Everyday Systems: Podcast : Episode 84

The Hygience Hypothesis as the Explanation for Everything

Hi, this is Reinhard from Everyday Systems.

Quick disclaimer: in this podcast, I always talk about issues about which I don’t have any formal expertise, but in today’s episode, I do so more than usual. When I Chat GPTed myself a little while ago (the new version of googling yourself) it told me that I am a Fitness Philosopher, whatever that means. So in that spirit, please take what follows as Natural Philosophy in the style of the ancient Greeks rather than as hard science. I did my honest, amateur best not to propagate any lies, but if anything seems dubious, please look it up.

Episode 84: The Hygiene Hypothesis as the Explanation for Everything.

I’m always surprised at how many people haven’t heard of the hygiene hypothesis. It’s basically this: there has been a huge, well-documented increase in the percentage of the population having allergies of all kinds in the developed world over the last century or so. You may have direct personal experience of this. You may have indirect experience of this as well, with all “nut free tables” and injunctions against packing peanut butter and jelly sandwiches in your kid’s lunchbox. The hygiene hypothesis posits that the reason for this, at least a reason for this, and a big one, is that our modern living environments are simply too clean. With all our hepa filters and hand sanitizer and pasteurized orange juice, people’s immune systems just haven’t had enough exercise to properly develop and learn who the real bad guys are – and so they misfire.

We evolved in an atmosphere of constant mortal danger, from microscopic pathogens to intestinal worms to sabertooth tigers. There are moose in Maine crawling with so many ticks that they die of blood loss. That was us 40,000 years ago. I mean really, it was nasty. You don’t even want to think about it. And so we developed powerful immune systems to deal with these threats.

Now in our relatively sterilized environments we’re not constantly struggling to fight off these environmental threats. Great, right? But the thing is, they’re still there, our immune systems, our defense mechanisms, like a large standing army with no external enemy. They are extremely powerful and capable but they have nothing useful to do. So they get up to mischief. They make up enemies to go after. Inappropriate things trigger them, because frankly, they’re bored and need some purpose in life.

As I mentioned there is good evidence for this: studies showing that children growing up in rural environments, with more exposure to farm filth, have lower rates of allergies, than do children in larger families and children with older, germ-bearing siblings. Other studies show that when people immigrate from poorer, dirtier countries to richer, cleaner ones their children start developing allergies at higher, first world rates. And then there’s just the sheer increase in the prevalence of these conditions over time in the developed world, which has been enormous.

The nice thing about the hygiene hypothesis, besides its snappy name, is that it makes a certain amount of intuitive sense, and it has this wonderful sense of irony built in (perhaps less wonderful if you or a loved one are suffering from one of these conditions): we thought we were making ourselves healthier with all this hygiene, and now look what we’ve done. Hubris, duly punished! Though, lest we take too much poetic relish in this, we should keep in mind that the constant mortal danger our ancestors faced was not so great either. If we had to make a simple trade, either hygiene or no hygiene, we probably made the right choice.

But maybe we don’t have to make a simple trade. I’ll come back to that thought in a bit.

The hygiene hypothesis was originally formulated specifically with regard to allergies and I think asthma. It has since been extended to a host of other autoimmune conditions: Type 1 Diabetes, Multiple Sclerosis, Inflammatory Bowel Disease, Rheumatoid Arthritis, Celiac disease, and more. It’s an astonishingly long and varied list. And I wouldn’t be surprised if that list got a lot longer.

Although the term, hygiene hypothesis, hasn’t been applied to neurological and psychological problems yet, at least as far as I’m aware, it strikes me that a lot of these conditions, too, operate very similarly, in that they involve the body’s defense systems overreacting or inappropriately reacting because they no longer have any real threats to engage them. And these conditions are also strikingly on the rise.

I’m talking about chronic pain conditions, like fibromyalgia in which the nervous system registers pain all out of proportion to the stimulus, perhaps because life just isn’t that physically painful anymore.

And psychological problems, too: Anxiety because we no longer have to worry about sabertooth tigers and what not trying to kill us, but we still have all that psychological defense apparatus and it wants something to do, and so now that guy who didn’t think something we said at a zoom meeting was funny gets promoted to a sabertooth tiger in our psyche.

Even depression because the horrible things that used to routinely happen to our ancestors are now (fortunately) rare enough to be tragedies, evening news, but again, we have all this psychological trauma processing machinery that’s just sitting around, desperate for any old grist for its mill, ready to turn that twinkie you shouldn’t have eaten last night into dead Cordelia.

We lived in a scary world, and so fear was an appropriate emotion, with many appropriate objects and outlets. We lived in a dirty world, a painful world, physically and emotionally – with almost every parent experiencing the worst thing that we can possibly imagine today, the death of a child. Even through much of the twentieth century, with its wars and revolutions and genocides, there was a “Job standing on every street corner,” as the Russian philosopher and literary critic, Lev Shestov, put it.

We were built for trauma. We needed all this defensive apparatus, physical and psychological, and we still have it, and now it needs us to give it something to do. Or it will get up to mischief. That’s what I’m calling the hygiene hypothesis writ large, this basic principle. And while it may not explain everything, it explains a lot. And just as importantly, it suggests some countermeasures.

OK, so our lives are too clean, too painless, too safe. Our bodies and minds expect filth, pain and danger, and when they don’t encounter them, they imagine them, they produce them, they will them into existence. Your peanut and your phobia are scapegoats, manufactured stand-ins for real but absent dangers. But they’re scapegoats with teeth and claws, straw men that can hit back, hard.

So what do we do? What countermeasures does the Hygiene Hypothesis Writ Large suggest? It’s not like we can just wake up, snap our fingers, say “easy peasy” and the phobias and allergens and other autoimmune conditions we’ve generated lose their power because we understand why they’re there. They may be monsters of our making, but they are still monsters, and mere thoughts, mere words, aren’t going to dispel them.

A guiding principle behind the countermeasures is: if too clean, too painless, too safe caused the problem, maybe we need a judicious, measured reintroduction of some of these elements. And indeed, there is a whole family of remedies that works along that template: the cure for an ill, or protection against an ill is to apply a controlled dose of the same ill. To take just a few examples:

Exposure therapy

Desensitization for allergies

Stress Inoculation Therapy

But I think this template has even bigger, broader implications than that. I think it has implications beyond just medicine, to the way we live our daily lives.

My 11-year old son and I were at an old-timey amusement park we love around here and we both love terrifying roller coasters. It’s strange, because some part of you thinks you’re really going to die when you go into free fall like that. You intellectually know you’re not, but the lizard brain is convinced, your whole body is convinced. And yet we love it. Maybe because finally all those misfiring fear systems are getting a dose of what they’re craving: real, physical danger. Mortal danger, as far as the lizard brain is concerned: Death, not just what some guy in a zoom meeting may or may not have been thinking. For a few blissful, terrifying seconds its sense of purpose is fully engaged.

It wouldn’t surprise me if one day doctors discover that one roller coaster ride is as effective a therapy as a full course of anti anxiety meds. Skydiving I’m sure would also do the trick, though that has a little too much actual danger for my taste. I’ve done it once, decades ago, in Las Vegas, to put some gambling losses in perspective, and it did do that brilliantly. Immersive VR video games – might be another way to achieve this. But I think you need the feel of the g forces to get the fear systems fully engaged. And if there’s anything we learned from the zoom epidemic aka covid, it’s that there’s something to actual reality.

In a fantastic book with a terrible title that I’ve mentioned before, Anna Lembke’s Dopamine Nation, a phenomenon known as hormesis is discussed, a term I’d never heard before. Essentially hormesis means pain therapy: healing great pain, usually great misfiring perception of pain, by the strategic application of controlled doses of little pain. Acupuncture is an example of this. The fact that those needles hurt isn’t incidental to acupuncture, an unfortunate side-effect, it’s the reason it works. The body feels a small, calculated dose of real pain so it doesn’t need to generate an even worse fake pain.

She, in that book, gave another example of people who take cold baths or showers as a kind of therapy. This is very old school. My great grandfather used to cut holes in the ice and take a dip in the Elbe river every cold winter’s day. But it’s trendy again. And I think there might be something to it. I myself, inspired by this, practice a modified, more cowardly version called the Scottish Shower, which consists of a short, one minute cold shower after a normal hot shower. The name is an homage to James Bond, a notable (if fictional) practitioner. The idea is this sudden blast of cold provides some invigorating stress to get your anti-stress systems humming properly. The body feels real physical stress and so doesn’t need to generate even worse fake stress. It’s also a nice feeling of accomplishment to have had the willpower and bravery to go through with it, good practice doing something you don’t want to but know you should. Nice way to start the day. To keep it from feeling like some kind of alpha bro wannabe Tim Ferris power move, I recite psalm 23 while I’m doing it, which functions as an approximate timer (it’s a fair bit less than one minute if you say it fast, which you will if the water is cold enough). Besides its timer and slime-of-the-internet cleansing functions, saying the prayer under these conditions also makes me pay attention to it in a whole new way.

The physical stuff, in a way, is easy, though I imagine there is some spillover benefit from facing physical fears or discomforts to emotional ones. The hardest, and maybe most important part is interpersonal relations. How can we move from conflict avoidance which just makes us more sensitive and anxious big picture (you can think of thus as interpersonal hygiene), to something messier, healthier and more resilient, without degenerating into verbal combat or worse, and, of course, this is the goal, without, inappropriately, seeing sabertooth tigers everywhere?

I’ve been attempting to address this issue for myself with Spider Hunter, a CBT for anxiety game, in which I give myself points for finding myself in uncomfortable situations, when I feel really not pleased with myself, situations I would normally have done my best to avoid. It’s nice because I have become a little more mindful of them, a little more accepting of them, so they don’t throw me into the spiral of self-condemnation and dysfunction that they used to. It’s even made noticing such emotional states, in a backhanded kind of way, if not exactly pleasurable, at least less bad, because I get the dopamine rush of getting spider points for noticing them.

I could imagine a new kind of interpersonal exposure therapy involving people pretending to get really mad at you, call you stupid, give you a bad performance review, whatever you’re most afraid of. The opposite of the gentle reassurances you usually get in a therapist's office. Picture a Marine corps boot camp with a very psychologically astute drill sergeant. I could imagine this being really helpful, though I also imagine it violates all kinds of mental health professional ethics. Maybe I’ll see if I can find a CBT buddy to try this with, though it’ll likely take a bit more of the gentler, Spider Hunter variety of CBT first to work up the nerve to make this attempt.

We do so many things so profoundly wrong. Helicopter parenting, “safe spaces.” We don’t need safe spaces, we need danger rooms. Well, maybe we need safe spaces sometimes, but we also need danger rooms. I read in an article recently about a phenomenon called “safetyism,” which is this trend of parents keeping their kids away from anything the least bit risky, especially outdoor activities, so they get fewer physical and psychological boo boos, maybe, but never really learn how to deal with risk and discomfort.

It’s possible that merely stopping taking all this “bad medicine,” stopping doing at least some of these dumb things, will do more good than any active interventions. It’s like when a doctor is about to prescribe a new medication, the first consideration is what medications you are already taking, and whether or not to discontinue any or all of them, and whether that alone might be enough, without adding anything else.

Many ills resulting from the unintended consequences described by the hygiene hypothesis writ small or large are beyond curing. At least in our present state of knowledge. But some aren’t, or aren’t completely. And our kids, certainly, stand a better chance if we are aware of them.

Siddartha Gauthama grew up in the ultimate safe space. His father, the king, set up his young prince in a wall-off pleasure palace, where no bad thing ever intruded. No ugliness, no illness, no cruelty, no death, no loneliness, no boredom. Young Siddartha didn’t even know that such things existed. You see, the king had gotten wind of a prophecy that foretold his son would either grow up to be a great ruler or a holy man. Dad vastly preferred the great ruler career track for his son. But one day, inevitably, young Siddartha got out, discovered suffering, ugliness, death and the rest of it, and today we know him as The Buddha.

That was the most perfect safe space ever built–and he escaped from it. We can too. At least, we can be inspired to try.

That’s all for today. It may have been a bit of a stretch, but I was as good as my word in terms of trying to make the hygiene hypothesis truly explain everything, from hay fever sniffles to the quest for spiritual enlightenment. I hope you found something useful or thought provoking or entertaining in all that.

Next month I’ll swing back around to my project of revisiting another original Everyday System for the compendium book, probably urban ranger or glass ceiling.

Until then, thanks for listening.

By Reinhard Engels