Open Thread: Stupid Treatments for Chronic Illness

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A few days ago I read Chronic Tension Headaches: a detailed self-help guide (I highly recommend his site for anyone struggling with chronic pain). In it, the author mentions that one cause of chronic headaches is wearing glasses that don’t fit your prescription.

Since I haven’t had an eye exam in five years, this instantly shot up my list of possible causes of chronic headache. And let me tell you, if I have had daily painful headaches for over a year because I’ve been wearing glasses that don’t fit, I will be overjoyed and will also feel like a complete moron.

I will also be extremely irritated at all my doctors, who saw I was wearing glasses and did not any point go “hey, did you have a recent eye exam? Out-of-date glasses prescriptions can cause daily chronic headache.”

This is not the first such stupid cause of chronic illness I’ve learned about. For example:

  • If you have anxiety, and you drink a lot of coffee, the coffee might be causing your anxiety. It’s a stimulant and stimulants cause anxiety.
  • If you are depressed and you live in a place that doesn’t get a lot of light part of the year, try sitting in front of a light box.
  • If you are depressed and no antidepressant is working, ask politely if you’ve been screened for hypothyroidism, anemia, and vitamin deficiencies, all of which are known to cause depression.
    • If you’re depressed and you can’t see a doctor, and you are pale, weak, and tired, and experience the compulsion to eat ice or dirt or something else that isn’t food (pica), take an iron supplement and see if it helps.
    • Similarly, try taking a multivitamin and see if it helps.

So I thought this open thread might be a good idea. What are some stupid treatments for chronic illness? When I say “stupid treatments”, I mean:

  • It is little-known and medical professionals might not tell you about it (so not medication, therapy for mental illness, etc).
  • It is relatively easily testable (so not “try this extremely complicated routine for six months and if it doesn’t work it’s your fault for not adhering to it”).
  • It is a treatment, not a thing you should have done three years ago to prevent your chronic illness.
  • When you hear about it, it makes you slap yourself on the head and go “duh.”

Since this topic is particularly likely to attract pseudoscience, I would like to lay out the following commenting guidelines:

  1. All suggested treatments must fit the definition of “stupid treatment” above.
  2. Your suggested treatment can treat at most three things. I will delete all comments about how a particular supplement, diet, or Traditional Chinese Medicine practice can cure everything from low back pain to diabetes to hair loss to insufficiently attractive feet.
  3. When talking about diets, all links should be to peer-reviewed scientific studies and not to websites of people advocating for the diet. If weight loss is recommended, you must provide a specific reason to believe that losing weight specifically will help, which is not “everyone knows that being fat is bad for you.”
  4. Known pseudoscience and quackery will be deleted at my discretion, unless the commenter both (a) acknowledges that this is pseudoscience and (b) either:
    1. Provides a plausible biological mechanism based on what we know of how the human body works
    2. Links to a systemic review or meta-analysis from a reasonably reputable journal (not The Journal of Acupuncture and Meridian Studies or The Journal of Poetry Therapy) that suggests the treatment will work.

Rapid Onset Gender Denial

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Recently, some transgender adolescents and young adults have begun reporting a disturbing new trend.

In recent years, a number of transgender adolescents have been reporting in online discussion groups that their parents suddenly have begun misgendering their children, disrespecting their children’s self-identified gender, and espousing anti-trans beliefs. We believe this may reflect a new clinical condition: rapid onset gender denial (ROGD).

Adolescents have described clusters of these beliefs occurring in pre-existing friend groups, such as the popular parenting website Mumsnet. Adolescents typically notice a process of immersion in social media immediately preceding their parent’s lack of acceptance: “binge-watching” trans-exclusionary feminist YouTube channels, excessive use of websites such as FourthWaveNow and TransgenderTrend, and accounts on self-identified “gender critical” subreddits. These descriptions raise the question of whether social influences may be contributing to or even driving this lack of acceptance in some populations of parents.

The adolescents and young adults that report this disturbing behavior are not in any way bigoted against anti-trans people. The vast majority of adolescents and young adults whose parents have ROGD support the right of radical feminists to found organizations that reflect their beliefs and believe that anti-trans individuals deserve the same rights and protections as other individuals in their country.

In proposing the existence of rapid onset gender denial, we by no means intend to disrespect people with real, valid anti-trans beliefs. We recognize that a small minority of people struggle with a crippling inability to accept trans people for religious or political reasons, and we support tolerance and accommodation of these uncommon beliefs. But this minority have had anti-trans beliefs for their entire lives. Parents with rapid onset gender denial are no hairy-legged bra-burning radical feminists or church-going anti-gay Christians. Even parent-affirming clinicians agree that most ROGD parents favor gay marriage— hardly what you would expect from someone genuinely anti-LGBT! On online fora, parents regularly discuss their “peak trans” moment: the moment when they “realized” that they were anti-trans. Most of these “peak trans” moments are inspired by stories spread by other ROGD parents– proof positive that it is a social contagion.

We recognize that parents with ROGD face real problems. Their children report that parents with ROGD are sensitive, intelligent people who often struggle with anxiety and depression. ROGD is a way of expressing very real distress. Many parents with ROGD are trying to cope with the stress of their child individuating, a difficult time for any parent. It may be particularly difficult for parents who put psychological weight on their children growing up to be a particular kind of person or who invest much of their self-worth in their child agreeing with them. Many other parents may simply be seeking attention: after all, their children are developing lives separate from them, which can be a difficult adjustment, and it’s perfectly normal for parents to be attention-seeking in this developmental stage. Still others may be using ROGD as a coping mechanism for other stresses in their life, such as depression or divorce. After all, it can be easier to blame these stressors on a child’s transition than to accept the harsh reality. Many ROGD parents engage in magical thinking: if their child simply detransitions, then all of the depression and anxiety the parents experience will go away.

Several children have noticed that their parents with ROGD have autism or “autistic traits.” Could ROGD be caused by autism? The rigid, black-and-white thinking associated with autism may lead parents to struggle with the idea of gender fluidity or the concept that someone they previously thought of as a girl might in fact be a boy. And people with autism often struggle with finding friends: the social acceptance they find in ROGD communities may have been the first social acceptance they’ve found in their entire lives.

Supporters of parents with ROGD say that recognizing that transness “isn’t real” improves parents’ lives. But the evidence from their children says otherwise. Many parents with ROGD appear angry, sullen, and withdrawn: they yell at their children, dish out unreasonable punishments, and petulantly refuse to call their children by the correct name and pronouns. It can be impossible for adolescents to have a civil, open conversation with their parents without their parents indignantly spewing insults or accusing them of making up their gender. Many others are depressed. Not only do ROGD parents openly admit their despair about their children’s transition, they have the distorted thoughts characteristic of a struggle with depression: for example, many grieve the “mutilation” and “death” of their children, who are in fact still alive and trying to talk to them. Worst of all, ROGD typically ruins parent-child relationships, with many parents alienating their children so much that a normal-parent child relationship is impossible and the child must go low- or no-contact to preserve their sanity. To any parent, their children are one of the most important things in their lives; this pernicious ideology destroys the precious parent-child relationship, one of the foundations of society and a bond any parent cherishes.

It makes sense that ROGD would cause such difficulty in parent-child relationships, because of the nature of the ideology itself. Parents with ROGD are known for their irrational and science-denying beliefs, such as that a twenty-two-year-old is a child if the parent identifies them as such. Unfortunately, you can’t identify out of biological reality. These beliefs will likely lead them to great distress if they don’t learn to accept and work with the reality that, whatever their friends say, some things– such as the fact that their adult children are fully competent to make their own medical decisions without parental input– won’t change.

Fortunately, treatment is available for ROGD. Several therapists have begun to specialize in the treatment of parents with ROGD. Unlike ROGD parents, we believe in scientific and biological reality, which is why our therapists practice CBT and other evidence-based therapies instead of Jungian psychoanalysis. It is a nonjudgmental course of therapy intended to explore the reasons that parents have ROGD. If, after a long course of therapy, it turns out that the parent genuinely has anti-trans beliefs, of course we will accept this. But it’s simply irresponsible to think that these parents might genuinely be anti-trans– making possibly irreversible decisions such as destroying their relationship with their children– unless we have explored all the other options.

Some Observations Concerning Medication Side Effects, And A Warning About Cognitive Impairment

[Note: this blog post was edited after publication because I realized I’d accidentally published an early draft.]

Often, doctors can only find out about side effects of medications if patients tell them. While some side effects are easily observed (like tremors) or visible on blood tests (like poor kidney function), many are only known to the patient (such as pain or nausea) or only easy to observe if you are with the patient for more than an hour every few months (such as emotional changes or fatigue). I only have anecdotes– so take this post with a grain of salt– but I think this systematically distorts the information people receive from their doctors about the side effects of medications.

Doctors love telling people about weight gain as a side effect of medication. It doesn’t matter if you are underweight, have unintentionally lost a seventh of your body weight in the past three weeks, or are literally dying, doctors will warn you that weight gain is a side effect of your medication so you must diet and exercise. In my experience, doctors are not nearly as assiduous about warning people about side effects that are a good deal more life-ruining than weight gain: fatigue, insomnia, suicidal ideation, or even addiction risk. (Of course, doctors being terrible about drugs with addiction risk goes both ways; for every person who is prescribed benzos without an appropriate warning there’s someone else taken off a medication that works well for them.)

Some of this, of course, is medical fatphobia. But I suspect a lot of it is that weight gain is one of only a small number of very common medication side effects that are completely visible to the doctor. You can see whether a patient has gained weight; it is not dependent on the patient noticing the weight gain, connecting it to the medication, and deciding to complain to the doctor about it. Naturally, weight gain is more salient.

The flipside of this is also true: if a medication has a side effect that is not visible to doctors, and patients don’t tell their doctors about it, it will be much much much less salient to doctors. The well-known example of this is sexual side effects with antidepressants. In the sixties and seventies, it was believed that sexual side effects with antidepressants were rare. Today we know that about forty percent of people treated with an antidepressant will have sexual side effects; for drugs that have a particularly high rate of sexual side effects, as many as seventy percent of people may experience side effects. Why did doctors fail to notice something forty percent of their patients experienced? Probably because– since sexual side effects are a very personal and embarrassing issue– their patients were too embarrassed to tell them.

But the more serious issue is cognitive impairment.

I personally have met at least five different people who experienced serious cognitive impairment when they took a medication, were not warned that this was a side effect, and did not realize that they were experiencing cognitive impairment until they stopped taking it. In no case did their doctors realize they were experiencing cognitive impairment.

A doctor talks to you, at most, for an hour or so once every couple of months. Many people can appear normal in a relatively scripted conversation for an hour, even if they have very serious cognitive issues. I know people who lost the ability to read books or to focus on a television show, people whose emotions were so deadened that they felt like they were p-zombies, people who couldn’t remember what had happened to them yesterday, people who could no longer connect effects with causes.

(All of my friends are quite young. A terrifying reality is that a doctor might notice medication-induced cognitive impairment in an elderly person and attribute it to the natural decline of old age. Doctors are aware of this, but as far as I know no one has a great solution to the problem.)

A friend of mine, Nicholas Rabinowicz, writes about his experience on antipsychotics:

A few years ago, I spent a week in a psych ward. While I was there, I was put on Risperdal. I was not told that it was an antipsychotic, or really anything else about it.
Within a couple days I started having near-constant headaches, but was told to stay on the medication and this side effect would eventually pass. (It stayed for the entire time I was on Risperdal.)

When I was discharged, I was able to look up Risperdal… and that was it. I could not read so much as a sentence at a time of the Wikipedia article on it. Someone else had to break it into smaller chunks for me, and this is how I finally learned that I was taking an antipsychotic.

I want to say that I then decided I had to stop taking it, but the truth is that I had already decided that when the headaches started. And I’m very lucky that I did, because without that I would not have been able to take actions to get off them. I was no longer capable of conceptualizing the idea that I could just stop taking them. I spent multiple months begging doctors to take me off them, and I was only able to do this because I had already been doing so when the cognitive effects started. Simply put, all I had on my side was inertia.

It was not until after I got off the medication that I was horrified at what had been done to me. I had not been capable of understanding until then. Everything except the headaches had seemed so normal.

This is a fairly typical example of what antipsychotic-induced cognitive impairment feels like from the inside.

And this is the real difficulty with cognitive impairment. Sexual side effects are embarrassing and uncomfortable to bring up, but they don’t make it impossible for you to notice the existence of sexual side effects. Cognitive impairment can and does disrupt the skills required to notice and take action about cognitive impairment: the memory that lets you realize that today isn’t just a particularly slow day; the meta-cognition that lets you notice that you’re not thinking the way you used to; the causal reasoning that allows you to connect it to your medication; the planning abilities that let you schedule an appointment with your doctor and complain; the feelings that make you believe that feeling like this is a bad thing.

I wish I had some recommendations for best practices to avoid this extremely terrifying outcome. Unfortunately, all I have is anecdotes, and I do not have an anecdote of someone who tried to notice cognitive impairment and succeeded. However, I would like to urge everyone– doctors and patients– to be more aware of the possibility of undetected cognitive impairment when people are taking drugs known to cause cognitive impairment.

Patients and loved ones of patients, be aware that the doctor may not tell you whether drugs cause cognitive impairment. Read the information that comes from the pharmacy carefully to see if there are any side effects that might disrupt your ability to notice side effects. If they do, ask your friends and loved ones to keep an eye out for uncharacteristic changes in behavior that might be a sign that you can’t notice whether your brain is working right.

If you are on antipsychotics, please send this article to a friend of yours right now, in case you fail to process your conclusions from the article.

Medical professionals, you are very plausibly missing a lot of very bad side effects of drugs! I am not sure what to do about this but I feel like it is worth trying to make you aware of this possibility.

Hugo Awards Finalists That Are Worth Reading

Short Story

Do Not Look Back, My Lion: A heartbreaking anti-war story, featuring lesbians and bizarre gender worldbuilding. This is what tragedy can be at its best: cathartic, transcendent, sublime. Highly recommended.

As The Last I May Know: The codes to use an apocalyptic superweapon are implanted in the heart of a child; to use them to defeat an enemy, the president must first kill the child with his bare hands. The story is told from the point of view of that child. I recommend setting aside some time to cry afterward.

And Now His Lordship Is Laughing: Horror-fantasy set during the Bengali famine, which is both a summary and a content warning. Reads like a particularly good The Magnus Archives statement, for those of you who are into that podcast.

Novelette

Omphalos: One of two stories Ted Chiang published this year! Set in a world where it is provably scientifically known that God created the world ex nihilo six thousand years ago; the worldbuilding is clever and well-thought-out, full of “of course it had to be that way” details. A profound and thoughtful exploration of finding meaning in a purposeless world. I broke down crying at the end.

For He Can Creep: A whimsical and charming story about Jeoffry, a cat who belongs to a poet, and his fight with the Devil in order to prevent the Devil from keeping his master from finishing his poetry. Jeoffrey’s voice is strong and clear, and the sentences are hilarious. If you like cats you’ll enjoy this one.

Novella

To Be Taught If Fortunate: Becky Chambers returns with another slice-of-life science fiction novella, this time set among some of the first astronauts traveling to exoplanets to explore alien life. Chambers is rigorously biologically accurate (at least to my layperson’s eye) and clearly fascinated by the details of biology. Plot happens– sort of– but Chambers is clearly far more interested in the intricacies of what it would be like to discover nonsapient aliens. If you prefer that your science fiction novels be mostly about what it implies about evolution that alien microbes use both chiralities, this will be up your alley. It also features some of the most stirring pro-space-exploration sentiment I have read this year.

The Deep: Adapted from clipping’s Hugo-nominated song of the same name. (clipping is Daveed Diggs’s band, and if you like Hamilton you should check them out.) If you enjoy a well-characterized autistic protagonist, a weird take on mermaids, and themes of remembrance of history in the wake of generational trauma, you might enjoy this. Unfortunately, strips out a lot of the Lovecraftian themes which I appreciated so much in the original song.

Anxiety is the Dizziness of Freedom: One of the two stories Ted Chiang published this year. As always, absolutely brilliant. A technology is developed which allows you to talk to versions of yourself who made one decision differently. Most of the book is devoted to the consequences of the technological development for society: support groups for people who found they made the wrong choice; the millions of dollars people are willing to spend on being able to see their deceased loved ones in alternate universes one last time. It concludes with a heart-warming affirmation of individual choice. Both Anxiety and Omphalos are much less depressing than usual Chiang and it is making me wonder if someone slipped him an antidepressant.

Novel

The City In The Middle Of The Night: My one-sentence summary is “YA dystopia but actually, like, good.” The character development is thoughtful and rich, and common dystopian tropes are subverted cleverly. Set in the twilight part of a tidally locked planet, the setting explores the concept of time. In totalitarian Xiosphant, everyone eats, sleeps, and works at the exact same time, or is severely punished for being late. In anarchic Argelo, you sleep and wake and work whenever you feel like it– or don’t. The alien species has its own unique relationship to time which I won’t spoil. The cities are richly detailed, with clever and true-to-life details, and yet the thematic unity makes it all hang together.

A Memory Called Empire: Written by a historian, and it shows. The Aztec/Byzantine mashup that is the Teixcalaanli Empire should not work as well as it does. The protagonist, Mahit Dzmare, is the new ambassador to the Teixcalaanli Empire. Like many people from her home, Lsel Station, she carries around the memories and personality of her predecessor in a device called an imago. But her predecessor’s imago is twenty years out of date– and he’s gotten up to a lot of shenanigans since then. If you enjoy political intrigue, rich worldbuilding, fast-paced and gripping plotting, people constantly quoting poetry at each other, and characters who arrange their elaborate betrayals to be a reference to classic epic poetry, you’ll like A Memory Called Empire.

Related Work

Becoming Superman: The serendipitous discoveries are one of the reasons I read the Hugo nominees each year. I would never have picked up J. Michael Straczynski’s memoir on my own, but it’s probably my favorite book so far this year. Straczynski was diagnosed with reactive attachment disorder after an astonishingly abusive childhood. His memoir is the story of a person in the general cluster B/CPTSD/reactive attachment disorder cluster striving to overcome the lessons he was taught in childhood in order to become a better person. (The better person is Superman.) I found it comforting, validating, reassuring, and hilarious; I recommend it to anyone in that cluster or who loves someone in that cluster. Also, frankly, it’s just great to see Straczynski live the dream by outing his abusive father as a literal Nazi war criminal. Vengeance is sweet.

Young Adult Book

Catfishing On CatNet: Cat Pictures Please is now a novel and it is every bit as good as the original short story. I assume this is a sufficient pitch.

Dragon Pearl: This is the first book I’ve read in the Rick Riordan Presents line, and it’s definitely making me want to check out more of them. Dragon Pearl is science fantasy in the best and goofiest way possible, a space opera set in a world where Korean mythology is literally true. The protagonist is a kumiho (fox shapeshifter) from a planet which is incompletely terraformed and therefore poor. At one point someone sabotages a spaceship by throwing things around to fuck up the feng shui. Yoon Ha Lee is writing for a middle-grade audience, which means that he has been forced to tone down his love of spaceship battles and only have a reasonable number.

Minor Mage: A classic Ursula Vernon story; if you like her (or Diana Wynne Jones, whom she’s typically very reminiscent of), I recommend checking it out. Oliver is a mage who has to go on a quest to end the drought, despite only knowing three spells, one of which unties shoelaces. Oliver wins through cleverness rather than through overpowering might. I particularly appreciated the harpist whose magic ability is to turn dead bodies into harps that play themselves and sing about who murdered them. He is so profoundly irritated about this state of affairs! I love it.

Deeplight: Once, giant Lovecraftian beasts– the gods– ruled the seas. A generation ago, all the gods died. Fifteen-year-old Hark, an orphan, grew up on an island with no advantages other than his ability to spin a clever story. Deeplight has Frances Hardinge’s characteristic twisty plot full of betrayal and intrigue, where you’re never quite sure who to trust. If you enjoy themes of body horror, antitheism, and emotional abuse in your children’s literature you will enjoy Deeplight immensely.

Poly ITT: Anti #15

1. Why do you believe what you believe? What would change your mind?

I think that pro-poly arguments often sound as though they should be correct, but their models tend to fail when confronted with actual humans.

As a very central example – it seems like poly people sometimes talk about jealousy as something of a brain bug, an irrationality, an unfortunate limitation to be worked around or fixed. But actually it follows pretty straightforwardly from the preferences that people tend to have about their relationships – in particular, the fact that people’s preferences about relationships tend to be positional: it’s not just that you want your partner to have a certain set of feelings about you and spend a certain number of hours with you each week and do some activities with them, you also want to be as important to them as they are to you; to speak crudely, you want to have as high a rank in their priority hierarchy as they have in yours. Usually you want to be the most important person in their life.

It’s not that poly people never have Most Important People – primaries are a thing – but when additional relationships are possible, it’s harder to maintain an equilibrium where both partners tend to put approximately the same amount of energy into the relationship. And in any case it seems that in practice people tend to have the specific positional preference that their partner should do romance and sex things ONLY with them. This isn’t a bug to be worked around, it’s a perfectly valid preference, the utility function isn’t up for grabs, and it’s generally unhealthy to try to make oneself be okay with things one is not actually okay with.

You could make the argument that having secondary relationships is no different than having friends, and abstractly it seems like that makes sense, but – in practice, romance and sex seem to be special? We see this in a lot of aspects of our society – humans have built up a lot of customs and norms around these things specifically. Sex actually isn’t just like everything else, it plays a particular role in our minds that can’t be abstracted away into “well it’s just like deciding to watch a particular TV show with just one person”. This is for evolutionary reasons which… don’t fully apply anymore given modern medicine and birth control and such, but (a) our brains are still profoundly shaped by those reasons, and (b) those reasons aren’t actually down to zero? We do in fact still get very messy scenarios around STIs and reproduction when multiple people are involved; I’ve definitely seen some which would have been much less bad or wouldn’t have happened at all without the polyamory.

I worry some about people deciding to be poly because it SEEMS like it should work, and then ending up in emotionally painful situations, trying to fight their natural inclinations, because it seems like they SHOULD be okay with their partner sleeping with someone else – there’s no law of physics or ethics they can derive that says it’s bad, so it should be okay, right? But this is a limitation of our knowledge of physics and ethics, not a true indication that it will in practice be okay – it usually isn’t, and fighting those instincts can be damaging to one’s self-trust and self-respect.

On a broader scale, I worry some about a world in which polyamory grows more popular and begins to impose its norms – not everywhere, not even in all of e.g. the US, that seems too remote a possibility to really worry about, but it seems not implausible that in coastal yuppy circles it will keep gaining popularity and normative force. Specifically I worry that – just as now it is (rightly) considered abusive to forbid one’s partner to have friends, in poly-normative circles it could conceivably become considered abusive to forbid one’s partner to have other partners. (Not that “forbidding one’s partner to have other partners” is really the right framing here, it’s a mutual agreement, but the analogous “I will only date you if you agree not to have friends other than me” is still bad.) I don’t think we’re anywhere near having such norms, but I don’t think this is outlandish to worry about; I do encounter people opining that polyamory is ethically better, and the arguments they make do seem to lend themselves well to being extended into a “monogamy is abuse” stance.

What would change my mind: hm, for one thing we need better research on this topic. But also, I guess, if polyamory stood the test of time and seemed to generally work for people? Inconveniently, to really evaluate it better we’d need broader social acceptance of polyamory, since otherwise this is hopelessly confounded (in both directions – on the one hand maybe if poly people are less happy this is because of societal stigma, on the other hand people doing a stigmatized thing tend to be pretty defensive about it and might not be fully open about its flaws), and also I’d want to see how things work out if a lot of people are poly for a long time. I personally don’t expect that this would work very well, and as such I don’t actually want this test to happen. But perhaps it will happen anyway, and then perhaps we’ll know more.

2a. A monogamous person has a crush on someone other than their partner. In a healthy relationship, what would happen next?

Generally you take steps to lessen the crush. Which notably does not mean that you should be ashamed of the crush or try to violently squash it down; trying to fight one’s emotions tends to make them worse. If having a crush feels shameful, you’ll avoid acknowledging it and taking steps about it until it’s grown to a point where you can’t possibly deny it but it’s also harder to deal with. Also, if you seize on any thought that might indicate a crush and worry that it means you’re being unfaithful, you are then dedicating MORE of your brainspace to those thoughts and training yourself to spend more time thinking about it! Whereas if your reaction is a quieter “oh, a thought”, it doesn’t have that effect.

You do want to avoid actively feeding the crush, though. This may mean spending less time around the person, depending on the situation; maybe if you usually hug them you might want to stop; if you notice yourself daydreaming about the person, maybe distract yourself with something?

I will note that I think crushes of a magnitude that is likely to be a problem are generally less likely to happen when you’re observing monogamy boundaries and generally happy with your relationship. Physical affection can feed crushes a lot; so can wishing/hoping/fantasizing, which you’re more likely to do if you don’t already have a relationship you’re happy with. If you’re not doing those things much or at all, you’ll be generally less susceptible to major unwanted crushes.

2b A polyamorous person has a date scheduled with their primary partner, but their secondary partner is in the hospital with an emergency and needs support. What typically happens next?

You go to the hospital, which is reasonable in itself; you’d also go if it was a good friend.

But it does matter, actually that it’s a partner rather than a friend. Your primary partner probably agrees that going to the hospital is the right move, but it doesn’t mean they can’t have feelings about it. Monogamy gives you a sense of security that of course this person is and will continue to be the most important person in your life; when you already lack that, even otherwise totally reasonable actions like “go support this person in the hospital” can ping an existing sense of jealousy/insecurity/unease. And then you may be having feelings about your secondary partner being in pain or in danger, which means you’re emotionally focused on them, which is also the kind of thing your primary partner might notice and be hurt by on some level even though it’s not at all unreasonable to have feelings about someone important to you being in the hospital. If it was just a friend, this would not matter nearly as much.

3. What would happen if 90% of people in a society were polyamorous? (You may assume they all practice one style of polyamory, or different styles.)

This is pretty hard to imagine because I think that the vast vast vast majority of people do better with monogamy, so it’s hard to imagine polyamory taking hold at the scale of an entire society.

I can imagine… oppressive setups that aren’t trying to satisfy most people? Like, men taking multiple wives in very patriarchal cultures – this makes sense if powerful men are in charge, the people hurt by this are primarily women and less powerful men. (Though I would argue that the powerful men with multiple wives are hurt too – they may be in charge, but they’re deprived of the chance to build an actually meaningful, equal, trusting partnership.) I don’t think this really counts as “polyamory” in the relevant sense, though.

I can also imagine certain pockets of society moving in that direction (hence my concern above that in social-justicey poly-heavy spaces it could come to be considered unacceptable to restrict one’s partner’s sexual and romantic choices). I don’t think this will sweep the world or even e.g. the entire US – I do think that monogamy generally works better by a wide enough margin that most of society would push back against any such pressures – but I could see this becoming normative in some circles.

What consequences can we expect in such circles?

There would be pressure for people to be more sexually available than they want to be. (We already see this effect for attractive young women in some spaces with poly or poly-like norms.)

There would be pressure for people to accept relationship terms they’re not actually happy with, because it’s considered unacceptable to want monogamy.

There’d be lots of complicated emotionally painful situations. For one – it definitely happens sometimes that – A (who is single) starts a relationship with B (who has a primary partner, C), because why not; the relationship wouldn’t have happened if they were monogamous, because B would already be taken, but it happening at all opens the door for A to develop strong feelings for B and then want them to themself, which is a recipe for lots of emotional pain – either they break off a relationship they really care about or they accept the indignity of being a less important person to B than B is to A, and they deal with jealousy on a regular basis, and all this is pretty bad for their self-respect. Or maybe B falls in love with A, too, and since that’s where their attention is going this causes them to grow more distant from C, and C suffers a slow-motion heartbreak that nobody can quite acknowledge because B is still dating them, right?

In the same way that people sometimes pay lip service to other unreasonable-as-stated ethical principles while in practice conducting their lives in a more reasonable way, I suspect that in such a culture there’d be couples that end up being monogamous in all but name. They’d be like, oh yeah we can love whoever we want, and maybe occasionally they’d make out with someone at a party or something, but on some level they’d realize that it would not actually be good for their relationship if they branched out more than that.

(And then one day one of them would get drunk while hanging out with someone they’re very attracted to, and think, well, I have the freedom to do whatever I want, right? and they’d sleep with them – and you’d think that without monogamy rules “cheating” wouldn’t be a thing, but emotionally it would be just as much a betrayal, except maybe worse because they don’t have the language for it or a known framework to understand it in, and the one who “cheated” would also feel betrayed because their partner is so unreasonably and unexpectedly upset with them, and it would be SUCH a mess.)

It’s not that there would be zero positive aspects to such a world. It’s true that people would get to explore their sexuality more and have some good experiences they otherwise wouldn’t. But this would be accompanied by lots of emotional pain, and for the vast majority of people I think it would also limit the maximum depth and trust that relationships could reach.

It’s like – if you really love microbiology, and also you really love ballet dancing, and also you really love astrophysics… you can try spending significant amounts of time on all of them, but that will severely limit how much you’ll accomplish in any given field. Whereas if you specialize, you will lose access to some of the things you enjoy, but you may be able to get really good at your specialty and become a respected professional in that field.

This analogy is imperfect in a few ways. For one thing, some people prefer not to specialize; they’ll do whatever for their day job, and in their off hours they’ll dabble in a bunch of different hobbies, and they won’t be an expert at anything but they’ll enjoy themselves and that’s valid. But while people do tend to value being good at something, the kind of depth of mastery that you get when something is your life’s passion is…. important to some people, but not anything like a universal need. Whereas the need for a deeply committed loving partnership where you fully trust each other and make each other your top priority and make a major effort to avoid hurting each other is – nothing is truly universal given human psychological diversity but this is pretty damn close. So norms that make that harder to achieve are pretty bad.

Also – you could be an astrophysicist and do ballet on the side, and this will limit how good you are at ballet but you probably won’t hurt your astrophysics work this way and you probably won’t accidentally fall in love with ballet so much you abandon astrophysics. But if you have a committed long-term partner, and you have a hookup buddy on the side, you may well hurt your partner, and you might fall in love with your hookup buddy and mess up your relationship that way.

My point here is – yes, you lose something when you decide to be monogamous, but you also gain something, and the thing you gain is in general way more important to human psychological health than the thing you lose.

Poly ITT: Anti #14

1. Why do you believe what you believe? What would change your mind?

You know the weirdest thing to me about this whole contest, about the entire framework the questions were asked in?

It doesn’t say a single word about kids. Not a question. Not even an optional prompt. The framing assumes an attitude towards relationships that is wholly foreign to me, and one I confess I don’t like: a focus on relationships as emotional support for the partners involved more than as a deliberately restrictive structure designed to create a healthy environment for future children. The level of attention paid to sex in conversations like this is similarly odd to me. Yeah, it matters, but there are so many more important things to talk about in my eyes.

I run the risk of coming off as a crank conservative here, I know. I won’t waste time establishing my liberal credentials. I grew up embedded in a traditional religion, and even though I left it and can now be fairly categorized as a secular liberal, liberalism is a second language to me. Its defaults are not my defaults. I know exactly how well my defaults worked for the people in my life. I recall two times in my life I saw my parents fight, neither at all serious. It just didn’t happen. I can count on one hand the people I knew until my mid-teenage years who didn’t come from monogamous, two-parent homes that at least looked healthy from my angle. And the whole while, I read online and noticed a) that the rest of society made fun of our approach, and b) that the rest of society seemed to have deep-rooted dysfunction, completely foreign to me. Because of this, every time someone proposes that those defaults are wrong and something else is better, I take a lot to be convinced.

As a gay man myself, I’m not going to tell anyone they can’t live in the way they feel is right for them. In particular, I think thoughtful, smart, pro-social people can make just about any arrangement work, and polyamory is hardly the strangest or most difficult. But positive structures are hard to create and easy to destroy, and entropy always looms. No matter how sincere and careful the people spreading the norms are, if those norms hint at hedonism, ease, and lack of structure, those are the parts most likely to trickle down and gain mass hold. A few happy, functional, pro-social polyamorous couples–stable, nice, and I wish them the best. A widespread norm of polyamory, though, is something I would expect to encourage a focus away from families as restrictive societal building blocks to relationships as hedonistic fulfillment of personal pleasure. Those two goals both have positive elements, but they are always in tension, and I value the first and want to live in a society that values it as well. This can be partially reduced to a tension between breadth and depth. By analogy, experts in a field can access aspects of human experience impossible to amateurs, and longtime residents in an area will build connections, memories, and understanding that necessarily elude tourists. An individual has plenty of depth, and long-term relationships offer an opportunity to build each other and raise others in a way that is fundamentally inaccessible with flings. This isn’t impossible in polyamory, but I believe it is more likely for someone focused only on depth to find the value there than for someone torn between breadth and depth.

Changing my mind here would mostly require seeing social scientists in the field landing on answers that contradict their own biases. I’m continually frustrated when I jump into social science research, see it reach a conclusion that strikes me as alien and bizarre (like “religious conservatives have higher divorce rates than others”), then dive in and realize the data says basically the opposite but the researcher massages it until they can technically get something that, if you squinted, looks like it supports their claim. Real example! I’d want to see socially conservative researchers find positive (or non-negative) social effects from polyamory before shifting my expectations substantially–or at least a project with a credible social conservative voice attached, even if they weren’t spearheading it. On a personal level, I see nothing that would convince me polyamory was right for me. It’s a firm dealbreaker.

2. Responses to scenarios

The prompt lists a number of scenarios, where all of the answers boil down more-or-less to “be generally decent and communicate openly.” Partner is jealous in a monogamous relationship? Talk through it. Affirm your commitment to them. Be trustworthy and trust them back. Have a crush on someone other than your partner? Well, committed love is hardly about crushes. Mention it if you feel the need, but if you’ve reached the point of serious monogamous commitment, you should have a lot more than a crush attaching you to your partner, more of a willingness to mutually build meaning than straightforward romantic feelings. Not that the romantic feelings for each other shouldn’t be cherished and sought after, but they’re just not the point.

In polyamorous relationships, I expect there would typically be similar open conversation in the case of something like an STI or tension between metamours. People are people. Most are decent most of the time. It would occasionally cause tremendous drama, and I expect one of your partners hating another would often lead to one breakup or another if they saw no way to make amends, but mostly it would just be the sort of hurdle that crops up naturally and can be dealt with reasonably in a relationship. And a date versus a hospital visit? Really, I’d be shocked if I had a friend in the hospital who needed focus and my partner wanted me to put a date above that. Given a closer relationship, the decision for both should only be clearer: visit the other partner in the hospital, find another time for the date. I would only add that time-dividing like that is part of the breadth-depth tradeoff I mention above, but in a case like that it’s not more than a passing concern.

3. What would happen if 90% of people in a society were polyamorous? (You may assume they all practice one style of polyamory, or different styles.)

If 90% of people in a society were polyamorous, the main difference I would expect is a massive nosedive in the number of children around. I’m also reminded of an xkcd comic I’m sure every polyamorous person is tired of seeing. People are complicated. Sex is complicated. Adding more people and more sex makes things more complicated. Society as it stands is already much more focused on sex than I’m natively used to, but I do expect that depth of focus on sex would increase given more polyamory. Many would prefer that, I imagine. I personally wouldn’t. The same goes for a broader feeling of hedonism. Since one-man, many-woman polygamous structures have proven viable long-term, I imagine looser polyamorous ones could find some sort of equilibrium as well, but I admit I have a hard time picturing a 90% polyamorous society not either shifting in the direction of de-facto monogamy or simply collapsing and reorganizing out of necessity.

Polyamory ITT: Anti #13

1. Why do you believe what you believe? What would change your mind?

My beliefs are based on a combination of experience and values.  In my opinion, the ultimate goal of a relationship is marriage.  Not the legal sense, but in the full “two people making a lifetime commitment to become a single unit based on their love for each other.”  I have been lucky to grow up around many marriages like this, and I’ve made it a goal for my own life.  That kind of marriage is a powerful thing, and a society made up of marriages like that would, I believe, have superior outcomes to any other society.  That kind of marriage also takes work, years and years of work, but the greatest rewards require the greatest investments.I understand that many people may not value the same things that I value, but to me choosing to pursue relationships with no long-term potential is similar to choosing to live in your parents basement and play videogames all day, instead of getting a job and supporting unhealthy for the individual and the society that they belong to.  This is a case of “the whole is greater than the sum of its parts.” Poly relationships…just seem like parts.

A consistent pattern of poly marriages lasting 20 years or more would make me change my mind. I have never heard of a poly group that was truly long-term in the sense of being able to raise a child.  Obviously a large number of vanilla heterosexual marriages fail too for all kinds of reasons, but as far as I can tell the failure rate for poly relationships is 100%.

2a. A monogamous person is jealous of their partner (for example, because they’re afraid their partner has a romantic interest in someone else). In a healthy relationship, what would happen next?
In some situations jealousy would be a valid response, e.g. if their partner was actually interested or having an affair with someone else. But since you specified a healthy relationship, we can assume there is no basis for the jealousy. Therefore, the next thing would be for the jealous partner to communicate their concerns, and together find a way to address them.
2b. A monogamous person has a crush on someone other than their partner. In a healthy relationship, what would happen next?

That person takes steps to distance themself from their crush.  Like the old story about “two wolves in side of you” the feelings fade away if they are not fed.
3. What would happen if 90% of people in a society were polyamorous? (You may assume they all practice one style of polyamory, or different styles.)

The notion of exclusivity in a relationship would disappear, followed by the notion of commitment. Relationships would become ephemeral–instead  of having partners for life, people would just have a list of whomever they happened to be sleeping with at any given time.  Additionally, without the focus on monogamy and commitment, there would be little appreciation for the work that goes into maintaining a healthy relationship.  Instead of encouraging one’s partner to grow and address their defects, the incentivized behavior would be to simply find a new partner.  Such a society of adults may be able to function well enough, but such a society could not provide a consistent environment for children to grow up in, and as a result a society like that could have no future.

ITT Poly: Anti #12

  1. Why do you believe what you believe? What would change your mind?

Bringing up children is a core task of a family unit. I would go so far as advocating that this is the sole rational foundation for the legal privileges usually granted upon marriage: the state has no reason to favor one relationship type over another just because the people involved have (or are thought to have) sex with each other. I believe that current secular norms regarding “no-fault” divorce or the non-stigmatization of non-marital cohabitation have (in spite of their proponents earnest desire to prevent tragic situations) set in motion (or at least greatly increased) social changes that ultimately resulted in the increase of the prevalence of children being raised in single-adult households, which naturally burden the “single-adult” and are strongly correlated with increased poverty and with the lack of opportunity for parent-child interaction and the child’s intellectual and social development.

From my limited readings, I got the impression that polyamorous relationships entail a very fluid understanding of the obligations of one member versus the other(s), going as far as requiring one member to not merely tolerate but to positively cherish the others’ outside romantic attachments as one important part of the partner’s “self-actualization”. I cannot see how this emphasis can be harmoniously combined with the ensuing likelihood of looking at each of one’s present attachments as intrinsically temporary , and I believe this is likely to result in much less stable arrangements and a less well-defined set of obligations towards the child.

I would change my opinion if, in a carefuly controlled study (or as controlled as feasible in the social sciences), polyamorous relationships were shown, across all social classes (though especially in lower SES) to:
A) not increase average, median or first-decile child poverty, <18 yo delinquency rate
B) not decrease children’s average, median or first-decile academic scores and mental health/social adjustment scores

2. A monogamous person is jealous of their partner (for example, because they’re afraid their partner has a romantic interest in someone else). In a healthy relationship, what would happen next?

A loving and frank conversation should ensue to understand why one partner fears abandonment or why the other is tempted to look elsewhere for the fulfilment of their romantic needs. Ideally, both partners should strive to understand the source of their feelings and work on improving mutual displays of affection/care.

3. What would happen if 90% of people in a society were polyamorous? (You may assume they all practice one style of polyamory, or different styles.)

I think that the loosening of sexual mores has made it more difficult for people with less sex-drive or who (due to philosophical/religious reasons) value chastity to compete for partners. This also has consequences in people (mostly women, due to their average lower libido) , whose interests in “going slowly” are now no longer as culturally supported , and who now may feel more pressure to engage in a sexual relationship before they really feel comfortable with that step. Likewise, I expect that, if 90% of the population became more comfortable with the idea of non-exclusivity, the remaining 10%, as well as the “bottom-half” of desirability distribution will become more handicapped in their quest for romantic fulfilment due to “prime mates” no longer having to (overtly) “settle” for one partner. Less extrovert/”sex-appealing”/etc. men and women will find themselves socially pressured to accept a “lesser role” compared to their partners’ more numerous relationships, and this may cause resentment. I do not claim that the total amount of romantic/sexual resentment will be larger than that in our present society, but I do believe that the resentment will be “re-distributed” in ways that do not strike me as socially advantageous. Nowadays, introverts/high conscientiousness individuals (both men and women) who are willing to devote themselves to a stable relationship for the sake of a larger social purpose (supporting their children and partner through thick and thin, for example) do have some expectation (when in a stable relationship) of being “rewarded” with increased romantic/sexual opportunities. If they are, instead, placed in a position where, in spite of their pro-social (but not “sexy”) qualities, their partners are encouraged/expected to spread their love around, their incentives will change and they will likely feel exploited and feel that society, as a whole, does not care about their needs and that pro-sociality is a fool’s game.

Poly ITT: Anti #11

  1. Why do you believe what you believe? What would change your mind?

I believe that monogamy on the whole leads to stabler relationships and healthier people.

Having monogamy as a societal norm gives a baseline expectation for relationships, and societal norms around it. If someone is married (or in a significant relationship) society holds certain expectations of them. If they are seen to be in a different relationship, it’s clear to anyone who knows them that they are in the wrong. This protects members of society that have less social clout from being taken advantage of, or being neglected, and encourages stable relationships.

Childrearing is one of the most important functions of society, and closely tied to monogamous relationships. A monogomous relationship gives the security and permanency needed to the incredibly difficulty time consuming act of raising children by increasing the cost of leaving a relationship and encouraging stability. With only one partner, monogamists have more time to focus on each other and their children. Having stable, healthy, engaged, and permanent relationships is essential for raising healthy and resilient children. I don’t mean that polyamorous relationships can’t raise healthy children – of course they can! – and conversely there are many failed monogamous relationships that had disastrous effects on children – but a societal norm for monogamy provides a bulwark and support to permanency for the purposes of raising children

Lastly, and perhaps counter-intuitively, polyamory is limiting. Polyamory encourages couples struggling with issues to avoid confronting their own problems and instead to seek out others as solutions. The security of a monogamous relationship provides fertile ground for a couple to grow and work together to better themselves, looking inward rather than outward for fulfillment and satisfaction, rather than looking for other people to meet their needs.

To change my mind I would hope to see evidence that polyamory can not only be successful, but can be successful across all strata of society. I would want to see evidence that polyamory doesn’t lead to less stability and poorer outcomes for children, and that i t leads to increased satisfaction in relationships for all partners.

2. A monogamous person has a crush on someone other than their partner. In a healthy relationship, what would happen next?

In a healthy relationship, they should acknowledge their crush. If it is someone unattainable (eg, a celebrity), it can be joked about. If it is someone seen often (eg, a colleague), they should be careful not to put themselves in a position where their partner would have reason to doubt their faithfulness. Likewise, the other partner should be confident in a healthy relationship to not be concerned or jealous.

3. What would happen if 90% of people in a society were polyamorous? (You may assume they all practice one style of polyamory, or different styles.)

I would expect to see a divergence in society – for some polyamory would produce healthy, successful relationships. Others would be left behind. Some of those wanting monogamous relationships would be unable to find partners. Still others would be in less fulfilling relationships and would struggle or be unable to grow. Fatherhood would take on a lesser role; with increased breakups the norm for children to stay with their mothers would also increase (and the knock-on effects that would bring). I would expect a polyamory norm to benefit those with power in society (and in particular, men) at the expense of those without societal clout (and especially women), as the socially powerful would have more say in defining their relationships, and the socially weak to feel an even stronger pressure to yield to others’ desires.

Poly ITT: Anti #10

1. Why do you believe what you believe? What would change your mind?

First, what I believe is this: there’s a Laffer-type curve for monogamy, and Western society is on the left-hand side of it. That is, individuals and society would benefit if more people formed monogamous relationships. There is probably a point at which there would be “too much monogamy,” but we’re not at it.

The people I know who are most interested in polyamory are high-intelligence, slightly eccentric types. And they are the people I’d most like to see form monogamous partnerships and start families. That’s not a preference based on eugenics. It’s a preference based on my observation that high-intelligence, slightly eccentric types make great couples, provide good environments for kids, and improve the communities around themselves.

I’ll allow that there are people for whom polyamory can “work,” and I don’t want to go around telling people how to live their lives. But if a friend asked, “should I get into polyamory?” I would strongly advise them against it. It’s not that I’d judge them harshly if they did; it’s that I want to “preach what I practice.”

What would change my mind? I’m open to evidence from either direction. If we find that places with less or decreasing monogamy start looking like great places to move – i.e., they are safe, have vibrant economies, and good schools – then I’ll happily start promoting non-monogamy. Similarly, if we find that places with more or increasing monogamy start looking like bad places to move, then I’ll update my model.

2B. A monogamous person has a crush on someone other than their partner. In a healthy relationship, what would happen next?

The monogamous person would sigh a lot, listen to music about unrequited love, pace back and forth aimlessly for hours, and eventually get over it.

Harsh, I know! But there are lots of things that one can (a) want, and (b) be better off without. Temptations are everywhere, and romantic ones aren’t particularly special.

That said, I have sympathy for people with crushes. Crushes are really intense – I’m still bruised by ones I had as a teenager! Getting over them isn’t easy, and I wouldn’t wish the experience of having a crush while in a committed relationship on anyone.

(3) What would happen if 90% of people in a society were polyamorous?

In my “Laffer-type curve” model, I think the optimal amount of polyamory is something like 5 to 10%. Enough that most people know some polyamorous people, and enough that people for whom monogamy doesn’t work have an alternative. But 90% is way past what I would want to see.

What happens on the left tail of the monogamy curve? I don’t think it’s a parade of horribles; I think it’s a subtle shift to a slightly worse society. Fewer stable households, fewer kids, less long-term investment. I don’t mean to imply that poly people can’t or don’t put down roots; I mean that in a 90% poly world there’s less incentive to do it (even for the 10% minority).

Put more viscerally: The 90% poly world is one in which every place is San Francisco (the city proper, not the greater SF area). There’s nothing necessarily wrong with the people there, but it has lots of obvious dysfunction and correspondingly few households with kids. I might live there if I have to for work, but I’d want to get out as soon as possible.