Muninn
Burnt out, over the hill autistic IT nerd and longtime SSC lurker
User ID: 3219
Muninn
2d ago
I am a man and I have extensive firsthand experience in this department. Me, I'm a simple vegetarian (which means I eat dairy and eggs) and only qualify for "disordered eating," which is to say that my eating habits are not even in the zip code of normal people but don't rise to the level of a full-blown eating disorder--autism, it's what's (not) for breakfast! My wife, on the other hand, has struggled with anorexia for most of her adult life and was 58 pounds at her lowest weight. There's no delicate way for me to say this, but the, "you don't want me to get fat, right," comment, her restrictive diet, and being underweight all combine to raise my suspicions that your girlfriend is anorexic. In fact, that's pretty much the diagnostic criteria for anorexia right there if we assume that the fear of becoming overweight is intense or otherwise exaggerated. If she is, there are other common signs that you've already noticed or will notice over time, things like being extremely self-conscious about her body, a negative self-image in general, hiding her body with loose clothing or layers, a general habit of withdrawing and isolating from friends and fun/enjoyable activities, fluid loading, especially with caffeinated beverages, noticeably low muscle mass on arms and legs, etc.
I actually came here to write about my own difficulties in my marriage due in major part to my wife's anorexia and I have been crying off and on as I write this because this shit is as serious as a heart attack and I want to find a way to convey this to you. Recovery is possible but it's a long and arduous road, requiring a good treatment team, a support network that unabashedly loves her and supports her unconditionally, and most importantly her own willingness to participate in treatment and sustained efforts to recover. Please feel free to respond/DM me if you want to talk more about this--I hope like hell that it isn't that bad, and I wish you well regardless.
Muninn
7d ago
Edit: I thought I remembered the funding for EHRs coming from the ACA but fact checking myself I'm less sure.
Good fact check! EHR funding was a part of the ARRA, aka the Stimulus.
Muninn
9d ago
Yeah, for the record, when it comes to mental illness in general, while I find the entire field fascinating, and I've been told that I could absolutely do clinical work if I actually wanted to do it badly enough to get the sheepskin, but it's more like I know a thing or two because I've seen a thing or two, since I've never been formally trained. As a Mottizen I would request that you please err on the side of mansplaining/docsplaining/etc in the future since it's hard for me to hit information overload. And I will shamelessly admit that I've become a sucker for any half-decent LitRPG stuff so the world of 12 Miles Below turned out to be quite the pleasant surprise.
Back to the topic at hand! I believe I have inadvertently muddied the waters there since the thrust of my original post was really a more off-the-cuff and less elegant version of your saying that it's not a high percentage of people but a certain population absolutely needs to avoid [drugs and alcohol], ie that for some folks drug and alcohol use can lead to psychotic symptoms while under the influence of the substance in question and perhaps dealing with those symptoms for some time afterwards. Our crisis department deals with the fallout from that often enough. I was not, in that reply, intending to delve into the much muddier question of whether or not drugs, and particularly psychedelics and hallucinogens, can cause psychosis all by themselves. Since you've already covered that ground, I'll just add to that particular question that my personal suspicion is that for some folks, their long-term drug use does contribute to periods of or even lasting psychosis, though I wouldn't go so far as to say that drug use alone was responsible for the psychosis. While this shows my age, my go-to association there is the story of Syd Barrett. He was definitely schizophrenic and I personally believe from the obvious and fairly common progression in his case that he would have been schizophrenic regardless of his drug use, but as Roger Waters put it, his enthusiasm for, and frequent use of LSD certainly didn't help. In the case of my particular anecdote I think it's there's a good chance that schizophrenia was brewing but the symptoms started subtle enough to be dismissed, but of course it's almost impossible to separate cause and effect out given that she was smoking dope regularly at that time as well. It certainly didn't help her any, either, and I think that if she were able to lay off of the Devil's Lettuce, she'd certainly be better off than she otherwise would be.
Muninn
10d ago
So @Throwaway05 has answered this well and the point made about the cause vs. reveals debate is a good one with no clear, correct answer. For the anecdote in question, this gal had been a long-term recreational user and was well into middle age when she started exhibiting acute psychotic symptoms pretty much out of the blue. Fortysomething is pretty late in the game to develop schizophrenia, though it isn't unheard of, like 15-20% IIRC, and her case generally seemed to be more of the sudden onset variety that was slowly clearing after each episode until she used again. On the work front, again, I'd agree that we see folks that french fried when they should have pizzaed and as a result are having a bad time.
Muninn
10d ago
Once Upon A Time, I read The Varieties of Psychedelic Experience, and one of the takeaways was that hallucinogens in particular did in fact permanently alter the brain's neural pathways and that also tracks with my own personal experiences, so I'd say your theory has merit. That said, on a meta level, I also wouldn't recommend that particular path to anyone, either, so there's that.
Muninn
10d ago
Just because I have lots of experience in this department, I can understand your skepticism. However, drug and alcohol induced psychosis is absolutely a Thing, propaganda notwithstanding. My old roommate was recently dating a gal who reached the point of marijuana-induced psychosis during the course of their relationship, in fact. By the end of it she couldn't hold down a job and had been hospitalized a couple of times for her episodes, and IIRC her continued smoking despite all of that was a big factor in the break-up.
Muninn
17d ago
Not that I'm old or anything, but the first Eagles memories I have are my brother and my father singing a song about a Dick Vermeil Super Bowl team set to the twelve days of Christmas. Separately, I can remember being annoyed at another time because the game was on and I wanted to play something on the Atari. But since I was talking about the deep-seated pessimism that can only exist from being so close so frequently only to taste disappointment, TO's first year was the next time I saw the Birds make it to the Super Bowl over 20 years later. Making it twice in the last decade is really a welcome improvement given that the next best thing was eternally losing the NFC championship and Big Red going off to Hawaii to coach the Pro Bowl.
Again.
Muninn
17d ago
Good for her and I totally get the Kelce angle, those boys lucked out in the genetics department. I've been a big fan of Saquon myself, my big concern was whether or not he would stay healthy followed by, "are we actually gonna commit to running the damn ball this year?!?" And, wow, I guess when I think about it, I've been a fan for decades myself, hence the recalcitrant pessimism that can only come from decades of being so close only to taste disappointment, which to be fair is something that is a staple of long-term fans of the Birds. "They lost a game, the season is over!!"
Muninn
17d ago
The game started off iffy for the iggles, my mother went all the way from saying "Saquon doesn't have it and the Eagles are going to lose, might as well bench him to protect him for the rest of the season, no injuries" in the first quarter
ROFL, clearly your mother is a dyed-in-the-wool, hardcore Eagles fan!
Muninn
19d ago
Wow, I want to thank everyone for awarding me an AACQ! I figured if anyone would appreciate a long-winded, repetitive, and self-indulgent peek into a typical bureaucratic/Molochian death spiral it would be my fellow Mottizens and it's heartening to see that it was so. I hope to write and contribute more in the future when my personal life isn't quite so demanding.
Muninn
1mo ago
Check out Out of the FOG, it's got a lot of good info on personality disorders, associated behaviors, and best ways to preserve oneself. If you're interested specifically in Borderline mothers, I'd highly recommend reading Understanding the Borderline Mother which is, of course, out of print and relatively expensive. AFAIK it's pretty much the reference material on how BPD presents to children and spouses, regardless of sex.
Source: my mother is BPD as are many women on her side of the family.
Muninn
1mo ago
American Hinduism is closer to ACX-Rationalism than the sort of conservative thought that is ascribed to India's rural Hindi heartland.
LOL, data set of one and all, but this individual cornfed, white bread, SSC/ACX lurking American Hindu agrees with you!
I'm reluctant to post this last part because I don't expect anyone to take this seriously.
Listen, I'm just a crazy spirit helping out my diety, so my opinion and $6 will get you a nice festive White Peppermint Mocha from Starbucks, but I take your experience as serious as a heart attack and completely believe that it happened to you exactly as you described it. In my own family my paternal grandmother was infamous for her presence in her home after she passed away until my grandfather joined her several years later. Both he and my uncle received occasional guidance from her and at least one direct message, usually when they were looking for something. Sounds woo woo and hokey, right? But how would you feel if you were wondering where that screw was that dropped out of your glasses and a thought came unbidden into your mind and said, "it's in the heel of your shoe!" It blew my grandfather's mind for sure. While I never had a personal experience involving her after her passing, it felt like she was hanging around the house to me, too. In fact, I'd say that her presence was palpable while he still lived. I've had many other personal experiences in my life as well, more than enough to satisfy my own questions about life, death, the afterlife, etc.
Now if you'll excuse me, I have to go torment some drunken writer/poet...
Muninn
1mo ago
Interesting piece, thanks for sharing! Reading a lot of that was intensely familiar, though I'd quibble with some of the premises of the series. But I was heartily amused by the talk of Axis II disorders in the DSM III and in fact had originally written a throwaway line about how over-represented personality disorders were on both sides of the mental health industry, but decided it would probably be too distracting. The psychotherapy CPT code graph was likewise spot-on and the talk about medical billing code complexity was as well. As the piece said, we in the MH field actually have it relatively easy, though anyone who's ever messed with interactive complexity knows full well that as with everything in this business, "easy" is relative!
Muninn
1mo ago
I've only used Epic as a patient but from that perspective it's always seemed fine to me. My understanding is that on the other side of things, it's layers upon layers of complicated but then, so is the practice of medicine itself, so yeah.
AI is looking like we could probably feed it the bulk of our documentation and let it spit out nice notes for the majority of staff, but of course HIPAA. I don't use it much myself, personally, but then again I'm constantly context switching between our EHR side and our IT side and my personal goal is to pass on as much institutional knowledge as I can. I can remember when my old boss was jealous of me because I got to build fun things and learn while he had to ride herd on the clinical side. Now I'm doing what he did while the young IT Specialist is building fun things and learning new stuff. He did learn the hard way that anything he touches, he owns that way though!
Muninn
1mo ago
Yeah I don't mind the skimming at all, even though I had fun doing the repetition bit when I was writing the piece, it bloated it significantly. But this is the Motte, after all, and the one commenter who replied to me wanted the detail so I ended up going with it.
Can't think of anything that I could really tell you that you wouldn't have already encountered. I don't need to tell you how awful the healthcare bureaucracy is, right? Though maybe I will add that our most common doc issue is that they can't e-prescribe to the client because someone went and added a full address to the "address 2" field of the client profile, exceeding 40 characters and also obviously breaking address verification. That one ended up being thanks to an instruction from the clinical head who evidently was never taught Federal address standards...
If you're interested, our clinical side has largely been neglected in EHR land for the last 8 years as two different medical heads did not or did not want to get involved in that area. The next medical head pulled a Brave Sir Robin after trying her best to do that and still be a Psychiatrist for a year, and I can't blame her. I've been in a few meetings with the new head of medical, who is an old-timer, and have discovered that the institutional knowledge problem that I harp on is a big issue there as well, mostly because we could probably streamline some stuff out of the workflow for the docs (Meaningful Use has been over for a while, after all) but also because the nurses abandoned their actual note along the way and started using an outpatient note instead, leading to the loss of data and my employer getting its wrist slapped by the State. Definitely a LOL moment for me!
And thanks for the read, it had me sympathetically SMDH many times!
Muninn
1mo ago
Yeah, I apologize for the lack of clarity, my fingers are in so many different pies that it'd be hard to list them all. Off the top of my head, though, I'm still doing lots of data analyst and EHR admin as well as major pieces of the different data that we ship to our State for various departments and initiatives, Exchange admin, 365 admin, network admin, general server admin, help desk (we're all vulnerable to walk-ins, after all), some firewall/security stuff... in fact, I actually built an antispam server from open source wow, 21 years ago, and ran it until we modernized our network in 2011. That particular guy was one of my prouder accomplishments until I got into the guts of administering our current EHR platform. Anyway, the truth of the matter is that ever since that point and really earlier that on any given day I was putting out whatever fire was the biggest, if there was one, and if there wasn't then I was waiting for the inevitable.
On the whole HIPAA thing, yeah definitely not so much plugged into opaque databases. For all that the minimum necessary rule tries to restrict information, in the mental health world we do all kinds of wacky stuff that makes trying to even tamp down staff access difficult. When it comes to higher up stuff, most of the work we do is still wide open, though there are restricted clients that require an extra level of access, even to those that can generally access all clients with impunity. Fun fact: I actually had to go in and fix a family member's record not too long ago. They had been restricted because I worked there but still, someone made a mistake and there it was. I already knew said family member had gotten themselves TDO'ed so it just tickled my dark heart but if we had our act together and I was actually just doing IT proper stuff I'd never have to do that. And because I'm on the subject, I just can't even with all of the HIPAA breaches I've seen. Lots of them are genuine, "didn't get the memo/comprehend the training," type stuff like emailing documents with PHI in the wild, which our antispam gateway doesn't always catch, but there have been a few doozies, too. One of the saddest involved a staff who had somehow discovered that her boyfriend was also dating a client of ours, and said staff looked at the client's record and then proceeded to dig herself into a deeper hole trying to cover it up. Just a sad story and the only one I've seen prosecuted. Surprisingly, we've actually been forced to rehire staff that breached HIPAA and got terminated for it!
Anyway, I completely agree with you about needing a better standard than O'Connor and for me that's a real example of how my individualist ideals can lead to serious suffering in the real world. I can think of a few different "frequent flier" type clients that really would be better off institutionalized and that doesn't even touch clients that are homeless and suffering. And sadly, refusing medication for some of our most mentally ill clients goes hand in hand with being frequent fliers. I'm hopeful that we can find newer and better drugs for the folks that suffer from the terrible side effects (some folks do tend to think they're just fine without the meds) but then again, if you've ever read Scott's banger on esketamine, FDA approval is another thing on the long list of reasons that We Can't Have Nice Things.
Muninn
1mo ago
I am enjoying Songs of a Lost World immensely thus far. The themes of aging, sadness, and loss speak directly to my experiences, even more so since 2024 has turned into another, "buckle up, buckaroos," kind of year of sweeping changes for me personally. I'm thrilled that The Cure has released an album this damn good in this day and age (and with multiple vinyl and cassette versions to boot!) and it's quite the poignant experience to listen to something that is so on point to my middle-aged self and that also makes my inner Goth Kid squee in delight.
Muninn
1mo ago
I want my body to be cremated, I want the ashes to be transmitted in a metal Folger's can, and then I want them scattered at the edge of a cliff into the Pacific Ocean.
Muninn
1mo ago
IRL, I used to work in the same building as a therapist and I used go to lunch with him. He told me it's fairly common in male victims of child rape to fetishize the behavior, that is, at least in the ones who are troubled enough to seek therapy. This didn't take place in a therapy-happy country mind you.
When I was a young man in a long distance relationship I would often end up listening to Loveline with Adam Corolla and Dr. Drew on my way back home Sunday evenings. One of those nights, they were discussing this in the more general context of the sexual experiences of children. Adam was talking about how while he was initially skeptical of the connection between adult sexual issues and childhood experiences, with enough time and repetition, he had come to believe that Drew was onto something when he always asked folks about their childhood when this sort of thing came up. He went on to liken a child's mind to wet cement that was slowly drying. Those childhood experiences would make an impression on the cement that ultimately cured into sexual expectations and preferences as an adult.
This made sense to me at the time and speaking as someone who works in the mental health field and is married to a therapist, I've heard more than enough stories like this myself to believe that this is the most likely explanation for all sorts of sexual preferences.
Muninn
1mo ago
Haven't read Andromeda but completely agree on 12 Miles Below. I read the first one and ended up devouring the entire series several months back and I'm hoping there's more soon!
Muninn
1mo ago
Thank you very much, that's excellent news! A cursory search has led me to an unofficial plug-in to support remote save; I'll give it a try and see if I like it better than Joplin.
Muninn
1mo ago
Damn. Speaking as a Joplin user who had never heard of Obsidian before, I really like the look of Obsidian and would love to use its additional functionality (compared to Joplin) but at $4 a month for non-local storage that's a no-go for me. A big part of my use case is the ability to make notes to myself on whatever device I have handy that I can encrypt end-to-end and automatically sync via WebDAV.
Yeah, she was institutionalized for that, I'm sure it saved her life. Sadly, she's still anorexic af, but she's managed a balance where she maintains a decent weight, so she's got that going for her.
More options
Context Copy link