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In which John discusses labyrinthitis, OCD, categories, the body in thought, and the body in pain.
1. Stigma is complicated. When it comes to stigma around mental illness, I've found this paper extremely helpful (I reread it often): One heavily stigmatized illness not mention in the video is HIV, and there has been a lot of research around the causes (and the consequences) of stigma w/r/t HIV; I recommend this overview:

But in general, illness is stigmatized partly based on our ability to treat them/our level of understanding, partly based on who tends to be most affected by them, and partly based on what the illness does and which bodily systems it affects (like, colon diseases are stigmatized in a way that heart diseases aren't). All of this has real impacts on health and healthcare delivery. Consider, for instance, this famous study showing racial disparities in pain assessment and treatment recommendations:

2. This is largely coincidental, but I think it's interesting that it's possible to imagine a patient with OCD being treated with both the medications that were used to treat my labyrinthitis. Althought it is not widely administered, meclizine (which is primarily an anti-nausea medication; you may know it as dramamine or antivert) may have some ability to treat so-called "diminished gating" in patients with Obsessive Compulsive Disorder (, and diazapam (commonly known in the U.S. as valium) is often prescribed to treat severe anxiety and panic attacks. (With regular use, patients often become tolerant to diazapam and/or physically dependent upon it, so it is often--or should be, anyway--prescribed with constraint and careful monitoring.)

p.s. Thanks to Rosianna Halse Rojas for very helpful feedback on this video!

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Good morning Hank, it's Tuesday.

So, three and a half years ago, I was diagnosed with a disease called labyrinthitis, wherein part of my inner ear became inflamed, due to a viral infection.

All at once, I went from feeling like I had a bit of a head cold to being completely incapacitated by vertigo; I fell over, began vomiting and was rushed to the hospital. And in the years since I've had a lot of treatment for labyrinthitis and I've started to wonder: is this disease mental or physical?

Let me begin by noting just how profoundly we stigmatise mental illness. When I was in the hospital there was initially some thought that my vertigo might be psychosomatic; that the dizziness could be caused by my chronic anxiety.

And I have to confess once they found an ostensibly physiological cause for the vertigo I was a little relieved because suddenly everyone was acting as if, and I started feeling as if, my illness was really real.

But of course, mental illness is also really real, and often has a physiological cause, like the brains of many people who have OCD, as I do, look different in fMRI scans than the brains of other people. We just don't really understand those differences very well yet. 

And illnesses that are poorly understood or lack effective treatments tend to be heavily stigmatised, see also endometriosis and irritable bowel syndrome and many pain disorders and leprosy.

Rarely do I need a footnote in a video but I do need one here.

The category of mental illness is just that: a category. It has uses, and it has limitations. And remembering that categories are often useful, but almost always limited, seems to me one of the big challenges of life right now.

Like the extremely silly discourse around whether a hot dog is a sandwich is of course very silly, but underneath it lies something important, which is that we want categories to be strict and inviolable, when in fact they are messy and constructed.

But right, so I got labyrinthitis, which is not a psychological illness, or at least I'm told it's not. I went home from the hospital with two medications, one a central nervous depressant called Meclizine and the other an anti-anxiety medication called Diazepam, that also lessens vertigo.

Both these medications were psychotropic in the sense that affected the way that I experienced consciousness, and both of them are sometimes prescribed as psychiatric medications, but in my case they weren't psychiatric medications because in my case, my illness was not considered psychiatric.

Both these medications reduced my symptoms while I recovered but I eventually found that even after I was mostly better and the virus was gone, I still had some sort of long term problems with my vestibular system, so my doctor sent me for therapy at a balance institute.

So I went to this place to retrain my brain's balance system and while I was there the therapist said to me, "We're just trying to rewire your brain", and in that moment I realised, "This is just like the other therapy I go to."

Like, in regular therapy I'm trying to get my brain to respond differently to unreliable anxious thoughts, and in this therapy I'm trying to get my brain to respond differently to unreliable inner ear information.

Now the exercises and medicines used to treat OCD are very different from those used to treat labyrinthitis, but the underlying idea is similar: medication and therapy.

And so is it a mental or physical illness? Yeah, ye-yes it is.

I find myself going back again and again to Elaine Scarry's observation in The Body In Pain: "To have great pain is to have certainty and to hear another person has pain is to have doubt."

I think that doubt compounds the suffering of people in pain, and I think it is further compounded when we imagine that someone's illness or pain is less real because it involves the mind, or because the observer can't see it.

The truth is the mind-body dichotomy is as insufficient as the category of sandwiches. Our minds are made out of body and our bodies think. In fact, on Earth at least, bodies are the only things that think.

Whether we call it mental or physical, other people's pain is as real as our own.

Hank, I'll see you on Friday