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PaperclipPerfector  9mo ago (text post)   2480 thread views

Wellness Wednesday for March 13, 2024

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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So.

Is there any good evidence that organic produce has health benefits or that conventional produce is health detrimental?

We've been doing thie for... 20+ years now?

There's very strong evidence that eating organic produce dramatically reduces the amount of pesticide metabolites in your urine. (Of course, from very small levels to even smaller levels). But that doesn't necessarily mean anything. I'm not aware of any strong evidence on anything else.

Here's an argument: A number of pesticides currently in use are going to be banned by the EPA over the next few decades. Organic lets you choose to avoid those now. I guess.

There is research that synthetic fertilizers reduce the nutritional quality of foods.

There is research on if synthetic fertilizers pose a risk to human health and contribute to the development of chronic disease (I'm not sure how conclusive it is, I haven't dug into it).

Has anyone concluded that being on Adderall or other stimulants long-term is the right choice for them? I've been on a low dose for several years and find it almost necessary for basic functioning (having the motivation to buy groceries, go to work, focus for longer than 3 minutes, etc.). I take a day or two off each week, and I basically mope all day on those days.

But on priors it just seems wrong that I should permanently be on stimulants. I didn't have trouble focusing as a child. I find the whole "I have a condition that didn't exist 50 years ago and need to be permanently medicated by something that makes me mildly high" thing just embarrassing and suspect. Also, it's getting harder and harder to get my hands on the stuff where I live.

I tried taking a break for several months and it didn't work out. I thought I would have withdrawal at first and then slowly get back to normal. Instead I was fine at first and things seemed to get worse over time. I was getting depressed from a cycle of not accomplishing anything all week, beating myself up over it, and doing the same the next week. That was kind of what life was like before I started on Adderall, though it might not have been quite as bad - hard to say. I didn't know what else to do other than to start taking stimulants again. Could being on stimulants simply be the right choice?

My partner takes ADHD medication regularly. She works an office job (mostly from home) that imvolves a lot of tedious grunt work.

The impression I have is that her medication is necessary for her to succeed at her job. Some of that is practical (being able to concentrate) and some of that is mental (not getting down about being disorganized or meeting the expectations of her colleagues).

From an outside perspective it seems like a constructed problem. Staring at spreadsheets, meeting arbitrary deadlines, and having no personal interaction with anything tangible seem like huge hurdles to focus. So the issue isn't concentration in general, it is concentration in the face of really tedious and unengaging tasks for long periods of time. I don't know if you’re in the same situation, or if agreeing with that would make you feel better about having to take stimulants. Like most things, it's a combination of personal abilities and the environment to which people are forced to adjust, rather than just a personal shortcoming.

I have ADHD, though I need the meds primarily so I can even force myself to open a textbook. It does help with normal day to day stuff, but the experience on Ritalin is unpleasant enough that I don't bother most of the time.

I'm not embarrassed in the least by it. Studying, on top of work, is something I can't dispense with at this stage of my career, so it is what it is. I did have problems focusing on studies as a kid, but personal tutors keeping me under their gaze handled the worst of it, unfortunately it turns out that in their absence I won't study unless my life depends on it, and such last minute grinding doesn't get you anywhere when the books could kill a toddler if dropped on them.

Evidently the meds work for you. Try a lower dose and see if that keeps you functional without a "high". But if it makes life more bearable and you suffer without them, longterm use is warranted as far as I'm concerned.

Did you use to take meds back in India as well? If so, which ones?

the experience on Ritalin is unpleasant enough that I don't bother most of the time

this would seem to sidestep any potential longterm issues of dependency, tolerance, etc. right? I guess I'm more concerned about daily use.

Use it long enough and you'll develop a tolerance, but that's what cycling and drug holidays are for.

But beyond that, there's no significant harm in daily use at therapeutic doses.

Close your eyes.

Breathe.

Open your eyes.

You can see, and you can breathe. So move.

If you can move, stretch.

Close your eyes.

Breathe.

Open your eyes.

You can see, you can breathe, you can move.

If you can do all those things, speak your own name.

Loud or quiet, say your true name. The secret one.

Close your eyes.

Breathe.

Open your eyes.

You can see and breathe and move and speak.

You know who you are.

If you know who you are, you know what to fix.

Close your eyes.

Breathe.

Open your eyes.

You can see, breathe, speak and move.

You have identity and purpose.

You can work, you can communicate, you can fight.

In that order.

Close your eyes.

Breathe.

Open your eyes.

Now: Begin again.

I've stopped using Hinge and can't bring myself to try again because every time I do, the same thing happens; I get a reasonable number of matches and likes, frankly more Likes than make sense. I'll have a short conversation, ask for a date, get a yes. Then the day of the date, she bails, sometimes with apologies, always without suggesting an alternate date. If I ask for another date, she says yes, next week rolls around and she bails the day of. This cycle continues until I take the hint and stop asking. I do not know how to get this to stop happening. I also don't get why I don't hear this complaint from other people; typically they complain about getting no matches or not hearing back after the first date.

I've considered completely cutting people off after the first flake. I've considered very tepidly expressing my disappointment at being flaked on. I've considered talking beforehand about how often I get flaked on and asking please please please if they don't want to turn up for a date, then just say that instead of saying yes and then flaking, because I find it way more painful than a "no." None of these strike me as good ideas.

And I live in fucking Chicago of all places.

Take a break from online dating whenever you need to.

Yes, if they don't suggest a new date, say ok and unmatch after a day or so.

In real life events are a much better way to meet people to date anyway. I say that as someone that is a veteran of online dating.

It's interesting to me that you seem to have better luck than me at first (likes/matches/conversations), but worse after that. I get some likes/matches/conversations (certainly not more than makes sense), but once we agree on a time and place, I can't remember the last time it didn't work out.

Wildly speculative theory: you're more attractive than I am (hence, more matches) but doing something offputting after that. Rather than do the confrontational thing and say no to you, or even unmatch, rather than be decent enough to be decisive at all, they just flake etc. Typical female behavior, and understandable enough, given the fear of anger from anything more direct.

Dealing with female passivity, flakiness, and fickleness, the female inability and indifference to uphold their word, is a common source of frustration for men that transcends time and space when it comes to dating.

Even after carpet-bombing messages on social media and/or OLD, cold-approach grinding, or the stars aligning such that your social circle gifts you with a prospect, you still need to perform the scheduling battleship and text-message jiu-jitsu to get a given girl to agree to a date. And even after she agrees, in the hours leading up to a date, it’s very possible she’ll cancel, ghost, or request to reschedule. Of course, if you call her out for her lack of accountability and trustworthiness, you’d be the weird anti-social asshole questioning her Wonderfulness, Lived Experience, and Emotional Truth.

There are no magic words, no "one weird trick"s. Check-in too little prior to a date and she might bail under the excuse that she didn’t hear from you, supposedly presuming you lost interest or that the date was off. Check-in too much and it might give her the ick, that you’re too insecure, obsessed, or pressuring.

As the time of the date approaches, aside from being late and/or flaking, a lot of girls will also exploit the fact that you’re basically a hostage waiting for them. At the last minute, a lot of them will try to re-plan the date such that you have to spend maximal time and money, and with minimal chances of her putting out. “Actually, can we meet at [expensive restaurant] instead?”

A lot of them will claim to run late with minimal communication and then cancel while you’re continuing to wait for them. Unfortunately or fortunately, a lot of them will also claim to run late with minimal communication before showing up. This is why I angle for the first date to occur at my place: Logistics to get the bang, more cost-effective, I can wait at my place instead of having gone somewhere if she’s running late, “running late,” cancels and/or ghosts.

The only real defense for a man is playing the numbers game and having enough prospects to diversify. It’s less devastating if your Tuesday night flakes when you still have Wednesday and Thursday night dates scheduled with other girls. Easier to drop your Saturday night if she plays hardball and insists on meeting at a restaurant, when you have a Sunday afternoon. Eventually one will come through.

Furthermore, one can schedule two dates the same day (e.g., 1PM and 7PM), such that if the earlier cancels you at least have the latter one. If the latter one cancels later on, at least you had the earlier one. If things go poorly with the 1PM, you still have the 7PM. If things go well with the 1PM at a slow pace, you can cancel on the 7PM. If things go really well with the 1PM at a fast pace, you can escort her out and go forth with the 7PM date.

Staggering dates is also an option. For example, scheduling an early afternoon date with one girl at 1PM, and the other at 3PM. If the 1PM girl shows up, great, and you cancel on the 3PM. If the 1PM flakes you might still have the 3PM.

One can also double book (or more), scheduling two dates at the same time with different girls. This way it helps increase the chances that one of them shows up. Once you have a fair degree of confidence that one will show-up, you can cancel on the other. Although, meanwhile, the one who you think will show-up might just flake on you at the last moment. The more GigaChad maneuver would be to have both show-up, where they can fight over you and/or you go for the threesome.

Canceling and/or floating reschedules on girls is risky, as they’ll act like you violated the Geneva Convention in offending their Princess Complex (even though they wouldn’t have given the slightest of fucks to flake on you), which could lead to you losing a hard-earned prospect.

There’s no reason to go easy and Be A Decent Person and/or Be a Gentleman. Young women are more than okay with wasting your time, money, energy. Not only are they largely indifferent to your time, a lot of them put a negative value on it. Wasting your time, money, energy, feeds their vanity and sense of validation. Many women will brag about it: “Only here to be spoiled," “Buy me food and tell me I’m pretty," “Just here to waste your time,” reads many a female online dating profile.

Young women are basically bratty children when it comes to scheduling and flaking. It’s essentially a survival tactic if you want to see a girl again, to bang her ASAP. This way she at least has skin in the game and will be more of a teammate in scheduling and coordinating.

Dealing with female passivity, flakiness, and fickleness, the female inability and indifference to uphold their word, is a common source of frustration for men that transcends time and space when it comes to dating.

There, fixed that for you.

Consider time and space transcended; this message has reached you from the land of married men.

There are a lot of people that haven't experienced the online dating market recently and don't understand the bad behaviour from all corners. People seem to be aware of what guys are doing (because it's socially acceptable to signal boost that type of behaviour), but there isn't an understanding of how that behaviour evolved, and how some women are quite happy to match with 50+ men and try to connect with the most attractive one even though they have no way of ever giving any of those men the attention required to develop something meaningful. Even girls new to the platform will match with many well meaning, reasonably attractive and social men, only to dump them (flake/ghost) once a handsome lothario enters their queue.

Everyone needs to stay away from apps unless they are in the top 10-20% of physical attractiveness. Even then...

If you are looking for commiseration, you have it. That sucks dude. Getting stood up is the fucking worst. That said, if you're looking for advice, here's my $.02

I'll have a short conversation, ask for a date, get a yes. Then the day of the date, she bails...

What you're seeing is the real-time adaptation of women against common dating advice for men. This is constantly going on, any standard advice faces adaptations against it. The standard issue advice given to men for online dating for years now has been text as little as possible before setting up an in-person date, because texting without getting a date is degrading and demoralizing and wastes your effort. If she says no to a date, you stop texting her.

The adaptation on the part of women has been to accept the date immediately, and repent at leisure. Because men have stopped chatting before a date, but women want to get to know you more before agreeing to a date, the strategy is to say yes to the date and just cancel it if she isn't feeling it. Which gets us back to where things were before men adopted the strategy of asking for a date immediately.

So if you want to avoid getting stood up, you have to up your texting game. You have to try for more engagement prior to meeting in person. Wait longer before asking her out. Have more interesting conversations before meeting. Have her really wanting to meet you.

Exchanging text messages is not a way to get to know anyone, and for people who apparently want to be texted, women are singularly bad at contributing to a text conversation. I do not know what being "interesting" means in this context. The only thing I can imagine is generic faux-deep prompt questions about if you can ever can't literally really. Whenever I see examples of successful online dating text conversations, it looks like two animals grunting at each other.

Strong disagree. The last few girlfriends I've had we're all from dating apps and having good text game with them prior to the first date was essential. Chat with them, tell them good morning, tell them good night (optional kissy emoji), ask them what they're up, exchange pics of pets or hikes you've done recently, send pictures of whatever you made for dinner (if it looks appetizing), and--critically--send them memes. Send them memes, make them laugh. And yes, you absolutely can get to know someone a bit before you meet in person and if they feel like they know you a bit, you've made them laugh, and given them a peak into your life, they'll be way less likely to flake.

You two have very different ideas of 'getting to know someone'. In one sense, it's understanding a somewhat complicated intellectual character, one's motives, the way one approaches one's life. In another, it's one's hobbies, the kind of simple jokes you like, little personal quirks, and which of the 10 big classes of twitter or instagram user you are.

But most people aren't primarily looking for an intellectual peer in a partner, different strokes.

Agreed to all of that, but you still have to do it to signal that you're interested in her.

Maybe send a brief message on the day-of saying "looking forward to meeting you tonight" or something?

I do this. It apparently serves as a reminder to them that they should cancel the date, since it's typically immediately after this that they cancel.

Beat them to the punch and send them a brief message on the day-of to cancel.

I'm joking of course but psychology and dating is so counterintuitive it would probably work.

Bummer.

Something along those lines is common, in my experience. It's a bit discouraging, but the subset of people will get progressively interested in you gets progresively smaller.

Total people on the app > people who will see your profile > people who will like you > people who will actually respond > people who agree to a date > dates that actually happen

For a lot of people, online dating is nerve-wracking, leading to flakiness. And most people will prioritize other events or commitments above a first date with someone they've never met, leading to further flakiness.

Just stick with it. You're going to have to talk to a lot of people before you click with someone.

Can you post screenshots of the convos?

Have you tried pushing for a short date the same day? No movies, no dinners, just a lunch or a coffee "to see if we click". If the girl vacillates, tell her you're not interested in window shoppers. This way it's them who get to hear a "no".

These are the typical dates that get bailed on, and no one is ever available that same day. The only thing I don't do is add in a cliché, since "seeing if we click" is the entire point of a date. That's like saying I need to "get rolling" because I am not currently where you are.

...am I supposed to add excessive clichés to my conversations?

No, no clichés, just treat it as another filter: if she's not willing to make time for you the same day, she's not interested, no need to plan a date.

I'd assume it's common for dating app women, when they do set up dates, to set up several and last minute cancel all but one.

I don't hear this complaint from other people; typically they complain about getting no matches or not hearing back after the first date.

Another one I've heard is the matches are of a poor quality in the sense that people don't like the people they're meeting up with even if they look good/decent which leads to cycling through a massive amount of people, which is exhausting and dispiriting.

I've not heard of your complaint as a recurring issue. I wonder if is a Chicago thing or a you thing.

That's a woman problem on dating apps. A man getting that many dates with women he doesn't want to date long-term but look good/decent is a successful dater.

It's an issue for moderately attractive (composite) men as well.

Believe it or not but men get tired of meeting new women as well. Not in the sense that they're uninterested in the sex but all the other shit. Then it turns into a grind of going through tons of people and the sinking realisation that your market value might not be as high as you would like, despite managing to score regularly.

People say that men are more ready to date down than women but that is a truth with modifications. For example, I strongly doubt that any of my friends would seriously date a woman without at least a bachelor in a decent field, or they'd have to be spectacularly attractive and even then I'm not so sure.

I've heard of men who swipe right on everything then report disappointment at dating many women less attractive than they'd like, but they don't want to risk possible ego damage by swiping only on attractive women and seeing few or no matches.

Shrug. I see matches with attractive women, they just never say anything. Or agree to dates then flake, as I said above. Once more, dates actually happening would be a huge achievement for me.

Awkward results from A/B testing Claude Opus and GPT-4.

Out of laziness, and because of only passing domain knowledge, I had them rank each other's responses and compare them to their own (blinded).

Claude claimed GPT-4 did a better job. GPT-4 claimed Claude did a better job.

Yay?

Here was the prompt for anyone bored enough to try:

We operate dozens of “gateway” servers around the world, whose sole purpose is to accept incoming WireGuard connections and connect them to the appropriate private networks. Any time you run flyctl and it needs to talk to a Fly Machine (to build a container, pop an SSH console, copy files, or proxy to a service you’re running), it spawns or connects to a background agent process. The first time it runs, the agent generates a new WireGuard peer configuration from our GraphQL API. WireGuard peer configurations are very simple: just a public key and an address to connect to. Our API in turn takes that peer configuration and sends it to the appropriate gateway (say, ord, if you’re near Chicago) via an RPC we send over the NATS messaging system. On the gateway, a service called wggwd accepts that configuration, saves it to a SQLite database, and adds it to the kernel using WireGuard’s Golang libraries. wggwd acknowledges the installation of the peer to the API. The API replies to your GraphQL request, with the configuration. Your flyctl connects to the WireGuard peer, which works, because you receiving the configuration means it’s installed on the gateway. //Break this down and explain it to me at a level of a beginner who only has a passing familiarity with these topics

Is it possible to go from sensitive to not so sensitive?

Being so sensitive does not allow you to function as well as other people. Things that get people down for a day, gets you down for weeks or even months.

If it's not possible to turn off high sensitivity then how does one use their high sensitivity for gain?

According to random youtube videos and quora posts, high sensitivity is a "superpower" which makes you creative and gives you the ability to "read" people.

Does this mean if someone who's sensitive starts creative endeavours they will be better than average?

Generally, some ways a person might become less impacted by their feelings are:

  • Internalizing ideas from Stoicism. There is a difference between the event and how we frame it. The feelings we experience are caused by how we choose to internally frame the event. We can choose to internally frame events in less distressing ways.
  • Realizing that some feelings are influenced by extra information that we add to events. If someone is rude to you then we might add the assumption that they don’t like us. We don’t know this for sure, it may just be that they are having a bad day. If we add a mental note that this extra information is tentative instead of certain then the feelings associated with it may be less intense.
  • Exposure Therapy. For example, working in a retail sales setting makes people less sensitive to rejection if they face it a lot in their job.

if someone who's sensitive starts creative endeavours they will be better than average?

Yes, it can help in certain situations, but it takes some training to make it work to your advantage. It is probably similar to how certain physical characteristics make people better at certain sports, but they have to (1) be interested in the sport (2) train themselves to use the physical characteristic advantageously.

Yes. Get yourself a bottle of wine, an Airbnb in a resort town in the off season, a girl who wants to spend a weekend making love. The next week the volume will be turned down on everything.

Boxing works too.

I suspect there are two concepts that are being conflated here -- sensitivity in terms of what you feel, and sensitivity in terms of what you detect.

One is being a highly sensitive person. While I think this is a useful construct, when you break it down I suspect it's a combination of neuroticism, agreeableness, and openness to experience in the Big Five model of personality. I don't think this is the sort of "sensitivity" that is conducive to "sensing" other people's hidden intentions, though maybe it allows you to be creative in particular ways that people with other personality dimensions would find difficult. I don't think it's a superpower. (Maybe if you want to write angsty poetry, of which I wrote much when I was a teenager.)

The other is what is often called "emotional intelligence." I don't like the term. I would prefer "cognitive empathy." This type of "sensitivity" makes it easier for someone to "read" other people's emotions and intentions because it allows you to mentally understand their perspective, modeling their behavior in your head. It has nothing to do with poor functioning, and in fact has everything to do with good functioning! It's the closest thing to a "superpower" in terms of what you're talking about.

My evidence for these being separate is that psychopaths, who are definitionally not highly sensitive in the first definition, are capable of being highly sensitive in the second definition -- that's where the ideas about psychopaths manipulating people by reading and mirroring their emotions comes from. In fact, to function at all as a psychopath, you probably have to develop a great degree of cognitive (system 2) empathy, because the more automatic emotional empathy that gives most people a head start in understanding other people's emotions is absent for you.

I suspect that the random youtube videos and quora posts are a bit of copium, combined with it being high-status and rewarded nowadays to praise sensitivity and emotionality to the high heavens.

Did you know stress can make you go blind?

I'm not talking psychosomatic, as was the topic of discussion in the CWR thread today.

Central serous chorioretinopathy

I had an episode about a year back, which thankfully abated on its own. Retina almost back to normal by the time I reached the hospital.

I was far less thankful when it happened to me again yesterday. Imagine a barcode, the size of your thumb, overlapping the center of your vision and slanted down and to the right. It wasn't a grey void, it came ribbed with stars and stripes for your displeasure.

It did go away after an hour, and I didn't bother to go for a checkup since there's not much need to do anything unless the visual disturbance persists for months.

It did make reading impossible, like trying to resolve text after being blinded by a flash, except it took its sweet time fading.

Eh, what's one more Sword of Damocles hanging over me as it goes? They're going to be fighting each other for space and place of prominence before they'll get me. I certainly don't have the option of "reducing stress" as is advised, what am I going to do? Quit my job and lay about? Give up on career progression? Fuck it, if my ethics questions are any hint, going blind would do more for the latter as I'd become effectively unfireable under the disability accommodation scheme.

Wow, and here I thought that Yakuza 0 plotline was contrived.

I certainly don't have the option of "reducing stress" as is advised, what am I going to do? Quit my job and lay about?

I mean, yeah... If your job's stress level can't be reduced below the threshold that it might permanently blind you, then yeah if we were friends I'd strongly advise you to quit or reconsider how immovable the stress level is.

I would wager the job is only a minimal contributor to my stress. It's tiring, and occasionally thankless, but as medical jobs go it's among the better ones I've had and few better are on offer with my current qualifications.

That's the rub. I need more qualifications. Hence grinding to near burnout for exams. The last time this happened I quit my job and was studying full-time. This instance came when I'm dying inside waiting to see if my borderline score gets me into psychiatry, after a sudden doubling (and recent octupling) of the competition means that a score that would have been a shoe-in a year back leaves me in limbo today.

There's no escape. Worst case I lose significant vision in one eye, and the odds of that, while not zero, are small enough that I have to keep on pushing forward. While CSR is a chronic condition with an unpredictable course, I only have the earliest stages where it resolves without further care. Treatments exist if it ever becomes something that doesn't go away after (semi-paradoxically) stressing me the fuck out for a few hours. If it comes to that point, I'm going to quit my job and lie in bed for a week. Maybe ten. And then take a bunch of meds and have lasers cauterize my eyeballs, if all else fails.

Today has been an awful day to have eyes. Or a nose. I can't say my ears have been assailed too badly so far.

That gentleman who can play the flute both ways was around, thanks to missing most of his mandible. I didn't miss having to do the dressing, especially since he's developed maggots and needed insecticide of some sort poured over his gnashing pincers.

But even worse was the other gent with a MASSIVE growth in his chest, like JFC I've never seen anything like it. He could have been an extra in the Last of Us show without any makeup. When I was swabbing out his insides, I was genuinely scared that if I poked too hard I might find myself inside his mediastinum and fondling his heart. It split open his ribs and stuck a good half a foot outside him, dripping with pus. I was all "isn't that an excessive amount of bandages" before I began, but no, you needed the output of a small cotton plantation to cover him back up.

The smell. It's a good thing I have a strong stomach and that I've had no time to have breakfast, lunch or dinner. I didn't have the appetite to check his notes so I don't even know what cancer he has, but I'm swearing to never get that one.

Gangrenous diabetic feet? Not that bad, I'll debride a dozen a day (and had to). But when you can smell the patient from the other end of the ward, that's when you wish the COVID anosmia stuck around for good.

As a layman, you are doing God's work.

Not everyone has the brain or the fortitude to do your craft and act like its all cool and no big deal.

Blushes

I appreciate the compliment, but dressing wounds isn't a particularly hard job. Incredibly disgusting, depressing (because these two chaps are not going to get better, though they'll probably die at home instead of in the ward, and someone else has been slacking, since the first patient definitely did not have maggots when I did this last week) and good at making you lose weight through a loss of appetite, but anyone can do it.*

Where I feel particularly useful, and like I'm actually applying my medical degree, is when I'm counseling patients. I was called to deal with multiple "difficult" patients and their families today and did a damn good job at it. I assuaged their doubts including on the relative benefits of further treatment options, helped synthesize conflicting opinions from multiple consultants (I keep the sordid deals and angry debates to myself) clarify concerns that they either didn't bring up with the senior doctors or the latter didn't have time to cover, and basically showed impeccable bedside manner. I know it's a good day when someone cares to ask my name, and so far it's never been because a patient wished to lodge a complaint against me. Someone even left me a gift once, shame I didn't have time to spare to go retrieve it from a building about a ten minute jog away.

Man, just let me get a psychiatry degree already. I'm already the poor soul delegated to deal with them, and it's because I do a good job at it.

But dressing suppurating wounds? I suppose I do it gentler than most. I know what the patients are going through and have no wish to prolong their suffering, be it by tearing off the old tape too fast and taking hair with it, or poking at things too hard. There are some doctors who, if not outright abusive, certainly have less care for these patients who are well past being able to speak up for themselves, and as they correctly reason, are going to die in 3 themselves. (3 what you ask? 2. 1..) . The ones who need it the least complain the loudest, here I have to go by muffled grunts and their diminishing frequency that my bone-sawing is doing some good.

But it's not difficult work. You just need a very strong stomach or the ability to keep your eyes open and still think of England. Thank you nonetheless, for all that I bitch about the profession I do derive some small satisfaction from helping. Even if here, it's too little too late.

*Should have seen my fellow interns run when asked to debride diabetic feet. I didn't find the sickly sweet aroma of rot nearly as off putting as they did, so it was a good opportunity to trade tasks I personally hate. Like plastering fractured limbs, I was still prying plaster of Paris out of my USB-C port for weeks afterwards.

What would happen if you swallowed a piece, big or tiny, of someone's cancer tumor?

Nothing at all. Well, barring some projectile vomiting into a conveniently placed bin.

Cancers are almost never transmissible by that route. Barring the odd exception like a sexually/contact transmitted disease in dogs and Tasmanian Tigers.

The piece would land in my stomach, all alone but for the gastric fluids (I really haven't had a chance to eat), and it would be promptly digested.

There's a minor risk of poisoning or gastroenteritis, depending on how rotten the tumor is, and this guy had a volcano.

But in all likelihood? I would come out of it with a well taught lesson not to open my mouth while dressing tumors, or spraying them down with saline prior to it. I was offered a mask, but it wouldn't help with the smell unless it was an N95, and would otherwise just fog up my glasses. I would rather eat a dozen tumors raw instead of endure a needle prick accident while reviewing an HIV or HepB case, the risk is almost certainly lower.

I'm largely used to this shit, today's cases were extra awful by the standards of a rather jaded Resident Medical Officer.

(I suppose you could make a nice steak out of a rhabdomyosarcoma, but I find that the clinical pathologists aren't game, and the cautery tools in theatre don't give them them quite the sear I'd like.)

Google just trained an AI that's meant to be a "partner" rather than a competitor in video games.

Most concerningly, it's been trained on Goat Simulator 3 (among other video games), so if you wanted to know why you're hearing air raid sirens and seeing distant mushroom clouds, there's your answer.

But on the less apocalyptic end, I think this is great. Maybe Lydia will do a better job of carrying my burdens and my buddies in Tarkov can be replaced by people with lower loot-goblin tendencies who are more reliable about covering my six. Having an AI partner that you can communicate with in natural language and even voice blows things wide open, especially a plug and play agent that can operate in arbitrary environments.

https://arstechnica.com/ai/2024/03/google-deepmind-wants-its-sima-ai-model-to-be-the-ultimate-co-op-gaming-partner/

Paper (PDF warning): https://storage.googleapis.com/deepmind-media/DeepMind.com/Blog/sima-generalist-ai-agent-for-3d-virtual-environments/Scaling%20Instructable%20Agents%20Across%20Many%20Simulated%20Worlds.pdf

I'm in my mid twenties, and I've recently realized that all the friends I've made after getting out of high school have been of superficial/situational type. I've had gym friends, with whom I'd hit the gym with. I've had party friends, with whom I'd hit the bars and clubs with. Then I've had hobby X/Y/Z friends, with whom I'd do those hobbies with. Those relationships never went beyond those common interests, and once either I or them stopped participating in our common interest, our relationship would fizzle out. I have the opposite experience with my childhood friend group. We barely have anything in common nowadays, but I know I can call any of them up and ask for help or talk about something absolutely random. I've never achieved that level of trust/closeness with friends I've made as I've gotten older. Is it what adult friendships are like or is it just me not being able to navigate social games? On one hand, I've been thinking it's on me - I've realized that all these new friendships require effort to maintain and progress. If I don't invite my gym bro friends to do other things with me, then our friendship will stay at the gym bro level forever. On the other hand, it seems a lot of people take that passive position, so always having to be the one that organizes things feels forced and doesn't grant much confidence in that relationship.

I have, perhaps surprisingly, managed to make new close friends as a mid twenties guy. Here's the trick, you first say "hey bro (or girl I want as a friend), I really enjoyed talking to you at that thing that time, we should get coffee sometime, how's next thursday?". Next, you need to talk one-on-one, it's hard to make a new close friend when you're always in a group with them, and you need to (gradually) tell them some of your secrets, vulnerability is required for close friendship. Virtually everyone to whom you offer one of your small secrets will reciprocate with one of their own, and thus the friendship builds.

Then, once you've hung out a few times one on one, you hit them with a heartfelt "hey man, great hanging out today, this is kinda weird to say, but I want you to know that I'm really grateful to have you as a friend". Think of yourself, would you allow yourself to grow closer in friendship with someone you weren't sure wanted the same thing? Realising that someone you considered a close friend doesn't feel the same probably hurts at the same level as romantic rejection. That's why the earnest declaration that you consider them a close friend works so well, it alleviates their fear that their friendship will not be reciprocated. People do want close friends, they're just afraid to hope.

Not only have you been friends with childhood pals for a long time, but you also had numbers on your side. 20+ people to make friends with every year for 12 years is incomparable to the (lack of) opportunities you have as an adult. On the bright side you hopefully have a better idea of the kind of person you like in a friend.

Meeting friends of friends can be a decent way of meeting people outside your usual sphere. But the real question is, what do you want out of your friends? Intimacy, mutual support, etc? To do that you have to gradually expand the scope of a friendship. It happens with time and effort.

Kinda like with dating, its a numbers game.

I will usually try and invite new friends along to other activities. I give them one to three invites depending on how much I like them, how good their excuses sounded (or whether they even responded), and how much advance warning my invites had.

Just showing up and being there is such a big part of adult friendship. We all get very busy lives, especially when you have kids. So I try and select for the people that can make it out to things. I think it tends to have a bunch of knock on effects too. These people tend to have their lives together. If they actually want to hang out with you they make it out too, so good vibes.

Once I have made a friend I'll usually try and keep them by just repeating the intitial thing, invite them to stuff. For long term friends I give them more chances to flake out. Anytime I go a few weeks without a social event I'll reach out to someone I haven't seen in a while.

I think if I had a party and all my friends could magically make it, and I wasn't concerned about logistics I could get about 20 people to show up.

I have similar experiences. I also think being the organizer is a thankless job but one people appreciate even if they never say it. I've seen first-hand that friendships are people who show up. That being said its only you who can say whether its worth the effort.

Depression, again

The question was posed in the last SSQ Sunday - what gets you out of bed in the morning? What gives you motivation or purpose? If unhappiness is not getting what you want, depression is not wanting. It is hard and embarrassing to write down the things I want. Embarrassing because they are shallow and venal, and because I am so far away from realising them. And yet by pretending otherwise, by telling myself I don't deserve these things and can't have these things, I am torturing myself and squandering my time.

I want to have a relationship. A loving relationship in which I can both receive and give love. Ideally a romantic relationship with a man, but at this point I would settle for a non romantic one with a biological child or a cute animal like a dog. For the most part, society tells people who are lonely or have depression that they should give up on love, that they don't deserve it. I don't really want to accept that. This is something pretty hard for me. I don't really enjoy sex and am generally pretty shy. I also find gay culture unappealing, on top of my neuroses and horrible self esteem.

The other thing I want is a great body. Despite going to the gym for some years I still feel very dissatisfied with my body and the way that I look, and it makes me feel like I'm lazy or undisciplined that I don't look as good as others. I guess it's pretty shallow and vain of me to express a value like this. But it's the proximate source of a lot of my negative thoughts.

Right now, I feel unbearably neurotic and negative. I'm not beyond pleasure or joy. But it feels ephemeral. I am currently standing in one of the most beautiful places in the world on a lovely warm sunny autumn day. I have no responsibility, no problems. But it leaves me cold. Sometimes I feel like I'm walking around like an idiot zombie, or about to burst into tears. I see the pleasure of others and feel vile and worthless. And I drift aimlessly around without really seeking out the things that might change my state of affairs.

Anyway, thoughts/opinions/perspectives welcome

I recently ran out of the SSRI I was taking. God I forgot how much being depressed sucks.

I don't have the best advice for you, because I never managed to get out of it without chemical assistance.

Not drinking, exercise, and purpose have all helped a lot in the past. Though the more depressed I got the harder it became to avoid drinking a lot.

I've always been reluctant to take an antidepressant. My mother took them once and she says they made her almost suicidal.

Exercise has never helped, personally. I'm pretty rigorous about exercise but even when I did physical labour job + regular lifting I still hated myself.

I think it's less about what I'm doing wrong and more about what don't have that's right. I don't have a relationship or a career or any real accomplishments.

Yeah they can have real shit side effects. I got lucky that the first one I took worked for me.

Exercise was kind of a temporary help for me.

When I was younger I had a low opinion of my appearance. But then as I got older and looked back at my younger photos I realized I actually looked good (not great but much better than I had thought). The thinking then became if my earlier opinion was wrong then my current self- opinion of my appearance could also be wrong. People much uglier and less fit than me had much higher self-esteem; and I truly think anyone working toward self-improvement is eminently positive.

Right now is the youngest you'll ever be from this point forward. As I've gotten older and advanced more in my career I've cared less what other people think and gained much more self-confidence, part of that is having the self-confidence to go out to events alone (art galleries, concerts etc.), and recognizing that I want to be around people even though I don't want to necessarily befriend them.

I sometimes also view other with their own families or in relationships and can feel quite low when I feel that avenue is inaccessible to me; what has helped me is to 'accept the things I cannot change' and also to support those friends and family who have their own families.

Accepting the things you cannot change is fine within certain limits. But in my case it feels like learned helplessness. Resigning myself to not getting anything I want just turned into an excuse not to try.

I do have low self esteem. I rationally understand that it's not rational. Other people compliment me on the way I look, particularly for my age. But I still find it difficult to internalize.

The full phrase is to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.

In my personal experience, depression is part biological and part psychological. What’s worse, depressed thoughts make the brain release depression chemicals, which causes a negative feedback loop.

Also in my personal experience, both the hardware and the software can be reconfigured. But not in the way society generally thinks they can.

First, biological depression. Before trying prescription drugs (assuming you aren’t already on them), have a physician check your blood for levels of vitamin D and zinc. Odds are you’re deficient in at least one.

Vitamin D definitely impacts my mood for the better when I take it within a half-hour of waking up, and I don’t presume to be a neurochemically distinct anomaly. The 10,000 IU pills are fantastic to get levels up, and 5k IU should be enough to maintain.

I have no clue whether proper zinc levels impacted my depression, but they’ve kept my colds from being horrible by improving my immune system, so I mention it anyway.

As for psychological depression, my personal experience is that unburdening myself through a CBT hack has made a huge difference.

The Fourth Step “moral inventory” of AA, CoDA, Al-Anon, and other such groups is an invaluable CBT tool which most CBT practitioners don’t use because they didn’t invent it. By listing the meaning, the semantic weight, of the choices others have made which impacted my life negatively, I was able to get to the cruxes of many of my issues.

Being in a weekly peer talk support group (such as those I mentioned above) with journaling has also helped me to face my issues head on. Never underestimate the value of company in misery.

I’m autistic and introverted, but I still need people around me for my brain to generate the community chemical, oxytocin. I have several community-based hobbies and a “Third Place,” church in my case, to produce lasting friendships. I also watch My Little Pony Friendship is Magic, which was the first thing to really pierce my depression of nine years by that point. I think the show affects my brain like the “ecstasy” drug does for those who take it. I recommend starting with episode 4 of season one, watching to around episode 10, then watching episodes 1-3. It’s on Netflix and the official page. And don’t worry, it won’t turn you gay. (These are the jokes, folks.)

And when the mind isn’t as depressed, it relieves the brain, which relieves the mind. Relieve either one for a positive effect on both, and life will have more meaning.

All this is well and good, but besides the point. As your Bible says, man does not live on bread alone. I am capable, sometimes, of enjoying myself. I can masturbate or drink alcohol or play a video game or watch an entertaining video. I can take a walk through nature or something more traditionally considered to be pleasurable. I can engage others in pleasant, polite conversation. None of these things make me feel less cold or inhuman on the inside, though they might distract me.

I have been depressed on and off for about 2.5 years. I don't think there's some biological mechanism. My moods don't seem to be correlated with sunshine days, diet, or supplementation. My testosterone is quite low but that's about it.

For for a moral inventory, I honestly don't feel that anyone has ever had a negative impact on my life (except myself).

The question, I think, is about desire and happiness. Is the route to happiness followed by putting aside or ignoring your idiosyncratic desires. And if so how do you separate your own desire from that of society.

That oft-reviled individualist, Ayn Rand, said that creating something great by your own standards of greatness is the only way to generate happiness.

There was a time about three years ago when I was struck by an inexplicable urge to build a new shed out of cinderblocks. I did not, for various reasons including the fear of hassles, but I believe it would have resulted in a satisfaction and happiness I have not felt since recreating a particular Macintosh AfterDark screensaver in Turbo Pascal on a 486 in 1996.

If you’re looking for a purpose toward which to put the work of your hands or mind, my suggestion is journaling your honest reactions while reading the book of Ecclesiastes, at least three reactions per chapter. Here’s a poignant translation.

The biggest thing that helped me cope with bad days is realizing that there will be good days in the future. I just think of the good times I've had recently and tell myself I'll experience those feelings again in the near future. It doesn't even have to be complex experiences, even just thinking about a song I really enjoyed recently usually helps. It doesn't cure depression/sadness but at the very least it prevents me from getting sucked into the doomer spiral. That way my shitty days don't turn into shitty weeks.

As for other things, I can relate to some of them. I'm not sure how to get out of that mindset though, so can't really help, sorry.

The knife cuts both ways, however. Logically, there will be happy days in the future. But even on the happiest days, I think - none of this will help, or change me - I will be depressed and ashamed and worthless again. And then I feel further ashamed - for not appreciating my own fortune, for not being sufficiently grateful, for not being as positive and upbeat as I should be.

You're not wrong. But the goal of this technique is to make myself feel better in the moment. I'm much better at managing bad mindset on a good day.

a cringe side story from a few weeks ago.

In feb, 2 close friends were crashing at our shared house for a weekend getaway. My roomate, an amazing cook, spent the entire morning making us his special waffles. He placed the waffles in a plate in front of me.

It was the morning. I was scrolling. I hadn't had my coffee. God, the excuses only make it worse.

But I ate the served waffles. I ate. I ate. I ate. And in my absent mindedness, I thanked my roommate for the amazing meal and went my merry way. Minutes later, it hits me. I went back to the living room. The guests had woken up. They'd heard about the special waffles. The amazing waffles that I knew all to well. But there were none. They found an empty plate, my gluttonous ass and a distinct lack of waffles.

The horror. Find every idiom on embarassment and those would still not be enough. I was red in the face. I was aghast. I could not meet my friends in their eyes. I was ready to cry. The last one wasn't a metaphor. Hell, I mean them all literally.

My bros were forgiving. After some initial confusion, justified leg-pulling, a heart-felt apology and genuine forgiveness, they moved on. But, it has kept me awake ever since. I'm supposed to be socially well adjusted. I'm supposed to be an adult. I don't have any real skeletons in my closet, but I have done worse things than eat an extra waffle. Yet, it's funny how this social faux-pas weighs on me more than any failure, outrage or altercation that I can remember.

I was in Carragher's shoes and I hope the poor lad can find sleep soon enough. Cringe is a powerful insomniac. (Lost some context here. Carragher is a football player turned tv personality. Yesterday, he had a similar faux-pas among his friends/colleagues and you could see the visible discomfort on the poor man's face)

P.S: I have since prepared a 5 course meal for the friend who cooked the waffles, now it weighs lighter on my conscience.

I’ve accidentally eaten people’s leftovers more times than I can count and the shame never ceases.

It's a sign of my maturity as an individual and proof of moral progress that I no longer steal my younger brother's leftover KFC or other takeaway from the fridge.

Frankly the other doctors have such appalling lunches that I wouldn't eat them even if I could get away with it. I've already complained about the hospital yoghurt enough, so the patients are safe.

Out of morbid curiosity, what do you consider an appalling lunch?

It depends on the breed of maggot in question. You don't want the ones from botflies, far too much umami. Common houseflies are best, especially with a sprinkle of paprika

They're having rice with lentils, miscellaneous vegetables and fish. I only like my rice fried or as biryani. I'm allergic to leafy greens, and I'm too old for my mother to forcefeed me fish.

I would not eat that if I was starving (I have, for reasons I'm not inclined to get into at 1 am, actually starved, as in I legitimately could not get food for days). But it's a bog standard meal. Why do you think I bother to work, if it's not for money to order in pizza, biryani, waffles and the like? When it comes to dietary advice, do as I don't.

Your position on rice means you're missing out on the greatness that is jambalaya, but I respect that you know who you are and what you're about.

EDIT: I just remembered you're in the UK, so you probably can't get decent jambalaya anywhere anyway.

You public menace.

Edit: never actually tried posting an image attachment here before, seems a bit clunky.

Have you ever used smelling salts to stimulate wakefulness? I am afraid I am naturally very drowsy person, caffeine does very little to me (apparently I have an efficient liver) and I was wondering if using ammonium salts may be a useful option. Are there any big 'no-nos' of using smelling salts? Do you have any good or bad experience? Or maybe you know any good hacks for some nice adrenaline flush in the morning?

You could try modafinil for wakefulness. It's a criminally underrated drug that I would describe as caffeine that works throughout the day.

It has no abuse potential (and people have tried), it's extremely safe, and it's a darn shame it's normally only dispensed to narcoleptics or people with severe daytime somnolence where other treatments have failed. Doesn't cause jitters or euphoria like most stimulants.

Sadly I developed a tolerance to it after a year or so, but I can still recommend it. You'll likely need a prescription, but feel free to bring it up.

Or maybe you know any good hacks for some nice adrenaline flush in the morning?

Are you already going outside for some natural sunlight in the morning? It's not an adrenaline flush, but it really can't be beat when it comes to natural wakefulness. Bonus points if you get in a morning workout in the sun.

Hmm. I'm someone who does not get positive effects from caffeine either. But I don't think the liver is to blame. An efficient liver would make the caffeine be processed and done away with quicker, but it wouldn't keep the effect from coming.

I've no idea about smelling salts, but dullness/drowsiness can be trained to not appear much. This was part of my meditation training. You can use strong antidotes against the dullness whenever it comes, and deconstruct it (how do you know you're drowsy? Ask yourself this and look at its component parts), and your brain will learn not to produce it (or learn to counteract it autonomously, perhaps).

You can do hyperventilation, and/or tensing of all the muscles in your body for a while, repeating that a few times, and if you're really drowsy put cold water in your face too. If you train at this every time you get drowsy, dullness will be significantly reduced in frequency and strength after a month or two.

Thank you very much, that's an interesting reply. Yeah, maybe some variations in brain receptors are responsible for variations in caffeine sensitivity, I haven't studied the topic much.

Could please expand a little bit on your meditation for wakefulness? I have good results from meditation, albeit not for wakefulness yet. If I understood you correctly: you observe your inner state in the morning and try to identify the state of drowsiness until it fades away gradually or you apply some other practices?

I usually try to hyperventilate a bit before work, but unless I force it strongly, the effect is only slight, so I'm looking for some other ways.

It's not a "meditation for wakefulness". Wakefulness is always one of the two factors that should be present in any meditation. You should be both calm and wakeful/alert in any meditation. I do not observe my state in the morning specifically, though a serious meditation practice will make your awareness of your mind and your sati (mindfulness, working memory) stronger at all times. The advice to deconstruct dullness is one of the things you should do to get a handle on the problem, to understand it. The other thing you should do are the antidotes I mentioned. You must respond to dullness with sufficient antidotes every time it shows up. As much as it takes. This is the way to train it out of your system. If you're not in a place where you can start hyperventilating, do muscle tensing and deconstructing of the dullness in order to understand it better. Set aside as many minutes for this as it takes.

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