Throwaway05
3d ago
Is this a translation issue? Like how "forty days and forty nights" just means "till it's done."
Throwaway05
3d ago
A million reasons. Because it looks bad? Because it's anti-social? Because people aren't qualified to determine what is or is not safe.
If I run up to you and punch the air around your face did I cause you any harm? No.
Does it suck balls and do you want that behavior banned? Sure.
Throwaway05
3d ago
I mean the point is that lots of people have way more subjective experience of bad behavior from bicyclists. Who kills more is only tangentially related to that.
Throwaway05
3d ago
The point is if you're just angry about cyclists breaking the letter of the law, then to be consistent you should be just as angry at drivers speeding.
No I a concerned about dangerous behavior.
I see plenty. At times an Idaho stop IS dangerous behavior. People are poor at assessing this.
Throwaway05
3d ago
I also don't see cars on the sidewalk driving aggressively towards pedestrians outside of rare one off events.
Anyone who has ever been around a random cyclist in any setting for any length of time has noticed irresponsible or dangerous behavior that would get a driver pulled off the road. Cyclists are more safe because they are smaller and slower but e-bikes have changed this calculus greatly.
If you bike you may imagine that you are not one of the problematic ones and this may in fact be true, but I've seen plenty of people who are too irresponsible and poor to own an actual vehicle, or are delivery drivers imported from the third world who think they are in the thunder dome.
False equivalency with highway speeding is insufficient to neutralize this common sense understanding that can be established walking around a city.
Any day I walk in a city for a significant amount of time I see a bike nearly hit a pedestrian multiple times. It is rare to see that happen with a car. If bikes are less dangerous it is not because of a failure of effort.
Throwaway05
3d ago
Are you just mad they get to and you don't?
They don't "get to." They are required to stop, just as I am (at least where I live). Some cars chose to disobey this, most to all bikes do. One of the reasons we have this as a requirement is because people can't be trusted to determine when it is safe to blow through stuff.
It's not safe and it is illegal and bikes break the law at much higher rates than cars do (with the exception of highway speeding for the obvious reasons).
Throwaway05
3d ago
Catastrophically bad and regular bad are not the same thing.
You can't compare a half assed stop at a stop sign in a car to blowing through a stop sign or red light at full speed on a bike.
Yeah the former is common for cars, but the latter is common for bikes and not cars.
Throwaway05
3d ago
I mean, plenty of insane bad drivers out there, but the difference between those and some of the cyclists is something else.
Throwaway05
3d ago
Again, the ability to walk around with a general prescription that can be used at any pharmacy is the default state - in essence it has been removed by regulatory burden and corporate oversight.
No reason it can't come back other than those things (and plenty of doctors are still able to prescribe via paper).
Take it up with the government.
Expanded OTC formularies are something that can be done in different cultural milieus but is simply incompatible with America. Too many people would kill or harm themselves or others. The costs and externalities are too high.
I don't know where you are in the story but their is an EXTREMELY good explanation for some of the behavioral inconsistencies (which I personally find narratively satisfying and ties back into my enjoyment of the representation of AI).
Keeping vague:
Throwaway05
3d ago
Any time I walk in a city I see a cyclist do something brain dead and dangerous. Every time I see a cyclist I see someone running a red light or stop sign. I do not see someone do something brain dead and dangerous every time I drive a car. I do not see someone running a red light or stop sign every time I drive a car.
I am aware of the existence of catastrophically bad drivers, I've seen videos online. I've never seen one in real life.
I've seen catastrophically bad cyclists many times.
Throwaway05
3d ago
As others have stated the bad behavior by ill behaving cyclists is just so so bad.
The other day I watched a guy on a bike run a red light in a LARGE busy intersection and nearly get hit by a car no less than three times while doing so.
How this person remained so unfazed (and also alive) is a mystery to me.
Brainless degenerates seem to be a minority of people behind the wheel of a car, but a common occurrence on bikes (probably driven by things like delivery drivers who do an outsized amount of cycling but are more dangerous than most).
Throwaway05
4d ago
In ye old days we gave you a physical prescription that you could take with you, show up the pharmacy and shout "gib dis" and if they said "no have" you could take the same piece of paper to another place.
Now we mostly use electronic medical records and we ask you what your pharmacy is and send the information directly to that pharmacy.
Why do we do it that way? Likely things like "regulatory burden" and "let's not accidentally D-DOS the pharmacies with all of these requests."
Now I personally prefer paper script pads for some types of things and ask for them myself, but if your doctor does not allow that it likely it is because whoever owns them (large hospital system or PE firm) does not permit them. We don't complain too much because handwriting a prescription is a pain the ass and our handwriting is more ass.
Throwaway05
5d ago
Interesting - I still love it (and relevant to here, especially for its representation of AI).
When do you feel it started to go off the rails?
Throwaway05
7d ago
That significant minority is definitely a Thing in my book, though, and what makes them stick out like sore thumbs to me is the DRAMA.
I appreciate you sharing your thoughts.
Good reminder for me that the certain magnitudes and types of pathology are disproportionately noticeable and dangerous and at the same time they are not representative of the "true" range and median of pathology.
Those people have the temperament and social support to be loud, proud and disruptive.
RE: your wife - I can't speak to the therapist end of things but I have noticed that physicians of all specialties are slowly starting to ask more questions and explore more nuance, but the pipleline (med school) is still quite rigid.
I expect us to loosen up in 5-10 years and for adjacent fields to do the same.
Until then....hang in there ugh.
Throwaway05
7d ago
Tell me what you think about this:
I've long conceptualized trans thought content as a combination of:
- Actual trans people (rare).
- Social contagion (this being where the lonely MTF types come from).
- Malingering (mostly in a forensic setting).
- Borderline identity instability (actual hospital presenters).
When I think about item 4. my model is more women who seems to be trans while having a borderline breakdown or are just chronically severe.
It sounds like you spot more often in men, in comparison to me. I think my blind spot here is that my personal life people I know who are MTF seem to not be borderline - mostly dissatisfied with the world, lonely, looking for ego sources, which writing that out sounds borderline adjacent but I don't get the vibe from knowing them (?compromised objectivity?).
You point out your high profile types though and I go oh yeah shit sounds right.
I think this may just be my pot of MTF based off of my background however.
Really interested in your thoughts because no fucking way in hell can I have a convo about this in an academic hospital.
Throwaway05
7d ago
I think it scratches the same itch as things like lego building, if that helps your mental model at all.
Throwaway05
8d ago
I also think that there is a significant subset of men that are BPD and misdiagnosed for various reasons, one of which seems blindingly obvious to me, but only on the BPD side
Sometimes I get so frustrated with clinicians, just because this dude is male and violent does not mean APD, listen to the rest of the situation yo.
Throwaway05
8d ago
I've actually heard it described two very similar but subtly different ways - the "borderline between psychosis and neurosis" (as in pathology in those gaps) and as "borderline level of functioning" in contrast to psychotic or neurotic level of functioning (hardcore psychodynamics). I don't know which is more true, but the clinical pearl is the same for both - experiences (including negative self-talk) can become so overwhelming they approach the character of delusion and hallucination, but of course the actual effect on the substrate and underlining biology is radically different.
Still, it is a great teaching point lol.
It's useful you point out the "didn't have much personality of their own" because that is a significant feature in the severe cases - you can see them simply not have have preferences or wants in the way a normal and healthy person does.
A tip I've seen good physician diagnosticians lean into is simply "how long do your mood swings last" if they aren't in the 5-7 day range it's unlikely to be Bipolar (I, anyway). Another good rule of thumb is that if you don't have an inpatient stay (and likely an involuntary one at that) then you probably haven't had a manic episode.
But yes diagnosis for purpose of insurance coverage and other things like that does happen.
I'm not an expert on this but I think it's often driven by attachment dynamics - mother/daughter and mother/son relationship are fundamental different as are male patterns of reality and independence exploration.
I do know some thing you can rule of thumb it as APD=male BPD= female with that being the majority of the cases, but I've noticed plenty of men who are really just BPD instead of APD.
Less so the other way around.
Throwaway05
8d ago
Yeah, I completely agree, although I think that the "borderline" aspect of BPD conveys important information, namely that the sufferer's emotional distortions can be indistinguishable from psychosis.
You aren't wrong but I don't think anybody really knows this these days except for die hard psychodynamicisists and I can't even spell that.
Wish people knew that though, same for "mood swings are not manic episodes." Every fucking doctor needs to know that one.
In any case my understanding of the state of the research is that it is a two hit situation - you mostly need the genetic predisposition AND the environmental stimulus. However as I suspect you know from past convos - cluster-b coping mechanisms from cultural heritage or family dynamics aren't necessarily the true disorder.
Throwaway05
8d ago
but if mom loved you, you were invincible. If she hated you, you were an enemy combatant to be destroyed.
This is called splitting and is one of the main coping mechanisms associated with the illness.
Throwaway05
8d ago
The rebrand of BPD as emotional dysregulation syndrome or something similar does a lot of work in capturing the much of the practical matter of the illness.
I think a lot of people also miss that most people with APD aren't true sociopaths and are also rendered miserable by the illness (especially later in life).
...and both seem to be mostly caused by a combination of genetics, trauma, and other shit you aren't in control of.
Man I miss free will.
Throwaway05
9d ago
I'm sure they did (again assuming not BPD).
Imagine you thought you had two arms but you actually have three arms. You have two arms. "Has anyone ever told you have three arms?" "No why would they do that, I only have two arms."
What's that third arm then? "What third arm" "THAT ARM" "I don't know what you are talking about."
It's a delusion because you are convinced, which is why that shit is scary af.
Generally people with delusions will tell you matter of factly or you'll have to be careful about them coming out because "do you have any delusions" always gets "of course not."
Throwaway05
9d ago
She did not understand that her delusion had been all in her head. She told me about it as though it had really happened. She didn't seem to have made any connection between the delusion and the anti-psychotic she was on. I could not convince her to tell her doctor about the drug use.
While someone else down thread points out this person probably has BPD (and I agree) it is worth noting that this is how delusions work (although in this case it is not likely a true delusion 'cause BPD).
Delusions are delusions because they are fixed, sometimes they clear or improve with medication but often they don't. If you like you can consider this kinda like "cognitive burn-in" (as in like a monitor), even if the conditions change such that the cause of the fixed and false belief is gone your brain is so used to thinking that...well it's stuck.
Many psychotic illnesses in general have a large component where patient's are in denial as to their illness (Anosognosia).
Borderline functions a bit differently, and while it is somewhat misleading to draw attention to this, the borderline in borderline is the borderline between psychosis and neurosis.
The cause of "delusional" thought content in the two conditions is wildly different on a substrate and biological level however they do appear somewhat similar superficially.
Why not? Nobody was harmed, which was your selected criteria.
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