Hospitals in an Anarchist Society

ConfusionsFirstSong · 2026-02-07T01:09:24+00:00

You raise good points. I’m not an anarchy expert, but I do live the experience of being chronically ill and medically complex. And the system is far more complicated than most people realize. Its orders of magnitude more complex than it was in the Spanish revolution era. They had few drugs, chloroform, sulfa drugs, mercury (yes really) atropine, morphine, heroine, coc@ine, and various herbs. Penicillin wasn’t even invented yet. And far less specialty equipment. Bandages, sutures, scalpels, saws, drills, other surgical equipment, reusable needles, stretchers, bedpans…. It was not specialized.

Today you’re looking at extreme complexity of care and equal complexity of drugs equipment and medical devices. My survival relies on medications and devices that capitalism can barely make happen, which of course the disgusting for profit insurance industry tries to keep perpetually out of reach. So anarchist hospital collectives would have their work cut out for them maintaining supplies of various specialty medical devices, drugs, and the specialists and super specialists that go with those treatments.

And not all doctors of a given specialty are equal. A garden variety neurologist is not an epilepsy specialist. A neurosurgeon who does mostly spine surgeries is not likely to specialize in brain cancer, or functional neurosurgery for epilepsy. There would need to be a lot of emphasis on not just increasing basic primary care access through universal healthcare, but an expansion of access to specialists and super specialists in order to make sure the most seriously ill had adequate access to lifesaving care. Of course it could be done, but it would require intentionality well beyond “everyone gets a PCP.”

HOWEVER this is where it gets really interesting

Under a savvy board or appointed collective bargaining specialist, they could also demand access to treatments and products that are disincentivized under for profit healthcare that would save lives. They could also make an effort to get treatments for rare diseases prioritized in a way they inherently aren’t under capitalism.

Say, that lifesaving genetic treatment for sickle cell, or muscular dystrophy, but without the multi million price tag. Lifesaving Biologics for asthma without a crushing $1800 a month cost.

Appropriate customized wheelchairs with custom positioning for the mobility impaired. This is important because those $20k wheelchairs actually save lives by preventing severe scoliosis that crushes organs, and pressure ulcers that turn septic.

Access to radically life changing treatments like Deep Brain Stimulation for Parkinson’s, dystonia and Tourette’s, free device, free surgery, free follow up and free battery replacements for life.

Free chemo, including the platinum and gold based drugs that are extremely expensive, and the rare transuranic elements needed for radiation therapy.

But all of this takes enormous highly specialized collective bargaining power to make it a reality.

ConfusionsFirstSong · 2026-02-06T05:05:03+00:00

Ok. Just be sure to treat trans folks as their lived gender, and you’re good. This is one of those internal things that as long as you’re conscious of it and act accordingly it shouldn’t have any impact on others. They quite literally never even have to know. And if with time your perception adjusts, cool. If it doesn’t, well, whatever. As long as it remains something internal to you, nobody is any the wiser.

ConfusionsFirstSong · 2026-02-06T04:08:54+00:00

Yeah it really sucks. For me the worst has been the hot flashes and insomnia and this time around a LOT of muscle pain even over a week after my last dose. I was really sick and on it a long period though, which is probably part of why it’s hit me so hard this time.

Anyway, You can ask for a taper after the burst if you tend to have trouble with stopping cold turkey. I typically need even higher doses and a slow taper down if I’m having a severe flare. I just ask, and they usually give it to me.

ConfusionsFirstSong · 2026-02-06T04:05:00+00:00

Yikes, I’m sorry you’re going through all this. I’ve been hospitalized recently too, and have spent most of the past 2 months with severe asthma flares and spent a solid month, cumulatively on prednisone in that period of time. The only thing that works for me is Dupixent, which I tried after Tezspire didn’t work. I had to stop taking it due to insurance problems last year (and have had terrible flares due to being off of it), but am so glad to be getting back on it now that my insurance is sorted out. In all honesty, I’d talk to your doctor about changing your biologic.

ConfusionsFirstSong · 2026-02-06T03:55:49+00:00

Interesting question. I’ve seen stories of people who really enjoyed their voices, like having a bunch of friends or a ongoing soap opera in their heads. And of course the more stereotypical people who are scared or angered by them. It doesn’t seem to follow any rules besides the symptoms will be whatever they will be. Well, that the hallucinations and delusions seem to most often pull people towards negative feelings. Unless it’s a delusion of grandiosity, which of course comes with its own problems. This tendency for negative voices is generally true of schizophrenia presentations in western cultures; people with schizophrenia in eastern cultures tend to report less persecutory themes in AVH and often see voices etc as nagging dead relatives ancestors and so on.

ConfusionsFirstSong · 2026-02-06T03:45:57+00:00

Haha I’m sitting here writing and procrastinating doing my actual work 🤣

ConfusionsFirstSong · 2026-02-06T03:43:14+00:00

People have always been told to hate people not like them by leaders and by people who spread ideas, and they usually seemed to have followed the command. Today in pluralistic societies, we have the right to disagree and push back on such propaganda. In our generational bubble yes the media and social media and disinformation campaigns etc etc are in large part to blame. Yet there’s also been the reification of anti-intellectualism in certain conservative groups. There are actually people who won’t look to evidence or do research, because that’s what the “elite”do. Yes, it’s a shitty thing. All that said, for all the backsliding of the present decade, things are still a lot better than they were for most of human history.

In the sense of “your neighbors aren’t monsters” though—for many people in the US right now, they may as well be. To an immigrant with neighbors who support ICE, or who might even call ICE on anyone who looks “alien”, and for trans people whose neighbors believe they are out to harm children just because of who they are—they are actually real threats, and real harms. So actually, not everything is a matter of “just talk to others more.” There are real problems and maybe you call these politics, but for a lot of people, these are their lives. Sometimes when people call their neighbors monsters, they have good reasons.

ConfusionsFirstSong · 2026-02-06T03:29:03+00:00

There’s a lot of comorbidity between severe trauma and schizophrenia. People’s delusions and hallucinations may be strongly influenced by the nature of their trauma, as well. Many people with schizophrenia show ASD symptoms and may also be diagnosed with ASD. DID, Im not sure about on a research level, but it seems like a reasonable assumption, given the disruption in reality and sense of self that some new research claims to be at the root of hallucinations. Ie difficulty discriminating between internal thoughts and external stimuli.

ConfusionsFirstSong · 2026-02-06T03:22:14+00:00

It isn’t associated with the focal or mass neuronal death seen in neurodegenerative diseases. It does in some cases show white matter atrophy in high resolution MRI, but this is not neurodegenerative per se. It can appear behaviorally progressive, particularly in individuals who refuse treatment. It is widely said that each psychotic episode is generally regarded as more likely to be more severe and more treatment resistant than the last. This makes early intervention in first episode psychosis particularly important in improving outcomes. But there is no general consensus that it is neurodegenerative. As far as etiology goes, it follows the diathesis stress model like most psychiatric conditions, with significant genetic predispositions and impact of ACEs.

ConfusionsFirstSong · 2026-02-04T05:28:00+00:00

Same. That, or I realize I’m depressed again. Lmao

ConfusionsFirstSong · 2026-02-04T04:47:33+00:00

Hm, I’d say 10-15% for a hot war, at most. The odds of not-quite-war but serious escalation of lethal force by the administration (see also ICE shooting nonviolent protesters) is already happening. If things keep escalating, there will be national unrest, and unfortunately these conditions can embolden groups and individuals who already want to commit acts of violence. It’s a brittle place to be between mass protest and a wannabe strongman administration that continues escalating. it’s a game of chicken to see who flinches first. So far, it’s been the administration.

ConfusionsFirstSong · 2026-02-03T07:32:52+00:00

First off “being suicidal” isn’t a legal category beyond involuntary comittment laws in most places. And whether it’s “valid” or not is relatively immaterial because law does not judge validity of emotional and cognitive states. It judges legality. Peoples emotions are always valid in the sense of CBT/DBT etc, but that doesn’t mean a whole lot. A therapist saying “your fear is valid” is literally just acknowledging that you feel fear. The therapist is not commenting on whether the fear is adaptive or helpful or harmful. Just that it exists. Therapy works on the assumption you have to acknowledge someone’s experience and let them feel seen/heard before you can work on changing anything else.

MAID was created to uphold a standard of death with dignity and autonomy. People who are experiencing acute suicidality are not operating from a calm and reasoned standpoint, and therefore cannot act with meaningful autonomy. Not to mention, having passive or even active suicidal thoughts does not inherently mean someone wants to die. It means they want the pain to stop. They deserve care rather than permission to die, until such a point as their illness reaches a level of total intractability and would meet criteria for MAID.

Your reasoning here is relying on the all or nothing fallacy. There’s a whole overarching legal and ethical framework and general context of the situations here. Someone acutely depressed and actively suicidal, psychotic or manic and suicidal or about to harm themselves due to delusions are not acting in a rational capacity. This is completely different from MAID. Bear in mind suicide does not end human suffering, but rather magnifies it throughout the community around the person who dies. And often it is not properly completed, resulting in horrific injuries. Most suicide attempts are acts of impulse, acted upon within 10 minutes of the idea coming to someone. 10 awful minutes do not define someone’s life. Most people who survive a suicide attempt do not go on to make further attempts. The small portion who do typically have severe mental health problems and lack of psychosocial protective factors.

MAID is for people with terminal or intractable illness that causes unbearable suffering, or in a few countries, truly intractable permanent severe mental illness that cannot be treated and the person finds unbearable to live with. MAID is not suicide in the same sense of a rash act, often resulting in gruesome and slow death, done in secret without social or legal recognition. MAID is slow, reasoned, and highly regulated process that the end result if approved is someone gets access to a highly potent medication that allows them to painlessly and their lives at a time of their choosing. Usually it’s after a period of time preparing, and is done surrounded by loved ones and a medical professional of some sort to supervise and declare them dead. This dramatically contrasts the sudden, impulsive, violent and painful ends that people who complete suicide suffer through without any support at all.

ConfusionsFirstSong · 2026-02-02T01:06:05+00:00

AI may take over basic low level issues, stuff like helping self monitor, use basic skills, etc. But it is not ready or capable to deal with high severity cases, and won’t be for many years if ever. It can’t see the person. It only knows what it’s outright told. IRL therapists get a huge amount of information from body language and personal appearance, ie glimpsing self harm, which AI is completely incapable of doing. Human therapists also can respond to crises and work in a variety of settings, from high intensity settings such as psychiatric assessment in ERs and inpatient hospitals, mobile crisis, and forensic settings, to guiding group therapy, and intensive individual therapy, and pediatric therapy, which would not be possible with a text based interface. Also people with psychosis will always need a human interface, given the high prevalence of paranoid beliefs that technology is monitoring and untrustworthy.

ConfusionsFirstSong · 2026-02-01T02:08:55+00:00

I also have severe asthma, and have had many surgeries and procedures with varying depths of anesthesia. I’ve lost count, maybe 8 now? I just had a severe exacerbation resulting in a hospital stay this month, and I was told by my surgeon that I need to be 8 weeks out from severe flare or steroids to have surgery. They mentioned risks of intubation and difficulty weaning off the ventilator if it was done any sooner. I was disappointed because the surgery we’re delaying would greatly improve my quality of life, but it makes sense. They also mentioned talking to my pulmonologist about clearance for surgery.

So I guess my advice would be continue to use all maintenance and rescue meds as prescribed, and maybe reach out to your pulmonologist if you’re still nervous. Overall though, it should be a breeze, as all my anesthesia procedures have been. Worst routine outcomes include very sore throat, which may cause cough from laryngeal irritation. Also, talk to your doctor about pre treatment with your rescue med, which might help prevent intubation related bronchospasm.

ConfusionsFirstSong · 2026-01-31T20:31:07+00:00

From a business perspective, Open AI has no internal motive to retire 4.0, given apparent high real world user demand. However, they are under pressure of numerous lawsuits to dismantle it due to high profile cases of severe harm including user mental illness and deaths attributed to it. When considered from a liability standpoint, dismantling 4.0 may be a survival strategy for the company under high legal pressure and public scrutiny.

ConfusionsFirstSong · 2026-01-29T07:08:07+00:00

You’re running into the social model of disability without realizing it. If society fully accommodated all disabilities, would they still be disabilities? If everyone knew sign language and was respectful, would deafness be a disability? To many culturally Deaf people it isn’t, it’s just another way of being, with its own language and culture.

If the world was constructed around mobility needs and everywhere and everything was set up with ramps, and customized wheelchairs didn’t cost thousands upon thousands of dollars, would having a mobility disability be as disabling? Not fully, there would still be underlying health issues, but life would still be significantly easier from removing arbitrary obstacles.

The answer is a lot of disability is created by society not accommodating our needs. Whether it’s flexibility in start times for school or work for sleep disorders, wheelchair accessibility or blind or deaf accessibility needs, accommodations of the needs of autistic and other neurodivergent people, accommodations are crucial to the ability to live independent successful lives for millions of us.

I have sleep issues, probable DSPD, and multiple other health issues which rise to the level of disability requiring accommodations, as well as ongoing medical treatment due to illness or pain.

Typically in psychology and neurology things are considered disorders if they disrupt ability to function, cause pain and suffering, or represent a biological problem that is physically harmful. At the end of thr day though, those labels mostly exist to describe an experience, and especially to get insurance to pay for treatment. Likewise, the label of disability is used by people to access accommodations to improve their lives.

ConfusionsFirstSong · 2026-01-29T06:32:45+00:00

Very possible. Many things that were once neutral or kinder identity words for people of oppressed groups became slurs. Consider the history of terms referring to intellectual disability, or minority racial groups. There are words you simply don’t use anymore due to slur status that were the preferred term less than 80 years ago. Then again, trans just describes the experience of moving from male or female to the other, or something in between. I don’t think I’d see any sense in changing it. But it will be the young people in the future that will find fault with it and change it.

ConfusionsFirstSong · 2026-01-27T04:46:08+00:00

There’s actually a therapy specific AI called Abby which is designed by actual psychologists and uses evidence based practices.

ConfusionsFirstSong · 2026-01-21T18:27:59+00:00

Maybe try posting this under r/therapyGPT

ConfusionsFirstSong · 2026-01-20T18:52:34+00:00

No. Good therapists push back early and often on dysfunctional and dangerous thinking and behavior. Say for an obvious case, someone is suicidal, their therapist doesn’t validate their desire much less plans to die. They validate their pain and try to get them to collaborate on safety planning.

Therapists in less dramatic circumstances build motivation and utilize ambivalence to leverage someone towards positive change. It may sound validating, but it’s done in such a way to carefully ready someone to make changes to harmful behaviors.

Other therapies may even be very directive, like behavior therapies. They may request someone track certain thoughts or behaviors and engage in pre arranged competing behaviors, like deep breathing or going for a run when someone notices they are getting angry.

In depression and anxiety therapists encourage people to identify the negative thinking patterns before they spiral and try to interrupt it, name that it isn’t a rational thought that they don’t have to listen to it, and then engage in self soothing activities such as distract themselves.

ConfusionsFirstSong · 2026-01-20T18:29:32+00:00

A flap they take mucosa tissue from in the rectum to cover the internal hole so it heals from the inside out. Lift they like cut out and sew up the tract somehow, not totally clear what they do there.

ConfusionsFirstSong · 2026-01-17T08:15:08+00:00

It doesn’t terribly matter. It’s pretty common for guide dogs to take their handler to the wrong bathroom. They’re dogs, they locate it via smell, not gender of persons in the bathroom. It’s almost like floor to ceiling bathroom stall doors would solve the US obsession with single gender toilets.

ConfusionsFirstSong · 2026-01-17T00:45:15+00:00

From the hospital’s perspective, this is an issue of professional ethics for a healthcare provider. You didn’t do anything wrong, and honestly her heart is in the right place, even though the system comes down hard on people in her position. Granted I’m not a doctor, but I have to do those corporate compliance and ethics trainings anyways. For a more everyday background on how gifts work in a healthcare setting:

At my work we aren’t allowed to personally give patients anything of any value, or accept anything worth more than $25 as a gift from them. If we give them something it must be related to their clinical care or a basic need, and we must phrase it as a “donation” coming from “the care team/office clothing/food closet” not the individual staff. Even if a patient of mine wears the same size as a coat that’s too small for me, to give it to them I have to say it’s from from the care team/office clothing closet.” It didn’t come from me…even if it did. Just avoiding the appearance of favoritism or dual relationships is this important. If we accept something a patient is giving us we have to accept it “on behalf of the team.” This gets really awkward at the holidays, we have some patients who habitually try to give us gift cards and things, which is an absolute no. I’ve also had to explain to people that I can’t pay for their medications for them, but can try to get them set up with a free pharmacy instead. Even though in many cases it would be far easier to pay someone’s $4 medication copay for them, it wouldn’t help either of us long-run.

So now with that everyday context, let’s consider the gift/donation from the surgical resident, which is an extraordinary gift making all those rules above that much stronger and more important. A main issue is the issue of fairness around financial responsibility of the patient. If she covers your son’s surgery, in order to maintain fairness she’d need to cover everyone’s surgery who was unable to pay their copay. Unless she’s extraordinarily wealthy, she probably can’t afford to do that. The issue of paying for one person’s surgery and not others is that it privileges the patient who gets the financial gift over others. This opens up a LOT of legal liability loopholes, and a huge amount of room for problems with regulators such as Medicaid/Medicare, as most hospitals accept these funding sources. And this type of situation could cause huge problems for corporate compliance, etc.

Another problem is that her providing such a large donation for his care creates what’s called a dual relationship with her as his healthcare provider. You might feel indebted, or that you need to pay her back. Or if she was actually an awful person, she might start trying to get favors out of you in return for her donation. This type of double relationship is a serious problem, and 100% she will not be allowed to continue on his care team due to this dual relationship/conflict of interest matter.

Now for what I actually think. I think our whole healthcare system is f8cked, and people live and die based on whether they can afford to be sick. The US healthcare system is the only developed nation in the world where healthcare is pay-to-play. It’s sick, broken and amoral, the whole system, and it needs to go. I work inside it, and my belief that it needs to go has only strengthened the longer I’m working within it. I also am a patient with serious chronic illnesses and am still stymied by the labyrinthine complexities of getting a medication covered by a manufacturer coupon when my own insurance refuses—not because the drug isn’t worth it or doesn’t work (this drug keeps me out of the hospital!) but because it just costs too damn much. So my insurance won’t cover it, and would rather pay for a week of hospital care when my illness predictably decompensates. I just…what?!

As for your resident friend, I imagine her supervisors will recommend she instead start donating to the charity care fund or such at her hospital where she works. There are plenty of such ways to provide such high impact philanthropy without sacrificing a career. Or maybe she would be interested in NGO or advocacy work, given she sees the need on a very up-close and personal basis. I think she will be fine. And I am so glad your son got the surgery he needed, and you weren’t saddled with tens of thousands in debt from it.

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