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Leah Libresco Sargeant's avatar

I think the absence of *maintenance* is one of the ways we lose contact with reality on the day-to-day level. If you spend a long time renting, your house's problems aren't yours to solve. Versus, if you're able to buy, you can't BS your house the way you can your boss. You have to learn how the physical systems work and how to tend them.

I worked at a start up that frequently needed ops people, and one of the best indicators we found was whether they had a background in stage crew. In theater, on the prop/costume/crew side, you can't BS for long—the show must go on. So people who had worked in that role had an essential honesty and practicality (a desire to *actually* solve the problem, not just prove they had *tried*) that was a great fit for ops.

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Midge's avatar

"Living in a world of artifice, no longer exposed to the unyielding hardness of physical reality, our minds now operate in a kind of cognitive bouncy castle — where all sharp edges have been eliminated and pratfalls are more exciting than dangerous... Inside the bouncy castle, where reality consists only of what’s inside your and other people’s heads, the truth is always negotiable — to the point where the very idea of objective truth can be dismissed as a negotiating tactic."

Millions of Americans still live in a state of hyper-agency, where even minor lapses in diligence could kill them. Whether it's asthma, anaphylaxis, insulin-dependence, or something else, the risk of pratfalls that are far more dangerous than exciting (nothing exciting about "I forgot my Epi-pen") is still real for many. But it's "freak" risk, risks about *your abnormality*, rather than a risk in common, like hunger or cold would be with less material abundance.

The risks of losing the fire flint or the food on a wilderness trek is a socially-legible risk: everyone can understand it, and stands to suffer some themselves if they decide to help you after your lapse rather than abandon you. Everyone *could* go a bit hungry to help the guy who lost his rations – and expect to trade in on the favor they did him later. No-one else catches "a bit of asthma" if the asthmatic kid loses his inhaler. Indeed, one form of "character building" abuse sometimes inflicted by well-meaning counselors is advising people physically dependent on medication to leave their medication behind, as if it were more a psychological security blanket than mitigation of real physical risk. This is rarely appropriate advice.

One would think coping with bodily medical risk grounds one in non-negotiable reality, but in fact it does not, since access to medical risk-mitigation is social access. It's fairly normal for patients who aren't "the standard patient" to find their physical reality dismissed because of social judgments:

"[R]are diseases in the U.S. affect about 30 million people. It takes an average of seven years before a patient is properly diagnosed. Any sort of misdiagnosis doubles this diagnostic delay. Getting a psychological diagnosis extends it 2.5 to 14 times, depending on the disease. 'Once you’ve been labeled an unreliable reporter, it’s almost impossible to get your credibility back,' Dusenbery said. 'Anything you do will just reinforce the perception and the circular logic built into psychogenic theories.'"

https://healthjournalism.org/blog/2018/11/women-more-often-misdiagnosed-because-of-gaps-in-trust-and-knowledge/#:~:text=For%20women%20with%20non,in%2C%20according%20to%20Dusenbery.

Those with the authority to run medically-standardized physical testing will not do so unless they can be socially persuaded to do it. Unpersuaded, resorting to the Prosperity-Gospel logic that patients can will themselves well remains appealing. It's hardly new logic, after all: Job's friends thought of the same thing, that his real material difficulties were spiritual, not material, consequences.

Questions like "How can I present as a credible patient?" and "How can I persuade someone to give medication priced far above its manufacturing costs at a price I can afford?" – questions more about social manipulation than material reality – increasingly preoccupy the minds of those facing daily non-negotiable realities, too. And perhaps it was ever thus. Social manipulation is an instance, not a failure, of instrumental rationality, just one using others as means, not ends.

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