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In a Tolkein-like world, I want to devise a rehab program for Dwarves to course-correct if/when they succumb to treasure-induced auromania. Symptoms include:

  • Paranoia - mistakenly belief that others took your gold
  • Developing a Pavlovian response to metallic "kling-klang" sounds
  • Burrowing long tunnels in a mountain without uttering a word in weeks
  • Hallucinations of glimmering, golden objects

I want to approach the task from a mental health / social science angle. Namely, I want to apply some form of cognitive behavioral therapy such as stress inoculation. However, I have very limited knowledge of the field and I think it would be time/effort prohibitive for me to aspire to be an "expert."

Question

If we accept the disposition to auromania as hereditary (part of Drawven DNA), how would modern mental health therapy, such as cognitive behavioral therapy, approach the condition?

Further clarifications:

  • Case by case solutions are acceptable, macro policies can work too
  • Assuming Dwarven minds are comparable to humans (not species-specific)
  • Solution should be entirely psychological, self-driven (most external factors are immutable, ex: wealth of gold in the mountain - can't throw the gold away)
  • As pointed out in the comments, the origin of the condition may be relevant. Let's assume Dwarves have a genetic disposition to developing auromania
  • The condition doesn't have to be cured outright, but should at least be meaningfully mitigated

My name's Durin, and I'm an auromaniac.

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    $\begingroup$ Difficulty is that you need to know where this fascination comes from. In something semi-related: if a boy is wetting his bed, you need to know where the stress comes from. Abandonment of a parent? Violence from a sibling? Not comfortable on his new school? Behavioral therapy isn't a one size fits all. You might use the same in a more general way, but the details will severely be different. $\endgroup$
    – Trioxidane
    Aug 19, 2020 at 8:30
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    $\begingroup$ @Trioxidane You raise a fair point; I tried to factor considerations regarding the origin of the condition in my premise. $\endgroup$ Aug 19, 2020 at 8:47
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    $\begingroup$ @SZCZERZOKŁY It definitely can. Someone with violent tendencies because of DNA, or simply the DNA that makes you fat or something, can definitely be moderated by behavioural therapy. I mean the second one is just getting them in a self sustaining cycle of less/different food and a more sporty attitude in life. This can be done even after they become fat. $\endgroup$
    – Trioxidane
    Aug 19, 2020 at 11:06
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    $\begingroup$ I. LOVE. THIS. QUESTION! $\endgroup$ Aug 19, 2020 at 17:00
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    $\begingroup$ I would think such dwarfs would self-medicate with heavy drinking. $\endgroup$
    – workerjoe
    Aug 19, 2020 at 20:14

2 Answers 2

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Considering that dwarves are genetically predisposed to develop auromania, the scope of the problem is too big for individual interventions only. It is also not clear from your question how big the problem is and how destructive it to society. I am going to assume that auromania is seen as a pathology and is undesirable in this particular society.

I think that dwarves in charge have to take a multi-prong approach:

  • cultural and social norms and values;
  • healthcare system;
  • individual therapy.

1. Discouraging gold-digging and hoarding

The dwarf government can use propaganda and various laws to achieve this.

For example, private property can be abolished and locks are forbidden. There can be horror stories about gold diggers who snatch children or follow their hallucinations to their death. The country can have festivals that encourage simple lifestyles, cooperation, sharing, and so on.

The culture would, probably, encourage highly structured activities, mostly in groups, where dwarves can support each other and take notice of any early symptoms of the disease. Rituals and routines are very helpful when dealing with mental issues.

If the problem is extreme and the society fails to deal with it, mass exodus and relocation to the grasslands/plains/forests can be considered. As with any addiction, no exposure to a thing that causes addiction helps to minimise the cravings.

2. Healthcare system

Since dwarves are genetically predisposed, it stands to reason to assume that auromania is not rare. The dwarf government can establish research facilities, universities, hospitals, rehabilitation centres, support groups, and a network of social workers to deal with the condition.

This infrastructure does not have to be high-tech. It can be envisioned in medieval terms. However, it should be centralised, well-funded, and based on science (whatever this science is in your world), not on superstition. The condition should be well-documented and remedies should be known, even if your society has not reached the level of genetics.

In a high fantasy setting, you can probably use monasteries as the foundation of this healthcare system. Professional associations (guilds, military orders, etc.) can also play a significant role. They would also provide structure to lives of recovering dwarves and psychological support.

3. Individual therapy

I am not expert on CBT, but I do not believe that it is universally helpful. When it comes to mental disorders there is no 'one-size-fits-all' approach. Depending on the stage, the severity of the symptoms, and personality, different approaches should be used. With this said, you still can focus on CBT in your work because it works for that specific dwarf.

I think that you should consider using CBT as a preventative measure (your teachers and priests can be trained in it) or for patients that exhibit only minor symptoms and are on early stages of auromania. If a dwarf completely lost touch with reality CBT alone can be ineffective and should be supplemented with medications and/or institutionalisation.

As for specific techniques, I would look into substance use disorders therapy and CBT for psychosis (these links are just examples of information that would be useful). Most of the techniques would focus on:

  • establishing a connection with a patient (delusional patients are usually reluctant to cooperate and can be mistrustful);
  • working on motivations (mixed success in this area);
  • developing coping mechanisms that help to filter out hallucinations and reduce their number;
  • increasing self-esteem;
  • managing cravings;
  • learning behavioural patterns and skills for better social adjustment;
  • preventing relapses.

All of this will be applied on a case-by-case basis depending on the severity of symptoms, patients response, therapists training, and so on. For psychotic cases, psychological therapies are tailored to individuals.

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  • $\begingroup$ I don't understand why a genetic predisposition might suggest that the condition is not rare. There are many very rare genetic diseases, including mental ones. $\endgroup$
    – cowlinator
    Aug 21, 2020 at 4:10
  • $\begingroup$ While I think your course of action is good, I suspect it is something akin to prohibition. "Ban" the gold, and they'll just want it more, but don't and people still have access to that sweet golden metal. Hopefully, it could become more like smoking (allowed but disdained), but there are rewards to auromania (ie wealth) so I suspect it's a tough road $\endgroup$
    – DWKraus
    Aug 21, 2020 at 4:12
  • $\begingroup$ @cowlinator Those diseases are rare genetic mutations that are not carried by the majority of the population. I specifically assume that dwarves carry auromania predisposition genes the same way we carry genes that make us aggressive. This assumption is based on generalised high fantasy notion of dwarves as gold diggers. The OP can adjust for his specific population. $\endgroup$
    – Otkin
    Aug 21, 2020 at 18:08
  • $\begingroup$ @DWKraus I would not compare this to the Prohibition. What I had in mind is a set of measures similar to what human societies employ to manage aggression. As you may notice, I am not calling for bans on gold. I am suggesting building a culture that makes wealth insignificant and meaningless. It is not gold per see that poses problems, it is what it symbolises. If you remove the symbolic component, cases of auromania should diminish. Think about it as money and wealth in our world. Cultures that value wealth a lot have a lot of people obsessed with money who spend their entire lives [continued] $\endgroup$
    – Otkin
    Aug 21, 2020 at 18:16
  • $\begingroup$ @DWKraus […] working and becoming richer and richer. And while doing that they build no meaningful connections with other people, destroy their families and friendships, and ultimately live unhappy lives. This is the closest analogue to the OP's auromania in our world, albeit it rarely reaches the levels of psychosis and we are not predisposed genetically to it. Money-obsession and desire for wealth beyond measure are mostly cultural phenomena that can be fixed by changing social values and norms, and promotion of simpler, yet, more meaningful lifestyles. $\endgroup$
    – Otkin
    Aug 21, 2020 at 18:23
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As far as the hyperfocus symptom akin to ADHD, here’s a good article to read.

https://www.google.com/amp/s/www.additudemag.com/understanding-adhd-hyperfocus/amp/

My favorite section:

“time limit and expect her to stop. “I tell parents they’ll need to do something to break the ‘trance’ their child is in,” says Silver, “such as tapping him on the shoulder, waving a hand in front of his face, or standing between him and the television or computer screen.” Unless you do, he says, the child may not even realize that you are trying to get his attention. “These children aren’t being disobedient,” says Nadeau. “Their brains just aren’t registering what you’re saying. That’s why the interruption should never be done angrily, and why you should allow a few minutes for the shift in attention to occur. It’s almost like pulling someone out of a dream.”

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