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Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @07:51AM (#21523453)
> Like so many things, PTSD feels self-evident once you know about it.

Only from the myopic perspective of people only used to a life of luxury and ease.

Throughout most of history several of the people most close to you would have made an early and often quite unpleasant exit before you reached adulthood -- most of your siblings and children would probably not make it into adulthood and women had a double digit chance of dying from child birth[1]. And that held true even if you were an affluent member of a relatively stable and successful society.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139114/pdf/med...

So a priori it seems extremely unlikely to me that severely unpleasant experiences have psychologically crippling effects on a majority of people. Because that would seem to be extremely maladaptive for almost all of the last few millenia.

Re:Book Review: The Body Keeps the Score by vector_spaces on Wednesday November 13, 2019 @08:37AM (#21523778)
A common misperception about ptsd is that it results from discrete traumatic events or episodes. It doesn't in general. More often it results from discrete or continuous traumatic events or episodes together with one or more of alienation, lack of social support, or ostracization. That is one reason why not everyone who experiences a shared traumatic event will develop PTSD.

So what is maladaptive are there breakdown in social ties and cultural/social infrastructure and process for supporting humans going though hell, not, in fact, my PTSD, thanks

Re:Book Review: The Body Keeps the Score by zsz on Wednesday November 13, 2019 @10:29AM (#21525181)
1. PTSD is in actuality frequently triggered by a single, discrete, traumatic event. 2. The feelings of ostracization/alienation and general disengagement from social discourse are indeed well known markers -- except, they follow, rather than lead the onset of PTSD. In other words, they manifest as a result of PTSD -- not the other way around.

Source: https://www.psychiatry.org/patients-families/ptsd/what-is-pt...

Re:Book Review: The Body Keeps the Score by lfuller on Wednesday November 13, 2019 @11:11AM (#21525723)
While what you're saying is correct, you're describing CPTSD (complex post traumatic stress disorder) rather than PTSD, which typically results from a single traumatic event.
Re:Book Review: The Body Keeps the Score by Nasrudith on Wednesday November 13, 2019 @09:59AM (#21524825)
> Because that would seem to be extremely maladaptive for almost all of the last few millenia.

Malnutrition says hello. If there is any lesson of history it is "That would be extremly non-optimal of society." is not an arguement against it actually happening. Unless it would leave them literally completely non-viable extraordinarily messed up things can wind up winning out in the circumstances.

A bunch of malnourished farmers who were several inches smaller than their hunter-gatherer ancestors won out against the bands. Despite the obvious disadvantages. Numbers and potentially emplacements allowed the nutritionally stunted to not only win but essentially wipe out hunter-gatherers to the point where they are mostly found where agrarians weren't there to compete.

Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @07:12PM (#21531313)
No one is making arguments for optimality of society! If your argument is that societies which traded off mental health of their members (almost certainly an individual fitness hit) for other benefits that allowed them to outcompete individuals in other societies to overcompensate that fitness hit (similar to farmers beating hunter gatherers), I'd be curious to hear what these psychologically more idyllic less successful societies far less prone to PTSD would have looked like.

You might be correct (and one sibling commenter has for example already blamed a change in the availability of social support networks), but it's certainly not obvious to me what the difference might be that suddenly made PTSD a recent "discovery". So I still think it's everything but "obvious in retrospect" in at least one meaning of that phrase.

Maybe it was always with us, and people just failed to recognize it, but naively it would seem that live almost everywhere ought to have been massively more trauma inducing than in the contemporary West.

Re:Book Review: The Body Keeps the Score by pjc50 on Wednesday November 13, 2019 @08:16AM (#21523629)
On the other hand you could look at this the other way round: catastrophic physical illness was widespread, why not catastrophic mental illness? And if you look at history with the right lens, you can find examples that might support this. There are huge areas of folk psychology around things like "demonic possession" that are usually attributed to what would today be understood as forms of mental illness.

Just because someone is surviving and even reproducing doesn't mean they're not psychologically damaged. Even to quite a considerable extent.

Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @09:50AM (#21524715)
Your analogy does not work. The reason people succumbed to widespread and severe physical illness, despite clear evolutionary pressure not to do so, is because there is equal evolutionary pressure on pathogens to successfully bypass host adaptations.

Any psychological or physiological damage which doesn't noticeably dent your reproductive fitness, isn't -- at least as far as evolution is concerned. But being a mental wreck along the lines that PTSD is often portrayed very clearly would negatively impact your reproductive success.

Re:Book Review: The Body Keeps the Score by jplayer01 on Wednesday November 13, 2019 @11:27AM (#21525932)
> But being a mental wreck along the lines that PTSD is often portrayed very clearly would negatively impact your reproductive success.

There are plenty of people with PTSD who have families (particularly, kids). Our reproductive age begins really, really, really early and our reproductive drive is incredibly strong. I don't know why mental illness like PTSD would in any way impact our ability to procreate as a species or at an individual level. It might make life more difficult and life might be filled with more suffering, but we're able to procreate under all kinds of bizarrely sub-optimal conditions.

Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @07:31PM (#21531460)
> I don't know why mental illness like PTSD would in any way impact our ability to procreate as a species or at an individual level.

One wonders if you could imagine anything that might in any way impact an individual's ability to procreate and have surviving offspring, if you don't see how significantly heightened suicide risk, being volatile and potentially dangerous to be around and restricted in normal functioning might in any way impact an individual's success in having surviving offspring.

Re:Book Review: The Body Keeps the Score by jplayer01 on Thursday November 14, 2019 @07:19AM (#21534807)
At a population level, we're ridiculously resilient. Or we wouldn't be here today in the numbers that you see. I just don't see PTSD being maladaptive enough. Maybe if you were born with it and were so dysfunctional that you couldn't interact at all with the opposite sex? Otherwise, I don't see it. There are too many other factors that are important for procreation for PTSD to override all of them.
Re:Book Review: The Body Keeps the Score by throwanem on Wednesday November 13, 2019 @08:07AM (#21523568)
The same reasoning, from the same prior, suggests that lead poisoning probably also doesn't exist. After all, the Romans made water pipes out of the stuff, and look how well they did.
Re:Book Review: The Body Keeps the Score by Filligree on Wednesday November 13, 2019 @09:17AM (#21524302)
Roman water pipes ended up covered in (substance I don't recall the name of), and so not much lead leeched into the water. Water jugs made of lead were probably more of a problem.

The same holds true for modern lead pipes. They work fine, until they don't.

Re:Book Review: The Body Keeps the Score by losvedir on Wednesday November 13, 2019 @08:26AM (#21523696)
Sure, and he makes the same point:

> Trauma is as old as living creatures; war, disaster, bullying, and rape far predate homo sapiens . . . Our evolutionary history should have prepared us incredibly well for all of this; the brain “getting stuck” in fear mode after a particularly bad trauma should be no more likely than the legs “getting stuck” in running mode after a particularly long chase.

I took his "self-evident" to be from his point of view as a practicing psychiatrist. Whatever our evolutionary history, lots of people present with it in modern times. For someone who treats such people, once you have the concept for it, it becomes very clear what the disorder is.

Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @09:14AM (#21524271)
He does indeed make the very same point and his review suggest he thinks of the author as more or less a proudly scientifically illiterate witch doctor whose patients' behavior bears not resemblance to that of his own patients.

This does however not prevent him from then recommending the book to one of his patient whom apparently is instantly cured by it.

Somehow the intro and ending seem at variance with the rest of the piece and I'm not sure your -- plausible -- reading entirely resolves this.

Lots of people presenting with a "disorder" is of course an imperfect indicator that the disorder has some objective basis in fact[1], but there is no real suggestion that Alexander thinks this is the case here. I'm not sure what to make of this piece.

[1] https://en.wikipedia.org/wiki/Koro_(medicine)

> Local official records indicate genital retraction endemics in Hainan Island and Leizhou Peninsula in Guangdong, China, as early as the late 19th century.

Re:Book Review: The Body Keeps the Score by jallasprit on Wednesday November 13, 2019 @08:32AM (#21523743)
Intuitively it would seem like PTSD is a result of a traumatic break in expectations, rather than the trauma itself. Now, here's my reasoning for this.

The brain is essentially a pattern recognizer in the sense that it will look for danger, and consider ways to avoid the danger.[1]

If we think about the nature of trauma in the past, it has been a society where you are told by your surroundings that things like childbirth indeed is a dangerous but necessary undertaking, supported by the idea that your children will be able to take care of you when you're too old to do so yourself. The pre-modern world was a much more dangerous place due to the lack of modern medicine, et cetera.

Now, in the modern world, the expectations about childbirth have also changed for the better. WHO states that between 2000 and 2017 maternal mortality dropped by 38% worldwide.[2]

Going back to the original argument about PTSD, intuitively it makes sense that if you're subjected to a traumatic experience, your resilience (towards PTSD and other disorders caused by traumatic experiences) are very much affected by the individual's expectation towards the traumatic event. If people go through the event, with the expectation that there is a very probable risk that they will die, it seems there is relief in knowing you survived. On the contrary side, could it be the case that having overly optimistic expectations crushed by trauma, lead to the diagnostic symptoms we associate with PTSD?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141622/

[2] https://www.who.int/news-room/fact-sheets/detail/maternal-mo...

Re:Book Review: The Body Keeps the Score by zsz on Wednesday November 13, 2019 @10:47AM (#21525407)
The brain processes and integrates emotional/instinctive responses, not abstract concepts -- even in situations where said responses are themselves caused by abstract triggers (e.g. stock market crash and subsequent loss of wealth/job/etc.).

In fact, the reason why some people are more resilient to the effects of PTSD than others is already well understood:

"While the presence or absence of any of these responses are not necessarily predictive, people who take a more active, problem-solving approach to the traumatic event are less likely to develop PTSD, while those who dissociate are more likely to develop PTSD."

https://www.voa.org/understanding-ptsd

Re:Book Review: The Body Keeps the Score by chrisweekly on Wednesday November 13, 2019 @08:33AM (#21523745)
"maladaptive... last few millenia"

In terms of selective adaptation, isn't the time scale for human evolution more like 40-50,000 years? IOW, biologically, aren't we living humans the result of evolutionary pressures that predominated in our distant ancestors' lives on the savannah?

Re:Book Review: The Body Keeps the Score by bobcostas55 on Wednesday November 13, 2019 @08:53AM (#21523957)
There's no such "time scale", it all depends on the strength of the selection. Lactase persistence went from zero to ~100% in some populations in less than 3000 years.
Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @09:33AM (#21524486)
Exactly -- Lactose tolerance is a common counter example to the strange notion that evolution in humans has somehow stopped either literally or practically (given supposedly glacial timescales).
Re:Book Review: The Body Keeps the Score by chrisweekly on Friday November 15, 2019 @08:22AM (#21544521)
You're both right, of course. I was thinking in terms of evolutionary psychology and neuroanatomy -- areas where the timescales are "glacial" compared to the rise in lactose tolerance over a handful of generations.
Re:Book Review: The Body Keeps the Score by bobcostas55 on Friday November 15, 2019 @08:32AM (#21544592)
There's nothing inherently slow about selection on psychological traits. To give just one striking example, there is extremely rapid selection against intelligence in advanced societies going on right now, at a rate of about 0.25-0.3 standard deviations per century.

US: https://www.pnas.org/content/suppl/2016/05/25/1523592113.DCS... (Table S11)

Taiwan: https://www.sciencedirect.com/science/article/abs/pii/S01602...

Iceland: https://www.dropbox.com/s/9vq5t6urtu930xe/2017-kong.pdf

Re:Book Review: The Body Keeps the Score by currymj on Wednesday November 13, 2019 @09:21AM (#21524342)
a posteriori, though, it is in fact extremely common for people to suffer from these symptoms after having those experiences.
Re:Book Review: The Body Keeps the Score by patrec on Wednesday November 13, 2019 @07:20PM (#21531369)
Sure – I'm just taking issue with the "in retrospect obvious". PTSD might still be real, or it might turn out to be in fact several different phenonema, with possible some more real than others. But there is a lot that's counter-intuitive.
Re:Book Review: The Body Keeps the Score by nyolfen on Wednesday November 13, 2019 @08:07AM (#21523572)
anthropologist greg cochran has made the same point:

https://westhunt.wordpress.com/2018/08/18/ptsd/

then again, from what we can tell about the premodern world it seems much more violent than what we are accustomed to.

Re:Book Review: The Body Keeps the Score by pjc50 on Wednesday November 13, 2019 @08:21AM (#21523660)
Per his wikipedia he appears to believe that homosexuality is caused by a virus? https://en.wikipedia.org/wiki/Gregory_Cochran
Re:Book Review: The Body Keeps the Score by pliny on Wednesday November 13, 2019 @08:31AM (#21523735)
What's your point?
Re:Book Review: The Body Keeps the Score by throwanem on Wednesday November 13, 2019 @08:58AM (#21524037)
"What do we know [about male homosexuality]? We have a lot of indications that there has been some change in the brain. After all, that's the most logical location for the cause of a change in behavior. Simon LeVay and others see differences in hypothalamic nuclei (similar to those seen in sheep). There are associated changes - the lisp, increased neuroticism and depression, etc. Somehow the cause is affecting the brain." [1]

I dunno, man. If you want to take seriously some dude who builds a house of cards from incredibly tendentious evo-psych nonsense so he can scale it to the dizzying heights of "this is why all gay men lisp", you do you.

[1] https://web.archive.org/web/20081011094900/http://zero.poynt...

Re:Book Review: The Body Keeps the Score by nyolfen on Wednesday November 13, 2019 @09:09AM (#21524193)
i know that invoking evo-psych is a thought-terminating cliche for many people, but saying “there are measurable common traits that could be associated with physical changes in the brain” doesn’t even fall into its realm
Re:Book Review: The Body Keeps the Score by PhasmaFelis on Wednesday November 13, 2019 @09:27AM (#21524410)
Someone who thinks that lisping is so common among gay men that it must be genetic rather than social is someone who is reasoning from stereotypes. This is roughly equivalent to claiming a genetic preference for rainbow bumper stickers.
Re:Book Review: The Body Keeps the Score by nyolfen on Wednesday November 13, 2019 @04:27PM (#21529784)
he is not saying that it is genetic; he thinks there could be a pathogen that influences brain development. did you even read what you were replying to?
Re:Book Review: The Body Keeps the Score by PhasmaFelis on Wednesday November 13, 2019 @10:28PM (#21532507)
My mistake, it's like saying there's a pathogen that makes you like rainbow bumper stickers.

Dr. Cochran thinks that gay men lisp because a pathogen has affected their brains. But most gay men don't lisp. It was only ever a cultural thing, it was never universal, and it's mostly gone out of fashion in the last few decades.

He says that preferential male homosexuality has only been observed in humans and sheep. This is utter bullshit. Homosexuality has been observed in hundreds of species, including primates, mammals in general, birds, reptiles, and arthropods. This is not new research: over 450 species were known in 1999.

It goes on and on. This kind of ignorance might have been understandable, if not excusable, in the '70s, but Cochran was writing in 2005. He's making confident scientific assertions based on lazy, decades-old stereotypes, and there's no excuse for that.

To answer your question: no, I didn't read the article, because I read one sentence and concluded that it was horseshit. I should have taken a closer look before commenting, but I've done that now and my first assumption was 100% correct.

Re:Book Review: The Body Keeps the Score by nyolfen on Thursday November 14, 2019 @05:52PM (#21540388)
> My mistake, it's like saying there's a pathogen that makes you like rainbow bumper stickers.

you ought to read about toxoplasma if you think complex behavior resulting from pathogen infection is outside the realm of possibility. 'lisp' is not strictly accurate, but gay men cross-culturally tend to particular speech patterns, including over-enunciation of the letter s, even as children; this isn't universal but it's fairly common, and i can't think of a reason that it would result from sexual preference per se.

>He says that preferential male homosexuality has only been observed in humans and sheep. This is utter bullshit. Homosexuality has been observed in hundreds of species, including primates, mammals in general, birds, reptiles, and arthropods. This is not new research: over 450 species were known in 1999.

i looked this up and you skipped over an important qualification: he said "at the-few-percent level". you should really learn to read what you're replying to.

Re:Book Review: The Body Keeps the Score by PhasmaFelis on Thursday November 14, 2019 @10:52PM (#21542072)
No, sorry, I did read the article for my last comment, and you're squarely in the wrong.

It is conceivable that a pathogen could alter speech patterns, yes. My point was that if Cochran thinks all or most gay men have a distinctive lisp, then at least half his understanding of gay men is based on locker-room rumors and stereotypes. If he can't be bothered to educate himself on those basics, it calls his entire article into question.

If that were that were my only issue with Cochran's article, it would still just be a nitpick. But he gets everything wrong:

> among the Kalahari Bushmen, there doesn't seem to be any at all. Typically, hunter-gatherers have trouble believing that homosexuality actually exists.

There is native Bushman rock art explicitly depicting male homosexuality. See Boy-Wives and Female Husbands: Studies of African Homosexualities, published in 2000. Lots of extremely conservative/traditional cultures will tell you that none of them are queer, despite all evidence to the contrary.

> increased neuroticism and depression

Yes, gay men are prone to depression and emotional trauma. There's been quite a lot of research done on the causes. It mostly concludes that, surprise, they get depressed because they're discriminated against.

> the idea that male homosexuality is caused by a pathogen makes good evolutionary sense, unlike every other explanation ever proposed.

I'll just give you the link. Note the 2004 Italian study, particularly. https://en.wikipedia.org/wiki/Biology_and_sexual_orientation...

> The only two species known to exhibit this behavior, at the-few-percent level, are men and sheep.

Despite your repeating this, it's still bullshit. There are plenty of species with homosexuality rates equal to or higher than humans: giraffes, lions, and elephants, just to name a few.

Any sources I haven't linked here can be easily googled in a few minutes. If you choose to believe that being gay is a disease, nothing I can say will change your mind. Just understand that this is something you believe because it "feels right", not because there's compelling evidence.

Re:Book Review: The Body Keeps the Score by East-Link on Wednesday November 13, 2019 @08:10AM (#21523594)
It's adaptive, not maladaptive