Envy Up, Scorn Down: How Status Divides Us

Professor Susan Fiske wrote in this 2011 book:

* Walking down a dark alley, you spot an approaching figure. What is the first thing you want to know? If you are a sentry, you cry out, “Halt! Who goes there? Friend or foe?” You need to know the stranger’s intentions, for good or ill. If the person seems to be on your side—a friend—you assume that the person is trustworthy, friendly, and sincere. If the stranger seems like a foe, however, then you probably do not assume that the person has those warm traits, and indeed you may wonder whether the person has some bad ones besides. We decide who is on our side by knowing who intends to cooperate or compete with us—that is, who has goals compatible with ours and who has zero-sum goals.

After inferring the stranger’s intentions, you will want to know whether he or she can enact those intentions. After all, why does an angry bunny matter (except in the Monty Python killer-rabbit episode)? If the stranger can act effectively, his or her intentions will matter to you. Curiously—and this is the key point—we decide who matters, that is, who deserving poor. The tensions generated by these distinctions have always occupied center stage during election years, but increasingly they pervade our society as it becomes ever more class-divided. The gaps between the top and bottom parts of the income distribution are wider than ever. We have become segregated by social class almost as much as by race, and because social class prejudices are less taboo than those based on race, religion, and gender, we often express social class biases without a second thought. What is more, the latest research reveals that status prejudices of all kinds—not just social class but any status dimension that pits people against each other, one up and one down—are prevalent and persistent in our society. All these observations underlie this meditation on comparison and how it divides us.

After inferring the stranger’s intentions, you will want to know whether he or she can enact those intentions. After all, why does an angry bunny matter (except in the Monty Python killer-rabbit episode)? If the stranger can act effectively, his or her intentions will matter to you. Curiously—and this is the key point—we decide who matters, that is, who can act effectively, by knowing their status. Worldwide, people believe that high status confers competence (hard to believe sometimes when we consider some of the buffoons in charge.2) But in theory and usually in practice, we believe in meritocracy and think that other people generally deserve what they get. All over the world, high-status people, those who hold down prestigious jobs and have achieved economic success, are assumed to be more competent than low-status people.

* People Get the Class They Deserve

It is our national orthodoxy that America is the land of opportunity. According to a pivotal survey by James Kluegel and Eliot Smith, Americans’ stable consensus endorses an opportunity syllogism:

(a) Assuming equal opportunity, then

(b) people get what they deserve, and

(c) the system is fair.

* “The rewards…in this life are esteem and admiration of others—the punishments are neglect and contempt…. The desire of the esteem of others is as real a want of nature as hunger—and the neglect and contempt of the world as severe a pain as the gout or stone.”

—John Adams, Discourses on Davila (1805), 341

People are obsessed by admiration and neglect, envy and scorn, the world over.

* While few of us are driven to burgle our neighbors, let alone the waitress, each of us is caught between those whose position we envy and those whose situation we scorn. We are comparison machines.

* Envy: I Wish That I Had What You Have (And That You Did Not)

Psychologists agree, notes Richard Smith, that envy combines hurt and anger.64 A long-standing expert on the subject, Smith explains that a person who feels envy is experiencing an illegitimate threat to a deserving self.65 The experience of illegitimacy provokes anger, and the threat to self creates hurt. Envy homes in on disadvantage. As Gerrod Parrott notes, envy involves seeing that another person has something you want and wishing that person did not have it because their having it makes you feel inferior.66 Envy can be malicious when it focuses on taking something away from another person, not just obtaining it for yourself. Wanting to damage the privileged other person is the essence of envy because the envied person causes your disadvantage. Consider that paragon of envy, Shakespeare’s Iago. Bypassed for the coveted post of Othello’s lieutenant, Iago develops a deadly envy that catalyzes his revenge on Othello, his wife Desdemona, and his aide Cassio.67 In wreaking havoc, Iago does not even wish to have Desdemona for himself but instead wishes to deprive Othello of her. Envy thus has both a passive side (longing) and a potentially active side (aggression).

* envy is pervasive precisely because all social systems entail inequality. Envy endures because social systems endure. As Molière observed, the envious will die, but never envy.70 Envy survives even in our own allegedly classless American society. All kinds of social systems, not just our equality-oriented one, must condemn envy to keep the peace.

* Envy is not jealousy. A jealous person fears losing a cherished personal relationship to a rival. Jealousy is more intense and more acute than envy because personal attachments change faster than the social system does. To be jealous is often to feel afraid, worried, threatened, rejected, suspicious, or betrayed, whereas the envious person more often feels inferior, ashamed, frustrated, bitter, or deprived…

* The flip side of envy is scorn. Otherwise known as disdain, contempt, or disrespect, scorn is rarely studied, probably for two reasons. When we envy someone else, we are usually aware of it and ruminate about it; our envy bothers us. We are often unaware, however, of scorning others; precisely because scorn is thoughtless, it often does not bother us. Psychologists most often study what bothers them, and being people, they are more bothered by envy than by scorn.

Another reason psychologists do not study scorn is that it is often a matter of neglecting and ignoring someone. “Silence is the most perfect expression of scorn,” claimed George Bernard Shaw, who would know.74 Scorn is the absence of respect, a lack of attention, a failure to consider. A failure to acknowledge another person provides evidence of scorn. In a famous story entitled “Silver Blaze,” Sherlock Holmes solves a case that hinges on “the curious incident of the dog in the night-time”: when a watchdog fails to bark at an intruder, Holmes deduces that the criminal must be the dog’s owner. In a variant on this absence-as-evidence, not only would a scornful dog not bark in alarm, but a scornful dog also would not even wag its tail in recognition.75 Scorn is known by what it fails to do.

* Comparison Corrupts

Keeping up is exhausting, and keeping others down has its own costs. Keeping up entails either emulating the trendsetters (benign envy) or, our issue here, slowing them down (malignant envy). To keep others down, you must suppress them so that they know their (inferior) place. Neither process is good for your health, not to mention the health of your target.

* Powerful individuals frequently fail to be compassionate in dealing with others.81 For example, power increases exploitation, teasing, stereotyping, and even sexual harassment. Power-holders treat others instrumentally.

* Power and status are always accompanied, however, by the risk of developing a scornful insensitivity to subordinates as power-holders control them, derogate them, fail to individuate them, and undermine their agency, all the while being self-serving and instrumental.87 Recent studies show that people induced to feel powerful develop deficits specific to understanding others’ emotions and thoughts. They fail to identify others’ emotional expressions, to consider others’ perspectives, and to appreciate others’ knowledge. Such disregard for people raises the disturbing possibility that power inhibits our ability to see others as fully human entities possessing minds; that is, power may allow scorn.

Consistent with this suggestion, people often view social out-groups as less than human, a scorn-filled judgment if ever there was one. The emotional logic runs like this: we are more human than they are because we have a more complex inner life. As Jacques-Philippe Leyens and his collaborators have shown, we more readily see the in-group as experiencing subtle, complex, uniquely human emotions such as love, hope, grief, and resentment.88 Out-group members—people unlike us—seem to experience only the same simple, primitive emotions that animals do (such as happiness, fear, anger, or sadness). Viewing “them” as feeling momentarily sad but not deeply grieving over the loss of family members, for example, makes it easier to avoid worrying about their misfortunes. This infrahumanization dynamic dampened empathy in the Hurricane Katrina debacle. Generally, white and black observers reported the other-race victims as experiencing less of the uniquely human emotions (anguish, mourning, remorse). To the extent that observers did perceive those emotions, however, they were more likely to offer help.89

Certain forms of social power reduce our ability to understand others’ inner experiences (thoughts and feelings), thereby reducing our capacity for empathy and resulting in scorn directed downward.

* You are most likely to seek a proxy when you need to predict your own performance, such as deciding whether to join a hike. A quick ability assessment predicts your fate.11 If the proxy is similar enough, you can project yourself into his or her boots and decide accordingly.12

Gossip creates a kind of virtual proxy: a group of people collectively try on someone else’s shoes. Gossip is, in effect, collaborative social comparison. People often assess themselves by talking about others. In some estimates, most adult conversations concern someone who is absent from it.13 People gossip with similar others about someone they agree is dissimilar. For example, an urban writers’ colony filled with distinguished social scientists often spent their communal lunches discussing—not great ideas—celebrity sex scandals. Such gossip is evaluative talk about an absent but relevant other. The celebrities were relevant because everyone knew about them and because their failings were all too human. Groups use gossip to bond and to communicate norms—that is, prescribed and proscribed behavior.14 And gossip is useful. Because gossip tells stories about people, we enjoy and absorb it better than we do abstract admonitions. Stories about people allow us to learn the easy way, by someone else’s example. Gossip not only informs us but connects us. We feel close by agreeing about a third party.15 The third party becomes a shared proxy for vicarious learning.

“The couples we knew were also aging…and paid rising taxes and suffered automobile accidents and midnight illnesses and marital woe; but under the tireless supervision of gossip all misfortunes were compared, and confessed, and revealed as relative.”

* In daily life, we all too easily blame the powerful. To explain their financial challenges, low-wage workers blame powerful institutions, such as government (blamed “some or “a lot” by 74 percent) and corporate America (64 percent), at least as often as they blame themselves (63 percent) and far more often than they blame fate (29 percent) or discrimination (30 percent).109 Many of us blame the political system for the gap between low- and high-income Americans (63 percent).110 Feelings about inequality poison trust, and loss of trust, in turn, undermines participation in the local community.111 Blaming the powerful arguably undermines our feelings of control, a loss that is well known to jeopardize health. Envy endangers the envious.112

Envy expert Richard Smith and his colleagues convincingly detail a “witch’s brew” of ways in which envy may make us sick.113 First, frustration is a component of envy, which is all about unresolved wanting, with an overlay of felt injustice. Giving in to the tendency to dwell on such grievances can undermine our well-being. Second, envy is self-destructive in that resentment, shame, and hostility can motivate us to hurt others, even at the risk of harming ourselves. For example, some people are willing to forgo personal profits if they can bring down the target of their envy. Third, envy damages close relationships that might otherwise provide an antidote to misery. Envy makes us feel inferior and probably prickly about receiving help or expressing gratitude.

Added to all these psychological risks is the totally scary low-status syndrome. Low status demands a vigilant attention to those with higher status, and this vigilance compromises health. Here’s why. Single-shot, acute reactions to temporary threats benefit from the body’s short-term stress responses, which ordinarily calm down after the danger has passed. If the body’s stress system stays on prolonged alert, however, as it does for people who are constantly vigilant, mental and physical health are damaged.114

As it keeps the nervous system on alert, with downstream risk to the cardiovascular and immune systems, vigilance becomes costly. Low-status people incur the costs of vigilance for good reason. People are chronically watchful when their lives feel out of control. Indeed, this is the cost of being lower in the hierarchy and looking up all the time at those who control one’s fate. Consistent with this analysis, men’s social class predicts their heart disease risk; in pathbreaking work, Michael Marmot and his colleagues, surveying the Whitehall sample of British civil servants, show that the risk rises with the experience of not having enough control at work.115 Besides lack of control as a risk factor, negative emotions are implicated in this finding, because resentment, hostility, anxiety, hopelessness, and cynicism (emotions related to envy) underlie the harms wrought by loss of control.

* Much as Americans may resent their elites, Americans themselves are the elite of the world.

* “The rewards…in this life are esteem and admiration of others—the punishments are neglect and contempt…. The desire of the esteem of others is as real a want of nature as hunger—and the neglect and contempt of the world as severe a pain as the gout or stone.”

—John Adams, Discourses on Davila (1805), 341

People are obsessed by admiration and neglect, envy and scorn, the world over. We are divided from each other by the often correlated differences between power (resources) and status (prestige).60 Elites within the United States and Americans in the world evoke envy and run the risk of scorning those who are less well off.

More generally, people in positions of power are vulnerable to neglecting those with less power. People without power, in contrast, focus closely on the powerful but may resent them. Just how do human beings understand the thoughts and feelings of other people who have more or less power? Does empathy allow us to understand and appreciate others despite the separations caused by individual, group, and national power differences? And when do power differences damage empathy and cause us to dehumanize each other? When do we scorn those below us and envy those above us? And what happens between us when we do?

In “The Housebreaker of Shady Hill,” John Cheever describes Johnny Hake, a Westchester resident with a cash-flow problem. Just laid off and totally broke, he “had never yearned for anyone the way [he] yearned that night for money.” He envies and resents his wealthy neighbor (“rich…the kind of man that you would not have liked at school. He has bad skin and a rasping voice and a fixed idea—lechery. The Warburtons are always spending money, and that’s what you talk about with them”). After lifting Warburton’s loaded wallet, Hake scorns a coffee-shop customer who pockets the previous customer’s thirty-five-cent tip (“What a crook!”).61 While few of us are driven to burgle our neighbors, let alone the waitress, each of us is caught between those whose position we envy and those whose situation we scorn. We are comparison machines.

Even dogs know when another dog is getting something they themselves deserve.

* What about envy, which is directed upward? While being envious of high-status, allegedly exploitative people might not seem important, in fact our feelings toward higher-status groups and individuals can catalyze a volatile mix of reactions toward those we grudgingly respect but dislike.

In Haslam’s system, a unique kind of dehumanization targets envied groups: they are denied the typically human attributes, such as warmth and sociality. These cold but effective out-groups are likened to robots. Perceived as threatening because they seem like automatons, out-groups dehumanized in this way are not so much disgusting as chilling. Think cyborgs. Businesspeople and their paraphernalia, from briefcases to suits, are associated in our minds with automatons, from androids to software.104 On the downside, we link both businesspeople and robots to being cold, conservative, heartless, and shallow, though we acknowledge that they are also organized, polite, and thorough. What both CEOs and computers are not is typically human: curious, friendly, sociable, and fun-loving.

In our own work we have found that members of ethnic groups who succeed as entrepreneurs (Jews, Asians) and subordinate out-group members who succeed as professionals (middle-class blacks, career women) fall into this ambivalent space, eliciting envy and resentment. Society views them as sacrificing their humanity to get ahead, a finding that parallels the chilling cyborgs of Haslam’s system. In surveys, people report that members of these groups—often seen as rich—are cold but competent.105 These particular out-groups also provoke more envy than other groups do. People in the lower right part of the BIAS Map are allegedly not on our side, but their competence makes them threatening (see figure 1.7).

The volatility of our mixed reactions to envied groups is dangerous. Envied groups are especially targeted when we make the common assumption that they are conspiring. All too often we assume that the powerful are in cahoots to carry out their dangerous intents, that they are all of one evil mind. Recall that canard, “the Jews control the banking industry.” In one study, Eric Dépret and I simulated a situation in which those in power hold all the cards and they all hang together, so that one feels helpless to influence them. In this scenario, undergraduates came into a study where they could earn money for their performance under the distraction typically inflicted by roommates. The distracters had either more or less power (they could interfere a little or a lot), and they came either from one college major (they were in cahoots) or from several majors (they were unlikely to conspire). Faced with a uniform bunch of high-powered math majors, psychology majors felt more unhappy and threatened than they did when dealing with a motley high-powered group comprising a math major, an art major, and a business major.106 They perceived high-status outsiders as having minds, but cold, calculating, threatening, conspiring minds. In the worst case, such a perception would justify the elimination of a high-status group as a threat to “us.”

* When envy entails anger and resentment, it harms the envied other. At a societal level, people who report both envy and anger toward privileged groups also report a greater tendency toward harming them.107 At the individual level, envied out-groups are subject to schadenfreude (malicious glee at their misfortunes) and aggression.

* THE SIGNS of envy and scorn are everywhere because the vertical dimension is everywhere. The vertical dimension, “ambition’s ladder,” is a necessary part of any human system. Group-living animals all have hierarchies. Even chickens have pecking orders. Coordination demands it. Stability demands it. Adjustment demands it. Despite the corrosive side effects of envy and scorn, our social systems require status differences. So we know them when we see them.

Yet envy and scorn embarrass us. We hesitate to admit feeling them ourselves, whether privately or publicly. When I tell people at parties about this book project, they are intrigued, but they rarely volunteer a personal story about envying or scorning someone. Nobody wants to own these reactions. It is as if we define and conjugate the verb “to compare” thus: “I evaluate, we measure, you judge, and they obsess.” What seems useful in the privacy of our own minds often seems pathetic or despicable in other people. So how do we detect these comparisons that none of us admit to making?

* status-competence is one of two immediate priorities in first impressions (the other being cooperation-warmth). One of the first things we seek to know about other people is whether they can act on their intentions. Our research shows that competence-status is one of two fundamental dimensions of social cognition, and our research is not alone in this conclusion.1 Data from Europe indicate that the status-competence dimension accounts for nearly one-third of the action in our first impressions of people.2 So all of us are alert to the relative status and presumed (in)competence of other people from our first encounter with them.

Whenever groups gather, some people soon rank higher than others.3 This happens because groups spontaneously award status.4 The natural leaders seem best at representing the group’s shared values, so they appear to be the most competent and expert, resolving uncertainty. Thus, they influence others and control incentives; they provide reassuring structure and predictability. This happens even in social groups, but more openly in work groups.

We seek to meet a variety of needs, besides earning a living, when we go to work. These needs include wanting to belong to a group and wanting some predictability and control over our lives within the group. These prediction-control needs arguably are best met in a hierarchical organization. According to Deborah Gruenfeld and Larissa Tiedens, status is crucial in all organizations, despite the easygoing management fashions of the twenty-first century.5 As groups of groups, organizations cannot coordinate their activities or motivate their members without granting some groups and individuals more power and value than others. Every known organization has a vertical dimension, according to scholars who have searched for an organization without one. When organizations form, status spontaneously emerges. We tend to prefer organizations that have a consensus about who ranks above whom. What is more, once established, status systems perpetuate themselves, justify themselves, and legitimate themselves.6 Hierarchy seems inevitable and even useful.

If we so relentlessly demand hierarchy, our brains must be wired for it.

* Individuals Mind Their Goals Through Envy and Scorn

Consider first our individual selves. Emotions inform our priorities by alerting us when a personal goal needs attention, and they help us maintain those priorities—by tracking not only our goals but our efforts to meet them. For example:

• Feeling guilty reminds us to make amends.

• Feeling jealous suggests that a relationship needs work.

• Feeling angry alerts us that we have been wronged.

• Feeling afraid focuses the mind on coping with a threat.

• Feeling happy signals that salient goals have been met.

Envy and scorn are no different from other emotions. Both envy and scorn identify a gap between what we have and what someone else has. “Envy is ever joined with the comparing of a man’s self; and where there is no comparison, no envy,” Francis Bacon observed.37 Scorn likewise compares self to other, with self coming out on top. Feeling envious signals inferiority; feeling scorn signals superiority. In envy, we might wish to attend to the gap, either bringing the other down (malicious envy) or bringing the self up (benign envy). As an example of malicious envy, we show schadenfreude while watching the hedge fund manager’s encounter with dog feces—or billionaires stubbing a toe or sitting on chewing gum (figure 2.6)—by the subtle activation of the smile muscles in our cheeks (figure 2.7).38 Schadenfreude especially results from envy when the other is similar enough to us to offer a personally relevant social comparison.39 Feeling resentful, angry, or wronged all predict schadenfreude.40 We really mind the gap.

* stigma by association arises even when a normal-weight person is merely next to an obese person.41 No surprise, then, that we tend to avoid other people with a bad reputation or simply an unattractive appearance—to avoid being tarred by the same brush.

* Envy and scorn interrupt other ongoing activities to alert us to the risks we run by not living up to a salient standard (envy) or by surpassing someone else and needing to maintain that distance (scorn). Envy and scorn as emotions signal the importance of social-comparison goals. Emotions get more complicated when we move outside the mind to face the other person, but we are rigged to manage that as well.

Partners Coordinate Through Envy and Scorn

We are interpersonal comparison experts. When we encounter another person, we rapidly judge the other person’s dominance or status.43 This creates a face-to-face comparison; envy and scorn may follow. How could automatic comparison possibly be useful to the encounter? Would it be better not to rank ourselves all the time? Maybe. But social-comparison emotions do inform partners about each other’s intentions, allow complementary behavior, and allow each partner to control the other’s behavior.44 The envious partner pays attention, and the scornful partner need not. Both envy and scorn allow the partners to make efficient assumptions that grease the social wheels. However, the coordination benefits differ on either side of the divide. What is good for the greater is not good for the lesser.

For the high-status person, both the comparison itself and its public nature generate pride.45 Pride is a self-focused emotion that tends to ignore other people. (Inattention, remember, is an element of scorn.) As the research of Dacher Keltner and his colleagues on interpersonal power shows, most powerful people are confidently cheerful because one’s own power feels good. For example, people express positive feelings in discussions with their romantic partner if that person recognizes them as powerful, or even when they are randomly assigned to be powerful.46 When people have the advantage, they feel capable of overcoming challenges and are confident they have the inner resources to meet the demands of threat, uncertainty, or effort.47 Henry Kissinger famously quipped that power is the ultimate aphrodisiac, but because many people seek power and dominance simply because it feels good, perhaps power has benefits even beyond the bedroom.

Dominance not only allows us to have positive feelings about ourselves but also creates negative feelings in us against others. When high-status people feel on top of the world, they are more likely to express anger and disgust (cousins of scorn and contempt).48 A furrowed brow indicates anger, and anger in turn signals dominance without any softening affiliation.49 In one demonstration of this, undergraduates viewed three dozen photographs of faces expressing a variety of emotions (anger, fear, disgust, happiness, sadness, neutrality) and rated each one on thirty-two personality traits. The traits fit into two basic dimensions and certain emotions convey certain personalities. Expressing anger and disgust (scorn!) toward someone else, for instance, suggests a dominant personality devoid of affiliative orientation (table 2.1).

Expressing anger not only implies ruthless dominance but also gains the advantage in negotiation against a weaker partner.50 Contempt subordinates, rejects, and excludes other people.51 Scorn signals the freedom to look down on others, so in that perverse way it serves the power-holder.

What could possibly be useful about the other side, the envious feelings that come with disadvantage? Presumably, none of us like to come out on the bottom of a comparison in an everyday encounter. And videos of our facial expressions reveal that we especially mind someone else doing better if the arena is relevant to us and the other person is close to us.52

The litany of discomfort is familiar to us all. If we are low status, public comparison makes us ashamed, a feature of envy.53 Similarly, we feel bad if our romantic partner has power over us,54 and our self-esteem suffers as a result.55 When we are at a disadvantage, we often feel threatened, which can make us judge that we have insufficient resources to meet the threat.56 In light of all this, how can feeling hopelessly one-down in social-comparison encounters possibly be useful?

Apparently, even shame, envy, inferiority, and threat are better than uncertainty, chaos, and conflict. Interactions are predictable when one partner agrees to be subordinate and the other is dominant. Sometimes surrender is better than a fight, and one way we communicate our subordinate status is by the emotions we express. When we express fear and sadness we come across as subordinate, not just in the moment,57 but as a character trait.58 The subordinate emotions trigger several ways of giving up: doing nothing if we are sad, running away if we are fearful, or feeling small if we are ashamed.59 All of these subordinate responses show how emotions can communicate lower status in a moment.

Emotions determine fates beyond the moment. Some facial expressions seem permanent, such as the face of someone who always looks innocent just because of having a face with the wide eyes and arched eyebrows of surprise (see figure 2.8). We are so sensitive to emotional cues of rank that we infer subordinate status even in people who are simply endowed with a sweet baby-face, regardless of age. We interpret facial immaturity, femininity, and weakness to mean subordinate status.60 Thus, we pick up even unintended emotional cues.

* Just as individuals track their goals through their emotions and partners track each other by reading each other’s emotions, so do groups manage their collective goals, and their members, by using group emotions.62 Gandhi notes that powerful groups scorn a rebellious minority by ignoring them and laughing at them before fully engaging them. In a more everyday example, we gossip not just to differentiate ourselves from the victims of our gossip but to connect with our co-conspirators. In social talk, group members bond when they share feelings about third parties.63

Through group-oriented feelings, the group extends the self. 64 As Eliot Smith, Diane Mackie, and their colleagues note, people incorporate the group into themselves, so they react emotionally on behalf of their group. Maybe the group itself does not literally experience emotions, but people report emotions they feel as a group member. (“As an American, I feel proud.” “As a Republican, I feel angry.”) These group-oriented emotions, distinct from a person’s feelings as an individual, depend on identification with the group and its shared values. If our cherished group is low status, we feel low status as a group member, and we experience the attendant emotions on behalf of our group. So, too, with high status. Our tribe’s place in society determines collective emotions, including envy and scorn.

* Why do people even care about a rival’s matchup with a third party? The philosopher Friedrich Nietzsche argued that the pain of own-group inferiority directs the mind to the substitute pleasure of out-group failure.66 Maintaining loyalty to our own group, in the face of demoralizing low status, works better if the members of our group can share anger about our rival’s allegedly illegitimate victory.67 Shared resentments cement group membership. We understand each other because we all hate “them.”

What is more, we are virtuous in direct proportion to the evil of our rival. Indeed, people who are highly identified with their group readily detect injuries to their group, reacting protectively and viewing group insults as self-relevant.68 This fits the Smith-Mackie idea of incorporating the group into the self. Loyalists who feel that their group is downtrodden put down the out-group in turn and discriminate against it.69 This can benefit the injured in-group, elevating collective self-esteem (members’ feelings about the value of their group) as well as the individual self-esteem of its members.70 For example, Jolanda Jetten and her colleagues studied people with multiple body piercings, a group whose members often feel stigmatized by mainstream society. The more a pierced person feels discrimination, the more strongly that person identifies with the in-group and the higher his or her feelings of collective self-esteem.

Besides organizing between-group relations, emotions also stabilize status within the group. Just as partners coordinate their relative status by expressing appropriate emotions, so people coordinate status within groups. Leaders are allowed to joke and laugh and to show anger and contempt, whereas followers may not show these emotions; however, followers may show shame, fear, and embarrassment.71 When employees mock their employer in public, the enterprise is doomed. Well-functioning groups apparently favor the emotional certainty of shared goals, clear boundaries, and stable hierarchy, despite the negative emotions that may be experienced by those lower on the totem pole. Individuals join groups in the first place partly to feel more certain and secure.72

Cultures Regulate Themselves Through Envy and Scorn

There is yet some good in public envy, whereas in private, there is none. For public envy, is as an ostracism, that eclipseth men, when they grow too great. And therefore it is a bridle also to great ones, to keep them within bounds.

—Francis Bacon, “Of Envy” (1597)

Francis Bacon observed that the threat of public envy could contain high-status people. Cultures can also regulate people through the threat of scorn. In this sense, both scorn and envy are moral emotions, distinguishing the cultural right from the cultural wrong. Again, people usefully tune in to envy and scorn in the service of cultural regulation.

Psychologists have rarely studied scorn, but they have thoroughly studied its cousin disgust and, to some extent, contempt. Disgust is clearly a moral emotion.73 When people break a taboo, other people judge them by saying, “That’s disgusting,” a real conversation stopper. In some circles, “nasty” implies either mean and cruel or gross and disgusting, so immoral behavior is nauseating. Disgust rejects, excludes, and repels. Our disgust toward some people signals that they have breached a sacred taboo, dirtying themselves, endangering sanctity and purity. When we admit feeling disgust toward homeless people and injection-drug users, we are reacting partly to the image of these people as contaminated, both morally and physically.74 Disgust announces that the culture excludes such people from full humanity. Moreover, our desire to avoid disgusting other people is a powerful incentive to avoid disgusting, immoral behavior.

* The groups that people prefer, in order to reduce uncertainty, are cohesive, solid groups with boundaries and homogeneity.

Such groups share defining beliefs and values, including what it means to belong and who is an ideal member. The most prototypic members become leaders partly because they make everything seem so certain. Leaders represent the group prototype; they are its icon. As a result, two cognitive processes are triggered. First, group members believe that the leader possesses the appropriate traits that represent the group. At a minimum, they believe that this individual is competent and able to act for the group’s shared goals and values, whatever those may be. Different settings require different traits in effective leaders (consider the commander in chief versus a group therapist).98 Naming someone a leader typically makes group members believe that the leader symbolically represents the group’s shared characteristics.

The second cognitive process associated with leadership is attention: people attend up.99 Attention follows power, perhaps partly out of admiration and emulation, but also out of need and envy. Attention provides details (accurate or not) about leaders. We view the powerful as fascinating individuals; they are somebodies worthy of our attention. Attention can increase our own sense that we understand what the powerful will do and how we might influence them.100 Attention provides us with that sense of certainty.

* Apart from static comparisons that embody status, we also enact status whenever we meet. Status allows us in our daily encounters to coordinate with each other without fighting it out. Status uncertainty would make these interactions stressful. Instead, we implicitly agree on who is higher and who is lower, and that being settled, we can get on more effectively. Synchronized, reciprocal signals coordinate the status dance.

* While talking, people use speech styles to signal dominance. Dominant speech is confident, direct, rapid, articulate, abundant, blunt, and standard speech.111 In the movie Matilda, Agatha Trunchbull, the domineering headmistress, illustrates many of these features when she dresses down Matilda’s father, himself no shrinking violet:

“WORMWOOD!!! You useless used-car salesman scum! I want you around here now, with another car! Yes, I know what “caveat emptor” means, you low-life liar! I’m going to sue you, I’m going to burn down your showroom, I’m going to take that no-good jalopy you sold me and shove it up your bazooka! When I’m finished with you, you’re going to look like roadkill!”

Dominant people use other tactics besides verbal bludgeons. When given a chance to act, powerful people act more than they deliberate, and they make changes, especially toward personal goals.113 Talking and acting indicate power. The lack of all these cues signals a willingness to be subordinate.

* In conversation, higher-class people disengage more, self-groom, doodle, and fiddle; they also engage less, failing to look, nod, laugh, or raise their eyebrows to indicate interest. These cues both reflect self-reported social class and predict perceived social class background. Of course, clothing reveals social class as well. Although the more obvious cues may be designer suits versus grubby denim, more subtle cues involve what Paul Fussell describes as “legible clothing”—T-shirts with writing or, slightly less low, anything that features the maker’s logo. Another memorable low-class signal is what he terms the “prole jacket gape”: an ill-fitting suit will have a gap at the back of the collar.118 Money buys understated, tailored attire.

* Society also requires that lower-status people cooperate with the higher-status people they may envy. Ongoing transactions demand that subordinates go along to get along, a kind of passive accommodation and association, according to our surveys. Higher-status groups control resources that lower-status groups need, so lower-status groups accommodate themselves to what they cannot change, when times are stable.

Nevertheless, envy produces mixed and volatile behavior. Consider the case of outsider entrepreneurs, such as Asians and Jews in diaspora. Historically, they have tended to set up successful businesses. In quiet times, lower-status groups put up with and even defer to these high-status groups, shopping at their stores, acknowledging though resenting their success. But when the chips are down, when society is destabilized, these groups are the first targets of mass violence, looting, and genocide. Examples of entrepreneurial outsiders turned into victims include the Koreans in the Los Angeles riots of the 1990s, the Chinese in Indonesia, the Indians in East Africa, the Tutsis in Rwanda, and the Jews in Europe. All were integrated into their host societies but were targeted for mass violence under social breakdown. Genocide often targets a formerly privileged out-group.

* status anxiety derives from a variety of common experiences, such as feeling unloved, having unrealistic expectations, endorsing meritocracy, fearing snobs, and being dependent. For almost all of us, our well-being is contingent sometimes on other people’s love, expectations, judgment, respect, and power, and this can make us feel insecure.

* Even though it is not the single most important source of their self-esteem, men’s self-esteem hinges more on social comparisons than women’s does (see the first columns in figure 3.2.).37 Men are more likely than women to value “doing better than anyone else at something that is important,” “thinking about how your skills and abilities compare to other people your age,” and “thinking about how well people your age perform tasks you must also perform.” Perhaps because men are—both stereotypically and in actuality—more openly competitive than women are,38 men define themselves more than women do in terms of independence and agency, that is, being effective in the world.39 The ability to be effective depends on knowing how others are doing, so it makes sense to compare. Men’s tendency to compare and compete stems as much from internal as external ideals about what defines the male role.

As the stereotypical relationship experts, women care more than men do about so-called reflected appraisals—how other people view them (see the third columns in figure 3.2).40 Women are more likely than men to value “having others think of you as a good person”; “getting praise from someone like a teacher, boss, parent, or older sibling”; and “having your friends, co-workers, or teammates recognize you’ve done a good job.” Having your well-being contingent on others’ opinions, as noted, undermines self-esteem. For example, an important dimension for women when they compare themselves to other people is appearance, especially their bodies. For women, this kind of social comparison predicts dissatisfaction with their own body.41 An entertaining if tangential example comes from my experience with a visiting colleague known for his exceptionally tailored and elegant appearance. Feeling suddenly shabby, I retreated to the women’s room, only to discover two female colleagues likewise repairing their appearance. The situation was especially odd because our colleague was gay; we were trying to meet the high standard he set, not trying to attract him.

* Conservatives prefer assurance, and liberals like novelty… Conservatives protect the in-group, whereas liberals promote equality between groups. Conservatives seem to specialize in the in-group, avoiding risk, endorsing hierarchy, preferring tradition, supporting familiar values, and prioritizing family allegiance.

* Social ties predict happiness and well-being better than almost anything else does.107 People are so sensitive to ostracism that they immediately feel crummy even when strangers leave them out of a computer game.108 The neural pathways for social pain parallel those for physical pain.109 And physical pain diminishes when we make social connections, from looking at a partner’s photograph to receiving social support from just about anyone.110 Tylenol cures both physical and social pain.111 As an improvised cure for social pain, people spontaneously engage in “social snacking” by seeking human images and surrogates. Even a volleyball on a desert island in the movie Cast Away becomes a friend named Wilson.112

People are no fools to fasten onto social connections. Social isolation endangers health, threatening the immune system, cardiovascular system, and health habits.113 Negative emotions, including loneliness, may damage immune functioning by inflammatory processes often associated with cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain cancers, frailty, and functional decline.114 Social support helps people survive heart attacks.115 Social ties also correlate with longevity, even controlling for physical health, smoking, alcohol use, obesity, activity, class, age, life satisfaction, and health habits.116

* We may protect ourselves from envy either passively or actively as well—passively, by downplaying our good fortune to prevent envy, and actively, by inviting others to join us. In many cultures, people publicly minimize their good fortune, abundance, and fertility. They may conceal or deny having what others covet. When hiding fails, people may undermine envy by sharing their good fortune in an effort to placate other people or even the gods.

* “For me they normally happen, these career crises, often, actually, on a Sunday evening, just as the sun is starting to set, and the gap between my hopes for myself, and the reality of my life, start to diverge so painfully that I normally end up weeping into a pillow…. I’m mentioning all this because I think this is not merely a personal problem. You may think I’m wrong in this. But I think that we live in an age when our lives are regularly punctuated by career crises, by moments when what we thought we knew, about our lives, about our careers, comes into contact with a threatening sort of reality.”

—Alain de Botton, “A Kinder, Gentler Philosophy of Success” (2009)

WE ALL need to know where we stand, especially in those “moments when what we thought we knew, about our lives, about our careers, [our relationships, our appearance, our health] comes into contact with a threatening sort of reality.” Life requires that our self-view at least approximately fit our reality, not to mention our hopes. Psychologists know a lot about this. One major reason we compare ourselves with others is to gain information in order to evaluate and improve ourselves, functions that serve the twin motives of prediction and control. Comparison informs us.

Our need to understand (and perhaps control) our fate runs deep. We are healthier and happier when we think that we know who we are and where we stand. Self-knowledge adapts us to navigate our days, from the minor level (“Do I wake up easily?” “Am I a good tennis player?”) to the major (“Do I get along well with my patchwork family?” “Do I reliably meet my work deadlines?”). Evolutionary psychologists argue that a self-concept serves our survival needs because it helps us not only in planning our own actions but also in coordinating with others.1 How could we know whom to join and whom to avoid without knowing who we are? How could we know what role to play when we do join others? How do we know what we can and cannot do if we do not compare our abilities to others? How well we get up, get by at tennis, get along with others, or get things done—all of these are relative judgments. Whether we should be the local alarm clock, tennis partner, family mediator, or group motivator depends on our abilities relative to those of others who are available.2 Other people serve as a reality check on our abilities (“I may be better than most people at getting up without an alarm clock, but I know where I stand relative to others as a tennis player, and it’s not good.”).

Having information allows us to predict what will happen, and that is a comfort. By and large, we do not like surprises, at least not the ones that come without party hats. Even more, we would like to be able to control what will happen, or at least understand the contingencies between what we do and what we get. We like to know about upcoming parties, raises, lay-offs, proposals, and babies; also, we prefer to have some say in these events. What is more, the illusion of information and control—as long as it is not too far from reality—matters more to us than its accuracy.3 That is, many of us tend to overestimate our own knowledge and influence, which reassures us that the world is not random and that what we do makes a difference. At a minimum, we like to believe that a trusted someone is in control, whether that someone is our president, our tech support, or our god. Indeed, some researchers suggest that our persistent religious beliefs stem from a need for at least vicarious control.4 Our motives for seeking prediction and control are among the most basic to our survival as social creatures.5

* People need information to evaluate and control their fates, to handle the times when, as Alain de Botton put it, “the gap between my hopes for myself, and the reality of my life, start to diverge so painfully” (2004). Sometimes we cannot close the gap with information, so we become skillful at the mental gymnastics of protecting self-esteem (chapter 5) or take refuge in our most comfortable and familiar in-group (chapter 6). Comparison operates in accord with the dictates of both the rational mind and the emotional gut.

* We practice some Olympic-caliber emotional gymnastics to protect and promote our fragile selves. That is, we choose our comparisons—self now to self earlier, self to other—in ways that protect our self-esteem.

* One strategy is self-comparison. We compare the new, improved self with our old, discarded self. As Anne Wilson and Michael Ross put it, we go “from chump to champ,” at least in our own stories.

* we craft our history by locating, constructing, and valuing events to minimize the awkward and accentuate the flattering. The past is our personal historical fiction that gives a pleasing but plausible account of who we are.

For the self at center stage, the future looks lovely. We fully expect ourselves to go from winner now to even more wonderful ever after. Our cheery optimism about ourselves qualifies as a positive illusion.9 Optimism motivates, persists, improves, and encourages, at least in the short run.10 Of course, unrealistic optimism, fantasies, and downright narcissism are not helpful. Pleasant fantasies, for instance, allow unproductive daydreaming, whereas optimistic expectations motivate effort, which makes them a self-fulfilling prophecy, in Robert Merton’s felicitous phrase.11 In life domains as varied as pursuing a crush, acing an exam, seeking a job, or enduring hip replacement surgery, we do indeed do better when we concentrate on the odds of doing well. Fantasies promote inaction, but high expectations motivate action.

The future self motivates us, and we value the future more than the past.12 Self-esteem depends on the future self more than on the past self because the future is elastic, while the past is rigid.

* Besides our hopeful prediction that good events will prevail over bad ones, we expect more sheer drama than we get. That is, we expect our future windfalls to delight us more and our future tragedies to devastate us more than they actually do. We overestimate both the intensity and the duration of our emotional reactions to events. We do this mainly by focusing on the anticipated event and neglecting everything else that will be going on at the same time—that is, the simultaneous events that will tend to dampen the main event. If we break a bone, it will indeed be horrible, but our partner, our job, and our friends will distract us from the mishap. Also, we will cope better psychologically because we will adapt faster than we expect. We especially exaggerate the expected devastation that will be caused by negative events; in fact, most of us are more resilient than we would expect. In short, we adapt faster than we expect especially to misfortune.16 Overall, when we compare our present self to our past self and our future self, we are motivated, more than the facts justify, and in spite of our admission that the past was cloudy, to forecast sunny if variable days ahead.

* Like the award-winning but modest real estate agents, we groom our image, if only to avoid potential resentment. Peer hostility is real. Malicious envy punishes the standouts with gossip, backlash, and revenge. High performers know this and often feel ambivalent about their awards. Psychologists used to call this feeling “fear of success,” one explanation for which is the tension between getting ahead and getting along with others.26

Besides genuine fears for self and other as separate individuals, enviable people worry about their relationships. More than one academic superstar has recounted not wanting to share their success stories at home for fear of straining rapport or escalating conflict. At class reunions, most people do not start conversations by reciting their résumés, and not without reason: a swelled head ensures retaliation by or ostracism from work teams and friendship networks. Our cultural axioms record these tendencies: “Tall poppies get mowed down”…“Nails that stick up get hammered”…“Pride goeth before a fall”…“Putting on airs invites puncture.” Moreover, cultural rituals enact these beliefs—for example, in an American celebrity roast. Under older Japanese business norms, a salaryman could disrespect his boss without consequence when both were drunk. In Hottentot traditional culture, the hunters could urinate on the most successful.27 American summer camps symbolically do the same in a skit that mocks counselors (preferably in late August). Social comparison creates interpersonal tensions that high achievers manage as best they can.

* The opposite of dismissing someone is to merge with that person. Envy can transmute into inspiration. A superstar becomes a role model if two conditions are met. First, we must believe that we have the opportunity to follow the person’s success, and second, we must believe that talent can grow, that it is not fixed.

* People who are feeling low (depressed, low self-esteem, bad mood) can especially benefit from downward comparison.38 Downward comparison reduces regret, for example, among older people.39 Considering “what might have been” also improves mood and motivates us to try again, if we can.40 In these ways, downward comparison can encourage some of us, some of the time.

* people at the top do not derogate others nearly as much as those who are trying to distance themselves from the heap into which they fear falling. Downward comparison is at best a short-term coping process, not a long-term strategy. Better long-term strategies maintain optimism, feelings of control, and adequate self-esteem. These strategies, in turn, encourage us to cope actively, seeking support from friends and family and not avoiding the issues.46 These personally oriented strategies rely less on social comparison—which typically preoccupies people with vulnerable self-esteem—and more on personal standards, which aid self-improvement as well as self-enhancement.47

To go back to the section title, scorn’s “no harm, no foul” happens in two ways. True scorn (self-protective downward comparison) says, “If I am feeling threatened, I am doing this to help myself, not harm you, so why do you care?” Neglect scorn (simple inattention) says, “No offense, but I’ve got my own work to do, and I am not actually busy looking down on you, so relax.” Either way, personal scorn may be less of an issue than worse-off friends fear it is.

* Illusions also benefit physical health.58 In particular, optimism predicts immune response, and even unrealistic optimism protects health.59 Relatedly, finding meaning in illness can slow disease progression as people compare their past self with their present and future selves. The acutely ill frequently report that their diagnoses set their priorities straight, making them cherish their closest relationships, appreciate their advantages, and value each day for itself. Several physical health benefits result from such realizations. Emotional well-being improves immune function and reduces other medical complications. Hope and calm raise the odds of maintaining healthy habits, and pleasant, upbeat attitudes attract support from friends and family. (Misery may love company, but company does not love misery.)

* our assumptions about the world are shattered by trauma.66 Most of us believe that the world is generally meaningful and benevolent and that we ourselves are worthy. Random injury and unexpected illness endanger those ground rules. Our psychological work as victims of these events requires that we rebuild our positive assumptions. To survive and thrive, we need to believe that the world is somewhat predictable and controllable, that we ourselves are basically good, and that we are securely attached in our relationships.

* We need our relationships, and we like to think that we are big enough to celebrate the successes of our friends and partners, but human nature interferes with the best ideals. Envy and scorn especially plague us when we are already downhearted. And when we are insecure in ourselves or in our relationships, we make ourselves more miserable by making intimate comparisons. As we have seen repeatedly, people who are unhappy or suffering from low self-esteem are more likely to seek comparison—downward comparison in particular.

* Turning malicious envy (“You shouldn’t have it”) into benign envy (“How can I get it too?”) is a more plausible strategy, although in attempting to inspire the downhearted (“You, too, can succeed”), the envied person could end up delivering a condescending insult. Still, as the last chapter showed, most of us are motivated to compare slightly upward, in the service of self-improvement, and so the envied person can try to persuade the envier to switch from a social comparison (you versus me) to a temporal comparison (your current self versus your future self).

Affirming the other is probably the most effective strategy, if it is sincere. Someone suffering by comparison can learn to accept that feedback after having a positive self-concept affirmed in another domain.94 People who are told that they have tested high on social skills and ambition then readily admit that an extremely attractive peer is in fact more attractive than they are. Because people can also control their own defensive responses by affirming themselves as a good and worthy person, perhaps the envied can mimic this by affirming the envier’s value.

Probably the most effective way to defuse envy is to become one with the other. If self and the enviable other overlap, the comparison evaporates. Close relationships researchers Art and Elaine Aron and their colleagues show that relationships thrive when people incorporate the other into the self.96 Overlapping the self with the other also facilitates empathy, of both the cognitive sort (understanding the other’s pain) and the emotional sort (feeling the other’s pain).

But we cannot merge with everyone. Simply trying to be likable as well as enviable undercuts the competition and encourages mutual cooperation. Sharing, as in holding a fiesta to spread the wealth, eases the tension. Claiming, as one award-winner did, that the individual recognition is “good for our tribe” places self and other on the same side…

* We compare partly to protect our fragile selves. Most of us compare our flawed past self to our new improved present self. Some of us maintain relationships by being sensitive to how we threaten others with our superior accomplishment. We change our own envy to inspiration, we shift our standards, and we use downward comparison to emphasize how much worse it could be. These are the self-protective mental gymnastics we practice with our comparisons, both up and down, to maintain our health and our homes.

* ARISTOTLE WAS among the first to tell us that we are profoundly collective beings. We prefer to be included: “We’d love you to join us” may be one of the most compelling human appeals. As chapter 3 noted, we have good adaptive reasons to be with others: we survive and thrive better if we are social than if we are isolates. Exclusion literally pains us, so to avoid being shunned, we aim to fit in with our own in-groups.1 Comparison facilitates our belonging because it shows us where we stand both within our groups and where our groups stand relative to other groups. Comparison between groups can be especially vicious, so envy and scorn between groups can be correspondingly brutal, as examples in this chapter will show. As group members, our first loyalty lies with our own group because we need it so much.

We may want to be individually distinctive, but not at the price of sacrificing membership in at least one worthwhile group that will have us, so we go along to get along.2 Our attunement with our own groups shows up in social contagion of all kinds, most immediately in emotions and perceptions.3 We imitate each other’s nonverbal behavior.4 Especially if anxious, we copy each other’s facial expressions and emotions.5 In fact, we unconsciously mimic even politicians’ facial expressions on television, which explains the electoral success of more than one warm, expressive, incompetent doofus.6 Not just our emotional contagion but our conformity to our groups is legion. We will even distort the evidence before our eyes, objective perceptual judgments, to fit in with a group.

* Conformity also shapes life-or-death decisions and outcomes, including those that affect our health. For example, binge-eating spreads through sororities: sorority sisters compare themselves with each other to gauge just the “right” amount of bingeing that correlates with popularity.8 Networks spread health habits and health standards across three degrees of separation; the obesity of your friend’s friend’s friend correlates with your own.9 In the decades-long Framingham Heart Study, investigators asked participants to nominate someone who would know how to reach them if they moved. Their nominations, the nominations of their nominees, and so on down the line, created networks of health influences.

* Nietzsche argued that inferiority promotes impotence: being bested makes a person feel helpless and hopeless. 2 Rather than take it out on ourselves, we find it far more soothing to blame someone else. Inferiority-based anger focuses on the fortunate precisely because facing our own shame is so intolerable. 3 And rightly so, for nothing is scarier than wounded pride: violence commonly erupts from threatened egoism, especially from an insecure egoist. Directing anger outward lets us avoid focusing on our own humiliation. 4 Comparisons thus lay the ground for violence because coming up short can be made the fault of someone else—or so it seems.
Small wonder, then, that both enviable and scornful individuals are unsettling. An enviable person makes everyone else feel inferior, but at least that agony is private. In contrast, a scornful person reveals our alleged inferiority, expressing our worthlessness. Both envying from below and being scorned from above trigger anger and humiliation… In either direction, enviable and scornful people provoke anxiety and insecurity.

* The specific costs of inferiority include public indignity and private humiliation. People care when both their public face and their private self-esteem are threatened by coming out on the bottom. And those who feel for any reason vulnerable are likely to be the most unsettled by the threat of inferiority.
On the other hand, it is famously lonely at the top. The specific risks of superiority include public embarrassment at being singled out and the private ruination of peace of mind and personal relationships. Many enviable people worry about other people’s reactions, namely, about the envy and resentment of other people. Privately, they may feel guilt or doubt about their position. The resentments of lower-status people may ruin their enjoyment of their position. Or lower-status people may bring down the elite, inadvertently by hard-luck contagion or purposely by demanding a share.

* Envy and scorn are reciprocal: the envied are supposedly competent, whereas the scorned are not supposed to possess much ability. The envied are supposedly coldhearted, but some of the scorned may be nice, at least those whose low status is not their fault. Why are these differences considered costs if each side gets at least some credit—ability, on the one hand, and niceness, on the other? We saw in the last chapter that high- and low-status groups divvy up the images, with high status claiming competence and low status claiming warmth. Why is this a problem if both sides agree on the division of assets?

* Assuming that elites are competent might seem a benign expectation, one fully in keeping with our collective faith in meritocracy, except for one thing: by linking status and competence, we too often make the reciprocal assumption that non-elites are stupid. And lower-status people rightly resent the implication of that expectation.

* We assume that high-status people are competent but not nice when we are comparing groups or individuals. 9 We all have a theory that smart people are cold, and that warm people are not too bright. It is unsettling to face an enviable (smart, high-status) person, because our default assumption is that this person is not on our side. So being one-down requires us to face not only our private envy, resentment, and humiliation but also the other person’s probable scorn, neglect, and even boasting.

* Low-status people have to be vigilant for another reason: from the position of the bottom looking up, status often correlates with power over resources, making their welfare contingent on the goodwill of those above them. 11 The superior’s intentions matter a lot to the subordinate: if the boss is with you, great; the boss can help you get where you want to go. If the boss is not with you, you cannot predict help from that quarter, so you have to keep an eye on this person.

* people can overcome their schadenfreude-glee by learning more about the other person. An investment banker who has been laid off but who keeps up appearances by commuting, with his briefcase, to Starbucks to search the want ads seems pathetic. If the same fallen master of the universe volunteers to advise and do pro bono bookkeeping for small business start-ups, he seems admirable.

* We cannot help ourselves. We have to compare because we are wired that way, as chapter 2 argued. Our brains are alert to upward comparisons, with the discrepancy-monitoring anterior cingulate cortex and the person-analyzing medial prefrontal cortex coming on line to react rapidly. Our brains respond to downward comparisons by activating systems consistent with disgust and other emotional arousal (insula). And when we can feel superior to those below us, the brain’s VS (ventral striatum) reward system lights up. Comparisons signal status via the envy and scorn emotions that alert us, and then our cognitive systems explain why we are feeling that way, up or down. Our behavior expresses those comparisons by revealing whether we feel larger than life or cut down to size. Still, being hardwired does not explain exactly why comparison happens—just partly how it happens. More reliable predictors of comparison fallout come from heeding other people’s insecurities.

Everyone engages in comparison, but some do it more than others, as chapter 3 indicated. This gets us partway to why. People who are individually oriented to social comparison lack self-confidence. They are people-oriented but also self-aware, even self-conscious. In the extreme, they are neurotic and unhappy—in a word, insecure. But an insecure personality alone does not predispose a person to making comparisons: only when feeling unhappy and out of control is the insecure person especially likely to obsess about who is above and who is below.
Not all lack of confidence is about anxiety, of course; sometimes we are simply uncertain and need to know more in order to compete effectively. This may be the reason for men’s greater tendency to compare, because male gender roles reward competitors. Women tend to prefer connection, which can be endangered by comparison, so they often avoid overt competition, except in gender-typed areas such as body image. Women do make themselves miserable by wishing for more perfect bodies and frequently lack confidence in the adequacy of their appearance. But, according to the research, men compare more generally. Whoever does it, all of us are definitely motivated to make comparisons by uncertainty about where we stand.
Ironically, comparison can create more uncertainty rather than relieve it; comparison may not always reassure. Even if brought on by circumstances, comparison malaise itself sounds like insecurity. Anytime we compare ourselves to someone else, we risk coming up short. Or we risk discovering that life is unfair. We have to value the potential for information over the potential for bad news.

* Why do we make comparisons? The answer boils down to information, self-defense, and group identity. As chapter 4 showed, we make comparisons to seek information that will help us predict and control our life outcomes when we are motivated by insecurity (or, more kindly, uncertainty).

* status. So without changing relative status, we can turn contempt and disgust into sympathy and pity when we see the other person’s perspective. This change does not improve the relative status of the stigmatized, but at least it puts people on the same team. Recognizing the humanity of even stigmatized others can make us feel more virtuous, valuable, and secure. When we catch ourselves at it, we prefer to think of ourselves as treating others as they deserve. But clearly, we can overcome our own tendency toward scorn when we take the trouble.
Envy On the other side, envying upward is even more irksome. But we might as well try to control our feelings of envy because they can be corrosive. According to Peter Salovey and Judith Rodin, we use three strategies to cope with our everyday envy:

• Self-reliance: Commit to your own business. Don’t give up. Control your resentment.
• Ignoring: Write it off. It’s not that important.
• Self-bolstering: You have other good qualities. 58

The first two of these intuitively sensible strategies focus on the cause of the envy, and they reportedly work well. The more emotion-focused coping strategy, self-bolstering, does reduce depression and anger, some of the emotional fallout from envy, so it works well in that way.
Besides these coping strategies, what do psychologists suggest? Julie Exline and Anne Zell propose several antidotes based on their analysis of the shame and secrecy that surround our feelings of envy. Drawing on the wildly successful techniques of cognitive behavioral therapy, they suggest that envy signals some unexamined assumptions that may be the root of the problem. 59 They would urge an envier to:

• Examine goals: Beliefs may be inaccurate (does a Corvette really make people happier?) or illogical (does a tidy desk really indicate productivity?) or unsubstantiated (how do I know whether that winning prize makes up for being lonely?). Changing core beliefs allows more adaptive, useful ones to run your life.
• Face deficits: Acknowledge limitations, and strive to improve in realistic ways. Accept yourself; balance awareness of challenges with gratitude valuing what you do have. 60

Even outside of therapeutic approaches, cognitive tricks can change your worldview. According to Mark Alicke and Ethan Zell, envy is all about social comparison, which is all relative. Compared to what? Compared with whom? They suggest the following:

• Shift time frames: No need to be stuck in the present. Instead of comparing with others, compare your own progress with your past and potential self. Have you not improved over time? Is the future promising?
• Question authority: Be subjective. Who says the other person is better? By what measure? Comparisons are always open to multiple interpretations.
• Channel anger: Maybe the comparison is unfair. If the enviable person has illegitimate success, then most of us feel angry. But anger is more mobilizing than envy, and resentment can be channeled into accomplishment.
• Control fate: If you have a chance to improve, then do it. Even if your rival’s circumstances are better, diligence is on your side, because you can control effort, even if you can’t control circumstances. 61

Longing is envy’s cousin. Benign envy wants to have what enviable others have, not to take it away from them. As one character put it in a novel by Henry James (William’s psychologically astute brother): “My envy’s not dangerous; it would not hurt a mouse. I don’t want to destroy the people—I only want to be them.” 62 Evidence for two types of envy comes from Niels van de Ven and his colleagues’ research showing that benign envy is oriented toward moving oneself up rather than bringing the other down. 63 Even though benign envy is still frustrating and unpleasant, because the comparison is explicit, nevertheless it is energizing because it allows more control than malicious envy does. Another suggestion, then, based on this research, would be:

• Move up: Use benign envy to motivate yourself.

Liking transforms envy into inspiration and admiration. We feel admiration when the distance between ourselves and another person is large and we not only identify with that person as part of our own team or tribe but wish the best for him or her. Acknowledging that relative status and competence differ between ourselves and envied others, we can focus on shared tribal loyalties, cuing friendliness and trust. And if the distance is not too great, self-improvement may seem possible. 64 How do we act on such admiration?

• Congratulate: Complimenting another person sincerely acknowledges that the other is deserving, links our fates, and allows us to be inspired.

* For each side of the envy-scorn mirror-window, concentrating on self blinds you to anything but your own reflection. But concentrating on the other makes you forget yourself as a target of either envy or scorn and attend to the other person’s feelings. In a relationship, this kind of responsiveness is a good thing. 65 Here are some ways to cultivate responsiveness, despite competition, in a close relationship.
Avoid Comparisons Partners and friends are reluctant to compare openly because it risks damage on both sides, whoever comes out on top or on bottom. 66 The concerned superior wants to spare the partner the public indignity and private humiliation, and of course the inferior wants to avoid having those feelings. Conversely, the concerned inferior wants to spare the outperforming partner public envy and private guilt; again, of course, the superior wants to avoid having those feelings. Let’s assume that both partners want to preserve the relationship and spare each other feeling one-up or one-down. (If they do not share that goal, then the relationship will soon degenerate into a state of each being in it alone, responsive only to self-interest. See prior section.) The simplest strategy deflects social comparisons in any potentially competitive domain. Spouses may minimize reports of their triumphs. Colleagues may discuss their toddlers to avoid discussing relative career accomplishments. High school classmates at a reunion may focus on the good old days to avoid awkward inequalities in the present.
Minimize Status Differences In a discordant relationship, partners envy each other’s good fortune or feel malicious joy (schadenfreude) at each other’s bad fortune. Responsive partners may share harmonious goals—what Fritz Heider called a “sympathetic identification”—in which they experience each other’s fortunes and misfortunes. True sympathy goes beyond mere emotional contagion. 67 To forge a harmonious relationship, the advantaged partner may downplay any privileges, disparaging or hiding them. This is the humble approach. 68 In close relationships, people worried about posing a threat to their partner may minimize any status differences by concealing their status, sabotaging themselves, self-deprecating, or promoting the partner, all efforts to close the gap. 69 In experimental games that simulate reciprocity in relationships, partners who come out ahead become hypercooperative and can alleviate the inequality by taking steps to reduce it. 70
Explain Away Any Differences In all relationships, origin stories (how we met) are cherished, but partners also value their shared mythology about relative expertise (who is good at what, and why). The partners carve up their expertise when each partner claims a valued domain. 71 One partner may be the scientist and the other the artist. This explains unequal accomplishment as grounded in distinctive talents. Sometimes partners can come to a mutual understanding by explaining any gap as fair. 72 For example, one partner may have made the effort to be a gourmet cook, whereas the other chose not to try; reporting the effort justifies the difference. 73 Expertise, talent, and motivation all are internal explanations.
Partners can also use external attributions to explain away difference. Explaining a success as a fluke minimizes any inherent differences, making the gap temporary. 74 Success stories that offer external, unstable, and uncontrollable factors (luck) make the teller seem modest and admirable. 75 In contrast, imputed arrogance comes from accounts that attribute success to internal, stable, uncontrollable, and desirable qualities, such as innate intelligence or beauty.
Reduce the Gap The person on top can lift the partner up. This has to be handled with delicacy, but if the protégé admires the mentor, improvement is possible, and over time the gap can diminish. As we have seen, envy gives way to admiration when we feel that we have an opportunity to improve. 76 So for the one-down partner, the one-up partner’s efforts can serve as an antidote to envy. And for the one-up partner, the appeal of the underdog increases if the one-down partner puts in the effort, thus deserving help and seeming more likable. 77
Mind the Relationship The key to concord is what Heider termed a “unit” relationship—one in which two people feel they belong together. Each includes the other in the self, as Arthur Aron, Elaine Aron, and their colleagues have so adroitly measured ( figure 7.6 ). 78
To encourage a unit relationship, emphasize the shared bond. For example, therapy works better when the therapist establishes co-membership early in the initial meeting. 79 That is, some kind of link to a mutual friend, a common identity, or a joint membership establishes safety and trust. In contrast, either envy or scorn signals a disconnect that needs repair. 80 Having a unit relationship ensures that comparison is not a zero-sum game because the partners’ interests overlap. 81 Cuing a “we” connection makes us think of our similarities instead of our differences. 82 To promote this sense of being a unit, we may placate our partner by investing in the relationship. 83 If we are worried about being envied, we will appease by helping and advising our envious partner.

* Value Others Our main antidotes to envy and scorn are making other people feel secure and valued, because these social comparison emotions arise from uncertainty. As Robert Vecchio shows, managers do well to heed the advice to praise and recognize their employees, to make them feel included and valued. 90 All of this soft diplomacy backfires if it is seen as manipulative, so sincerity and plausibility are key.

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NYT: Rising anxiety over declining social status tells us a lot about how we got here and where we’re going

Why is status important? After survival, it is probably the most powerful human impulse because it has so much sway over one’s long-term survival and likelihood of successful reproduction. The opposite of status is humiliation. Constant humiliation results in loneliness because nobody sane wants to hang out with those whose life is ongoing humiliation. Nobody wants to have sex or dinner with people who are low status. Loneliness leads to death. Pain experienced while lonely is twice the pain and joy experienced while lonely is half the joy. Most people find a two mile walk a bit of an effort without an audio distraction, but a four mile walk with friends is a joy.

Most conflicts are not resolved by negotiation or fighting (these modes are tiring and usually inefficient). They are resolved instead according to who is dominant. If I want to meet up with somebody who has more status than me, I need to fit in with what is convenient to him. He’s not going to bend to me.

The longer you have to wait for your phone calls to be returned, the less status you have.

With a modicum of self-awareness, you should know whether you are dominant or subordinate in all of your important relationships. One way to tell is by the relative length and speed of your emails. Lower status people write longer emails to people above them who in return write back briefly if at all. Lower status people usually have to wait longer for a reply than higher status people. If you consistently reply quicker than your correspondence, you are likely of lower status. If you consistently write back fewer words than your correspondent, you are likely of higher status than him.

Thomas B. Edsall writes in the New York Times:

More and more, politics determine which groups are favored and which are denigrated.

Roughly speaking, Trump and the Republican Party have fought to enhance the status of white Christians and white people without college degrees: the white working and middle class. Biden and the Democrats have fought to elevate the standing of previously marginalized groups: women, minorities, the L.G.B.T.Q. community and others.

The ferocity of this politicized status competition can be seen in the anger of white non-college voters over their disparagement by liberal elites, the attempt to flip traditional hierarchies and the emergence of identity politics on both sides of the chasm.

Just over a decade ago, in their paper “Hypotheses on Status Competition,” William C. Wohlforth and David C. Kang, professors of government at Dartmouth and the University of Southern California, wrote that “social status is one of the most important motivators of human behavior” and yet “over the past 35 years, no more than half dozen articles have appeared in top U.S. political science journals building on the proposition that the quest for status will affect patterns of interstate behavior.”

Scholars are now rectifying that omission, with the recognition that in politics, status competition has become increasingly salient, prompting a collection of emotions including envy, jealousy and resentment that have spurred ever more intractable conflicts between left and right, Democrats and Republicans, liberals and conservatives.

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Sunrise, Sunset

Sunset was amazing last night:

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Purchased: Leaving the Sex Trade By Deanna Lynn (12-8-20)

Book excerpts. Previous interview.

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A History of Psychiatry: From the Era of the Asylum to the Age of Prozac

Edward Shorter writes in this 1998 book:

* For historians of psychiatry who wrote 30 or 40 years ago—the last time anyone attempted an overview of the discipline—the story seemed relatively straightforward. First there were those wicked biological psychiatrists in the nineteenth century, then psychoanalysts and psychotherapists came along to defeat the biological zealots, establishing that mental illness resulted from unhappiness in childhood and stress in adult life. Freud’s insights opened a new frontier in our understanding of mental illness and little more needed to be said. Between the 1950s and the 1990s, a revolution took place in psychiatry. Old verities about unconscious conflicts as the cause of mental illness were pitched out and the spotlight of research turned on the brain itself. Psychoanalysis became, like Marxism, one of the dinosaur ideologies of the nineteenth century. Today, it is clear that when people experience a major mental illness, genetics and brain biology have as much to do with their problems as do stress and their early-childhood experiences. And even in the quotidian anxieties and mild depressions that are the lot of humankind, medications now can lift the symptoms, replacing hours of aimless chat. If there is one central intellectual reality at the end of the twentieth century, it is that the biological approach to psychiatry—treating mental illness as a genetically influenced disorder of brain chemistry—has been a smashing success. Freud’s ideas, which dominated the history of psychiatry for the past half century, are now vanishing like the last snows of winter. The time has therefore come for a new look.

* Part and parcel of European culture, the fateful notion of degeneration was picked up by the eugenists, by social-hygienists intent on combating mental retardation with sterilization, and by antidemocratic political forces with a deep hatred of “degenerate” groups such as homosexuals and Jews. Psychiatry’s responsibility for all this is only a partial one. Academic psychiatrists in the 1920s were not generally associated with right-wing doctrines of racial hygiene, though there were exceptions to this, such as the Swiss psychiatrist Ernst Rüdin who after 1907 worked at the university psychiatric clinic in Munich, and the Freiburg professor Alfred Hoche who in 1920 coauthored a justification for euthanasia. 101 Academic medicine in Germany on the whole stood waist-deep in the Nazi sewer, and bears heavy responsibility for the disaster that followed. After 1933, degeneration became an official part of Nazi ideology. Hitler’s machinery of death singled out Jews, people with mental retardation, and other supposedly biological degenerates for campaigns of destruction.102 The Nazi abuse of genetic concepts rendered any discussion of them inadmissible for many years after 1945. The notions of degeneration and inheritability became identical in the minds of the educated middle classes. Both were synonymous with Nazi evil. After World War II, any reference to the genetic transmission of psychiatric illness, whether as one factor among many or as inexorable degeneration, became taboo. The mere discussion of psychiatric genetics would, in civil middle-class dialogue, be ruled out of court for decades to come.

* The first biological psychiatry as a clinical approach died long before the Nazis. It was not necessarily discredited by research findings. That’s not the way paradigms change within medicine. People simply lost interest in brain anatomy once a new way of looking at psychiatric illness appeared on the horizon. The new approach saw illness vertically rather than cross-sectionally…

* Many histories of psychiatry see psychoanalysis as the end point of the story, the goal to which all previous events had been marching. Yet with the hindsight of half a century since Freud’s death in 1939, we are able to achieve a different perspective, in which psychoanalysis appears not as the final chapter in the history but as an interruption, a hiatus. For a brief period at mid-twentieth century, middle-class society became enraptured of the notion that psychological problems arose as a result of unconscious conflicts over long-past events, especially those of a sexual nature. For several decades, psychiatrists were glad to adopt this theory of illness causation as their own, especially because it permitted them to shift the locus of psychiatry from the asylum to private practice. But Freud’s ideas proved short-lived. In the longer perspective of history, it was only for a few moments that the patient recumbent upon the couch, the analyst seated silently behind him, occupied the center stage of psychiatry. By the 1970s, the progress of science within psychiatry would dim the lights on this scenario, marginalizing psychoanalysis within the discipline of psychiatry as a whole. In retrospect, Freud’s psychoanalysis appears as a pause in the evolution of biological approaches to brain and mind rather than as the culminating event in the history of psychiatry.

Yet it was a pause of enormous consequence for psychiatry. Freud’s psychoanalysis offered psychiatrists a way out of the asylum. The practice of depth psychology, based on Freud’s views, permitted psychiatrists for the first time in history to establish themselves as an office-based specialty and to wrest psychotherapy from the neurologists. Moreover, psychiatrists aspired to a monopoly over this new therapy. In the mind of the public, psychotherapy and psychoanalysis became virtually synonymous. If patients wanted one of the fashionable new depth therapies they would have to go to a psychiatrist for it, for the American Psychoanalytic Association initially insisted that only MDs could be trained as analysts, and later that only psychiatrists could be so. In retrospect, this insistence was bizarre, for psychoanalysis required no more medical training than astrology, and the attempt to impose a medical monopoly over Freud’s technique was a self-interested ploy to exclude psychologists, psychiatric social workers, and other competitors from the newly discovered fountain of riches.

Ultimately, psychoanalytically oriented psychiatrists were unable to preserve their monopoly. After the 1960s, all manner of nonmedical types demanded admission to the training institutes, for there was no intrinsic reason why professors of English could not do analysis as well as psychiatrists. Even worse, what had previously passed for the scientific basis of psychoanalysis began to collapse. It could not be simultaneously true that one’s psychological problems were caused by an abnormal relationship to the maternal breast and by a deficiency of serotonin. As evidence began to accumulate on the biological genesis of psychiatric illness, psychiatry began to regain the scientific footing it had lost at the beginning of the analytic craze: The brain was indeed the substrate of the mind. By the 1990s a majority of psychiatrists considered psychoanalysis scientifically bankrupt. Thus Freud’s model of the unconscious and the elaborate therapeutic techniques he devised for laying bare its supposed contents failed to stand the test of time. Accordingly, analysis largely vanished from psychiatry, discredited as a medical approach to the problems of mind and brain, although nonmedical psychoanalysis continued to flourish. The whole affair turned out to be the artifactual product of a distinctive era. Psychoanalysis failed to survive because it was overtaken by science, and because the needs that it initially met became dulled in our own time.

* In psychoanalysis by its very nature, doctor and patient communicate in the enterprise of soul-searching, creating the suggestion that one is being cared for emotionally. Thus psychoanalysis became popular initially because it filled a sentimental gap in the consultation. It offered a doctor-patient relationship in which patients basked in what they believed to be an aura of concern.

Numerous physicians other than Freud understood these psychological cravings, but Freud was the first to elaborate a therapy that would appeal to middle-class sensibilities, in particular to the desire for leisurely introspection. Yet his theories possessed a powerful additional resonance because, owing to his own ethnic origin and social position, he had privileged access to a group of patients who were especially needy in psychological terms: middle-class Jewish women in families undergoing rapid acculturation to West European values.

…Although by 1860 every city in Western Europe had a contingent of Jews, the Jews of Vienna were distinctive in constituting virtually the city’s entire middle class. Whatever circle one examines—journalists, bankers, businesspeople, academics—all had a significant Jewish component by the end of the nineteenth century. This tremendous preponderance of Jews in the middle classes reflected the great social progress the Jews of Europe had made since the end of the eighteenth century, when they lived largely sequestered in the small towns of Poland, Russia, and the Ukraine. As a result of the Jewish emancipation of the nineteenth century, the small-town Jews of the east flocked to the cities of the west, using the high-school diploma as a launching pad for careers in the liberal professions. In 1890, for example, 33 percent of students at the Vienna University were of Jewish origin.1 Fully one half of the professors of Vienna’s medical faculty were Jewish.2 As many as two-third’s of the city’s physicians were Jews.3 Thus, rather than being marginalized or scorned for his ethnic background as some have claimed, the young Sigmund Freud found in Vienna an intensely Jewish setting where he had every prospect of advancement through dint of hard work.

* The early analysts became well known for searching out sexual material. Viennese psychiatrist Emil Raimann, who knew Freud and his patients well, complained that Freud was able to persuade these complaisant and easily suggestible young women to say anything he wished them to. “The patients who consult Freud know in advance the information he wants to extract from them. These are patients who have let themselves be convinced of the causal significance of their sexual memories. Individuals in whom sexual motives play no role are aware that they would consult Freud in vain.” (Raimann noted that in working-class families in Vienna there was plenty of sexual contact, even incest, but no hysteria. Yet among the closely guarded young women of the city’s better families, where there was no possibility of sexual trauma, hysteria flourished.)

…[the Freudians were ] the only ones to offer a road map of how one got from sexual desire and repression of it to neurosis. On the basis of this map, psychoanalysis, a term Freud first used in 1896, would turn into a movements.17 It launched itself on the world as a group of doctrines comprising three main areas: study of the patient’s resistance to thoughts that attempted to press into the conscious mind from the unconscious; concentration on the causal significance of sexual matters; and an emphasis on the centrality of early childhood experiences.18 The core doctrine, from which Freud never wavered, was that neurotic symptoms represented a trade-off between sexual and aggressive drives and the requirements of reality.

* Freud was so intent on propagating his own views that, by turning psychoanalysis into a movement rather than a method of studying subrational psychology, he denied analysis the possibility of ever acquiring a scientific footing. The master’s insights were to become articles of faith, incapable of disproof. And the efforts of others to criticize Freud’s wisdom would always be considered evidence of “resistance,” of personal pathology, never as scientific hypotheses to be dealt with in the way that science treats all hypotheses. Alfred Adler fell away, as did Wilhelm Stekel, Freud’s physician-patient who had suggested establishing the Wednesday group in the first place. Such far-distant fans of analysis as the Zurich academics Carl Jung and Eugen Bleuler would soon turn heretic, as did later many others. The efforts of all these critical individuals to nudge Freud away from the bedrock of childhood sexuality on which he built his theories would fail. But a core of faithful remained. And it was these loyal captains who, in the belief that they possessed an inner truth, took psychoanalysis to the wide world.

* Did Freud and his followers really know these truths? Or were they simply self-suggesting one another into accepting highly dubious propositions as being somehow “confirmed”? Freud tended to see himself more as an adventurer than a scientist, once telling Fliess flatly, “I am actually not at all a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador-an adventurer, if you want it translated—with all the curiosity, daring, and tenacity characteristic of a man of this sort.”20 His inner circle was rife with toadyism, for the other analysts were economically dependent on Freud for referrals. (He kept a pile of their calling cards in his drawer, and would dole them out to patients according to his whim.)21 “Freud never realized how much of a suggestive impact he had on his followers,” writes historian Paul Roazen, “and therefore could be led to think that his findings were being genuinely confirmed by independent observers.”22 The issue of validity would therefore haunt psychoanalysis until its eclipse within psychiatry.

* As psychoanalysis set out to take over psychiatry, therefore, it was with a doctrine that was therapeutically uncertain, intellectually highly speculative to say the least, and best adapted to the psychological needs of a deracinated group in transition: young middle-class Jewish women who aspired to be like their non-Jewish counterparts. It would be hard to imagine a therapy less appropriate for the needs of people with serious psychiatric illnesses.

* Given the intrinsic inappropriateness of psychoanalysis for psychiatry, there must have been some other force driving it forward in Europe than the power of the idea itself. That force was middle-class enthusiasm. Freud’s ideas proved tremendously popular among the educated classes as a codification of the kind of search for self-knowledge that had run through bourgeois culture throughout the entire second half of the century. Psychoanalysis was to therapy as expressionism was to art: Both represented exquisite versions of the search for insight.

* Regular psychiatrists were bemused at the grassfire spread of psychoanalysis within the middle classes. One physician at the Budapest psychiatric clinic tried to account for it along the following lines: “The flood of patients seeking salvation through psychoanalysis is explainable partly from the publicity, partly from the receptiveness of our time to introversion and introspection.” It was a procedure of obvious appeal to “hypersexual neurotics,” he said.31 Thus we have a core of physicians dubious, even contemptuous of “hypersexual neurotics” and their problems, and an educated middle class keening at the doctor’s office for further self-insight.

* What ultimately converted a chic therapeutic boomlet into a mass ideology shaping almost every aspect of American thought and culture was the Holocaust. In the 1930s, fascism drove many analysts who were Jewish from Central Europe to the United States, where they lent the strippling little American movement the glamour and heft of the wide world. On the face of it, this massive transfer of culture from the German-speaking world to the English had positive results for psychoanalysis, reinforcing the homespun American heterodoxy with the prestige of internationally acclaimed figures.81 In the long run, however, the migration of the European analysts proved fatal for psychoanalysis in the New World, for the refugees brought with them a stifling orthodoxy, a reflexive adherence to the views of Freud and his daughter Anna that American analysis was never able to outgrow and that ultimately caused, within medicine at least, its death from disbelief.

* American psychiatry before World War II was biological psychiatry and within a few years after the war it was largely a psychoanalytical psychiatry.

* From the viewpoint of the history of psychiatry, the vicissitudes of the Jews in the Old World and New were a matter of capital importance. The common theme linking the misadventures of psychoanalysis on both sides of the Atlantic was the desire of recently acculturated middle-class Jews for some symbol of collective affirmation. Although Freud sought mightily to downplay any kind of ethnic specificity in psychoanalysis, the subtext of Freud and his followers to the non-Jewish charter culture was: We Jews have given this precious gift to modern civilization.

Why would Jews need such a symbol any more than any other ethnic group? In the history of modern times, Jewish people have had to endure not just one but two great shocks. Every people that undertakes the long journey from small-scale life in the traditional village to middle-class life in the big city undergoes one major shock: the shock of assimilation and integration, the psychological upheaval that goes with newness of arrival. In their move from shtetl life in the small towns of eighteenth-century Poland and the Ukraine to such bustling cities as Berlin, Frankfurt, and Vienna, the Jews underwent this shock just as everybody else did.

But then a second shock lay in store for the Jews, the Holocaust, and the forced transplantation of hundreds of thousands of individuals who themselves had only recently become middle-class, from a comfortable and bourgeois European existence to the nightmare of scrambling for a passage to America. This second shock was experienced by no other cultural group.155 It profoundly shaped the desire of the American Jews for some kind of a special symbol of self-affirmation, a collective badge of pride in the chaos of the living city. That symbol, I argue, was psychoanalysis.

At the turn of the twentieth century, the Jews of Central Europe were experiencing the cultural confusion of a massive deracination. Between the 1860s and 1900, countless numbers of people were torn from the ghettoes and shtetls of Eastern Europe, without becoming as yet newly rooted among the middle classes of the West. Many of the Jews of Berlin and Vienna had left their religion behind and were rapidly trying to assimilate by changing their names and by converting to Protestantism (less so to Catholicism). Yet despite their best intentions, despite their knowledge of the plays of Schiller and of the refinements of the German language, they encountered a baffling wall of anti-Semitism. There was something about psychoanalysis that made it, according to historian John Cuddihy, a “plausible ideology for [a] decolonizing people.”156

Jewish patients with psychoneurosis were therefore drawn to it. Perhaps psychoanalysis was seized upon because it extended the possibility of finding one’s identity from within, as opposed to the external signposts that orthodox Judaism offered. And it may have appealed to Jewish women in particular. Perhaps these cloistered but well read and highly curious women—members of a “middle-class drenched in spirit” in the words of Viennese novelist Robert Musil—were simply more self-reflective, more psychologically minded that the women of the non-Jewish lower-middle classes below them who worked alongside their husbands in shops, or the women of the nobility above, busy with the social whirl of the salon.157 Or perhaps Jewish men and women alike adored psychoanalysis because it was “our thing.” In any event, psychoanalysis in the early days had a very specific social address.

It was above all among the middle-class Jews of Berlin, Budapest, and Vienna that psychoanalysis proved such a hit. Historian Steven Beller finds the Jews of Vienna, as outsiders, using psychoanalysis to “make a political attack on Viennese society by an alliance of scientific rationality with instinct” against the city’s traditional sensual baroque culture.158 In Budapest, there were descriptions of psychoanalysis in the Jewish quarter, the Leopoldstadt, as an almost “incomprehensible and impenetrable secret doctrine or ceremony….”

Historian Paul Harmat concludes, “Psychoanalysis was most popular among enlightened Jewish circles as a result of their minority situation.” 159 Of course, non-Jews had recourse to analysis as well. Yet among patients, there seems to have been a kind of Jewish tropism. The analysts themselves also tended heavily to be Jewish, and many of them assumed that Jewishness helped one to appreciate Freud’s wisdom fully. As Freud said in 1908 to the Berlin analyst Karl Abraham, on the occasion of a malentendu with Carl Jung (then one of the few non-Jews in the movement), “Please be tolerant, and don’t forget that it is actually easier for you than for Jung to follow my ideas … because you stand closer to me as a result of racial affinity, while he, as a Christian and son of a pastor, finds the way to me only in the face of great inner resistance.” On another occasion, Freud reassured Abraham, “May I say that what attracts me to you are our related, Jewish characteristics. We understand each other.”160 Freud’s inner circle was almost entirely Jewish, and Ferenczi said to Freud of the one non-Jewish member, the Londoner Ernest Jones, “It has seldom been so clear to me as now what a psychological advantage it signifies to be born a Jew…. you must keep Jones constantly under your eye and cut off his line of retreat.”161

Within the middle-class Jewish public, psychoanalysis became signposted as belonging to some larger Jewish worldview. Humorist Salomo Friedländer, writing in the 1920s under the pseudonym “Mynona,” made analysis the portal through which Christians who wanted to convert to “true Judaism” must pass. In one tale Friedländer allows the wildly anti-Semitic Count Reschock to fall in love with the beautiful Rebecka Gold-Isak. Losing his bearings completely, the Count decides to convert to Judaism to win his prize. Rebecka insists that he must become truly Jewish before she will accept him. The Count’s first step on the path of a Jewish identity is an analysis with Professor Freud. “This destroyer of fig-leaves,” as Friedländer termed Freud, “robbed the noble Reschok soul of its protective coat with such anatomical certainty that the Count fell with a cry into the arms of his alarmed servant.” (Reschock goes on to have a famous surgeon convert him from a blonde Prussian warrior into a “Jewish Torahstudent.”) 162 Jewish and non-Jewish readers alike found the Friedländer fable delicious, yet accepted implicitly its premise that psychoanalysis was identified with Judaism. If psychoanalysis is written as a history of ideas, these social themes are unimportant. But if we try to understand its rise and decline as a movement, the singular tropism that many Jews felt toward analysis, both as doctors and patients, is of considerable significance.

With the passage of time, in Europe at least, psychoanalysis lost its Jewish stamp. Although it had originated among the Jews of Vienna and Berlin, as it developed, it ceased to be their property. There was certainly no Jewish tropism among the chief physicians of the many private clinics that offered psychoanalysis. And in Switzerland and England, psychoanalysis was known to be a specifically non-Jewish affair. As Swiss psychiatrist Max Muller commented of the 1920s, “It was characteristic of the psychoanalytic movement in Switzerland that, unlike other countries, it did not consist predominantly or almost exclusively of Jewish physicians and lay-analysts.”163 And the two most prominent advocates of analysis in Switzerland before 1914—Eugen Bleuler and Carl Jung—were if anything anti-Semitic. (It is perhaps indicative of the mood of the Bleuler household that, upon discovering that Viennese psychiatrist Erwin Stransky was Jewish, Bleuler’s wife expressed great astonishment and said, “Well then you must at least have an aryan soul in you.”)164 Commenting on the plethora of Jews in psychoanalysis generally, Ernest Jones noted, with relief, that apart from the refugees, “in England … only two analysts have been Jews.”165 Before 1933, a number of Jewish physicians figured prominently among the opponents of analysis.

After 1933, all this changed. As a movement, analysis in Europe was destroyed. Its main representatives who fled to the New World were Jews. For these battered and profoundly disoriented survivors, psychoanalysis became one of the Jewish accomplishments that could be presented to the host population as a ticket of entry. Among the refugee Jews, both physicians and nonphysicians—psychoanalysis became a badge of Jewish solidarity in the face of a population of Anglo-Saxons perceived to be racially hostile, psychologically insensitive, and culturally backward. Said Martin Grotjahn of his fellow emigré analysts, “Psychoanalysis symbolized for them the light of the Old Country to be carried to the New Country.”167 But it was a light that Jews had created, and in whose warmth they would bask for several decades.

The American Jews had not experienced the trauma of emigration. Yet they too had arrived as outsiders, and as psychoanalysis acquired new prestige in medicine after the Second World War many Jewish physicians and patients alike were drawn to it as a symbol of collective self-affirmation: This is what we have created. By it we shall become better and in doing so bring enlightenment to others.

After 1945, American Jews took on psychoanalysis as a kind of mission civilisatrice, a healing gift to all the world, which is not at all an overwrought formulation considering the prose with which Jewish analysts themselves described their mission to humanity. How things have changed for us, Franz Alexander assured his colleagues in 1953, “as soon as all that you professed is accepted and the world is asking you sincerely and avidly to explain the new truth. They turn to you now: ‘Please tell us all about it. How does the new knowledge help us, how can we use it constructively to cure a neurotic or psychotic patient … to alleviate social prejudice and international tension, and to prevent war.’”168 Is it any wonder that Jews themselves would preferentially have recourse to this new knowledge?

Why had psychoanalysis spread so rapidly after World War II? asked psychologist Seymour Sarason. “Most analysts (and a significant portion of the psychiatrists who received training during the war years) were Jewish. For them, Hitler and fascism were not abstractions but threats to existence. And for them, Freud represented a Moses-like figure whose contributions had opened up new vistas about the nature of humans….” 169 For Sarason and Alexander, Jews were a gifted but marginal population, still ill at ease and unintegrated.

Surveys establish the extent to which Jewish physicians predominated in the practice of psychoanalysis. In 1959, two researchers drew up a profile of psychiatrists who believed in psychoanalysis: Eighty percent of them were of Jewish origin and tended to be upwardly mobile, insight-oriented, and deracinated (in contrast to the biologically oriented psychiatrists in the sample, who tended to be mainly Protestant). On a number of characteristics, the psychoanalytically inclined Jewish psychiatrists stood out from the non-Jews: They were agnostic, as opposed to the organically oriented Protestant psychiatrists who retained some shreds of their religious faith. They were more leftist, and they were more aware of the importance of social class, as opposed to the Protestant group who were somewhat embarrassed by the subject.170 When Arnold Rogow quizzed a sample of 35 psychoanalysts and 149 nonanalyst psychiatrists in 1965, he found 26 percent of the analysts willing to declare they were Jewish; a further 17 percent were willing to say they had Jewish mothers; a third were unwilling to say anything about religious affiliation. (By contrast, the figures for the nonanalyst psychiatrists were lower in all three categories.)171 On the basis of these statistics, it is fair to infer that a majority of the practitioners of psychoanalysis were of Jewish origin though of course numerous non-Jews entered the field as well. How about patients? It seems to be the case that Jews overconsume most psychiatric services in proportion to their numbers in the population. This is certainly true of psychoanalysis. In Rogow’s study, one third of the analysts said they had practices consisting heavily or overwhelmingly of Jews.172 A variety of other studies revealed the same finding in other ways.173 Most dramatic perhaps was a random, nationwide survey of the adult American population in 1976, which found that 59 percent of Jewish respondents had at some point in time received psychotherapy (in contrast to the non-Jewish help-seeking rate of 25 percent).174 In other words, more than half of all American Jews had sought out psychotherapy at a time when psychotherapy was overwhelmingly psychoanalytically oriented. It is not stretching the facts to refer to psychoanalysis in the middle decades of the twentieth century as a kind of Jewish “our thing.”

* Yet since Jews are under discussion here, this might be the place to mention the role that the loss of a social base appears to have played in the plunging popularity of analysis. In my opinion the main source of this loss was the increasing social assimilation of the American Jews. They no longer required psychoanalysis as a badge of collective identity because they were no longer affirming themselves. Instead they were becoming like everyone else.

* Yet a handful of intellectuals in particular became identified with the antipsychiatry movement.130 And the force of their ideas brewed up a mass hostility to the advance of biological thinking within psychiatry. The movement’s basic argument was that psychiatric illness is not medical in nature but social, political, and legal: Society defines what schizophrenia or depression is, and not nature. If psychiatric illness is thus socially constructed, it must be deconstructed in the interest of freeing deviants, free spirits, and exceptional creative people from the stigma of being “pathological.”131 In other words, there really was no such thing as psychiatric illness. It was a myth.

Although antipsychiatry movements had flourished throughout the nineteenth century, their late-twentieth-century rebirth began with the virtually simultaneous publication in the early 1960s of a series of exceptionally influential books on psychiatry. Most famous perhaps of these was Michel Foucault’s Madness and Civilization, published in 1961 (see p. 276), which argued that the notion of mental illness was a social and cultural invention of the eighteenth century. Yet there were several other blockbusters, and collectively they became the intellectual springboard from which the theorists of deinstitutionalization of the late 1960s would launch themselves.

Earliest of the founding fathers—they were all men—was Thomas Szasz, a Budapest-born psychoanalyst, who had trained just after World War II in Chicago. When called to active service in the Navy in 1954, Szasz, who was then 34, used the time to put down on paper a notion that had long troubled him, that mental illness was in fact a “myth,” a medical misapprehension foisted on individuals who had problems in living. In his 1960 book The Myth of Mental Illness, he called the whole notion of psychiatric illness “scientifically worthless and socially harmful.”132 The book enjoyed wide currency and the American intellectual class began asking, if there is no such thing as mental illness, how can we justify locking people up in asylums?

* The works of Foucault, Szasz, and Goffman were influential among university elites, cultivating a rage against mental hospitals and the whole psychiatric enterprise. Yet the book that did most to inflame the public imagination against psychiatry was a novel written by Ken Kesey. Kesey had just finished taking a creative writing course at Stanford when he volunteered for government LSD experiments conducted at a veterans administration hospital at Menlo Park. He stayed on to take a job as an orderly at the hospital. Out of this experience came his 1962 novel One Flew Over the Cuckoo’s Nest, a book that formed the image of psychiatry for an entire generation of university students. Kesey’s notion of psychiatric illness was embodied in the novel’s antihero, Randle McMurphy…

By the end of the 1960s, the antipsychiatric interpretation of “so-called psychiatric illness” had gained the catbird seat among intellectuals both in the United States and Europe. In these circles, a consensus had formed that the discipline of psychiatry was an illegitimate form of social control and that psychiatrists’ power to lock people up must be abolished with the abolition of institutionalized psychiatric care, Pinel’s therapeutic asylum.

Even though these interpretations were very popular among college students and intellectuals, actual patients found them less convincing. Joanne Greenberg, author as “Hannah Green” of I Never Promised You a Rose Garden, had a real psychiatric illness. She hated the Kesey book. She later said, “Creativity and mental illness are opposites, not complements. It’s a confusion of mental illness with creativity…. Craziness is the opposite [of imagination]: it is a fort that’s a prison.”

* Long before the rise of the antipsychiatry movement, the destruction of the asylum had begun. Patients were to be returned to “the community.” That the very phrase now turns to ashes in one’s mouth is evidence of one of the greatest social debacles of our time.

* Midst this horrendous publicity for psychiatry, on which the antipsychiatric movement would later feed, several basic realities were obscured. One is that most patients younger than 65 were discharged relatively rapidly from mental hospitals: They did not experience prolonged stays to say nothing of lifelong incarceration. In the years 1946 to 1950 at Warren State Hospital in Warren, Pennsylvania, almost 80 percent of all patients under 65 were released within five years.144 Second, much of the bizarre posturing and disordered movement that Deutsch and later antipsychiatric writers ascribed to “hospitalism,” meaning the iatrogenic results of institutionalization, turned out to be an inherent biological feature of such illnesses as schizophrenia that, in affecting the entire brain, affect the entire nervous system as well.145 Third, even though conditions in mental hospitals were unsettling enough, there were worse alternatives. One was being tossed to the mercy of the streets.

* In the United States, the number of patients in state and county mental hospitals declined from its historic high of 559,000 in 1955 to 338,000 in 1970, further to 107,000 in 1988, representing a decrease over the 30 year period of more than 80 percent.148 The red bricks lost four-fifths of their patients. In 1955, 77 percent of all psychiatric “patient care episodes” occurred in mental hospitals, in 1990 only 26 percent. Amplifying the shift was a fivefold expansion in the total volume of care in mental-health organizations over that period, from 1.7 million episodes in 1955 to 8.6 million in 1990.149 This was a shift in the locus of care virtually without precedent in the history of medicine.

* Reducing the threshold of what constitutes psychiatric illness was partially doctor-driven, partially patient-driven. Psychiatrists have an obvious self-interest in pathologizing human behavior and have been willing to draw the pathology line ever lower in their efforts to tear as much counseling as possible away from competing psychologists and social workers.

* Ignoring the perils of school-teacher psychiatry, educational professionals grasped gratefully for this new pathologizing of boyhood. In 1968, “hyperkinetic reaction of childhood (or adolescence)” entered the official nomenclature, supposedly manifest in restlessness and distractibility.5 In 1980, this became officially known as “attention deficit disorder with hyperactivity.” 6 It is still unclear whether there is some core group of those diagnosed as “ADD” who have a real organic disorder. The point, however, is that medical therapy for it could be done only by MDs, prescribing an amphetamine-like compound called “Ritalin” (methylphenidate). By 1995 doctors were writing 6 million prescriptions for Ritalin a year, and 2.5 million American children were on the drug.7 This is one way of maintaining market share. Since ancient times, both boys and girls have become anxious about scary stories. Yet it would have occurred to no one across the centuries to give psychiatric diagnoses to these anxieties about fantasms, not at least until the advent of “posttraumatic stress disorder” (PTSD), a syndrome initially associated with the trauma of combat (see pp. 304-305). Whether a distinctive veterans’ psychiatric syndrome involving stress actually exists is unclear. But even if it exists, once PTSD became inserted into official psychiatric lingo, the popular culture grabbed it and hopelessly trivialized it as a way of psychologizing life experiences. By 1995, therapists were talking about “PTSD” in children exposed to movies like Batman. According to one authority, 80 percent of children who had watched media coverage of a crime hundreds of miles distant exhibited symptoms of “posttraumatic stress.”8 The anxieties of the children themselves were nothing new under the sun. New was psychiatry’s willingness to persuade parents that the quotidian problems of maturation represent a distinct medical disorder. The boundaries of what constitutes depression have been expanded relentlessly outward.

Depression as a major psychiatric illness involving bleakness of mood, self-loathing, an inability to experience pleasure, and suicidal thoughts has been familiar for many centuries. The illness has a heavy biological component. Depression in the vocabulary of post-1960s American psychiatry has become tantamount to dysphoria, meaning unhappiness, in combination with loss of appetite and difficulty sleeping. Thus it comes as no surprise that the incidence of depression so defined has been rising steadily and occurring at ever younger ages.9 In 1991, the National Institute of Mental Health began organizing a “National Depression Screening Day,” in the context of its “Mental Illness Awareness Week.” Such programs encourage family doctors to diagnose depression more often in their patients and refer them to psychiatrists. Although this is partly legitimate—a missed major depression may result in a patient’s suicide—the ultimate effect is psychiatric empire-building against other kinds of care. Indeed, the American Psychiatric Association jubilates over “record numbers” each year.10 As a consequence of this continual hammering of the depression theme, depression has become the single commonest disorder seen in psychiatric practice, accounting for 28 percent of all patient visits.11 (The availability of drugs such as “Prozac,” said to be specific for an entire “spectrum” of affective disorders [see pp. 323-324], has doubtless contributed as well to increasing the diagnosis of depression: Physicians prefer to diagnose conditions they can treat rather than those they can’t.) Personality disorders have become a whole sandbox for empire building.

Although the concept of a disorder of the personality—in which everybody suffers but the patient—remains scientifically rather murky, in practice imputed personality disorders have taken off. Diagnoses such as antisocial personality disorder arose preferentially in private psychiatric practice and were virtually unknown in other medical settings.12 Multiple personality disorder (MPD) roared in from obscurity to become epidemic in the 1980s.13 Other so-called disorders of personality represented merely the exaggeration of familiar character traits. Yet the entire notion of giving patient-status to people because they are troublesome to others represented a pathologizing of essentially normal if irksome behavior. Thus these diagnoses of personality, as well as the other ballooned disease labels, dipped greatly the threshold at which individuals were said to be ill.

* Leaders in the field started speaking of “minor depression, mixed anxiety-depression, and mild neurocognitive disorder as … conditions that may deserve consideration as separate categories.” The notion of “subthreshold symptoms” gained currency as a means of reaching out to “previously subthreshold patients.”14 This is the language of empire-building and market-conquest. The evidence that these conditions represent diseases, or disorders, in the sense that mumps and major depression are disorders, is extremely slim. In insider discussions, psychiatrists were perfectly frank with one another about shifting the focus from disease to unhappiness.

* In the 1990s, psychiatry was being bent out of shape by a colossal kind of failure-to-fit. Psychiatrists had been trained for one thing and ended up treating another. They had trained as residents to treat the major psychiatric illnesses. But once in office practice, they gravitated to the commoner and more lucrative psychoneuroses. In doing so, they found themselves in direct competition with the social workers and psychologists. Rather than returning to the main psychiatric diseases, the terrain of choice of biological psychiatry, they went in the opposite direction, expanding the definition of illness to include behavior and symptoms previously reckoned as “subthreshold,” and catering to the great American public’s demand for psychotherapy in dealing with problems of living.

* Increasingly, the view became accepted that psychoanalysis was not for illness but for the interior voyage. While insisting that psychoanalysis was still valid therapy for “the major psychoses,” analyst Robert Michels decided to take a more embracing stance: The discipline was ideal for “the optimalization of experience and the enhancement of sensitivity.”96 Indeed, said critic Adolf Grunbaum, picking up on comments that Michels had made elsewhere, analysis was most akin to “an edifying experience of the kind provided by, say, a season ticket to the opera.”97 From Studies in Hysteria in 1895 to a ticket to the opera in 1994: what an odyssey! By the mid-1990s, psychoanalysis had by no means gone out of fashion among intellectuals, and it was a rage in many departments of languages and sociology. In 1994, the University of Dublin began offering an undergraduate arts degree in psychoanalysis. 98 The late-twentieth-century trajectory of psychoanalysis had carried it beyond the discipline of psychiatry and into the ether of arts and letters where, however it fared, it would no longer be identified as a privileged treatment for psychiatric illness.

* American psychoanalysis had always exhibited strenuous resistance to the collection of data on the outcome of therapy.

* “There is virtually no evidence that therapies labeled ‘psychoanalysis’ result in longer-lasting or more profound positive changes than approaches that are given other labels and that are much less time-consuming and costly.”

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From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era

Edward Shorter writes in this 1993 book:

This cultural pressure is the crux of the book. The unconscious mind desires to be taken seriously and not be ridiculed. It will therefore strive to present symptoms that always seem, to the surrounding culture, legitimate evidence of organic disease. This striving introduces a historical dimension. As the culture changes its mind about what is legitimate disease and what is not, the pattern of psychosomatic illness changes. For example, a sudden increase in the number of young women who are unable to get out of bed because their legs are “paralyzed” may tell us something about how the surrounding culture views women and how it expects them to perform their roles.

Psychosomatic illness is any illness in which physical symptoms, produced by the action of the unconscious mind, are defined by the individual as evidence of organic disease and for which medical help is sought. This process of somatization comes in two forms. In one no physical lesion of any kind exists and the symptoms are literally psychogenic; that is to say, they arise in the mind. In the second an organic lesion does exist, but the patient’s response to it—his or her illness behavior—is exaggerated or inappropriate. Culture intervenes in both forms, legislating what is legitimate, and mandating what constitutes an appropriate response to disease. Our late-twentieth-century culture, for example, which values individual dynamism, regards physical paralysis and sudden “coma” (both common before 1900) as inappropriate responses.

Psychosomatic illnesses have always existed, because psychogenesis—the conversion of stress or psychological problems into physical symptoms—is one of nature’s basic mechanisms in mobilizing the body to cope with mental distress. People have always tried to achieve some kind of plausible interpretation of their physical sensations. They cast these sensations on the model of well-defined medical symptoms available in a kind of “symptom pool.” Only when an individual’s act of making sense amplifies the sensations, or attributes them to disease when none exists, does psychosomatic illness come into play.

The two actors in this psychodrama of making sense of one’s sensations are, and always have been, doctors and patients. The interaction between doctors and patients determines how psychosomatic symptoms change over the years. Doctors’ notions of what constitutes “genuine” organicity may alter, perhaps as a result of increased scientific knowledge or of new cultural preconceptions. Although patients’ notions of disease tend to follow doctors’ ideas—a kind of obedience that has started to break down at the end of the twentieth century—patients may also change their notions of the legitimacy of symptoms for reasons that have little to do with medicine.

* Given the reluctance of the unconscious mind to be made a fool of, patients have always tended to reject psychological interpretations of physical symptoms. They find this kind of attribution unsettling because it seems to make inaccessible to them the remedies of medicine, conferring upon their symptoms a kind of hopelessness. Patients often think, Who after all can control the action of his or her unconscious mind?

* This lamentation about the lack of insight in somatizing patients constitutes a steady stream in medical literature. Every decade has its offerings. Here is Herbert Berger in 1956 on the subject of his first few years of medical practice in a small town: “The certainty that I lived in a belt of inbred neurotics became firmly fixed in my mind. Coming from a large urban center myself, I felt fairly certain that the residents of my community had intermarried … and that this explained the large number of functionally incompetent individuals whom I met.” Later he realized that this was just a typical general practice. “Gradually I have come to recognize that these individuals never wish to be told that they are just nervous. The word ‘imagination’ is anathema to them for they are certain that they are seriously ill, and they expect and demand that the physician treat their disease with considerable respect. It is often necessary to medicate these people.” Referral to a psychiatrist, said Berger, was impossible. “The patient is often reluctant to admit even to himself that he is mentally sick, whereas he can continue to believe that he is organically ill as long as he visits the office of a non-psychiatrist.” Berger treated these patients with placebo therapy (giving them injections of a muscle relaxant called mephenesin) plus a kind of Dubois-Dejerine-style psychotherapy.98

Over the years a kind of informal consensus on the management of the somatizing patient established itself within internal medicine and neurology: Seek out the convenient fiction. “Almost every one is filled with the belief that he is debilitated,” wrote Baltimore physician Daniel Cathell in 1882. “Say to the average patient, ‘you are weak and need building up,’ and you will instantly see by his countenance that you have struck his key-note. So much is this the case, that many of the sick, fully impressed with this idea, will want you to treat them with tonics and stimulants, even when their condition is such that these medicines are not at all indicated.”99 In Harley Street it was rather more fashionable to tell patients they had “malnutrition and dyspepsia producing nervous exhaustion” (rather than the reverse).

* When the doctors’ idea of “legitimate” disease changes, the patients’ idea changes as well. When the doctors shifted their paradigm from reflex neurosis emphasizing motor hysteria to the central-nervous paradigm of sensory symptoms, the patients shifted accordingly: Symptoms of psychosomatic illness passed from the motor side of the nervous system to the sensory. Anxious to present legitimate disease, somatizing patients in the last quarter of the nineteenth century and the first quarter of the twentieth abandoned the classic hysteria of the past and adopted sensory symptoms that would correspond to the new medical paradigms of central-nervous disease and psychogenesis. Pain and fatigue came to the forefront of the consultation as examples of symptoms that “exhausted cerebral centers” would be likely to produce. For what better corresponded to the notion of intrinsic cerebral deficits than the highly subjective sensations of pain and tiredness?

* In the social history of medicine there is no more striking phenomenon than the disappearance of classic hysteria. Enthroned in the middle of the nineteenth century as the quintessential illness of the “labile” woman, the fits and paralyses that had been summoned from the symptom pool since the Middle Ages—spreading almost epidemically during the nineteenth century—virtually came to an end by the 1930s. Although doubtless caused by many circumstances, this change was in part a consequence of changing medical paradigms.

* At the psychiatric hospital in Florence, for example, grave hysteria declined from 4 percent of all admissions in 1898-1908 to 0.1 percent in 1938-48.2 Whereas the total number of patients diagnosed as hysterical at Cery Hospital, the university psychiatric clinic of Lausanne, did not change between 1910-29 and 1970-80, the kinds of symptoms that “hysterical” patients presented did alter significantly: Eighty-one percent of all hysteria patients in the former period displayed muscular tetany and agitation; only 27 percent did so in the latter. Fainting declined from 47 to 31 percent of all patients, and globus hystericus (lump in throat) from 13 to 5 percent. The dissociative conditions so popular at the turn of the century also dropped off sharply: “Twilight states” (états crépusculaires), which is to say second states, declined from 57 to 24 percent of all hysteria patients; amnesia dropped from 32 to 18 percent. By contrast, general fatigue rose from being present in 4 percent of all hysteria patients to 13 percent, and visceral problems from 8 to 22 percent. Whereas no patients had complained of sexual frigidity in 1910-29, 22 percent (all of them women) did so in 1970-80.

* In 1916 almost all German neurologists came to agree upon the purely psychological origin of shell shock. Since then we have trained an entire generation of physicians in this tradition. Shell shock is now nipped in the bud, meaning that we would let the front soldiers rest for a couple of days instead of sending them home as in 1914-18, where their symptoms would become fixated and contagious to others. By 1945 the military district had over 30,000 beds and over 3000 neurological cases; and the neurotic division almost never contained more than 30 or 35 soldiers.

* From the viewpoint of the patient, pain and fatigue had the benefits (1) of corresponding to what doctors under the influence of the central-nervous paradigm expected to see, and (2) of being almost impossible to “disprove.” Highly subjective sensations, neither pain nor tiredness can be said not “really” to exist, in the way that the Babinski test can “disprove” a hysterical paralysis or an ophthalmic diploscope can “disprove” the presence of achromatopsia (claimed inability to see colors). One could disprove medically many motor symptoms by demonstrating their lack of an anatomical basis. The potential anatomic basis of fatigue and pain was, by contrast, so much more complex and difficult to investigate that patients could retain the symptoms far longer before physicians would start murmuring the word “hysteria.” Advancing medical knowledge had the ironical result of driving somatization deep into the nervous system, where a “million-dollar workup” would be required to clarify matters.

Writing the history of chronic fatigue as part of the symptom pool involves disentangling it from the diagnosis of neurasthenia. This is a chicken-egg problem: Did a rise in the frequency of fatigue prompt adoption of the diagnosis neurasthenia? Or did Beard’s creation of neurasthenia elicit a rise in the complaint of tiredness among patients who wanted to be taken seriously? Both are likely.

* The psychosomatic symptoms of the 1990s are not very different from those of the 1920s. Now as then, pain and fatigue continue to be the commonest physical complaints. But there are two significant differences between the psychosomatic patients of the 1990s and those of the 1920s. Sufferers today are more sensitive generally to the signals their bodies give off, and they are more ready to assign these symptoms to a given “attribution”—a fixed diagnosis of organic disease. Many patients today have acquired the unshakable belief that their symptoms represent a particular disease, a belief that remains unjarred by further medical consultation.

This increase in illness attribution stems, at the level of the doctorpatient relationship, from the loss of medical authority and from the corresponding increase in the power of the media to suggest individuals into various fixed beliefs. At the cultural level, these new patterns come from a distinctively “postmodern” disaffiliation from family life. If the psychosomatic problems of the nineteenth century resulted from an excess of intimacy in the familial psychodrama, those of the late twentieth century have been the result of the opposite phenomenon: a splintering of close personal ties and the lack of intimacy. These changes of the late twentieth century have had the effect of making people more sensitive to bodily signals than ever before and more willing to shift the attribution of their plight from internal demons to external toxins.

A New Sensitivity to Pain

Our culture witnesses a kind of collective hypervigilance about the body, a sensitivity to variations in weight, for example, that has sufficed to make many fortunes in the industry devoted to dieting and slimming, or a bowel consciousness that keeps pharmacy shelves stocked high with medically unnecessary laxatives. This kind of extreme alertness to the body’s normal functions is itself without historical precedent. But even more striking is a willingness to amplify bodily signals so that they become evidence of disease and justify seeking help or taking medication.

People today believe themselves to be highly symptomatic. After reviewing various studies, one scholar writes: “Only 5 to 14 percent of the general population do not experience symptoms in a given two-week period. The average adult has four symptoms of illness on one out of every four days.” She concludes: “There are probably many people with vague symptoms in search of a diagnosis.”1

Some of these symptoms are psychogenic; some come from organic disease. People today are more sensitive to both.

* In addition to psychogenic pain, fatigue is the other great somatoform symptom of the end of the twentieth century. For many reasons one might expect people leading frenetic, compartmentalized lives in crowded cities to feel tired. But we are talking about fatigue as an illness rather than simply feeling tired at the end of the day. Many individuals who are chronically fatigued believe something is physically wrong with them and end up having more than just a symptom. From their physician or from some other source, they acquire the diagnosis of chronic fatigue syndrome. Accordingly, fatigue is both a symptom and a syndrome, or pattern of illness.

* In the 1990s it is above all chronic fatigue syndrome—consisting of a combination of severe fatigue, weakness, malaise and such mental changes as decreased memory—that has won out over its competitors, just as reflex hysteria triumphed over spinal irritation in the nineteenth century.

The saga of chronic fatigue syndrome represents a kind of cautionary tale for those doctors who lose sight of the scientific underpinning of medicine, and for those patients who lose their good sense in the media-spawned clamor that poisons the doctor-patient relationship. As a precondition, we have a pool of nonspecific symptoms in search of a diagnosis. These symptoms include, in the experience of Donna Stewart, a psychiatrist who has dealt extensively with fixeddiagnosis somatizers, “transient fatigue, headaches, muscle or joint aches, backaches, digestive upsets, respiratory complaints, vague pains, irritability, dizziness, poor concentration, and malaise.” It is chronic somatizers, Stewart continues, who are “especially prone to elaborate on non-specific symptoms, and tend to embrace each newly described disease of fashion as the answer to long-standing, multiple, undiagnosed complaints.”28

How does a given symptom become a disease of fashion? An epidemic of illness attribution, or epidemic hysteria, seems to involve two phases: (1) appropriating a genuine organic disease—whose cause is difficult to detect and substantiate—as a template; (2) broadcasting this template to individuals with often quite different symptoms, who then embrace this template as the explanation of their problems. This broadcasting is effected by sympathetic physicians, patient support groups, and the media.

* Chronic fatigue syndrome is without a doubt the illness attribution that has dominated the last two decades of the twentieth century. One researcher estimated in 1990 that “at least one million Americans [are] currently carrying a diagnosis of CFIDS [chronic fatigue immune dysfunction syndrome], and possibly another five million are ill and yet to be diagnosed.”32 By 1990, some four hundred local support groups for the illness had arisen in the United States, and the Centers for Disease Control of the U.S. Government, in Atlanta, were receiving a thousand to two thousand calls a month about chronic fatigue syndrome.33 Many similar stories of wildfirelike spread elsewhere could be told.

A whole subculture of chronic fatigue has arisen in which those patients too tired to walk give each other hints about how to handle a wheelchair and exchange notes about how to secure disability payments from the government or from insurance companies.34 The whirl of activities within this subculture sounds so diverting that one can understand why the members would be reluctant to part with their symptoms. Among various local associations for chronic fatigue in England, for example, we encounter the following notices: “Berks and Bucks. On 21st May [1988] there will be a stall for M.E. [myalgic encephalomyelitis, the English version of chronic fatigue] at the Young Farmer’s RALLY at the ChildBeale Wildlife Trust near Pangbourne. Please do look out for anything yellow that you can spare,” wrote the local organizer, “and either post it to me or let me know so that I can arrange for its collection (Stall themes are colours).”

“Gloucestershire. Seventeen members, together with partners and friends, attended a coffee morning at Lapley Farm, Coaley on March 5th. This was an excellent turnout for such a large and scattered county…. Next: Family Ploughmans Lunch, also at Lapley Farm, on Saturday, June 4th. We are hoping to arrange a meeting for the autumn in Cheltenham.”35 Chronic fatigue thus can become a way of life.

* Yet infectious mononucleosis never really achieved phase two—diffusion to large numbers of somatizers in an epidemic of symptom attribution—because doctors looked for the characteristic misshaping of cells before granting mono as a diagnosis. It was really after the discovery in 1968 of Epstein-Barr virus as the cause of mononucleosis that EBV became a disease of fashion, because the vast majority of the population bears EBV antibodies in the blood. Disproof was impossible. Finally “evidence” was at hand that sufferers were “really ill”: Their blood tests (and everybody else’s) showed the antibodies. This particular proof seemed to be dramatically delivered in 1984, when an epidemic of stillinscrutable character occurred at Lake Tahoe. EBV antibodies were detected in blood samples of some of the victims, and the case for organicity seemed to be clinched.42 In the mid-1980s EBV was warmly embraced as the explanation of one’s difficulties, a series of learned medical articles strengthening the supposition of organicity. 43EBV was christened in the press “the Yuppie flu,” an infection to which fast-tracking professionals were thought especially vulnerable.

Unfortunately, the very ubiquity of Epstein-Barr virus caused its downfall as an illness attribution. In 1988 Gary Holmes at the Centers for Disease Control, along with coworkers, realized that the correlation was poor between those patients who had hematological evidence of chronic EBV infection and those who had the symptoms of chronic fatigue. Holmes therefore rebaptized chronic Epstein-Barr virus infection as chronic fatigue syndrome, or CFS.44 This renaming did not sit well with patient groups, who promptly renamed their condition CFIDS, chronic fatigue immune dysfunction syndrome, to better insist on its organicity.45

These two templates therefore, neuromyasthenia and mononucleosis EBV, provided the presumption of organicity for self-labeled sufferers of chronic fatigue in the United States and Canada. Donna Greenberg, professor of psychiatry at Harvard, wrote of these diagnoses: “Chronic mononucleosis and chronic fatigue syndrome represent neurasthenia in the 1980s…. It is in the nature of chronic fatigue that [the diagnosis] will inevitably recruit subjects with depressive disorders, anxiety, personality disorders, and other common medical syndromes such as allergic rhinitis or upper respiratory infections.”46 Exactly as appendicitis had given way to colitis, and reflex neurosis to neurasthenia, so in the United States chronic EBV gave way to CFIDS as somatization attempted to keep one jump ahead of science.

* In a curious inversion of the normal diffusion of scientific findings, the media advocates of CFS seize immunological data as they become available in the lab and apply them willy-nilly to their pet illnesses. “Not just the blues,” trumpeted Newsweek, as a cover story of November 12,1990, on chronic fatigue syndrome alerted readers to new findings about “a newly discovered herpes virus called HHV-6.” Research on patients’ “interleukin-2” levels had also proved promising, the story said.63 Although individual sufferers may display disparate immunological abnormalities, no pattern of findings has emerged common to CFS patients as a whole. Nor is it clear how widespread these abnormalities are in the general public, nor to what extent they are shared by individuals with other psychiatric illnesses. Driving forward the pseudoscience underlying CFS has not been the medical profession itself—it has been the media.

In the United States, a widely read story in Rolling Stone magazine in 1987 gave the signal for converting chronic fatigue into a media frenzy. Entitled “Journey into Fear: The Growing Nightmare of Epstein-Barr Virus,” the journalist-sufferer, once “in control of my career and my life,” explained how an “enigmatic disease” had rendered her “unable to lift my toothbrush or remember my phone number.” Of course her physicians had been unhelpful. “After rendering their diagnoses, my doctors made it clear they had served me to the limit of their ability. One of them, the internist, tried to comfort me: ‘At least it isn’t terminal.’” The writer cried a good deal and felt “a sadness akin to the raw grief of mourning.” Then one day she read about the Lake Tahoe “epidemic” and realized what she had.

The writer located a physician-enthusiast. Because she carried with her copies of all her blood reports “rolled up and stuffed in my bag,” she pulled them out for him to look at. Sure enough, she had the Lake Tahoe disease. He explained to her that her reports displayed the “reactivation phenomenon,” a phenomenon unknown to his medical colleagues generally.

“I understand there are doctors who leave the room after speaking to one of these patients and can’t stop laughing,” he told her.

The message to Rolling Stone readers was that a terrible epidemic was ravaging the country and that a mainline physician was the last person one would want to put one’s trust in.

* Television has spread this plague of illness attribution even more rapidly than the print media. A “chronic fatigue” story on “TV Ontario,” for example, prompted more than fifty-one thousand viewers to try to phone the station during the forty-minute segment.68 A short spot on chronic fatigue on Channel 3 in Philadelphia produced seven hundred calls to the station—a record for that particular program—and a further two thousand inquiries to the CFIDS Association.69

On September 23 and 30, 1989, NBC aired a two-part show in the “Golden Girls” series, featuring Dorothy’s struggle with chronic fatigue. Her first doctors, mainline physicians, had been beastly. As Dorothy is about to leave for an appointment with “her virologist,” her friend Rose tells her: “Good luck, I hope he finds something wrong with you…. Oh, I don’t mean something wrong wrong, I just mean something wrong so you’ll know you’re right when you know there’s something wrong and you haven’t been wrong all along.” (This is the exact functional equivalent of nineteenth-century young women hoping to be admitted to hospital for ovariotomies.)

In the program Doctor Chang, the virologist, reassures Dorothy that “she really is sick and not merely depressed…. There are new diseases arising all the time,” he says.

“So,” Dorothy says with relief, “I really have something real.”70

Dorothy’s encounter with chronic fatigue demonstrates the oppositional stance to mainline medicine of this subculture of invalidism, a refusal to accept medical reassurance. The chronic fatigue sufferers of today are far more skeptical of medical authority than were victims of ovarian hysteria in the 1860s or brucellosis patients of the 1930s. In 1990 Woman’s Day bannered “The Illness You Can’t Sleep Off.” “Can you imagine,” asked the author, “how it feels to know there is something terribly wrong with you and have one doctor after another tell you there can’t be?”71 This theme of medical incompetence and indifference runs throughout the movement, which elevates the patients’ subjective knowledge of their bodies to the same status as the doctors’ objective knowledge. This presumption of privileged self-knowledge of one’s body dovetails perfectly with media marketing strategies.

The rejection of psychiatric diagnoses by chronic fatigue patients is much more violent than are the normal reactions of medical patients to psychiatric consultation, and is itself a characteristic of the illness. Anything smacking of psychiatry or psychology is completely taboo. The chronic fatigue subculture evaluates internists, for example, not on the basis of the quality of their clinical judgment but their friendliness to the diagnosis. The work of Stephen Straus, a distinguished internist at the National Institutes of Health in Bethesda, was initially greeted by hosannas because in 1985 he seemed to take the EBV explanation at face value. Three years later, however, Straus became an object of vilification when he said that psychopathology might help to explain the symptoms as well.72 “Expecting Stephen Straus to talk about CFS for very long without inevitably mentioning psychiatric disorders is like expecting Blaze Starr to walk without jiggling,” wrote one disappointed sufferer.73

The chronic fatigue subculture brims with folklore about choosing physicians thought to be sympathetic. How does one pick a doctor? A patients’ organization advised selecting one who would share test results and let the patient keep a copy—a bizarre request in the context of normal medical practice.74 Chronic fatigue patients, reluctant to disclose emotional symptoms, are often quite resistant to psychological probing of any kind from the doctor.75 Needless to say, psychiatrists are unwelcome in the subculture of chronic fatigue. The several psychiatrists who appeared at a chronic fatigue symposium in 1988 in London were called, by one physician-enthusiast, “colourful and frankly strange remnants of prehistoric medicine” and “as mad as hatters.”76 Behind this fear of psychiatry is the horror that one’s symptoms will be seen as “imaginary,” which characterizes most patients with fixed illness attributions. Thus patients welcome the occasional blood abnormalities that turn up in their testing.77

Another characteristic of the subculture of invalidism is its “pathoplasticity,” the willingness to change symptoms and attributions as new fads appear. Chronic fatigue sufferers are quite willing to believe that they also have other illnesses that are stylish at the moment. Monilia infections, sometimes called candida or total body yeast infections, enjoyed a certain currency during the 1980s. “Could Yeast Be Your Problem?” headlined one American chronic fatigue newsletter.78 An English sufferer suggested an “anti-candida diet,” including “half an avocado pear sprinkled with lemon juice.”79 A number of English patients expressed their concerns about yeast in letters to Doctor Dawes: “I put myself on an anti-candida diet, and persuaded my doctor to give me Nystatin [a fungicide],” wrote one patient. “He is gradually reducing the amount of Nystatin I am taking but he was reluctant to allow me to have Nystatin in the first place. I am not sure that he is the best judge of how much I should be taking.” (Doctor Dawes responded: “A number of people need to take it for a year or two.”)80

Other patients believe they have chronic fatigue and multiple food allergies (“causing immediate sensations in my stomach and legs”).81 Pyramiding the syndromes one atop the other, one person wrote to a physicianenthusiast, “I have CFS and was recently told I have Candida and given a special diet that excluded food items to which Candida sufferers are allergic. I was about to start when I saw you on TV and now wonder, what happens if I am also allergic to foods on the Candida diet.”82

Still other patients believe that they have chronic fatigue and hypoglycemia (“It took me two years to find a doctor who understood.”)83 Or that they have TMJ syndrome, polio, and Lyme disease. One sufferer believed she was being poisoned by the mercury fillings in her teeth. She failed, however, to get better after having all the fillings removed.84 Indeed, the only current disease chronic fatigue patients are sure they do not have is highly stigmatized AIDS. The occasional suggestion that whatever organism ails them is similar to the one producing AIDS is greeted with dismay.85

One study has demonstrated how closely the diseases of fashion are interwoven with one another. Fifty patients with “environmental hypersensitivity,” a disease attribution closely related to chronic fatigue, were asked what else they thought they had. Ninety percent were found to be “suffering from at least one other media-popularized condition,” including EBV, food allergy, candidiasis hypersensitivity, and fibrositis. More than 10 percent of the patients reported eight or more diseases of fashion. In 1985, when the study began, all patients attributed their problems to environmental sensitivity, but by 1986 many had shifted to Candida albicans as the main cause, and by 1987 EBV had become particularly popular. Most of the patients were on disability; none expected to return to his or her former job (88 percent were women). The author concluded: “These patients are suggestible and at high risk for acquiring diagnoses that are popularized by the media.”86

Such hypersuggestibility is conceivable only in a population that has quite lost its moorings in the folk culture of body knowledge. In the United States there was once a common set of assumptions, or folk culture, about health and illness that was handed down from generation to generation. These assumptions gave people a commonsensical understanding of their own sensations. Instead, individuals today are buffeted by every new “finding” on television or in the morning paper. Accompanying this loss of contact with a folkloric inheritance and its tranquil interpretation of bodily symptoms, has been a loss of willingness to believe in “what the doctor says.” For example, the percentage of patients in the United States willing to use the family doctor as a source of “local health care information” declined from 46 percent in 1984 to 21 percent in 1989.87 As for selecting which hospital to attend, more than 50 percent of patients polled in 1989 said that “they or their family have the most influence in selection of a hospital”—as opposed to listening to the doctor—up from 40 percent in previous years.88 (Non-American readers will recall that private American hospitals compete for patients.) According to a Gallup poll in 1989,26 percent of patients said they respected doctors less now than ten years ago (14 percent said more). And of those who respected doctors less, 26 percent said, “they [the doctors] are in it for the money.” Seventeen percent claimed that doctors “lack rapport and concern.”89

The late twentieth century is writing a new chapter in the history of psychosomatic illness: fixed belief in a given diagnosis. The diagnosis itself may be changeable, based on fashion, but the fixity of belief remains the same, a questing after certainty resulting from the rising influence of the media upon public opinion and the corresponding decline of medical authority.

* Although the term postmodern has been bandied about in a nonspecific way, it does have a specific meaning in the area of family life: the triumph of the desire for individual self-actualization over commitment to the family as an institution.90 This kind of larger commitment, not a commitment to specific individuals but to the ideal of “family,” characterized the modern family of the nineteenth-and early-twentieth century. In the postmodern family, the notion of “relationship” has taken priority over the concept of the family as a building block of society. Indeed since the 1960s the relationship has often supplanted the concept of marriage itself. Sexual relationships involving periods of living together are becoming the antechamber to marriage.91 Adulterous relationships often exist on the side for both partners, and after divorce the partners are spun once again into the world of relationships. So the notion of “relationship” has deeply pervaded the institution of marriage.

The intrinsic logic of the relationship lies in achieving self-actualization, or personal growth, instead of pursuing communitarian objectives. It is this search for individual psychological fulfillment for the individual partners that gives the postmodern family its remarkable fragility, for once personal growth ceases within marriage, the marriage itself terminates. Thomas Glick, a senior demographer at Arizona State University, wrote in 1987: “The relatively fragile state of American family life at present is undeniable in view of the prospect that close to one-half of the first and second marriages of young adults will end in divorce.”92 Accordingly, instability is becoming the rule rather than the exception.

The keynote of postmodern life is the solitude and sense of precariousness arising from ruptures in intimate relationships. As the average age at marriage rises, the number of young people living alone increases. Divorce further accelerates singlehood. And the social isolation of the elderly has greatly increased.

* What are the consequences of postmodernity for psychosomatic illness? People who are socially isolated tend to have higher rates of somatization in general than those who are not. One scholar concluded, after a review of the literature on health and loneliness, that “loneliness is linked with reported feelings of ill health, somatic distress, and visits to physicians as well as physical disease.”

* By removing “feedback loops,” social isolation intensifies the tendency of individuals to give themselves fixed selfdiagnoses. The advantage of living closely with others is that one can test one’s ideas. I’m feeling poorly today. Do I have chronic fatigue syndrome? No, it’s because you slept poorly last night. This is the kind of feedback that occurs routinely in living together with others. We profit from the collective wisdom about health and illness of our co-residents. These feedback loops cease to function when one lives alone, and function imperfectly in living solely with one other individual, for one is either cut off from the collective wisdom entirely or has substantially reduced access to it.

The unmarried, divorced, and widowed tend to be easy prey for chic media-spawned diseases because they have few “significant others” with whom they may discuss interpretations of their own internal states. Of fifty patients with chronic fatigue syndrome seen at Toronto Hospital, “most were unmarried women and at least 4 had been divorced.” Their average age was thirty-three, and fully 50 percent had had a major depression before the onset of the fatigue.99 Of eight patients in one study who were “allergic to everything,” four were married, two divorced and two single.100 As for “twentieth-century disease,” psychiatrist Donna Stewart describes a population of young, middle-class female sufferers whose personal lives were in chaos. Of her original eighteen patients reported in 1985, seven were married, eight single, and three divorced.101 Lacking feedback loops, such individuals have only the media against which to test readings of their internal sensations, and the media purvey the most alarmist view possible.

In the nineteenth century the “restricted” Victorian woman gave us an image of the motor hysteria common among women. In the late twentieth century somatization has become the lot of both sexes. Both men and women have been victims of the shattering of the family, and both experience the kinds of pain and fatigue distinctive to our century. It is the lonely and disaffiliated who give us the image of our own times, who are the latter-day equivalent of the hysterical nineteenth-century woman in her hoop skirts and fainting fits. The difference is that, whereas the nineteenth-century woman was virtually smothered by the stifling intimacy of family life, the disaffiliated of the late twentieth century expire in its absence.

The development of psychosomatic symptoms can be a response to too much intimacy or too little. And if our forebears of the “modern” family suffered the former problem, it is we of the postmodern era who endure the latter. The disaffiliated, having lost their faith in scientific medicine and unable to interpret body symptoms in social isolation, seek out alternative forms of cure. The therapies are largely placebos, if not directly harmful to the body as in the case of colonic irrigation—a revival of the outdated practice of curing reflex neurosis by “getting those poisons out of there.” This alternative subculture represents a population that has lost its faith in medical reassurance, that in the absence of folkloric family wisdom seeks its knowledge of the body from the media, and that has taken the full blow of the “relationship” stresses of postmodern life. It is a generation that did not invent psychosomatic illness, but finds itself singularly vulnerable to pain and fatigue that have no physical cause.

Posted in CFS | Comments Off on From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era

I Remember The First Time My Back Went Out

I believe it was late 1992 or early 1993. I had just passed the Reform Beit Din for my initial conversion to Judaism. I had just started placing and responding to singles ads. I had met a woman over the phone that week and I was fantasizing about her. I think we’d had one good conversation. I had been largely bedridden (about 18 hours a day) for the previous four years with Chronic Fatigue Syndrome (CFS). I was living with my parents in Newcastle, CA. They were away for a few days. I rolled out of bed one night to go pee when my lower left back suddenly seized up and I was absolutely helpless. I couldn’t get up. Nothing like it had happened before. We lived on seven acres. Nobody was close. I started crying aloud for help but nobody could hear me. I panicked. I thought about the woman I’d just met and I dreamed she’d come to rescue me, but no rescue came.

After about 30 minutes, I managed to roll on to my side and push myself up. The pain was severe for a couple of days and then it gradually lessened. I couldn’t believe how vulnerable I was. Not just CFS, but my lower back could go into spasm and I would be essentially paralyzed.

After that, about every year or so, my lower left back would go out similarly and I would be hobbled for a couple of days and then gradually return to normal.

Now I’m reading about John Sarno MD’s methods and I am trying to explore the hidden emotional forces in my back pain. I’m wondering if I had a desire to become became helpless so this new woman would rescue me.

I remember in the weeks prior to my February 1988 collapse into CFS (when I was taking 21 units at college and working about 30 hours a week in addition to strenuous workouts every other day), I kept getting this unwanted and embarrassing thought — “I’m going to break through to success or I’m going to break down. Either way, I’ll get the love that I need.”

Howard Schubiner MD blogs:

It is important to realize that Mind Body Syndrome is not a new diagnosis. When Dr. Sarno described Tension Myositis Syndrome (TMS) in the 1970’s, he created a new name for a syndrome that has actually been known for hundreds of years. I agree with Dr. Sarno that we do need a name for this syndrome (and I will explain why in future blogs). However, when you look at the history of medicine you will find many examples of MBS. I highly recommend the book by the University of Toronto historian, Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Medicine. Dr. Shorter uses the term psychosomatic, which is commonly used in medicine, but a term that I do not prefer to use because it has a connotation of being unkind to the patients, implying that they are somehow less than normal, or somewhat “crazy.” As I often say, I know that people with MBS are not crazy because I have MBS and I know I’m not crazy.

In any case, the reason people get MBS, or physical (or psychological symptoms) due to emotions which are often unconscious, is that they are human. They have a human brain that processes emotions in certain ways and they have human existences that often cause great stress in our lives. That is why there has always been MBS and there will always be MBS. However, the type of symptoms that the brain creates in our bodies does change over time.

For example, we know (courtesy of Dr. Shorter) that a common manifestation of great stress and emotions in the 1600’s and 1700’s was the development of paralysis. A story that captures this is about a young man who was beaten, abused, and berated his whole life by his father. When he was approximately 25 years old, while being berated once again, he had a great surge of energy and suddenly went to hit his father with his fist. At that very moment, his arm became paralyzed and he couldn’t move it at all. We know that he didn’t suddenly have a stroke because he regained use of the arm fully within a short time. And therefore we know that the cause of the paralysis was a combination of emotions, which were all unconscious (i.e. he was unaware that he was feeling them), and the main emotions were anger, fear and guilt. In those centuries, doctors did not consider this type of reaction to be caused by psychological factors, but rather some kind of physical condition. In the 1900’s, doctors learned how to tap on the tendons of an arm or leg and determine immediately if there was a stroke or some other severe neurologic condition. We now call these reflexes, the deep tendon reflexes, and use them all the time. When they are normal, in someone with sudden paralysis, we know that there is no neurologic condition and that the cause of the paralysis is due to MBS.

Since doctors have been able to use deep tendon reflexes, the number of people with paralysis due to stress and emotions has dropped drastically so that it’s relatively rare. Why? The cause of MBS is in the mind, in our unconscious mind that is trying to help us cope with great stress. The unconscious mind will find some physical symptoms to use when necessary and it will choose a physical symptom that makes some kind of sense. And typically, it will choose a physical symptom that will not be seen as “psychological.” Since paralysis is now seen as psychological, it is rarely used by the unconscious mind. We are more likely now to get Back Pain, headaches, fatigue, and stomach pains, which are more likely to be seen as physical conditions and therefore more acceptable to our self and to the doctors.

This is one reason why there are so many people today with these chronic symptoms and often they do not respond to biomedical treatments. Since so few doctors are aware of MBS, they often are not treating the underlying cause of the symptoms and therefore the treatment is trying to cope with the symptoms of the problem and is less likely to be successful…

MBS is not new. As long as there have been humans, there have been physical symptoms caused by stress and emotions. It is important to realize that physical symptoms, even very severe physical symptoms can be caused by stress and emotions. In fact, the emotions that tend to have the largest effect on us are precisely those that we are unaware of. There are two ways to think about how these symptoms can be produced.

The first way is to understand how the neurologic system works. Pain is a learned response, i.e. the body actually learns how to produce certain symptoms by experiencing them. For example, I had a patient who fell and hurt her back as a teenager. A decade later, she was in a very difficult situation in a job where she felt trapped and unable to get out of her problems there. At that moment, suddenly her back seized up and she had tremendous pain. The nerves that send signals from the back to the brain had been fired when she fell as a teenager and those nerve connections had been “learned” at that time. When a significant emotional situation arose where she had no way out, her body responded in a way that it already knew, by producing the Back Pain it had learned 10 years earlier.

A good way to understand how MBS works is by thinking about phantom limb syndrome. In this syndrome, which is very common among amputees, pain or other sensations can be felt in the part of the body (arm or leg usually) that is missing. There is obviously no disease in that area, yet we can feel pain (often severe) that appears to be coming from the missing body part. What has happened is that the nerves that send signals to the brain have been sensitized and are continuing to fire and those signals are interpreted as pain by the brain. A vicious cycle is formed of sensitized nerves that send signals to the brain, then those signals get amplified in the brain (by a structure called the anterior cingulated cortex; more about that area of the brain in upcoming posts), and then signals are sent out to the body by the autonomic nervous system (the fight, flight or freeze system). This pain is real, very real. However, there is no tissue breakdown, no tissue disease in the body. This is exactly what happens in Mind Body Syndrome. We may feel pain in an area of the body, for example, the head or back or stomach, yet there is no tissue breakdown, no tissue disease there. Of course, pain can be caused by tissue breakdown or disease, such as occurs in cancer, infections, or fractures. When the doctors are unable to find disease after a careful and thorough search, the diagnosis of MBS is usually correct. It is important to realize that MBS is a physiologic process, i.e. a process that occurs due to normal reactions of the body. When we get scared, our heart speeds up; when we get nervous, our stomach tightens up or we get clammy hands. These are physiologic processes, normal reactions that are 100% reversible. That is why MBS is curable. It can be reversed by interrupting the vicious cycle.

Posted in Back, Personal | Comments Off on I Remember The First Time My Back Went Out

Recent Shows

00:00 Who are the real sex pests?
06:00 Millenial Woes addresses the sex pest accusation, https://www.youtube.com/watch?v=FH6rrwDJsco
20:00 Where Woes went wrong, https://trad-news.blogspot.com/2020/12/woes-finally-lauches-sex-pest-defence.html
1:13:00 The American Conservative magazine conference with Michael Anton, Chris Buskirk, https://www.youtube.com/watch?v=wOk4VBdfIlw
1:54:00 Back Pain and Tension Myositis Syndrome, https://www.tmswiki.org/forum/threads/back-pain-and-tension-myositis-syndrome-tms.11990/
2:04:00 Prof John Mearsheimer – US Foreign Policy under President Biden, https://www.youtube.com/watch?v=KaTGGdsomf4
2:05:20 R&B Lecture: “Daughters of Esther and Peace Between Abrahamics” by Roseanne Cherrie Barr, https://www.youtube.com/watch?v=TMdn4yZeU8o
2:07:30 Dooovid makes Roseanne Barr laugh with a Luke Ford quote
2:15:00 Reb Dooovid joins the stream
2:34:00 Dooovid’s ability to find weak points
2:36:00 Dooovid found help for his anger in Hinduism
2:36:40 Dooovid’s multiple truth hypothesis
2:42:00 Prominent SPLC Board Member Vanishes from Website Amid Racism, Sexism Scandal, https://pjmedia.com/news-and-politics/tyler-o-neil/2019/03/26/prominent-splc-board-member-vanishes-from-website-amid-racism-sexism-scandal-n64720
2:51:30 Project Veritas releases CNN Tapes

Posted in America | Comments Off on Recent Shows

Why Did Blacks Make More Progress Before Civil Rights Than After?

From comments to Steve Sailer:

* By every standard you can measure….blacks were much better off before “civil rights.”

Prior to the left “helping” blacks with desegregation, blacks had thriving businesses, an intact family unit, a much lower rate of illegitimacy, strong churches and church attendance, lower rates of crime and substance abuse, etc.etc.etc.

Welfare incentivized single motherhood….and fatherless boys do MASSIVE crime. Out of wedlock births are now 76%, the more intelligent (leadership class) fled to white hoods to escape high crime leaving blacks without decent leaders, substance abuse and gang crime exploded, the entire family structure was destroyed, and now blacks are dependent on govt. handouts.

* Black people, on the whole, had much more self-respect in the earlier era, even though they didn’t advertise it to anywhere near the degree they do now. Sort of ironic.

The various pathologies which characterise way too much of black culture today were trivial back then by comparison. We now have a society which disparages personal responsibility and celebrates every kind of immorality, and is much more racist than ever before. Also sort of ironic.

I’ve seen single black moms struggling with their sons. It can’t be easy. Our cultural propaganda makes it nigh impossible. No one dares tell kids that they shouldn’t have kids of their own, outside a stable family unit. The results are everywhere.

* Anything subsidized grows: TANF, SNAP, Section 8, heating assistance, free school lunches and breakfasts, free preK-12 education, Pell grants, etc, etc. We are subsidizing the reproduction of the least able people. The crop of neck and face tatooed carjackers that bedevil our streets have been brought into being by the good intentions of people like Nancy Pelosi and Chuck Schumer.

* America has been sliding downhill overall since 1970, with blacks sliding even more than whites. Striving for equality is just one of many things that America can’t do as well as it could 50 years ago. Personally, I look at the Apollo 17 mission returning from the moon for the last time one month before the Supreme Court decided the U.S. Constitution includes a right to abort fetuses, and I wonder if the nation turned its back on the blessings of God available to it. Secularists can formulate that idea in their own secular terms if inclined.

* Moving to the North with lots of good jobs in factories for those with limited education or skills undoubtedly helped. But as the workforce for manufacturing declined, it probably affected blacks the first and the most, as there were no comparable employment opportunities to replace them. Toss in badly misguided social policies and we have experienced a social disaster.

They were then sold on the transformative promise of college education, with the result that culturally they place a high premium on credentialism while being fleeced like no other group by the higher ed industry. That has led to the current moment of millions of people with useless degrees and no practical skills believing only a systemic force organized solely to hold them back is responsible for all the disappointments.

* Things that hit the fan for Blacks around 1970: Black fathers disappearing and Black marriage rates plummetting; deindustrialization; lots more whites going to college on financial aid; drug use and selling by blacks going way up; rising crime rates.

Plus let us not forget the ability of white people to replace black labor with Hispanic labor due to mass illegal migration and stagnation of wages that has now lasted decades and loss of labor union membership.

* Perverse incentives in the 1960s turned the black lower class feral: that’s well understood by now.

Perverse incentives today are turning the black elite destructive and useless. I’m thinking of incentives like: white credulity, meaning that a hate hoax results in career advancement and monetary rewards; booming employment as DIE enforcers, resulting in talent (such as it is) getting channelled away from honest productive work, and the proliferation of professional black racists; intensification of affirmative action (from a thumb on the scale, to a foot on the scale), eroding the need to study and perform even at the levels a mediocre person would be capable of.

* There’s also been a general race blind falling behind of the working class, which disproportionately affects blacks compared to whites and so ceteris paribus increases the black-white gap. It’s something that the civil rights movement is partially responsible for because it helped suck the oxygen away from old school economic liberalism that was dedicated to giving the working class stability and economic resources. It’s still a pretty common response to pointing out how much more economically equal the US used to be or certain other countries currently are to say that well those places are racist so we shouldn’t copy them. Civil rights also poisoned many whites against the left broadly

You’re also ignoring the fact that the black-white relationship never stabilized around no net discrimination, but has been ratcheting up more and more net anti white discrimination for decades.

Posted in Blacks | Comments Off on Why Did Blacks Make More Progress Before Civil Rights Than After?

Sailer: Both Pfizer and Moderna Could Have Announced Their Vaccines’ Efficacy Before the Election, Which Likely Would Have Meant a Trump Victory

Steve Sailer writes: “… if Trump really were the authoritarian strongman his haters claim he is and his fanboys hope he is, he would have done something about this, such as, at minimum, dispatch his SEC to warn Pfizer that if they don’t disclose results according to their published protocol, they will be sued. But that’s not who Trump is… Trump probably would have been re-elected if he’d made Pfizer follow its published protocol or let Moderna carry out its clinical trial on the kind of people who want to volunteer for clinical trials. But Trump failed at those tasks.”

* They would have lots of reasons not to announce it before the election. One of the super legitimate ones is to not have Trump turn their vaccines into a toxic highly partisan political issue like he did with hydroxychloroquine.

If the pharmaceutical companies hate Trump it’s certainly not because he did anything worthwhile to earn their hatred. There would be plenty that a real right wing populist would have done to do that, but that’s not Trump.

Overall I and I’m pretty sure Steve have no idea what is and isn’t typical in in drug trials. It’s kind of absurd to say that the delay (if there even was a delay) was definitely because of one thing or another without some kind of real smoking gun (e.g. an email laying out intent, not what Steve calls a smoking gun). The argument Steve is making is ultimately a probabilistic one that has to be built on a very deep foundation of background knowledge about the process.

* Some in the African-American community have argued that there is _too much_ testing on Blacks, and have called for Blacks to stop volunteering for trials.

“Earlier this month, Kimbrough, the president of Dillard University, and C. Reynold Verret, the president of Xavier University of Louisiana, issued a public letter announcing that they were participating in a Covid-19 vaccine trial. Kimbrough and Verret, both leaders of private, historically Black universities in New Orleans, encouraged their students, faculty, staff, and alumni to consider participating in the same trial or others like it…

Their message was in line with others from HBCU leaders and the Congressional Black Caucus. But their letter, because it was aimed in part at students, provoked outrage.

The HBCU leaders should not put students forward as experimental “lab rats,” parents, alumni, and others fumed in a torrent of social media comments that generated headlines in the local press. A prominent economist said they had contributed to the excessive recruitment of Black people for trials. Leaders of a Black church political group demanded that Kimbrough and Verret “immediately disclose if they are being paid to urge students to participate in the trials.”

* Sailer: Now, both StatNews and the New York Times have reported that Pfizer stopped processing nasal swabs from late October until the day after the election in order to not know if it were time to disclose the results of its clinical trial according to the protocol it had published.

Pfizer is free to offer evidence against what these two publications have stated. If you are aware of any evidence other than emphatic denials, please let us know.

* Rejoinder: My point is that I have no idea how unusual it is that they stopped processing nasal swabs, what their official explanation is, how reasonable that explanation is. Vaccine testing and approval is an area I know very little about.

Now I know their official justification: because they wanted to change the benchmark to one more rigorous and didn’t want to cross the threshold of the previous benchmark until they got permission to do that change. Is that unusual? I have no idea. Is that explanation bullshit? I have no idea. I don’t have the background knowledge to make that call.

* What’s particularly bizarre about the account of Moderna’s decision to slow down its trial is that it reports that it was the head of Operation Warp Speed itself, Slaoui, who was putting pressure on it to do so.

Is this really accurate? Was Trump unable even to get Slaoui on board to get the vaccine out as soon as possible? Was Slaoui himself pressured by other forces to push for tests on minorities at the expense of speed?

* Mr. Sailer is assuming here:

1. there was a subset of voters who were awaiting news about a potential vaccine under Trump’s watch, and were ready to change their mind the moment there was an announcement;

2. there was a subset of voters who up until the election day were uncertain who they were going to vote for, and needed “good news”, in particular on the vaccine front, and decided not to vote for Trump because he failed to deliver.

The problem with Sailer’s peddling of this vaccine political conspiracy theory, while possible, is that there had been tens of millions of mail-in votes already casted before Pfizers alleged malfeasance, and thus they would have been unaffected compared to those going in person to the polls. More than likely, people had already made up their mind about who they were going to vote for.

Posted in America | Comments Off on Sailer: Both Pfizer and Moderna Could Have Announced Their Vaccines’ Efficacy Before the Election, Which Likely Would Have Meant a Trump Victory