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
A day in a psych ward will disabuse you of the notion that there's a bright line between sanity and insanity.
Just to start, we have distinctions between a true delusion, a fixed belief and an overvalued idea. Said distinction is incredibly subjective and often artificial.
The overvalued idea is the most familiar. Someone becomes absolutely convinced their neighbor is sabotaging their career, or that 5G towers are causing their migraines. The belief is wrong, probably, and they hold it with more intensity than the evidence warrants.
However: if you corner them and argue carefully enough, they squirm a little. They might say "well, I suppose I could be wrong, but..." There is still some kind of cognitive negotiation happening. The belief is upstream of their reasoning, but their reasoning is not entirely offline. Lots of people you know have overvalued ideas. You might have some. I might have some. Most of the time, they're like the mites that live on your skin, not beneficial, but not so debilitating you'll inevitably run face first into the consequences of your poorly founded beliefs.
The fixed false belief turns the dial up. Now there is no squirming. The person is simply certain. A deeply depressed patient knows, with the same confidence you know your own name, that they are a fundamentally evil person who has ruined everyone around them. You cannot argue them out of it because it does not feel like a belief to them - it feels like a perception, like reporting what they can plainly see. The fixedness is the thing. Evidence just bounces off.
I emphasize false fixed belief, because you might well believe that you have 5 fingers per hand. Someone might show up and make a really convincing argument to the contrary. Maybe they claim to show that Peano arithmetic is flawed, or that you have somehow grossly misunderstood what the number 5 means, or what counts as a finger. You are unlikely to give a shit, and for good reason.
(There are the usual "proofs" that pi is equal to 4, or that 1=2. The mathematically unsophisticated might never be able to find out the logical error, but they usually do not actually end up convinced.)
The true delusion (what Karl Jaspers called the primary delusion) is something stranger still. It is not just a fixed false belief. It has a particular quality of being un-understandable from the inside out. A man wakes up one morning and suddenly knows, with crystalline certainty, that he has been chosen to decode messages hidden in highway signs. There is no paranoid personality that led here, no trauma that makes it psychologically legible. It arrived fully formed, like a piece of foreign software running on his brain.
(Look up autochtonic delusions for more)
Psychiatrists following Jaspers say you can't empathize your way into it. You can understand a depressed person thinking they're worthless, but you cannot really follow the phenomenological path to "the license plates are speaking to me specifically."
Other than that, delusions are completely immune to evidence, and also culturally incongruent. Put a pin in that till I come back to it, it's very important.
The clinical rule of thumb: overvalued ideas yield under pressure, fixed beliefs are immovable but emotionally coherent, and true delusions feel less like conclusions the person reached and more like axioms that were simply installed.
You know, I tried my hand at writing a few Koans about psychiatry a while back. I might as well share one I'm fond of:
A patient who had recovered from psychosis came to Master Dongshan and said, "For two years I believed the government had implanted a transmitter in my skull. I was as certain of this as I am now certain it was a delusion. The feeling of knowing was identical in both cases. How am I to trust any of my beliefs ever again?"
Master Dongshan said, "You are asking perhaps the most important question in all of epistemology, and I notice you arrived at it not through philosophy but through suffering."
The patient said, "True enough, but forgive me for not finding your statement very helpful."
Master Dongshan said, "No. That's why you paid me to prescribe you meds, not for a lecture on philosophy. But consider: everyone around you walks through life with that same unjustified feeling of certainty. They've just never been given reason to doubt it. You now know something that most people do not. You know that the experience of being right and the fact of being right are completely different things."
The patient said, "I have.... issues with framing this as some kind of gift. It feels more like a nightmare. I can no longer trust my own experience."
Master Dongshan said, "You have described the starting point of all genuine inquiry. Most people never reach it. They are too comfortable inside the feeling of knowing to notice it is only a feeling."
The patient was not comforted, but was, in a way he found no use for, enlightened.
Okay. You can take the pin out now.
Notice the emphasis on culture context. If you've ever mindlessly scrolled TikTok or Insta reels, you might have seen a "prank" where this second-gen Nigerian citizen in the UK follows random older first-gen immigrants, introduces himself, then declares that "he was sent from Nigeria to kill you."
He then makes some weird gesture with his hands, takes out a pinch of salt from his pocket and throws it at the victim. They immediately panic, though the response varies from running away screaming, running at him screaming with the intent to do bodily harm, or to pull out a Bible and chant verses while weeping.
(Hardly a once-off. It seems a concerningly large number of elderly Nigerians carry a convenient pocket Bible for such occasions)
He doesn't pull out a knife, he's unfailingly polite, he just throws salt at them, which I'm given to believe is supposed to represent some kind of black magic curse.
Can a pinch of salt hurt you? Not unless you're a slug.
You might feel like laughing at these silly, superstitious fools. Haha, they think witch doctors can hurt them!
If you (for a general you) are a Christian, or any other religious denomination, you are exactly as laughably deluded from my perspective. You hold what, to me, is a clearly unfounded belief that is immune to updating on empirical evidence. That saint who rolled their eyes and spoke in tongues? You don't see people getting beatified for that these days, after we've got EEGs and research on temporal lobe epilepsy.
Unfortunately, if we used this perfectly reasonable standard for insanity, the patients in the psych ward would outnumber those outside. Grudgingly, we keep track of whether the delusions you hold are common, especially for your cultural milieu, and whether they are causing you disproportionate harm. Also, can we do anything about it? Is there a drug I can give some deeply religious pensioner that'll stop them from believing in God? Not that I'm aware of. If they're peeling off their skin to get at the hidden chip inserted by MI6, then I at least have some hope that risperidone will help.
Wait till you see the nonsense involved with evaluating delusional disorder. Othello syndrome involves feelings of immense jealousy and suspicion that your partner is cheating on you, based on little evidence. Simple enough?
And then you see someone who has a seemingly sweet, loving and faithful wife, who gets diagnosed with Othello syndrome, and then discover that said wife was actually cheating on them all along. It's not paranoia if they're really out to get you.
How the fuck is a psychiatrist supposed to know for sure? We simply persevere, and it mostly works. When it doesn't, it makes the papers and we get served lawsuits.
If someone has Othello syndrome and makes their partner so annoyed that they end up cheating, does that retroactively invalidate the diagnosis? You can tell me, after you find a time machine. I'm sure plenty of philosophers have made a living writing about Gettier cases, but I'm not a professional philosopher, and I don't let philosophy get in the way of fixing people.
Yes, same day as the essay I wrote about hanging out in the outpatient clinic. There was a lot more that happened which I haven't had the time or energy to cover. I writeup a mere fraction of the weird shit I see in my career.
It was the clearest-cut example of Cotard delusion I've ever seen. One for the textbooks. The fact that it has a name in the first place is also evidence of it being more than a one-off idiosyncracy (not that I know if my colleagues read Sacks, I haven't).
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
I'm not claiming that there's zero value from making laws that are difficult to enforce.
Littering leaves litter. Cheating prior to LLMs? Easier to catch. There is far more clear-cut evidence of wrongdoing, or at least some kind of accessible physical evidence that can be used to adjust priors.
This is much harder when the standard is any use of an LLM at all. How do you know? How can you even find out, short of someone being incredibly sloppy or confessing?
It's closer, quantitatively and qualitatively, towards writing legislation against thought-crime without some kind of futuristic machine that can actually parse thoughts. You might have a law on the books saying it's illegal to jerk off while thinking of minors, but even if you catch someone with their pants down, they can just claim they envisioned Pamela Anderson. How can you tell?
Plenty of rules for the Motte hinge on subjective assessments by us mods. But it would be absurd to add one that says that you can't swear aloud after reading a comment from someone you don't like.
The worst part is that false accusations will run rampant. That increases moderation load, and that effort would be better spent elsewhere.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Laws that cannot be enforced are laws not worth drafting. If they had just said "entirely or mostly LLM written submissions are banned", then that would have exactly the same impact and outcome.
I don't know the reputation of the mods at HN, though I've never seen heard of egregiously bad behavior or serious complaints, which is at least a positive signal. Maybe they will try and be reasonable, I just don't think that even a reasonable effort will succeed at catching more than small fraction of the fish in the sea. It'll definitely result in a massive surge of flagging and spurious reporting, which has its own downsides.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Thank you! That's what I recall.
PS: I'm able to confirm that that child was slated to have an EEG.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Just a few days ago, I met a patient who was convinced that they did not, in fact, "exist". He believed himself to be a rotting corpse, and initially declined his antipsychotics on the grounds that a dead person had no need for medication (a valid argument, as opposed to a sound one).
After some debate, we decided to tell him that the drugs would prevent his "corpse" from decomposing and causing a stink that would inconvenience the rest of the ward. Pro-sociality intact, he found this a compelling argument, and swallowed them without any further fuss.
So no, not even "Cogito ergo sum" is foolproof. The universe, and the DSM, must account for even better fools.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
There is no solution. There is no proof-of-work or proof-of-humanity that is not severely error prone, extremely laborious, or that avoids requiring some kind of totalitarian police state dedicated to monitoring every word written by a human, or every token outputted by every known LLM.
It can't be done, or at the very least it won't be done.
On Hacker News, it’s now so bad there's a new guideline, “don’t post generated/AI-edited comments”. Unfortunately, due to the extreme intellect of the average Hacker News commenter, it can be hard to distinguish their profound technological insights from even a markov chain trained on buzzwords. Indeed, looking at top threads I still notice lots of slop-like posts from brand new or previously inactive accounts, like this one. I've been sarcastic, but I really like Hacker News, and hope it finds a way to stop the slop.
HN is the best parody of HN. There are plenty of (almost certainly human) users who could be trivially reconstructed by telling an LLM to write in the style of the biggest grognard pedant with arboreal-reinforcement of the anus it can envision.
Their attempt to ban "AI-edited" submissions is laughable, an attempt to close the barn-door after the horse was taken out back, shot, and then rendered into glue. There is no way to tell, distinguishing entirely AI written text is hard enough, let alone attempting to differentiate between an essay that was entirely human written, and one that took a human draft and then passed it through an LLM.
I intend to munch popcorn and observe the fallout. In all likelihood, a few egregious examples will be banned, alongside a witch-hunt that does more harm than good.
On the Motte, at least for now, I haven't seen any obvious bot posts. There were a couple AI-assisted posts (by "known" humans) over the past couple months that got called out.
The majority of bot posts (that anyone can tell are bot posts) are spam that is caught by the moderators and never see the light of day. I can't recall a single example of us allowing someone in who we thought was human, and then finding a smoking gun that would make us conclude that it was a bot all-along.
I am on record stating that I do not see an issue with LLM usage, as long as a human is willing to vouch for the results and has done their due diligence in terms of checking for errors or hallucinations. I do not make an effort to hide the fact that I regularly make use of LLMs myself when writing, though I restrict myself to using them to polish initial drafts, help with ideation, or for research purposes. This stance is, unfortunately, quite controversial. Nonetheless, my conscience remains clean, and I would have no objections to anyone else who acted the same way.
None of the tools that purport to identify AI-written text are very good. Pangram is the best of the pack (not that that means very much). I've tested, and while the false positive rate on 100% human writing (my own samples) is minimal, the false negative rate is significant. It will take essays that have non-negligible AI content and declare them 100% human, or substantially underestimate the AI contribution.
And that is with no particular effort to disguise or launder AI output as my own. If I actually cared, it would be easy as pie to take a 100% AI written work, then make small changes that would swing it to 100% human by Pangram's estimation (or prompt an LLM to do even that for me). The tools help with maximally lazy bad actors, but that is their limit. Eventually, they won't even catch said lazy bad actors.
Asking the LLMs? No good. Even worse.
I took an essay I wrote myself (the only AI involvement was proof-reading and feedback, most of which I ignored). Then I asked Claude Sonnet to summarize the content in 100 words, then to itself write a prompt that would be used by another LLM to attempt to reconstruct the original.
Summary (
90 words):A British-Indian psychiatry trainee, stranded in India due to flight disruptions, informally shadows their old hospital's outpatient psychiatry department out of boredom. They encounter chaotic conditions: nonexistent documentation, language barriers, and patients too poor to access consistent care. Notable cases include a dangerously over-medicated woman, a Bangladeshi medical tourist on a mystery drug nobody could identify, and a six-year-old with possible ADHD, seizures, or a genetic syndrome - nobody could tell. The author leaves impressed by the pace, nostalgic for the chaos, and still unable to diagnose the child.
Prompt:
Write a personal essay in a dry, sardonic first-person voice with a light literary register. A British-Indian psychiatry trainee, stranded in India due to flight disruptions, informally shadows their old hospital's outpatient psychiatry department out of boredom. They encounter chaotic conditions - nonexistent documentation and patients too poor to access consistent care. Notable cases include a dangerously over-medicated woman, a Bangladeshi medical tourist on an unidentified mystery drug, and a six-year-old with possible ADHD, seizures, or a genetic syndrome - no conclusion is reached. The author leaves nostalgic for the chaos and unable to diagnose the child.
I then asked fresh instances of Claude itself, as well as Gemini Pro, to write a new essay using the above as verbatim instruction.
I then took all 3 essays, put them in a single prompt, and then asked Claude, Gemini and ChatGPT Thinking to identify which ones were human, AI, or in-between.
You may see the results for yourself. Gemini's version of the essay was bad, and thus flagged by pretty much every model as either AI, or the "original" that was then expanded. The other two, including my own work, were usually deemed 100% human. Well, one is ~100% human, the other very much isn't.
Gemini in Fast mode:
https://g.co/gemini/share/0d4e6279bf8f
Gemini Pro:
https://g.co/gemini/share/119274d62e32
ChatGPT Thinking in Extended Reasoning mode:
https://chatgpt.com/s/t_69b3fad20c9c8191a27e3542685f20ba
Claude Sonnet with reasoning enabled:
I can't link directly, because the share option seems to dox me with no way of hiding my actual name.
Here's a dump instead-
Claude was the only one to correctly flag essay 3 as human, and that is likely only due to chance.
ChatGPT was the only model with memory enabled, and it failed miserably.
What else is there to say? Good luck and have fun while there's some hope of telling the bots apart from humans, if not humans using the bots.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
patients can read it that way, and it does generate consternation and distrust at times. Not necessarily a reason to not do it.
I think, on a empirical basis, that this effect is insignificant. Med influencers make significant amounts of money and acquire fame by attracting patients using case reviews, and I don't think Scott has ever suffered for it.
With respect to the bus problem - don't report so that the guy feels comfortable opening up and can get treatment and harm mitigation is often selected as the answer.
Would be ranked very low here in the UK. The best answer would be to try and warn him to cut down on drinking (if he just happens to be an alcoholic but doesn't disclose driving while drunk) first, and then if he persists or outright admits to drunk driving, the doctor is to inform him that he's duty bound to report to the DVLA.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
I'll take a look, thanks for the rec!
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
India is a big country, with many Indians (citation available on request). I genuinely don't think that you can uniquely identify anyone I've ever written about, barring myself. A schizophrenic man from Bangladesh? A young kid with behavioral issues? Victims of polypharmacy? Good luck narrowing that down to less than a thousand people.
A classic question like "do I report the alcoholic school bus driver" is fraught as hell and younger generations have basically been taught not to engage with the question and to report to risk management.
Interestingly enough, this scenario is pretty explicitly addressed when it comes to the ethics curriculum and guidance for British doctors. I would be expected to warn the patient to desist from dangerous drinking, and if they disclosed drunkenness on duty or continued to drive, I would be legally obligated to report them to the DVLA so that their license gets yanked. This applies doubly so for bus and truck drivers (I refuse to call them lorries).
There is a lot of bloviating about ethics here. UK medicine is obsessed with the topic. It was half the grade on the exam that gatekeeps most postgraduate training.
There exists a massive top-down push to reinforce the image of doctors as a noble, duty-bound cadre of esteemed professionals. That self-conception is gradually fraying in the younger generation, because we sure as hell aren't paid or treated like we're special.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
I had a similar question on my SSC post, so I'll reproduce my response:
Interesting, is that a point for the Sapir–Whorf hypothesis?
Not necessarily! Psychosomatic complaints are all too common even in developed, English speaking countries. It's not like many patients in India won't express their feelings in terms that directly match with standard (English) psychiatric nomenclature. Plenty of people will use the closest equivalent for "low mood, apathy, agitation etc etc" even if the language lacks a specific term for depression. After all, I'm sure people got depressed well before it was recognized as a clinical syndrome, or had ADHD and autism before the modern taxa evolved.
Of course, cultural idiosyncracies do matter, and some diseases genuinely are culture bound or spread by social contagion (see Scott's posts about the latter, especially anorexia).
It's also not necessarily the case that our diagnosis of a psychosomatic cause is perfectly accurate. Optimistically, one can say that my peers were exercising clinical judgment. Pessimistically, they were quick to pattern match and put people in buckets. There's no law of medicine that says you can't have depression and actual gastric reflux or peripheral neuropathy. The lonely old lady with backpain might well have arthritis, and we do try and check. We just have very little time to do that checking.
I'd say that in the absence of a widespread understanding of "depression" as a clinical condition, most of these patients are coming to see a doctor because of their perceived bodily ailments. They do not envision themselves as depressed, but will still acknowledge sadness, anhedonia etc. But what they claim to seek is relief from physical suffering, and said suffering often but not always comes from psychiatric intervention. I am genuinely unsure if they understand the link, but people do seem to know that the psychiatry department deals with the mind and that they didn't just pick the wrong door.
At some point, someone made the judgment call that the underlying issue was psychiatric, so they ended up in the outpatient clinic. On the other hand, when I was an intern in the medicine department, we had plenty of patients my seniors deemed to be psychosomatic who were treated the same way, but ended up there by some sorting mechanism I'm not familiar with.
I’m wondering if this could be an explanation of the part of the rise in depression/anxiety/mental health conditions in modern societies, or even the mental health gap between liberal and conservatives. Previous generations/less developed countries don’t have better mental health (in fact, from stories I heard from older family members, it might have been far worse in the past), but they’re just unaware of their own mental scape, and lack even the words to describe the concepts we take for granted.
I read a very convincing article arguing that the gap is an artifact (I think it claimed that when specific terminology was adjusted, the purported mental health gap vanished), but I'm afraid I don't have a link handy. If I remember who said it, I'll share. It might even have been Scott.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
Absolutely and unironically based behavior. Good luck! Probably don't tell her about the spreadsheet or the applied mathematics, at least before she's hopelessly smitten.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
For what it's worth, I'm not being sarcastic when I say I have a low opinion of the Hippocratic oath.
Seriously "do no harm"? Am I allowed to use a needle to prick skin. Oh, that shouldn't be taken at face value, and there's some kind of implicit utilitarian calculus involved? Why doesn't it just say so?
Similarly I will not give to a woman a pessary to cause abortion.
There's a reason very few institutions use the original oath, leaving aside the random injunction against operating on kidney stones.
Do you have second thoughts?
Not particularly! I've certainly never had anyone identify a particular person on the basis of a post. The closest was when I was almost geographically doxxed, but the person doing it was acting mostly out of curiosity. There's no way for a casual actor to identify anyone I've described, and it's far too late to deploy the kind of OPSEC that truly motivated actors would have issues cracking. In other words, pray for me and not for anyone else I've written an ink-portrait of.
Could be generational. You seem often to seek out the snark; I'm far more traditionalist.
Well, you're an unusually sincere person. I like to think that I'm usually sincere and honest, but yes, I do enjoy a helping of sarcasm. At the very least, British humor appeals to me on a spiritual level.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
My apologies, while I didn't interpret it as as a challenge, I was slightly snarky in my reply because of an unrelated internet argument.
When it comes to formal case reports or research publications, there are relatively bright lines doctors are expected to follow. This varies heavily from place to place, but for example, I can use a CT scan of a patient in a publication without their express consent, as long as I make sure things like name or ID is reasonably redacted.
When it comes to random writing on the internet, there is some grey, but mostly "nobody really cares." If I had mentioned actual names (and someone then raised a complaint) and provided very specific information, the GMC could theoretically come knocking (assuming they could then identify me, I doubt Reddit would care, they're not the same as the UK government, even if they're their attack dogs).
I mean, if I was writing about the UK. They don't care what I do in India as long as I don't break local laws or get into trouble with the police/local regulators. If I was in the UK, there is a small but non-zero risk associated, but once again, depends on what exactly I say. The British equivalent of this story, as written, would be fine.
not the Hippocratic oath.
Never swore it. I'm not kidding. Some places don't hold particularly high opinions of some long dead Greek bloke who said that doctors shouldn't operate on kidney stones. Not even the modernized version. It's not legally binding anyway, there are actual laws and professional codes of conduct that supersede it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
Since none of this contains patient-identifiable information, I'm in the clear. And for all anyone else knows, this might be an entirely fictional scenario with all characters simply fractured fragments of my psyche. I am also a dog on the internet, woof!
Beyond that, it depends on the jurisdiction, and even the UK isn't anal enough to come after me for something so trivial and vague.
Love your posts bro.
Thanks <3, whatever level of homo is socially acceptable these days haha.
Write a book.
I do, but it's about a cyborg psychiatrist who does way cooler things than I do. Also on hiatus, because his not-as-cool creator has a lot going on.
If you want a non-fiction book or memoir, I don't think I've quite got the material yet. It usually takes a lifetime to build that up. My job is usually (and thankfully) quite boring and mundane most of the time. I seem to come across something worth writing about once every few months or so, and the majority of the time it makes more sense as an essay.
And come to America, specifically Florida, I want to read your multi part write up dealing with our insurance, our minorities, and our whites.
I would if I could! I still harbor hope of moving to the States one day, at this point I would happily trade all the headaches American doctors face for the ones I have, let alone the massively higher pay. If not, I'm sure I'll visit at some point, and I would happily swing by if you'd have me. What's a gator but a very ornery dog? I can handle those just fine.
E: absolutely insane that you still have a Reddit account that’s 11 years old. I find that sort of thing fascinating as well.
Eh, it's there, I mostly use it to lurk these days and occasionally post. The closest I came to violating Reddit's TOS was Motte-posting, and that hasn't been an issue since I migrated here with everyone else. My engagement levels dropped drastically. Even if I had something to say, there are few places I'd want to say it, or where I'd expect a good reception. Culture War? That's here. Less controversial stuff? I happily crosspost.
In general, I think I'm a pretty good citizen by Reddit standards. I've only once been banned, on /r/SSC of all places for tangentially referring to the Motte as the place for CW issues, and that was quickly overturned on polite appeal. For what it's worth, it's less self-censorship than it is the fact that I do not enjoy engaging with the average Redditor.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
Thank you for taking the time to write that up! It aligns with what other neurologists have said on Reddit, and my attempts to dig deeper.
liked staying up late = maybe just maybe, he may have an inkling that the episodes are more common in night (=nocturnal seizures).
I didn't get that impression, but I'm not going to make strong claims either way, this clinical assessment was far from ideal. If I had the time, I would have drilled deeper, specifically looking for any temporal patterns, but at the least the mom didn't mention it. In her words, the boy just liked staying up late, and that's more likely to be because he's got a phone.
Call the Resident, if possible.
Sadly, that probably wouldn't help. It is very difficult to contact a patient like that (EMR? What EMR?) and nobody would bother short of an acute emergency. At least we arranged a followup in a month, and I expect that the other doctor will probably be there. I'll drop him a text anyway, just in case it makes a difference!
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
The child was quite extroverted and responsive when talking to me or my colleague. If he was the shy type, he's better at hiding it than I am haha.
I can't really comment on his articulacy. My Hindi is far from the best, and his mother was the primary informant. But he sounded... fine?
If this was a once off? Kids do dumb things for no good reason. So do us adults. But the repeated pattern and general picture points towards something in the DSM and not "just a rambunctious boy child". But what precisely? Impossible to answer authoritatively with the information I have at present. I hope I do get to see the followup and final diagnosis, but I wouldn't bet on it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
For what it's worth, you can use the contact us option in the sidebar to message (all) mods. But it's probably just faster to ping or DM us, I know that I rarely check the general mod mail.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
Yup. I've let it out of the cage, @ControlsFreak
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
Aggression related to panic attacks?
Very unlikely! Even plain old panic attacks would be unusual at that age, let alone such a specific kind of aggression. They're also not usually associated with amnesia or dissociation, more like hyper-focus.
After I posted on /r/Medicine, I had a few actual senior neurologists show up. They lean towards my hypothesis that it's some kind of seizure activity, but there's no consensus on whether it's a temporal lobe one, a different kind of focal seizure such as one affecting the frontal lobe, or if there's a slightly different variant called absence seizures that might be causing sleep issues and poor academic performance. The only real way to know would be an EEG, which would hopefully be identified the next time they attend (I regret not insisting on it, but I was a guest and deferring to those with more local expertise).
He'd be dead, wouldn't he? Survival time is usually less than a week after symptoms appear, though I'm surprised to learn you can have morbid rabies for months or years before symptoms show up.
My mention of rabies was mostly sarcasm. The kid would have a lot of other issues before they (might) end up biting people. It would have been glaringly obvious and even here, with less than perfect triage and routing, very unlikely to show up in the psych OPD. But yes, if it was rabies, he would be done for.
I was about to claim that it's impossible for rabies to be latent for years, but apparently there are a handful of claimed cases?
https://www.nejm.org/doi/full/10.1056/NEJM199101243240401
Rabies infection in these three patients did not originate in the United States but resulted from exposures in Laos, the Philippines, and Mexico. Since the three patients had lived in the United States for 4 years, 6 years, and 11 months, our findings suggest that the onset of the clinical manifestations of rabies occurred after long incubation periods.
I am not sure how much to trust them. Either way, it's rare. But funny excerpt:
The patient's father recalled that the child had been bitten by a neighbor's dog shortly before leaving the Philippines for the United States. The dog was said to have remained healthy and was eaten about a month later.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
and the CCP looks like it’s actually going to stand up to him about that
I would like to know more. I've heard about the firings, but not about any signs of the rest of the party developing a backbone.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
4d ago
Oops. Thanks!
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
5d ago
Hah. It's only fair that you make it your life's goal to educate me on Heidegger (without asking for consent, though I probably would have given it anyway), you notice something attributed to Heidegger come up in conversation, and then, with dawning dismay, realize that it was a misattribution. I can imagine the disappointment! I relish in schadenfreude!
You are correct. I'm not making an argument against solipsism, I'm explaining the difficulties now associated with identifying if a string of text online was written by a member of Homo sapiens sapiens.
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