self_made_human
Kai su, teknon?
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
User ID: 454
This one caught a couple reports for "Boo outgroup", but while I think there's slight consensus building and some of the former, I don't see anything worth warning you for.
I only write this mod hat on to point out that while your comment is hardly ideal, a polite reminder and not a formal warning will hopefully suffice.
Edit: I'm afraid I didn't see that this was a top level post in the main thread. We expect more effort and less heat in that context, so consider this a warning to avoid this in the future.
self_made_human
Kai su, teknon?
20d ago
Indeed. When I need to send someone to a therapist, I tell them it's a sign of both confidence and competence when they make it clear that's there's a time limit for that. Either they note you making good progress, with an end goal in sight, or they tell you straight up that you're not a good fit and send you on.
Not that people can't need prolonged therapy, but maybe I'm just jaundiced from all the girls I've spoken to who should be wearing grippy socks. But they need Jesus, or his brother in the asylum.
Rolls up sleeves
Aight, I'm here to pitch. I might not be a psychiatrist, yet, but it's that or die trying so I'll try and defend the much maligned field.
On an object level. You're mostly right. Psychiatry is largely pre-paradigmatic. We only have very vague ideas about the underlying underpinnings of many of the most common diseases.
We can find pretty reliable correlates in some cases, such as subtle differences in neuronal wiring or the activity of larger regions that associate with mental illnesses like depression, autism, OCD and so on. Unfortunately, much like the discovery of Tau proteins in Alzheimers, just because we have a marker for the illness does not mean that reversing the marker will reliably reverse the disease. All the drugs that claimed to reduce neurofibrillary plaques did jack-shit for actually curing Alzheimers.
However, being a part of modern scientific medicine, it cannot but assert that mental disorders can be explained by studying the body, the contradiction being that the day psychiatry discovers the bodily cause of mental disorders will be the day that it ceases to exist as a specialization of medicine, for said cause would fall under the jurisdiction of another specialization: If it’s in the brain then it would be neurology, if it’s in the genes it would be medical genetics, and if we were to discover a new organ in the body then a new specialization will be born to study it, leaving psychiatry in the past.
Oh boy.
For example, autism
Now, we’re going to get a little technical. Grey matter ripples into peaks and troughs called gyri and sulci, respectively. According to researchers from San Diego State University, these deep folds and wrinkles may develop differently in ASD. Specifically, in autistic brains there is significantly more folding in the left parietal and temporal lobes as well as in the right frontal and temporal regions.
“These alterations are often correlated with modifications in neuronal network connectivity,” Culotta says. “In fact, it has been proposed that strongly connected cortical regions are pulled together during development, with gyri forming in between. In the autistic brain, the brain reduced connectivity, known as hypoconnectivity, allows weakly connected regions to drift apart, with sulci forming between them.” Research has shown the deeper theses sulcal pits are, the more language production is affected.
Yay! We have a neurological, albeit still rough, understanding of what's going on here.
And yet, pray tell what a neurologist is going to do about it? Take an autistic child to a neurologist or neurosurgeon and ask for them to be cured. I'm sure they're too kind (for all their ego), to laugh you out of the room, but all they can offer is pity and a referral to a shrink or SALT.
Similarly, depression is primarily a disease of the brain (leaving aside conjectures about the gut brain axis, general inflammation and so on). Can a neurologist do anything about it?
Well, nothing a psychiatrist doesn't already do. In other words, therapy, meds and more aggressive interventions like electroconvulsive therapy (and ketamine, LSD and so on).
What have you achieved, barring a rebranding?
Even as we begin to understand some of the underlying processes of pathophysiology in depression, such as why rebooting the brain with induced seizures works when meds fail, it does not change the fact that ECT works beyond reasonable doubt.
In a world where we suddenly discovered, with perfect accuracy, the exact neurological underpinnings of mental illnesses (and didn't just cure them in the womb or immediately developed miraculous treatments), you know what would happen?
Specialization of labor. In other words "neurologists" doing the same shit as psychiatrists do today.
You're falling prey to semantics and fuzziness of definitions.
Geriatrics is a perfectly respectable specialization in medicine despite, last time I checked, there being no "old age organ" (well, maybe the thymus). Huh. Why hasn't their lunch been taken by all the cardiologists, oncologists, neurologists and other people with well-defined magisteria?
Specialization.
It is convenient.
It works.
On the other hand there are the encyclopedists, who will argue that the fact that we haven’t discovered the bodily sources of mental disorders does not mean that we won’t succeed in the future. We have certainly made discoveries in this direction: Not only do we know now that it is impossible to be sad or mad without a brain, but we also know what specific brain part or substance is required. But even after all the advances in neurology, still no neurologic exam is indicated for the diagnoses of mental disorders, and for good reason. Because ultimately, what decides if someone has a mental disorder or not are arbitrary criteria. The fact that homosexuality is no longer a mental illness is only because of the fact that society has shifted its values towards the acceptance of diverse sexual orientations, were it not for that fact we would speak about the “homosexual brain” just as we know speak about “the depressed brain”. We could also speak about “the carpenter brain” or “the the writer’s brain”, and treat all of those conditions as illnesses.
You poor man. You've been beaten to the punch by Dr. Scott Alexander Sisskind on several occasions, though I'm too lazy to link more than one, but which handily contains links to yet more ink spilled on the topic. Worry not, it happens to the best of us.
So are mental disorders real? Of course they are. Whether they are mental or disorders, that’s another question. They are real because they are a set of behaviors that have been observed to occur together: Feelings of sadness, self-harming ideas or behaviors, inability to feel pleasure, these are all things that are real, observable, measurable, and treatable. But are these symptoms a mental problem? Are they a medical problem, or a problem at all? This is highly debatable, and in any case, not a solid foundation for a science.
My answer is a resounding mu that brings all the local cattle to the yard.
None of this matters. Not that I really see any reason to call it "highly debatable".
You mistake medicine as practised as "science" whereas what doctors outside research settings do is closer to engineering.
I don't particular care that we don't know the exact cause of depression. I know of multiple batteries of tests that, with reasonable accuracy, tells me whether or not a given patient will benefit from counseling, medication, and other interventions, and which, when measured serially over time, tells me if it's working. And vice versa, if you take someone who doesn't have the markers of depression and feed them SSRIs, it doesn't make them happier. So what if it isn't actually a deficiency of serotonin that causes depression? The drugs, while less effective than desirable, are not useless.
I really don't see any reason to twist yourself into knots about whether depression is "mental", as opposed to what, neurological? Biochemical? All of the above in same capacity, depending on your appetite for abstraction?
"Medical"? Come on dude.
To draw an analogy, let's say you have a malfunctioning PC, or maybe a server rack in an AI datacenter. A vascular surgeon notices the water cooling is leaking and bills you $70000. A cardiologist checks the PSU. The neurologist makes sure the RAM is seated tightly or otherwise asks their neurosurgery buddies to bend some socket pins and reapply the thermal paste.
Whereas what psychiatrists are doing is both a combination of relatively simple things like giving drugs dusting the fans, as well as the equivalent of prompt-engineering an LLM. The brain, despite operating according to the same physical laws as an H100 loaded with GPT-4, is just as nigh impossible to understand from first principles, and some higher order discrepancies difficult to treat by looking at bare meat/metal. That does not mean we exist in utter epistemic helplessness. What we do works. It is not perfect. It is not complete. It is, however, not useless or a waste of time. What is is semantic arguments and forcing allied specialists to do jobs that they're no better equipped to do than we are, simply because that sounds neater and more scientific. Categories and doctors were both made for Man, and not the other way around.
Complex systems that aren't amenable to direct analysis at the elementary level are still amenable to modification and control. That is what psychiatrists do. If we were folded into neurology, then congratulations, all you would achieve is neurologists performing the same tasks a psychiatrist does, and likely end up creating a new subspeciality which is all but psychiatry in name (and we already have the opposite approach with some of the nerdier shrinks becoming neuropsychiatrists) .
This is the same line of thinking that would assume that, if one day we replaced the Standard Model with a Grand Unified Theory of Everything, then we no longer need those overly abstracted biologists, and those fussy chemists. Why, just model everything at the level of fundamental quantum mechanics? What do you mean the computer caught fire when I tried to diagnose ADHD using Feynman path integrals?
None of what you say is forbidden knowledge tacitly swept under the rug by psychiatrists, the witch doctors. The typical reaction, from anyone who has acquaintance with a textbook written after that fraud, Freud, would be the same long-suffering sigh as if you accosted an economist and told them that their models are flawed because they assume rational actors acting in enlightened self interest. They know that's not how it works. They're more than happy to fudge their idealized calculations or look for deeper trends. It's not an easy task, and in many ways, the interaction of many minds operating under relatively well-defined incentives is easier to model than a single one which is a fractal, sweltering, wet and buzzing ball of noise on the verge of criticality .
It's all rather moot at that point.
self_made_human
Kai su, teknon?
15d ago
I presume that casually dating doesn't count? I'm in between committed relationships right now, especially since I'm leaving the country in 3 months. But it's a refreshing experience after being in committed relationships for 7 years.
I don't think I'd be happy single, or at least celibate. Like any red blooded young man, I do enjoy getting laid, and while seeing several new people every week might be novel, my friends, and internet strangers, assure me that it gets stale eventually. So if I meet the right person, ideally in about 3 to 5 years, I'd strongly prefer to settle down and start a family. Friends and side activities, while something I enjoy, aren't enough.
Ah, women. Can't live with them. Can't live without them. If there was a pill that could harmlessly switch off just libido, I think I'd be happy enough, but it doesn't exist and is have qualms about taking it in the first place.
Please note the edit/update.
In general, the mods take more pains to police top-level comments more, and enforce the standards most strictly there. Something buried a mile deep gets more slack. Not infinitely more so, certainly, but this would have passed under my threshold if buried in a comment chain 5 replies deep.
I was under the impression that this wasn't a top level comment, and in context of wider discussion, and at that point, it would have deserved a tut-tut more than a formal warning.
Sadly, I've been disabused of that notion, and this doesn't fly as a top level comment. He doesn't have any previous mod record, hence a warning to knock it off suffices.
self_made_human
Kai su, teknon?
17d ago
I suppose that's one way to be told you should try for med school, or a career as a pharmacist. Can't say dealing drugs has worked out badly for me, all said and done.
self_made_human
Kai su, teknon?
14d ago
Ever tried the Total War franchise? I love Warhammer 3 the most, given that it's got faith, steel and gunpowder, all good for shooting up barbarians.
But there are more historical ones, in pretty much any setting you desire. The campaign gameplay might not be as complicated as Paradox games, but seeing thousands or even tens of thousands of soldiers clashing and bleeding has its own charm. I'd recommend Rome 2, Shogun or Three Kingdoms if the Warhammer series isn't your thing.
self_made_human
Kai su, teknon?
2mo ago
That is an utter abomination of a username. I'm impressed.
Man, as someone who fucking loves guns, it sucks that the one country in the world where a man is free to shoot tannerite in full auto (with tax stamps, and officer, I promise that this is an oil filter, please walk very softly around the dog) does such a poor job of protecting it despite a clear constitutional right.
The ATF is a meme, goons who have far more power to ignore common sense and wider jurisdiction than they deserve. Alcohol, Tobacco and Firearms, one of these isn't like the others. I don't know why Republicans didn't do their level best to de-fang it, especially when they had four years to do so, but I suppose that speaks to the general incompetence of the Trump Admin, or to the perfidy of the Deep State, depending on which of our regulars you ask today.
Was that simply not a priority? I would assume it would receive overwhelming support from the Republican voter base.
self_made_human
Kai su, teknon?
1mo ago
I don't know enough about the American legal system, until it's my headache, but how much does seniority matter in the SC?
Are the new "young" judges put on the back bench (metaphorically)? My understanding is that they're all nominally equal, so what does it take for one to establish themselves like Thomas did and get taken seriously. How much does their opinion matter, and how is that sausage made?
self_made_human
Kai su, teknon?
20d ago
We do at least still have beatings and alcohol, and blood letting too, if you're diagnosed with hemochromatosis.
Frankly speaking, while depression might be more prevalent today as a disease exacerbated by modernity, I can't imagine our ancestors weren't anxious or stressed the fuck out.
I mean, I don't want HBD to be true either dawg, but I have to face the facts.
The most credible studies for average IQ in India peg it in the upper 70s or low 80s. We have a very heterogeneous population with some groups having significantly higher IQs than others, and no end of drama surrounding it, because in the absence of knowledge about HBD, it's inevitably attributed to classism, casteism, historical privilege yada yada. Hence almost 80% AA quotas in many things.
I don't come from an upper caste background, far from it, we just skirt above the borderline for being so low caste that I'd get some gibs from it, as opposed to just being fucked in the ass for no good reason.
The primary reason Indians have such a reputation for wits abroad is because the majority who have the ability to cross several oceans and settle there have some unusual combination of intelligence, entrepreneurship and courage. They're almost certainly more likely to be upper caste, to the point that Silicon Valley is beginning to notice™. For the wrong reasons, of course. Do you know why a lot of upper caste Indians in the West have such virulent disdain for lower cast FOBs? It isn't all rank casteism, many of them even from the more reputable places like the IITs are AA hires, and they represent a form of persecution or discrimination against the upper castes. As I must reiterate, I'm not upper caste for crying out loud, and my family were war refugees fleeing a genocide, but in this manner, all Indians who aren't lucky enough to be scooped up by AA are equally screwed in academics and even government employment, so I empathize more with the upper caste guys despite not being one.
But so what if my particular caste or ethnicity isn't the smartest? My family has no shortage of talent, and that's genetic too. They made the mistake of being conscientious professionals and deferring childbirth, which how you end up with high mutation load and thus me. It's not like there aren't any smart people in the black community, even if the odds are stacked against them from before birth. A lot of the dysfunction is cultural as well, how much, I have no idea. My main beef is with people who say it's all cultural and/or intentional discrimination, the latter being farcical in the US, given how much money is poured into attempts to uplift them, to no avail, which is in turn taken as a sign that the Bottomless Hole needs to filled with more $$.
While I mostly agree with @FeepingCreature, except on the issue of values, where I genuinely consider smarter humans to have more moral worth (though you have to be VERY retarded for me to think you have none, or undeserving of a life with minimum dignity), my primary issue with HBD denial is aggressive redistribution and racism of the gaps, but I've long advocated for genetic engineering to help solve the disparity. It's doable, without compromising whatever physiognomic features are dear to you if you really care. Iterated embryo selection is enormously promising, it could be even better if national genetic databases in the US and UK weren't so leery of letting researchers do IQ research on them, because of the implications. Still, that's largely moot, since we likely won't have time to deal with it before AI replaces even the most cognitively talented natural human and thus makes dick or brain measuring a bit redundant.
I've come to accept that India will probably never catch up to China. They're just smarter. But that's not much skin off my back. And it'll all be ogre soon enough.
self_made_human
Kai su, teknon?
29d ago
I tried to come up with a cogent counterargument and find I'm coming up short.
Look, they weren't all that bad. The psychologist will presumably recover, once she stops screwing her ex. The fashion designer, well, she's doing better. There were definitely better dates, plenty, though I can't really commit with the whole leaving the country thing ahead. But I make sure they know that, I would despise myself for leading someone on.
There are certainly several more who I can pass off as sane, but there's not much to say about them, barring some flirting and early morning goodbyes. It's the crazies, the damaged ones I remember the most, mostly because they had me feverishly leafing through my textbooks to figure out if I was the one going insane.
Here's hoping that Scottish girls are notably less psychotic on average, but I'll be honest, it feels nice to help people who desperately need it, though as you can tell, even I have my boundaries and soon enough, a justified fear of losing my license, so said boundaries only get tighter. At the very least I know that I am very good at the whole counseling and talking people into doing what's good for them thing, even if I can't prescribe more than SSRIs and benzos (and wouldn't want to, I send them to more qualified psychiatrists most of the time). At worst, I know my voice can lull them to sleep, which is worth something I guess. I'm not kidding when I said one of them was actively suicidal and about to do something awful, but thankfully it seemed to be more of a single isolated episode on a background of severe depression, so yeah, probably saved her.
Whereas the thought of an arranged marriage just makes me depressed. I can't always fix them, but I'm happy to let them make me worse.
self_made_human
Kai su, teknon?
1mo ago
The main issue is that he was a single issue poster, and after being told to knock it off, he mostly does the very bare minimum to try and skirt it.
As we've said before, Holocaust denialism is not a verboten topic here. Far from it, I struggle to think of any viewpoint we censor, we've got open pedophiles here, and in most places on the internet they'd get banned the moment they even hinted at it.
But his behavior is clearly in bad faith, while at the time @somedude contested the ban, I was the only mod up and checking, I did talk to the others and we're in consensus that his behavior is unacceptable.
self_made_human
Kai su, teknon?
1mo ago
While I can't empathize with either gay or trans people (in the strict definition of empathy), I certainly sympathize with the latter and mildly envy the former.
You know how, for many men, the ideal girl is "one of the guys"? Well, gay men are living the dream in some ways, such as showing up to a random park or club and being nigh-guaranteed a quick fuck in a toilet stall. Straight men have to work for it.
Ah, women, can't live with them, can't live without them.
As for trans people, particularly the ones with body dysmorphia/gender dysphoria, I happen to be a transhumanist and so approve on principle of any change or improvement one might desire to the prison of one's flesh. I mean, I'm not a 6'9" 42069 IQ ubérmensch, so there's room for improvement within mere biology.
But that doesn't mean that the universe, or the rest of us, are obliged to indulge your desires, especially when it comes to how we accept your self-expression. Trans people, I'll consider them women/men when they are biologically indistinguishable from the average natal man/individual of their desired sex. Until then, well, I'll shake my head and use preferred pronouns mostly because I'm polite.
That is a cheque that medical science as it exists today simply can't cash. No amount of hormones, surgery or makeup will get you there. I still sympathize and empathize with them simply not being happy in their bodies, I think the correct solution is to change the body, when that's feasible.
You are allowed to dream. So do I. But the universe isn't obligated to make it come true, or easily. Simple self-identification is suitable only for football clubs.
As for AGPs? I agree that they're a large fraction, potentially even a majority. I have even less desire to indulge them, but I hardly think they're wrong for being sexually aroused by the idea of femininity.
self_made_human
Kai su, teknon?
1mo ago
I am an atheist, and I'd go so far as to say I'm an anti-theist, though I keep my religious squabbling to places like the Motte. As long as someone doesn't impose on me, I can deal with a little spirituality in a partner, even if I strongly disapprove.
I don't think my aunt knows this, but it probably doesn't matter. I doubt British-Indian women are particularly devout themselves, especially if they were raised there. And most view Hinduism as more of a cultural tradition they're fond of rather than nursing burning desires to undergo a pilgrimage to the Himalayas and see the Ganga sprout, somewhere before it turns into a river of shit and corpses. And I'm not going around burning temples to the ground either.
And besides, there are literally atheist strains of Hinduism, most famous being the nastiks, which ended up being the common word in most Hindi-adjacent languages for atheist. It's a very tolerant and syncretic religion, it's unlikely any Indian girl I meet there will care as long as I chuckle ruefully as she tries to set fire to the place with lamps for Diwali or insists on wearing a sari during festivals and smearing food-grade pigments on me during Holi.
It's not a big deal really, unless they're from super conservative backgrounds or fresh off the boat.
Errr...
I just found out a distant aunt of mine is already lining up Nice Indian Girls for me in the UK. You know, eligible bachelor nephew showing from the Homeland, getting a degree worth a shit, gotta snatch them up young.
This is not a joke. And frankly I'm an idiot for not seeing it coming, given that I am Indian and know their proclivities for matchmaking, especially within their community.
Well, at least she's in London, I pray her auntie-network doesn't reach all the way north, though I'm already fishing for excuses to dodge that for now. Like, I think I'd be a good dad, and I do want to settle down soonish, but not that quick, let me fucking live a little. And while I'm not particularly picky about ethnicity, I doubt she has buxom blondes lined up.
What exactly are you trying to convey through this comment barring pure antagonism? Consider this a warning. I don't extend a short ban only because you don't have any prior offenses in the mod queue, but personal attacks of this nature, especially so non-sequitur, are not kosher.
Edit: After this received a bunch more reports, I'm upgrading you to a day's ban. I feel like even a regular in good standing would deserve rebuke for an uncalled for and random attack of that nature, and you haven't earned that. Do not do that again.
self_made_human
Kai su, teknon?
1mo ago
Errr.. I didn't actually realize that was publicly visible. I was trying to put that in the internal mod log, and levity is one way of handling that job, which can be thankless at times. It was more of a joke than anything else, I genuinely do not have a strong opinion on the matter.
I am in two minds on the matter.
Primarily, I have strong libertarian sympathies. I would prefer, for myself, the absolute right to choose any procedure for any reason (personal finance and avoidance of externalities allowing), and my standards for informed consent are "I explained to you, quite simply, that there's always a potential for things to go wrong, and now that they did, that's unfortunate, but you knew what you were getting into".
Unfortunately, this does have negative consequences. I am mostly willing to accept that, but all else failing, I would at least hope for a formal certification of a person as a "sophisticated patient", in much the same way that the FTC declares certain people sophisticated investors and allows them them to indulge in high risk (and high reward!) activities that they deem too dangerous for gullible proles.
In practise, this is a de-facto standard doctors extend to other doctors under their care. The gynecologist we saw would normally refuse to insert an IUD in a nulliparous unmarried woman, but when my girlfriend and I could argue UKMEC guidelines with her and point out that the benefits outweighed the risks (even if not as much as oral contraception), she happily went for it. Similarly, I disagree with the old adage that "doctors make the worst patients".
Bullshit. Sure, a few people are inclined to think they know better than their treating physicians, but the majority, having both referred and been referred to, understand the limits of their competence and can also be relied on to actually know what you mean when rattling off the standard boilerplate, which usually makes normal eyes glaze over.
But this shouldn't be something winked-nudged for other doctors and allied health personnel. If I encounter someone who has done their research and seems generally intelligent, I sincerely wish I could hand out a pass that both indemnifies me from some medicolegal risk if they were to take less than ironclad advice, and also lets them access more experimental therapies without the headache of FDA waivers in terminal cases and so on.
A lot of people from these parts would qualify. Much of the griping about paternalism from doctors here and in adjacent parts of the internet arise from intelligent, often UMC people not realizing that they're not typical in terms of what a normal doctor encounters, and our default priors are heavily biased against accepting it when a patient excitedly advocates for an experimental therapy they read about online (in your case it might be legit, but it is more often a misreading of WebMD or, shudder a Tumblr blog for alternative medicine).
Usually, your doctor does know better. Though a good one should also recognize an informed patient.
I had a terrible day. Overworked, underpaid, but what was most painful was seeing a poor lady with metastatic gall bladder cancer that was all but 100% confirmed. Severely jaundiced and anorexic, multiple distant mets including to the spine, and unlikely to be worth anything but palliation.
Her family was adamant that the diagnosis be kept from her. In the UK, that would be flat out illegal unless I fastidiously document that the patient themselves declined to learn more about their diagnosis. But in India, and many other Asian countries, family members usually handle such matters, especially for old, poorly educated people who are unlikely to take the knowledge of their impending demise well.
"Is it a gallbladder stone?" She asked me hopefully while her family was off haggling with my supervising consultant. I was about to go into a painstaking explanation about her cancer, and did get well into it, but I was rapidly grabbed by her son and daughter and told to please not tell her she was about to die, and certainly not from cancer.
Luckily for me, I doubt she understood half of what I said, especially since my Hindi is only passable, and soon enough, I was tip-toeing around the sudden change in surgical plans and why, a patient with "cholecystitis" was going to be have both an ERCP and an FNAC of a supraclavicular node.
"But my neck is fine doctor! And my back hurts." The PET-CT showing avid uptake disagrees. Maybe the back pain was from a fall a few months back, her daughter prompts. Sure. Maybe. Maybe it's also the mets causing fragility fractures, I don't say.
"Is she going to get better? What does chemotherapy mean?" I get asked by the family, who have processed about 10% of what the senior surgeons have told them. Well, at least I don't have to lie that the sudden pivot to an ERCP will improve her jaundice and QOL if not her life expectancy by much. And you'd hope after 6 months here I'd know how to explain how chemo works. She developed SOB after the OP, ?PE, and I watched the bacon being made as my surgical consultant grabbed a passing CCM doctor (who made the mistake of walking through the ward) and they haggled over what tests met very strict criteria for cost-effectiveness. No ABG for you, a CXR and ECG? Yeah, they can afford it. She got better till she inevitably gets worse.
To add insult to injury, I had a mandatory communications training course that day. Aced it, of course, but I had to chuckle and groan at how divorced from reality much of it was. And then I face-palmed when the final quiz began asking questions about HIPAA, which is not a thing in India and not covered in the course itself, strongly suggesting the material had been designed by ripping off a US source, or perhaps the latter hadn't localized it particularly well. All the actual citations and foot notes should have made me sus in the first place.
Some people are dumb, or simply won't understand no matter how much you dumb things down. We avoid this truth, except where formal diagnosis of mental incompetence lets us firmly but gently usher demented grannies back into the chemo ward, and most importantly that this is true even for seemingly functional members of society.
That's about it. Any wonders I wish we could all be smarter so my chosen preference of letting everyone decide, for better or worse, about their health, would cost less in bodies and money? I'll still pay with mine.
self_made_human
Kai su, teknon?
1mo ago
Ozempic. If you can afford it. Nothing easier and simpler, or trendier.
There's nothing wrong with wanting your wife/husband to take care of themselves. Like, sure, being eye candy and a good lay aren't everything in a marriage, but goddamn if someone's letting themselves go, there are polite ways of telling them it's not making you happier.
Getting buff yourself? Not the ideal way, IMO. Sure, that's worth it for its own sake, but you're better off whispering to her that you think you're gaining weight and need to diet, and hoping she takes the hint. But I while I don't know her, or you, my experience is that when a woman self-conscious about her own looks sees her husband working his ass off at the gym all of a sudden, she's more likely to think he's trying to look better so leaving her is easier. Ignore if you guys are so happily married that this isn't a concern, but I would not recommend this route myself, unless you make it a point of hitting the gym and then do your level best to convince her to tag along, so she knows it's not like that.
self_made_human
Kai su, teknon?
1mo ago
Give doctors the right to point firearms at their patient and tell them to take their fucking meds on the pain of death.
It's a good day at work, can you tell?
self_made_human
Kai su, teknon?
29d ago
Eh, while Indians are hardly at the top of the totem pole, I hardly do badly (trivia, the bottom of the pole is allegedly more prestigious).
Sure, the salary sucks, and NHS doctors are henpecked and taken for granted by a populace used to not paying for showing up at the ER with sniffles.
But I do fine. If you think the girls on dating apps are crazy, wait till you see the kind of screenshots I've been sent about the guys. The very existence of Indians as Model Minorities and often the highest earners by ethnicity is proof that group differences can be overcome by an individual. I'm not the average Indian, or even the average British Indian.
On a more serious note, I've noticed that men who are having decent success (in terms of lots of matches) on dating apps seem to run into a lot of crazies, and it's unsurprising that psych med students have the worst ratio of all. Having "doctor/psych trainee" in your dating app bio kind of screams "do therapy for free, but you can tip me with sex". Neurotypical women also don't really want to date, they want to have a stable relationship, so they spend as little time as possible on these apps, so you're already oversampling from a biased sample.
When I made my account, post breakup, I had genuinely lost hope I'd match (into psych) at all. I was looking for something more serious, but at least half the nutters came from that short period. At that point, it was just "doctor at [reputable hospital]". And I expected to be here for significantly longer, losing my mind in other ways from the terror of bullshit exams. I was advertising a stable relationship, for the little good that did.
At any rate, I do do therapy for free, and find it an enjoyable reprieve from my own problems, including on this very board, though sadly nobody has offered to pay me back with sex quite yet. Upvotes and sincere praise are enough really. But yeah, people dating online are being sampled from the kind of people who are less likely to make it offline, even if it's become normalized and the predominant way people date. Even more so in the West, so the odds of running into the utterly deranged should be lower from a more representative sampling.
So far, I remain convinced that the primary reason therapy, in all its myriad forms, beats placebo, even for the most retarded forms, is because it's a decent substitute for having a nonjudgemental and perceptive friend, the kind who'll keep your secrets to themselves. I'm pretty good at that, even for women I sincerely would not approach without a syringe loaded full of haloperidol or lorazepam. Instead, I just vent to online strangers with more identifiable information redacted.
self_made_human
Kai su, teknon?
1mo ago
They wanted to avoid the Hyperborean Restricted Airspace Zone. If you thought the Iron Dome was hair trigger you've seen nothing yet.
self_made_human
Kai su, teknon?
1mo ago
Honestly, my approach is, fuck it, why not?
Well, there are actually reasons why not, such as the hope we can find a less ghoulish cure, things like mirror therapy for phantom limb (well, that one's already gone, its just that maybe there's an equivalent), or the fact that they might go on disability.
But if someone who is otherwise healthy and financially sound wants to chop off pretty much anything for any reason, my opinion as a psychiatrist-about-to-start-training is a shrug, presuming I was convinced that nothing else we could do would help.
Surgeons aren't that gung-ho in my opinion, maybe it's because I worked too long in Onco Surgery, but I've seen more cases turned down as non-resectable or not worth it than those that were done knowing it was futile. Surgeons usually want what's best for the patient too, even if it's in conflict with their wallets. They're rich enough that's not the biggest deal.
Chop off a mole, a limb, a dick, anything at all. As long as you make sure you're not a burden on the rest of us, it's not my business, unless you ask me for my advice.
Us mods aren't monolithic, though we try to present a unified front. I'm sure there are some out there who would be harsher on OP, or more keen to monitor deeper threads. You can't expect perfect consistency. But I happen to be the one up when the more Westward mods are asleep.
If it had been deeper down, then I would assume that:
A) Far fewer would have their eyeballs contaiminated. I don't recall us mods ever being involved in the most degenerate case, namely DMs, at that point one person or the other should block and move on.
B) It might have been in the context of a heated debate, where being somewhat uncharitable can be occasionally excused, if not indefinitely or infinitely. Someone can be provoked into being exasperated, or less than maximally polite, and I was giving him the benefit of the doubt.
C) His mod record is otherwise clean.
Hence I initially wanted to politely tell him to shy away from that kinda thing without putting a dent in his invisible to you mod record, but when it's a top level post, absolutely not, it's warning worthy. He's got 83 comments, and no warnings till today, so as far as I can tell, he's mostly within acceptable bounds. Unfortunately, B isn't true, though that was an error on my part while trying to clear the mod queue. At any rate, a warning would probably be the default mod action, it's unlikely any of us would want to ban him for a first infraction, even one clearly in violation of norms. Repeated misbehavior and being incorrigible? Or just something awful? Banhammer swings.
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