self_made_human
Kai su, teknon?
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
User ID: 454
self_made_human
Kai su, teknon?
10m ago
I expect it's somewhat less litigious than the US, though of course it still keeps people up at night.
I've read that the SSRI and increased suicide risk is a real phenomenon, when they start working enough to overcome the lethargy and apathy, which lets users finally find the energy to apply those lovely suicidal thoughts lurking in their heads. Not that I've seen that stop anyone prescribing them, there's nothing better for the majority. Maybe jump to ECT if the depression is severe enough/psychotic?
self_made_human
Kai su, teknon?
22m ago
Excellent! Using the knowledge we just discussed, which PRNs would you administer to yourself for that aggression???
Haloperidol 😌
Then again, maybe I have PTSD from exams, and therapy (CBT, if memory serves) is first line in the UK.
B-52 is the medical slang for that PRN regimen, don't see people abusing it (if that's what you meant by that comment).
Ah, the innocence. While I'm more familiar with the bomber aircraft with that designation, you really need to visit /r/drugs, sort by top all time, and just see the RIDICULOUS things people do with or on benadryl. Who thought people could get addicted to a bad time?
Medical beer works great! We need to bring it back.
Especially for us doctors. Sadly, the glory days of the NHS when doctors smoked cigars in their chambers and they had a bar in the doctor's mess were over before I was born.
On paper you have a risk of increased adversed events (most notably respiratory depression) when those two agents are mingled.
What ChatGPT won't tell you is that is likely not real and just a recommendation generated by an abundance of caution. Origin was probably adverse events in people with comorbid substance use, including alcohol.
Hmm.. A lack of evidence based practice? In medicine? Never imagined that was a thing.
I'd be rather surprised to see respiratory depression on that combination, unless they were the kind more fit for the ICU, but I'm just a baby doctor and I'm here to learn.
self_made_human
Kai su, teknon?
43m ago
I'm not that lazy so I asked GPT-4:
A senior doctor likely provided this advice based on several important considerations regarding the safety and effectiveness of treating acute agitation in patients with psychosis:
-
Effectiveness of Current Medication:
- If a patient is already on a medication that is working well (like olanzapine, which is Zyprexa), it often makes sense to increase the dose of that medication for breakthrough agitation. This approach minimizes the introduction of new medications and potential drug interactions.
-
Drug Interactions:
- Mixing intramuscular (IM) olanzapine with benzodiazepines can pose significant risks. One of the main concerns is the potential for additive central nervous system (CNS) depression, leading to profound sedation, respiratory depression, and potentially life-threatening consequences.
-
Safety Concerns with IM Administration:
- IM olanzapine and benzodiazepines, when used together, have been associated with severe adverse effects, including respiratory depression and cardiovascular instability. This combination can lead to excessive sedation, increasing the risk of aspiration, and can complicate the clinical management of the patient.
-
Clinical Guidelines and Best Practices:
- Many clinical guidelines and pharmaceutical recommendations explicitly advise against the concurrent use of IM olanzapine and IM benzodiazepines due to these safety risks. These guidelines are based on evidence and case reports of adverse outcomes.
-
Minimizing Polypharmacy:
- Increasing the dose of an already effective medication helps avoid polypharmacy, which can complicate treatment plans, increase the risk of drug interactions, and make it harder to determine which medication is responsible for any side effects.
In summary, the senior doctor's advice is grounded in clinical safety, evidence-based practice, and the principle of minimizing harm while effectively managing acute agitation. By using more of a medication that is already working, like Zyprexa (olanzapine), and avoiding the combination of IM olanzapine with benzodiazepines, the approach aims to optimize patient outcomes while reducing the risk of serious adverse effects.
I suppose that's the gist of it?
self_made_human
Kai su, teknon?
49m ago
It's a good thing I took my Ritalin and have a psych textbook open, or I'd have permabanned for the aggressive attack with education at a vulnerable juncture /s
Thank you, while you Americans have an abominable addiction to brand names, I can understand that those are principles that'll come in handy.
Do not mix IM Zyprexa with benzos however.
I can Google that, but you're in a teaching mood, so might I know why from the horse's mouth?
Unrelated question to check reading comprehension (this is a joke). Do they use hospital prescribed alcohol to manage withdrawal in India? It's so stupidly effective and simple and I don't know why we don't do it more anymore.
Never seen it happen, and I've been here longer than I'd like. It's the usual benzos to cover the acute withdrawal, and it matches up with NICE guidance to boot.
Go assess the patient (skip if the bandwidth isn't there, admittedly). Nursing and ancillary staff are seldom reliable narrators for if a patient needs meds. Bonus points if you can learn which staff and teams are reliable for this. Sometimes you can save everyone trouble by throwing a pissed off person a sandwich. Also be aware of the risks of sedating someone you need to interview or examine later, can easily cause downstream workflow problems especially if it's a hospital setting and you are pulling in consultants.
Good stuff. I'm taking notes, albeit with the cafeteria being the way it is in the NHS, I might be tempted to steal the sandwich. Certainly not paying for one out of pocket, do I look like I make US money haha. I do prefer practical and common sense interventions where possible, Scott's story about the lady with OCD and hairdryer stuck with me.
Haldol/Ativan/Benadryl (B-52! If you've never heard the term) works well and is popular for a damn good reason. It's fine as a default.
More from hanging out in /r/drugs to watch in sheer awe at the people who choose to abuse deliriants, in the case of Benadryl, but Haldol? That's good old haloperidol and I love it like me mum.
self_made_human
Kai su, teknon?
2hr ago
I used to like Holmes a lot more till I realized that Doyle was being a lazy bastard and cheating. I mean, that's a bit harsh given the standards of his time but the point still stands.
Deductions and clever reasoning are fun, but the kinds Holmes regularly makes are only true by author fiat. That's not how Bayesian reasoning (or reasoning in general) works. Sometimes the reason the dog didn't bark in the night was because it was constipated and really had to take a shit. The sheer confidence with which he just takes a look at a whole bunch of random phenomena which could very well have other reasonable explanations and zeroes in on the right one.. That's not the right way to model someone brilliant, even superhumanly so.
A good mystery novel, IMHO, is one where enough of the pieces are laid out in clear sight, and an astute reader can make the same deductions as the protagonists can. That's never been how it worked in Holmes. Sure, plot twists and aha moments can be entertaining, but the mechanistic underpinnings aren't there.
self_made_human
Kai su, teknon?
1hr ago
They bear almost no medicolegal responsibility, as long as they do their job, which is being largely useless. Seriously, if you, as a random doctor on the ward, ever get called over while harried to death in the middle of your shift and they ask you to sign off on their suggestions, then it's all on your head if something goes south. And if you refuse, well, you better be ready to face the ire of your seniors, who'll tell you to be a team player.
Fucking, hell they make more money than I do for my first year as a CT1 trainee. Matching my salary next year to boot. Maybe a quarter the time in education, exams where it's ridiculously difficult to flunk, and then they rake in the big bucks and have stable postings without rotational training and can coast until they often end up poached into managerial positions that were once expected to be done by doctors.
It might be a clown world where you're at, but here, the inmates are running the asylum. The UK has a massive shortfall of actual training positions, so it's both a miracle I made it on my first go, and people who don't are SOL till next year around while yet more medical students are pumped out. (I note the conflict of interest as an IMG, but I don't care, they have it easy compared to the shit I go through, and if they want to protest the erosion of pay and scope creep, I'm with them in the picket line)
self_made_human
Kai su, teknon?
1hr ago
I'm ever more grateful thay a quick poke with haloperidol and lorazepam solves most of my "emergencies".
Ah, truly the specialty for me.
self_made_human
Kai su, teknon?
9hr ago
In India, the few private hospitals that do hire NPs use them for one purpose only, they're usually trained to do procedures in the ICU, I'd say usually under doctor supervision, but I was a Medical Officer fresh out from an internship and my presence was superfluous. At least they never dared to take training opportunities away from actual CCM residents or registrars, if they wanted to do something, they got a crack at it.
If you think the US is bad about mid-level scope creep, wait till you hear about the UK.
There, NPs and PAs are both just about as useless as there, but have been bulldozed in by the government because they're far cheaper in the long run than an actual doctor, you know, the kind that expects career progression and also has the temerity to run away for greener pastures when fucked with.
They can't prescribe, nor order most investigations, and anything they do has to be be double checked by a harried doctor. Thankfully, the movement to curtail their expansion has been taking off hard, with doctors both working to rule (Oh, as a PA you report only to my consultant? Sorry, I'm snowed in, I can't sign off on a patient I haven't personally reviewed, please go badger the boss, they'll be very happy about it).
In fact, new guidance on the level of autonomy they possess, especially in GP, makes it so that they're effectively redundant in any practice, so the latter are now begrudgingly forced to accept that actual GPs are non-negotiable.
Add in scandals over them grossly overstepping their remit, and fucking up cases that would be obvious to any semi-competent doctor, such as dismissing obvious MIs with good old PPIs and a paracetamol..
It's all exacerbated by rotational training, with consultants unwilling to invest effort in mentoring and training their juniors who are going to fuck off to a new hospital, whereas they could at least teach the rote mechanical skills to a NP/PA who'll be working under them for their whole career.
What's doubly farcical is that they're paid more than FY1 and FY2 doctors, who are both more competent, and in the latter case, actually capable of ordering followup investigations for whatever they suspect is the case.
self_made_human
Kai su, teknon?
2d ago
Yes, actually. I mean, I'm mostly familiar with the value of citizenship during the Republic, but there were literal wars fought by the Latinates for the right to be full citizens of Rome. It came with voting rights, and I seem to recall it also provided more legal protections and other rights.
self_made_human
Kai su, teknon?
4d ago
I recently spoke to a cute med student on the dating apps, same med school as my younger brother.
She tells me she knows my brother. I mean, who doesn't? He's a looker, all the girls and a good quarter of the guys want to know him, in the biblical sense, but she wasn't so crass. All good.
She she says she knows my dad. Okay.. But I've heard worse.
She goes on to say that not only are our parents colleagues, they're from the same med school. What a coincidence!
I ask my brother about her. You know, due diligence. He gives me a look, and tells me to keep my filthy paws off her if I know what's good for me. Huh. That's new. I swear he's never had that particular reaction before, and I wanted to know why, but he just shook his head, asked me to confirm her surname, and wandered off.
Then she says that hey, your dad was visiting our place just a month or so back, how's he doing? Quite well, thank you for asking. What field of medicine are your parents in? Gynecologists themselves?
I matched into psychiatry. Then I found out, after a very reasonable amount of flirting, that I had matched with my psychiatrist's daughter on a dating app. I told her that I had literally called him a month back to share the good news. The former, the latter was nothing but bad.
My dad delivered her by c-sec. He does that to a lot of people, it's not a very exclusive club, after all, how could it be, when I'm a member?
My fucking brother, he was laughing his ass off in the next room, the walls, while thick, weren't nearly enough to hide the chortles or my beet red face. Then the asshole goes on to tell my parents about her, and I limp back home from work, only to have my dad ask me if I want to marry her.
I chuckle and throw my employee ID card somewhere it won't be missed. Then I take a good look. He's not joking. This is the opposite of good, but what am I good at except brushing off commitment?
No? Then stop fucking around, SMH (he's also shaking his head, and I mine). She's a Good Girl™, studious, from a respectable family. You want to get married? I can call her dad right now. He's not kidding either. I thought I was dead inside, but apparently it's always possible to make room for desert and to make what's already dead roll over and die again.
I assure him that as someone about to move countries and stay in Scotland for 3 years and change, marrying an Indian med student only halfway through her course is the ABSOLUTE LAST THING I want to be doing.
Ah, but they're well off enough, and so are we. We could fly her out every six months or so to see you.
-_-
My mom was in the room and giggling her ass off. Thank you for the moral support mom.
I tell my dad that I don't think a healthy marriage involves the newly weds living a continent away, seeing each other every blue moon. He doesn't seem all that fussed, and I realized that roughly summed up the first few years of his marriage, given how he was on the sigma grindset. I suppose there's a reason they had their honeymoon when I was three years old. No, I tell him, given that if there's ever going to be a shotgun wedding, her dad will be the one wielding one, only to keep me at bay. He's my fucking shrink, he knows things. He'd need a shrink himself if he let me anywhere near his cute and nerdy daughter, and I'm not licensed yet.
At this point, my mom asks me if I care to examine the latest batch of single ladies lovingly handpicked out for me by my aunt in London. I've well and truly had enough, I stomp out of there with steam, tinted pink with dying brain tissue, hissing out of my ears.
My life is a farce. Joke's on me. So are the drinks, but only because I'm going to be downing a lot of them.
self_made_human
Kai su, teknon?
4d ago
I recently spoke to a cute med student on the dating apps, same med school as my younger brother.
She tells me she knows my brother. I mean, who doesn't? He's a looker, all the girls and a good quarter of the guys want to know him, in the biblical sense, but she wasn't so crass. All good.
She she says she knows my dad. Okay.. But I've heard worse.
She goes on to say that not only are our parents colleagues, they're from the same med school. What a coincidence!
I ask my brother about her. You know, due diligence. He gives me a look, and tells me to keep my filthy paws off her if I know what's good for me. Huh. That's new. I swear he's never had that particular reaction before, and I wanted to know why, but he just shook his head, asked me to confirm her surname, and wandered off.
Then she says that hey, your dad was visiting our place just a month or so back, how's he doing? Quite well, thank you for asking. What field of medicine are your parents in? Gynecologists themselves?
I matched into psychiatry. Then I found out, after a very reasonable amount of flirting, that I had matched with my psychiatrist's daughter on a dating app. I told her that I had literally called him a month back to share the good news. The former, the latter was nothing but bad.
My dad delivered her by c-sec. He does that to a lot of people, it's not a very exclusive club, after all, how could it be, when I'm a member?
My fucking brother, he was laughing his ass off in the next room, the walls, while thick, weren't nearly enough to hide the chortles or my beet red face. Then the asshole goes on to tell my parents about her, and I limp back home from work, only to have my dad ask me if I want to marry her.
I chuckle and throw my employee ID card somewhere it won't be missed. Then I take a good look. He's not joking. This is the opposite of good, but what am I good at except brushing off commitment?
No? Then stop fucking around, SMH (he's also shaking his head, and I mine). She's a Good Girl™, studious, from a respectable family. You want to get married? I can call her dad right now. He's not kidding either. I thought I was dead inside, but apparently it's always possible to make room for desert and to make what's already dead roll over and die again.
I assure him that as someone about to move countries and stay in Scotland for 3 years and change, marrying an Indian med student only halfway through her course is the ABSOLUTE LAST THING I want to be doing.
Ah, but they're well off enough, and so are we. We could fly her out every six months or so to see you.
-_-
My mom was in the room and giggling her ass off. Thank you for the moral support mom.
I tell my dad that I don't think a healthy marriage involves the newly weds living a continent away, seeing each other every blue moon. He doesn't seem all that fussed, and I realized that roughly summed up the first few years of his marriage, given how he was on the sigma grindset. I suppose there's a reason they had their honeymoon when I was three years old. No, I tell him, given that if there's ever going to be a shotgun wedding, her dad will be the one wielding one, only to keep me at bay. He's my fucking shrink, he knows things. He'd need a shrink himself if he let me anywhere near his cute and nerdy daughter, and I'm not licensed yet.
At this point, my mom asks me if I care to examine the latest batch of single ladies lovingly handpicked out for me by my aunt in London. I've well and truly had enough, I stomp out of there with steam, tinted pink with dying brain tissue, hissing out of my ears.
My life is a farce. Joke's on me. So are the drinks, but only because I'm going to be downing a lot of them.
Well, I do write a hard scifi novel set in the wake of an abortive singularity where people start getting superpowers for Plot Reasons™, so I suppose I've given it some thought. Or at least I had governments and polities would react.
It depends on how dangerous said power is. For someone who is no more threat than a random dude with a knife, you really don't have to bother. When they're the modestly dangerous, thorough surveillance and mandatory psychiatric followup. If they're incredibly powerful, they're usually conscripted into the military. And if they're both powerful and act up, then time for their brain to be put in a jar, or tamper proofed (fail deadly) high explosives embedded in their occipital protuberance.
Anyone who falls in between, they get a full time slap drone assigned to them, a concept happily ripped off from Banks. Something constantly hovering over their shoulder, ready to call for backup if sedatives, neurotoxins, or a bullet fails.
Some powers, such as telepathy or mind control, are severely restricted on pain of death. Non-consensual mind control is a capital crime, at least if you're not on a leash by a state. Technomancers are absolutely not supposed to mess about with AGI, on pain of having their heads exploded.
Of course, some people are simply too powerful to be handled in such a manner, but the governments of the globe devote a great deal of effort in having contingencies for their contingencies, and if you get really out of hand they'll have someone teleport you into the sun, or maybe a black hole. Not that even that can put down the equivalent of Superman.
If you want a more in depth explanation, well, I guess I wrote the book on it? But you can achieve a lot by playing them off each other, and mostly normalizing the strict monitoring and regulation of the lot. Which is how I'd expect it would go down.
self_made_human
Kai su, teknon?
2d ago
Maybe go on a mostly-chaste date or three, just for fun, if she's on the same page? Have fun, get some practice, go to a show, overact romantic with a twinkle in your eye, be more frank about your life and situation than you might otherwise be, try out some conversational gambits that you might hesitate to use if you thought more was on the line. Whatever mask you wear, drop it a bit.
That does sound lovely, but while what I'm about to say definitely sounds like a humble brag, it really isn't meant to be one. I don't want her to get attached, or to end up attached myself. It's only a few short months till I'm gone, likely for good, and I don't want to make things more painful than they absolutely have to be.
She's a very sheltered girl, and if I'm my usual flirtatious self, that means they have a distressing tendency to fall for me. I'm not an asshole, everyone I've seen after my breakup, I made it clear that I'm going to flee India for good eventually, and when the news of my match came in, rather soon. This hasn't stopped a few people from clinging onto me more than they should. I don't blame them, the average guy they encounter is shit, I've seen men hotter, richer or more muscular than me fuck things up, their sheer negative rizz causing atrophic vaginitis from a block away. So if I do go out on a date, no matter how chaste, I'd rather not leave her missing me. I'm not so full of myself as to claim it's a guaranteed thing, far from it, but it would make things very awkward.
I already know that I can be charming when I care to be, and that I'm not rusty. She's better off not being the subject of further experimentation, especially when I really don't expect either of us to hold a candle for that long.
If she's that closely connected, she might wind up being a family friend in the long run, and this would make a good story for when your own respective kids meet on a dating app.
🤨
More seriously, she's doing just fine, and when we do talk, I make it a point to be both mildly flirty and also walk their through any stress or concerns she has about med school. I do genuinely like helping people, and unlike my own brother, she takes it seriously and is thus stressed out over how it's going, despite being more talented and harder working than the two of us put together. So at least I know I'm a mildly positive experience and someone she can talk to.
My future kids? They can fend for themselves.
And if you hit it off, well, you might be needing a new shrink soon, what with the move and all, right?
It helps that I'm going to be surrounded by them, more than I can shake a stick at. Worry not, that's one of the perks of being a psych trainee, they know how shit my salary is and might take pity and waive some of their consultation fees.
All I really need a psych for is refills of my ADHD meds, sadly the wait list in the NHS for a formal evaluation is 2 years long, though I'd hope my existing diagnosis suffices. At any rate, I want to switch off Ritalin, it works but it also happens to suck.
So it won't be the ideal situation, but if she's close enough to the ideal girl for you, then don't let her get away. Don't make the modern mistake of having an image in your head of what your life should be like, and then waiting for it to fulfill itself. If she's got brains and integrity and a sense of humor, and you find yourself falling for her, seize the opportunity when it presents itself. (Finding out if someone has integrity, in the time you have available, there's the rub...)
Who knew the Motte was filled with so many hopeless romantics? The prognosis is always terminal.
I think she's fun and very sweet. She certainly did a good job calming me down after a nurse behaved so abominably with me I blew my top and vented about it later. But I don't know her well enough to put down a definitive diagnosis of "wife material". She's young, she's got a long road ahead of her, and even I'm just halfway done. And I'm sure you see why I have my reasons for keeping a modest distance, all the good I can do for her, it's from afar, and if I get closer, chances are it'll just hurt the two of us.
(I'm a terminal romantic myself. It sucks.)
Ay yo, I didn't force her to make an account on a dating app 💀
Depending on the definition of fucking around in play, I feel like I've certainly earned myself some leeway given:
- I just got out of a relationship that was, despite genuine effort put in by both of us, simply not working out, worsening my stress and depression to the point I quite literally was leaking fluid inside my retina.
- I'm leaving the country in a few months. Quite possible for good. Ideally so, it's more a matter of where I want to end up once my stint in Scotland is done, returning here isn't something I plan at all.
- She didn't ask for the whole thing to be escalated either. She assured me she didn't want her dad finding out, and I sure as hell didn't want my own family, my brother couldn't resist getting one in at my expense.
At any rate, I assure you that I have been nothing but nice to her, even if I don't consider myself in a position to get married right now, and I think she'd move to a convent if she found out that this was the consequence of trying out adventure for a little bit.
I sense a tale waiting to be told. Sure, Germany is far too close for comfort for the British, ancestral memory and all that. I suppose you can subsidize the alcoholism and I'll get the sauerkraut. I think both of us could use the drink, if not the wiener.
Your family cares about you. Be glad.
Oh I certainly am touched, my family is great, not that it stops me from muttering about the way their care and concern manifests on occasion. I'm only mildly exasperated; I'm no lemon or old beater that I need an enthusiastic salesperson or a dozen trying to sell me off to the highest bidder, but eh, enough stress might bring about the male pattern baldness earlier than expected and it's always good to have a backup.
Apart from all that, what is your family's opinion on you moving to Scotland?
My parents never wanted me to move abroad, and were vocal about it. To them, an ideal ending would be me taking up my dad's reins as a surgeon, or at least marrying a woman just regaining her sanity after a gyne MS, so that his massive clientele and skills can be handed down to someone who needs them for more than writing the odd examination or two. Well, they've got my younger brother still in the oven, and while I doubt he's insane enough to take up gyne either, I'd bet decent money he'll be getting married off eventually, preferably to a surgeon. He's far more handsome, but simply doesn't give a single fuck about the fairer sex. Not gay either, he ignores the horny fucks sliding into his DMs, and those include one of his male professors from med school. I suppose he'll just shrug and bear it. I'm deeply jealous, that's a level of sanity that I can never aspire to.
But that's all the ill I can speak about my parents. They've been supportive of my own ambitions, even if it means I'm flying the coop. The worst they've done is occasionally argue and try and dangle carrots before me, never the stick. They have valid arguments, both emotional and practical, but so do I. I don't think I'd ever be happy in India, I fit in much better abroad.
Right now, they're feeling the same melancholic, bittersweet happiness that I do. Parting is such sweet sorrow, but they're proud that their son is getting around to adding more alphabet soup behind his name, and a degree in the UK still gets their peers nodding appreciatively, so they can't complain. A postgrad degree is what everyone is dying to acquire post MBBS, while doctors might seem interchangeable to a layman beyond knowing their age and specialization, the lack of the latter doesn't get you very far in the eyes of your peers or your career.
I certainly wouldn't be getting so many marriage offers if I hadn't proven that I have some degree of academic competence, at least not from the parents of other doctors, though that's partly because until you've got that locked in, the rest of your life looks an interminable grind getting there.
Cheers to you, not that I can drink on duty. I can use a continental vacation at some point, and a beer, dearly.
self_made_human
Kai su, teknon?
3d ago
Marriage is very much something I'd prefer to do after getting to know someone, preferably live with them in advance to test the waters, and finally, have it not be an utter ballache to manage my own life around, given that I only know for a fact where I'll be for 3 years, even 5 or 6 is stretching it.
At least consider the girl's perspective, she encounters a family friend's son on a dating app, is kinda taken by him, but for the love of god, we've got both matrimonial websites and dating apps around. I assure you we didn't meet on the former, and it wouldn't just be jumping the gun, it would be sodomizing it, for either of us to leap straight to marriage.
Neither of us want to get married! She's only halfway through med school! I'm moving abroad. How on earth is that going to work unless we were childhood sweethearts holding a candle out for each other?? The last time I was at her place, I was probably younger than 10 and she must have been barely out of toddling around, I didn't even know she existed until this happened.
Ahhhhhhhhh
self_made_human
Kai su, teknon?
5d ago
Porn? I think it's harmless, potentially mildly positive and at least net neutral. I've already discussed in the past how it's associated with decreased rates of sexual assault. Of course some dudes do get addicted, but the overwhelming majority just jerk off and move on.
Social media? Relatively robust link to anxiety and depression. Most like causation and not correlation.
Sadly, I consume both, though the latter only because women are spooked if you don't have an Instagram profile. That does diminish the porn consumption, though I did say I don't think it's bad for you.
self_made_human
Kai su, teknon?
21d ago
I went to the trouble of writing an effort post somewhere that was read by like 8 people, so I'll just reproduce the primary bit, and tack on additional commentary at the end.
https://en.wikipedia.org/wiki/Psychotherapy
Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for numerous conditions.[8][22]
One line of research consistently finds that supposedly different forms of psychotherapy show similar effectiveness. According to The Handbook of Counseling Psychology: "Meta-analyses of psychotherapy studies have consistently demonstrated that there are no substantial differences in outcomes among treatments". The handbook states that there is "little evidence to suggest that any one psychological therapy consistently outperforms any other for any specific psychological disorders. This is sometimes called the Dodo bird verdict after a scene/section in Alice in Wonderland where every competitor in a race was called a winner and is given prizes".[151]
Further analyses seek to identify the factors that the psychotherapies have in common that seem to account for this, known as common factors theory; for example the quality of the therapeutic relationship, interpretation of problem, and the confrontation of painful emotions.[152][153][page needed][154][155]
Outcome studies have been critiqued for being too removed from real-world practice in that they use carefully selected therapists who have been extensively trained and monitored, and patients who may be non-representative of typical patients by virtue of strict inclusionary/exclusionary criteria. Such concerns impact the replication of research results and the ability to generalize from them to practicing therapists.[153][156]
However, specific therapies have been tested for use with specific disorders,[157] and regulatory organizations in both the UK and US make recommendations for different conditions.[158][159][160]
The Helsinki Psychotherapy Study was one of several large long-term clinical trials of psychotherapies that have taken place. Anxious and depressed patients in two short-term therapies (solution-focused and brief psychodynamic) improved faster, but five years long-term psychotherapy and psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability for different psychotherapies.[161]
Meta-analyses have established that cognitive behavioural therapy (CBT) and psychodynamic psychotherapy are equally effective in treating depression.[162]
The bolded section is the one I can't easily verify, at least not when it's 9 am and I've been up all night studying.
Specifically regarding CBT, I found the following metanalysis-
https://pubmed.ncbi.nlm.nih.gov/23870719/
Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g = 0.49).
Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.
And when speaking of CBT as applied to more psychiatric conditions:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
Addressing the specific claims of similar efficacy to the forms of therapy based on pseudoscientific principles:
CBT for depression was more effective than control conditions such as waiting list or no treatment, with a medium effect size (van Straten, Geraedts, Verdonck-de Leeuw, Andersson, & Cuijpers, 2010; Beltman, Oude Voshaar, & Speckens, 2010). However, studies that compared CBT to other active treatments, such as psychodynamic treatment, problem-solving therapy, and interpersonal psychotherapy, found mixed results. Specifically, meta-analyses found CBT to be equally effective in comparison to other psychological treatments (e.g., Beltman, Oude Voshaar, & Speckens, 2010; Cuijpers, Smit, Bohlmeijer, Hollon, & Andersson, 2010; Pfeiffer, Heisler, Piette, Rogers, & Valenstein, 2011). Other studies, however, found favorable results for CBT (e.g. Di Giulio, 2010; Jorm, Morgan, & Hetrick, 2008; Tolin, 2010). For example, Jorm and colleagues (2008) found CBT to be superior to relaxation techniques at post-treatment. Additionally, Tolin (2010) showed CBT to be superior to psychodynamic therapy at both post-treatment and at six months follow-up, although this occurred when depression and anxiety symptoms were examined together.
Compared to pharmacological approaches, CBT and medication treatments had similar effects on chronic depressive symptoms, with effect sizes in the medium-large range (Vos, Haby, Barendregt, Kruijshaar, Corry, & Andrews, 2004). Other studies indicated that pharmacotherapy could be a useful addition to CBT; specifically, combination therapy of CBT with pharmacotherapy was more effective in comparison to CBT alone (Chan, 2006).
In the particular case of BPD, after talking to @Throwaway05 I looked into the actual benefit of DBT, and was surprised to see that it was genuinely far more effective than I expected. Somewhere around the ballpark of 50% success rates in curbing symptoms and letting quite a few of them lead entirely unremarkable and functional lives. If 50% sounds underwhelming, wait till you hear the typical cure rates I'm used to.
So:
Is therapy and therapy speak actually harmful to people that have mental illness?
A clear no. The evidence base is nigh unimpeachable, even if, as discussed above, the most bullshit insanity inducing forms like Freudian or Lacanian psychotherapy still beat placebo.
My personal working hypothesis is that therapy acts as a decent substitute for a friend, a non-judgemental and understanding one who has seemingly endless time to listen to your problems, and is forbidden, on the pain of losing the way they make a living, from disclosing your troubles. Unfortunately, quite a few people genuinely lack actual good friends, so even such as ersatz substitute has notable effects.
This is an entirely different question from the fad we've been having for quite a few years of "therapy culture", or the insistence of people to co-opt/misuse therapy speak to lend their bullshit legitimacy. Then again, there are practising Freudian and Lacanian therapists, and few other people seem to have the same burning urge I have to burn their houses down. Even then, I must concede they beat placebo, as well as the dead horse that is repressed penis envy.
Anyway, therapy seems to beat placebo, and works synergistically with drugs, even if you cynically notice that therapy based off nonsense does much the same thing as more considered approaches, but it's not in dispute that it works. At least I have the consolation of being able to throw drugs at people instead of just talking at them as a licensed shrink in training, for all the quibbling about if SSRIs work, ain't nobody claiming their ADHD isn't being helped when they're zooted up on stimulants.
To conclude, is therapy helpful when administered by someone who knows what the fuck they're doing? Yes.
Are they/us responsible for random idiots using it as an obfuscation technique? Not really, though the upper echelons of HR are often staffed by people with degrees in psychology where I'm at.
Is it possibly a net negative for the set of {all people subjected to mealy mouthed terminology}? No clue, but you asked about the actually mentally ill, and you have my answer. No surprise that a few of them pick up on the lingo.
self_made_human
Kai su, teknon?
3d ago
You need to change your username my guy. It's far too easy to mistake that for asexual, and I might be a horny bastard but I'm not quite that far gone yet haha.
self_made_human
Kai su, teknon?
3d ago
He has seen into the abyss and with that you are still a viable candidate. That speaks about both the alternatives he is aware of and likely his calculus of what the baseline mental state of the educated Indian male of your social stature. If his daughter is hot go for it, and rub it in your brothers face that you overcame adversity.
To the best of my knowledge, her dad doesn't know, and I'm immensely grateful. I asked her if he'd ever mentioned me as a patient, and was suitably impressed that he'd never brought it up at all, not even when my dad was around. A far more respectable psychiatrist than I am (even when I do finish my degree), he seems to take client confidentiality seriously while I just file off the serial numbers enough not to get into trouble with my governing body.
I'd have preferred to keep my parents blissfully ignorant, but my brother had other ideas. The sheer ingratitude, when I was the one taking Ritalin to coax and prod him through his finals? (Said Ritalin prescribed by the girl's dad. Sigh.)
Eh, while I'd be lying if I said I didn't think with my dick, it only holds a rotating seat in the Insecurity Council, though of course wielding a veto. But right now, marry a med student with 3 years to go who would then have to worry about her own UK licensing exams? Bruh. I can flex on my own brother in other ways, not that I don't love the cheeky little shit.
If I had to guess, I do think her dad would be open to the suggestion. I haven't really done anything awful, he just happens to know I was pretty depressed at one point and have ADHD. No real skeletons in my closet, just the overflow of my mom's sarees.
Besides, it's rare for girls to get married off while still med students. The only odd case or three I can recall, they were Muslim, from conservative backgrounds. Most Indian parents, the Hindu ones, at least, are kind enough to wait till you're out of med school before the real nagging about the pitter patter of little feet begins. They'd be happy enough to have an informal engagement, all the more so if the couple to be had genuine interest, but the formalities can wait.
Having spent more time examining the London offerings, I would say that if the girls are below 27 it is ok to see. Barely out of university so they haven't had time to adjust their own presentation to match local white standards, old enough to not be blind waifs ignorant of basic functions, amenable enough to listen to their mothers and will get scolded by their own parents if they go against the man. Finding white girls to date in Scotland is all well and good, but do recall my earlier points about mass distribution curves, and also be wary of their extremely low tolerance of UV radiation.
I'm listening. I'm learning. I even look at some of the girls sent my way, not that anyone has convinced me to take them seriously quite yet.
At least my long stint in Oncology means I can tell a melanoma when I see one! I bring a lot to the table 💪
self_made_human
Kai su, teknon?
22d ago
I fail to see how this analogy is remotely appropriate.
The primary reason that people who are vegan/vegetarian (for non-religious reasons, and even plenty of those) condemn the consumption of meat is because their heart aches at the idea of eating cute little animals, with souls, emotions and a life of endless frolicking in the pastures to look forward to. Most of the arguments advanced alongside that primary concern, such as "sustainability" and environmental issues or resource consumption, are there just to buttress their core concern.
I wholeheartedly agree with @Quantumfreakonomics when he says that:
I am not a person that cares much about the suffering of animals, especially not the ones that taste good. Still, strictly speaking, the suffering is not an integral part of the process. If it could be removed, all else being equal, that would not decrease my utility in any way. I am agnostic on lab-grown meat. If it tastes good, is cheap, and is of comparable healthiness to legacy meat, I will eat it.
After all, I've repeatedly said much the same myself.
Hence the recent fad, only just losing steam, of feverishly trying to find vegan substitutes for meat products. Impossible Burgers and all that jazz. Vegans, begrudgingly, note that they either like meat or that people who otherwise care dearly about animal welfare are dissuaded by the dullness of a life without nice steaks or a side of ribs to go with it.
So lab grown meat completely cuts the Gordian knot. No cute animals were hurt (or at least far fewer, if you don't look too closely at where fetal bovine serum comes from, but presumably we can avoid that too). What's there left to object to, on primary moral grounds? A chunk of vatgrown muscle tissue is probably less sentient than an equivalent amount of fungi.
But of course, like the environmentalist movement and the cleanest and greenest source of energy we had/have/can have*, nuclear, much of the opposition arises from the abhorrent idea that their self-flagellation and virtue signaling will become entirely redundant. What brownie points do you get for not eating a cow, when the average Joe who just wants to grill is using a steak that's indistinguishable from one made the old fashioned way, tastes just as good, and might even be cost competitive?
We're not there yet, and the last overview I read of the topic suggested it's not going to be easy at all, but the sheer idea that their performative ascetism is moot must gnaw at their bones (veganly).
*Barring fusion, or farming black holes I guess.
self_made_human
Kai su, teknon?
4d ago
Honestly, I'm impressed you manage to be so productive, considering all you mention.
I write the most when I'm drowning in work and responsibilities, it's a pleasant form of procrastination. But in this case, I have a legit fire under my ass, I can't afford to fuck up the one good thing I've got going haha.
I did a while ago, recommended to a friend too. "I'll take a look" - never did, flaky bastard
Why, thank you. If I had a Patreon, I'd bump you up to cameo in novel tier, but since I don't, I'll just hand that to you for free. If you do actually want a character to show up, just let me know and I'll make it happen.
self_made_human
Kai su, teknon?
4d ago
I believe the cool kids are primarily on Snapchat, but insta hasn't turned into an old age home quite yet.
A large bit of it is that women love snooping on profiles. It helps them get a lay of the land, though it's not like guys don't do that, but that's for altogether different terrain.
Does the guy know how to dress? Has some semblance of a social life? Does he have anything interesting going on that isn't just drinking beer, playing football on a PS4 and so on? Useful things to know. While the utter absence of a social media presence isn't necessarily a deal breaker, it's a big deal to the kind of women who haunt dating apps. And what am I, if not obliging? And what are my two dogs, if not incredibly photogenic? All I have to do is stick my face in the frame and they'll do the heavy lifting.
I've already said that you were incredibly lucky to be using dating apps before they were turned into glorified gacha games, and that too, meeting someone you could spend the rest of your life with there. Well, it's been long enough since that was the case that the two of you must be having a nice, comfortable old time. Don't mind me, not jealous in the least.
self_made_human
Kai su, teknon?
26d ago
If only all our trolls put in this much effort. Thumbs up for that alone.
Look, I completely understand that you're unhappy with what @TitaniumButterfly said, and understandably so. He's been warned by @Amadan, and presuming he doesn't clean up his act, or at least say such things in a less maximally inflammatory manner, he's probably going to end up banned.
However, your own response, especially submitted as a top level comment in this thread, doesn't fly either. I'm not going to put anything on your mod record, since you're new and justifiably incensed, but at the very least, you need to put more effort into a rebuttal. Yes, I'm aware of how weird that sounds.
If you'd just stated this as a reply, I probably wouldn't have bothered to respond or put on the mod hat, but once someone has been modded for their actions, you should leave it at that and not performatively call them out to make a rhetorical point. After all, to make a very lukewarm defense of them, they went into a great deal of explaining as to why they hold the view that they do.
More options
Context Copy link