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
3mo ago
For the record, while I appreciate the name-drop, I've largely checked out of this debate. I read the article when it crossed HN, which I browse daily. The strongest critique of Mythos is that GPT 5.5 Pro reaches similar benchmarks while being cheaper and generally available. Which is to say: Mythos isn't quite as special as Anthropic would like, because a competing frontier model already demonstrates equivalent capabilities. See the problem there? Or, from my vantage point, the absence of one?
Why so checked out?
Not because I've recanted, and not because I've stopped believing my own forecasts. It's that anyone who hasn't gotten the memo by now is beyond my ability to help. I've been on this beat for years, sounding the alarm for about as long. Litigating whether each fresh data point lands above or below the trendline has stopped feeling like a useful expenditure of my evenings. I still have the arguments cocked and loaded, still bookmark whatever catches my eye, with roughly the clinical curiosity of an ICU physician watching creatinine and urea climb and eGFR slide in a patient with end-stage renal disease. Erdos problems falling like dominos and Terence Tau watching from the sidelines, Tim Gowers writing up breakthroughs from OpenAI's unreleased general-purpose models, METR's task-horizon metrics snapping like a mediocre school psychologist trying to score Einstein on the Stanford-Binet. (At some point the instrument stops measuring the subject and starts measuring its own inadequacy.)*
TL;DR: my supply of fucks is running thin. If you're pinging me hoping to extract an argument about AI capabilities, calibrate accordingly. I've got bigger fish to fry before I get thrown into the fryer myself. Good luck to whoever still has the energy for it.
*Go ask ChatGPT for citations and actual links.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
There’s got to be a clinical term to describe this.
Autism. I have a case study:
https://www.themotte.org/post/3755/friday-fun-thread-for-may-15/443629?context=8#context
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
ToaKraka, you are a wise man. I am less wise, and wish to enquire if it's masturbation when one side of a Siamese twin jerks off the other.
In all honesty, arguing about whether masturbation is "sex" is arguing about semantics. I'm fond of that kind of mental masturbation, but I think trying to use it as a central example is inappropriate. If I ask a patient if they're sexually active, I don't want to know if they had a recent date with Rosie Palm and her five sisters. In a non-clinical context, if my buddy rings me up and tells me about the great sex he had last night, I'd kick him in the butt if it was that banal.
If it doesn't involve physical contact with and penetration of another person, doesn't count for me.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
Edinburgh has to be my favorite city in the UK, with Manchester lagging behind in second place.
London? I've warmed to it considerably since my first visit in 2022, but I've also cooled on the prices. There's no way I'm going to spend that much money on rent and general expenses, particularly in a profession with little scope for geographical arbitrage.
Edinburgh strikes a nice balance. It's got good vibes, plenty of places to see or things to do. I mean, I'm not actually going to do any of those things, but it's the thought that counts. I suspect that I'm biased towards Manchester because I have family there, its not that remarkable. It's clearly not in the same league as London, it's just reasonably priced and not a complete snooze-fest.
Glasgow? Bruh. There's something in the air. A faint stink of rot (which might well be literal). The day I was in Glasgow probably increased the average mood when considering the population average, and I'm depressed. It just feels wrong, and I was in the nicer parts, staying in a fancy hotel. I didn't feel physically unsafe (I've been in some shady places for reasons I'd rather not get into, thanks), but it's gloomy and lacks the architectural charm of Edinburgh. I've only felt as utterly disappointed by a city when I visited Aberdeen, and that's so far north you run into polar bears.
In contrast, Edinburgh rents are reasonable, it's got a cultural scene that I could get into, in theory (it hosts ACX meetups!), and it's not super expensive. I could see myself living there, modulo futures where I do settle down in the UK.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
Lending yourself a hand is the best way to get rid of the spawn. Can't comment on the diabolical nature of the process without gross hypocrisy.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
have sex with your hand
I'm afraid I have bad news for you. Or great news, depending on how you look at things.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I'm grateful for the explanation, but I must note that you've explained the thing that least needs explaining. It's all good. You clearly know more about floor planning or the lived experience of Blackness than I can ever hope to.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
You censor "closet" after this comment?
You know, I really will never truly understand you.
I have not had a positive experience with meditation, but I've got nothing against it. I'm happy recommending it (weakly) for the average person. After all, we've stolen aspects like mindfulness and inducted it into validated and reasonably effective forms of therapy. CBT, DBT, they all have a little bit of Eastern meditation in them for taste.
Meditation is a non-starter for me because of my ADHD. It doesn't particularly appeal to me in general, but I'm not saying that it's inappropriate for other people with ADHD. I prefer relying on medication for my mental health issues (and I know that they work for me). Speaking about ADHD in particular? The drugs do more than any form of therapy/meditation can do. That claim has all the evidence it needs in favor, including in RCT form.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I believe you, and I rescind the offer. I'm a sensitive young man going through a tough time, and harsh words will make me cry.
I'm pleased to say that I do feel a little bit better with my exam out of the way. Only moderate depression instead of moderately severe depression! A directional improvement!
Now, I still finish work with only the desire to crawl into bed to keep me going, but I'm noticeably better at hiding my feelings. I've noticed a threshold effect, after a certain point I simply do not give a fuck anymore, and I'm back below whatever line that implies. Everything hurts, quite literally. I don't have the time or energy to engage in a hobby more involved than arguing with people online. But I forced myself to make plans for the weekend, and I intend to see them through.
Perhaps I shouldn't be grabbing a pint (or two) after work with such a degree of regularity, but it's fucking Scotland we're talking about. I've been here long enough to understand Glaswegian accents. Most of the time.
Less sighing, a diminished but non-zero appetite. Sleep that is within the range of normality for overworked resident doctors. Cracking jokes at work (most of them funny, only a minority at my own expense). Life as a doctor is easier when you lightly flirt with the nurses, while not quite looking like a cat dragged me into the ward. The NHS rewards good cheer, or ersatz-impressions of it. If you look and act sad and miserable, you'll find that people treat you worse for it. How queer.
I've mentioned, in the past, that I think one of the interns likes me. I suspect that my suspicion is well-founded. Why? Through independent confirmation.
For context: I work in a female-dominated workplace. Apparently men just don't want to be doctors anymore. No objections while it works in my favor. I was engaged in menial busywork at my desk while two of the lady doctors were chatting away. I wasn't paying attention, until one of them turned towards me and said "oh, [x] your girl is doing [something I genuinely can't remember]". She had a smirk on her face, while my other colleague giggled. NHS HR polices are what they are, so I replied with a "no comment". That is literally what I said, expression as neutral as buffered water. This only made them titter harder. I understand women just well enough to be extremely perplexed by them. I have a lot on my plate, and workplace romance would be a complication, to say the least. She's probably too smart and competent for me anyway.
Good feedback from my clinical supervisor too. Genuinely nice guy, though I don't understand how he manages to make it to the gym religiously, before work, be a good father to his tween son, all while working as hard as he does. Some people are just built different. If he thinks I'm doing a decent job, I believe him. He strikes me as the kind of person who would be very clear and open if I dun-goofed.
I caught my seniors from a different department in psychiatry doing something quite bone-headed with regards to a patient I'm not even particularly responsible for. If I was more depressed, I would have just given up, but I managed to find the energy and righteous indignation to lay out my concerns in front of other, more senior doctors, with citations and clinical arguments in hand. I didn't get it all my way (though I think I was in the right), but I did make a difference. Good to know that all of that exam cramming taught me something of actual value.
I even managed to make it to a teaching session and actively engage in learning, instead of phoning it in. It's a good day when a very renowned professor sends "good question!" and similar compliments my way. It's even better when I manage to out-nerd half the senior clinicians, and actually answer some of the hardball stuff when he looked at me expectantly. I am absolutely the teacher's pet - my ability to look deeply engaged and nod along has been finely honed since childhood. You need it if you've got ADHD and may or may not have stopped paying attention several minutes ago. Fake it till you make it.
I'll take it. I'll take it all. This isn't euthymia, but it's the next best thing after the actual next best thing.
I know I replied to your comment. I remember writing it and hitting submit. I can't see it on my profile. The universe is gaslighting me, or I've gone past pleasantly drunk into Korsakoff territory.
Oh well. It might just be user-error or shit wifi. I said that the Paper B gave me a cardio workout that met my annual quota, even before the fire alarm went off. We can ignore the day spent wandering Glasgow, or the very, very long trek home.
I also remember typing out that your reminder prompted me to go do push-ups till failure. The only reason I don't feel like a failure is that I did well over double-digits. If I haven't gone to the actual gym (which I've been actively paying for) by next roll-call, I authorize anyone and everyone to call me unkind names.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
You know, you've given me a lot of reasons to feel depressed and these are better than any that came before.
Fortunately, I don't own any property in India. At least none that I know of. Second home? I don't even own a first one, at least not till my parents hand theirs over. Which they won't, for the next 30 years at the least (which I am perfectly happy with, because the alternative would be that they've passed away). My mother was seriously contemplating buying a nice little house in India in my name, which I turned down because I have no concrete plans of moving back. Not if I can help it.
I don't wish to look down on the average Britisher. I don't. I detest their government, which has delusions of grandeur, or at least of empire. If you have an economy that stagnant, a system this unsustainable, you shouldn't be fucking up a high speed rail network or building tunnels for bats. You shouldn't be doing your utmost to make the best and most talented avoid you. I dare not call myself the best, let alone the most talented, and that's why my sorry ass is here. Could be worse. It could also be much better.
My general advice is to speak softly or carry a big stick. The current UK's political class are loud-mouths with limp dicks. I pity the average citizen, and I'm sad that I actually have it better than they do. At least I can pack my bags and leave if it gets too much to handle. Such squandered potential. It would be so easy to love the country, all I can really say is that its people don't deserve what they're going through.
You mentioned Ireland, and I've actually considered it as a perfectly viable alternative. Compared to Scotland? Similar weather, similar alcohol intake, and I suppose I can learn to love redheads instead of fake blondes. I'm a little more iffy on the EU and its value proposition, but I'll take more cash in hand most days of the week. I'm not sure why you're still there, but I suppose finance works differently.
They have the balls to expect me to pay taxes on my Indian income/capital gains. That wasn't true when I moved here, but I believe it applies even to immigrants without an ILR. I think that goes into full force either yesterday (metaphorically speaking) or somewhere around 2028. I don't know, I don't care. That's my accountant's problem, or it would be, if I had one.
The US can pull off that move, but the UK is huffing paint thinner. Why yes, make it even less appealing to move here, when your economy is clearly thriving and your weather pulls tourists from Ibiza. I love paying 50% taxes on my salary past £current figure (that I crossed a while back). I love regressive tax systems and cliffs.
The Paper B gave me enough cardio for a year, once you account for exam anxiety, the fucking fire alarm going off, and the long, long walk back home.
You know what? I'm going to do a bunch of push-ups. Right now. T-5 minutes. I'm going to be worked to the bone this week, but if I don't go to the gym next week, I should be yelled at.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
Any doctor who has completed or is currently on the relevant qualifying UK training programme (for example, foundation doctors applying for core training or doctors who are completing or have competed core training applying for higher training).
Yay. ☺️
What ‘significant NHS experience’ means is still up for debate in 2027. But analysis from NHS England has projected that a two-year NHS experience threshold (as per original 2025 BMA ARM policy) would have minimal impact on reducing training bottlenecks over forthcoming recruitment years, negating the purpose of the Act.
Nay. 😒
I know about this, as I should, since my future hinges on it. But I'm not seeing anything about consultant posts, which is why I was perplexed. If they were discriminating against me on that basis, I haven't heard about it, and it's not covered by the BMA article
I'm a core psychiatry trainee. That means I'm "completing" core training. It's in the name, unless they have very serious opinions on ab workouts.
As far as I can tell, I'm safe. About 90% confident saying so. I caught the last chopper out of Saigon, or the last C-17 Globemaster out of Kabul. Sacrificing my sanity or my will to live to get there was a small price to pay. I tell new Indian doctors who want to train abroad not to waste their time aiming at the UK, and not just because of recent developments.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I'm not entirely sure what you mean by that, since I'm only aware of planned changes to the UK training pathway. Last time I checked (all of a week or two back), the fact that I'm already in training and will (hopefully) acquire a British degree makes me quite safe. Even if I want to go through the pain of becoming a senior registrar and then fight for a substantive consultant post. Not perfectly safe, since things are up in the air. To be specific, the number of years of NHS experience you need to be treated as on-par with British medical graduates.
Am I missing something? If yes, then the main way I cope with this is by ignoring the problem till I can't put it off. Worst case, I'll end up a perma-reg or a locum consultant, or join a private company. That's not glamorous work, but it pays the bills, and I already live well below my means. If the UK isn't an option, then I think there's a chance I have an out in the form of NZ. If my USMLE issues clear up, that opens doors I'd rush through like they lead to nirvana. In the worst case? I can leave for India, rather unhappy about everything except the increased vitamin D production. All of this was half the point of the pain and suffering, I retain some optionality, even if it's not as much as I'd like.
The disclosure that you're black comes as a surprise to me. I clearly haven't been as scrupulous with keeping up with the ToaKraka lore as I ought to be. The mental image of you I had in my head looked like one of those 1960s pencil pushers at NASA, including the pocket protector and white shirt. Now it's closer to a better version of Steve Urkel, though I am sure you're an actual human being and not a walking caricature.
My hair is pretty nice. Just short of unmanageable East Asian straight, though I suspect that I've settled into a pompadour and fade that I'll keep well past the point it goes out of fashion.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
Shameless hijacking of the SSQ for a Wellness/Fun topic, because I just can't wait till the middle of the week. Forgiveness requested in advance.
Ahhhh. The exam is over. Is it over for good? I don't know. The Royal College usually takes about 5 weeks to release results, uncannily close to how long you spend waiting on a new antidepressant before you can tell anyone whether it's working.
By this point in my career, I've made peace with the fact that my anxiety and post-exam nihilism do not correlate particularly strongly with exam performance. I've done well (or at least passed) every test to date, even when the emotions actively present while I'm staring at the screen are some mixture of incredulity, frank confusion, and mild despair.
I dare say I felt less actively homicidal during this year's Paper B than its predecessor. The majority of questions seemed reasonable. There might be one or two utter stinkers in there, but unlike last time, my frank confusion is just as likely to be the product of my ignorance as it is incomplete information or bad phrasing. Progress, of a sort.
Working myself to near-meltdown did pay off, even if the last week and change was spent un-teaching myself what SPMM taught me.
When I first saw them reference NICE/SIGN guidelines from 2019/2020 many months ago, I assumed they did this because the guidance hadn't meaningfully changed since then. This was wrong. Badly wrong. About 20% of the material is out of date. The core management of psychiatry has not undergone any fundamental upheaval (haha, no), but NICE does its usual cost-benefit/utility analysis and pushes out minor updates whose effects ripple through the decision trees. I spent my last week of revision correcting these dangerous errors instead of actually being able to study. I pay these fuckers to do that for me. They haven't updated jack-shit since at least 2022.
Can you give methylphenidate to a child with ADHD and comorbid tic disorders? SPMM (quoting older NICE) says no. New papers by 2025 say: uh, actually, probably fine. No need to condemn the poor bastards to guanfacine, which doesn't help with inattentiveness. This precise question came up in my exam, and I chose methylphenidate, praying that if the College demands its trainees stay up to date, it has the courtesy to do the same.
I said I was tired. I still am. Nervous energy and the upper limits of Ritalin intake only go so far. I came out of the exam hall craving a drink. Craving two, maybe, or three and four if time allowed. Six seven? What, do I look Italian?
This means I have not bothered to sit down and do a proper post-mortem to see whether my answers were correct. I couldn't be arsed. Still can't be. Maybe tomorrow, if I haven't forgotten everything by then.
The most exciting event during the exam was the fire alarm going off, prompting a rapid evacuation of the test center. Nobody seemed to be in a position to answer reasonable questions like "is the building actually on fire?" or "can we pause our fucking tests while you figure this out?" or "what if I'm willing to fight the fire with water (coolers and actual extinguishers) if that's the price of a pass?" We spent half an hour in the rain, grumbling and despairing in equal measure.
It turned out to be a false alarm. We were allowed back to our seats, and after an interminable wait, the invigilators managed to get hold of the RCP and wrangle extra time on the test for us. I consider this an absolute personal win. I stretched my legs, drank some water, and took an ibuprofen for the mounting headache. If the exam had actually been cancelled or postponed, I was angry enough to sue, and so were most other trainees. Some intend to lodge a formal complaint anyway.
I used the extra time to revise my revision, changing a grand total of 2 questions to another, equally plausible answer. Idk, the vibes were better. I was exhausted, it had been 4 hours in there, and ibuprofen and nicotine gum only go so far.
I left with time to kill and went to the seedier, smaller parts of Glasgow. Always a good way to get a feel for the place. At a tiny pub the size of my living room, I had a pleasant time with the bartender and his geriatric buddies. I fielded multiple questions about the accent (I have a mental script handy) and explained that their guess on its provenance was as good as mine. They suggested Canadian, which is... maybe? Some of them had actually visited Toronto, so they might be onto something. I'll continue calling it a mongrel for now.
Then a haircut. Not strictly necessary, but I needed to treat myself. I treated myself to a hefty bill: £38 for a cut and shave at a Turkish barber, where my actual barber was a pleasant enough Scottish man with ADHD and depression (we had a productive discussion that changed nothing; it was idle conversation). At least it's a great haircut, done super quick. Maybe ADHD can be a superpower, if that superpower is running a trimmer at speed? Whatever. I got a nice hot towel waterboarding experience (probably billed) and coffee and nicotine gum (entirely free, thank god).
Then a sinfully delicious meal at a pub. Goan venison with rice and a whole-ass femur cracked open to let the marrow out. I could have had seconds. Instead, I settled for a helping of Vietnamese later from somewhere cheap and cheerful.
Then a train back, where I had the opportunity to debrief my parents before it got too late in India. To my pleasant surprise and bemusement, I'd received another arranged marriage proposal. Daughter of dad's medical colleague, a fully qualified dentist. I would like to claim I used to have a slight crush on her when we were kids meeting every year or so, but I could be imagining things entirely. Apparently she'd been stalking my Instagram and liked what she saw? Good for her, girl, but I live in a different country and like my teeth the way they are. If I didn't, I'd go talk to those Turkish gents. They'd hook me up.
I was also bombarded with an unusually high number of likes on dating apps, those technically-still-on-my-phone shrines desperate to remind me of their existence. I suppose my sunny disposition suits Glasgow, which lacks any solar insolation for most of the year. Certainly for as long as I was in it. Someone claimed I had a contagious smile, which is probably the better kind of very local endemic condition.
Not a bad day. Managed to take the train home uneventfully, managed to crawl into bed, and also managed to dread going back to work tomorrow. My sleep cycle is in dire need of new tyres. I'm tired. Adios.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I'll rest when I'm dead, but thank you, the exam went as well as could be hoped.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
Thank you <3
I have never been this angry at an upcoming exam in my life, mostly because the "best" study material is out of date or dangerously misleading. But I'm less stressed than I was before, which might be mostly due to fatalism, but I'll take it.
Im definitely drinking something more alcohol-enriched than root beer tomorrow, I can tell you that.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I have answers that cannot fit in the margin of this comment box, mostly because I have a career gating exam tomorrow. Ask me later?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I have had two exes who managed to out-horny me, to the point where I was the one who had to stay in the dog-house when I turned them down. The spirit was willing, but the flesh couldn't take it anymore. No comments on the bruising. And I'm a red-blooded young man (or at least I could pass as young when this happened). It's one thing to know the theory, it's another to engage in praxis.
(Yes, steak too lobstery, butter too juicy, yada yada).
I suppose I'd take that over dating women with a low libido, which is no fun either.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3mo ago
I mean, I expect that selection pressure will eventually result in a return to normal or historical TFRs, if only because the high fecundity populations replace the ones who act like pandas in captivity.
I also think the late-reproducing people have a ton of negative externalities on the rest. of us and as they fail to replace themselves those externalities will fade and all of the well-adapted people will be happier and wealthier.
I am somewhat perplexed by how you, after telling me that I haven't done a basic cost-benefit analysis, happen to casually gloss over the rather catastrophic near to medium term economic and societal damage of societies with far more old people than children, or drastic population decline as projected.... in pretty much every developed country. And many developing ones.
I don't lose sleep over this, because I expect technological interventions like AGI+robotics, artificial wombs etc to reduce or eliminate the current coupling between population growth/composition and the stability of national economies. I genuinely don't think we're going to need humans for their physical or cognitive labor in a decade or change, possible less. It's the same reason I don't worry particularly hard about the worst case projections for global warming, if it gets that bad, someone is going to burn a billion dollars of sulphur or inject it into the stratosphere. Inertia only goes so far.
You do not seem as optimistic, nor even as open to technological solutions, and I do not see how you can reasonably claim that your distaste for nudging or assisting the sub-fertile into having more children (by any means) can compensate for decaying infrastructure or potential collapse in a generation or two. If it's business as usual with no major technological breakthroughs and serious social engineering (or even just the widespread adoption of the suggestions I've endorsed), I don't see how you account for the disaster that represents.
I'm glad you noticed the innuendo. I'll update the tally accordingly.
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