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
Last week, I bought fried chicken from an M&S nestled inside my hospital, before heating it in a microwave and then joining the other doctors for lunch. Thought it was pretty solid, and this week, I nipped in to see if I could get another helping.
I found the same dish, read the label more closely and was... less than happy to discover that it said "cook before consumption" on the front, alongside "guidance for handling raw meat". The rear only confirmed my mounting horror. I dare say I felt outright queasy. Oh well, ignorance was bliss, and it's been long enough that if I was going to get salmonella, I'd know by now. I'd rather be a victim of deceptive advertising than food poisoning.
("Southern Fried Chicken", and you expect me to think it hasn't been fried already? Fuck.)
For the sake of my mental health, I'll assume that you've just had really bad luck. If I moved to the States and never managed to find decent biryani? I'd self-deport.
I think you have a point. English snobbery is something I've only looked at second-hand, and I hope it stays that way.
I'll give myself a pass mark, not because I physically went to the gym (I didn't), but because I've been doing non-zero amounts of exercise at home and bought a set of dumbbells (which I did use! I'm not using the mere act of purchase as an excuse).
The next few weeks are going to be hectic. I've got an important exam coming up, and while that's not entire incompatible with working out regularly, it makes it hard.
You sir, are a gentleman, a scholar, and possibly a gourmet too.
Yeah. British mushy peas can stay in the dishes where they belong.
While I appreciate the effort, they don't call it the Land of the Free for nothing. I'm sure the lowest ranked state would spank the entirety of the UK.
And I suspect that the climate map is slightly misleading in terms of presentation, if you don't carefully compare across seasons, you'll miss the dramatic temperature shifts seen in some parts.
And now you're cooking with gas brother. In fact, you've made me incredibly hungry just looking at that, but I will resist the urge by thinking of England (and whatever passes for biryani in the wider UK).
Plan? More like aspire. If the problem with my med school (they've been lazy about specific American accreditation, and the accreditors just as lazy) gets resolved within the next 3-4 years, it's quite likely I'll give the USMLE. If the problem solves itself later (and I'm a senior psychiatrist) then it's theoretically possible for me to seek to transfer my credentials without the USMLE and another bloody residency program.
At the end of the day, I don't have much control over the timeline. I'm also already in training, I have a good enough shot of progressing further in my career elsewhere, and the thought of sitting down and grinding for yet more competitive exams when I might have a wife and kids does not feel great. Even worse, AI is nipping at my heels, so it might become an entirely moot proposition by then.
But if I have the luxury of choice? Then California, baby. Or Texas. Or most of the US, really, probably excluding Alaska. Scotland is cold enough for me.
Sorry dude, I'm the one who is very sleep deprived. Not your fault, and looking at it with a coffee in me, I understand the riff.
It looks absolutely delicious, but I must complain about portion sizes. That's the quantity I'd feed a teenage girl, a real man needs twice as much, especially after all that work haha.
- The site blocks the UK for
- Using a VPN, I seem to see that the link is down.
Oh well, I can only imagine the masterful quality of your biryani, while settling for bastardized versions to be found in Anglo lands.
You must have had bad biryani. This is understandable, since the best stuff is only truly available in India.
Even in the UK, I've struggled to find anything as good as what I was used to at home. The best I've found is acceptable, it's biryani-shaped and roughly tastes like biryani. And then the "Indian" restaurant I ordered from yesterday served it with peas.
Fucking peas. I haven't been as flabbergasted since I tried lasagna with peas in it. Why not just piss in my mouth instead? I'd probably enjoy that more, in all honesty.
Of course, there's regional variation. Pakistani biryani is different, so is the Afghan kind. There's like half a dozen other variants from India. The one I'm most fond of can't be found anywhere nearby, for love or money.
I believe @DirtyWaterHotDog mentioned finding actually appetizing biryani in the States, he might be able to guide you better.
To be fair, it could both do nothing for you and also be very effective for the average person.
And that is precisely what I said, so I'm not sure what your point is. I'd rather have had bog-standard uncool depression instead.
Good post, even if I studiously ignore most of the lifestyle advice for myself. For what it's worth, the antidepressant effects of exercise are significant (g of - 0.63 when walking briskly, which compares favorably to both CBT and most antidepressant drugs). Even better, you can capture the majority of the benefit with about 2.5 hours of brisk walking a week. I knew that living so far from the bus stop was doing something for me, that isn't just wearing out my shoes.*
*I don't think it did anything for me, but defer to RCTs over the anecdotes of a very lazy man
I'd be hesitant to blame Woke for this, really, though I've already plead general ignorance on trends on the ground (I'm not physically there, and I don't interact with the Indian diaspora on an intentional basis). Sure, identity politics was enthusiastically adopted by a specific clade of diasporans, but there are fewer true believers than you might think. People will do anything to improve their odds on college admissions screens, and this is hardly unique to Indians. In fact, they're in a particularly awkward spot.
I think @Testing is more likely to be right here, though that's a low confidence claim. Then there's reaction-formation: if anti-Indian sentiment is on the rise in the States, the natural thing is to band together. My impression is that the worst of it is mostly restricted to X and other social media cesspools, the average Indian on the ground in the US hasn't really noticed active discrimination. In the UK? We're still very much model minorities, the usual vitriol is reserved mostly for other (sometimes visually indistinguishable) South Asians.
Thank you. Whenever I feel the need to go tut at Count (more often than I wish or like), the usual culprit is that he's sneering at the locals and asking for them to be replaced. I can't even imagine doing something along those lines, my right to reside in a Western country is clearly a privilege, and I refuse to bite the hand that feeds. I don't think the West is perfect, but it has my loyalties not just because it offers me a higher standard of living (in some ways).
In the ending of The Camp of the Saints, I'd like to imagine you'd be like the character Hamadura, a westernized Indian taking a last stand against the destruction of western civilization together with the Frenchies (or in your case, the Brits).
Unfortunately, the phone call was always coming from inside the house.
Moving to Germany or the UK would be easier for the typical professional Indian looking to emigrate, but my strong impression is that the US remains the first choice. Not just because of the pay, though you're correct that it's a major component. It's just far from trivial to achieve, even for those not bottlenecked or gate-kept by professional licensing like I am.
While that's true, it isn't what I'm gesturing at. Sure, I'd be impressed if the average American could tell apart the difference between a North Indian and a southerner, but even within my nominal ethnicity and geographical origin, I've always stood out. Intentionally or otherwise, I just never felt like a good fit.
(Depending on which specific metric you use, Indians can be 3-4 times as genetically "diverse" as all of Europe combined. Still, the cultural components, from a distance, are probably comparable. There are Indians who are as different from other Indians as a Finn is from a Spaniard, with the primary commonality being shared religion. This forum, of all places, doesn't need reminder that that's not as strong a binding agent as some might think.)
Am I overindexing on specific character traits? I'd hope not, but the way I see it, the kind of people I want to hang around with live in Silicon Valley. Scotland isn't a terrible place (if you ignore the weather), but it never would have been my first choice. Not even the UK as a whole. It is what it is. My life isn't terrible, and there's a plausible case that my future would be better here than back home, even if I can't quite say that with conviction.
Would you be willing to expand on this a little at some point? I've been grappling with some issues around this personally and some perspective from your side of things might help a lot.
I'm not sure what I can add, really. Perhaps it's clearer if I specify that I'm not like most Indians in India, or even most UMC, well-educated Indians. I don't share their politics, their ideologies, or even much of the culture. Back home, the number of people I considered to be on a similar intellectual wavelength could be counted on my fingers. I wouldn't even need both hands.
Abroad? I don't know dawg. I know a surprisingly small number of Indians in the UK, courtesy of living up north, where brown skin can be a mild curiosity. I don't even seek them out when I see them. In the US? How would I meet them by a route that isn't an online exchange?
I look Indian. I don't sound Indian. I don't act particularly Indian, beyond a fondness for biryani. I have little interest in, or engagement with, any popular form of Indian culture or media from home. I'm a Bay Area rat in spirit. I know more about American cultural trends and politics than I know about India, let alone the UK. I'm happy keeping it that way, unless I have a pragmatic reason to do otherwise.
Several of my closest friends in those times were first or second generation immigrants. In most cases, they weren't just American, but they felt more American than me. They flew the flag at home, played sports in school, participated in neighborhood cookouts (with mildly weird limits depending on where they came from originally), and did all the things you'd expect from somebody who really liked being in America. One of the best trap shooters I'd ever met hadn't ever fired a gun until he got his citizenship, but he started coming to meets as soon as he could because, in his words, "I'm an American now". Hell, in some ways it was aspirational for somebody like me. I figured that if families from a country as poor as India could manage to live the American dream, maybe a dumb redneck like me could too.
https://www.themotte.org/post/565/culture-war-roundup-for-the-week/116844?context=8#context
That's my post popular post on the Motte. Ever. So I can only presume that, if I were lucky enough to be in America, you'd describe me in much the same way as those other Indians you first knew. I envy them. They're living the life I wish I had. I consider myself to be a temporarily estranged American, by misfortune of birth and circumstances outside my control. But if wishing were horses, I'd have given PETA a heart attack and paved the Bering Strait with equine corpses to get there. Right now, I impatiently wait for future opportunities, while feeling barely suppressed rage at how my options were curtailed.
Do you have any idea what's going on? It's caused a measure of cultural whiplash for me. I can't tell if it's a change in culture in India, or different social classes and subcultures immigrating, or changing views towards America, or what, but fuck me if it's not a noticeable difference.
No clue. I don't even have solid speculation to share. I haven't been in the States after 9/11, and it might just be random chance that you just ran into people who happened to be less ideologically motivated and more in it for the money. To be fair, I'm also in it for the money too, American doctors make salaries that make me salivate, even after moving to the UK.
It's a shame I didn't see Amadan's comment while it was fresh. I'm almost tempted to AAQC it again, I think it's that good.
The one thing that we ask of Mottizens is the ability to engage in civil discourse, including on controversial topics. Especially on controversial topics. We make allowances for the fact that this is a rather big ask, especially by wider internet standards, but it's also the whole fucking point of this place. You can say just about anything, as long as you say it politely, and back up inflammatory claims proactively. What counts as inflammatory? Now isn't that a debate for the ages? I'd like to use the "reasonable member of the public" doctrine, but that's got more loopholes than the factory where they make basketball hoops.
This is fine. It really is. To channel Sam Altman (hiss hiss), the Motte is nothing without its users. The users wouldn't be here if us mods didn't do the unpleasant job of occasionally cracking a few skulls. I don't like doing that. I doubt any of us do, and that's in part because we were negatively selected for that tendency. We do it because even the clearest, easiest-going set of rules on the planet won't stand up and defend themselves. Entropy is a bitch.
Does anyone think I like the anti-Indian stereotypes floating around on the web, or that surfaces even here on occasion? Hah. You wish. I console myself with the (true) fact that I am very, very far from the modal Indian, and that the complaints usually lobbed against them aren't applicable to me (assuming we're talking about something with more merit than generic accusations of shitting on streets. And when the criticism does encompass me? Including for characteristics I really can't change? Well, the Indian Subcontinent probably selected for thick skin, for protection against malaria if nothing else.
Very few things written here are truly worth getting heated about, I say, even acknowledging that I've lost my cool in the past (albeit for other reasons, anti-Indian sentiment is rather low on the list of things that reliably rile me up). And well, on the flip side, getting a warning or ban on a niche internet forum is not the end of the world. Go read a book. Touch grass. Feed your kids, or go make kids.
Digression aside: something that more people should know is that if you are genuinely uncertain if a planned post of yours clears the bar, you can just... DM us. The mod mail exists. You can ping the mods and ask, "hey, is this okay to share?" Almost nobody does this. More people should. We should probably put this next to the rules.
All I can really say is that it's easier to treat depression and make lifestyle changes than the other way around, particularly for moderate to severe depression. At least that's my personal experience, there's enormous heterogeneity here.
I suspect that my depression was, in hindsight, mostly due to a case of Shit Life Syndrome. Recently-ish, life improved and so did my mood.
However: I've written about my experience with a clinical trial for psilocybin. It worked wonders, even if the chemical didn't change the material aspects of my life or work. That was all the existence proof that I needed that I could be in a bad place, unhappy with how things were going, without necessarily feeling depressed about it. I've been on plenty of standard antidepressants, and they did fuck-all for me. That is not a general indictment of the class, the drugs aren't perfect, but they do work. For some people. Some of the time. NNT between 5-7. I feel this discrepancy in my bones, more than most psychiatrists do.
Then I dabbled with other substances, after my life got better. I would like to claim they helped, but the problem is that I was already feeling pretty good when I took them, and my main goal was to make the euthymia stick. It's been a month, and I'm doing well. I remember being terrified that I'd immediately relapse when I'm back to work, and that hasn't happened yet. Thank $Deity for that. If it does happen, I'm going to go see a psychiatrist and ask for IV ketamine, it's effective, particularly for treatment resistant cases like mine, and doesn't have the memory-loss issues of ECT.
And hey, if you need more tailored advice, DM me.
Playing Tarkov for the first time without watching half a dozen new player guides and keeping a map open on your phone is masochism. The game is ridiculously obtuse about its mechanics. That's not a good thing, but once upon a time, the payoff to all that hard work felt very good. I went from a survival rate of 30% to 60% over 5 wipes, and a KD of 2 to 7, I think. Albeit that includes PVE kills too. I was only above average as a PVP player, perhaps just average when adjusting for playtime.
Searching my username alongside "Tarkov" will turn up a fairly unflattering paper trail re: my relationship with the genre. Reading it in chronological order resembles the journal of somebody trying to quit caffeine while living above a coffee shop. I'm not quite sure how I managed it, in the end.
One extreme form is the extraction shooter, where 95% of the gameplay is routine.
This gets at something hard to convey to people who haven't logged the hours. Hardcore extraction shooters share a structural feature with actual combat, or at least with everything I've read about actual combat: long flat plateaus of tedium, occasionally interrupted by short bursts of unfiltered terror. Your life isn't, strictly speaking, at risk, although I suspect if somebody pulled the actuarial tables on long-term Tarkov players we'd find some interesting blood pressure data. But the stakes are higher than in any comparable genre. A single death can wipe out days of progress. Every kill you score has cost somebody, somewhere, an evening they aren't getting back.
The thing that makes this fun (where "fun" is being used in roughly the same sense that ultramarathons are fun, or possibly in the sense that some hobbies are genuinely satisfying to participants and indistinguishable from torture to onlookers, Type 3 fun to be specific) is that death turns out to be effective pedagogy. And not only for the people writing the obituary. You absorb caution and prudence almost involuntarily, and your gut, given enough thousands of hours, becomes something pretty close to a calibrated instrument. You look at a dozen doors, a hundred bushes, and a few broken windows, and you just know that something ain't quite right.
There's also a gameplay premium on what military types call violence-of-action. Once the rounds are close enough to part your hair, you discover that holding still is functionally identical to dying. The best fights play out like choreography: two people of roughly comparable skill trying to outshoot and outguess each other in the span of about eight seconds.
And the decision tree branches forever. Is your magazine still good for another burst, or did you spend most of it on the last guy? Do you loot the body now, or wait in case his teammates are about to round the corner? Do you chuck a grenade into the room where you're pretty sure somebody is camping? Do you, in the immortal words, feel lucky, punk?
Then there's the social layer, and like most things, the game is better with friends, or with acquaintances who rapidly end up becoming your friend. Do you trust the new player you've been mentoring to actually watch your six? Do you accept, in advance, that he probably won't, and forgive him in advance because you remember being him? Do you risk your own kit recovering your dead teammate's gear so the insurance payout works out in his favor? There is no single right answer to any of these. The game just keeps teaching you that some answers are better than others, and you'd better figure out which is which, fast.
And then sometimes you do everything correctly and you still get domed by some guy in a bush three hundred meters away. War is, as the saying goes, heck. I don't play Tarkov anymore, although the reason has more to do with BSG's ongoing mismanagement of the property than with the underlying design, which is still genuinely unlike anything else on the market (except maybe Gray Zone Warfare, which I'm trying to get into). Whatever else you can say about it, nobody else is making this game. It's a shame BSG is unmaking their game. One step forward, two steps back, toes inside their own ass. I'm too old to deal with that nonsense.

So I'm studying for the MRCPsych again, and the standard resource everyone uses for this is called SPMM. SPMM costs money. If you pay extra money, you get mocks. If you feel desperate, you can pay even more money, for a "stats crash course,".
The MRCPsych Paper B is heavy on statistics. Most of my colleagues find this difficult because most of my colleagues went to medical school, where the stats curriculum is approximately "p < 0.05 means good." I find it less difficult, which is not the same thing as enjoyable.
The problem is that SPMM's stats teaching is bad. I read a passage, frown, screenshot it, send it to ChatGPT or Claude, and ChatGPT says "yeah, this is wrong." This has happened enough times that it has stopped being surprising and started being a sort of recurring bit. The remaining percentage of the time, the notes are oversimplified to a degree that would make an actual statistician put their head in their hands, which I'll grudgingly accept as the cost of doing exam prep.
Now, I present the question that broke me today.
There's a study, presumably real, looking at childhood trauma and hallucinations in adulthood. There's a graph. The y-axis is the probability that someone has childhood trauma somewhere in their history. The x-axis is "number of hallucinatory modalities," running from 0 through 5, because apparently the authors decided five was enough senses and shipped it. Sure, I guess we can skip proprioception, vestibular positioning, and the other minor crap.
The question: "The predictor that emerged as the statistically significant variable is most likely to be..."
I pick ratio variable.
Let's examine my reasoning. The variable is a count. Counts have a true zero, where zero modalities is a meaningful and non-arbitrary absence rather than an arbitrary point on some scale. The intervals between values are equal: going from 1 to 2 modalities is the same conceptual distance as going from 3 to 4. And the ratios mean things, in that a patient hallucinating across four modalities is doing so across literally twice as many modalities as someone hallucinating across two. This is the textbook definition of a ratio variable. Stevens 1946. Every introductory stats book ever written.
SPMM informs me that the correct answer is "ordinal." I wanted to die.
I tried to be charitable. Maybe SPMM is operating from some idiosyncratic but defensible framework I'm not seeing. Maybe there's a niche position that count variables with low cardinality should be treated as ordinal because of how they behave in small-sample inference. Maybe somebody, somewhere, has a real argument.
I went to ChatGPT and laid out my case. ChatGPT said my logic was textbook, my answer was correct, and SPMM was wrong, but I should still pick whatever SPMM said in the actual exam because the exam doesn't care about being right, it cares about agreeing with whoever wrote the answer key. This is very sound career advice and also makes me want to lie down on the floor.
I pushed back. I said no, I have standards, I want to know whether there is some technical sense in which SPMM could be right and I am wrong. ChatGPT politely declined to manufacture one. After some pushing, it concedes, and says that I should go with my original answer if this specific question comes up in the actual exam. I screamed internally, because screaming externally would wake my neighbours.
The really insulting part is the upsell.
SPMM, having taught me statistics with the precision and care of a man hammering a nail with a banana, also offers a paid crash course in statistics. I will let you guess how I feel about paying them additional money to clear up confusions they themselves introduced.
There are two hypotheses.
Hypothesis A: SPMM is teaching stats badly on purpose, so that you have to buy the crash course to fix what they broke. This is the version I want to be true, because at least it would mean someone, somewhere, is in charge.
Hypothesis B: at some point, an underpaid registrar was handed a brief that said "write 500 stats questions, here's £500, you have a weekend". They paid peanuts, and the monkey just offered me a banana.
Hypothesis B is overwhelmingly more likely. It is also worse, because at least under Hypothesis A there's a coherent villain. Under Hypothesis B there's just a pipeline of tired people producing slightly wrong content for other tired people, who then sit in their flats at midnight wondering whether they're losing their minds or whether the material is in fact wrong, and there is no one to be angry at, because everyone in the chain was doing their best with too little time and not enough money, and the result is diffuse ambient wrongness that lives in PDFs forever, gaslighting trainees into doubting whether ratios still mean what they used to mean.
Anyway. Number of hallucinatory modalities is a ratio variable. It will continue to be a ratio variable on the day of the exam, and if it doesn't, the number of homicide victims in a future study will remain a ratio variable.
Edit:
The study is "Association between childhood trauma and multimodal early-onset hallucinations" in the BJPsych. The authors ran a hierarchical binomial logistic regression with childhood trauma as the binary outcome and number of hallucinatory modalities as a numeric predictor, reporting OR = 2.24 (95% CI 1.16 to 4.33) per additional modality. You can't meaningfully report a per-unit OR for an ordinal predictor. Reporting that OR is exactly what you do for a count variable on a ratio scale. The original authors treated it as ratio. SPMM has marked me wrong for agreeing with the people who wrote the study.
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