Throwaway05
17hr ago
The meme in the U.S. is that the majority of Psych (and to a lesser extent Neuro) consults are inappropriate. Both tend to get Delirium/TME consults for which the recommendation is "fix the underlying medical problem" (with a side helping of "no this 85 year old grandma does not have late onset schizophrenia). Psych also gets capacity consults - any physician can determine capacity and should be able to do so unless something weird is going on. You call Psych if mental illness is complicating things only.
Throwaway05
1d ago
by making someone in California have like 10x less say than the same person in Mississippi in Congress and the presidency.
The Electoral College prevents a small number of influential and high population urban centers with views that may be broadly considered alien from running a country most of the size of a continent. It is likely responsible for quite a bit of US stability.
Look at the Hunger Games, where a large capital dictates unpopular policy to the other regions.
It's likely we would have significant ongoing issues with places like Texas trying to leave if California was in charge.
The EC allows the federal government to have teeth without a shit ton of civil wars.
The American founding fathers were some of the most brilliant and successful political theorists in the history of mankind. Don't throw out the political technologies they invented because it has been recently expedient.
Throwaway05
1d ago
Oh there's no rush. Get well soon.
Oh no, I was guessing that ED was the rotation.
Why is your CL service busy? Do your surgeons not understand how capacity works?*
*This insult of European surgeons not guaranteed to match the medico-legal requirements of British healthcare.
Throwaway05
1d ago
Pshh skip the meet cute hoss, I want to know what the rotation is.
Busy......Emergency?
Throwaway05
1d ago
I think this is a really stellar comment!
Throwaway05
1d ago
To your point about culture, I do think part of it might be that society sees Internet activity as not really being "real" social interaction, even though hanging out on a forum is probably filling the same psychological need that hanging out at a pub would've done.
Absolutely, any para-social or other unconventional socialization is still socialization. Assessments aren't really updated to reflect this (well, for the most part).
If you are the kind of person who is posting here you may appreciate and benefit from interrogating your own personality in an organized way - maybe figure out why you are this way, maybe to see if it's what you truly want. If that's the case...chase the thread.
Not doing so is perfectly cromulent however, especially because learning about yourself can be an info hazard that can't be put back in the bottle.
Throwaway05
1d ago
Hopefully he's just on a new rotation :/
Throwaway05
1d ago
I think this is a good time to take stock of your stances on things and go "do I really think this is a good/bad idea or am I just responding reflexively because of Trump."
By all accounts the lack of a proper presidential ballroom has been considered a minor national embarrassment for years... but people in D.C. just don't want Trump to be in charge of fixing the problem. That level of petty vindictiveness isn't a surprise, but it shouldn't really be supported, and if you speak to the relevant officials I'd bet money that most of them only oppose it to salve their constituents and not out of genuine belief. Supporting the worst impulses of the populace isn't always wise.
On top of that we have the current issue. Imagine if you were nearly killed in a plane crash or in the hospital, and the Swiss Cheese model successfully prevented the bad outcome. Do think the response to a "near miss" is to leave everything as is? No, we make improvements to close the hole, to avoid the risk of multiple holes lining up next time.
Blessedly the system didn't totally fail. That's not a reason to make no adjustments.
Throwaway05
1d ago
A few things moving in parallel here:
-
The explanation as to what a personality disorder or personality is is a long lecture at absolute minimum. It's a complicated concept with very specific (and for some dimensions debated) meanings. Takeaway: It may be reasonable to go "meh" in response to labels.
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Schizoid personality disorder is one of the most poorly understood diagnostic entities in medicine. Patients essentially never present for psychiatric care because they don't see the need (and unlike say anti-social PD, they don't otherwise live their lives in a way that gets them attention). To my understanding the only reason why we know anything at all about this diagnosis is for historical reasons (it was thought to be a pre-morbid state for schizophrenia and was therefore very heavily explored, once we figured out that wasn't the case we stopped expending excess resources on trying to spot it and it went away*). Non-psychiatric medical providers see these patients far more than psychiatrists (since they do still require medical care). Takeaway: I'm not sure really this label means anything or requires anything.
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The internal and external expression of the self is heavily impacted by culture and environment. Takeaway: I'm not sure a diagnosis that primarily served to describe behaviors in a wildly different social milieu totally applies to modern heavily atomized culture.
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Asking this question is suggestive of the diagnosis not being relevant - satisfaction with the state of affairs is hallmark of the diagnosis.
-
Regardless of any of the above and anything related to the diagnosis - it is totally reasonable to have questions about your self, your preferences. Some people are fine with being solitary. Some people are being solitary as a defense mechanism. Some people are fine with being solitary as a defense mechanism. It is hard to explore these things by yourself, and in a situation where you don't have a lot of external entities to help you, a therapist or other professional way to organize and explore yourself is totally reasonable.
*not 100% sure on this.
Throwaway05
2d ago
I mean that's not unfair. Mark is a serious person who has been to many, many of these types of events. On the other hand he's a journalist not a security expert, and security experts usually decline to aggressively comment on these types of events.
I'd say on the face of it it doesn't seem well secured, especially with some of the semi-public details (security started inside the building, movement was restricted to the presence of a generic hotel key sleeve, etc.).
Throwaway05
2d ago
Thankfully the people interested in doing this kind of stuff are generally idiots but that doesn't save us from sufficiently motivated state actors should that become relevant.
I've clocked at least one smart person engaged in domestic terrorism in the U.S. in an intelligent way, and I suspect there are more they just don't get noticed, caught, or publicly emphasized. I'm sure the TLAs are aware, however.
Throwaway05
2d ago
I don't think it is a significant leap to mention the importance of keeping our head of state safe while we are in a shooting war with a nation whose head of state we killed and that has espoused direct desire to kill our head of state.
Throwaway05
2d ago
We are at literally kinetic war with an adversary that spends a lot of time and money on assassinations and terrorism..........
Throwaway05
2d ago
I mean you have credible people making comments. Mark Halperin (who is usually very calm and measured) complaining is why I made this post.
Usually people with knowledge don't publicly comment because you don't want to create -ideas- but this time a lot of people were close by and in the splash zone and are pissed.
Throwaway05
2d ago
Much as I'd love to blame it on that I don't think so. This wasn't individual agents being unfit or stupid, this was top down problems.
Throwaway05
2d ago
To add to this, if you are young and have unconventional opinions it can be very easy to not have anyone to share them with, especially these days.
This makes them not very battle tested.
Throwaway05
3d ago
From what I can tell the Hotel was essentially allowed to go about its business and the security cordon was in the building close to the event. You could get very close to the event itself with a generic hotel keyboard. Minimal access control. Someone could easily have preplanted a surprise or walked close with one and rendered the primary security buffer irrelevant, and then had others follow.
People who have been to similar events before said that the security was rather lacking in comparison to other events.
I certainly have been to places that have been more aggressive in searching my bag or person multiple times further out.
Throwaway05
3d ago
Obvious in hindsight, but still.
Making sure the guests at a 1000 person hotel aren't armed or smuggling in materials is obvious in foresight, not hindsight.
...at least I hope so.
Throwaway05
3d ago
So best I can tell security at the recent dinner was somehow even worse than at the campaign event that nearly cost Trump his life. This sounds incredibly stupid but mainstream media reports of the security indicate it is so. And this is in a...storied location no less.
This is also not a situation where things have been calm for a while, we are at war and several attempts have been made, and people have died (ex: Kirk).
Some of this is probably due to security theater elements - security was never good, so it remains not good. You'd think we could make a bit of a change though?
Are all of our institutions really so rotten?
And perhaps more importantly - how many times can we get lucky and how will our civic norms survive when that luck runs out?
Throwaway05
3d ago
I mean you had violent Leftists, see the Black Panthers and the Weather Underground.
The explanation I've always seen is that they took to the Academy, took it over, and then piped the violent ideation into young people long enough that it became accepted.
See: "Long march through the institutions" etc.
Throwaway05
4d ago
I laughed a long time at this.
Throwaway05
4d ago
How about Paddington?
Throwaway05
4d ago
Come on now.
I can call for the assassination of Hitler during WWII and refuse the call for my neighbor Fred and be entirely moral and consistent.
The gap between Democratically elected Trump and a bunch of Authoritarian monsters who just finished killing tens of thousands of their own population and we are effectively at war with.....it's not quite as bad as Fred and Hitler but it is still significant.
Throwaway05
6d ago
Also missing is William Neil McCasland, a retired Air Force major general, who hasn’t been seen since he walked out of his Albuquerque, New Mexico, home on February 27, leaving behind his phone, prescription glasses and wearable devices […] McCasland was at the center of some of the Pentagon’s most advanced aerospace research and once commanded the Air Force Research Laboratory at Wright-Patterson Air Force Base. Months after the 68-year-old went missing, officials still can’t say where he went, why he left or whether someone else was involved.
If this is the guy I am thinking of then the rumor is that the situation is completely understood it is just being withheld for family privacy reasons. Aka the guy wandered off and died from early dementia, killed himself or something similar.
The more healthy hospitals I've worked in have often had residents (and sometimes attendings) cross lecture - psychiatry explains capacity, surgery comes to IM to explain wound case basics etc.
If you feel like tilting at windmills its a nice thing to try.
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