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self_made_human

amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi

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joined 2022 September 05 05:31:00 UTC

I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.

At any rate, I intend to live forever or die trying. See you at Heat Death!

Friends:

A friend to everyone is a friend to no one.


				
User ID: 454


				
				
				

			

		

	














	


		


			



	

		

			

			

				

					

						

							
						

						

							
							

								
self_made_human


								

								

								
								
									
								
								
								
								

								
							
					
 
				


				
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi

				
				
				

				

					15 followers  

					follows 0 users  

					joined 2022 September 05 05:31:00 UTC
				


				
					

					
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


					
					
					
				

			


					

						
					



		

	

 











			
			

			
			

			




	


		

			
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				Hamnet, infant mortality and attachment styles
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Have most Catholics come to terms with the abolition of purgatory? I'm genuinely curious.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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Thank you for the advice, but you are (fortunately) wrong here.


I pay for ChatGPT and Gemini. I am also familiar with AI Studio since the Gemini 1.5 days. I use them regularly, and make sure to pick the good models. I read Model Cards when new LLMs come out! I am a regular on LW and HN haha. I have essays on LLM hallucinations, I argue with people here about how to best use them, from a place of >0 technical knowledge. I tell people about AI Studio like every other week, for the same reason.


I was intentionally refraining from relying on an LLM to answer for me, even if I think the LLM would have done a good job. I checked later, and fortunately, I was right. This was both a courtesy to the person I'm talking to, and because I wanted to check the quality of my own knowledge. Mostly the former.


Thanks nonetheless, I know enough to say that your advice is good, in case anyone needs it more than I did.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
You had me going at the start.




that you had hot enough teachers for that.




Look, for once I'm the person grading on a curve. There's an apocryphal story/meme of a man being so horny while internet deprived that he jerked off to a smoke detector, describing it as a "ceiling titty". At that age, I could relate, I am much calmer these days, and I do not miss having a raging libido with no real outlet.


But yeah, a few of the teachers could get it. Still would, except that they've probably gone from MILFs to GILFs. It has been a while, and I am not willing to start a relationship with such a problematic age gap (it would be elder abuse).




Or maybe you truly are a MILF enjoyer. Not that I judge, considering how many of my peers are nowadays MILFs.




At that age, MILF meant women from 27 to 45. And porn actresses somehow go from "barely legal" to "MILFs" on the lower side of that range, with almost nothing in between, so maybe I was prescient.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Hamnet, infant mortality and attachment styles
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Nah, I'd say it covers a lot of autistic or adjacent men too, in my experience. Women require a non-negligible amount of emotional labor, as much as they claim to be responsible for all of that. I'm lucky some of it comes naturally, but I often have to make an intentional effort.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Hamnet, infant mortality and attachment styles
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Good post. AAQC'd. I agree that there is a strong cultural component when it comes to attitudes and reactions to childhood mortality, for the same reasons. I would so far as to say it applies to miscarriage, I am somewhat confident that women in India do not make nearly as much of a fuss about them, when compared to American counterparts. That includes wanted and planned pregnancy. It is usually treated as a sore disappointment, instead of a reason to break down and receive a great deal of sympathy. We are also much more pragmatic when it comes to abortions, especially terminations due to physical abnormalities in the fetus.


Of course, everyone would be extremely sad and upset if the baby was birthed at term or someone's child died during infancy. Most people younger than my nearly centenarian grandpa do not remember the days of 50% infant mortality here. Antibiotics and cesareans made a HUGE difference.


PS: I think you should have saved this for Scott's book review contest, especially if you added more citations in support of your theories.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				My Willing Complicity in "Human Rights Abuse"
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I appreciate the advance warning. I will reward you, not with a metaphorical cookie, but a real beer if I'm down at the Wharf: if you are not particularly Muslim, if I am there again, and if you care to. The main thing that struck me about CW, other than the cleanliness and wealth, was how cheap the booze was in London terms. I'm glad Finance people are stingy and very eager to engage in arbitrage, at least when it benefits me.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I have seen and heard some very concerning things in the UK, from people of what I expect come from a comparable background. I'm glad that I'm too young to be subject to too many vascular risk factors other than a poor diet, but my eyebrows did hurt from the exercise.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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I can see what you're getting at, in theory, but I think that if that was the driving impetus behind an entire intern year, then I feel like the lesson would be learned in 2 months. I know that you meant that there's actual clinical learning going on, but it didn't take me very long to learn to do the attendant drudgery on command.


Of course, performing surgery as the primary surgeon after graduation (without the necessary postgrad qualifications) is nominally illegal in India, so our bosses and seniors knew that too much effort teaching us actual procedural skills would be wasted time.


The situation is very heterogeneous in India, sometimes the interns do do just scut work and make no meaningful decisions, sometimes they're effectively in charge and winging it, which hopefully does teach them something. In the UK, FY1s are glorified secretaries, FY2s are thrown into the clinical crucible, IMO too abruptly.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Look, I fantasized about sleeping with my (female) teachers from 8th grade onwards, it was a sex-segregated institute, and I had sadly little contact with female peers. I was too chubby and acne ridden for a teacher seducing me to be a remotely realistic prospect. But if they had been blind and demented, I don't think I'd have accused them of sexual assault. I'd be hell-yeahing with the boys.


A gay art tutor once tried and (failed) molesting me, and at no point was I into it. My parents fired him, but did not press charges as I wish they had. It probably wouldn't have gone anywhere.


I still remain a MILF-enjoyer, and most of my serious relationships were with slightly older women. Sadly, MILF increasingly just means women my age, both because of a regression in the strictness of standards on porn sites, and the unkind passage of time.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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Thank you for elaborating, I'm appreciative.




Also, usually the intern year for surgery is wasted on floor monkeying only pretty much.




Ah. So this is universal, speaking from experience in the UK and India. I've heard even other postgrad trainees (in the UK) make the same complaint.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I apologize for the rambly, incomplete post. A few things came to mind after writing, and a more polished draft on my blog addresses some of them.


But since you ask:


The risky texting with multiple men (or boys, or women, or LLMs, I'm not sure to 100% certainty) was somewhat suggestive. Also, I think I had some reason to think that a potential partner had been the perpetrator of abuse, but don't quote me on that.


I promise that we would not have admitted on the basis of such scanty evidence, it was merely discussed, a mistake because I was listening and I love writing. The safeguarding after sexual abuse was probably the necessary and sufficient cause behind the admission.


But people are conservative enough that just the idea of a young teen girl watching porn and wanting to screw (even an age appropriate) boyfriend would have a few psychiatrists here diagnose hypersexuality. I would disagree with them, dismissing them as out of touch old fogies who did not see genitalia of the opposite sex till med school, if that was all the evidence. Right now, I mostly suspend judgement.


(My parents were annoyed when I first dated a girl. Naturally, it was someone I met at private coaching outside of high school. Naturally, their primary concern was that I was distracted from studies. Unfortunately, they were correct: That bitch deserves blame for making me so depressed that my grades suffered and I didn't get into a very good med school. They did not accuse me of hypersexuality, at least not till much later, and that too tongue-in-cheek, mostly because I had another bad breakup and was processing it by bringing too many women home since I was too cheap to pay for a hotel. Don't judge.)


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				My Willing Complicity in "Human Rights Abuse"
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Thank you. I genuinely did not lie about tearing up, I would be ashamed of a cheap rhetorical trick to gain sympathy. I am often caught in the position of seeing the worst misery the world can offer, and doing much less than I wish I could to alleviate it. I try my best.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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Boo. I genuinely was looking forward to a longer, more detailed polemic! I am zooted on stimulants, and not in a mood to study, so medicine-adjacent cognition is a good way to fool myself that I'm doing something productive.


I will note I have never heard another surgeon say this, at least in India, and I know more surgeons than can fit in a large OR. At least while maintaining aseptic conditions.


Then again, specific laparoscopic training is not a core part of the surgical curriculum, from my understanding. I have had my own seniors approach me, asking for my dad's number so they could ask him to teach them laparoscopic surgery with proper depth. He is somewhat famous for being a good, albeit short tempered teacher. My dad tried teaching me too, though all I can say is that I didn't drop the camera or cut off anything too important.


(He also taught himself laparoscopic surgery using a textbook, sometime in the 90s. Once again, deadly serious. He was a pioneer in these parts. I am but an ant in comparison.)




My favorite for this is autoimmune encephalitis, seldom seen, often missed, never fails to make the psychiatrist feel like the smartest person in the world and everyone else feel like a dumbass




I would agree with you, if I had ever seen a case of autoimmune encephalitis. Best I've got is a genuinely unresolved case provisionally (so long it became permanent) diagnosed as extremely treatment resistant schizophrenia, where we excluded it and half of WebMD as differentials. My boss had to book a private plane to send him to the only ward in the country that would take him, this is not a joke or exaggeration. This is in the UK, and the government paid for all of it. I'm sure you're jealous, I hope you're jealous, give me one reason to not desperately wish I was in your place :(


(I will take a concession that you wish you didn't have to worry about insurance)


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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Listen nobody here wants me to bitch about the decline in surgical skills training driven by laparoscopic and robotic surgery. It is poorly received every time! Every time!




Hey, don't be so harsh. You do have an audience for that diatribe, even if it might just be me. Let it all out, I have a father who I cannot accuse of lacking surgical skills even if his expertise is in laparoscopic surgery (and he is world-class at it, if I say so myself). This is a safe space.


Thank you for taking the time to indulge both of us. I am relieved to not be accused of being too wrong.




In the U.S. we shuttle things from Psychiatry to Neurology once we understand them (schizophrenia used to be early onset dementia, then we figured out what dementia was and punted it over). If something is still a psychiatric problem it means it is quite a bit more tenuous and complicated than a nevus or blood pressure evaluation.




Among the many things I've seen that I've neglected to write up so far, was a patient who came to us that day with vertigo and double vision. She clearly had strabismus, as I could tell when I made eye contact (singular). No, there were no psychiatric symptoms, even after questioning. The people who accept and direct new patients to the relevant clinic are less than perfectly reliable, and that is without getting into some of the very questionable referrals I personally observed. We sent her off to neuromedicine, medicine and ENT, they deserve a taste of their own medicine. They've done much worse.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Content warning: An undercooked, rambly post with minimal editing but it's a slow news day, clearly. Also, sexual abuse, so I don't bury the lede entirely.


I recently heard about (but didn't personally review) a very interesting patient. Same Indian hospital I mentioned visiting, but now in the ward itself and not the clinic.


The most senior doctor, the lady in charge of the department, was interrogating the interns and trainees who had reviewed her. While I was standing around and trying to look present.


I initially heard:


    

  • The girl was addicted to her phone, and used it for 12 hours a day.
    • 

  • She obsessively made extremely "cringe" Instagram reels, and that quote is verbatim, including while still in hospital, before her phone was taken away for violating the privacy of other patients. A colleague opened her public profile and showed us. They were, in fact, very low effort and cringy. I will not get into the ethics of his decision, I don't care personally, and it was for a good cause. Everyone else agreed they were cringe.
    • 

  • She had a poor relationship with her parents. Why? Apparently she had recently made a boyfriend, and they did not like him. Her father had usually been quite doting, but even he drew the line here. They physically hit her (which is still far from remarkable in India, at least where I lived. My ass has no permanent scars but my mother sure bent me over the knee till I was big enough to risk her joints breaking).
    • 

  • She was particularly mad because her older sister had just made a boyfriend, and her parents were cool with that.
    • 

  • No, I don't know anything about the character and disposition of either man.
    • 

  • She was very mad about her phone being taken away, even if the doctors had actually been generous in even letting her keep it in the first place. No phones is standard policy, even if not consistently enforced.
    • 



At this point, the senior doctor asked me for my thoughts. I jumped, I had been thinking about a cute kitten I saw, one that had not been subject to the same teratogenicity seen in the ones hanging around in the medicine ward upstairs, as observed my myself while an intern. Maybe I had been wondering if I should pirate Mewgenics. Anyway, digression over.


"Uh.. Why was she admitted in the first place?" I asked. Both a genuine question, and an attempt to avoid being caught zoning out. This sounded... normal, or at least I would not hospitalize someone for doing this. It's 2026, even I, once committed to abstinence from brainrot, occasionally browse Reels. It sounded like normal teenage girl stuff.


She had been subject to sexual abuse, quite recently. My teacher (because I was present in my capacity as a very slightly overqualified medical student, at least in practice) didn't immediately elaborate.


But I soon learned, once again from being there, albeit with clearer ears:


    

  • She had told the doctor taking her history that she was very frustrated that she was in college and that it was unfair to deny her the right to a relationship at such a formative time in her life. I will add that I misheard this, she was not in college. You are being subject to a stream of thought.
    • 

  • Her older sister had caught her staring at her, in the dark, in her bedroom. I don't know if it was a shared one. She had been standing there, menacingly, by all reports. But she had not made any move to hurt her, beyond the usual tantrums.
    • 

  • Till this point, I thought we were talking about someone in college. No, she was 13, and not precocious enough to make the cut. At least academically, I'll get to behavior.
    • 

  • She had been caught talking to multiple people via DMs. While my colleague was euphemistic, I get the strong impression sexting or at least strong dirty talk was involved.
    • 

  • She regularly used sock-puppet accounts to engage with her posts, which weren't that popular. I do not really want to judge the good looks of a 13 year old, but in all honesty, she was plain. That included a fake account masquerading as her sister, and also using fake accounts to make allegations about her sister.
    • 

  • She was described as hypersexual. A trainee she got on well with said that she had disclosed kissing a boy, though I don't know if she went further. She told him she fantasized about romance and sex, and watched porn regularly.
    • 

  • There had been an effort made to distinguish behavior from fantasy. She claimed she had never acted on her interests, but desperately wanted to.
    • 



Then the bombshell: she had accused her father and grandfather of sexual abuse, on the basis of viewing porn and probably material trying to raise awareness. This was probably not the reason she was admitted (though I didn't specifically ask). She said her father had, a few years back, touched her privates. He did not do anything (more) explicitly sexual. She claimed her grandpa had once embraced her, taken her head, and rested it against her chest. That is all. She had not found it objectionable at the time.


We debated this for a bit. The general consensus, which I agree with, is that her grandpa was doing normal loving grandpa things. I do not want to accuse her father of abuse.


Her mood had not been obviously bad. She had, after all, been making reels in the ward.


At this point, the senior doctor mentioned ADHD, and pointed at excessive phone use as an example of a driving need to avoid boredom. I looked around shiftily, I have ADHD myself, and my screen-time has been, by objective report, very high. But I did ask if she was contemplating EUPD/BPD. Okay, I did make an error, it was at this point that I learned she was 13, which did make me raise an eyebrow.


She said that she was open to the idea, but the patient was too young at present (this is true, I checked since I didn't want to trust my memory more than I can throw it). Good suggestion, she told me, but people can grow out of things, and upbringing and support can make all the difference at that age. I have no reason to disagree. I also mentally considered histrionic personality disorder back then, but the same issues with age arise. I do not believe she was on meds, though I could be wrong.


I did not promise that there was a point to this essay, but I did find the whole situation thought provoking. Maybe the main reason she was admitted was safe-guarding and observation, I am confident that is part of the reason at least. Nobody pinned a firm diagnosis where I could see it. It just struck me as an example of a grey area, all the more unusual for an Indian context. You might be okay with the idea of a 13 yo girl having a boyfriend, and maybe having sex with said boyfriend. Maybe my teacher was slightly out of touch, and being on the phone all day is now entirely normal. I am guilty, though I tell myself I use it productively. Maybe being deeply jealous of her sister is a normal enough reaction to circumstances. I do not have the full picture - because I have ADHD and the ward was noisy. Mostly the ADHD.


I will, both for personal and professional curiosity, and by (imagined) public demand, seek answers if I ever visit again, or maybe just text my new friends. What I found the most concerning, at least from memory, is the potential hypersexuality, which genuinely can be a sign of past sexual abuse, even if she's just about old enough for it to be debatable.


This post brought to you by a large dose of Ritalin, after I made the mistake of taking it while too tired to actually study. I hope no one predicted this halfway through the essay.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I replied before reading all of the comments, so I'm glad to see others feel a similar way. If I was dead, the fact that my wife kept my data and memories, and tried to play a video game I would like with our child would have meant everything to me.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
While I wouldn't be quite that harsh and blunt, I do agree. Now's probably not the time to be wondering if he had slightly questionable porn bookmarks or retained pictures of an ex.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Until you mentioned a daughter, I was 95% confident you were gay. Now I'm down to 10% confidence, mostly because of the possibility of adoption.


Oh. Reading along, I just realized he passed away. Sorry. I'm glad you're doing your best to keep his memories alive, and even play into his interests. If my future wife went to such lengths when I was in the grave, I would be very happy about it.


To actually answer your question, I think the data you extracted is worth more than the system itself (at least when it's clearly broken). If your husband was alive, he would probably care more about the fact that you retained the information and the fact you even want to play HL3 with your daughter, rather than the fact that you played it on his old pc. If your daughter wants to keep it, keep it. Otherwise you might feel a little better if you, say, gave away some of the working but unnecessary parts to charity or some eager kid who is friends or family. Thank you for trying, either way.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
They didn't, but mostly because I have been too busy to use them for anything I did not expect them to do by default. Whenever a new and exciting model launches, I stress test it extensively, but for at least a year, the models are good enough for my personal and professional needs. Last time I saw a massive improvement in quality that unlocked entirely new use-cases that blew me away was o3, otherwise I tend to feel slightly impressed.


From memory, GPT-2, 3 and 4, then whatever Claude just came out then, then o1 (from seeing others use it), then R1/o3. Native image gen with a variant of 4o. Those standout. Everything else falls under slightly better in ways that don't stick out.


But I am happy enough with them being good for research or editing my writing, or generating images. If they get significantly better in a manner that is glaringly obvious in normal use, I'm close to worrying (much harder) about losing my job.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Eh? I think being a traveling merchant or a trade hub doesn't count by my standards.


I'm sure they've helped with the cost-reduction scaling curve and overall adoption and implementation of desalination, but they did not invent it, and as far as I'm aware they do not directly export it or have independent cutting-edge R&D that isn't just hiring a Western firm. I could well be wrong here, please correct me if I'm missing something.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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The following meant as a genuine question to a professional, not a combative gotcha:




Thank you for clarifying, and I'm not being sarcastic. While 99% of the medical professionals who reviewed my post had nothing but praise, there were two pedants and hostile interlocutors who ticked me off. One was a British doctor, who claimed he had studied in India, and accused me of gross clinical negligence, sneering at patients and colleagues for being "beneath me", and went as to far as go claim that I was a med student making things up using an LLM. I had a few choice words for him, but I am pleased to say actual verified psychiatrists are not that picky.


I do not have a very strong opinion on ODD. Mostly because I haven't done an official placement in child psychiatry, this example was literally the first time I tried reviewing an actual small child.


But I do share some degree of skepticism. However, from a pragmatic perspective, I think the diagnosis is fine. Scott has written about this, and I have little to add, but the gist of it is that the purpose of a diagnosis and clinical label is both to identify a "disease", and also to make getting care and intervention significantly easier. Sometimes the latter is more important to the patient or their family. At least it usually gets things covered by insurance.


It is difficult to distinguish between a child with ODD and one that is a petulant asshole. I am not even 100% confident that there's a qualitative difference.


But like the usual example of ADHD, many mental illnesses exist on a spectra, overlapping with the "normal" range. Is someone with a blood pressure of exactly 139/89 (on repeated tests) hypertensive? Not by the definition interpreted maximally strictly and literally, but half the reason we keep doctors around is to exercise clinical judgment and to rely on their discretion. I'd give him a pill to reduce the pressure.


Many cases of ODD age into the similar but technically distinct Conduct Disorder, and many later get diagnosed with Antisocial Personality Disorder, usually when they're old enough to qualify. Referring to my exam notes on Forensic Psychiatry, about half (!) of male prisoners in the UK have ASPD.


Clearly the diagnosis is identifying something. It just isn't as clearcut as we'd wish.




What do you mean, "not obeying your parents" is classified as a mental illness?




That's not enough. It has to be very unusual and disproportionately bad, by the reference frame of other children of similar age. A 2 yo throwing a tantrum wouldn't count. A 7 yo who refuses to listen to his parents, doesn't respond to punishment, keeps acting out in serious ways? Much more defensible, even if it's a question of degree and not kind.


An ODD diagnosis then, will help with getting psychological help, and very rarely medication (but mostly to treat the very common comorbidities like ADHD).




So I guess what I'm asking is: do you think a real case of ODD looks more like your Bangladeshi young man who occasionally flips out and bites his family members for no reason, while getting along with them the rest of the time and having no coherent complaint against them? Is that what it's supposed to look like, and thus, the reason why non-obviously-corrupt doctors take it seriously as a diagnosis? It doesn't sound like it, since you weren't sure about the diagnosis in this case. But if not, what is a perfect platonic case of ODD supposed to look like, and how do you distinguish it from a perfectly sane kid who dislikes their authority figures (or authority figures in general)?




You are correct it wouldn't be typical. As I note, I am green when it comes to child psychiatry, most of my knowledge is theoretical. In clinic, I thought of it more as a could-be, with non-negligible probability worth excluding, instead of a very likely.


The child will very likely get multiple diagnosis, and even if there does turn out to be epilepsy, there might be other factors at play. I don't think a single disease can suffice.


Then there's the possibility of ID, which very commonly has behavioral issues. If there is ID, it might not be worth an additional diagnosis. Without opening the DSM or ICD, I can't tell you whether a diagnosis of ID would rule out ODD, I think probably. To help explain, when a person with dementia hears voices or feels depressed, we usually do not slap on a diagnosis of schizophrenia at 85 or MDD. Such signs and symptoms are very common in dementia itself, and we use a broader umbrella term called BPSD, but we still do use antipsychotics and antidepressants to treat it.


In other words, a wash. You can make a defensible argument either way.


I am out of my comfort zone, and I won't be lazy and ask ChatGPT because you clearly want my entirely human opinion (in reality, I would be asking ChatGPT myself, it's handy). Perhaps @reo might have something to add, he knows a lot more than I do. Maybe @Throwaway05 even if his OPSEC is so strong and his knowledge base so broad that he could be in anything from IMT to psychiatry to an ER specialist to a dermatologist. Maybe I could ask my peers in India, but ODD is rarely diagnosed here, certainly not as much as in the West.


Or I could ask ChatGPT and interpret the answer for you, it's genuinely up to you. And thank you for the question, it's a good one. I regularly have such doubts myself, for example whether BPD and the new diagnosis of cPTSD are meaningfully different.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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I mean, I doubt Hippocrates had modern informed-consent guidance in mind when he came up with it. The core issue is that the original is horribly dated, and even modernized versions are very far from clear when it comes to concrete operational advice. Nor are they necessary, we have medical regulators and legislation to cover professional ethics, and their authority supersedes the oath.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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As a note for @MathWizard and yourself, you need to use @RandomUsername, not u/.


That links to a Reddit profile. One of the minor differences on this site.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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Thank you. You've made any argument I could have made, and with more detail and rigor than I could bring myself to muster right now. I've very appreciative.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
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I am not known to be exceedingly humble, but even the atrophied organ responsible for those feelings is a tad bit overwhelmed by the high praise. Thank you. I do what I can, I'm a doctor for many reasons (including money, that's a big one) but I also genuinely do try to help.