Laura B

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Some Thoughts on My Psychiatry Practice

It was interesting to re-read this article 2 years later.  It reminds me that I am generally working with a unique subset of the population, which is not fully representative of human psychology.  That being said, I believe this article is misleading in important ways, which should be clarified.  The article focused too much on class, and it is hard to see it as anything but classist. While I wrote an addendum at the end, this really should have been incorporated into the entire article and not tacked on, as the conclusions one would reach without it are quite different. I believe I didn’t incorporate it largely because I am not a strong writer and didn’t know how to do this in an elegant way without losing my other points. 

This article needed some discussion of internal vs external locus of control. My current clients have a strong sense that they have control over their lives.  This leads to attempting more actions to change their situations but also internalizing their failures.  The population at the Medicaid clinic feel that they and in fact do have less control over their lives.  This is an important thing to point out.  I had one older minority client who basically described a lifetime of being buffeted about by various government policy changes and oppressive interference in her life for the last several decades.  She suffered many tragedies that were not within her control.

I believe I also over-simplified the psychology of both my current and former patients for clarity. The majority of clients who come to me do want medication.  I do see people struggling with past traumas and current situations which are out of their control.  I definitely saw people at the Medicaid clinic suffering from identity crises.  Money was not absent from the concerns of people on government assistance.  I still think the spirit of my comparisons is accurate, but the oversimplifications are dangerous, and I’m not certain that the greater point was worth the confusion. 

I still believe the conclusion that struggling to hold onto identity leads to great human suffering. It is not a simple problem to solve, nor necessarily one that should be fully solved.  I will leave that to others to debate.  I do spend a lot of time working with people on examining their expectations of themselves, where they come from, and whether holding themselves to these standards leads to anything positive in anyone’s life. 

Explaining "The Crackpot Bet"

"That was when close friends started delicately checking to see if I was “okay.” "

I would suggest seeing some of your close friends in person and seeing if they think you are ok instead of 'reassuring' them that you are fine. Your 'explanation' is not at all reassuring on this front. The whole incident seems out of character from what I remember of you, and I'm guessing your friends are right to be concerned. I recommend not writing more in public forums for the time being.

No, it's not The Incentives—it's you

There is a lot of arguing in the comments about what the 'tradeoffs' are for individuals in the scientific community and whether making those tradeoffs is reasonable. I think what's key in the quoted article is that fraudsters are trading so much for so little. They are actively obscuring and destroying scientific progress while contributing to the norm of obscuring and destroying scientific progress. Potentially preventing cures to diseases, time and life-saving technology, etc. This is REALLY BAD. And for what? A few dollars and an ego trip? An 11% instead of a 7% chance at a few dollars and an ego trip? I do not think it is unreasonable to judge this behavior as reprehensible, reguargless if it is the 'norm'.

Using peers in a field as a proxy for good vs. bad behavior doesn't make sense if the entire field is corrupt and destroying value. If 100% of scam artists steal people's money, I don't forgive a scam artist for stealing less money than the average scam artist. They are not 'making things better' by in theory reducing the average amount of money stolen per scam artist. They are still stealing money. DO NOT BECOME A SCAM ARTIST IN THE FIRST PLACE. If academia is all a scam, then that is very sad, but it does not make it ok for people to join in the scam and shrug it off as a norm.

And being fraudulent in science is SO MUCH WORSE than just being an ordinary scam artist who steals money. It's more like being a scam artist who takes money in exchange for poisoning the water and land with radioactive waste. No, it's not ok because other people are doing it.

Some Thoughts on My Psychiatry Practice

That might be true, but it is very hard for people to make reasoned changes when they are deeply depressed. Depression has real cognitive effects, which people frequently complain about. Depressive reasoning often looks like I SUCK I SUCK I SUCK I SUCK Everything is my fault and I screwed it all up, and I can't fix it, and I can't fix it because I SUCK I SUCK I SUCK. Ok - let me focus for a second - If I change this... I SUCK I SUCK ... Ok, if I change this thing then... why can't I think? Oh right I SUCK I SUCK I SUCK... etc, etc. Getting people out of that pattern is very helpful.

Some Thoughts on My Psychiatry Practice

Number 1 is the politically correct thing to say, but was not what I actually observed when working with Medicaid patients. People complained far less about poverty than I (who come from a middle-class upbringing) would have anticipated. People adjust to what they are used to. It's the middle class, with the constant fear of downward mobility, which really suffers from monetary issues. There were some interesting interactions between race and class, which are hard to express without the internet eating me. Being hispanic and poor is very different from being black and poor, which is different still from being white and poor. And I'll leave it at that.

2 just sounds correct. America has reached the apotheosis of individualism. We can't all be the star of the show, and it hurts when you find out you are not.

Some Thoughts on My Psychiatry Practice

The latter. Most 'analysts' today do not consider themselves primarily freudian.

Some Thoughts on My Psychiatry Practice

My new practice is only 3 months old, so no one with full on DID yet, though some people have these rando dissociations (which are likely trauma related) I had one patient in my former position with DID. Very interesting case, but hippa lol.

Transhumanism as Simplified Humanism

I just read this article from the Atlantic - I wrote the comment first- but I think it eloquently highlights most of these points.

https://www.theatlantic.com/amp/article/379329/

Transhumanism as Simplified Humanism

A few thoughts on why people dislike the idea of greatly extending human life:

1) The most obvious reason: people don't understand the difference between lifespan and healthspan. They see many old, enfeebled, miserable people in old folks homes and conclude, 'My God, what has science wrought!' They are at present not wrong.

2) They don't believe it could work. People as they get older start recognizing and coming to terms with mortality. It suffuses everything about their lives, preparations, the way they talk. The second half of a modern human life is mostly shoring things up for the next generation. Death is horrible. It needs to be made ok one way or another. If you dangle transhumanism in front of them, but they don't believe it has any possibility of happening, then you are undoing years of mental preparation for the inevitable for no reason. People have mental protections against this kind of thing.

3) On some level people don't want their parents to live forever. Modernly extended lifespans have already greatly extended the time parents exert influence over their children. Our childhoods essentially never end.

4) On some level people don't want to live. That might be hard for you to understand, but many people are very miserable, even if they are not explicitly suicidal. The idea of a complete life, when they can say their work is done, can be very appealing. The idea of it never ending can sound like hell.

Advances in Baby Formula

Sick babies are often too weak to suck much - and this is true even if the baby isn't sick enough to require a nicu stay. If a baby has to be in the hospital - it can be difficult logistically to breastfeed them, and of course if women aren't dedicated to it, they won't maintain milk. My son was required to stay in the nicu for 4 days (for ridiculous reasons - he was fine). I was only allowed to stay in the hospital 2 nights, and I was exhausted and needed to sleep.
I ended up allowing them to feed him formula since my milk was slow to come in - no one strongly encouraged me to stay there and breastfeed in the night. I got a 5 minute tutorial on how to use a pump, which was briefly suggested. It's great that some hospitals are encouraging breastfeeding and providing donor milk to premature babies. I don't know how universal this is. I know other women who have complained of similar problems I faced.

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