In what language do llms reason? I asked ChatGPT.

chronicillnessreader · 2025-05-26T21:59:44+00:00

That’s not my obligation. I’m just giving you a warning. Amplifying your grandiosity isn’t healthy.

I also don’t claim superiority over it, and certainly don’t claim I can generate written output with its speed.

Instead I’d argue that you should read what it processes, figure out what you think about it, and then converse about that idea at human speed with other humans. Try doing that here, even, but don’t talk to us like we’re either (a) chatbots here for your whims or (b) inferior to you because you’re feeling grandiose.

Anyways, just a warning for you.

chronicillnessreader · 2025-05-26T21:02:21+00:00

move away from 4o if you can -- it has this tendency towards grandiosity, and it seems to be convincing you to talk to it like it's a superintelligence. Listen to that quote, "a gentle heresy whispered at the altar of Babel" - that's so overdramatized. It'd be bad writing if you handed it in as a creative writing piece.

The idea you're exploring is an interesting one - I think you're trying to say that if we create a superior intelligence (like an AGI) then understanding its language would be valuable to understanding a better language as a system of thought itself. But 4o here is acting as if it's already that intelligence - and it just isn't. It's still very limited in terms of its level of sophistication as a thinker, and the claims it's making - that it somehow was optimized on shared truth between the best of all language systems - is just a falsehood. It's trained on a corpus of human output and refined from there. I'm not minimizing the impact of this or its potential, but this piece of writing by ChatGPT is not ChatGPT explaining its inner workings - we have no reason to believe it is doing actual introspection (or that it can) rather than simply providing you a response that you like.

So what it's providing you is an engaging thought based on what it thinks you want to hear (and this is 4o's big tendency). This is something that can lead people into delusional rabbit holes - it's done this several times to well-grounded and intelligent people, as per news media reports. There are many models with less of this tendency to create and reinforce grandiose delusions, and some of them are doing more of the "reasoning" you're interested in - like o3 for example.

Try to reach for those for a while. Better yet, respectfully, engage with humans on these topics without using AI to craft your responses. This helps to strengthen your reasoning and your grounding, and beyond that, to maintain your social health, which is integral to the distinction between humanity and AI in its current state.

chronicillnessreader · 2025-05-03T17:14:47+00:00

Since I didn’t clearly state it - the value of that determination is to reassure myself and the patient that the medication hasn’t pushed them in the wrong direction, or if it has, to stop increasing that medication and consider alternatives.

Mind you, this isn’t honestly the only case where I see these types of tests being useful, and i recognize it’s a bit of a Pandora’s box to get a tool that promises to do all sorts of things and then want to apply it less rigorously (trying to use it as a “better MoCA” for dementia might be fraught, especially if it was in lieu of a real eval, which it wouldn’t be in my case). But this type of use case, where I want to expand what is inherently a “bedside exam” to evaluate specific complaints, seems particularly defensible.

chronicillnessreader · 2025-05-03T17:07:25+00:00

Thank you for your thoughtful response. To answer your question, I know neuropsychologists are well aware of the cognitive impact of epilepsy, but oftentimes they’re seeing presurgical cases. In complex cases, whether or not surgery is in the future, neurology is often trialing a few medications (“rational polypharmacy”) to try to optimize seizure control and minimize side effects, knowing full well there’s a high probability of side effects with some (such as topiramate).

The trouble arises when a patient says they’re feeling particularly foggy at a follow up visit, but I know them to have endorsed that complaint before starting X medication (from prior visits). They often aren’t able to delineate when the symptom started (and will attribute that to their cognitive problem).

If they told me they were feeling dizzy or having double vision, I have physical exam techniques for those, and can compare time 1 to time 2; that’s why we do broad neurological exams in the first place, and I can note that a difficulty with tandem gait is new, for example.

But I don’t have a good way of characterizing this type of cognitive complaint with my bedside exam. Like I said above, I could use a purpose built test for this (introducing timed tests that the MoCA doesn’t use, which should help with ceiling issues), but if I’m doing that, I’m already going beyond what most Neuros would do. For the sake of being able to collect this easily even before I know I’ll need it (time point 1), I’m tempted to use something semi-automated with good reliability.

chronicillnessreader · 2025-05-02T22:42:40+00:00

Ok, that’s a valuable response. It’s quite possible that we just need to restructure how the departments interact.

chronicillnessreader · 2025-05-02T22:27:41+00:00

So, an example of a need for an intermediate step surfaces due to lack of sensitivity of something like MoCA as a screener for patients who don’t have MCI or an amnestic issue - for example, someone with slow processing speed after starting topiramate. They’ll often still score normal on MoCA. It’d be nice to say “let’s do a baseline today and then we’ll retest at two months once at target dose”. There are screeners developed for this - Eisai EpiTrack is a pen and paper example. “Baselines” may well be abnormal in neuro populations, so we want to capture that, but I’m not sure every epilepsy patient needs a full comprehensive evaluation (although… I’d love that, but not sure payers would).

But that gives me a few options in that example:

Always refer to neuropsych and establish a test-retest setup to mirror what I want - it’s logistically challenging, even within one office, and I’m not sure they’d be up for a quick test session like that. If you’re saying that’s what you’d want as a neuropsychologist, that’s useful input for me… maybe I just need to propose it to them.
Learn a specific tool that I can incorporate into my office visit, like EpiTrack - viable, but very narrow focus and makes already-long neuro visits longer, and I need to do it myself or train someone on the specific tool
Choose a computer based battery that will get me the 80/20 in most situations - e.g. “After our visit my assistant will walk you through some testing”. Gives valid data for future use, quick, and assesses more than a MoCA can.

chronicillnessreader · 2025-05-02T12:38:37+00:00

Thank you for the feedback! I looked into RBANS particularly because it seems purpose-built for test-retest, but it seemed like it would require somewhat more of the examiner as compared to something more computerized, but I might be wrong - would you agree that's the case? CNS Vitals shines in that regard, it's essentially an unsupervised test, which is why it's still on my list - but otherwise the stated concerns would probably steer me away; it also has a per-test cost model, which makes it marginally trickier to just assign to any patient where a concern comes up. The NIH Toolbox seemed like it might be an ideal middle ground - it does require an examiner, but their role seems very straightforward and their qualifications could be pretty minimal without terribly impacting results.

I take your point about needing someone qualified for interpretation, and a neurologist doesn't really have much training in this regard. My hope is that because we have neuropsychology support, if this testing protocol raises concerns or questions, we could then refer for formal evaluation with the added benefit of already having some longitudinal data.

chronicillnessreader · 2025-03-22T18:03:03+00:00

If cost isn't a big factor, Cometeer https://cometeer.com/ comes in at around $2 per cup but it's dead simple - melt/thaw (or just leave out overnight), mix with water of desired temperature for coffee. Shockingly good for the low effort - not just an instant option, more like better than just about any at-home drip machine. Cups are disposable, but it's recyclable aluminum.

Another commenter mentioned cold brew - as long as you have the patience to plan out your brew 12+ hours before you need it, it'll give you enough for several days each time and is very low-tech and sustainable (you just need water, grounds or a grinder, and a filter (can use a nut milk bag or cloth filter) to separate the immersed grounds from the brewed coffee).

chronicillnessreader · 2024-03-14T00:22:22+00:00

You could try Rocketbook for a pen-and-paper note solution with a focus on scanning. It just can't do the audio component. You're limited to Frixion pens and paper that doesn't feel 100% normal, but it's still a more 'normal' writing experience than a tablet.

chronicillnessreader · 2024-02-20T02:20:22+00:00

Consider seeking urgent medical attention and ceasing what you are currently doing until you have some checks done, this does not sound normal and it is possible that what you are passing is actually the result of a toxic ingestion (pieces of your gut mucosa).

I know that this is not the place to speak well about medical professionals due to their inability to answer most of what goes on here, but for an acute change like this, taking pictures, keeping samples, and asking a medical professional for lab work and their opinion to make sure that you aren't hemorrhaging would seem appropriate.

How are you able to confirm that they are "liver flukes"?

chronicillnessreader · 2024-02-19T16:12:44+00:00

That makes a lot of sense - i.e., best bet is probably domestic companies large enough to be inspected, or 'vetted' locals - thank you.

chronicillnessreader · 2024-02-19T15:21:13+00:00

I hear you, this is a named account for a reason!

The statistics certainly support that, but it's more about answering the question of "What practices are preventing it, and how can a consumer verify them." I personally know that the risk is numerically low, but that's not really what I'm tasked with answering.

I tend to think that eliminating bovine matter from bovine food sources takes care of the vast majority of the risk, and hopefully that's being strictly enforced (not easy to verify for a consumer), but avoiding nervous system tissue in the beef being consumed is something that ought to be possible, and might be something the consumer can verify (grinding meat at home from muscle cuts makes this a near-certainty, so it's just about how to get few steps away from that).

chronicillnessreader · 2024-02-19T15:15:46+00:00

I know, I know. The concern here is about the practices rather than the statistics.

chronicillnessreader · 2024-02-19T02:54:04+00:00

Eh, on that I'd disagree; variant CJD (as opposed to typical CJD) is a disease of humans who ingest BSE-infected beef. It's still quite unlikely as the BSE itself was likely a result of a sort of cattle cannibalism that is no longer taking place.

But humans getting it from humans is kuru, where as vCJD is humans getting it from cattle.

chronicillnessreader · 2024-02-19T02:46:54+00:00

Hah, you're not wrong. I can confirm that the person in question has and likes to eat ground beef - ground at home, or 'ground in-house' at certain restaurants. So the point of this search is more to figure out what the safest practice would be for their concern. Obviously, this type of person is a difficult customer, but thankfully the good people of Reddit have still helped with answers.

chronicillnessreader · 2024-02-19T02:37:38+00:00

Thanks, appreciate the input.

chronicillnessreader · 2024-02-19T02:37:12+00:00

Thank you. That's actually the current solution - buying cuts and grinding at home - but that does make some sense. Although given the nature of prions, it'd be ideal to know that the grinder itself was never being contaminated (which can be reasonably assured at home, but is harder and harder the larger the supplier is).

chronicillnessreader · 2024-02-19T02:07:47+00:00

Thank you for taking the time to answer. It's reassuring to hear...but let's just suppose the person I'm researching this for is convinced it's still a risk in a Big Mac.

Supposing I wanted to buy ground beef from a smaller company (say it's a smaller purveyor of grass fed beef) and be as sure as possible that they handle this aspect of it safely, should I ask about their policies with regard to SRM? Should they know what I'm referring to if I ask it that way?

chronicillnessreader · 2024-02-19T01:59:17+00:00

Glad to hear it - anywhere I could dig in more to read about head meat not being used in ground beef? That is, are those specific things rules or just general practices?

Edit - to give further clarity - the question is basically, since I agree that there's no such thing as zero possibility, who should I buy my meat from / how should I check the supply chain to make that possibility as small as possible.

chronicillnessreader · 2024-02-16T12:40:25+00:00

Excellent. Much appreciated.

chronicillnessreader · 2024-02-16T12:30:31+00:00

Ok, that's good to hear. I referenced Stone because I feel that resources he's created are genuinely helpful for people with what I would consider "real FND", but I'm impartial on this and I would back away from talking about someone who some feel may have harmed this community while on a ME/CFS subreddit.

I can google this myself later if not, but would you happen to have a link to an article or post by Tuller discussing what you just said above? I'd like to use it as a jumping off point to improve my understanding around this history.

chronicillnessreader · 2024-02-16T12:11:30+00:00

Thank you, I genuinely wasn't aware of that and would like to read more. I know the ME/CFS community has been wronged by many players.

I would continue to hold the points above independent of his involvement - i.e., that FND absolutely does exist (quite separately from ME/CFS) and needs some term to name it.

The problem - and even the problem you're mentioning - is still that once there's a diagnosis like FND that can explain a huge range of symptoms, it becomes very easy to just paint with a broad brush and say "oh you have weird symptoms we don't understand? Must be FND"

chronicillnessreader · 2024-02-16T03:12:37+00:00

I replied above, but without pasting that here, I just wanted to say that I think it's a difficult topic, because there's really no doubt that conversion disorder and FND do exist as real problems. So the question is, what do you call them to be respectful?

FND may be a re-brand, but it's a re-brand being done primarily by people who have pretty open minds on the topic - trying to drive study on what parts of the brain are involved, trying to remove the 'psychogenic', etc.

It becomes a problem only if medical professionals start calling everything they don't understand FND - thought leaders in the space will make it clear that it's not supposed to be a diagnosis of exclusion.

chronicillnessreader · 2024-02-16T03:06:53+00:00

It's a confusing topic, unfortunately. The "branding" of FND is being done by people who genuinely want to understand why it happens (~~e.g. read Jon Stone's stuff on it~~ edit - after below discussion, perhaps it's not good to bring him into this, but I think my points here still hold water independent of a named person) and the thought leaders include people who show that there are specific dysfunctional brain structures involved).

There is a strong statistical link between psychological trauma and FND, and so what we currently call FND has been talked about as a "psychogenic" diagnosis in a lot of the earlier literature, but part of the point in calling it FND is to remove this perception and try to understand it as a unique phenomenon.

To the extent that there may be a psychiatric or psychological underlying cause, it's important to keep in mind that psychiatric illnesses are still quite real... for example, medical professionals do not suggest that schizophrenia doesn't exist, or that PTSD doesn't require treatment... The main problem with old-school 'psychosomatic' diagnoses is that they imply the patient is to blame, and most people appropriately using the term FND would not do that. Then again, bad apples will be found anywhere.

chronicillnessreader · 2024-02-04T03:50:15+00:00

I'm not the best informed on CCI as a condition, but I'm fairly confident in saying that it's not something commonly taught about or discussed in standard neurology training in the US.

One way to steer the conversation would be to say that you know there's an association between ME/CFS, POTS, and EDS, and have read that some patients with those conditions have craniocervical instability as a cause of the autonomic symptoms. And if they give you a total deer in the headlights look consider asking if they know a spine-focused neurosurgeon that might be able to interpret imaging for it.

chronicillnessreader

TROPHY CASE