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PaperclipPerfector  30d ago (text post)   1832 thread views

Wellness Wednesday for May 13, 2026

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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New Year's Resolution check ins:

  1. Work. Submitted manuscript last Friday and hoping it makes it through review quickly (it's a revision, so it should).
  2. Fitness: Did 2x tempo sessions last week and hit 50 miles. Weight is still mid 170s, but I'm in a mild (300-500) calorie deficit every day, so this should start to change a bit in the coming weeks.
  3. Intellectual Stuff: Haven't been meditating as much as I would like. One more meeting for After Virtue. Also fallen off the wagon a little on blog posts and language learning. I blame work.
  4. Finances: We found a third roommate to start in September. Europe travel will be a big expense, but it'll be nice not to skimp super hard for most of the rest of the year.
  5. Dating. Date went really well on Sunday and am seeing the girl again on Friday!
  6. Tarot. No session this week
  7. Socializing: feeling a bit overbooked with social events, so aiming to cut back a little bit. I've had a dinner or hang out every night this week and it's just been way too much.
  8. Screen time: 1.33 hours phone again. Definitely noticing a very strong relationship between screen time and energy levels.
  9. Mental health: feeling very tired but also very wired which is not good.

How goes it @FtttG, @self_made_human @birb_cromble @falling-star @Tollund_Man4 ?

The Paper B gave me enough cardio for a year, once you account for exam anxiety, the fucking fire alarm going off, and the long, long walk back home.

You know what? I'm going to do a bunch of push-ups. Right now. T-5 minutes. I'm going to be worked to the bone this week, but if I don't go to the gym next week, I should be yelled at.

Current spending is $665.18 lower than it was on the same day last year.

I have two big expenses (car insurance and the second half of my home repair bill) coming up, so I expect to overshoot again in the next eight weeks. In the meantime, I'm going to try to keep spending down to mitigate that.

FYI it's birB_crombLe. And I assume you meant to post this in this week's thread.

  • Had an idea for a blog post which I intend to write the first draft of this evening.
  • Went to the gym three times last week. Yesterday I did a 5k run on my lunch break, then went to the gym in the evening. I intended to do deadlifts, but found my lower back was bothering me too much, so I did bench press instead. After years of my herniated disc bothering me on my lower right side, the pain now seems to have migrated to my lower left side. Then on other days (like today) it returns to the lower right. Very strange. I need to get into the habit of doing lower back stretches several times a day even when I really don't feel like it. Can deadlift 1.84x my bodyweight for 3 reps, squat 1.22x for 8 reps and bench press .87x for 6 reps.
  • Have not consumed any pornography since waking up on January 1st.

Sigh.

I went to a speed dating event that wasn't the one that checks vaccination status. It's been a year, the last time I tried one I ran into a bit of "men are all such trash, amirite?" and one woman who'd been to multiple events and was annoyed she kept on seeing the same guys. I didn't tell her maybe those guys are also disappointed to see her again. Obviously I didn't match with anyone, no shock, not much disappointment.

This time the most political thing I encountered was someone being an anti-nuclear de-growth-er. So no real complaint on that end.

I also had that same feeling I get when I go to a gamestore or some other geek event: "I'm the coolest guy here. That is not a good sign." A lot of lumpy faces and bad haircuts.
Three good conversations, three fine ones, and three eh ones.

After the event, two of my good conversations stopped me to chat. Apparently I was the "most normal" guy they'd talked to, my conversations were great. Also mentioned one guy who got way too handsy; including thigh touching. According to the bartender he's a frequent flier. So either he's not being reported, or the organizers have a high threshold for banning.

And of course, even with that tier of competition, no matches for me. My suspicion that no one ever actually winds up meeting anyone at these events is nigh-confirmed. I don't know why women even bother going to these if even the "best" guy there is apparently insufficient.

Another mildly interesting note was two women both mentioning being in a book club and being fatigued/annoyed that every book was smutty. Typically bringing up books gets me the JKR is a Disgusting Bigot line.

From far away, this sounds like a decent result. Not ideal, obviously, but way better than the last speed dating event I went to. It sounds like it's worth going a few more times FWIW.

The lack of "Men Are All Such Trash Amirite?" was reassuring, but I've gotten pretty tired of hearing how great I am and still not being deemed worthy. Feels like being called a Nice Guy, and that's just 2012 all over again.

I get that. To me it seems you at least have an opening, and a few more visits might produce either a girl who's organically interested in you, or enough practice/experience to get out of the Nice Guy filter.

Does it make sense to eat lysine made for farm animals in case of poverty? Some of mixes contain only 50% lysine but for fixing aminoacid imblanace high purity (pills) is not needed, and seems to be an improvement made to justify high price.

Are you not eating complete proteins? Even vegans get plenty of lysine from soy.

I don't get what is "complete" protein. I eat too much bread because of cost and general unwillingness to cook. Soy is somewhat difficult to buy here, I also don't want to cook from soy flour and I dislike taste of tofu

Once you get above the age of 30 your body really knows when it is eating healthy unprocessed foods and when it is not. You can cook very hearty meals that are still made from mostly unprocessed ingredients that are really good for you. Better performance at mental and physical tasks are just the start.

If you have the time, I highly recommend learning to cook. You will save money, improve your health, and learn a skill valued by everyone around you (might be culture dependent, YMMV).

A complete protein has all the amino acids your body cannot create itself from base ingredients like the glucose in bread. Prolonged deprivation of complete proteins will weaken your body and mind. The good news is that you can get complete protein meals easily by eating meat, milk, or eggs. Air fryer steaks, drink milk, boil eggs. Very easy to do, tasty, but more expensive.

You can also do this as a vegetarian but it takes more effort and you will need to invest more time learning to cook. Beans need soaking, vegetables need washing and cutting, etc. It can work well but needs some attention to pairing complementary sources of amino acids, like beans and rice.

Some nutrients are not absorbed well in human digestion in pill form. There may be genetic variance and/or gut microbiome issues with taking concentrated vitamin or amino acid pills. You may try to compensate for poor nutrient absorption by overdosing and risk poisoning yourself.

The reliable way to get nutrients is to eat real food cooked yourself so you can be assured of the taste and quality. There is no shortcut here, unless you have a trusted family member prepare food for you.

I was lucky enough to have my mom prepare home cooked meals for me growing up. I didn't understand that I was lucky until I lived alone and ate a lot of empty starch like bread and instant noodles. I permanently ruined my health doing a few years of this until I learned to cook a little bit. I just tried to poorly imitate some of my mom's simpler meals at first, but gradually developed my own style.

If cost is an issue, you should pay attention to weekly supermarket ads which usually have a rotating selection of discounted but fresh meats. You can use plastic freezer bags to buy meat cheaply in bulk and save it for cooking later.

You can also do this as a vegetarian but it takes more effort. Beans need soaking, vegetables need washing and cutting, etc. It can work well but needs some attention to pairing complementary sources of amino acids, like beans and rice.

Soy, dairy, and eggs are complete proteins and require next to no effort to prepare.

He said there was no access to soy nearby. Dairy was expensive? And eggs were insufficient?

You mentioned dairy and eggs in the previous paragraph, so it seems fair to point out.

Oh yeah I did. I noticed after posting he said in a different comment chain that dairy was too expensive but at least the ants avoided it and that the eggs were not enough.

I have to believe this is some kind of troll at this point though, I don't think any real person seriously considers eating only bread and livestock lysine pills as a reasonable and thrifty way to live. But in the remote chance this isn't a troll then it's good we encourage him not to accidentally kill himself from radical nutrition lifehacks.

I guess there was always some guy eating weird things to test them as safe for everyone else, or else human society would not enjoy the unusual and tasty things we have today. Look at this mushroom Trog, it's totally tasty and not poisonous at all! Avoid those green ones though.

I live in Russia and i'm poor. Nowhere i said that i conisered eating only bread, thought there are such days ocasionally. Livestock doesn't get lysine pills, they get lysine supplements in other cheaper form.

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It'd be much better to learn to earn money. I don't like steaks. Evenmore, all meat products became untasty and rot very fast, so I can't cook for 1-2 days and be done with it.

The reliable way to get nutrients is to eat real food cooked yourself so you can be assured of the taste and quality. There is no shortcut here, unless you have a trusted family member prepare food for you.

That sounds funny.

Some nutrients are not absorbed well in human digestion in pill form.

Does this have something to do with lysine?

you should pay attention to weekly supermarket ads

oh no, more attention... and i have no working freezer.

Evenmore, all meat products became untasty and rot very fast, so I can't cook for 1-2 days and be done with it.

Sous vide is your friend. While it shines for proteins for a small investment of 120$ (decent circulator+ vacuum) allows you to precook prodigious amounts of food that afterwards stays without spoiling in the fridge for months - almost anything you could cook is well beyond 7d pasteurization.

Sorry, I assumed you were employed already but short on time. Learning to earn money is also a high priority.

Pre-cut meat products do expire quickly, but they usually last in the chilled portion of the fridge around 3-5 days at optimal freshness, unless the source is bad. National US supermarket chains without in-store butchers (centralized slaughterhouses) have problems with quickly expiring meat. I cook beef and chicken with only salt added and no spicing, so meat close to spoiling is easier to detect.

Without a working freezer, your options for saving money on food by taking advantage of deals is much more limited. You also will have difficulty storing precooked meals and raw ingredients, so I understand your difficulties.

Are you renting or owning a home independently? Or is it a situation where you are renting a room from a live-in landlord, who limits your kitchen use and freezer use as part of your rental contract? I have done the latter, and as a student with just a room you still have options.

The very best no-cooking heat allowed option is whey protein shakes. I am lactose intolerant so I used to mix my shakes with lactose-free milk and took lactase pills. You can mix whey with plain water too, it just tastes much worse. Whey protein is arguably superior to meat, the somewhat unpleasant taste of unflavored whey is the main hurdle. You can buy big 5 lb jugs of flavored or unflavored whey protein online and search for the best deals. You mix protein shakes with water in a blender bottle, or a cup and a fork if you can tolerate lumpy clumps of unmixed powdered whey. Whey shakes are a complete protein and extremely satiating, you will have no problems with hunger. Cost-wise whey may seem more expensive than bread but you need much less whey to feel satisfied so it may be a cost savings depending how much you are spending on bread.

What kind of bread are you currently buying? US supermarket presliced white bread? Or are you a customer of a local bakery? How much are you spending on bread every week?

And on the poor human gut absorption of vitamins and amino acids in pill form, I mention it not specifically about your intended lysine use but for nutrition in general. It may or may not apply to lysine, I don't know about that. I only know that bodybuilders usually dislike "wasting" time on cooking but even they will not use single amino acids pills for nutrition because it delivers suboptimal results at best, and in the worst-case scenario you will find yourself paying an expensive ambulance and emergency room medical bill.

A complete protein is one that has all essential amino acids in reasonable supply.

Are you mostly eating bread? No meat, no dairy, no eggs, no buckwheat or quinoa?

Word "reasonable" is doing heavily lifting here. I eat eggs but this isn't enough. Diary has a problem that it's expensive and also usually comes in packaging that cannot be recycled, i don't like that. (on the good side, ants don't like milk) I eat a lot of buckwheat, but cereals are quite lysine deficient so to get balanced i should eat more buckwheat than cereals.

Are you living in the US? Dairy is relatively cheap here, not subject to sales tax, and likely subsidized in the form of input feed subsidies.

Zepbound Diaries: 25 Shots in Edition

Last Friday was my 25th Zepbound injection according to my tracker, and my first on a 10mg dose. I've gotta say going from 7.5 to 10 was a bigger adjustment than I'd expected, I went from 2.5 to 5 to 7.5 pretty much without any issues but 10 had me feeling run-down and perpetually semi-nauseous for about 3 days. Unpleasant for sure, but not really that bad as these things go. Similar to a mild flu I'd say, especially when combined with seasonal allergies which has led to much sneezing and dripping to my coworkers' exasperated amusement. To provide a brief recap:

Sex: Male
Age: 29
Height: 71.25"
Starting Weight: 278.0lbs
Goal Weight: 200lbs
Starting BMI: 38.8

Insurance has been generally fairly cooperative with my prescription aside from one minor kerfuffle when they switched up how they wanted my Doctor to send my prescription in which resulted in me missing an injection. They twisted my arm to get me to switch to 3-month prescriptions instead of 1-month prescriptions, but my 3-month cost is $25, same as my 1-month cost was, which I'll admit is slightly confusing but I'm not going to complain.

As of Sunday morning I weighed 231.0lbs. Since beginning Zepbound 6 months ago I've lost 47lbs and I have every confidence I'll drop below 230 in the next week or two bringing my total to 50lbs. I have a current BMI of 32.2, putting me firmly in the middle of Obese Class I, meaning that without much fanfare I have de-prestiged from Level 3 Fat to a mere Level 2 Fat.

In terms of side-effects, the nausea is mildly irritating. Before starting Zepbound I prided myself on having an iron stomach. Pretty much the only thing that could get me to puke was sticking a finger down my throat and doing it on purpose after an overly exuberant night of drinking. Smells didn't do it, gross sights didn't do it, I either made myself puke or I didn't puke. These days having an extra bite of dinner on injection day is enough to send me sprinting to the sink. Fortunately I'm getting much better about eating slower and actually listening when my stomach says "fuck off we're full" so these incidents are few and far between. Also, tragically, hair loss. Possibly a function of age as I'm getting to about that point in my life, but I have my mom's hair and her side of the family never suffered from male pattern baldness, so I'm calling it a side-effect. Not super noticeable yet, but definitely some thinning on the peak. I'm hoping it comes back when the weight loss slows down, but if it doesn't oh well. Plenty of guys can pull off bald but you know what helps you pull off any look? Not being fat.

On the non-scale victories front, a friend commented that I looked thinner, and specifically called out my face as looking significantly slimmer. I thanked him politely and tried not to show that the little fat kid inside me was doing cartwheels and shouting "yippie!" because that is Simply Not Done.

All in all, I'm deliriously happy. I'm losing weight. I'm not a grossly obese fuck anymore, I'm a merely obese fuck. Progress.

47 pounds in 6 months is genuinely impressive. The BMI comment is interesting though because at your starting weight BMI was already a pretty blunt instrument. Once you get closer to your goal weight the more useful question becomes what your actual body composition looks like rather than just the number on the scale. A lot of people hit their target weight and still feel off because they lost muscle along the way without realizing it.

How is your skin handling this weight loss? Any unsightly folds yet?

What do you plan to do after you reach your target weight?

No folds no, so far everything seems fine. If it comes down to it I'll look into surgery, though I've heard insurance approvals for that not only take time but are a pain in the ass.

After I reach my target weight, I'll probably either stay on whatever dose I'm on or go down a dose for maintenance.

FWIW, I've had similar results doing it the ghetto way, aka. Chinese peptides, 16 weeks in. I more or less followed this article and went with retatrutide from a vendor that was cheap but had reasonably good test results from those who'd submitted them. I've probably saved what I spent on it ($250 for a 6-month supply. Having to pay with crypto was annoying to my non-crypto using self, but not a dealbreaker.) from cutting my grocery/takeout budget (I don't know about my bar budget. I'd say I've been drinking less/going out less frequently but it's still easy to spend money in a hurry when I do go out.).

As far as side effects go, I've had mild nausea/heartburn at times, not so much at the time I've eaten something, but more from waking up in the morning still full. Hangovers have been rough, but it's hard to disentangle side effect from just drinking on an empty stomach. The main negative I'd say is that there's some substance to the FUD about increased heart rate. It was noticeable and irritating for the first two months, not so much since then, and the last time I took my blood pressure it was okay/as expected if not great: 132/80 at a BMI of 27 (I really have to be careful about my weight when it comes to blood pressure. It starts going up quickly if I allow myself to become overweight at all.). Other side effects have been to be expected with a fairly aggressive calorie deficit, a lack of energy and being cold AF most of the time (I keep my place at 76F and my boss likes it at 68-70F at the office, so I'll be that guy wearing a jacket inside during a Southern summer.).

Note, due to a math error I started off on a higher dose than intended, 4mg for the first two months instead of 3mg. Since, I've increased the dose slower than indicated by OP's graph, going with 5mg instead of 6 for the third month and 7.5 instead of 9 for the fourth month. In hindsight I'd have started out with a lower dose and escalated more slowly instead of being sloppy and impatient so I wouldn't have been so tired.

I've bounced between 190 and 225 since my mid 20s but started this at 235lbs (went from a semi-physical job to being a desk jockey at a trucking company and put on 20lbs in ~6 months). Roughly 16 weeks in (I skipped a week two months in due to being sick AF.) I've lost 45lbs. My goal for now is to get back to my college weight, 170. Maybe I'll go for 160; I'm not overly muscular or particularly active so there's no reason to lie about muscle that isn't there.

On another twitter rumor, reta hasn't been a magical "not an addict" shot. Being allowed to vape in the office is still my favorite perk on the job, as is the free Diet Mountain Dew. On the other hand I've been drinking less, though I'm not sure how much of that is the shot versus being thoroughly bored with the crowd at my usual bar and/or busy at work for the last few months. My patience for being at the bar and not entertained has been very low as of late.

On another twitter rumor, reta hasn't been a magical "not an addict" shot.

I know people are exploring GLP-1s for this as well, but I've had a similar experience with Zepbound. I still start my nicotine habit each morning around 7am with a double-lipper of zyn and refresh as needed throughout the day.

Going from 14% to 25% body fat while the scale barely moves is exactly why weight alone tells you so little. Losing it gradually over 6 months is the right call, anything faster and you end up losing muscle along with the fat which just makes the composition worse in the long run.

My head hurts. Been sick all week. But I got my chapter written, so my work week is done, and I fly out for my honeymoon tomorrow, so all I've got to do is pack. All looking up from here. Going on an Alaska cruise. Excited.

Congrats! Cruises are awesome. May you have many years.

I suspect that I'm having a depressive relapse after a month or two of genuine euthymia. No surprise that coincides with a return to work and exam grind. My workload is probably 3-10 times what it was on my first rotation. I used to get bored during my shifts. Now I barely have a moment to park my ass, and the other doctors and I have to draw straws to decide who gets to have lunch first. I used to have the time to (at least in theory) revise my notes during working hours or browse the internet. Right now my phone is helpfully noting that I've reduced my screen time by a remarkable margin.

Is this going to get better? Hah. Haha. Hahahaha. This is going to be my life for the next 5 months, no relief from the pain. I am under-medicated for my ADHD. I have worsening migraines. I leave work wanting nothing more than to crawl into bed and stay there.

What clinched the self-diagnosis was sighing. Literal, audible sighing. The last time I was properly depressed, a junior colleague clocked this tell before I did, which surprised me, since I thought I was hiding things well. The literature, predictably, confirms a correlation. (The body keeps the score and occasionally narrates it out loud.) I caught myself doing it yesterday. Then an intern asked me why I was sighing.

@ToaKraka was kind enough to link to the PHQ-9 screening questionnaire lower in the thread. One glance at it made me wince, I didn't have to add up the numbers to know it didn't look good for me.

The good news is that Paper B pressure lifts next week, possibly forever if I pass. I have never failed an exam in my life. That fact is a load-bearing pillar of my self-esteem, and I am aware of how that sentence sounds coming from a psychiatry resident. I'm willing to risk the burnout. The exam has to be cleared eventually, deferring wouldn't buy me study time anyway, and a pass earns me twelve to eighteen months of academic reprieve. The workload stays the same. This is the only consideration keeping me from filing the current monomaniacal focus under "obviously irrational."

Apparently, around 20% of psychiatry residents experience burnout or depression. Lovely. Glad to have good company. I know the pharmacological management of depression like the back of my hand.

Before anyone panics, I'm going to talk to my GP, and warn her that I might need to see a psychiatrist. The last time I did this was slightly awkward, given that I knew precisely what she would suggest before she said it, and she was kind enough to treat me like a fellow professional and go off my self-assessment. I know precisely what to do if it gets too bad to bear.

Let's hope it's just exam stress. Being fully honest, that's not likely to be the case. But it'll help, on the margin. But tripling my stimulant dose?* Proper migraine prophylaxis? More optimism on that front. And I know the NICE referral pathways well enough to demand that I get something more immediate and robust than another course of Standard Antidepressant.

*What a fucking joke. The ADHD assessment and treatment pathway is designed to weed out 90% of people with ADHD before they see an actual psychiatrist. At least if you don't spend a third of a month's wages on a private assessment and consultation. I fell off that wagon because of... depression and ADHD. Getting back on it will be either time consuming or expensive, and I'll take the latter any day of the week.

Oh well. At least I'm not a gynecologist. Gotta look at the bright side of things.

In my experience with ADHD medicine/stimulants (both adderall and lisdexamfetamine) there was a terrifying drop off in efficacy / tolerance level increase after a very short time.

This was around Covid and there was some kind of shortage, so I got prescribed 40s of Elvanse (lisdex) and told to halve them. That was incredible for like 2 weeks. Then I had to take the whole pill. After another 3 weeks, even that stated to fade. That’s around when I quit. From time to time when I need to do long, uninterrupted, boring work I take one, and it works well, but I never do it more than three days in a row for the reason above.

Do they really work for you daily, years on end?

Do they really work for you daily, years on end?

For 90% of my life, I never had to take them daily. Back in India, I'd normally use my methylphenidate SR infrequently, and take a sustained course only before my exams or when I had to study. I'll do anything but open a textbook when not on medication, and even then, it takes a lot of willpower to not end up procrastinating. It's not a coincidence that my Motte-posting goes up drastically around then.

That changed in the UK. I thought I could work unmedicated and save it for my professional exams. No luck. I need something like 20mg of methylphenidate SR just to keep myself going through a 9-5. Then I might need 20-50mg to get studying done on days when I'm not working. I find it borderline impossible to study at all after a full day's work.

When I'm taking methylphenidate at a stretch, over 4-6 months almost daily (as I have done for serious exams in the past)? I think there's an escalation from 20mg a day to 40mg a day over that period, which isn't that significant. And when the exam is over, I get a long drug holiday which resets any tolerance.

I was switched to dextroamphetamine (IR) last year, which is much, much easier to tolerate for me. I was being titrated up, and I was only on my second month and 5mg twice daily when I fell off the train and stopped seeing my psychiatrist. Because I was depressed. Because that's the sensible thing to do when you're getting depressed, of course. Stupidity induced by sickness aside, 10mg a day is a modest dose, and I expect that I'd have gotten up to something much higher by now.

So tolerance hasn't been a serious issue for me, or at least I never seem to get to the point where it's inadvisable to increase doses. The methylphenidate fucking sucked, so I didn't even want to increase the dose.

You probably know the usual advice: drug holidays. If you have a more experimental psych, they might be willing to swap you around between different drugs so that you never become entirely tolerant (I don't remember the degree of cross-tolerance, but methylphenidate and amphetamines have somewhat different mechanisms of action).

There's personal idiosyncracy involved, but in general, most adults on ADHD meds settle down to a steady-state and can keep it that way. It sounds like you're unlucky in having unusually fast tolerance buildup.

In retrospect you ever think you’d have chosen a different career path entirely? The front lines of health and medicine always had zero appeal to me. I definitely have my preferred path I would’ve chosen, except for the fact that the industry hadn’t matured and established such that there was a viable and well defined path at the time I’d have come of age to first begin pursuing it in higher education.

Is it possible for you to pivot to a psychiatric modality that’s less straining on you mentally? When I read the DSM-IV several years ago, that alone was enough to give me a mental illness. How do you feel about the people who say psychiatry is a fraudulent, applied science in the first place?

In retrospect you ever think you’d have chosen a different career path entirely?

Not really. I entered med school because that was the default expectation, and I couldn't think of better alternatives (I was nudged, not forced into it). I discovered I genuinely like psychiatry as a subject, whereas I genuinely loathe most other branches, particularly internal medicine or surgery. Not for me.

In hindsight, I discovered I do like programming a little. But I found this out too late, and I wouldn't have been brave enough to choose that after high school. It possibly would have been a bad choice for me.

I think perhaps like you albeit at a younger age I just wasn’t mentally prepared for it; and having the right attitude and perspective is a huge part in being able to make it in various disciplines and when you’re up against challenges.

I don't know about mental fortitude on my end dawg. My ADHD diagnosis is not fake. It just didn't exist then, nor did I receive any medication. It's not like I manifested a work-ethic and appreciation for higher education of my own volition, I just found out that the drugs solved problems that nothing else could.

Is it possible for you to pivot to a psychiatric modality that’s less straining on you mentally?

Yes, but you need to remember that I'm a psychiatry resident. I don't get to choose what I do or where I go for the next 2 or 3 years. This placement is unusually awful, and I can't just tell them they need to send me elsewhere. I am optimistic that after 5 months, I'll be somewhere much, much quieter.

I expect that if/when I'm more senior, and as @Throwaway05 suggests, more experienced, it won't be so bad. I have a decent idea of what I'd like to do (General Adult psychiatry, probably). That is a long time away. The British system is retarded.

When I read the DSM-IV several years ago, that alone was enough to give me a mental illness.

I've only read the V. And the ICD-10 and 11. Sorry for being a poser. Don't worry, memorizing them gave me mental illnesses too, or at least made my existing ones worse.

How do you feel about the people who say psychiatry is a fraudulent, applied science in the first place?

I diagnose them with moderate to severe intellectual disability. Or I would, if I could. Instead, I ignore them, and feel glad about the fact that 99% of people don't have such awful takes. There's plenty of room for critique of psychiatry, which I have done myself, but it's not a fraud. I treat sensible criticism with respect.

I could have sworn you said something about The Motte overuse when on ADHD meds, but I can't find it again, so just saying this here. I have found success using LeechBlock NG extension on my PC (especially Lockdown Mode), and the StayFocused app on my phone (which does have a small monthly subscription fee).

Thank you for advice, I do appreciate it. But I will say that my Motte use is a hobby and, in a very real sense, a coping mechanism.

Let's say I've had a really, really bad time before my exams. I've been taking more stimulants than I can tolerate. They're wearing off, and my focus is gone. Or I'm waiting for the next dose to kick back in. This is dead time. I can't study. Instead, I could be using Twitter or Discord. I'd rather be here. I get to talk about interesting things with interesting people. I write about what's going on, which is in part a letter to ny future self. I hope that pain and suffering converts to some degree of amusement for my readers, someone ought to be laughing after all.

And guess what? Half of what I write about is psychiatry. I love psychiatry. I just don't like the way it's taught or trained in the UK. This gives me a small fig leaf. I can pretend that I'm being semi-productive. Maybe some if it is genuinely productive

But without truly draconian steps, being on the Motte is good for me. It's where the people cheering me on live.

I know what residency is, I’m just loosely thinking about your career trajectory more broadly. Residency can’t be pretty brutal, sorry to hear what you’re going through.

I haven’t read the ICD-10. My mother was a homemaker all her life but her small library was filled to the brim with a lot of medical literature that she liked to read and study about (for some reason). Occasionally I picked things up here and there.

But don’t be down on yourself to think you didn’t have the bravery to go into programming when you entered fucking medical school. Passion is what allows you to endure and if you’re going through that, you’re a very capable guy. My like of healthcare as a subject matter rests at the floor. I couldn’t do what you’re doing.

I diagnose them with moderate to severe intellectual disability.

Hahahahaha.

Instead, I ignore them, and feel glad about the fact that 99% of people don't have such awful takes. There's plenty of room for critique of psychiatry, which I have done myself, but it's not a fraud. I treat sensible criticism with respect.

There’s actually quite a sizable minority of people in the US that truly believe that. Maybe it’s the case that psychiatrists over-diagnose people(?); don’t know. I’ve never seen one. A lot of people seem to think psychiatrists are just glorified counselors that deal drugs. I don’t know if it’s still a common practice to think you can establish a working hypothesis on someone in 15 minutes. That seems completely absurd to me. But I’d take your word on the matter as a psychiatrist over mine any day of the week.

Really hope you do well.

I understand residency, I’m just loosely thinking about your career trajectory more broadly. Residency can’t be pretty brutal, sorry to hear what you’re going through.

Thank you. Yeah, it can be an uphill struggle. But when I feel like crying myself to sleep, I remind myself I didn't become an OBGYN resident and the smiles sort themselves out. Psychiatry is probably the least taxing? I don't know, maybe the Public Health or Occupational Medicine people sleep at their cubicle all day.

But don’t be down on yourself to think you didn’t have the bravery to go into programming when you entered fucking medical school. Passion is what allows you to endure and if you’re going through that, you’re a very capable guy. My like of healthcare as a subject matter rests at the floor. I couldn’t do what you’re doing.

Very kind of you to say. I will note that being a programmer in India is not a good time. The opposite even. If I'd grown up in the States, maybe I'd have been more open to the idea, but life is what it is. I even seriously considered a career pivot and was grinding MIT OCW and Leetcode (I did one medium successfully!) before I matched into psych, but I desisted when I realized that GPT-4 was better than me and would stay that way. Good call. I'd be so screwed right now.

I haven’t read the ICD-10. My mother was a homemaker all her life but her small library was filled to the brim with a lot of medical literature that she liked to read and study about (for some reason).

Goodness. I only read that stuff because I'm paid to. Tell her it's not too late to become a shrink, I've seen junior doctors in their late 40s in the UK. Why do all of that for free?

There’s actually quite a sizable minority of people in the US that truly believe that. Maybe it’s the case that psychiatrists over-diagnose people(?); don’t know. I’ve never seen one. A lot of people seem to think psychiatrists are just glorified counselors that deal drugs. I don’t know if it’s still a common practice to think you can establish a working hypothesis on someone in 15 minutes. That seems completely absurd to me. But I’d take your word on the matter as a psychiatrist over mine any day of the week.

Psychiatrists both overdiagnose and underdiagnose people. We misdiagnose people too. We're only human. Some of us are better than others (for example, I'm worse). It depends on a lot of considerations, and most importantly, we don't really have blood tests for depression or a brain scan we can do to declare schizophrenia. You have to consider all kinds of nitty-gritty details like the tradeoff between sensitivity and specificity, ROCs, cost-benefit analyses etc, inter-rater validity for diagnoses etc. But there is no obvious rampant abuse where I can see it.

Really hope you do well.

Thank you! So do I :(

But when I feel like crying myself to sleep, I remind myself I didn't become an OBGYN resident and the smiles sort themselves out. Psychiatry is probably the least taxing? I don't know, maybe the Public Health or Occupational Medicine people sleep at their cubicle all day.

It’s an attitude that certainly helps. I won’t say I was ever strongly interested in psychiatry per se, but one thing I always paid attention to in my intellectual development was publishing houses and the topics they often target. I was obsessed several years ago by reading a lot of what came out of Guilford Press and read a concise copy of the DSM-IV that was really popular. I loved it and it caused me to go into a real deep dive into that world for a few weeks before I moved onto other topics.

… being a programmer in India is not a good time. The opposite even.

Any reason why?

If I'd grown up in the States, maybe I'd have been more open to the idea, but life is what it is. I even seriously considered a career pivot and was grinding MIT OCW and Leetcode (I did one medium successfully!) before I matched into psych, but I desisted when I realized that GPT-4 was better than me and would stay that way. Good call. I'd be so screwed right now.

Indeed. The tech sector is getting crushed quite badly from what my friends are experiencing right now. And they are ‘not’ fans of the whole AI thing at all. I know how to code here and there but as far as large-scale enterprise projects, yeah; no. I don’t want that on my shoulders. I’m content being a fully middle of the road kind of guy. Mentally I could handle that kind of pressure. I’ve always had the grit to face down stress and pain, but it doesn’t mean I enjoy it. I hate it as much as anyone else does.

Goodness. I only read that stuff because I'm paid to. Tell her it's not too late to become a shrink, I've seen junior doctors in their late 40s in the UK. Why do all of that for free?

I think she just had a passion for that stuff, the same one that I’m lacking to go into a field like that. She’s deceased now but when I was a kid all throughout life she’d be keeping up with that stuff. I only read a fraction of it in broad strokes.

Psychiatrists both overdiagnose and underdiagnose people. We misdiagnose people too. We're only human. Some of us are better than others (for example, I'm worse). It depends on a lot of considerations, and most importantly, we don't really have blood tests for depression or a brain scan we can do to declare schizophrenia. You have to consider all kinds of nitty-gritty details like the tradeoff between sensitivity and specificity, ROCs, cost-benefit analyses etc, inter-rater validity for diagnoses etc. But there is no obvious rampant abuse where I can see it.

Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis? I still imagine there’s a rigorous process in place that’s more than just professional guesswork (although I’m sure sometimes it seems that way, it’s multidimensional).

Do you think it’s possible to have something like blood tests for depression in the future? I’ve read quite a lot on Behavioral Genetics (not trying to get far away from psychiatry) but is it possible there will ever be a cross-disciplinary convergence where psychiatry may be subsumed into some greater branch of genetics? When I read studies about how divorce is heritable (or rather it shares a strong genetic link) or just how strongly our biology determines personality and behavior, it’s startling at times. Especially if parenting really doesn’t matter all that much, then maybe fields like psychiatry and pharmacotherapy or pharmacogenomics may dominate the healthcare of the future. Fascinating to me.

Thank you! So do I :(

You got this, 😤 ❤️ 👊.

Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis?

Oh boy. This is a long and tough topic. So Medicine is hard. Some people get that some people don't but it needs to be carefully examined.

Some questions are harder than you think, and we don't realize it because we take so much for granted.

So like what is a disease anyway? What is sepsis?

The later is a question still under investigation even though treating sepsis is a core hospital task.

What about a run of the mill bacteria infection? Well turns out usually we are just pattern matching or guessing based off of what died to the antibiotic. An actual culture is useless or impossible most of the time. Spirochetes took forever to identify because splashing shit with these colors we usually use didn't work (yes that's what we do! Random dye!).

A lot of stuff might be an infection and we just don't know yet because who knows what caused it. It's a miracle we figure out prions existed for instance.

So sewing and cutting and surgery is great and all but the noodly thinking bits are an important and interesting part of medicine. Cue nosology.

But you asked about psychiatry though.

That's a further complicated question. The brain is like the most complicated thing in existence, and mental health is the most complicated and multifactorial aspect of medicine.

The specifics become specific, it is why doctors have jobs after all. Some diseases have neuro-chemical markers, brain imaging findings, genetic components and other "hard stuff." This is evolving and of unclear clinical significance.

Sometimes we go off what facilitates communication - depression is hard to define. If everyone including the patients agrees what depression is then you've found it. Sometimes this becomes a cultural negotiation.

Sometimes clinical response is king - if it looks like a duck and quacks like a duck and gets slaughtered by medication like a duck then you got it.

To TLDR it - explaining the specifics of a diagnosis in a thorough way is easy to convey to people in the field who have a shared assumption base, but to people outside of it a lot will be lost in translation and it can look like some stupid questionnaire defines everything.

The rigor isn't what we want but it's more than you fear.

Thanks for showing up. I suppose you can still sympathize with an early-career sod like me, and I'm grateful for that. Now all we need is @reo for the senior psychiatrist take. Don't let the team down dawg!

there are so many replies that i got confused as to where to place this. so i just wrote about the philosophy of medicine, as i understand.

Medicine is the only field where the tool and the patient are the same kind of things - one complex human system meeting another complex human system. That is not a limitation, which needs to be overcome. It is precisely the practice.

Medicine is basically a field where no single model is complete, and the models are always being revised.

By model, i mean it is a simplified picture of how something is or how it works. And it is useful exactly because it leaves things out. Doctors are a special kind of cartographers trying to build up better and better maps to different types of territories.

How do we build those? We started with dissecting the human body, of a cadaver precisely not alive human. Some of us had experience with dissecting a frog or cockroaches (plenty a dime at my place). if you have never seen an open frog, you would be very surprised how much empty it really is. so we cut open a cadaver slowly, methodically, and matched with the photographs in an accompanying manual. we did what it asked us to do, and we continued to match and understand the specific naming systems. the naming systems and particular language are a new language which we learnt so that we can read and talk through that new language with other doctors and nurses and be sure what we are trying to convey is correctly and unambiguously understood by them. and we use it to read books, articles, journals, all life.

Over time, we got comfortable building those new language and mental models of how some particular structure in body is seen and how it is expected to be at a certain place only and not at some other place. Then we shifted to not normal stuff aka pathology. Those normal structures - how can they go wrong. so that knowledge was built upon multiple such cuttings of not-normal structures. We built branches over our normal mental models. eg. the stomach model has this normal model and these abnormal models (which can be of a huge variety).

We also pattern matched these newer not-normal models to find patterns across multiple structures and systems. So, we found Infection Models work reasonably well across the Stomach model, Liver model, Kidney model, etc. This all works pretty well for most of the structures.

Except the brain system. The system is completely different from all other systems. For example, it has a different way of blood supply. Which we named blood-brain-barrier (just a model to say that there is some kind of barrier to normal passage of stuff between the brain tissue and blood).

Over time, more correctly in only last few decades, we have started to see the brain in exquisite detail live and we have been able to have some understanding of which side and which parts of it do what (or get active doing some particular activity).

So for brain things, the models are relatively new and they have to be assessed in terms of what the patient says about his problems, how we are able to see what is happening, what we give (by trial and error) and how it affects the patients. we keep on doing it, write the entire process and revise it more and more. since it is a relatively new field, there are lot of competing what-to-do models, including non-medicinal models and medicine-models. we have done lot of experimental stuff to name all the various little parts of all these models (namely the little chemicals which go to and fro), but they are mostly arbitrary. imo, we are a long way from deep understanding.

The brain has a different problem too. The structure of brain and the function of brain are very disjointed categories. like if you are reading this line, a combination of light pattern goes from this LED to your eyeball, to a functioning wire connecting the back of the eyeball to back of your brain, and then it lights up a particular set of other wires, which are criss-crossed across lot of other brain parts. This is just this little reading line. add the memory of this particular style of light pattern with what it means. now build upon this layer of complexity to what things are normal (the normal model). what things are out of normal (huge number of other not-normal models). and what-to-do models about all those.

When someone thinks of DSM as some sort of fixed written well defined set of maps, i think it is a wrong idea - it is like confusing the map with the territory. IMO, it is a good (at present) way to have a comprehensive set of loose maps. and it will be revised as our understanding gets better, sometimes worse before getting better. sometimes, there will be paradigm shifts.

Same with the genetics parts: yes, those are some newer models, in which we pattern-matched some particular sequences with some disease patterns, because we found few which were absolutely always associated with one particular way of the patient's model of behavior (we call them sure-shot way to label a model). and at other times, it was just found to be more common (we call them more or less probable ways of having a particular set of problem model).

But my base understanding is: Medicine is an interactive playing of what patient shows up, what lenses the doctors have, what models are used to try to change the course of patient's behavior and how it can help in changing the course. At times, it is as simple to sit and listen to the patient and the doctor needs to lend the ear and hold the hand. And at other times, it is a full fledged active working of doctor, a nurse, and 3 attendants to tie the patient and give a sleeping medicine.

So, given how much of this is model-stacking on model-stacking, where does the irreducible human encounter fit? I don't think it as a failure of science, but as the thing which makes medicine medicine and not engineering.

Well differential diagnosis is always a struggle to deal with because symptoms may be compatible with a handful of underlying conditions. Common symptoms are also more often than not precursors to more narrowly defined symptoms that can be isolated to a diagnosis. Medicine is a hugely multifactorial discipline and it’s understandable why seemingly simple things involve a complex decision making process. Seems like it’s still messy enough that a lot of it is educated guesswork. How much would you say the average person takes for granted that particular matters are “settled” as far as concepts like “health,” and “disease,” go and that these debates don’t exist behind closed doors between doctors? In other words do these disagreements and debates only belong to relative edge cases or is it pretty widespread across ailments?

Do physicians generally “know” or feel with a high degree of confidence when they’ve correctly zeroed in on what the problem is? I’m just imagining the mental flowchart-like references to chasing a problem down isn’t actually that much different from a mechanic who chases down the chain of failure in a car, or a technician who’s chasing down a motherboard failure on a laptop. By what clinical standard do absurd ideas like Drapetomania, or genetic feeblemindedness, or pathological altruism fail to pass scrutiny? Is it simply because our culture doesn’t legitimize such assumptions?

One book I loved reading years ago was Atul Gawande’s Checklist Manifesto, and it was striking how it effective it’s been proven in medical settings. It’s a great thing to have in a discipline that involves some of the most complex pattern matching capabilities needed that are known to man.

Also, why was it a miracle prions were discovered?

Do physicians generally “know” or feel with a high degree of confidence when they’ve correctly zeroed in on what the problem is?

It depends on the thing, but it is important to keep in mind that for many problems diagnosis is not important (especially in psychiatry). Fixing a problem is important, but a clear diagnosis? Nah. In psychiatry most problems are fixed by an SSRI or an antipsychotic - who cares if they have schizophrenia, schizoaffective, or bipolar disorder if the solution is the same. Who cares what the cause of the hypertension is? Rule out some important things to rule out, and then move on.

Also because the level of specificity - sick, infection, bacterial infection, anaerobic bacterial infection, a specific organism, the specific genetic profile of the specific strain of that organism, all of these are accurate diagnosis, but you can stop early and often should.

So it's hard to answer some of these questions without being reductive or ponderous.

Prions

Our tools aren't magic - for a long time the start of the art for identifying bacteria was dumping dye on it. Identifying something as weird as your own bits during slightly weird shit is hard as hell.

More comments

Any reason why?

There are millions of them. The median salary is shit. Hundreds of thousands are desperate to move abroad.

If you think getting out of India as a doctor is hard, oh boy...

Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis? I still imagine there’s a rigorous process in place that’s more than just professional guesswork (although I’m sure sometimes it seems that way, it’s multidimensional).

I'm really sorry, but a proper answer here would take more time than I can reasonably spare. I really shouldn't be here in the first place :(

TLDR:

  1. We see if our diagnoses are consistent between different doctors for the same patient
  2. Standard psychometry, reliability and validity work. Does the written test that says you're depressed come back strongly positive for someone who is about to neck themselves? Oh god don't get me started on construct validity etc
  3. Do the drugs work? Do they reduce symptoms? The answer is mostly yes. Even antidepressants, where the Number Needed To Treat is between 5-7 when compared to. placebo.

Do you think it’s possible to have something like blood tests for depression in the future?

We mostly use blood tests to exclude other physical causes for depression, like hypothyroidism, anemia etc.

Technically? You can use low 5-HIAA levels, but nobody does, probably for good reasons I don't have time to Google. Maybe @reo or @Throwaway05 can show up and do the dirty work for me. Help a brother out, ya know.

Neuroimaging isn't entirely useless either, in the sense that there are things in the brain we can observe changing in the depressed. But it's not very reliable. Same with OCD, autism or schizophrenia.

You got this, 😤 ❤️ 👊.

So I hope. So I hope. Thank you.

There are millions of them. The median salary is shit. Hundreds of thousands are desperate to move abroad.

Is this due to over saturation? Other countries having first mover advantage? Corruption / nepotism? Etc. What are the high paying careers and positions over there, or is more of a problem of economic mobility?

Over saturation? Definitely. Anyone can get a CS degree, and it's not even strictly necessary. Medicine, on the other hand, is strictly regulated and there's a limit on the number of doctors entering the workforce.

The best paid programmers in India usually work for FAANG or adjacent companies, at the Indian branches. Some freelance, earning Western wages while at home. The majority just get by working shitty jobs for long hours with average pay (which means pitiful pay by Western standards). The worst off are TCS code monkeys, who really have nothing going for them.

Keep in mind that this isn't necessarily worse than many other professional careers. Engineers in India aren't enjoying themselves either.

The easiest way to get career or income mobility is to get hired by a foreign company, establish a reputation, and apply for a transfer to a foreign branch. I have a cousin in ML who makes big bucks (by Indian standards, which means close to my UK salary). He's been offered roles in the US, but only on a temporary "put out fires" basis, and not at comparable wages to what someone living and working there would make. I've encouraged him to take it, or simply apply directly at American companies for local full-time roles (H1B route, probably). He entered ML well before it was cool or over saturated, even if he wasn't involved in LLM work. That means he's extremely lucky/forward thinking, probably the latter. I remember him installing weird vision models on my gaming PC when he used to visit, back in 2017. Good for him, I want him to get out while he still can.

And yes, the quota system for H1Bs only worsens things. Everyone is desperate to get one of those.

This is going to be my life for the next 5 months, no relief from the pain.

Rotations get better. By the end you'll look back at your level of knowledge and efficiency and be horrified. Remember this part.

Also - I think you said you are on consults, consults in any specialty are highly variable. Some seasons, weeks, months are harder than others. Sometimes jack shit will happen because the hospital is stuffed and another specialty is suffering. The tide goes in an and out, but it does GO.

When I was in residency I had a senior who made the claim that people are fast or slow, and that that never changes. I've learned that's true, but only for some personalities. You do not have that personality.

You can get faster and more efficient if you want to. So want to. And figure out how to do that.

Thank you. But I don't think this rotation is likely to get much better, and I say this while fully acknowledging the possibility that depression and fatigue is coloring my judgement.

You have to understand that I'm surrounded by other, competent doctors. Some of them scarily so. They don't get the breaks very often either, barring the "mandatory" lunch break half of them eat at their desk.

I hope I get faster and more efficient. I'm touched by your faith in me. The workload still seems daunting. Oh well, it's 5 months. I've done a full year of about-as-bad, and that only made me so depressed I seriously contemplated quitting medicine. Right now, I'm older, wiser, and better acquainted with antidepressant guidelines. Getting better medicated is my best bet for making this bearable. I am pursuing it like my career depends on it, which it may well do.

It's impossible to have a good version of this talk in this setting, but I will try - usually (but not always, I'm not there, I don't know what you are struggling with) the problem for early phase trainees is excess cognitive load associated with stuff that should be "free." Writing notes shouldn't usually require thinking, it should only require time. Basic interviews will be effortless. Physical exam (oh wait psych lol)...

Later the difficulty will be true medical decision making in complicated cases, advanced level exam and interview, and leadership and administrative tasks. These have higher ceilings.

For now you are probably finding it painful to do basic things. I mean yeah, that is what training is for. Most of the work is those basic things though, and as you do them more often you will find them easier, they will be automatic. Even sitting at your desk working is less exhausting if dictating or typing your note is automatic and not an onerous process as you remember how to accurately describe such and such thing.

Example - as you start getting more experience you'll notice how remembering everything for the patient encounter gets easier. This is not because you are gaining memory kung-fu, it is because your brain is automatically knowing what is important and pertinent and what is default.

This process will happen as time goes on, but with some mindfulness you can accelerate it - or if that's hard you can just ride the wave and know it will happen.

It's happened before for every trainee and it will happen to you.

One of my favorite processes in medical education is watching textbook driven people go "you aren't teaching me" and then gradually realizing that the work is the teaching and that they learned the textbook without needing to sit down and do that bullshit.

It comes. It's hard and you have to do it, but the knowledge and skills come.

Then things get easier.

*Above advice not valid for procedural skills.

Thank you. There is a lot of context I haven't shared, and probably won't share, even in private (with anyone, not you, you'd be more likely to know than most).

Writing notes shouldn't usually require thinking, it should only require time.

That's not the biggest problem I have. I'm happy to write proper psychiatric notes. I write essays on the internet for fun, and that's more intellectually taxing.

Physical exam (oh wait psych lol)...

You'd be unpleasantly surprised. I definitely was. Psychiatry works very differently here. As a trainee at my level, I do a lot of medical management of physical illness, and I don't like it one bit. This will only change when I become a registrar. I'm not sure what the threshold for "call medicine and ask them to manage this" is in the US, but it's much higher here. That's what's really killed me in the past. [More highly relevant information that I am studiously omitting.]

An early trainee is a glorified ward donkey. All I can do is bray and scratch my ass.

I agree that things will get better later, with time and experience. You know why my last placement sucked. This one sucks for entirely different reasons. Mostly the drastically higher workload. It should get better, once I push through the next 5 months, which I intend to. I worked very hard to get here, I have nowhere better to go, and I do sincerely believe things will get better eventually. I still appreciate the support.

Wishing you luck brother!

Thanks. Glad to be depressed together, and hoping we can get well together. At least you know my advice comes from a place of unusual professional and personal familiarity.

This is a weird question, but my dears, if I can't find weirdoes here to help answer it, where will I find them?

So... what do you do if you're not lonely?

By which I mean, all the pop psychology and media opinion pieces and chatty helpful (annoying) little mental health wellness driblets tell you you should be lonely if (check off list of things).

Apparently there's a loneliness epidemic. Or maybe there isn't, opinions differ. But there is agreement: lack of connection is bad for you, including bad for your physical health. Some are optimistic that AI can be your friend instead.

Yeah, but... I'm alone, but I'm not lonely. I can check off that list:

Lack of human connection? Yes
Social isolation? Yes
No friends? Yes
No close family members? Yes
No romantic partners (this seems to be the big one, the cri de coeur of the incels and I do not mock them with this)? Yes
No kids/fulfilment? Yes
Not even furbabies? Oh hell yeah no pets
But you socialise? You travel? You do things? You have hobbies? No

I should be curled up in a ball crying and weeping and wringing my hands about wanting all that, and I'm not.

Now, am I depressed? I think I might be (can't get a diagnosis, the one and only time I mentioned suicidal ideation to my doctor I got asked was I self-harming or tried suicide? no? nothing to see there, then), but while the big light-bulb "aha!" moment there should be "and that's because you're so isolated", I don't think so. I've wanted to be dead (not the same as wanted to commit suicide, I've never tried that) since I was about eleven, but here it is decades and decades later and I'm still here.

The cynical view is "but you need friends because friendships are transactional and can be monetised; if you do things for them they have to do things for you". That's never worked for me, because the few times back when I was young and dumb enough to ask, in return for 'do this for me get that for me of course we'll do the same for you', "okay so now can you do this for me?" suddenly and miraculously it was always the wrong time, inconvenient, impossible for some reason.

So I never grew to regard friendship as transactional because I could never get those transactions going (sorry, Rorschach, I disagree with you there even though I would be sympathetic to a lot of your thinking and if that makes me an authoritarian, Alan Moore, then too bad).

But I'm not lonely. I'm on my own, and I'm happy that way (if you accept that this, for me, constitutes "happy"). Mostly I don't like people. I can fake it, I can get along for short bursts of interaction at work and elsewhere, remember things other person said and bring them up or talk about some topic in the news, but about five minutes is my maximum tolerance and ability to pretend normality. After that, I have to consciously remind myself "do not say out loud 'I wish this person would shut up and go away and stop bothering me', keep the expression of mild interest and pleasant smile on until they do feck off, don't look at something else like paperwork or computer screen or whatever".

So what do I do, when I'm supposed to be lonely and wanting all that human connection, but I don't. I really, honestly, don't.

What do you do when you're supposed to be lonely but you're not?

But I'm not lonely. I'm on my own, and I'm happy that way (if you accept that this, for me, constitutes "happy"). What do you do when you're supposed to be lonely but you're not?

This plus "not wanting to be alive" (!) suggests some underlying tensions here?

Based on somebody else's assertion below, I'm going to respond as an assumed co-religionist, so disregard if that assumption is false. I also don't have as much life experience as you, so I want to apologize if it's presumptuous to say this, that's definitely not my intent. I've thought a lot about the fact that most people, married or not, parents or not, have a very good chance of ending up in effective solitude, so in a real sense I'm speaking to my future self here.

"Cool friends, fun hobbies and a cute pet" is a very urban-atomized, Enlightenment-via-Instagram model of the Good Life. I think you're fortunate to have the resources to push back against it. But you know there's also a clear tradition of writing, by far smarter folks than us who have also suffered far more, and whose experiences thus give them the right to opine, pointing out that pure indolent, avoidant solitude is also not how humans are meant to spend the life they are given. Like dogs, I think we are really better in service, even unpleasant service, than in leisure. Definitely not because, like, "volunteering makes you friends" or because human beings will ever reciprocate the painful care you give (luckily Christianity is very clear on this!), but because (at least as I understand it) unreciprocated love also appears to be what God does, possibly the nature of Creation itself, hence is just part of our basic design.

I don't want to get out over my skis here, so I'll quit with the dubious theology. But you are a clever woman, excellent with language, based on your posts at least a generous-natured person with some wisdom and capability. Is there no way that you're being called to put those talents to service? Nothing dumb and menial that needs doing in your parish, your neighborhood, your building? No way that you should be the one to help a plant, an animal, a child, some other person in your world, whom you are currently failing to assist? If apparently not, do you ask enough to be sure of hearing the call if it came? Do you at least pray hard for all the rest of us losers, like the anchoresses did? (Because if you don't, uh, I at least could sure use somebody to put in a good word for me.)

I guess what I'm saying is, are you quite sure you're not the one lazily shirking reciprocity for the gifts you've been given, and could the cognitive dissonance here be a bit of a guilty conscience? And that's coming with all sympathy from someone who knows this struggle to be real.

are you quite sure you're not the one lazily shirking reciprocity for the gifts you've been given

That is definitely part of it. I really don't like people, so I grumble hard about "God commands I love you (dammit)".

I'll add that if you're alone, and it's all you've ever known, it's hard to know what you're missing. I've lived all my teens completely isolated, and had you asked me, I would've said I was happy, or at least "satisfied". Then I got a friend, who became my best friend, and I realized what I've been missing this entire time. Later I got a partner too, and that truly cemented that I never want to be alone again.

While I do know that people who genuinely aren't interested in other people do exist, they tend to be extraordinarily rare. Now this is going to sound really dismissive, but I would put most people like me (and maybe you) into one of two camps. They just either haven't found someone they actually work well with. Or they do interact with others, but it's unpleasant, basic interactions that drain you instead of adding anything. Which gives you the perception that you don't like socializing in general.

But I bond with people over common interests(presumably most people do). If you don't have hobbies, if you don't have pets, if you don't have some common interest in talking about something with someone, why should you talk with them at all? Why should they talk to you? There is another option with which you can bond with others, which is your own personal life experiences, be they good or bad. But I wouldn't recommend that, since it hasn't worked well for me in the past.

I would recommend socializing more, because it can be an incredibly pleasant and fulfilling experience.

Also I have to ask, do you truly not have hobbies? Like what do you spend your free time on? Maybe your definition of a hobby is just more strict, but pretty much anything you do in your spare time from reading, to cooking, to playing games, or working out can be counted, among many others. Do you not do any of that? You mention Alan Moore, so presumably you read comics, so that's one thing, that you either don't count so it fits into your post more cleanly.

I would recommend socializing more, because it can be an incredibly pleasant and fulfilling experience.

Tried that, in my youth. Hated it. Really find it draining to be around people, with noise and lights and drinking and chatting and everything. I've skipped more "this is our graduation dinner and happy time, here's your invite!/this is the work Christmas party!" occasions because I've gone to one or even two of those previously and the result was "the amount of enjoyment I got out of going was much less than staying home and doing my own thing".

I'm happy under my little rock!

That's not what I mean. I was also happy under my rock, but I'm happier under my rock with someone else. Even simply mundane everyday activities are more pleasant if you do them with someone you like, and who likes you.

Like this study showed anything is more enjoyable if you do it with someone else. Doing laundry, cooking together, watching movies, going out. That's the kind of socializing I'm talking about.

Not work parties where you're surrounded by strangers you don't know, don't care about, and aren't invested in.

Doing laundry, cooking together, watching movies, going out.

And that gives me the hives. Possibly because I've become too used to This Is My Routine And This Is How Things Are Done, but trying to (for example) work in a kitchen with a sibling makes me very uncomfortable. I'm working training in a new co-worker and the amount of times I've had to bite my tongue about "go away! lemme do this myself!" (because I am not doing this myself, that is the point of training someone else to do it) has been very high.

I really am just "hermit crab, this my shell, go find own shell, farther away the better".

I've been mulling over this comment since I read it shortly after you posted yesterday. Like others, I have the impression that within your comment is a need, a plaintive statement of dissatisfaction, though most of what you write here suggests the opposite (that you're happy, though you immediately qualify the term.) Yet you do now wish and long have wished to not exist:

I've wanted to be dead (not the same as wanted to commit suicide, I've never tried that) since I was about eleven, but here it is decades and decades later and I'm still here.

Why? Not why are you still here but why would you wish to not be?

I didn't answer immediately because I'm certainly not a trained counselor or psychiatrist but I felt like I wanted to probe deeper into your motivations in posting this comment. I'm probably just as weird (to use your term) as anyone on here but with a more normie veneer. I too have little problem being alone most of the time. I've spent vast swaths of my life alone, and not in the "we're all really alone" sense but in the no one else anywhere near me sense. I'm not a stranger to it. But it can be a great weight. It's like anything, fine for as long as it's fine, but too much of it and you're asking for trouble. You sense this, though you're not giving voice to it.

Why? Not why are you still here but why would you wish to not be?

I couldn't understand it. At the time I just felt tired. Tired of everything. Didn't want to continue existing.

I also had bouts of whatever the opposite of solipsism is; that is, I used to feel I was not, in fact, a real person really existing. My reason could talk me down with "but if you're not here, what is this entity experiencing the sensation of not being real?" but what most convinced me was tricking myself with "well that's my mother, and I believe she has an independent, real, existence, so if she's my mother and she's real, I have to be real, too, because she couldn't be my mother if I wasn't real".

Very odd feeling. Never done drugs so I have no idea if the reports of ego death or whatever are similar.

Depersonalization though you've probably researched the phenomenon yourself. Again, interesting. Does this come and go even now or is it just a memory of how you used to be?

Haven't had it in a long, long time and this is memory of how it used to be. It was a very odd experience, and puzzling; if I wasn't real, then who or what was this "I" experiencing this?

Generally it was "hey guys, am I a sociopath?" and the response so far seems to be "yeah of course, you weirdo" "okay, thanks for the clarification!" 😁

Because as I say, I'm reading and hearing all this "loneliness epidemic" stuff, even to the extent of participating in a work webinar about social isolation and suicide (cheerful topic) and while the speaker was going on about "and this and this and this means people are isolated and that means increased risk of that bad outcome and that bad outcome and that", I was internally going "but I don't feel like that, I don't have this and this and this but I don't miss it or want it?"

Very interesting. You're not quite what I would have predicted or imagined, and I'm not terrible at predicting/imagining, though of course I'm not Kreskin. You don't seem insane or sociopathic to me, except when you do, but then that's just Woman TM. Vive la difference. You got Sloot in here derailing the conversation so that's a point on the board for you. I'm sorry if my interest seemed untoward, but I am forever trying to print faces on the masks/usernames here.

Oh no problem, I am absolutely terrible at name remembering (I can remember faces, you should hear me go "oh! that's so-and-so, you know, that person from back when we did the thing! is her name Margaret? Jane? something like that?" about people I worked with for eight years but have not seen for a whole six months) so I can't match up usernames to people on here. I just go "hey isn't this that same numbskull who said that dumb thing about peppercorns?" and launch into the fray even if it's not, in fact, the same person.

I mean, you spend a lot of time posting here and, I assume (but am not 100% certain), in the ACX (formerly SSC) comments, that's not exactly IRL friendship but it's not not social interaction. Perhaps, as an antisocial person, that is enough to assuage your need for human connection.

One problem people have is in what they think a “friendship” is. I knew many people from all walks of life growing up, but I can count on maybe little more than two hands the amount of people I can truly call friends, the rest are either acquaintances or people teetering on the edge between one or the other. There’s people I’ve known for 20 years who I’m on great terms with who I wouldn’t describe as my friend.

Several years ago, my best friends younger brother came home from school one day and when we were all hanging out he asked me what the difference between a friend and an acquaintance was. I said “an acquaintance is just someone you know.” “A friend is someone who puts in work on your behalf.” (Putting in work is a phrase used by gang members to commit acts to socially prove you’re a part of the in-group.) If you’re someone’s friend, you care about them, and work where you can in ways that promote their self-interest where opportunities are available to do so; because your friends are an extension of you. I’ve made sacrifices and taken hits to my reputation for my friends before, to me that’s what it means to be someone’s friend. I will go far out of my way to support my friends. Very far out of my way.

If you feel normal without many friends (or even any), I don’t think there’s necessarily anything wrong with you, although it’s a little sad you’ve not experienced the sustained joy of sharing interactions and experiences with others that make you feel connected. For some people it just takes time, for others they just haven’t found their tribe yet.

May be worth noting HereAndGone2 is a woman because - women as a group tend make poor friends per your definition (which I agree with). In all the women I've known in my life in school or work, they were all just acquaintances despite me putting in work on a platonic level, at least I think so. From my observation of all of my male friends, none of them have any female friends either (unless their wives count), and some of them are very social butterflies not posting on the Motte.

Almost all of the women who have put work in for me are mom and female relatives. I do come from a clannish family so that's probably not surprising. But no unrelated women, except maybe the wife of one of my social friends has ever given me any advice or help. I did not get a chance to befriend that woman unfortunately, as I ended up moving away from the area. I'm still friends with the husband, but we're too busy to socialize now.

Being a woman, I suspect it's difficult to make friends as other women are generally poor friendship material. Men might be difficult to approach as they would see friendship gestures as sexual interest.

I didn’t not know that, :o. Thank you.

Men and women are capable of being friends but in my own life I generally advise against it, especially if they’re in a relationship. I have many women friends in my life but the nature of those friendships is built very differently from the ones I have with my guy friends. (Yes, most of your guy friends want to fuck you; I don’t care how much they lie about it.) It’s also a major reason I don’t date women who keep male friends. Women aren’t stupid, they know what they’re doing by keeping men in the mix that play into the role of their backup plans “just in case.” In a relationship you’re either all in or not. A person who keeps one foot permanently out the door tells you much about the sincerity of their commitment.

Men often interpret women’s friendship as sexual interest because most men get zero attention from women. But I’ve seen it the other way as well, where women insist they’ve dropped every signal and the guy isn’t interested. (No. He sees it. He doesn’t want to risk interpreting your sexual interest as friendship, so he cautions himself not to press it. He’s not stupid either.) The problem is women flirt and express interest with full plausible deniability, and that’s why they lose out on so many opportunities. If you want to make a move, it has to be one that’s unmistakable and that you can’t back out of; you have to be able to bear risking rejection.

There’s only two women in my life (apart from my mother) that I’ve had an “I have to be careful about this person,” moment; who could read me very well; and it was eerie. I loved hanging with them though because they had an incredibly high powered perception and amazing situational awareness. It was very evident to me that they hid their intelligence from the rest of the group, but they were very confident people and just every “once” in awhile they’d drop the mask on purpose. Occasionally we’d be talking about something and look over at each other at the same time and smirk. They knew what I was thinking before I did and could see right through me. They were ‘incredibly’ sharp women and kept me on my toes.

Well said, I have had similar experiences. And I believe it is never good to be a backup man and/or piggy bank, but most men tire of it as they age and see the orbital relationship for what it is. My friend's female cousin is an absolute man eater, to the detriment of every man she lures in and to her own life. Predictably, she works in a strip club, has no dad, and was raised by grandma. She has many, many orbitals.

I agree. And I would never allow myself to be that guy or tolerate that kind of disrespect. If she’s prepared to accept that I’d never marry her I suppose I’d be content with “being a thing,” but I’m not under any illusion for even a moment about what kind of relationship this is.

Some or most of what you describe is due to the distinct one-sidedness of male-female friendships, compared to male-male or female-female friendships.

Commonly, a woman will tend to expect a male friend to monkey dance and serve as a meatshield for her; spend effort and money on her; help, provide labor, and do favors for her; in ways she wouldn’t expect a female friend to do.

If a female friend asks for help or a favor, she’ll be more inclined to assist since you gotta help a sista out and everyone knows how difficult it is to be a woman. If a male friend asks for help or a favor, he’s being needy, entitled, and/or pathetic. Doesn’t he know how busy she is and how valuable her time and energy are? Ugh, stupid man-child.

This describes approximately 0 male-female friendships I've had, though some relationships may qualify.

Think you meant female-female friendships in the end of your first paragraph. I may be personally have grown up around many self-centered women, because I noted the female-female friendships seemed shallow without much work put in either direction. Hard to tell though from the outside. This is mostly an observation of my female relatives and former classmates.

Think you meant female-female friendships in the end of your first paragraph.

Indeed, I did. Fixed.

I may be personally have grown up around many self-centered women, because I noted the female-female friendships seemed shallow

Or what if the women you grew up around are not unusually self-centered or their friendships not unusually shallow for women?

It’s pretty funny how female friendship groups tend to be self-selected for similar attractiveness levels, with perhaps the exception of a token fat/ugly friend as popular lore would suggest.

No, I think you are preaching to the choir here, I do believe female-female friendships are more shallow compared to male-male friendships. It's why I think HereAndGone2 has trouble finding friendships worth sustaining, there are too few fish in the pond worth the effort.

I can relate with most of the things you've said. I'm an introvert with social anxiety that has prevented me from being more social throughout my life. I've been working on it in the past year or so, but I'm still far away from being described as "social". Aside from the fact that not having some sort of support system you can rely on if things go bad is objectively not good, I think you should reflect on whether you've successfully managed to distract yourself from your shortcomings in social life. For me, that's definitely the case. I'm a natural workaholic. I derive value from work, winning games. So it's very easy to get distracted - find a goal, an idea to pursue, a new game to play and I can sit inside for weeks on end being obsessed. I can do this for years. But the brief moments when I run out of things to do are brutal. I no longer have distractions to keep my mind from reflecting. I start feeling like something is wrong in my life. If that sounds familiar, then I think you gotta start reflecting on your life and pinpoint what's wrong. If not, perhaps you're just a hermit and that's okay. I know I'm not, so I gotta make change or I will be looking back at my life with regret and I don't want that. Even though it's so comfortable to be in your own little world in the moment

So, uh, what do you want?

You put it as a problem in need of a solution, yet by your own description you seem more or less happy (for some value of "happy") with your life.

By the fact that you are asking, I guess you aren't entirely happy. Is it just because you look around and see other people doing things you aren't and wonder what's wrong with you? Or do you vaguely sense something missing in your life?

Tbh with your religious beliefs and temperament I'd half-seriously suggest checking out convents.

Assuming that's off the table, well... You sound like you may be depressed. I think you have some conception of depression as being miserable and hating life all the time, but it can be just a gray blah that prevents you from enjoying life.

A lack of friends is very sad. Friendships don't have to be all transactional.

A lack of hobbies is also very sad. I mean, what the fuck does one do with one's life, aside from working, if you don't have a family? It's never too late to take an interest in... something.

You sound like what you lack is a purpose. If you have no purpose in life other than to get up every morning and do it all again, that would be pretty depressing to me.

Tbh with your religious beliefs and temperament I'd half-seriously suggest checking out convents.

Back when I was eighteen or so, a lot of people suggested I should be a nun. But joining religious life just because you don't fit into secular life doesn't work (that was a huge part of the reason for all the abuse and sex abuse cases in the Church). I knew by myself that I did not have a genuine vocation so that was not for me.

I don't mind if the explanation is "you're just weird or mentally ill or both". It was a reaction to all this about loneliness that I see getting mentioned more and more, and how the default assumption is "everyone wants and needs X, Y, Z" (funnily enough, right now I'm listening to the radio and a song is on with a chorus of "nobody to love" where the singer is lamenting that state), and I'm going "well I don't, so not everybody". If that means "okay a tiny, tiny proportion of the population are just weirdo loner nutcases", fine. I was just wondering "am I the 1 person out of a hundred million who feels like this, or is it genuinely "7,999,999,999 people want love and connection and you are the 1 human on Earth who doesn't"?

Well, if you are not unhappy, you are not unhappy. What you describe seems like a pretty joyless existence to me, but there have always been loners who genuinely don't like socializing with anyone. I don't anyone here is going to try to persuade you that you must make friends and must have a relationship to make your life worth living.

Not a problem, just more an idea of "have you considered that in fact some people don't want X or Y?"

I suppose a bit like recommending to a gay guy "now what you really need is a nice wife, so you'll have someone to love and take care of you". Not what is wanted.

The messaging seems to be taking for granted that everyone wants friends, family, lovers, social interaction. If you don't have it, you miss it and want it. If you don't have it, this is loneliness which is a problem.

For the majority of people, that's true. But for some people it's not, and so the pat answers about "well find friends, get involved in your community, mix with people, get a hobby that will help you meet others" and the rest of it is like, as I said, telling a gay guy that all he really needs is a good woman.

Following the gay guy analogy, what if the gay guy posted on a forum asking why everyone assumed he was bi or straight even though he checked every gay guy stereotype? He said he was annoyed everyone kept telling him to get married to a woman - he was so gay that he couldn't even walk in a straight line!

He did confess that despite all this, he might actually be attracted to some women, some of the time. My advice to this gay guy would be to try and date some women again, and maybe he could finally figure out his gayness or lack thereof. Even if women had never worked out for him in his entire flaming life, maybe he was just unlucky all along or something. But if he didn't feel like dating women again, that was okay too. Some gay guys just have straight-conformity anxiety, and it will probably never go away.

My friend, let me introduce you to the myriad wonders of gender and sexual orientation. Your hypothetical gay guy could be described as homosexual (that is, he only wants to bonk people of the same gender) but hetero- or biromantic, that is, he can feel romantic - not sexual! - attraction for his own and other genders.

Also pls note not use "man" and "woman" as icky terms reinforcing binary sexuality, ignoring and insulting entire wonders of Genderbread Person, thanks!

the problem with introverted fucks like you is that your isolation stems from conceit, you are convinced you are alone by choice and volition and not because you had to get accustomed to your pariah status that only got more ossified over time through repeated social rejection (whether you choose to acknowledge this or not). People around you likely do not hold you high in their opinion and you probably don't even understand what all you are missing out on, at least try to figure out the mental configuration those supposed ''normies'' operate from and then reject it once you have proven your ability to be a part of that social cohesion. The most insufferable dudes I know are both introverted and arrogant about their solitary status

  • -16

Thank you for the cheerful assessment, and is it any wonder I don't like people?

When I was a kid, my friends were willow trees. In the years since, I have never seen any reason to prefer a human to a tree.

I can definitely say that at school I was not bullied or socially rejected. I did hang out with other kids, just that I never wanted to do this by choice as my first option. I was more content on my own.

"You're a loser because nobody likes you so you have to pretend you don't care about it" is not true in my case. I don't feel all this need for connection and intimacy that, apparently, I should be feeling according to the received wisdom. But I don't feel this need or lack.

Now, you are probably perfectly correct that my wiring is all messed-up and I'm nuts and the rest of it, but I just find it unusual that surely there must be more people, even if only a handful, out there who are solitary and happy to be that way and not wishing they had all this normal life?

You know the saying about "Be at least two of Truthful, Useful, and Kind"?

Even if your armchair psychologizing is accurate (dubious), you still fail 2 out of 3 and seem to have posted this only to be nasty.

I'm only letting you out of the new user filter to give you a temp ban since this isn't actually your first post. You've been around, kind of, for a while. Obviously a sockpuppet though, probably a ban evader. So next time maybe I just don't let you out of the filter.

Work more? Assuming you are not set for retirement and maybe plan to have kids in the future a bit more money saved never hurts. If you're not lonely or depressed get out there and make some moolah! Unless you feel unmotivated to work for whatever reason - then maybe you are lonely and/or depressed.

My childbearing days are behind me, thank God. I never wanted children, because I knew I would be incapable as a parent and would cause more harm than good. Also, you need another person even for a minimum period of time to get pregnant, and I couldn't tolerate even that minimum of being involved with another person.

What do you do when you're supposed to be lonely but you're not?

Nothing.

I mean, what do you expect us to say? Should we be arguing you into loneliness? Do you want us to be arguing you into loneliness? I'd be more concerned about that impulse, if present, than the claim you're not lonely when you "should" be.

Humans are not made alike. Normality is not a well-delineated construct, as shocking as that might sound coming from someone in psychiatry. The same stimuli or stressor that can make someone jump off a bridge might make someone else shrug and carry on carrying on.

The opposite of shocking would be me observing that you are an introvert. That is the kind of cutting, incisive socio-cultural commentary I'm paid for, which explains why I'm paid less than I'd like. You do not strike me as schizoid or schizotypal. You do not sound autistic. There is no obvious psychiatric diagnosis to pin on you, which I am usually loathe to do anyway for random people on the internet. You claim to not even be suffering, which is the main reason I ever break from psychiatric dogma and go "fuck it, I don't care what NICE says, the important thing is to help".

Being introverted, bookish and self-contained isn't a problem, particularly if you don't want to be otherwise. The world has room for all kinds. You don't have to feel lonely just because you're alone.

While I'm here: a GP responding to a disclosure of passive suicidal ideation with one checklist question and then dropping it is bad medicine. I am embarrassed. I can only hope that this happened well in the past, before standards were raised (in theory). If you do not quite feel like you're where you want to be mood-wise, there is little harm in seeing a new GP and getting assessed for dysthymia or low-grade depression. Some people can be surprisingly functional despite moderate to severe depression (wink wink). People with depression are, unfortunately, often lacking the energy or motivation to go get the help they desperately need, even if you don't sound as desperate as many. If you were, I'd be telling you to take this to your actual doctor immediately, instead of the Motte.

Should we be arguing you into loneliness? Do you want us to be arguing you into loneliness?

No, I was just curious to see what you guys would say, because at least on here something other than the commonplace is considered. If I look around, the advice and discussion is all about "loneliness, what do we do about it, is it an epidemic" because the default assumption if "if not having A, then result B" which is loneliness.

But some people are "if not having A, result C". Now, maybe the answer is "yeah that's 'cos you're a psychopath" and maybe so. For example, the current hit movie "Hail Mary Project" where the protagonist is pressganged into that expedition, against his very vehement opposition and protest, where he is kidnapped, drugged with amnesiacs, put in a coma, and shot off into space on what is a suicide mission (they can get out to the Tau Ceti planet but they won't have enough fuel to get back to Earth).

And the expectation is, and the result is, that he will solve the mystery and send the solution back home to save Earth. He's explicitly told, by the person who ends up shanghaiing him, that he has no connections on Earth: no family, no partner, not even a dog.

And this is all supposed to make him care enough to save them? Were I in that situation, even if I found the solution, I'd send back the message "Fuck you and fuck Earth. You sent me here to die? Well all of you can die along with me. I don't like any of you, I don't care about any of you - WHICH YOU TOLD ME TO MY FACE - and I don't have any reason to help you".

Isn't there some drug you can prescribe that would induce crippling feelings of loneliness in this defective person?!

Alcohol is a good solution, but sadly it's over the counter in Ireland and my prescription would be redundant. I don't think she's likely to be carded.

That's more of an indirect, slow burner though. A lot of collateral damage involved before the sought-after effect can really kick in.

Hmm. You might want to consider cocaine or meth. The comedown involve, among other things, a strong sense of regret and loneliness. Unfortunately, dentists seem to have a monopoly on the former, and I'd need to be an American shrink in order to prescribe the latter.

Read that as 'regret and homelessness' which made me laugh, almost.

Apparently there's a loneliness epidemic.

You forgot to copy-and-paste a link here.

Now, am I depressed? I think I might be (can't get a diagnosis)

Astral Codex Ten suggests taking the PHQ-9 questionnaire for self-diagnosis of depression.

So I never grew to regard friendship as transactional because I could never get those transactions going.

Mostly I don't like people.

Based (1 2). This is the part where we suddenly fall in love.

You have hobbies? No.

Or not.

Well, I sort of have hobbies, mostly "reading, listening to music, and getting away from people as fast as I can". All the solitary pursuits. It was a constant problem when writing up CVs because you're supposed to put a list of hobbies which are thinly-disguised (or not disguised at all) lists of achievements for why you are such a go-getter successful hard-charger who will maximise value for any employer: captain of this, winner of that, involved in club A and sport B and activity C where you were leader and organiser and winner winner winner.

Having "I don't do any of that" on the 'this is where you sell yourself' document never helped, so eventually I just dropped it anyway. Ironically, the first time I handed in a revised CV with that taken off and went to interview was the first time ever an interviewer asked me "What about your hobbies?" 🤣

Well, I sort of have hobbies, mostly "reading, listening to music, and getting away from people as fast as I can".

Quote from a text message sent by me to my mother (who has failed to take up any hobbies several years after I pestered her into retiring): Reading books and watching shows are not sufficiently interactive to count as real hobbies.

Hobbies can delay cognitive decline in old people. Try designing a code-compliant dream house.

Hobbies can delay cognitive decline in old people. Try designing a code-compliant dream house.

This is the most ToaKraka sentence I can possibly imagine. I'm not sure if the emotion it evoked in me is surprise, per se, I'd need to consult that stupid book Tumblr loves, "A Dictionary of Obscure Sorrows".

Occhiolism? Adronitis? They're all made up words anyway, more made up than words normally are.

Your "dream house" is code-compliant. Of course it is. It could never have been otherwise.

What would be the point of designing a house that you can't build?

Codes don't cover just structural integrity (though you should look at those parts, too, in order to avoid laying out a gigantic living room without realizing that it needs a bunch of obstructive columns in the middle to hold up the roof). They also prescribe minimum dimensions for rooms (both habitable rooms like living rooms, and non-habitable rooms like bathrooms).

What would be the point of designing a house that you can't build?

Realistically, who's going to stop you? Genuine question, if you submitted a compliant project and then built something else that's not very obviously out of code, barring some incredibly nosy neighbours, as long as you don't have to sell it, wouldn't you just be able to do it?

The local code official conducts inspections throughout construction. If he isn't slacking, he presumably will notice the difference between the 7-foot-wide living room shown on the plans (code-compliant) and the 6-foot-wide living room from which you have cannibalized a foot of width for the adjacent bedroom (not compliant), or between the 77.5-% stairway shown on the plans (code-compliant) and the 85-% stairway from which you have cannibalized a foot of length for the adjacent bedroom (not compliant).

What would be the point of designing a house that you can't build?

The only houses I've ever built were in the Sims or Rimworld, and I doubt they were up to code. If they were built in real life, I'd be sued. I'm glad that this is only an academic concern, I'm a doctor and the House of God has all the planning permits it requires.

But yes, if you're designing a house you intend to build and then live in, code compliance isn't something you should ignore. I'm just wistfully observing that even your recreational activities are incredibly pragmatic.

Update since @FtttG already thanked me for my previous depression post, (read my blog already Ft!), but I am doing much better!

The primary issue in my case was playing too many video games, especially of the addictive, competitive kind. After I set that down I naturally went back to spending more time reading, in prayer/meditation, and generally just taking care of responsibilities at work and in the household, which has been great for my mood. Ultimately I find that in retrospect it's often quite obvious why my mood has dipped, but when I'm in the middle of a depressive episode it's frustratingly hard to understand or take action on it. Oh well.

I also want to do a quick shoutout here to anti-depressant drugs. For over a decade I dealt with depression and refused to take any prescriptions for it. While I do think it's good to resist treatment for a while, ultimately I caved and I'm glad I did. I'm on an SNRI and it has been a tremendous help to me. So if anyone is on the fence about it and has struggled with depression or anxiety for a while, I'd recommend at least trying some.

What does it feel like when you’re going through a depressive episode? Is it some kind of spontaneous mental rush of sadness or grief? Are there specific life events that trigger it? Depending on the kind of thoughts you choose to meditate on and contemplate, controlling your state of mind plays a very large and active role in influencing your mental state; which is hard because humans don’t have direct access to their emotions.

At any rate, great job if you’re feeling better! w00t w00t!

Mmm I would say it tends to feel like a lot of tension in my body overall and just a sort of pessimistic outlook on life.

Glad to hear you're doing better!

I just wanted to say that over the years I've realized we all need different things. I'm someone with an addictive personality, who soothes their anxiety with high dopamine habits. Leaning into the habits causes me anhedonia, and so I work to avoid these super-stimulations. When I recognize these unhealthy practices and reduce their frequency or dispel them altogether, I am a lot happier, more social and more productive. It can be difficult to avoid what we gives us pleasure, but if we know it's unhealthy for us, that means there must be other things out there that we can enjoy more without making us depressed.

Those depressive states are hard to recognize and act in, but perhaps something triggered it, and then perhaps a cascade after that. Recognizing that could help. I'm happy to hear you came out of it.

So if anyone is on the fence about it and has struggled with depression or anxiety for a while, I'd recommend at least trying some.

Has there been a new generation of antidepressant since 2012 or so? I have known four people who started antidepressants and then blew their brains out within a year. As somebody who's struggled with depression in the past, that scares the shit out of me.

If you're talking about pills you can pop? No. Probably not. Which I'm happy about, because it means my textbooks don't change regularly; and which I'm sad about because, well, I've been depressed. The worst part is that the workload and my upcoming exam is threatening to send me into a relapse.

The good news is that IV or nasal ketamine is much better established in terms of safety and efficacy now. There's rTMS, which isn't as effective as ECT but is a solid option.

I have known four people who started antidepressants and then blew their brains out within a year.

Antidepressants do not meaningfully increase the risk of suicide for those 25+, the profile is best described as mixed but in a positive direction. For children and adolescents, there's enough elevation to warrants extra caution and more monitoring. In the UK, we'd follow up an adult on a new antidepressant 2 weeks after initiation, those younger a week or so earlier. This is usually explained as the drugs sometimes giving you the energy to act on existing suicidal thoughts before they reduce the suicidal ideation or impulse. In other words they're fixing you, but in the wrong order. In the elderly, the evidence is even more robustly in favor of a net improvement on all fronts.

Current best practice for adults here is to monitor a followup review 2 weeks after starting someone on one, to check this hasn't happened.

Has there been a new generation of antidepressant since 2012 or so?

There's Auvelity, which is two old drugs in a new trench coat. But if you want something novel, the last one was probably vortioexetine, agomelatine or zuranolone, depending on how annoying or pedantic you went to get about things.

And of course, the emerging evidence for psychedelic therapy.

As the saying goes, the plural of "anecdote" is not "data". Astral Codex Ten:

50% of patients are “responders” and 50% are “nonresponders”. (Source: personal experience. This study gives similar numbers, but this sort of thing is very hard to operationalize, and I will just go with personal experience.)

The probability that your four people were all in the unlucky 50 percent who get no benefit from SSRIs is 6 percent—low, but well within the realm of possibility. If you broaden your net of anecdotes to encompass the denizens of this website, you probably get something closer to the expected 50 percent.

SSRIs are trash. They lead to a death drive in some people. And are hardly better than placebo in most others, while giving side effects.

I thought this for a long time, until I started them and they immediately helped me out of years and years of depression.

I am on an SNRI and have chronic pain though, so it might be different than most.

I haven't heard from anyone who liked their "SSRI" that it wasn't actually an SNRI. After years of complete failure of several SSRIs and a mixed effect but finally some benefit from an SNRI, I wish someone would have told me much, much sooner to try Wellbutrin (though I wish they offered it in lower doses).

Rebuttal from Astral Codex Ten

A small minority of patients do worse on SSRIs. These patients bring down everyone’s average, and then studies find that “on average” “participants” only get an effect size of 0.5. Fine, but in real life the people who felt worse on SSRIs would have stopped them immediately.

My reading of Kirsch is something like: Antidepressants will work for about 50% of people. For those people, they will have a large real effect size of 1.0, plus a large placebo effect size of 0.9, for a very large total effect size of 1.9.

There's no reason to think that people who developed the death drive or worse depression will just stop taking the pills. They'll likely be told to give it a few months in order to let it build up in the system and take effect or some such.

It's not through random chance that most spree killers are on these things.

I think SSRIs and that class are still the cutting edge. Scott Alexander has a good article about them but I can't find it at the moment, I think @self_made_human linked it to me a while back.

Scott Alexander has a good article about SSRIs, but I can't find it at the moment.

Link

read my blog already Ft!

My bad, I've been putting it off. I assure you I'll read at least one post before the day is out.

Ahahaha I didn't expect that to work, but hey I'll take what I can get.

Rob Henderson introduced me to George Mack's suggestion of fixing bad smartphone habits by having two phones: the Kale phone and the Coke phone. Rather than using one phone for everything, uncouple the good from the bad. Your kale phone only contains Google Maps, notes and Kindle, and only 2-3 people know the number. Your coke phone has Facebook, Instagram, Xitter, WhatsApp etc., and you give this number out to anyone you want to. You bring your kale phone with you everywhere but make a point of only looking at your coke phone at designated times.

I bought a new phone recently and I'm experimenting with a variant on this. While my new phone does have WhatsApp and I don't have two phone numbers, I've made a point not to install Instagram or Facebook on it and have disabled YouTube (but not uninstalled – think I need to enable developer options or something). My new phone comes with me everywhere, while I leave my old phone (which has Instagram, Facebook etc. installed on it) at home. It's been less than a week but so far I think it's helping, and I'm feeling less of a compulsion to look at my phone on public transport.

Now all I need is to find a way to block this site from my new phone.

I’m generally finding success with simple rules. Like because screens are a problem, I tend to treat any digital entertainment as if it were “furniture”. My suggestion is to offload as many of those “Cokes” to a desktop computer that lives in a single room. Do the same with video — have a designated big screen that you watch video on. What this does is force you to make a decision to do those things. If you have to go to the computer room or tge TV room to use those screens for those things, you have to leave the place where you are and go to the other room, and thus have to decide you want to do that over whatever else is going on.

This is kinda how old school tech wasn’t as hard to turn off in 1990. The miniaturization necessary to make a computer portable enough to be part of your EDC wasn’t there. The TV only worked when plugged into the wall and the cable box. This you were generally tied down to a situation where if you wanted to do a chat (AIM or Yahoo Chat were around in that era) you generally did so on the big family computer, and you could not do it anywhere else. If you wanted to go outside, you had to log off. If it was dinner time, you had to log out to go to the kitchen to eat.

Rather than that, you could just use an ereader and a regular phone. Ereaders can only really be used for reading, and there's a ton of stuff that's still better to read that browsing social media. Even royalroad slop is better.

At least for me, the idea of having two phones is a waste of money, but I don't use my smartphone that much, just my pc/laptop.

I hate e-readers, reading books on them feels like work. I'd never buy two phones at the same time, but hanging on to my old phone while it's still working makes sense.

E-readers I don’t like for the same reason I find it difficult to do content creation on a tablet. It feels too constricting and I need to space out and feel like I can breathe when I’m on the system. I have Bluefire Reader on my iPhone but even so, I only read a few pages on a book I’ve stolen off LibGen or somewhere else until I receive a copy of it in print.

New Year's resolutions check-in:

  • Posted my eleventh blog post of the year last Thursday (technically a few minutes after midnight). Expanded from a comment I posted here in response to @ThomasdelVasto looking for guidance on dealing with depression – thanks for the inspiration.
  • Went to the gym three times last week. On Wednesday I just did some core exercises which I found here. Friday was squat and overhead press. On Saturday, I decided to warm up with some stretches and core exercises before deadlifting. During deadlifting I used my belt (having not used for the last few weeks), then for good measure I did some stretches afterwards as well. This seemed to work: my disc isn't bothering me as much as it was. Yesterday I did a 5k run on my lunch break, planning to go to the gym this evening. Can deadlift 1.84x my bodyweight for 3 reps, squat 1.2x for 7 reps and bench press .87x for 6 reps.
  • Have not consumed any pornography since waking up on January 1st.

How goes it, @thejdizzler, @self_made_human, @birb_cromble and @falling-star?

I'm back on track with my goal. Spending is now $172.96 less than this time last year, despite dental bills and home repairs.

I know I have a few more big expenses coming up, but it's nice to see it for now.

Sorry if you got a second ping just now, I just noticed I misspelled your username.

  1. Work. Going to resubmit second manuscript this week as soon as protein database gets approved. Very excited to be done.
  2. Fitness: Did a DEXA scan yesterday and found out all the extra weight I've gained in the past few years has been fat. I am up from 14 % body fat (the healthy hunter gatherer percentage) to 25%. This alone explains many health issues and lack of running performance. Will keep the forum update as to my progress, but planning on losing this gradually over the course of 6 months. Goal is to get back to 150.
  3. Intellectual Stuff: Meditating consistently at least once a day now for 5 minutes. Reading Bernard Cornwell's Saxon Stories and am thinking about getting into film more!
  4. Finances: Third roommate is still not locked down. Spending on track for a pretty conservative month. I will have some European travel this summer, but that should only set me back a few months.
  5. Dating. Really would like to stop watching porn. Going on a date on Sunday afternoon.
  6. Tarot. Great session on Monday night. My old roommate seems to be doing much better now!
  7. Socializing: visited my friend Dhruv in Florida for the weekend.
  8. Screen time: 1.33 hours phone! Would like to be consistently under 1: the only thing holding me back is travel and porn.
  9. Mental health: feeling excited and motivated.

The only gym I'm going to for the next week and change is for the mind. Paper B season, pray it doesn't give me too many mental papercuts. I'll try and exercise at home, even if I all I really want to do is curl up in bed and cry.

gym I'm going to for the next week and change is for the mind

Time to plug my favorite cultivation novel!

https://www.royalroad.com/fiction/41330/virtuous-sons-a-greco-roman-xianxia

Ah virtuous sons is so good. Pity it hasn't gotten a chapter in a while.

I would threaten to shoot you, but you're an American doctor and probably wouldn't be fazed.

I have literally already had a patient threaten to shoot me today!

...and that's not counting the nonsense on my commute.

You should go ahead and marry self_made already so we can get him in here. Not sure if a doctor's medical license transfers with marriage, but perhaps it should!!!

If I ever stop posting it is because I relayed this idea to the missus.

I enjoy the implication that you'd keep posting even if you were shot, and that marriage to me is a more likely prospect still. If I were to be shot or stabbed in clinic, you bet I'd be writing an essay about it.

https://thelastpsychiatrist.com/2011/03/bad_at_math.html

Tis a shrink tradition.

More comments

3-10x pay differential detected, opinion rejected. We can trade places if you like, as long as you're not a surgeon. Psychiatry prepares me to deal with psychotics on public transit, and if I made as much money as you likely do, I wouldn't take the bus.

psychotics on public transit,

Who said anything about the mentally ill? Threats of murder are how Americans say hello.

The only guns I pack while driving are under the shirt, and they're low-caliber. I'll figure things out.

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