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PaperclipPerfector  11mo ago (text post)   2819 thread views

Wellness Wednesday for November 22, 2023

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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"Kids typically resort to the silent treatment when they feel like their words don't matter, and they have no other way of pushing back."

I feel like the first half of this was more true for me. I didn't really see my behavior as pushing back though, but rather pure avoidance--responding seemingly always made things worse, so I just stopped responding because that was apparently the least bad option.

I'd say it was usually alienating feedback rather than negative feedback. Feedback that made me feel like I didn't belong. A lot of times it wasn't intentionally negative, but just the fact that I had different opinions/views than the rest of my family would lead to such withdrawal because expressing them would require confronting that feeling of not really fitting in.

What are you counting as silent treatment? It could mean making a point of pretending someone doesn't exist, or it could be expecting someone to proactively reach out more than they're interested in doing so, or it could be badgering somebody who then retreats without satisfying your appetite for their input.

I could have been accused of all three at points. In the first case it would have been simple carelessness and taking someone for granted rather than a conscious tactic to upset them. In the second it's just disparate needs for reassurance. The times that I most remember consciously choosing to be silent were when I didn't fully understand myself and so couldn't say what I felt, or I did understand myself and knew that my position was either unacceptable or indefensible, or a combination where I knew my position was unacceptable but couldn't understand and express why I held it even if I wanted to. In that aspect I'd say it more closely matched "their words don't matter" rather than "act like a brat", but it assumes that sufficient words are available to be said.

What was I hoping to achieve? Distancing myself from what I felt was unpleasant and uncomfortable or insurmountable. Simple defence. I was never trying to make anyone else feel bad ("pushing back", even if passively), and I still can't fully wrap my head around the idea of both wanting to make someone feel bad and imagining that not talking to them is the way to do it. Passive aggression relies on baiting someone into questioning what they did wrong. Either they come to agree that they did something wrong and address that, or they're forced to accept the frame in order to deny it whereupon they can be attacked directly (actually obliquely). But it depends on them taking the bait, which depends on them caring, which depends on them noticing.

When you say "unacceptable or indefensible," do you mean you knew you were in the wrong? Or you knew that, even if you could verbalize your feelings, they'd be rejected or torn down by argument?

To spare you a long rambling post I wrote: Yes. But there's many more reasons to not say anything, an important one of which is feeling that either I can't find the right words or the words I can find would only make things worse. However in reference to the question at hand the motives are all either neutral or defensive.

In a nutshell avoidance or conflict aversion of one form or another is a much more probable cause than passive aggression.

When you're being given the silent treatment, is it unwise to ask why and seek reconciliation? You are, in a sense, rewarding the behavior.

On balance if you're confident that's what is happening and you want to reconcile then perhaps it's best to take the bait and cut to the chase. But if someone has backed off because they feel imposed upon then following them around making further impositions will only make them back off further, or drive them towards adopting a mode closer to active aggression. For a teenage boy I'd assume they withdrew in response to feeling imposed on in some manner rather than ignoring you to "get you back", but there's always exceptions.

This might be a particularly feminine social weapon, I admit.

Girls do seem more prone to it than boys. Eg, https://www.apa.org/monitor/julaug03/girls

I think it can start for a myriad of reasons but thinking can lock itself in somewhat and become self-referencing to continue the behaviour regardless of origin. It could be they are seeing through us phoney adults....

Yes, this makes sense as a strategy. Having some experience of it from both sides I've noticed there's a perception of moral righteousness you can hold onto (exploit?) that starts out comforting against a background say of stress, confusion or pain

As to always a male behaviour surely thats laughable. My friends relationship has the tendency to pattern as him doing something a bit egregious (being too hungover to take kids somewhere) and her punishing him with silent treatment for the appropriate length of time...

So, for some odd reason, one of the family member's staying with me started screaming in the middle of the night. Hearing an adult male yelling in my house, where I typically am the only adult male sleeping there, I shot upright...and threw out my upper back somehow or other. I'm not sure if I fell asleep in a bad position, or had a pre-existing injury, or what the hell, but right between my shoulder blades is screaming at my every time i turn my head left or right or look down.

Other than the embarrassment of realizing that in a fight-or-flight my body seems to have chosen, not even freeze, but "die." I'm treating it, and hopefully it will get better soon, but I'm kinda not sure what direction to go with working out. Anyone have good recommendations of exercises that won't strain that area of my spine? The stuff I was doing last week is all out of bounds, I'm not going to be doing KBs or Olympic lifts for a while. So I need a new plan, but I'm not sure what it is yet, and I can't think of exercises that won't implicate my upper back in any way. Like in the past, I dealt with a bad lower back strain by doing a Smolov Jr for Bench month, but I'm not sure what to do without my upper back.

The stuff I was doing last week is all out of bounds, I'm not going to be doing KBs or Olympic lifts for a while.

I don't know exactly what's wrong with your back, but two-handed kettlebell swings have actually really helped when I've tweaked my back, as I do every five years or so.

What I do is start with a conservative range of motion, and then after several reps the pain-free range of motion increases a bit. I continue until I can do the full range of motion pain-free. Usually the pain comes back after a while, but it gives me short-term pain relief and probably accelerates healing.

Not sure if this works as well for the upper back, but it's worth a try. Generally you want to use the injured muscles ASAP to increase blood flow to the injured tissue, rather than just resting it completely.

It actually wound up resolving itself with two days rest, some yoga, and a day standing in the freezing rain at a football game.

Re kb: I was thinking more in terms of kettlebell sport, where it's all overhead lifts.

This isn’t that uncommon; I regularly wake up screaming in the middle of the night.

I'm not a sports physician or physio, but I would say once you've recovered to mix in more stretching and pilates. There's clearly small muscle groups that have not been toned by your regime that can be thrown out in this way. I don't know how old you are, but this kind of thing is recommended as you age. From what I've heard it will also help prevent weight training related injuries.

I don't have any exercise advice for you but I really want to know: why was he yelling?

I have yet to get a satisfying explanation. He says he was watching a movie on his phone, half fell asleep, and scared himself when something happened on screen + being in a different place than he expected. This seems unlikely. His father thinks he got into my liquor after everyone went to bed and had some kind of alcoholic fugue, and strongly implied no more drinking this week. This would fit but nothing is missing, and he's not the kind of guy who hides the evidence. His sister, my wife, just thought it was some kind of nightmare/terror thing. Which makes sense but, dude, it was a LOT, if that happened regularly you'd know about it. From what I remember hearing I kind of felt like what he was screaming seemed like a coherent sentence moreso than hallucination, "I DON'T EVEN WANT TO FUCKING BE HERE" etc, so it seemed immediately like he was talking to a person and snapped, maybe late night facetime with a girlfriend who really pissed him off? But he has no current gf he's talking about openly.

None of these possibilities are really very explanatory.

Without additional events I would just right this off as night terrors. I've done similar things in my life (shouting while asleep) for no reason at all. It wasn't a chronic condition, just happened to be a one off weird half-sleep where your mind plays tricks. Very embarrassing, but not uncommon.

Yeah it was just super freaky. Doesn't seem to be a big deal or anything.

It might not be advisable to work out depending on what this is. It's pretty common to get pain from misaligned costovertebral joints and in that case you need to do stretching exercises.

If you don't want to go to a physio I recommend looking it up on YouTube, there is a plethora of good instructional videos going through every possible injury and demonstrations of what you can do yourself.

I'm moving to New Zealand in 8 days to start a (potentially) 2 year working holiday.

I guess I should be happy and excited. Instead I feel listless and anxious. I have lots of stuff I need to organize and get sorted that I just haven't. Other than my visa, flight, and a short hostel booking I don't have anything. Worse, I can't evade the thought that I'm going there to escape the things I don't like about myself and my life, and that I'm going to take my same issues there and replicate the same problems.

Other than that, bulk has kind of stalled out at about 83kg, which is always where I start to struggle to gain weight. That said I have made some small strength gains.

Good luck, which city are you moving to?

Auckland, but all I have is a hostel for a few days. I'm not sure if I want to stay given what most Kiwis have said about it.

Yeah that doesn’t sound like very appealing accommodation, what are you looking to do in the country? Anything I can help with?

I don't really know what I want to do yet. I have money saved up so there's no real pressure for me to get a job right away.

Good luck! The anxiety is normal. You will get used to making plans on the go and being more spontaneous fairly quickly. Try to be serious about using this time to break some undesirable habits and hopefully form new and more desirable ones. You will come across a lot of unattached young adventurous females so for example it’s a very good time to start being more daring with flirting :). Try to meet other people doing a similar travel and keep in touch. You will get homesick after a while and it’s nice to have some familiar faces once in a while. Try to be very open to experiences. Don’t say no to people who invite you to activities unless you have reasonable worries about your safety.

I'm gay so unattached women aren't really that appealing to me, though I'm willing to try anything once. I do want to try getting out of my shell more in that regard, though. I have very little sexual experience and I find the idea of sex more scary than exciting. I guess that's another pattern I want to try and break.

Thank you for the advice, though.

A bit of a personal question: how did you come to the conclusion that you are gay with very little sexual experience?

Because I am, and always have been, attracted to and sexually aroused by men. I kind of more deliberately put it together in adolescence. I just don't like having sex that much.

Can I ask why you chose New Zealand? For context, I'm a local here and I'm in the process of doing the reverse; getting a working holiday visa for Canada, trying to make significant changes to my life, even bulking (84kg myself!).

I live in the UK, and we have a lot of kiwis here. The firm I was working for was perhaps 50% kiwis on visas. They all came off as really nice and friendly, and you talked about how beautiful their country is.

More generally, I've been going through depression on and off for a bit over two years now. I don't know if moving to the other side of the world will fix me or help me but it's worth trying, and might be a good experience anyway. I don't really like the person I am right now. I also have friends who have done similar things (though in Australia), and they seem to have benefited from the time.

Btw, any recommendations for places to go, things to see, jobs to work?

I can't deny the country is beautiful! It's largely peaceful here too, which is great for that environment of trust and friendliness. I'd be interested in reading a follow up post from you on how you feel your mental state evolves throughout your trip. I'm not going to leave the country til mid-2024, so hearing your perspective as someone who's figurative footsteps I'll be following on in could have some valuable insights.

You're here for two years so you have a lot of time to explore! I'm not sure what you would like to do for work, so I'm not sure what to recommend there. If you want to live in a proper city you only really have one option, Auckland. It's a less friendly place than the other cities but it's the business hub of the country and the infrastructure reflects that. Wellington has an arty vibe and prides itself on being kind of quirky, a bit like Portland in the US. It's very very windy though, and can be a bit insular, making it hard to break into a social scene. Christchurch is a great city right now, it's finally recovering from a devastating earthquake a bit over a decade ago. It seems to be the best place to go for your bars, clubs, and restaurant style social scene. Lots of friendly people there who have just come out of some terrible times together. There are loads of smaller places to live, but I have always seen them as kind of sad myself so couldn't really give you an earnest recommendation there.

Apart from that there's a lot of natural beauty so if you like hiking you could be on a different trail every weekend. Your more touristy spots would be Queenstown, Rotorua, Taupo, Waiheke Island, Marlborough. Honestly it's too much to cover in one post. A lot of people show up, get a self contained van or camper and then go on a months long road trip to see as much as possible.

What about Dunedin? Is it a shithole?

Not sure if shithole is the word I would use, but I wouldn't really want to live there. It's kind of a student city; Otago University is infamously known for being a year long party. There's a movie set in the city, Scarfies. Well known locally, but getting a bit outdated these days.

I've lived in London pretty much my entire life so I think I'd rather be away from a city. Plus, every New Zealander I've spoken to has said not to stay in Auckland.

To be honest I'm not really sure what I want to do either. Farm work sounds interesting and different to what I've done before. Unfortunately I can't drive so that might limit what I can do.

Auckland gets a bad rap, and is actually pretty nice if you're used to city living. You do need a car to live there, public transport is a mess the entire country over. Wellington and Christchurch would both accommodate you well enough without a car as they're small places. In any city you wouldn't have much trouble finding work in hospitality or other service industries. There's a bit of film/television work around that often requires short term contract workers. In my opinion, farm work is probably going to be a big challenge. They're quite far from civilisation and without a car you'll feel that isolation. If you can manage to get a license you can easily run around the country living in a van doing seasonal labour - mostly picking fruit, or working in meat/seafood processing. Otherwise, if you're open to doing tourist work there's a lot of that available in tourist towns, but you'll need good luck to find affordable accommodation there!

I had ICL surgery yesterday. It’s like LASIK but for people with stronger prescriptions. So I’m now the proud owner of two implanted contact lenses, and I’m already typing this without the extreme glasses I used for the past 2+ decades. It’s amazing what the body can withstand.

The only sedation for the first eye was 2mg Xanax, so I remember it reasonably well. There were three bright lights shining in, backlighting a series of uncanny inserting sensations. Bizarre, but tolerable. For the second, they added some IV sedation, so my memories didn’t really form. I assume it was more of the same. I was out and recovering in less than an hour.

There was one unfortunate snag. The gel used during the surgery is hard to remove, and some remained in my left eye. This risks blocking drainage ducts, which it did, causing high pressure and crippling pain…starting hours after the surgery. I’d come home and napped as the drugs wore off, and when the pain kicked in I almost immediately deposited my entire lunch on the floor next to the toilet. I have only felt a head pain like this when I had a migraine that temporarily removed my ability to speak English. Maybe the sinus surgery would compare, but that came with a lot more in the way of drugs.

Anyway, after some alarmed phone calls, I was shuttled back to the clinic, vomiting all the way. This is a known issue, and they were prepared with anti-dilatory drops to, uh, apparently dilate the duct. Eyes are strange. By eight or nine I was pain-free, stomach-free, and changing clothes to get in bed. I’m told I even brushed my teeth.

Perhaps I shouldn’t be writing this. They say dream journals improve your recall of the events, and I don’t need to remember any more of this nightmarish carousel. Still, I think it was worth it. I can see like the rest of you regular humans, now, only a day after some guy rummaged around in my head.

God bless my girlfriend for handling me, as they say, at my worst.

That sounds hellish. As my own eyes have deteriorated over the years I've considered some type of surgery, but always just fall back on eyeglasses and a new prescription. I sometimes wonder what it would be like to see (and hear, and... other things) with the same clarity as when I was a boy. The first time I ever put on glasses (my girlfriend-at-the-time's sister's, as the 3 of us sat in a movie theater) I was dumbfounded how clear the screen was and I had just forgotten over years of gradual weakening eyesight.

Hello all, how are you? I hope you all have been doing well.

I haven't been doing so great. I have personal contacts and a support system, but I think this community is one of the few places where my actual feelings will be understood, and my thoughts appreciated.

I'm struggling with finding psychotherapy that's effective for my combination of depression and anxiety, which I've dealt with since I was a child. I had my first recognizable depressive episode in the first grade, not kidding, so this is something that's obviously deep-rooted and temperamental in nature. In that sense, I'm not looking for "insight therapy" where I'm supposed to suddenly figure out what's causing my problems, but for skills-based therapy that can provide discrete and specific interventions I can rely on when my distress or my anhedonia get the better of me. Even solutions-focused brief therapy sounds better than insight therapy at this point.

I actually have a pretty good handle on my emotions and their causes -- counselors in the past have said I have a lot of insight into my problems. The issue isn't that I don't understand them, or are alienated from the true causes, but that I don't know what to do about the negative behaviors I have already identified I have. I'm not really coming into psychotherapy looking for a diagnosis, but a treatment.

I'd like to illustrate my problems with psychotherapy by talking about my most recent, and current, attempt at seeing a shrink.

The most concerning sign of my worsening depression is my attitude towards other people has gotten pretty harsh -- I'm quick to get angry, make snap judgments, even be tempted to be rude -- which is outside of the norm for me. I see this problem as more of a symptom than an underlying issue; I feel more pessimistic and irritable, so I'm eager to lash out. My real problem, I think, is that I don't have as much patience for others as I used to, because I feel on edge all the time.

Unfortunately, I think my new therapist saw this as a bigger part of my problems than it is, and we ended up going down a rabbit hole of "let's explore your feelings of annoyance to see what they tell you about your hidden emotions," and "your negative judgments of other people must be reflective of too much self-criticism." I didn't get any value out of this.

Another issue for me is that psychotherapists are all-in on "unconditional positive regard." This often feels to me like therapists pledging never to actually criticize the problems of the clients who are coming in for a critical eye on their problems.

My current therapist likes to bill himself on being "shame-free," but I'm coming to believe that the optimal amount of shame for personal growth, even in a therapeutic relationship, is not zero. While I don't think a therapist should be mean to their clients, I do think some level of fatherly Jordan-Peterson-style, "get yourself together, man, make something of yourself, you're better than this!" would be incredibly helpful and motivating.

One particular incident stands out -- I was talking about how I got in a social media rabbit hole of drama-reading that made me angry (a common thing for me, as themotte knows), and how I knew I shouldn't do it but did it anyway. He was quick to jump in and suggest "taking the shouldn't out of it," which instantly rubbed me the wrong way and made me feel like my convictions weren't being respected. He seemed surprised when I expressed a strong resolve to just... not use social media, because I see it as harmful to me. Has he never had a client who resolved to avoid things that are bad for them?

It's not that I feel my "shouldn'ts" in this area are imposed on me, or act as a source of guilt... I just recognize that this thing isn't something I like, it's not compatible with my value system, and I don't want to do it any more. I worry this particular therapist has made "avoiding negative judgments" so integral to his therapeutic approach that even when a client comes with an earnest sense that a particular behavior is wrong for them, he still feels the need to taboo their sense of resolution as maladaptive.

I do wonder if this is just a personality difference between men and women, where the average man is motivated more by rising to the challenge of fulfilling expectations and the average woman is motivated more by knowing people care about her and will support her regardless. This is one of the strong reasons why I wonder if the severe over-representation of women in psychology is really distorting the practice, so much so that even men are tailoring their treatment of male clients to the average woman's preferences and needs. When someone a while ago talked on here about "lefty mental health," think that was part of what they were talking about.

So, I feel like my current bout of therapy isn't working. We're not clicking. I've never actually had this happen before, despite trying therapy several times in my life -- I've always just kind of gone along with things, not thinking too much about what I'm looking to get out of therapy other than someone to listen. Now that I've thought critically about what I want to gain from treatment, I'm more judicious about what I need in a therapist. So I don't think this particular guy has the expertise or the right frame of mind to offer skills-based therapy, and is just generally a bad fit for me.

But I'm kind of stuck. As I've said, I've tried psychotherapy several times in my life, and it's made little difference in the overall trend of my mental health. In an earlier attempt at therapy, the only actual unit of value was the advice to use deep, slow breathing as a quick antidote to anxiety (something something parasympathetic nervous system), which to this day can legitimately feel like taking some sort of dissociative drug in terms of how chilled out it can make me.

If therapy has anything to offer me, I don't think it consists of therapeutic theories or piercing insight, but would offer more practical steps to counter negative self-talk and reduce bad thought/behavior spirals. The problem I have is not that I don't understand my problem and don't understand when my thoughts and behaviors are unhelpful, it's that, in the moment, I either feel egosyntonically aligned with the unhelpful things, or I feel situationally powerless to counter it. What I need is a therapist who recognizes that, and can provide direct and practical advice.

But increasingly I just feel like psychotherapy is a dead-end, and what I actually need is to finally get my GP to refer me to a psychiatrist, who might be willing to try one of the fancier anti-depressants that sometimes help people with treatment-resistant anxiety and depression. I've bounced between a few SSRIs and SNRIs in my life, but haven't seen much difference other than the fucked-up sex drive.

Hell, shock my brain at this point, I just don't want to feel on edge any more.

Any thoughts? Please be gentle.

My real problem, I think, is that I don't have as much patience for others as I used to, because I feel on edge all the time.

I feel the same way. I have somewhat alleviated this by being more intentional about the environments/situations I put myself in. In things like men's circle, book clubs, and mental health support groups I have much more patience for people. It is probably due to some combination of me finding the discussions interesting, people being more open-minded, and/or being in situations where people can talk about more vulnerable things.

I guess you could dig deeper into what you like and dislike about certain environments, but I mostly rely on intuition. If I lose patience with people I'll just disengage with that specific environment and spend more time in one I like.

In an earlier attempt at therapy, the only actual unit of value was the advice to use deep, slow breathing as a quick antidote to anxiety (something something parasympathetic nervous system)

That technique, along with the parasympathetic nervous system, is explained in much greater detail here: https://www.lesswrong.com/posts/QnZRvud7fXfpdxBY3/againstness

I do think some level of fatherly Jordan-Peterson-style, "get yourself together, man, make something of yourself, you're better than this!" would be incredibly helpful and motivating.

Sometimes people need information on what they need to do. They need to look at their problems from an outsider's perspective to gain insight. However, once they have the necessary information then sometimes they need an outsider to provide motivation/accountability in order to follow through on something (for example: they know they need to eat healthier). If you need help following through on something there are other ways to get that without therapy.

I'm of the opinion that great therapists are few and far between. Like a fraction of a percentage of the ones practicing are going to be confident and have their shit together enough to give you the Peterson style advice you're looking for.

That doesn't necessarily mean you stop looking. But it does require a new lens on therapy. If it's something you want to get something good out of, it's going to be a long slog. You'll need to do research, get referrals from other therapists, and try to find the absolute best ones.

To put it bluntly, I think to be a good therapist you need to be damn near enlightened. And frankly it sounds like you are adjusted well enough, I would say what you need is more spiritual type growth. Take that as you will.

This comment may in no way help you. But it's unlikely to hurt you, either.

When my youngest son was in elementary school the group of kids who walk together to school (not a friend group--a pre-determined, decided cohort of children, one of whom has a flag) would be out there waiting around 8 o'clock. My son sometimes had an issue where as this moment approached he would get so worked up and beside himself with nervous energy that he would have to sit on the toilet. This got to the point where he would end up delaying the other kids, which is a big no-no in Japan, and his frazzled mother would go out and tell them all he would come later, they could go on.

I don't know if my solution was the best one, and it was certainly short-term, but I knew from bitter experience that getting scolded wasn't going to help him, nor was reason or threat or pleading. What did help was that every morning then I would set a deep metal bowl with ice water (like literal chunks of ice in it) and a towel. He would dunk his face for ten seconds, wipe dry, and off he went without ever making anyone wait again. I don't know how long this lasted, but it was long enough that wifey began worrying and told me I shouldn't be setting up the ice unless he asked. I knew better than that, too, though.

Eventually he didn't need the dunk, but I'll keep the ice machine full for the future.

This is all vagus nerve/parasympathetic nervous system hacking, as you alluded to, which is what reminded me.

I've bounced between a few SSRIs and SNRIs in my life, but haven't seen much difference other than the fucked-up sex drive.

Are you certain they didn't make things better? I had to go on and off of SSRIs and SNRIs like 4 times before I finally accepted that it wasn't coincidence that better things seem to happen to me when I'm on them, and worse things seem to happen when I'm off them. I really thought it was coincidence at first, but eventually realized that I notice and accept the better things when I'm on these drugs.

This is a valid point. For what it's worth, I do notice an immediate and marked decline in my mental functioning if I ever forget a dose or skip one. It's subtle, but I've had it happen several times where I forgot to take it and then, like 12 hours later, realize I've been way more anxious than I normally am. I am suspicious that this is just a withdrawl -- let's call it what it is, and not use euphemisms like "discontinuation syndrome" -- that I would recover from if correctly tapered off. That's why I haven't discontinued the medication at this point.

However, I don't notice an overall difference in mood now vs before I started medication. I think the emotional blunting probably has some impact in "taking the edge off," but not enough for it to be a major improvement that helps me function more normally. I don't think it's pure placebo, but I also don't think the size of the effect is large enough for it to be worth the drug dependence and side effects.

Not OP, but I tried 3 SSRIs and 1 SNRI and they didn't help in the least.

I definitely believe both you and OP that there are probably people for which these drugs have no effect. But I also think it's worth doublechecking, since I definitely had my aforementioned experience.

SSRIs have pretty weak effect sizes, but that's not the same as them being entirely useless after all.

Thankfully, Scott has a deep dive on the subject, sparing me the trouble:

https://slatestarcodex.com/2018/11/07/ssris-an-update/

All this leads to the third thing I’ve been thinking about. Given that the effect size really is about 0.3, how do we square the scientific evidence (that SSRIs “work” but do so little that no normal person could possibly detect them) with the clinical evidence (that psychiatrists and patients often find SSRIs sometimes save lives and often make depression substantially better?)

The traditional way to do this is to say that psychiatrists and patients are wrong. Given all the possible biases involved, they misattribute placebo effects to the drugs, or credit some cases that would have remitted anyway to the beneficial effect of SSRIs, or disproportionately remember the times the drugs work over the times they don’t. While “people are biased” is always an option, this doesn’t fit the magnitude of the clinical evidence that I (and most other psychiatrists) observe. There are patients who will regularly get better on an antidepressant, get worse when they stop it, get better when they go back on it, get worse when they stop it again, et cetera. This raises some questions of its own, like why patients keep stopping antidepressants that they clearly need in order to function, but makes bias less likely. Overall the clinical evidence that these drugs work is so strong that I will grasp at pretty much any straw in order to save my sanity and confirm that this is actually a real effect.

Every clinician knows that different people respond to antidepressants differently or not at all. Some patients will have an obvious and dramatic response to the first antidepressant they try. Other patients will have no response to the first antidepressant, but after trying five different things you’ll find one that works really well. Still other patients will apparently never respond to anything.

Overall only about 30% – 50% of the time when I start a patient on a particular antidepressant, do we end up deciding this is definitely the right medication for them and they should definitely stay on it. This fits national and global statistics. According to a Korean study, the median amount of time a patient stays on their antidepressant prescription is three months. A Japanese study finds only 44% of patients continued their antidepressants the recommended six months; an American study finds 31%.

Suppose that one-third of patients have some gene that makes them respond to Prozac with an effect size of 1.0 (very large and impressive), and nobody else responds. In a randomized controlled trial of Prozac, the average effect size will show up as 0.33 (one-third of patients get effect size of 1, two-thirds get effect size of 0). This matches the studies. In the clinic, one-third of patients will be obvious Prozac responders, and their psychiatrist will keep them on Prozac and be very impressed with it as an antidepressant and sing the praises of SSRIs. Two-thirds of patients will get no benefit, and their doctors will write them off as non-responders and try something else. Maybe the something else will work, and then the doctors will sing the praises of that SSRI, or maybe they’ll just say it’s “treatment-resistant depression” and so doesn’t count.

In other words, doctors’ observation “SSRIs work very well” is an existence statement “there are some patients for whom SSRIs work very well” – and not a universal observation “SSRIs will always work well for all patients”. Nobody has ever claimed the latter so it’s not surprising that it doesn’t match the studies.

This is 2018, pretty sure the "SSRIs are a placebo" thing came out after that.

I strongly disagree, I'm quite confident it was a relatively mainstream argument well before 2018, Scott wrote a post in 2014 to which this serves as an update, and that was partially motivated by the claims that SSRIs were useless/placebos.

Edit: The placebo theory is clearly mentioned in the text excerpt I posted as well as in his original blog post.

I mean that there was some big meta-analysis released a lot more recently than Scott wrote his article, which got a lot of press coverage. I think it was this one but I'm not 100% sure.

your negative judgments of other people must be reflective of too much self-criticism

I struggle with this. I have to make a conscious effort to be more forgiving of myself and others.

Other 'interventions' that have helped spending more time in meat-space with other people (church, civic-organizations like Rotary or Lions club, youth athletics with my children). Technological controls that restrict or limit my access to the internet.

I took SSRI for about 18 months, around 7 years ago. They reduced / blunted all my emotional response and tanked my libido.

In terms of situation, you sound pretty similar to myself, though your condition might be more severe. My own perspective is that skills based therapy is probably going to do nothing for you. When it comes down to it, my ability to rationalize my negative thoughts is too strong for me to overcome. On anger, I sympathise. Holding a lot of anger is really unpleasant especially when you don't have any good way of expressing yourself.

To that end, I think insight-based therapy could be a better choice. The way I see it insights are basically ways of fitting your symptoms into a narrative that you can resolve.

Since it usually comes up, I personally found that exercise doesn't really help at all with this stuff, except acutely and sometimes not even that.

When it comes down to it, my ability to rationalize my negative thoughts is too strong for me to overcome.

This is definitely something I've struggled with. I think one of the big challenges for smart, philosophical people who struggle with emotional regulation is how powerful the rationalizing impulse is in them.

That's one of the big reasons I want to lean more towards skill or solution based therapy, actually -- I'm not particularly interested in altering my worldview or doing extensive cognitive restructuring, and to be entirely honest I would find it impossible to lean on the judgment of a psychotherapist when doing so. I think someone would have to be close to enlightened -- as @TheDag said -- to actually offer insight into my cognitions or personality that would both ring true and motivate change. Otherwise, and this is what I've run into with the current therapist, I would quite easily be able to argue against their supposed insights to my satisfaction, if not theirs. My hope would be that, with a more skills-based approach, we could talk more about behaviors than cognitions. And my behavior is really what I want to be different.

I cannot speak to the efficacy of therapy. I myself have seen a therapist for the last year and a half and been involved in a men’s group for six months. I actually just quit doing my individual therapy, but will absolutely continue my men’s group.

My thoughts are that therapy really doesn’t work, but it offers at least some placebo effect. That is, it gives me some peace of mind that I’m doing something to try to fix my negative mental health. But I still have a deep rooted belief that therapy is not all that helpful. Which is interesting. Because when I posed this belief to my men’s group, all the men in the group strongly agreed that therapy was helpful to them. I, myself am not convinced. Really, the main reason I like men’s group therapy is that I get to shoot the shit with men for two hours a week without phones. The sessions are therapeutic, but I don’t feel like I take much with me out into the real world.

My opinion on SSRIs is that they also don’t work. At least not for me. But I do have good experience with other, stronger drugs, particularly those prescribed for bipolar or stronger mood disorders. You may consider giving those a try. And you don’t need to see an in-person psychiatrist for those. Depending on where you live, you may be able to find a virtual doctor or nurse practitioner. Ive found this to be low to medium helpful.

Have you tried Dialectical behaviour therapy?

I haven't really considered it, as my understanding is it was created for borderline personality disorder. When I investigated it, I was troubled by the focus, certainly part of what's necessary to treat BPD, that it puts on trying to get people to realize they're not well ("recognize the illness"). I guess it just sounds condescending. I don't have the instability of self-image or interpersonal relationships that characterizes BPD, my perceptions there are some of the most stable views I have. So insofar as DBT is oriented towards that, I'm not sure it's applicable to me.

But nevertheless, looking at it with fresh eyes, there's definitely a lot about DBT that does apply to the problems I face, especially how the focus is on skills to deal with dysregulated emotions, taking them almost as a given, because for me they kind of are. Being able to gain a certain amount of cognitive distance between my emotions and my thoughts is actually a big part of how I cope with my problems as it stands. If I let them carry me with them, I think my emotions would quickly become overwhelming. Insofar as I appear to casual observers like @TheDag to be well-adjusted (and this is something that I hear in person as well, acquaintances and even friends are often surprised how much I struggle with my emotions), it's because I have a mode of thinking that challenges impulsivity and counters dumb decisions with a calculation of utility. That is probably the nerdiest way to put it, but still, it's true.

Often I think that, if I weren't so introverted and behaviorally conventional, I would be much, much more emotionally challenged and poorly adjusted than I am. My negative emotions, philosophical (and thus often detached) orientation, and conventional behavior operate kind of in a homeostasis that helps me cope. If one piece were missing, I think I would spiral out of control.

There's probably something to the DBT assertion (that I saw on the wiki page you linked) that emotional dysfunction can persist because it's rewarded or not challenged by the environment. As it is, I think I don't expose my dysfunction to the world to the point where its consequences would alter my perception. I was reading about schema therapy the other day (it might even have been a lesswrong post?), and I think in part my problems persist because my negative perceptions are never challenged by reality, because I don't act on them. There's probably also something to that.

If psychology and psychiatry aren't working for you, try something else. (Or try again - the right med and/or therapist could in fact exist. I think guanfacine is highly underrated.) Lift is the obvious answer, or exercise more broadly, if you aren't already. Or even more broadly, get off the internet and go do things at a place.

If any of you needed to start considering looking into egg donation, and didn’t have many familial-social hookups, what would your strategy be to get a good quality egg?

  1. Look for a service that provides details about the donor beyond pure biometrics, ideally academic qualifications as a proxy for IQ (and thus a proxy for good health, if weakly so).

  2. Look for the donor who was the youngest at the time of donation, within that group. Avoid eggs from donors significantly over 30 (do these services even accept those? Idk)

  3. Obviously screen for any known illness, including familial.

academic qualifications as a proxy for IQ (and thus a proxy for good health, if weakly so).

There's also hobbies as proxy for good health - someone who lists marathon running as a hobby is relatively unlikely to be unhealthy. I don't know how you could screen for good mental health or...lack of propensity for autoimmune disorders. Anecdotally, a disproportionate number of high-achieving ambitious women wind up with autoimmune disorders, and some are reasonably healthy and can do things like pole dancing or hiking. Although they have chronic fatigue or chronic pain. So there's that; if you're interested, the RCCX theory by Dr. Sharon Megalethery seems plausible although I'd take it with the whole shaker of salt.

If you're really stretching it...ballet dancers and gymnasts seem to really be a mixed bag, they're likely to be in that cluster of 'smart, determined, somewhat neurotic, queer, neurodivergent, potential autoimmune issues' that RCCX theory kinda points to.

Protein Restriction In?

In the 1930s, Walter Kempner treated over 18,000 patients with obesity, diabetes, heart disease, and renal failure by changing their diet. At the time, treatments for malignant hypertension were few, and those with the disease had a life expectancy of months. With Kempner's magic diet, many patients saw their conditions improved or reversed.

What was the magic diet?

  • White rice
  • Fruit
  • Fruit juice
  • Refined table sugar
  • In some cases, vitamin supplements (A, D, thiamine, riboflavin, and niacin)

And nothing else. The diet macros come out to about 4% to 5% protein (<20 g per day), 2% to 3% fat, and the rest was carbohydrates.

The diet was hard to follow. The alternative was death, and it was the 1930s, so Kempner famously whipped his patients to keep them on the diet (double blind study pending to see if whipping patients also improves renal function.)

But it worked. It fell out of fashion once people had literally any other option than eating rice and being whipped, but it kept many people alive who otherwise would have been dead. Kempner's studies also contributed to the body of work that Ancel Keys drew from when he declared Saturated Fat the enemy.

Cut to the Year of our Lord 2023.

Brad Marshal (pig farmer, French-trained chef, occasional Molecular Biologist,) has kicked off a craze in alternative nutrition. He has lost 14 lbs in 28 days by lowering his Branch Chain Amino Acids (BCAAs) to 8g or less a day. BCAAs are a group of protein that are especially high in muscle meat and low in gelatin.

Big deal, he cuts out a food group, eats less, loses weight, right?

He is eating "2800-3000 calories per day on average, some days more." Given his age, weight, and height, his Total Daily Energy Expenditure (TDEE) should be around 2,360. Yet, he claims to be eating more, and therefore his TDEE must be much higher if he is losing weight. If it's all water weight, then how is he depleting glycogen while eating 500g of carbs a day?

Another prominent case study and blogger is ExFatLoss, who has been tracking his weight and food intake for years. He has been running a series of diet experiments and has noticed that the more protein he restricts, the more weight he loses. He has also dived into the literature and discovered that protein restriction seems to improve metabolism in mice and human studies. The specific culprit is Isoleucine, which researchers are able to completely restrict in mice diets (less able to do so with humans without really intrusive studies.) When isoleucine goes down, fat stores go down and calories go up. Some mice are able to eat 80% more than controls and still lose weight.

This is Wellness Wednesday, not culture war, so I think I'll end the comment here.

In the 1930s, Walter Kempner treated over 18,000 patients with obesity, diabetes, heart disease, and renal failure by changing their diet. At the time, treatments for malignant hypertension were few, and those with the disease had a life expectancy of months. With Kempner's magic diet, many patients saw their conditions improved or reversed.

I thought the prevailing twitter-narrative is that obesity and related conditions like diabetes and hypertension were non-existent or unheard of until the 80s--and then boom! So much for that. it goes to show how narratives are popular because they confirm our preexisting beliefs about how society is or ought to be, not what is actually true. 18,000 is hardly rare or unheard of , especially for a single doctor, so we're easily talking millions of obese people. Obesity must have been widespread but massively underreported, particularly among middle aged people and older people in the '30s , not some rarity as commonly assumed by the internet-experts.

As for the diet itself , yes, consuming rice or any macro or food in a calorie deficit will cause weight loss. AFIK, there is nothing in particular special about rice. As for it 'working', it's way easier to treat diabetes and hypertension than reverse obesity, as shown by the dearth of effective drugs to treat the latter and the very low success rates of diets. If it worked it would be widely reproducible and 'common knowledge', but it only seemed to work for select patients for weight loss.

There's a huge difference between 1-2% of kids being obese and 20% of kids being obese. Even if less than 10% of people were overweight, that would still provide doctors with millions of patients in the 30s. There is plenty of evidence that the overweight population has increased dramatically, even just in our lifetimes it is obvious.

One thing that could effect the obesity rate in the past is that many people with diabetes or heart disease just died. If someone dies, they aren't counted in the population obesity statistics.

But the Twitter Bros have their own explanation - by the 1930s many people in the American South were eating shortening, peanut butter, and other foods laden with Poly-Unsaturated Fats. We can actually see a difference in metabolic rates between Northerners and Southerners in the 1930s.

For the diet part, I don't think that rice has a "thinning" quality like opium has a "soporific" quality (sorry if you don't get the reference, that's a philosophy joke.) But one of the more interesting things about the Kempner Rice Diet is that even people who did not eat at a calorie deficit and did not lose weight still saw diabetes reverse and insulin sensitivity go up:

As Kempner pointed out, any obese patients were indeed encouraged to lose weight—but the improvements in blood sugar levels and insulin requirements occurred “both in patients who lost weight and in those who did not have a significant weight change” (his words). Kempner’s data, both in this paper and in the massive collection of his work filed away at Duke University, showed that the diet could benefit diabetics even when their weight and energy intake didn’t budge.

I'm always up for a good fad diet!

That said, my first instinct is to not to trust a guy who weighs 230 pounds with 32% BF. Especially when the same guy also lost weight on a croissant diet (that apparently didn't stick).

If he sticks with it for a year and gets down to 15% BF, I'd love to hear more about it. In the mean time, Penn Jillette's potato diet has much better results.

That said, my first instinct is to not to trust a guy who weighs 230 pounds with 32% BF. Especially when the same guy also lost weight on a croissant diet (that apparently didn't stick).

if any diet worked it would be common knowledge. we would not need to be berated about it (like with keto), nor would there need to be huge discussion and communities around it (more discussion generally means less effective). The problem with the potato diet is it's hard to stick with it...people become ravenous for non-potato foods even if stuffed with potatoes. Also, it has to be plain pototatoes..no mashed, fries ,etc.

That said, my first instinct is to not to trust a guy who weighs 230 pounds with 32% BF. Especially when the same guy also lost weight on a croissant diet (that apparently didn't stick).

He's way fat.. if someone espouses diet advice but cannot apply the diet themselves to not be fat, loses credibility in my book, but I think he has some good info anyway .

I started giving this high-carb, low-fat, low-protein diet a go. I started losing weight almost immediately, but found myself feeling anxious/depressed after a couple of weeks (I think from lack of fat). At the moment I'm trying to up my fat intake but keep BCAAs (specifically isoleucine and valine) low to see if I can keep losing the weight.

agree. I find this 'fats are good' mantra to be overrated. i was able to lose a lot of weight and keep most of it off by limiting fats to close to zero as possible.

Well upping my fat didn't actually help in the end. I think the issue was a lack of tryptophan caused by the low protein diet.

That's great! I hope the low-protein swamp diet works. You could also try a heavy cream fast like ex150.

According to webMD, these foods have BCAAs:

Whey, milk, and soy proteins. Corn. Beef, chicken, fish, and eggs. Baked beans and lima beans. Chickpeas. Lentils. Whole wheat. Brown rice.

Yes, in order to get the BCAAs so low, they are eating Glass Noodles, Dextrose Powder, and Cream. Some fruit and veggies, limited amounts of meat (3 oz) and gelatin. Those who eat rice/wheat avoid meat.

I can’t do shape rotator exercises (raven’s progressive matrices, 90% of ‘aptitude’ / non-verbal IQ tests). I have what is probably the strongest ‘verbal tilt’ I’ve ever heard of. I really do score 99th percentile on verbal and somewhere around 60th percentile on spatial. I did much better than that in actual math, but I think some have speculated that math can go both ways, such that there are both verbal and non-verbal reasoning ways of doing it.

The sad thing is that I genuinely enjoy doing them (matrices / ‘pick the bottom right shape’), but anything above intermediate difficulty (I bought a German puzzle book that categorizes them nicely) and I can stare at it for an hour and not figure it out.

Any other wordcels here? Do you think it’s affected your ‘real’ life?

The lopsided verbal is a Jewish thing.

I misread thing as thug, assumed that this must be some sort of sentence anagram, and wasted about twenty minutes of my commute trying to work it out.

I need better glasses.

Blind ass

B Islands?

Do you have Aphantasia, an inability to visualize in your mind's eye? I do and am horribly at shape rotation.

hmm. I think I almost do too, but seem ok with shape rotation, though i’m way better at math. Interesting hypothesis

Here is a test: Did you know that it is normal for people to see images in their mind's eye when they read books?

I don’t think so, I can visualize shapes and scenes in my head I think, although perhaps less well than others can.

Based on my SAT scores, I'm probably more of a wordcel. But probably not as much of a drastic difference as you. I'm probably 95-99 percentile verbal. And 80-90th spatial.

In a different era I might have gone down the route of being a lawyer. Programming and spatial thinking was in too high of a demand though. So I ended up as a web developer.

Its been a weird career progression. I find that my intelligence set is not expected for a programming job, or it is expected, but I'm expected to quickly turn into a manager. I can keep up great in meetings, and communicate with a bunch of people on difficult topics. But then when I am left to do greenfield expansion into new areas (a place where the shape-rotators thrive) I'm left confused and lost.

But I found my way into a job that is more wordcel oriented and my shape-rotators skills are rarely called upon. It has been nice and relaxing.

wow. this is leaving me with a lot to think about. Maybe programming wasn’t the right career, and i should embrace the management? hmmm

What’s the book, please?

Can you share one that you struggled with? I'm wondering how I'd fare. I'm very much the opposite with weak verbal skills.

I can do the problems in RPMs, it's not easy, but in general, I do what I did for the example you linked to, which is decompose the pattern into primitives, verbally reason through how each one evolves, and then get the answer.

I believe in the example linked, it's 5.

Another trick I learned to help with my poor visuo-spatial imagination relates to the questions where you're shown multiple angles of a single die, then asked to say what a hidden side shows. If I have pen and paper, that's easy enough, but if not, I make a fist, and then imagine each aspect corresponds to a symbol, and then I can see the answer easily enough.

I would say that I'm a 99.999(9 or 99) wordcel, and about 75th percentile in terms of shape-rotating. I was good at maths till 10th grade, but in the 11th, I began to struggle both because my ADHD made my eyes glaze over during calculus and trig, and in the case of the latter, I missed several introductory classes. I remember seeing my personal tutor in maths raising an eyebrow and asking if that's how they taught me to solve trigonometric identities in class, breaking everything down into the smallest factors and then trying to make them cancel out, whereas the way the later questions were designed required you to memorize the equalities if you wanted to have any hope of solving them in a useful time span. I did better at stats and algebra.

I didn't really have much in the way of internet access at the time, I'm confident that with the quality of mathematical education found on YouTube and elsewhere, combined with the ADHD meds I was started on in med school, is have done much better. I'd certainly have killed to have access to GPT-4, I rely on it heavily for didactic purposes.

I'd certainly have gotten into a better med school!

At any rate, medicine is close to an ideal career in my particular case, the closest a typical doctor comes to using applied maths is figuring out drug dosages, and you're unlikely to need stats or calc at all unless you're doing research. 50% of it is rote-memorization, and ~50% is having the fluid intelligence to figure out the implications of the facts you memorized. Medicine is counter-intuitive enough with all the edge cases that you can't just work backwards and figure everything out from first principles.

I've only given a standardized IQ test once, for a job application, and I never saw the figures, but the recruiter told my girlfriend (who also happened to have applied!) that I scored very highly. I also scored >99% in the standardized aptitude tests (disguises IQ tests) many Indian students receive towards the end of schooling. I did a full RPM once through an app, and got a score of 130 IQ, but it wasn't proctored so the reader is welcome to weight that as they please. I know that I'm very strong verbally since I beat out about 2 million other people in an exam that measures aptitude in English in a standardized manner, being literally first, with a nice cheque that went towards a gaming pc and time on the podium with some very famous people. I remember being a little embarrassed that the cute girl who came second was far more academically illustrious than me, but a win's a win, she can cry on the pile of money she's likely sleeping on 🙏.

Back to medicine, as long as I have pharmaceutically enhanced diligence, I've yet to run into anything I simply can't understand, and I think I do a decent enough job at it. I managed to teach myself most of it, given that I was very depressed for most of my time in school, and we had about a year where classes were irregular due to political turmoil causing financial issues. But I passed whatever the GMC threw at me with flying colors, so I have a great deal more confidence and less conviction that I'm an impostor in a white lab coat these days haha.

I would say that I'm a 99.999(9 or 99) wordcel

99.99999th percentile would be one of the top 1000 people on the planet in terms of verbal IQ. Pretty impressive!

Maybe 5 9s could be pushing it (well past the margin of error or inter-test variability, the same score that got me 1st one year was an 8th in another), but I'll stand by 4 of them.

I think the test breaks down at that level. I'll grant you that you're say one in a thousand, maybe ten thousand. Maybe even one in a hundred thousand. But if you were one of the top thousand people on the planet...I'd think that your writing would be better than it now is. Not that it isn't very good...but is it 'top 1,000 people writing in English who are alive today'? Not all that sure.

Also: do you have classmates that could memorize entire encyclopedias or medical texts, word for word? I've seen people do some fairly impressive feats of memorization - such as 'memorizing a 100-slide PowerPoint deck after reading it once and tell people that a thing came from slide 67'. No, he wasn't autistic, as far as I know.

It was a test of one's general command over English, not literary talent, which is far more subjective and difficult to evaluate. I certainly don't claim I'm in the top 1000 of living writers myself.

do you have classmates that could memorize entire encyclopedias or medical texts, word for word?

Not where I could see them, at the very least.

Can you link to the English exam? I’m very curious. The stratification required to differentiate (unambiguously) between 1st and 2nd place among 2 million test takers must be pretty high.

I'd love to, but given that my name's in the papers from when I won, I'd be doxxing myself. I arguably already have!

I was good at maths till 10th grade, but in the 11th, I began to struggle both because my ADHD made my eyes glaze over during calculus and trig, and in the case of the latter, I missed several introductory classes.

Basically had the same experience, thankfully did go to the best school available(in Russia there is an alternative way to get into, bypassing the SAT analogue), but picked up personal tutor gig as a side hustle and had to learn all of it anyway.

Offtopic question but how saturated is the personal tutor market in India? Here it is not all, almost any 95th percentile and higher can earn decent money from it, while working remotely, people most often just don't consider this an option.

I'd say it's gotten about as saturated as the market can bear, and believe me the demand is massive. Everyone wants their kids to have a leg up, and the quality of education even in the better schools is questionable, in part because the school teachers correctly expect that their students will be going elsewhere for in-depth coaching.

Most personal tutors who make a name for themselves aim to move past one-on-one coaching to larger batches, it's just more lucrative that way. There are plenty of large coaching/Ed-tech companies, but we've crossed Peak Education, because the billion dollar Byjus disintegrated.

Back to medicine, as long as I have pharmaceutically enhanced diligence, I've yet to run into anything I simply can't understand, and I think I do a decent enough job at it.

Medicine is not massively g-loaded, is it? It's mostly memorisation, hence the popular med school anki subreddit. I can't think of anything day-to-day that actually requires reasoning about. I think it's why doctors suck at thinking from first principles and shut down when you ask them about something outside their "training set".

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC165701/

47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures.

Results of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.

This is the best I could find with my Google-fu.

Medicine is usually brutally competitive and meritocratic to get into, or it certainly is in India, so there's a lot of filtering for g going on before people enter the training program.

I would be immensely surprised if IQ didn't correlate well with performance in the profession, as it does with job performance on pretty much anything anyone ever cared to check.

I don't deny that there's a great deal of memorization involved (I did say the same myself), but you have to keep in mind that med school != clinical medicine. As for "massively g-loaded", what's your definition for "massive"?

It certainly rewards tenacity and conscientiousness, especially when you clear the minimum IQ bar, and doctors are significantly above average, on average.

https://www.gwern.net/docs/iq/2002-hauser.pdf

At the top of the list, in the low 130’s, are either physicians and surgeons or professors and researchers, depending on the study you look at. The range amongst physicians and surgeons is tightly clustered, whereas the range for professors and researchers is broader. Below that, in the high 120’s are lawyers, followed by accountants in the low 120’s. Pharmacists average around 120 and nurses in the high 110’s. You can find a link to the full list with more professions in the description.

(Quoting the person quoting Gwern's post)

How much of that is due to pre-selection, and how much it matters after you're in? Shrug.

I think that the average researcher is way more determined than the average doctor - it's not uncommon for researchers to have been preparing for careers in research since they were in junior high school. I've known researchers who, as undergrads, answered emails and worked on projects from ER hospital beds. Well, one - but the rest of the lab didn't think it was that big a deal that her boss asked her to do work from the hospital bed and mildly reprimanded her for thinking it was a bit much.

Put it this way: plenty of researchers could do the equivalent of passing the anatomy final on day one of medical school. Very few doctors could have done the same.

I would be immensely surprised if IQ didn't correlate well with performance in the profession, as it does with job performance on pretty much anything anyone ever cared to check.

I actually believe this isn't the case so much, at least for the median. The reason for this is partially what you already mentioned, extreme pre-filtering. This is then combined with very generous compensation, practically ironclad employment security, limited opportunities for career advancement and a high work load. This strongly incentivices defection on the part of doctors.

I have no doubt that almost all doctors I meet are intelligent, whether they're a good doctor or not depends on whether they're diligent and actually interested in their work, not their relative intelligence within the doctor cohort.

This isn't unique to doctors either, mind you. It happens in all professions with sufficient compensation, status and employment security. People get satisfied and check out.

People get corrupted and intelligence isn't a protection against that. You can't really tell beforehand whose going to be a hard worker either.

I can believe that doctors average 130 IQ (though it seems a little high), and I totally expect that IQ correlates with performance.

Maths is far more g loaded than medicine. People who study maths will talk about eventually hitting a wall and no longer being able to progress. At a certain level you no longer have the cognitive power to comprehend the ideas.

I've never heard anyone talk in such a way about medicine. In medicine it seems like there is not much to "understand". Is it possible to get stuck on a question in medicine and not understand the answer? My impression is no. Are there 10x or 100x doctors? Doctors who can do things the average doctor can't?

Maths is far more g loaded than medicine. People who study maths will talk about eventually hitting a wall and no longer being able to progress. At a certain level you no longer have the cognitive power to comprehend the ideas.

yes, math is probably the highest g-loading, along with physics. This is why months back I argued that Elon is not as smart as top mathematicians and theoretical physicists, which got a lot of rebuke, but I think is still true.

Are there 10x or 100x doctors? Doctors who can do things the average doctor can't?

Unlike programming, doctors don't scale, so the impact of superlative talent is bounded. But in my experience, the best doctors end up becoming super-specialists, especially in surgery, and act as the last port of call when use normies don't cut it. So it's not that they can do everything significantly better than the average doctor, but they cover the cases we can't.

Is it possible to get stuck on a question in medicine and not understand the answer?

Not particularly, unless you're in research or doing something particularly complicated in neurology or biochemistry.

Having struggled on and off with motivation and generally down feelings, I recently started journaling. I've only been at it for a few weeks, but it seems to be helping. I feel more energized after writing something down, and it's more motivating than my 'passive" entertainment options of reading and watching films.

Do others have a similar routine around writing, or similar experiences? I know the stoics are all about it.

I do keep a daily journal, but it's just a basic description of events.

I used to do some hand-written journaling, but starting a daily digital journaling and note-keeping has been helpful to me and my mental clarity. Don't know how I ever lived without it. I make several notes per day in Standard Notes (a pretty good app). It's satisfying in itself to create and keep an overview over all things important to past, present and future me.

I've kept a regular handwritten journal for the past 8 years. I started doing it while entering sobriety, initially as a way to track cravings and triggers, but eventually as a way to track thought/emotional patterns, self-narrative, and as a reference for the important events of my life. I had a viciously negative inner voice for years that manifested with self-destructive behaviors. By writing my daily thoughts and behaviors onto the page was I able to view my experiences with a different perspective and write counter-narratives to the negative voices. Countering the negative self talk wasn't easy because I believed the negativity was right, but eventually the positive counter-narratives and affirmations became reflexive when any negative self talk came about and I lost the negativity.

Nowadays when I am brought into an emotional state of intense anxiety or panic, I reference my journals to see how I'd been triggered similarly in the past and see how the prior events played out while also gleaning any coping mechanisms that were effective. Similarly for depression.

My journals are some of my most important possessions. I find that when I go back and read my journals, I like myself a lot more than on a regular day and have much more compassion for myself and what I struggle through regularly. There were days when I used the journal as motivation, wanting to go out and do things that were worthy of writing down and that I would enjoy reading in the future. The journal also encourages me to treat every day as a different experience and to break up the mundane routines as much as possible. Finally, they're an archive of all the stuff I've done, and as I get older, it's nice to be able to go to the journals and get dates for certain events and place them all in a time line, as it becomes all to easy to forget.

I've never been good about journaling, but I do like writing on websites as a way of putting my thoughts out there. Even if I don't write down about 80% of my thoughts, the process of putting them into a pre-written-draft in my head seems helpful.

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