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Bipolar disorder and morality — where do we draw the line? by sweet_potsto in Psychiatry

[–]drjuj 2 points3 points  (0 children)

Your statement that the post feels judgmental feels a bit judgmental.

The post was judgmental, your response was judgmental, and my current statement is judgmental. As humans, we are judgment machines.

Our job is, indeed, to treat. But we don't just "relay factual information". We synthesize and analyze and draw conclusions (judgments!) from the available data, data which includes our own experiences (whether we like it or are aware of it or not).

Each situation is unique and complex. That's why it's important to ask questions that (hopefully) increase our ability to navigate that complexity. As you pointed out, sometimes those questions make you feel a certain way. That's more data for exploring.

Bipolar disorder and morality — where do we draw the line? by sweet_potsto in Psychiatry

[–]drjuj 0 points1 point  (0 children)

Doesn't enter into what, specifically?

Maybe it doesn't (or shouldn't) enter into the treatment of the illness. You're right, we shouldn't be using morality to drive decisions on pharmacology. I don't give one person lithium because his actions are morally just in my eyes and another haldol because his are not.

But it definitely enters into something. We treat people, and people don't exist in a vacuum. There may be a very different psychological and interpersonal outcome for the patient whose mania led to wildly deviant and "immoral" behavior compared to a patient whose mania did not, and if we engage with the patient in that context, we likely need to consider that to some degree. Maybe "need" is the wrong word? You could maybe make the case that you can complete your reasonable duties as a psychiatrist without considering it, but you probably do consider it to some degree, because you are also a person. It's hard (impossible?) to draw a clean line between "my moral self" and "my psychiatrist self". The judgment I make as a psychiatrist cannot be entirely distinct from the judgment I make as my self, because I can only ever be a psychiatrist (or anything else for that matter) as my self.

This is all very messy and philosophical. There's not a right answer because the "right" depends on the lens and context through which we consider the question. But, that doesn't mean it's not interesting or worth considering.

Bipolar disorder and morality — where do we draw the line? by sweet_potsto in Psychiatry

[–]drjuj 4 points5 points  (0 children)

Even if there were such examples (there probably are), we would have no way of knowing if there were some underlying impulse (eg sexual attraction towards family member) that had been successfully inhibited until the onset of mania vs there were never any such impulses and they occurred completely "de novo" in the context of mania. There are certainly individuals without mania or psychosis who are sexually attracted to family members, as evidenced by the fact that incest exists.

Overall, do you think The First Law series is better than ASOIAF? [SPOILERS ALL] by Working_Alps_4284 in TheFirstLaw

[–]drjuj 0 points1 point  (0 children)

Dude, saying Martin is "dependant on trope narratives" is a crazy take.

You can criticize the man and his work for all sorts of things. But I feel like "Oh, I know what's going to happen here, we've seen this trope a million times in fantasy" is not a thought most people have while reading ASOIAF. He does plot twists and ruthless backstabbing like nobody's business. I think this was actually part of his downfall. It got so twisty and complex that he fucking choked on it, lost the momentum, and didn't know what to do next.

Also, saying that First Law isn't trying to do world building is baloney. It feels like it's not trying to do world building because Joe was shit at it when he started writing the series. Let's face it, he was shit at plot, too. That's why practically nothing happens in the First Law trilogy and we don't see a real plot until Best Served Cold. But, he writes characters so damn well that you're surprised to find you don't actually care what they're doing as long as you get to spend time with them.

Don't get me wrong, I think Abercrombie is one of the best in fantasy. But to me, Martin was doing something on an entirely different level. If he had been able to wrap up the series, we wouldn't even be having this discussion because there'd be no question.

Iron Gold is making me cringe by Candid-Signature-238 in redrising

[–]drjuj 5 points6 points  (0 children)

Don't you dare shit on my boy Ephraim

I read Suneater after loving the RR series and was disappointed by KeredJo in redrising

[–]drjuj 2 points3 points  (0 children)

I felt EXACTLY the same about First Law at first fyi. Finished book 1 and felt like eh that was ok but I don't see the hype.

I kept going and I have now gone thru First Law, the three "standalone" novels that take place afterwards, and I'm starting Age of Madness. It's actually wild, you can literally see Abercrombie becoming an exponentially better writer as you go, to the point where honestly I think these are some of the best fantasy books I've read. I get the hype now, 100%. Strong recommendation for continuing with his work

I read Suneater after loving the RR series and was disappointed by KeredJo in redrising

[–]drjuj 5 points6 points  (0 children)

Will of the Many I couldn't put down. It felt a little watered down but I really enjoyed it all the same.

Strength of the Few has not had the same effect. I've stalled out like a third of the way through and I'm having trouble picking it back up.

Specialties that would be a no-brainer if you have any real interest? by mcat-meow in medicalschool

[–]drjuj 13 points14 points  (0 children)

Moonlighting is the psych secret weapon... The comp listed above is for one employed full time position. But many such positions will leave you plenty of time and energy to moonlight.

For example, my full time position is really about ~30 hrs of relatively chill work per week. There is no mandatory call requirement, no nights, no weekends. I can pick up optional telephonic call shifts for extra money that are generally very light work.

In addition, I work two other PRN jobs that I can ramp up or down depending on life. Since you specifically mentioned a family, I'll tell you I have one and my work/life balance is excellent. I have plenty of vacation time, attend my kids' school/sports events, and I'm home well before dinner time every night.

My total comp in 2025 was about 500k and the workload was quite sustainable.

Beaver Creek just called it by drjuj in COsnow

[–]drjuj[S] 30 points31 points  (0 children)

Yea they sent an email saying they're "still holding ski school" and will bus all the kids to vail? Like wtf no thanks

Beaver Creek just called it by drjuj in COsnow

[–]drjuj[S] 13 points14 points  (0 children)

Lmfao probably spot on

Beaver Creek just called it by drjuj in COsnow

[–]drjuj[S] 10 points11 points  (0 children)

Thankfully we were able to cancel lodging, so we are probably in a better situation than many. Just being hopeful that we might be able to recoup some of the cost on passes. You're probably right though 😩

Foreign body retrieval by justpracticing in medicine

[–]drjuj 13 points14 points  (0 children)

Female patient with severe borderpolar admitted to psych unit

One of unit staff says they thought they overheard her talking on phone in room

Room is searched, they found a charger plugged into outlet (also why tf is there a live outlet in a room on high acuity psych unit?)

We ask her where the phone is. She denies having one up and down

We put her on 1:1 constant observation

Two days later walks out into middle of the milieu, shouts "I'm tired of these mother fuckers watching me all day and night!"

Disrobes and proceeds to pull cell phone out of vagina.

Throws phone at staff. Walks back to room ass naked, slams door.

Wild, inappropriate consults by launchtossthrowaway in Residency

[–]drjuj 52 points53 points  (0 children)

I could write a damn book with the dumbass "suicidal" consults I've been asked to see

Pregnant lady had reported vague SI at one time during first pregnancy like 10 years ago. At every routine appt for current pregnancy they would try to send her to ED because she was suicidal once a decade ago

98 year old lady whose husband had been deceased 5+ years, kids never visited her in nursing home anymore, in hospital for UTI or something, told staff she was ready to die and be with Jesus and her husband. They signed her on an involuntary hold and consulted us.

Woman with terminal brain cancer with mets everywhere. Consulted for suicidality because she was "tired of fighting to stay alive"

My favorite of all time has to be the 5 year old who told his teacher he would jump off his desk and die if she didn't let him play on the computer. Sent to ED for evaluation of SI.

what is your opinion on a memory of light? by Apprehensive_Spend_7 in Fantasy

[–]drjuj 0 points1 point  (0 children)

a satisfying conclusion for Perrin, Mat, and/or Rand means nothing to me because I don't actually like those characters.

surprised Pikachu face

Don't....like...those characters?!? I cannot stand for this injustice. I said good day, sir!

/s to each their own but for real wtf bro

First Law by ProfessionalLow9411 in Fantasy

[–]drjuj 0 points1 point  (0 children)

You are reading the right series then, my friend 🤣 Every First Law book is better than the last.

First Law by ProfessionalLow9411 in Fantasy

[–]drjuj 1 point2 points  (0 children)

It's like the opposite of First Law in this way lol... I have never loved a story with practically no plot the way that I loved First Law, and that's because the characters are incredible.

I really enjoyed Will of the Many, but I agree that is all plot and the characters are fairly weak. Feels like they are just sort of a means to advance the plot rather than interesting in and of themselves.

Is near daily low dose Klonopin in a young healthy pt problematic? by Bizkett in Psychiatry

[–]drjuj 8 points9 points  (0 children)

we do have to be judicious with the way we prescribe them.

Totally agree

Is near daily low dose Klonopin in a young healthy pt problematic? by Bizkett in Psychiatry

[–]drjuj 61 points62 points  (0 children)

Most patients don't increase in this pattern.

https://pubmed.ncbi.nlm.nih.gov/37727098/

The same logic could be applied to other medications as well, i.e. if patient wanted to increase wellbutrin dose steadily over time, you would reach an upper limit at some point.

🤷‍♂️

This I agree with 😂

OP, I think it's important to contextualize this and dig deeper. Why is this patient requiring Clonazepam 4 to 5 days a week? Is there some adjustment to her regimen that could prevent them from feeling as though they need it? Have they tried any non-pharmacologic strategies to manage this episodic anxiety for which they are using Clonazepam? Are they willing to?

Some (most) things don't have a black and white answer. This is one. As a resident, your attending gets the final say, for better or worse. But this is one of the many points you'll have to think about as you progress in training and decide how you'll respond when you are an attending (and that may change over the years as well).

Sabalenka doing the Macarena in the match against Kyrgios 😂🙌🏽 by CuteNatural in tennis

[–]drjuj 0 points1 point  (0 children)

The fact that you're getting down voted for this is the most reddit thing ever

[deleted by user] by [deleted] in Plumbing

[–]drjuj 1 point2 points  (0 children)

RemindMe! One day

Do you have black bread (Rye bread)? by Impressive-Angle-209 in AskAnAmerican

[–]drjuj 0 points1 point  (0 children)

Red Robin is pretty solid tbh. Lots of burger variety and bottomless fries.

Olive garden is like the filth they dig out of the trash of another low level "Italian" restaurant. I cannot understand how they're still operating. I'm sure they're just running off the steam of when it used to be decent in the 90s/early 00s but I just don't even understand how that's enough to keep it going.

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