatible with sitting in a chair for hours listening to boring lectures. OCD is similar. The mental line between crippling OCD and a highly successful professional career with a reputation of being a “perfectionist” is a thin one. I’ve seen this line crossed, with tragic results…

All that said, I think awareness of mental illness and self-mis-diagnosis largely isn’t the primary problem. The successful person who became a crippling OCD shut-in was convinced OCD was a myth until it was far too late. If only they took it seriously while they still had enough functioning to follow therapy instructions, they might be in a much healthier state right now.

As someone with ADHD, I couldn't disagree more if it's being suggested that ADHD is merely an issue of "not being compatible with sitting in a chair for hours". That's totally not the case and an awful misrepresentation that supports the stigma and encourages those seeking attention for a mental health label they can flaunt.

Sure, there are those that use that as a reason for why they think they have ADHD or an excuse for drug seeking, but it's not the sole symptom, and in some cases not a symptom, for those who legitimately struggle with it. Those who have it, know how crippling it is dealing with the rumination, confusion, irritability, insecurity, regulating emotion, depression that can and often does result from these aspects, among a list of other issues. Not everyone deals with every aspect as it's more of a spectrum than anything, but personally I deal with the ones listed among other things and daily life's been far from an issue of "not being able to sit in a seat/getting bored easily".

Please don't minimize it to a frivolous cliche.

I know that severe ADHD is crippling. I've friends with it. It's no joke. I am talking about mild cases only, and would've edited by post but I couldn't. Hopefully this isn't the case anymore, but back in the 90s there was a push to give ADHD drugs to any kid who couldn't sit still for the school lectures.

ADHD here at a higher level of disability. It's way more than a different mode of thinking. It's crippling and the reason I can barely function in any work setting. Medication and therapy throughout my life, since I was 2, only got me to this level. Without it I'd of probably been dead years ago from just following every impulse and getting myself in situations where I'm way over my head and way too stressed to deal with anything.

I agree with you 100%. Sorry for being unclear. I just meant at low levels ADHD can be a different mode of thinking. Much like OCD can simply be a more cautious personality… until it becomes so cautious that it’s disabling and no longer just a “cautious personality” but a completely pathological OCD mode of thinking. It’s important to be aware of both ADHD and OCD and other mental illnesses so that we can seek treatment before the issues become intractable.

That’s interesting. What you said actually reminded me of when I took my dog through obedience training and the trainer told me that a lot of working dog behaviors are basically normal wolf or wild dog impulses tuned to be way way stronger through artificial selection.

So, for instance, shepherd breeds’ herding instincts come from a combination of a sort of compulsive desire to keep things together and a deep suspicious of aberrant. Consequently, these breeds are prone to neuroticism and anxiety when those traits present too strongly.

>Instead we are being encouraged to respect their gender identity,

I, too, can rephrase bad things in superficially-positive language to make them seem like good things.

>The science on this is pretty clear

Ah, off course. THE SCIENCE^TM. The single, monolithic, Science; which by very happy coincidence happens to hold the opinions you deem acceptable.

>[1] I implore you to watch this video

I implore you to understand how bias and cherry picking works, for every heart-wrenching sob story about brave and stunning joe or jane finding their "true self" there are 10 heart-wrenching stories about kids being misled into mutilating their bodies irreversibly by their peers, teachers and caregivers as they chase their mythical true self, and the overwhelming power of state and mass media are on 1 side and not the other, namely that of trans activists.

>If you are under the impression that being trans isn’t stigmatized enough

I'm always amazed by the ability to live in parallel realities that human minds have, it's like sensory data is just an abstract high-level description that isn't enough to determine reality, and each person constructs their own reality by filling in the blank. Like, judging from my experience online, being trans is really really privileged. Is there any other groups (besides the usuals, which are also privileged) that can make public discourse salty against a comedian for 6 or 7 months straight because they made fun of the group ? Is there any case of people being outraged that comedians make fun of men ? Men literally had one of the corporations marketing products for them to shit on them in an ad in 2019, and the whole incident was forgotten in days. Yet, here you are, apparently the group that is coddled and put on a pedestal seemingly everywhere is oppressed and stigmatized.

> Being lgbt isn’t a mental illness.

No one in this thread was claiming that. With the possible exception of aspects of trans, but don’t conflate that with the larger LGB community. Separate issues, and not being discussed here.

…

Divide and conquer is the latest tactic of anti-LGBT folks. They realized it’s futile to attack the gays (for now) so they are focused on separating the T from LGBT, because trans issues are currently less understood by the broader public (who remains largely ignorant of the issue beyond culture war flashpoints). I’ve seen a lot of people making claims about gender in this thread, imagining themselves to be in opposition to trans “ideology,” while actually being perfectly aligned with it (such as that gender-non-conformity doesn’t make a person trans).

No, it’s the other way around, certain groups have been aligning themselves with other interests through which they attempt to broaden their base of support.

I'm supportive of what you're trying to say and thankful for the video you shared.

Just to add some context the parent author is might be trying to refer to "rapid onset gender dysphoria" ( https://journals.plos.org/plosone/article?id=10.1371/journal... ) which, while far out of my understanding, is a rather new topic that's still being studied.

>Activism has won against science.

What are you trying to say here? Problematic isn't a scientific quantity but maybe you're throwing this in from some other context? Personally, these days I see people of all walks invoking science when they just mean "my own common sense."

It’s more that the word science has been redefined.

People confuse their own preference with science. Also, because preference is political, what to research and what science is focused on is a political question.

It's intellectually dishonest to criticize such movements because the vast majority of criticism is coming from people who have never done a lick of study in the fields attempting to diagnose these conditions. Also, apparently it never occurred to people that Google is one of the reasons that more people are getting diagnosed now. Before, people just treated you as weird and allowed you to languish in your own personal little hell. Seeking help at all was seen as a sign of moral weakness. At least now people can go to a doctor and actually get tested for a condition that you recognize having.

By extension it calls into question the whole surge of gender identity issues. Or at least there is a fear that it will. Better to give a wide berth to these issues.

Not everywhere. Common sense prevails in many parts of the world.

New paper ignites storm over whether teens experience ‘rapid onset' of transgender identity

https://www.science.org/content/article/new-paper-ignites-st...

https://journals.plos.org/plosone/article?id=10.1371/journal...

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