https://astralcodexten.substack.com/p/contra-resident-contrarian-on-unfalsifiable

I. Contra Resident Contrarian . . .

Resident Contrarian writes On Unfalsifiable Internal States, where he defends his skepticism of jhana and other widely-claimed hard-to-falsify internal states. It’s long, but I’ll quote a part that seemed especially important to me:

I don’t really want to do the part of this article that’s about how it’s reasonable to doubt people in some contexts. But to get to the part I want to talk about, I sort of have to.

There is a thriving community of people pretending to have a bunch of multiple personalities on TikTok. They are (they say) composed of many quirky little somebodies, complete with different fun backstories. They get millions of views talking about how great life is when lived as multiples, and yet almost everyone who encounters these videos in the wild goes “What the hell is this? Who pretends about this kind of stuff?”

There’s an internet community of people, mostly young women, who pretend to be sick. They call themselves Spoonies; it’s a name derived from the idea that physically and mentally well people have unlimited “spoons”, or mental/physical resources they use to deal with their day. Spoonies are claiming to have fewer spoons, but also en masse have undiagnosable illnesses. They trade tips on how to force their doctors to give them diagnoses:

> In a TikTok video, a woman with over 30,000 followers offers advice on how to lie to your doctor. “If you have learned to eat salt and follow internet instructions and buy compression socks and squeeze your thighs before you stand up to not faint…and you would faint without those things, go into that appointment and tell them you faint.” Translation: You know your body best. And if twisting the facts (like saying you faint when you don’t) will get you what you want (a diagnosis, meds), then go for it. One commenter added, “I tell docs I'm adopted. They'll order every test under the sun”—because adoption means there may be no family history to help with diagnoses.

And doctors note being able to sort of track when particular versions of illnesses get flavor-of-the-week status:

> Over the pandemic, neurologists across the globe noticed a sharp uptick in teen girls with tics, according to a report in the Wall Street Journal. Many at one clinic in Chicago were exhibiting the same tic: uncontrollably blurting out the word “beans.” It turned out the teens were taking after a popular British TikToker with over 15 million followers. The neurologist who discovered the “beans” thread, Dr. Caroline Olvera at Rush University Medical Center, declined to speak with me—because of “the negativity that can come from the TikTok community,” according to a university spokesperson.  

Almost no one who encounters them assumes they are actually sick.

Are there individuals in each of these communities that are “for real”? Probably, especially in the case of the Spoonies; undiagnosed or undiagnosable illnesses are a real thing. Are most of them legitimate? The answer seems to be a pretty clear “no”.

I’m not bringing them up to bully them; I suspect that there are profiteers and villains in both communities, but there’s also going to be a lot of people driven to it as a form of coping with something else, like how we used to regard cutting and similar forms of self-harm. And, you know, a spectrum of people in between those two poles, like you’d expect with nearly anything.

But it’s relevant to bring up because there seem to be far more Spoonies and DID TikTok-fad folks than people who say they orgasm looking at blankets because they did some hard thinking (or non-thinking) earlier. So when Scott says something that boils down to “this is credible, because a lot of people say they experience this”, I have to mention that there’s groups that say they experience a lot of stuff in just the same way that basically nobody believes is experiencing anything close to what they say they are.

Granting that this is not the part of the article RC wants to write, he starts by bringing up “spoonies” and people with multiple personalities as people who it’s reasonable to doubt. I want to go over both cases before responding to the broader point.

II. . . . On Spoonies

“Spoonies” are people with unexplained medical symptoms. RC says he thinks a few may be for real, but most aren’t. I have the opposite impression. Certainly RC’s examples don’t prove what he thinks they prove. He brings up one TikToker’s advice:

In a TikTok video, a woman with over 30,000 followers offers advice on how to lie to your doctor. “If you have learned to eat salt and follow internet instructions and buy compression socks and squeeze your thighs before you stand up to not faint…and you would faint without those things, go into that appointment and tell them you faint.”

Translation: You know your body best. And if twisting the facts (like saying you faint when you don’t) will get you what you want (a diagnosis, meds), then go for it. One commenter added, “I tell docs I'm adopted. They'll order every test under the sun”—because adoption means there may be no family history to help with diagnoses.

This person is using a deliberately eye-catching title (Lies To Tell Your Doctor) to get clicks. But if you read what they’re saying, it’s reasonable and honest! They’re saying “If you used to faint all the time, and then after making a bunch of difficult lifestyle changes you can now mostly avoid fainting, and your doctor asks ‘do you have a fainting problem yes/no’, answer yes!” THIS IS GOOD ADVICE.

Imagine that one day you wake up and suddenly you have terrible leg pain whenever you walk. So you mostly don’t walk anywhere. Or if you do have to walk, you use crutches and go very slowly, because then it doesn’t hurt. And given all of this, you don’t experience leg pain. If you tell your doctor “I have leg pain”, are you lying ?

You might think this weird situation would never come up - surely the patient would just explain the whole situation clearly? One reason it might come up is that all this is being done on a form - “check the appropriate box, do you faint yes/no?”. Another reason it might come up is that a nurse or someone takes your history and they check off boxes on a form. Another reason it might come up is that everything about medical communication is inexplicably terrible; this is why you spend umptillion hours in med school learning “history taking” instead of just saying “please tell me all relevant information, one rational human being to another”.