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ratherblather

psychiatric help 5¢, but the doctor is out

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joined 2025 November 07 18:35:55 UTC

"Can't you see how fortunate you are? You have worn yourself out through ceaseless striving, you have filled your muscles with pain and anguish. And what have you achieved but to bring yourself one day nearer to the end of your days?"

I'm probably out to lunch.


				
User ID: 4030


				
				
				

			

		

	














	


		


			



	

		

			

			

				

					

						

							
						

						

							
							

								
ratherblather


								

								

								
								
								

								
							
					
 
				


				
psychiatric help 5¢, but the doctor is out

				
				
				

				

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					joined 2025 November 07 18:35:55 UTC
				


				
					

					
"Can't you see how fortunate you are? You have worn yourself out through ceaseless striving, you have filled your muscles with pain and anguish. And what have you achieved but to bring yourself one day nearer to the end of your days?"


I'm probably out to lunch.



				

				

				

				

				

					

					

					
					
					

					
User ID: 4030


					
					
					
				

			


					

						
					



		

	

 











			
			

			
			

			




	


		

			
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				Wellness Wednesday for September 2, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I have meditated in the past and I agree, it's helpful. Thanks for the suggestion.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for September 2, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I'm not going to follow through with that - it was an idea, is all.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for September 2, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Lol, thanks. As a part of the aforementioned "lifestyle changes" I'm cutting out alcohol for the time being, actually. I would normally agree!


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for September 2, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Does anyone have experience with short-term use of psychotropic medications (SSRI's, Benzos, etc.)? I have experienced an absurd amount of situational stress and grief over the past few weeks - long story, very tragic - and am looking for a little chemical help to make it more bearable. However, I don't want to be on them for very long and I know that coming off meds can be difficult once you start. Anyone have personal background? And yes, I'm trying to make lifestyle changes but any advice there would help as well. Appreciate it.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 31, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Perhaps middle-management isn't the perfectly apt term, but I still think the dichotomy (that some employees are concerned with appearances, and others are concerned with the bottom line) holds regardless of how you categorize the respective camps.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Quality Contributions Report for August 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Wow! I didn't expect to make it on the list. After lurking here so long, it's a delight to actually have gotten there. Glad my background could be of some use.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 31, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
For those seeking to discredit nominally progressive institutions, these examples are a satisfying just-so story. As you say, these ideas support the premise that progressives are hypocritical, undiscerning, and intellectually dishonest. I can understand the temptation, but I am drawn to another explanation. Companies are not single-minded entities, but loose collections of hundreds of individuals. It strikes me as almost tautological to say that the HR and branding departments are likely to be strongholds of progressive thinking, well-attuned to the image that the company wants to present. On the other hand, it seems equally intuitive to think that middle-management is not so concerned with appearances, instead prioritizing the bottom line. Ultimately, then, the conflict we observe not does not arise from a rusty cog in progressive ideology but instead a lack of internal coordination/agreement.


There is no way for me to prove this, of course, but the continual tension between games company employees and management (via union drives, public awareness campaigns about crunch, etc.) seems sufficient to point to the values gap between the two groups.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 24, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I can't imagine the law was written to fail. It seems more likely to me that the legislature tried to cast a wide net in its phrasing to ensure that not a single show escapes its reach. Drag is a malleable medium and it has a substantial grassroots presence. If the law was too specific, it is not unthinkable that motivated drag performers would tweak their shows in such a way to evade the ban, all the while they wink and nod to their knowing audience.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for August 26, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Out of curiosity, does your gym have a hack squat machine? I know they get some flack because they're less of a "compound" lift, but they are substantially more gentle on the back from my experience.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 24, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Reading this immediately reminded me of the Goomba Fallacy, which is an example of the Association Fallacy that you're broadly speaking to. I'm not normally one to bandy around fallacies, but it fits here.


To discuss the rationality of it requires specific examples. In some cases, the association is utterly ridiculous, like in the Goomba Fallacy. Another example that comes to mind is the notion that people in "red states" or "blue states" ought to suffer or experience material consequences as penance for the sins of their political leaders. Wine moms in North Carolina should not be denied natural disaster relief as penance for their sin of voting for Trump, not to mention the countless Democrats living there. On the other hand, some associations are quite viscous and difficult to overlook. The common pop-feminist idea — I've been victimized by a man, therefore I should act aloof and oppositional toward most men — may legitimately have protective value. Sure, #notallmen, but I think a young woman keeping her distance from young men she hasn't personally vetted may be protective, even if it is irrational. And, of course, plenty of associations are pre-rational, made entirely on the basis of in-group identification or out-group animosity.


The question that remains for me is how to distinguish between counterproductive, over-fitted associations vs. ultimately helpful ones. I think perhaps the solution is trying not to rely on just one demographic variable. Instead of screening against "men" as a category, perhaps it's best to screen against men of certain backgrounds, men who appear impoverished, men who have drinking problems, etc. so the associations can get more granular and actionable.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for August 23, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I think it's well-within the Overton window if you're a conservative or at least "family oriented." The problem is that it's verboten among most blue-tribers, for whom any incentives, no matter how gentle, toward more traditional family structures are equated to regressive coercion. The best they can do is support cheaper/subsidized childcare, which isn't nothing. However, if the Nordic countries where that already exists are any reference, cheaper childcare alone does little to promote additional births.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Don't forget "accountability."


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Yikes. The defense just wrapped. If the prosecution is any good, they'll pounce on this.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


I think a combination of the inherent limitations of visual storytelling and the dumbing down of stories in general because of reductions in attention spans is a more likely set of culprits.




Pretty much. I also think that movies are uniquely limited in their ability to tell deep, thematically complex stories about psychologically whole characters. Certainly, the most virtuosic films can pull it off, but it's so difficult that we regard it as effectively magical when it happens. A book can have a duration of dozens of hours. It can take you on digressions with little regard for your need to be stimulated. The mental act of immersing yourself in the written word is enough to keep you engaged. Films, on the other hand, plateau at around 3 hours in length. Durations longer than that tend to be quite unpalatable to most audiences. As a result, they cannot spend nearly as much time creating rich worlds and instead have to "keep things moving."


Many people aware of this tend to prefer watching prestige TV shows, so they can see characters develop over the span of many hours. However, TV production has its own set of problems: more stringent budgets, more demanding and intricate production schedules, lower profitability resulting in less ambition, etc.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


The impression I got is that she didn't endorse any CAH before or after the killings until meeting with someone hired by her defense.




Uh-oh. In my experience CAH tend to be quite persistent and well-documented, since they are public enemy no. 1 when it comes to patient safety.




...without proper practice managing symptoms things can go off the rails very fast.




I think this is the only scenario that I could really accept - if the killings happened in her first episode of psychosis, prior to treatment. It's going to come down to how thorough her psychiatrists were in documenting the progression and severity of her symptoms, so they can generate a rough timeline of her illness. I think we will probably never know these details and can only hope the court does its due diligence.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Comment as you wish! I welcome more discussion even if you think it's redundant. I have education in the issues at hand, though I do not currently work in a diagnostic capacity with psychotic populations. I'd describe more, but I am overly protective of my online footprint and anonymity is why I enjoy participating here.


I haven't read about Clancy extensively, so my comments are tentative and open to correction. Generally speaking, psychotic diagnoses are a shitshow. Presentations vary wildly within the same diagnosis and treatment is a blunt instrument, to put it nicely. The defense claims she experienced some form of bipolar disorder with accompanying post-partum depression. From what I have read, her presentation aligns more with depression with psychotic features, but again, these categories are extremely fuzzy.


Notes taken from her psychiatrist indicate she was experiencing what are commonly called "command hallucinations," or voices that tell you to do things. It seems trivial to us mentally sound folks to resist voices - just say no - but it's not merely a voice. These hallucinations are often experienced like a form of possession, where the voice is accompanied by a loss of control or feeling of being "overridden." I once worked with a man who attempted to strangle me while crying and saying, "I'm so sorry, I don't want to do this." I believe him. He warned me when he was about to lunge so I could avoid it. I knew him well and in his right state of mind, he was a kind and gentle person. During his worst moments, he believed he was possessed by a pagan god. There was nothing we could do to talk him out of it, the only thing that worked were very strong doses of rescue medication (usually benzodiazepines). It is entirely possible that Clancy had similar experiences. It's hard to say. Much of the commentary around her mental health has focused on the depression, suicidality, and sleep disturbances that she experienced, rather than the psychosis. I am surprised the defense has taken this approach.


The other point I'd like to make is that the day-to-day experience of psychosis varies incredibly. I've worked with patients who have had fantastic weeks and consistent upward progress. These good periods can create a false sense of security and normalcy and often result in medication adherence wavering. Naturally, the progress comes to a swift halt (or even regression) in these cases. Even worse, sometimes downturns occur for no apparent reason despite consistent treatment. Here, there is little that can be done other than providing rescue medication, hoping the episode passes, and tweaking the prescription. Even within a single day, presentations can change dramatically. As such, the claim that she could wake up in the morning, take her kids to school, and come home to kill them does seem psycho-medically plausible.


Ultimately, it's hard to diagnose her remotely or evaluate the validity of the expert claims. I am very interested in her presentation these days. She appears to be able to sit in the courtroom with minimal difficulty and is evidently not experiencing these symptoms anymore. Perhaps she's just better at concealing them. I wonder what changed - was it time, or a new treatment?


I've written this and am only now seeing you are a physician. Apologies if some of these observations are elementary to you.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


she was suffering from mental issues, but in my judgement not nearly severe enough to completely strip her of her agency and free will




I didn't read the previous subthread, so I can't speak to the discussion you all have had there. I'd just like to point out that you're displaying the behavior that I described in my post. You acknowledge that she has some degree of mental issues - in other words, her cognition and impulses are different from yours, perhaps more distorted or reactive. Yet, because she isn't "completely" stripped of agency, you are choosing to categorize her as "culpable," which is likely the moral matrix in which you would regard yourself. Of course, what she did is monstrous and she is culpable in some form. But why does it have to be an either/or?


I think suggesting that a short-term medical anomaly affecting 1-2 in 1000 women is representative of baseline female hormonal function is quite dishonest. When people are in the throes of mental illness, we do deprive them of autonomy and rights temporarily (5150's), but once their mental normalcy returns, their rights return in tow.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Correct, this binary distinction is precisely what I'm talking about in my other examples.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Of course - legally speaking, she has minimal wiggle room and the consequences will be unquestionably severe. Her case just got me thinking more about how attitudes toward moral transgressors develop generally. Should we regard someone with derision, pity, anger, fear, or another emotion? What makes something a "troubling mistake" or an "act of depravity?" Should they be treated with dignity or cruelty, punished or reformed? All these questions are at play based on what the cultural apparatus deems is the person's nature, and I think language isn't doing us any favors.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It seems coherent enough on its face, at least as coherent as the inverse. Anti-stock, pro-flow would look something like: accommodate transient immigrants to contribute to the economy, but do nothing to assimilate them to the local culture and disregard most requests for permanent residency. I think that would work well for smaller economies (especially those defined by a primate city where the immigrants could be siloed), though I don't know if a country as large as the US could write sensible policy with this in mind.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
What does it mean to be “crazy?” I’ve spent much of the past few days stewing on the story of Lindsay Clancy. For context, she is a mother who, in the throes of postpartum something-or-other, whacked her three kids. Killing your own offspring is, on its face, an unambiguous evil. Only the most fanatical (and likely also psychotic) of anti-natalists would suggest otherwise. Clancy has not been characterized as an unambiguous evil. The exact nature of her mental illness is still at issue in the trial, but many figures have converged on the idea that Clancy was not of sound mind and thus is not culpable the way you or I would be. I suspect that no matter what her sentence is, a vocal chorus of mental health advocates will decry it as excessive. I sympathize here — having worked with the severely and persistently mentally ill, living with acute psychosis is hardly living at all.


I think this case is an interesting segue into something I’ve noticed more and more about how we adjudicate moral harms in the public sphere. I’d like to soapbox for a moment. Cool? Thanks. The experience of harm, at least colloquially, is limited to two parties: the offender and the victim. These people experience the qualia of the situation with their own eyes, ears, limbic systems, pain receptors, and memory banks. Unless we were physically present, the rest of us schmucks don’t have that privilege. We can only experience the event through language. We describe what happened. We ideate on the nature of the harms, the observed damages, and the more latent impacts. Most importantly, we construct a theory of mind for those involved. We daydream about what they might have been thinking, or, in cases like Clancy’s, if they could think at all. Bluntly, we want to know if we should treat them harshly or if there are, say, intervening factors that reduce their culpability. All of this is mediated by language.


Many of these intervening factors can be modeled on a spectrum. Someone can be more or less psychotic, more or less cognitively impaired, more or less ignorant to their situation. For the sake of discussion, let’s assume that Clancy experienced severe psychotic symptoms. In this case, minimal gymnastics are required to describe her nature as such. Clancy is psychotic → therefore she didn’t know what she was doing → therefore she’s off the hook. Thus, it is written. However, how should we treat someone who was a little less psychotic? How about a little less than that? What if they had psychotic symptoms, but they were subclinical or didn’t neatly fit diagnostic criteria? This is where language fails us. Human qualities may be modeled on a spectrum, but language is discrete. And so, the spectrums get “sticky,” and the labels gain outsized importance. A line must be drawn. The person must be sorted.


These sticky spectrums exist for a variety of traits. If you’re “just” poorly socialized and have a blind spot for a particular social norm, you’re expected to do better. If you’re diagnosed neurodivergent, it’s more tolerable to break the norm because you “can’t control it.” If you’ve had a few drinks and crack skulls in a bar fight but are otherwise a normal chap, you’re probably on the hook for assault. However, if you’re a person in the throes of capital-A alcoholism, you can break into a family’s home, sleep on their child’s bed, and avoid charges because you’re burdened by a sickening disease. If your IQ is 70, you can be sentenced to death. If your IQ is 69, you’re much too intellectually disabled for that to be fair. In each of these cases, the mental states at the time of the offense are similar if not near-identical, and yet resulting judgments vary based on how we categorize the offender’s nature. We don’t adjudicate based on “sort-ofs” and “somewhats.” In common parlance, either you’re an alcoholic or not. Either you’re intellectually disabled or not. Either you’re culpable or not. This strikes me as unfair.


I suppose I’m advocating for the spectrums to be less sticky, or for words to have less of a gravitational pull. Clancy will likely receive a modified sentence based on her state of mind. Yet, what ought we to do with people in the midst of mild, manageable psychosis who may still yet have impaired judgment? Maybe they don’t get away with a full insanity defense, but their sentence could be modified accordingly. This is why I oppose mandatory minimum sentencing. The job of the court — and the court of public opinion for lesser matters — is not just to determine what happened, but to determine the appropriate consequence. The question is whether or not this is a utopian suggestion. Is human nature too punitive to implement this mindset at scale? Are we interested in justice or just blood?


Relevant Scott: The Categories Were Made For Man, Not Man For The Categories


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for August 12, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Go to therapy. I used to work a similarly demanding job with a severely mentally ill clientele. The things I experienced weighed on me terribly and friends can only offer support to a certain extent. After a certain point, I almost felt like I was doing harm by telling them these horrible stories that they were not equipped to process or understand. A therapist will listen and listen and listen, and probably offer you at least a few helpful tidbits. Consider seeing one with a specialty in meaning-making or depth work, but I always say the best therapist is the one that is cheap and accessible enough that you will actually go to sessions. Best of luck.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of August 10, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I'll counter your generalization with a generalization - I don't necessarily agree. Many of my friends in college were jaded-ex-religious-turned-leftist types, and you could immediately tell who was raised Catholic. It depends on the area, of course, but I think Catholics have a stink about them that Protestants just don't. I think it has something to do with the papacy and how old the Church is compared to the many Protestant communities that are comparatively much younger.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for August 12, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Any guides or advice for attending academic conferences? I'm a late bloomer in that regard so I haven't gone to a "real" conference before - nothing national or with much significance. I know, generally, that you go and listen to talks and "network", but that's far from a complete understanding. I feel like social norms in academia are so opaque. I don't want to be clueless upon arrival.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for August 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Blegh, I forgot about Substack notes. I think you're correct, though. As an aside, it's unfortunate that creatives can't just create, they now have to advertise, market, and distribute. I wish we could revitalize the publishing industry (or at least whatever romantic facsimile I hold of the publishing industry) so they could handle all the chaff.