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Off the clock doesn't mean ethics are optional does it? Are you allowed to fuck your patients after work?
As they used to teach journalists, the primary metrics of an insult are delivery, intent and impact. Even a merited comment can be insulting if it's used to demean someone publicly. And legally we're talking ethics, not lawsuits. Your delivery started with labeling it as 'LLM psychosis' or 'homegrown schizophrenia,' then backpedaled to psychedelics and 'high risk'. That's not constructive critique, it's pathologizing a philosophical post.
You should try focusing on ethics for a bit. Or diagnostics. I don't care how 'intimate' you are with crankery, you can't fucking diagnose it off an internet post. That's what is supposed to set psychiatrists apart from armchair psychiatrists, part of what you are supposed to learn at medical school isn't how to spot crankery it's how to distinguish between spotting crankery and being a dick and why diagnosing over one internet post is always the second one.
IANAL is an age old internet acronym because lawyers are held up to a similar level of scrutiny. You are correct that it is not the same however. NAD didn't take off the same way, because most of your profession know not to give medical advice over the internet. Most of them understand that they have traded shitposting for a higher level of respect, for the opportunity to be listened to when they do leverage their medical credentials. I can see a scenario where you notice a regular poster change over time, or fixate and spiral, and warily offering them advice. You called this guy a schizophrenic who fried his brains on drugs after ONE OP.
My claims stand. I didn't read the op again, it wouldn't change anything. My claims would stand even if he'd smeared shit and blood on a picture of the Pope, scanned it and attached it as an op. My claims are not about his behaviour, they are about yours.
If you are really determined to maintain your right to shitpost with your credentials, show me what in the op you decided met the diagnostic criteria for either schizophrenia or drug-induced psychosis.
I also agree you're coming on a bit strong, but to me but I think the odd contrast from the doctor is solely because of the last line signaling a kinship of ideas. If instead of that last trans-humanist line, the post stated other beliefs we'd could instead be treated to some Chat gpt regurgitated remark of joy at the absence of a god-shaped hole.
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Dafuq? Do you deign to notice the bulk of my second post? Where I engaged with his arguments?
"Philosophical". Right.
I invite you to have a quick browse through /r/AskDocs.
At any rate, I didn't don my doctor cap in my first comment. It was only when he elaborated that my concerns continued to mount.
Pointedly ignoring that my earnest advice was prompted by OP's behavior. Very convenient.
@faul_sname , @SnapDragon , @lurker despite being laymen, have noticed the exact same concerns that I have. It doesn't particularly matter a jot whether or not I flex my credentials online, and I have been entire honest about them. Unless he pays me and takes me on as his doctor, the harm caused by advising him to seek an appointment with someone with actual jurisdiction is nil.
Holy fucking shit this is fucking retarded. @Throwaway05 how many posts does it take to diagnose schizophrenia?
Woah nelly, okay a couple things going on here.
While I'll note that the way @self_made_human rolled in is not quite how I would go about it, I would also be lying if I hadn't done shit like that before, and I'd definitely be fucking lying if my fucking cursing and fucking casual language in my posts wasn't also considered grossly unprofessional by my colleagues (just in a different dimension). We aren't perfect.
However it also seems that OP is not particularly upset at the accusation - I try to pay careful attention to where my feelings are coming from in situations where I'm more incensed than the victim. Something to consider.
Also, even if your point has validity the way you framed it will probably result in the mods rolling in at some point.
Okay now the fun part! As a didactic matter, schizophrenia isn't quite what people think it is.
Schizophrenia is a specific mental illness with a number of symptoms, delusional thought content is one of them but not required. It is also one of a number of psychotic disorders and while it is the one people think about and doctors usually see the most (sort of) that doesn't mean it is always the problem.
Loosely, thought content exists on a spectrum of:
"Normal" -> Culturally accepted but bizarre (I may say this is woke, an atheist may say this is religion). -> Crank shit (think Terence Howard) -> Crank shit with other symptoms (Schizotypal personality disorder) -> Delusional disorder (the person has a delusion, which is a fixed, false belief and impaired reality testing with respect to this specific item, but no other problems) -> Schizophrenia/Schizoaffective, etc.
Medical illness and substance use can move people temporarily or permanent along this line. Some of the connection points have evidence they are related in a way that represents a true spectrum some don't.
Some other illnesses like intellectual disability, autism, borderline personality disorder, anorexia, and OCD can functionally put people somewhere on this line even though they are probably less a part of this spectrum.
Human cognition is strange. Some of the mega woke may be truly delusional but functionally much further left on the spectrum. Brains do what they want, sorry rambling.
In any case for schizophrenia specifically you need other symptoms. Most bizarre rambling on the internet (absent substance use) is usually schizophrenia because its most common and has significant insight impairment so they want to share the oddity in a place where people won't yell at them. Not all of it is tho.
Other things you expect to see are hallucinations (usually auditory, not visual), impairments in personal and social functioning (less obvious on the internet), and disorganized thought and speech - that's usually the clue with schizophrenic ramblings on the internet.
However the difference between "crank" (which as we know is sometimes right) and disorganized can be quite a fine distinction.
Edit: I guess I didn't answer the question? It can be clearly done in one post sometimes, which I did a few times on the old forum. It can take considerably more. Shouldn't really be done over the internet, but if someone tells me their blood pressure is 190/120 I can just diagnose them with high blood pressure. Certain kinds of weird shit (like the gang stalking subreddit) is pretty pathognomonic.
That's weird, I thought you answered the question perfectly well before your fake edit - it was unprofessional and not the way you would have gone about it, and you need other symptoms to diagnose schizophrenia. You just caveated it with the fact that you are sometimes unprofessional. My assumption is that if this was a beauty forum and someone pointed out that it's fucking disgusting of you to casually label someone 'guaranteed a landwhale in my medical opinion' for having a bp of 190/120 you'd realise you made a mistake and cut it out. Then your explanation of what schizophrenia is further made my point.
Also I'm fully aware of where my feelings come from, they come from the knowledge that I joined a community based around the writing of a psychiatrist I respect, a psychiatrist I know would never treat schizophrenia so flippantly despite using it quite a bit as an example in broader discussions of mental illness and the culture war. They come from my expectation that other doctors had a similar level of self awareness and, if they acted unprofessionally and were called out, wouldn't spin a bunch of childish bullshit excuses up like 'waahhh other professions aren't held to the same standard! I'm not on the clock at the moment! You didn't bitch at the laymen! Prove he isn't schizophrenic, go on then!' They come from learning that you too claim you diagnosed schizophrenia in one post despite just explaining earlier in your post that no, you fucking didn't. You at best spotted symptoms much more obvious than anything in the op, because the writer of the op isn't fucking schizophrenic.
I mean TBH I did submit my post and then go back and instantly edit it because I felt the specific question (as opposed to the context) was worth addressing. I'll come back to that.
As for your frustrations yes I don't think SMH was being particularly professional and at the same time he's young, hasn't finished training (and hasn't yet gone through the parts of training that really hammer in the professionalism) and didn't seem to bother OP so I'm not super upset about it.
And on the other hand you seem upset - that's a valid feeling and also a bit disproportionate given OP's lack of disgruntlement.
Soooooooo how do I balance gentle wagging my finger at all parties involved without furthering exasperation?
I think we should lean back on "the vast majority of people here are just living their life doing their best and being directly called out is going to create defensiveness that isn't really conducive towards helping someone acknowledge error and improve."
Lord knows I give myself some grace so I should probably to other people as well, when possible.
That said, so back to the meat of the thing (cognition is neat!!).
Yes you should be able to diagnose schizophrenia from a specific type of writing but if someone is producing some alternate theory of physics or whatever it will be hard to tell if that is representative of disordered thinking or just the weird shit being weird shit (not commenting on correctness with that). I haven't read OP's thing because the exercise holds little interest to me but I doubt it's very diagnostic, but we have had posters here (well I think only on reddit?) that I saw and was like...."oh."
To give a clear example (and you can find this kinda stuff on reddit if you know where to look):
"listen listen listen help me please PLEASE i cant get the polices to help ive called 13 times a day for the last 13 days and they keep telling me I need a doctor but I dont need a doctor I need someone to get them to stop following me I cant get rid of them even when I use the bathroom I can hear them in the next room over telling me things I need them to stop stalking me but the police won't help my family say I need to calm down but I am calm I just dont know what to do about them my doctor gave me a medicine for anxiety but I dont like how it makes me feel and what they say about it online makes me thing the doctor is working with them so I won't go back I dont know what to do help"
You see that and someone is clearly having an exceptionally bad trip or true psychosis with poor prognostic indicators.
I didn't mean to imply that you were being somehow duplicitous by using the fake edit, if that was the impression I gave - even if you just decided you didn't want to mess with the flow of your post, it's just a part of forum culture imo, it happens, and I don't see much difference between seconds before/seconds after - but it also feels
But yes, I am upset and I obviously have a bit of a hair trigger for this issue, however I would have been less frustrated with your response if you had said you could diagnose psychosis in one post - that's undeniably possible. But I guess the real sticking point for me is that the op is clearly not schizophrenic. Call it insane (in every sense) stolen valour. (Obviously it's more like the opposite, I don't want others to suffer the same stigma I and others I know have and I know people's brains don't delineate between shitposting and advice so neatly.)
No worries, let me message you separately.
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I think you latched on a little too strongly to this issue, and it would be advisable to let it go.
Why would this be advisable? Would failure to let it go mean that he has a mental illness too?
I wouldn't know that, but he's certainly making a mountain out of a molehill and it's slightly cringy.
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