Out of Sync

I’ll admit it: I had a bout of depression once, the real thing, so bad I went to see a shrink about it. I didn’t end up following the shrink’s advice (“here’s six different meds, plus twelve more to balance out the side effects of the first six”), but the whole process was interesting.

So much of “family practice” is just doc-in-the-box, which makes the title “primary care provider” a joke — you never see the same guy twice, and even if you do, you never build anything approaching a relationship. So when you present yourself at the office with four of the six necessary diagnostic criteria for a “mental health” issue, he’s pretty much required to refer you up the chain. At which point you think you really do have “depression” (or whatever), which means that drugs can cure you, so you show up at the shrink demanding the drugs. After all, what’s the shrink for, if not to dispense the SSRIs?

At no point, however, did anyone suggest that maybe I was overreacting. Which is why I was there in the first place.

Let me back up. The reason I suspected I had real, clinical depression — by which I mean, a serious chemical imbalance in my brain — was that I was blue way past any possible rational justification. Objectively, life was pretty good. I had no more stress than the next man; there were, in fact, millions of people who’d be happy to take my place. So why was I so paralyzingly miserable? I’d say “you’d have had to put a gun to my head to get me out of bed some mornings,” but on mornings like that, kameraden — thankfully few — I might’ve told you to go ahead and pull the fucking trigger. That’s the kind of sad I was.

The docs, though, just applied the checklist: Sleep disturbance, drinking too much, eating too much, inability to concentrate, and have I lost contact with friends? Hahaha, what friends. Yep, that’s depression, let’s get you pilled up!!

Maybe I was overreacting, though. For all they knew, a good swift kick in the ass would’ve sorted me right out. I got that same list of excuses, minus (usually) the “suicidal gestures” stuff, every time a sorority girl got too drunk to type out her term paper the night before it was due. Maybe all I really needed was to get screwed, blued, and tattooed, as I think they say in the Corps. Certainly the docs had no way of knowing…

What I’m getting at, comrades, is that something as simple as the return of a sense of proportion would cure most of our ills. I really was depressed — literally, chemically — but was this guy?

The reason why he’s so hard to pin down as right wing or left wing (or patsy) is that it’s not important to him, writing the note.  The purpose of the note isn’t to convey information, it is to convey mood, and the seemingly random and contradictory positions he takes on issues is all in an attempt to win you, the reader, over to his side. He knows for sure he is angry, he knows for sure he feels wronged, but he can’t logically and realistically link the real world events to his level of anger.  So he confuses you with words while blanketing you with mood.  You have no idea what he’s talking about, but you definitely sympathize with the frustration.  Boom– he got you.

“This guy” being Joe Stack, so there was definitely something wrong with him. But note the conclusion:

If you had granted every single one of his wishes, he would still not have been satisfied, he would not have been happy.   As bankrupt as he was, he still had a plane, a house to set on fire, a car… note also he didn’t seem to care about his family he left behind. The problem isn’t what happened to him in his life, it’s how he viewed his life and its expectations.

Emphasis his, but it’s dead on. This guy’s misery was all out of proportion to his circumstances, and he knew it, and yet… he didn’t know it, because he thought “his happiness” and “his circumstances” were supposed to be interchangeable.

Note the solution we seemed to have settled on for this problem. We’ve medicalized the universal student tendency to not want to go to class into “attention deficit disorder,” but this loopy bint is sanitizing the insides of her nostrils against the Kung Flu and she’s in the Washington Post. And I’m sure I don’t have to point out the likelihood — by which I mean metaphysical certainty — that this woman lives a life beyond our dreams of avarice, in a neighborhood the entire Rotten Chestnuts readership couldn’t afford even if we all went dutch.

I’ll put it as plainly as I can. Nothing, not even the bubonic plague, justifies this:

as long as I’m buying the soap, I should stick some up into each nostril and wash it out a bit. He also suggested isopropyl alcohol, not to drink, but to dip a Q-Tip in and then gently move it around the inside of each nostril. It may sound almost as ridiculous as the suggestion to somehow put bleach into our bodies, but a little bit of soap and alcohol probably can’t hurt. I also dab my eyelids with Ocusoft Lid Scrub in the hopes that any virus on my eyelids won’t go any further.

I’m not a psychiatrist or anything, but holy cow, that’s florid psychosis. (Needless to say, she’d actually inject bleach if she hadn’t convinced herself that the Bad Orange Man told her to, and she’d much rather die of COVID than take hydroxycholoroquine).

In my whiter pilled moments, I’m coming to believe that’s all it will take: Calling a spade a spade, or, in this case, calling a lunatic a lunatic. Somehow injecting into our discourse the idea that maybe, just maybe, behavior divorced from any possible tether to reality is bad.

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13 thoughts on “Out of Sync

  1. ganderson

    What’s crazier- that woman or the outlet that felt it should be published.
    Also – think about the whole trans madness- the proper response would be “I’m sorry, but you may claim to be a girl, but you’re not.” We don’t do that, though.

    1. Pickle Rick

      No. Here in Pennsylvania, the Governor makes one the health commissioner for the state, because he wants to rub our nose in shit.

    2. Some Guy

      I always wonder how much trouble I’d cause if I presented a case and said “patient is clearly delusional, he thinks he’s a woman.” It’s an emperor’s clothes kind of situation in medicine, every knows, no one wants to say it.

      1. Severian Post author

        I have close friends in the psych biz; I’ve seen this up close. If you present with a minor dissatisfaction – the kind a good swift kick in the ass would cure – the doc can drug you to the gills… and will, because it’s billable. Present with florid psychosis, though, and you’ll get nothing, because today’s clearly delusional self-harming lunatic is tomorrow’s civil rights pioneer and you can’t be too careful.

        Yeah, we’re pretty much fucked. You can take it to the bank that “sluggish schizophrenia” will be in the DSM 6. A tenner in a labor camp is only cure, comrade.

  2. Codex

    And if we can so it without being cruel… “So. You just stay over here being crazy as long as you need to. I’m going to go back to getting stuff done. Give me a holler when you’re ready for a helping hand, okay?”

    1. Severian Post author

      Exactly. You can’t help someone who doesn’t want to be helped. You can only help them reach the bottom faster. I had an alcoholic buddy once. We staged an intervention. “We can’t stay friends with you when you’re drinking, because we just end up enabling you. You want help drying out, we’re there, but the call needs to come from inside the clinic. Until then, you’re dead to us. We’ll pray for you.”

      That’s the definition of “being cruel to be kind.” Looking back, I wish I’d done it much earlier. But because it IS cruel, you’d rather do just about anything else…

      In this woman’s case, I can’t even imagine what it would take. Like I said, she’s in the Washington Post. All of us together couldn’t afford her house. Being crazy has worked out great for her. I have no idea how to fix this…

      … Except I no longer tolerate lunatics in my own life. You’re soaping your eyelids? Gone. You’re voting for Biden because Trump is a meanie? Gone. And I mean *gone*, sugar tits – don’t ask me for so much as the time of day, because you’re insane, or so deliberately dumb it’s functionally the same.

  3. Some Guy

    Medical education is set up to create checklist medicine. The clinical interview is taught as going through a series of checklists and then sometimes feeding those answers into an algorhithm. All of our written tests, including the medical boards, are multiple choice. During our simulated interviews you have 15 minutes to see your patient and in that time you must ask about certain points. Actually practicing is no different. Those checklist points we had to ask for grades become points we need to include in our notes to become billable.

    Then to talk about the kind of person that gets into med school in the first place. Grade grubbers, as far as the eye can see. They whined, cajoled, and threatened their way to a 4.0 and see no reason why they can’t just continue on this way. It works for the same reasons it worked before, administrators want tuition fees coming in and professors don’t want bad reviews to get them fired. There was one concrete hurdle to this plan, the national medical boards. They come in three steps, and step one was used by residency programs to see if applicants actually had learned what they were supposed to. Needless to say this hurdle has been steadily undermined. First, people get their hard whined for testing accomodations carried over from their undergrad. So yes, there are people who are literal doctors who got extra time on the boards. Next, they managed to get the first step turned into pass/fail. The argument for this included saying people shouldn’t be judged by just one test score but for their “community service” or “advocacy”, they need to look at the “whole candidate”. It starts next year so that’s something to look forward too.

    So what happens when the inevitable occurs and a patient dies because it was just too hard to make sure you were entering orders in for john peterson instead of peter johnson? They become the “second victim”. You see there is more than one victim from a medical error. There is the poor schlub who died, but whatever he’s dead now, who you really need to focus on is the second victim, the provider who committed the error, wait committed is too judgmental, who was “involved” in the error. You see it was just an event that happened, no one could have predicted it, no one could have stopped it, it just happened. Seriously, just google “second victim” it is as ridiculous as anyone would expect.

    1. Severian Post author

      I watched my buddy go through all his boards, including psych boards. I have vowed to never get sick, or die trying.

      (I had a chance to become a “standardized patient” back in grad school. I didn’t think I had the time, but I should have made the time. It would have been very instructive. Do they still do those?)

      (In case you’re unaware, they used to make med students do clinical evaluations on actors, basically. It’s a real person, but the “standardized patient” can only answer certain questions, in a very specific way. The student has to figure out the right way to get the right info to make the correct diagnosis).

      1. Some Guy

        Yeah, they still use standardized patients. They even turned it into a part of the boards, initially it was so foreign grads could prove they were able to speak english but they quickly made it mandatory. The boards are a huge money making scheme, they can charge what they want and you literally have no other choice than to pay. Not to mention that since board scores matter so much there is a huge test prep industry. Being a standardized patient must be unsettling, a lot of medical students have never held a job or done any significant activity that wasn’t meant to pad an application. I remember when my class was going to do their first patient encounter almost half the time in the class the day before was spent on people asking questions regarding shaking hands. They had no idea about even basic etiquette. My gripe with the system is that medicine isn’t an academic pursuit, it is a trade and should be taught as such. People start off pushing stretchers and emptying garbage in high school and work their way up so by the time they are a docotr they know how the whole place works.

  4. Joseph Moore

    Something I’ve written about at length: to the conventionally educated, a doctor is a scientist – he’s got lab coat, after all. If a doctor were also a scientist would be a mere coincidence: nothing about medical training makes one a scientist. (Hell, it’s doubtful advanced training in even hard sciences is intended to produce any more than a capable technicians.)

    Thus, the over-certainty with which doctors pronounce is taken as part of the Science stuff the conventionally educated so effingly love. Doctors, trained to follow checklists and protocols, don’t want to deal with all the questions which would show up if they spoke to their patients with the amount of uncertainty that’s really there. So they all (almost) speak with unwarranted authority, to cut off argument.

    Some of them then go on to work for the government.

    To dispute the pronouncements of the CDC or WHO is thus heresy! SCIENCE has spoken.

    Some Guy – right, it’s a craft. High end-vo-tech, like law or business school (although more thorough, one desperately hopes). Teaching used to be that way, taught as a craft – when Catholics imported thousands of teaching sisters for their parish schools, the ‘educators’ went nuts: the ladies just apprenticed, instead of getting processed and certified by state-approved normal schools! Even college professors used to get jobs based more on the impression they made than the degrees they got: Mortimore Adler I don’t think ever got a degree, but taught college, because it was evident on inspection that he was a freaking genius.

  5. ganderson

    I’ve long argued, to no avail, that teacher training should be 100% apprenticeship based. And… those nuns knew their shit, it was a good way ( not that it was planned that way) to deal with the issue of childless women. Now they become cat ladies.

    1. Severian Post author

      There is a *small* body of education “theory” that I found useful. You would pick it up in practice during the apprenticeship, but nice to have before.

      For college instructors, at least, a better body of theory would be in rhetorical techniques. You can convey a lot more information by telling stories effectively, as it holds the attention of a large lecture hall.

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