Good to know that refs and atoms are not safe to use in virtual threads. I would have definitely found that out the hard way since atoms are so simple to use.
This is of course the correct answer to the question. But additionally, I made the joke because I somewhat Identified with the 'Jack' use case mentioned in one of the pages on the PySpreads site
The audio player is unfortunately not on GitHub yet, I've still got a few kinks to work out before it's in a shareable state. The statusbar project was also shared mostly so the other Nimdow users could play around with it, so the code quality is quite sub-par.
JNRowe beat me to it! Feel free to browse the rest of my GitHub, its mostly Nim code. And if you want to talk Nim or Fuse you can join the Nim Discord server (or the Matrix or IRC bridge) or post on the Nim forum.
Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid.
Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with.
My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.
That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."
Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.
I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
>Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs.
Correct on the important points here:
- They are trained as a medical doctor
- They went though an additional 4 years of training during residency as a medical doctor.
- Due to that additional training beyond PhDs, they are granted prescription privileges.
>You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.
You can, but:
- You usually won't, if we were to pick an example at random from "therapists".
- That isn't the sort of therapist we're discussing here, as the article points out.
- A PhD can be in anything, not just psychiatric disorders.
- A PhD requires significantly less training in treating patients than an MD.
>I don't really see any reason why a psychiatrist would be any better than a therapist
For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go.
Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.
On the therapy side, though, I'd hazard a guess that if their PhD was in an appropriate discipline, it would show at least some potential that they take this seriously, rather than "what is the minimum effort and education I can undertake to throw my shingle out as a therapist?"
> * they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.*
I believe too much credit and merit is given to psychiatrists. I'm not arguing that an average psychiatrist is less knowledgeable than an average psychologist, therapist, or licensed councilor/social-worker. I, as well as much of society, benefit from the existence of both fields.
However, despite psychiatrists going through a more academically and scientifically rigorous training program, I often find the work of psychiatrists to be anything but scientific. If anything, psychiatry is more of an art than a science.
I try to have clemency for the field psychiatry, but it can be difficult at times. We are talking about a field that has to work with the nebulous black-box that is the human mind, which is no easy feat. To my understanding, we treat mental disorders as if they are organic diseases, and many of the said disorders, if not all, have consistently failed to demonstrate any reliable evidence of an organic etiology or biomarker for diagnostic purposes beyond a reasonable doubt. The field also relies on completely arbitrary heuristics based on vague symptoms to diagnose conditions many of which have significant overlap.
I have read plenty of peer reviewed psychiatric papers and journals. While it is not my field of expertise, I have noticed that in much of the academic and scientific literature there seems to be a better attempt at making a quantitative assessments in terms of the efficacy of various treatments. Obviously, nothing is perfect, but that is neither here nor there.
Speaking of treatments, we also have countless medications used to treat psychiatric conditions with little more than hypotheses as to how or why many of the commonly used medications actually provide relief.
I have been diagnosed with ADHD, and I had to go through many rounds of psychometric testing and questionnaires in order to receive a diagnosis (administered and proctored by a Psy.D). After I received the diagnosis, the treatment from psychiatrists have been nothing more than throwing pills at a wall and seeing what sticks. After over a decade of treatment from a multitude of medical professionals, there has yet to be a single attempt to quantifiably measure whether or not the medications I have trialed actually provide relief. During the whole entire decade long ordeal, I have never once had blood drawn, thyroid checked, a sleep study, neurological evaluation, etc.. If I quack like a duck, waddle like a duck, then I am a duck, right?
Anyway, while psychometric testing practices are not without subjection to plenty of scrutiny and criticism, such testing still seems to have been the only attempt at some sort of empirical analysis in my entire treatment process. Everything else has been nothing more than a series of brute-forced attempts.
If the success of treatments are predominately measured by the greatest reduction in symptoms with the least amount of adverse side-effects, then I sometimes wonder if a pharmacists with training in various mental conditions could almost entirely replace psychiatrists?
I am not quite sure how your post relates to mine, but your struggle seems tough. As someone who also has ADD, I can sympathize.
Consider letting go of your strict expectation of measurement (a blood draw, for example, wouldn't evaluate if you're feeling better or not, nor would a thyroid test), and evaluate for yourself if a treatment is making you feel better or worse, more effective or less, over a sufficient observation period. If worse, bring it up with your care provider.
Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication, and honestly it's kind of a superpower. Many successful people have had it.
Anyways, I'm sorry it's taken so long for you to feel good about yourself. That sucks.
I appreciate your sympathetic and empathic vibes. What ever struggles you may be going through/gone through, I hope you know I feel the same for you.
My point, which I probably failed to convey, was that the field of psychiatry is about 50% bullshit. Psychology is probably about 75% bullshit. Arguing which is more equipped to treat a condition is like arguing if either Greek Oracles or Astrologers can predict the future better.
I would love to had a long format discussion with a psychiatrist and pick his or her brain about this topic. Not necessarily from a treatment point of view. I just want their opinions and insights on topics like we are discussing in this thread.
> Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication
I have considered this. I've been treated for a decade now, and I can say with confidence that I figured this one out within a few months of treatment. I've tried countless treatments, multiple times, etc.. I can say with great confidence that what I am currently taking is the "least worst of them all." On an average day, I maybe get like 20% to 40% reduction in symptoms. Better than nothing, but not exactly the help I was hoping for. I'm still paralyzed by executive dysfunction, but the tricky part is that things other than ADHD can cause this, so it's difficult to separate the signal from the noise.
> honestly it's kind of a superpower
Perhaps at one time in our evolution, I would agree. However, in modern times, I strongly disagree. I do not see any situations in which it can benefit somebody. I find that many people who were successful with ADHD were successful despite of ADHD and not because of ADHD.
Port forwarding is easy and self-reliant compared to using a third party's free service though
Not saying that's for everyone but I do feel like the default should be to click the two buttons in your router interface and third parties a fallback option or conscious choice. Probably just as quick as signing up for tailscale, if it weren't for that all routers feel like they need to reinvent a UI so it's never twice the same
Not everyone can get port forwarding, though. If you're stuck behind one of those terrible CGNAT+no IPv6 ISPs, you can't host your own services from home that easily. There are more of those shit tier internet providers out there than you'd hope or expect.
When have either of us lived in a universe where "deserve" has anything to do with reality?
Is that the source of everyone's dysfunction, wandering around whining about "deserving love"? How could I ever give love if I were so desperate to receive it? My life's far from sad. But all the sad people out there seem to agree with you with their whining about deserving love. Have you ever explored that connection?
Yes, genuine people who aren't playing social games laugh spontaneously, they don't contact the moral police to determine whether they can laugh or not. Other people who are more prone to going with the herd will wait to see what other people are doing and then determine whether they should laugh or not. You actually can see this in real time watching stand up comedians - for certain jokes the majority of the crowd will laugh in a different manner to normal to feedback to the comedian that the joke is funny but dancing on the line of acceptability. A good comedian uses that information and either addresses it immediately or changes their set accordingly.
So yes, I found the use of the word "patient" funny because the context shift is funny to me. Like seriously what is your attitude to life, that you're only allowed to laugh about things specific to your own profession? That at all other times you must be deferential with head bowed and no sense of humour? The whole point of comedy is the coming together of unexpected and differing viewpoints on topics, which is an inevitable part of being human, because we all have own own unique backstories which have gone on to shape our views of the world.
> Your comment is unhelpful and barely related to the article.
I would love to know what you deem qualifies you to be the arbitrer of what is and isn't helpful. My comment may be unhelpful to you but your experience is not everyone's experience, I would wager that for anyone not familiar with this terminology or what vet's face on a day to day basis, then it is likely helpful and relevant.
> Also, I don't feel like "empathizing with animals" is a huge insight that you've cracked. Most people do it.
I am no longer, but I spent a year as vegan, primarily for reasons of animal empathy, years prior to finding out about this patient terminology. And it still altered my perception. There is more than one way to gain insight and there are different levels of insight. Things look different from different angles. This was a new angle for me.
> Then you get mad at a group for presumably downvoting your irrelevant comment?
You're downvoting someone for sharing their personal growth experience. After a certain amount of downvotes a post gets flagged and can no longer be seen. So you're essentially trying to silence me, not because I've said anything hateful, but purely because what I've said doesn't align with your own views. And I consider that to be pretty fascist behaviour and I will call it out when I see it because it doesn't lead to good outcomes.
After a certain amount of downvotes a post gets flagged and can no longer be seen.
A post must be flagged separately from downvoting to become dead. It might look like heavily downvoted posts get killed automatically, but those are just correlated events. A post that attracts a lot of downvoting is also more likely to attract flagging. A post that is already in the most-downvoted-possible state (-5, I think) can get more downvotes but those just won't do anything at that point.
I have not flagged or downvoted your posts. I just want to clarify this point of HN comment logic.
It's barely related to the article because it is about suicide and you come in to tell an anecdote about how funny you find it that they use a certain word. Just completely tone-deaf. It's the word they use, nothing funny about it, and an article about suicide among vets is not the place for it.
People having different viewpoints does not make you immune to criticism. You could just not talk, you're not the center of the universe.
Complete horseshit. This isn't someone's funeral - it's a discussion forum. And even if it was a funeral, some people will crack jokes at them because that's how they cope. Do you think no-one told a joke at George Carlin's funeral? Do you think that soldiers don't crack jokes in the trenches because "it's not the appropriate place"?
I'm absolutely fine with having my viewpoints criticised, what I'm not fine with is being flagged and silenced simply for having a viewpoint that isn't hate speech. I consider the comment that did eventually get flagged as being justified because I got angry and frustrated in the moment at receiving five down votes in the space of a minute and let it get the better of me by calling animal lovers fucking militants, but if that line was removed and the comment was still flagged then I wouldn't consider it justified.
> You could just not talk, you're not the center of the universe.
Again, I don't know how you can type with a straight face and accuse me of being a narcisst when you are literally acting like you are humanity's judge, jury and executioner of what is and isn't relevant, what is and isn't funny, what is and isn't appropriate and who should and shouldn't speak. If you don't personally find it useful or funny fine, but don't act like you're speaking on behalf of all humanity, it's completely sanctimonious.
How did you even notice this? Get off the computer, it's clearly not doing your mental health any favors. You seem very unhinged. Ranting at groups due to perceived persecution and calling them "fucking militant" is not decent behavior.
> Do you think no-one told a joke at George Carlin's funeral?
The comedian? Yeah he's a comedian, I would expect jokes to be told at his funeral.
How is it unhinged to post something on an active discussion site and then to refresh the page a minute or two later to see if anyone has replied? That's called having a conversation, there's nothing unhinged about it. There are no notifications on this site, if you want to have a conversation with someone you either refresh the page or you subscribe to the RSS feed of your comments.
All you're doing is trying to deflect away from my arguments and hoping you can frame me as being insane to try and position yourself as right by default. Because how could anything I say have any merit if I'm as "unhinged" as you have declared me to be, for commiting the cardinal sin of checking my messages? That is some dark, manipulative and abusive shit right there.
I'm not hoping to frame you as anything. You posted the multi-paragraph comment calling people who like animals "fucking militants" all on your own before I showed up. Getting that upset/irrationally mad at a group over some downvotes is what I find concerning.
But yeah, apologies about the dig at you refreshing the page frequently. I'm having to do the same to check these messages.
I then got attacked for it and dragged into arguments I didn't really want to have by other vegans. And this similar behaviour has happened repeatedly on other threads to do with veganism, animals, the environment and other culture war topics. It is always particularly bad on anything that could be related to veganism.
I've seen this downvoting pattern happen so frequently now on both mine and other people's comments that it is becoming difficult not to see this as people with a targeted agenda, downvoting things they like with the hope of it getting flagged early and taken out of the conversation all together. Like if you look at the post history of one of the people I ended up in an argument with on on the link above, their entire history is solely dedicated to environmental activism and picking fights with people on these topics to the point that Dang ended up banning him:
It seems unlikely to me that, within a minute, five unrelated people out there all simultaneously read my comment, which in the grand scheme of things was pretty benign, and then decided to downvote it. And I keep seeing this stuff happening on threads that are related to culture war topics over and over again.
Here was another one of my comments on a culture war topic that suffered the same downvoting treatment that eventually had it's flagged status overturned by one of the moderators:
All I want to do is come online and share my experiences and stories with other people like I'm in a bar just chatting to people. I can and have told these exact same anecdotes in real life without getting attacked for them. It's one thing having a debate with someone on here about some tech topic but it really feels like a punch in the teeth when you share a deeply personal story, purely with the intention of hoping it helps enrich someones day, just to then get turn round and attacked for it. We don't do this to each other in real life, I don't get why people insist on making it different online.
