self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
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!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
I cleaned my flat.
A rather unimpressive achievement until you consider I've only recently surfaced from a very long stretch of depression, looked around at the wreckage, and genuinely wondered how the fuck I lived this way.
Okay, still not that impressive. I'll concede the point. I'll talk about it anyway, because the mechanics of how a reasonably functional adult ends up living in squalor happens to be the interesting bit.
The best analogy is what software engineering calls technical debt. You ship something that works but is badly structured, and you tell yourself you'll refactor it later. You never refactor it later, you've got bigger fish to fry. Instead you build more things on top of the bad structure, and now refactoring would break everything, so the cost of fixing it keeps growing while the probability of fixing it approaches zero. The codebase still compiles. The product still ships. Nobody outside the team can tell anything is wrong.
Depressive debt works the same way. An empty coke can here. A cardboard box there. It's trivial, really, coming back home exhausted, surveying the detritus, and deciding you can't deal with this right now. You'll handle it over the weekend. And then the weekend arrives, and the little free time and energy you have left feels like it should be spent on something that doesn't make you want to cry. So the can stays. The box stays. A second can joins the first. Some takeaway containers. An Amazon package you opened but never broke down. Each individual item is nothing. The aggregate is a lifestyle.
The insidious thing is how gradual it is. Nobody wakes up one morning in a scene from Hoarders. You just wake up one morning and realize there's barely any room for the mouse on your desk anymore, and you're not sure when that happened. Could have been Tuesday. Could have been November. Time does strange things when you're depressed, mostly by not doing anything at all. Days just sort of laminate onto each other.
For a long time, my life resembled that Homer Simpson meme: the one where he's looking hella fit from the front, all the ugly fat and cellulite cinched up by a belt, just out of sight. Dress well, groom yourself, and you can make a remarkable number of people think you've got your life together. I've been running this play for a while and the success rate is surprising. Surprisingly good. The bar for "having your shit together" in your late twenties or early thirties is apparently: shower and shave regularly, own clothes that fit, show up to things on time. Nobody asks follow-up questions. Few request a home inspection.
In my defense, my flatmate is a younger gentleman who leaves half-empty packets of sertraline and boxes of Wegovy pens lying about everywhere. The parallels to an essay I wrote were lost on me until much later. We are two rather depressed motherfuckers trying to keep it together, or at least not scare the ladies away. He only cleans when his girlfriend is coming over. (I have no idea how he bagged her, but I'm impressed. She's the landlord's daughter. And a hottie. I hope he gets a discount on rent.)
I must confess that I, too, only really clean when I have women over. I can imagine an evolutionary psychology paper on this. Something about mate-attracting displays and habitat maintenance. The male bowerbird builds an elaborate construct decorated with colorful objects to attract a female, and I, a higher primate with an even higher education, do essentially the same thing. My version involves frantically shoving pizza boxes into bin bags at 6pm while texting "running a bit late, see you at 8."
Unfortunately, for the past year and change, the women in question have lived elsewhere, and I usually meet them halfway or stay at theirs. This has predictable consequences for the state of my flat. The slightly less predictable consequence is them assuming I'm seeing other people when I decline to have them over. There's a real irony in being suspected of infidelity because your bedroom violates the European Convention on Human Rights.
My flatmate and I get along: we barely talk except to split the bills, and we make few demands of each other. Just two dudes being dudes. I let him colonize the supermajority of the living space with retro consoles and an ungodly heap of clothes on the couch. I don't even mind too much, at least not for my own sake. My bedroom might not be palatial, but the very few things I care about fit inside it.
I am somewhat miffed that he let the kitchen sink pile up with an unholy mound of unwashed dishes, and that he didn't have the courtesy to bag his trash when I asked him to. I'd have taken it out myself. But I've dealt with the worst of it now, in part as repayment for my own slipped promises. Glass houses, stones, etc.
Something that both did and didn't surprise me: it was less arduous than I thought. And that's depression in a nutshell, isn't it? The disorder that makes everything look impossible, including the things that take twenty minutes. Add in ADHD to taste, if you like your food cooked half-raw. Borrowing some terminology from behavioral psychology, call it a task initiation deficit. The clinical way of saying the starter motor won't start, but the engine can spin fine. Once I actually started filling bin bags, the momentum carried itself. The flat isn't spotless. But it's livable. It looks like a place where a person lives, rather than a place where a person is slowly losing a war of attrition against entropy.
Why did I finally do it? In part because I'm less depressed. Partly because someone's coming over.
Mostly the second thing.
But I did it anyway.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
I would say that things have flipped these days, if you were to compare 5.6 Sol and Fable, Sol is less agreeable, even if both are notably less sycophantic than most earlier models.
A week that's oscillated between manageable and hellish. I'm bone tired and it's only a Wednesday. No exercise that isn't my glutes getting a hell of a workout.
There's very cheery signage by the hospital stairs stating: "taking the stairs is free exercise!". When I've gone up and down multiple levels half a dozen times in a day, I've never been more motivated to engage in vandalism.
The good news is that I've gone from unbearably stressed to only mildly stressed but very harassed and put upon. I've been stuck late multiple days to clean up other people's messes, and my juniors have sometimes overenthusiastically multiplied our workload. I have refrained from yelling at them, I've just sighed bitterly and cast a mildly disappointed glance before telling them what they should have done. The fact that all of us ended up stuck over an hour late to fix things was all the punishment anyone needed.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
8d ago
I discovered that one of my new coworkers is ex-military before entering medicine, and is perfectly happy to nerd out over the fun toys.
I think we were discussing the relative strengths of offensive and defensive hand grenades when the new female trainee interrupted us for something, apologized, and said that she had absolutely no idea what we were talking about, but said she loved the passion nonetheless. I said that I'd lob a hand grenade at her for disturbing the peace.
More relevant is the fact that he's my neighbor, and has a gaming PC. I might actually have someone to play with, though I give only 25% odds we manage a match anytime soon. Maybe Helldivers, or Arma Reforger, since he owns both.
Otherwise, I've occasionally played Rimworld, and I've made it a point of booting up my pc and getting the game (with about 100x the original install size of mods) loaded. It takes 15 minutes (and that's with a ridiculously powerful pc), and minimizes the activation energy required to sit down and game. I've managed it some days this week, which is a sign that much of the anhedonia has lifted. I just don't have the time for anything more involved.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9d ago
You're welcome! Don't worry, your dad could well be a narcissist, and if he's an asshat, you have the right not to contact him regardless of a formal or informal diagnosis.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9d ago
It is entirely possible you do have ADHD. Based on what you've described, the clinical suspicion is at a degree that warrants formal assessment, and pursuing one is a move I would happily encourage.
That being said, I wince at anyone invoking "rejection sensitivity dysphoria," which in this context strikes me as a rather useless pseudo-diagnostic label that pathologizes being a Sensitive Young Man.
RSD appears in neither the DSM-5 nor the ICD-11, has no validated measurement instrument, and the term traces back mostly to one enthusiastic clinician in the 90s rather than any systematic research program. The construct it gestures at (emotional dysregulation in ADHD) is real enough, and the DSM-5-TR now acknowledges overreactive emotionality as an associated feature. That is very different from being a core feature, or being helpful in terms of narrowing down the differentials. Feeling terrible when a girl leaves you on delivered is not a neurological syndrome. Young man, that's the human condition, plus youth.
I used to be one, you know. Which is to say young. I'm still a man. In terms of sensitivity? Mostly I've just become increasingly willing to tell people to go fuck themselves, or more politely, to stand up for myself when I'm clearly in the right. There was a time when being left on read would have felt like the end of the world to me. These days I shrug and move on, or at worst wince slightly and forget about it by the next week. This will happen to you too, and it will manifest as external confidence. People can tell when you've got it, and they act accordingly. Time and reps, mostly. No pill need popping for that particular problem.
At best, marked rejection sensitivity might point toward a comorbid anxiety disorder, which is worth mentioning to whoever assesses you, since the comorbidity rates between ADHD and anxiety disorders run somewhere around 25-50% depending on the sample. But as a diagnostic marker for ADHD specifically, it offers little.
Now, I am a psychiatry trainee, and I do have ADHD. And my life has interesting parallels:
My dad, despite being a good doctor, was loathe to acknowledge that his son(s) have mental health issues. I'd blame it on him being from a different generation. When I was older and telling him about my problems again, he mentioned episodes around my age that sounded awfully like depression to me, except he hadn't had the vocabulary at the time, and more importantly, he had managed to push through and flourish anyway. In his eyes, a son who was clearly intelligent, academically and professionally successful, couldn't possibly be mentally ill, let alone chronically. He flinched away from the notion. In his cosmology, that's the realm of the insane and the delusional, and if you're objectively succeeding, everything must be fine upstairs.
I wish that were true.
On that note, I'd be careful bandying accusations of narcissism about. Not because you're necessarily wrong, but because I remember being around your age and being quite mad at my dad, and the heat of the moment is a poor time to hand out cluster B diagnoses to family members. Hold that belief lighter than currently feels natural. You can always revisit it when you're older and know better. That would the kind of statement that would have annoyed me when I was younger, but it's true nonetheless.
Pragmatically speaking: stimulants work on just about everyone. This has been known since we gave dextroamphetamine to entirely normal prepubertal boys in 1978 and watched their motor activity drop and cognitive performance improve, a finding replicated in normal adult men. That makes "I took Adderall and functioned better" a poor confirmation of the diagnosis, in the same sense that telling someone who perks up after a cup of coffee that they're "caffeine deficient" is a suboptimal diagnostic framework. Scott's essay on Adderall covers the gatekeeping problem well: attention is a normally distributed trait, the diagnostic cutoff is somewhat arbitrary, and most psychiatrists and possibly the majority of patients knows it.
Even more pragmatically:
ADHD is associated with a life expectancy reduction that is more alarming than I originally remembered. This paper found an apparent reduction of about 6.8 years for men and 8.6 for women, and Barkley's earlier estimates are thereabouts too. The mortality rate runs roughly double the general population's, pushed up by accidents, substance use, and the general downstream consequences of poor impulse control and executive dysfunction.
And treatment works! A Swedish registry study of around 150k patients found medication initiation associated with a 19% reduction in all-cause mortality over two years, concentrated in deaths from unnatural causes. The usual observational-study caveats about confounding apply, and the follow-up window is short, but the direction of the evidence is consistent across studies of injuries and hospitalizations too.
That's why I don't much care about gatekeeping this diagnosis as zealously as some do. The failure mode of slightly over-prescribing a well-tolerated medication with fifty years of safety data is considerably less bad than the failure mode of leaving a disorder with those base rates untreated because your dad is a dum-dum. I care about results uber alles, and I care even more about the fact my disease is comparatively mild. The medication changed my life for the better.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
10d ago
I have told him that, and I could tell he appreciated it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
10d ago
I presume you missed the drama from last week. I particularly care about what my boss says for multiple reasons:
- He's my boss, and my career progression is gated behind his approval
- He's not lavish with compliments
- I can trust him to be a pretty fair dude
That's why his praise matters, and why his criticism stings. He'd been concerned about my performance earlier, while operating off what he personally acknowledged as outdated information. Instead of developing a martyr complex about it, I decided to go above and beyond, and I had the good fortune of being able to demonstrate it live.
He's the kind of guy who cares far more about action and results rather than getting into group cuddle and commiserate sessions. I spoke his language and, as I hoped for, he reacted very positively. We might not always see eye to eye, but I can have a productive professional relationship with him, and that's more important.
I was so stressed out I could barely get out of bed over the weekend. But I manned the fuck up and went to work, and ended up using my own judgment, arranging urgent scans and discovering an acute and extremely concerning pathology in a patient my seniors, including my supervisor, had been blase about. That is it's own reward, but it helps that I also was congratulated on this and also got assessments done. I also had my supervisor (the one I had a difficult meeting with) explicitly say I'd been doing a good job, and that he'd heard and seen excellent things about me. Go figure.
I have given up on the NHS, and am pursuing private psychiatry in earnest instead of just contemplating it while emailing around. That involves coughing up a significant amount of money for a re-assessment of my longstanding ADHD, but it's better than the alternative, and I'm getting what I half suspect is a collegial discount.
As I tell everyone, insight is necessary but not sufficient. I try to supplement this extremely novel observation with getting shit done and improving. I dare say I succeed.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
I'd like to see a Tesla Model S redefined as an "electrical mobility vehicle". Particularly if it's in self-driving mode.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16d ago
A lot of things are "normal" with aging. Like heart attacks, and cancer, unfortunately. You're going to lose lung capacity with age, but finding it more difficult to breathe through your nose? I'd find that worth at least a mirror and a light even if it was someone genuinely elderly reporting.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16d ago
Please, do show me the rule violated. Preferably with quotes. I do have a blog.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
17d ago
Go to therapy. Touchy feely bullshit aside, just the opportunity to talk to someone who is good at listening and will be discreet about things is often worth the money. This also describes friends, but I'm not sure even I have a ton of friends who would listen to me vent about things along those lines for as long as it takes for catharsis.
Alternatively, I second the questions about whether you can switch to a less... visceral branch of law.
I just fucking know that if I had opted for law, I'd have turned to drink. Sorry you're going through this.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
17d ago
It's been a pleasure watching the fresh batch of baby doctors arrive on the ward, all wet behind the ears, lanyards tight around their throats. It makes me feel nostalgic, protective, and very old, all at once.
My colleagues before this lot were excellent, so the bar was set high. You can absolutely tell the new ones are new, but they compensate for the gaps with genuine diligence and a willingness to learn, which is all I can really ask.
Although "gaps in knowledge" is the wrong phrase. Talk to them for five minutes and the knowledge is plainly there, filed and indexed and ready to be recited. What makes an experienced clinician is the intuition about which parts of it apply to the person in front of you. Chess grandmasters famously don't calculate more moves than amateurs; they just see the board in chunks, and the bad moves never make it to conscious consideration in the first place. Medicine is like that, except the board is a 78-year-old with three comorbidities who has stopped taking one of her medications and hasn't mentioned which.
It's one thing to know the drugs and the diseases cold. It's another beast entirely to have a messy, inconvenient human in front of you, and that description covers the other doctors as fully as it covers the patients. Eventually, through sheer exposure, observation and practice, you just know. The relevant information stops requiring a search through your head, or a panicked Google in the loo (I am not above this). You build up what I can only describe as a mental cache, log(n) for the things that matter. Inconsistencies start to make you itch before you can articulate why.
Then there's the tacit stuff, none of which appears in any curriculum. How to refer to General Surgery without being swatted away. The exact words that make a busy Med Reg give a damn. Tactical phrasing that gets an urgent CT head done urgently rather than eventually. Presenting a patient so it parses for a doctor as exhausted as you are, who lacks the benefit of having spent the last four hours with them. Shortcuts through the hospital. Where to liberate your fair share of patient coffee, the single perk of the job. How to comfort the disturbed and disturb the comfortable, when clinically indicated. Which consultant will cheerfully field the silliest question, and which one will not suffer fools. The importance of booking annual leave early, so there is something to live for that isn't an ARCP. Getting along with your colleagues, because the NHS is a harsh mistress who will grind you down, and collegiality is a slow, reliable form of karma that they will be drawing on regularly. And, in due course, a tolerance for my worst puns.
I've been rather delighted by the FY1s and their impostor syndrome, which has a prevalence I estimate at 100%, give or take 0. They do their best to hide it, and you can always tell. I say that the shoe does fit, and eventually they'll stop noticing the blisters. They're fresh out of med school, and suddenly here is a human being who might die if you sneeze at them wrong.
Catch.
The most poignant case was the new core trainee. Lovely girl, fretting that she didn't know a thing. I told her, firmly, that if she knew everything already she'd be wildly overqualified, or at minimum a Senior Registrar. You're here to train, miss. It's in the name. You'll be fine.
On day one I told them that stupid questions do exist, and that I was issuing everyone a month of exemptions. The exemptions have been used. Expired ones remain welcome, because God knows I still ask colleagues, sotto voce, things I very much hope nobody senior overhears.
Sigh. I was there once, permanently braced for the moment someone worked out that I had no idea what I was doing. You pick up a few tricks, and hopefully avoid killing anyone en route. I think I've become the sort of senior I wanted when I started. Visibly stressed, clearly overworked, but always willing to make time for those need mine more than I do. I've certainly known worse.
As Black Wednesdays go, last week was far from the worst.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
17d ago
I recommend seeing a doctor. You might have a deviated nasal septum, could be inflamed sinuses or low grade allergies, you might have nasal polyps, it might actually be an issue further downstream. But short of someone actually taking a look inside, what do you really expect anyone to suggest?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
18d ago
Ungodly levels of stress, but better overall. Managed some exercise.
I've continued to get good feedback from work, and my relationship with my boss is back to cordial. I've got a presentation tomorrow, and I asked him for his input. He was very pleased with the choice of case, and said he'd defend me from any serious pimping if the other seniors had had their cereal shat in. What more can I ask for?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
19d ago
The floor has risen significantly. Even prior to Sonnet 5 (haven't fucked around with it it), the previous Sonnets were highly capable and treading into Opus territory at times.
I still think that for anything that isn't trivial/low-effort, the better models justify themselves very easily. I use the best that my plan allows unless I have a good reason to drop down (usage limits on a 5x plan are still annoying as hell).
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
19d ago
I am genuinely taken aback by this take. I know you're being sincere, but I can't understand where you're coming from. It's easier to say what LLMs can't do for me. And I very clearly benefit from the additional intelligence the paid models provide. They're not eating white collar work for no reason, they can do a surprising proportion of the work that a regular human can do on a computer.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
20d ago
Mu. Alternatively, invalid type.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
Honestly, I agree she had it coming. Use the belt.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
If adherence to the requisite format was beyond your abilities, I'm sure there would have been room for an apology. I have just learned not to expect very much.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
I understand that your day job involves coming into a situation where you had no original stake, or direct involvement, and then assuming an advisory position despite a clearly superficial understanding of the facts of the matter. I ask that you keep it there, I'm not paying you.
On a factual basis: no, I haven't presented myself as perfectly flawless on any day of my life, even I'm convincing women to let me sleep with them. Good grief. I, like a real human being, have made actual errors. And like a responsible trainee doctor, I've disclosed that to my boss. They're not material here, because the one specific issue he raised wasn't my fault.
Have you ever considered the possibility, in theory, that someone might actually be liked and good at their job? Or is that an entirely foreign prospect for you?
Beyond that? I hope your advice finds someone who needs it. If you want the fuller picture, I can ask my boss to sign up on themotte.org. I'm sure he has the time. God knows where I find it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
I think going into a moshpit as someone who wears glasses is remarkably inadvisable. Always wanted to try it, at some point, but then I remember that potential traumatic brain injuries are not going to improve anything.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
You're a clinician, what does a person who always thinks they are the greatest, and is always correct about everything, and reacts aggressively when their ego is challenged sound like?
I know perfectly well what that person is. The problem is that I resent your implication that that's a fair description of me. You don't have to go digging very far to find examples of me admitting that I'm wrong about something, really. Here, I'll make it super easy for myself and kill two birds with one stone:
The recent shakeup at Google, with the departure of Jeff Dean, puts them out of the running as a frontier lab. I'm not saying they don't have a hope at all, I'm saying that regaining the lead is going to be even more of an uphill struggle. In other words, I was wrong.
Now, back to you, Coil:
Have you stopped beating your wife? Yes or no answers only, please. I'm too old for these games.
You're welcome! Keep in mind tidiness definitely exists on a spectrum, and there are plenty of slobs/untidy people without mood disorders. God knows I'm not the neatest even when euthymic.
But it helps to have some scaffolding, a reason to clean. I can bring myself to do it then, whereas if it was purely for my sake, it needs to get pretty bad before I can be bothered to do something.
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