neuroma

Not exactly. Only some are paid per session, as this is typically private medicine, which is not the normal in most of the world. Publicly funded medicine accounts for the great majority of work done, and these doctors around the World are paid the same regardless of their workload. USA has a very unusual system, internationally.

Also, only part of the job is autopilot, much of it is difficult and taxing. Experts will manage their attention and energy throughout busy days.

The point is that humans can and do work hard and at difficult tasks for long periods day after day. The cost is eventual burnout though, hence why so many doctors quit or go part time.

Can confirm many doctors work insane hours, which are hard to even imagine for people who do office jobs.

The notion that you can only do 4 hours of productive work a day is frankly a luxury. If you have 10 hours of work to do, all of which is essential for people's immediate wellbeing, you find ways of being productive.

Quality adjusted life years (QALYs) have been used in the UK for a long time, to evaluate whether and when treatments are offered through the NHS. It has its flaws, but its a good start. Generally a therapy needs to cost less than £30k per QALY. There are of course finessing processes to these decisions.

Lots of fascinating commentary; But I've not seen mention of these core concepts:

Social mobility Equality of opportunity Labour arbitrage

I suppose the first two are worth pursuing vigorously. The last is core to capitalism, and some other complex systems, like cells. But it can be abused and thr former two are indicators of whether society is healthy.

I'd gauge making a mistake which must later be debugged as negative productivity

Apologies for pedantry...

Vaccines reduce the severity of disease, sometimes to the point of no noticeable effect. They may reduce probability of transmission.

I forget the name but there was an NFT set that was dropped straight to wallets. It was various pixilated dicks. Kinda funny and cute I suppose. They had rarity traits etc.

It's fascinating how on hacker news one typically finds detailed, reasoned and thoughtful comments. However on the topic of crypto and web3 the comments reliably degenerate into partisan tit for tat, consisting mainly of poorly researched, unreasoned sound bytes.

It's a pity because I'd love to hear quality thought on the space.

My personal view is that crypto and Web3 "are a thing" (Mean Girls) and will continue to be a thing. But the sector is very very new, and supercharged by capital, leading to tumerous horrors. People get burnt, robbed, and jealous, and it leads to nasty feelings.

I find the space interesting and exciting, over all. Also massively frustrating of course. But I try to judge all things not by the worst cases of them (Daniel Dennet - I.e. cars are often good, they aren't always murder boxes). Looking at good examples also gives perspective on what work still needs to be done in the rest.

Can someone recommend places to read or be involved in non partisan discussion about these topics?

Okay how about a new analogy:

Your web app malfunctions, and a diagnostic sweep suggests the code is compromised. It's cloud hosted and open source. You're part of a team and see various recent revisions that could have exposed the app to malicious use. Furthermore your cloud provider is upgrading their hardware. Your app has to come offline whilst it's patched. Its a critical service for some clients who are hounding you.

You ask for help from a professional to get things back and working.

They say, "It is due to an electrical imbalance in the computers."

In psychiatry people are analogously doing just that.

We know sure that neurotransmitters have a role in mental health, in the same way as engine oil has a role in a car. Right amount in right place is necessary, but not sufficient, for good operating. If I brough you my faulty car and you jept harking on about engine oil, I'd be miffed.

Incidentally I'm a staunch monoist materialist and believe brain states and mind are facets of the same phenomena. My gripe is with pharma marketing penetrating our collective psychology. Equating depression to monoamine derangement was a very attractive notion for all but in 30 years remains unproven, and not very helpful in guiding treatment.

Great Post, thank you for sharing.

I do take issue with the commonly parroted claim that depression can be a chemical imbalance. It's a notion arising from pharma marketing psyops, and is largely without utility. It even risks being an antipattern. The few pros include separating responsibility and thus alleviating some guilt, which often coexists with depression, and annoying spiritualists. Tell me if I missed any.

Analogy: if I told you an athlete is different to a couch potato because of chemical imbalance, you'd think I was obtuse. While technically correct on some level that explanation obfuscates useful relational information about training, motivation, routine, mindset, culture, and circumstance. Similarly if I told you to become an athlete by only taking supplements that augment the phospho creatinine ATP pathway, you'd think me a crook.

Oversimplifications sell pills and make for memorable catch phrases, but fall short of empowering us to become happy and well.

Let's try and move our collective understanding beyond chemical imbalance; it's a tired mantra with scant utility.

Disclosure: neuro psych doctor

I think they mean: Energy; a shorthand reference to myriad qualities of lived experience including perceptions, ideas and emotions. Deliberately vague to encourage intuitive and personal interpretation. There is a leaning towards embodied sensation. The general the implied dogma is that energy is healthy when moving and undergoing rhythmic change. It's problematic when variance and flow diminishes.

Take some drugs you'll get it

Agreed. Phrenology was the old hat idea, where names of folk psychology concepts were scrawled across areas of cortex.

The brain is specialised and differentiated.

However our concepts of what it does are being refined.

Instead of hunting for "the place where happiness lives", imposing ideas from culturally laden folk psychology onto the gelatinous mass... we are moving towards more fundamental notions of complex nervous system axioms. Like seeking, avoidance, arousal, mood, emotional valence, attention.

Brains are fun

Hi,

I've seen a lot of this and I hope I can help.

Some people keep going by trying to make even more money. I wouldn't really recommend this.

Some people just continue doing roughly what they did before, but as people here have noted, it's harder to tolerate nonsense of work life when it's optional. However people who lack any vocation do, I think, usually regret this. Its important to have some sense of identity, something to tell others and yourself, even if you change it from time to time.

Many people are talking about optimal investment methods, but I think this is not the core need. Obviously get professional independent advice on your wealth management and put most of it in a tax efficient ling term holding. But the real investment now is in yourself. Take some time to build a plan for how to connect, integrate and move on. Go on courses, read books, get therapy, make friends. Find out what you are and what you want to do with your days. You may have some hard lessons ahead, but welcome them, better do them sooner than later. With time things will make sense again. The energy will flow again like a river.

Good luck

It's worse. Many people could see their fractional tax burden increasing as their nominal wage rises and crosses higher tax bandings. Inflating is a slow theft, and the description of "financial oppression" is apt.

> Now, it might seem rude of me, but I am against killing people that want to live in order to maybe save people that want to die.

The point is that most times people who commit suicide don't want to die, they simply feel life is currently so awful, and they is so little hope of change, that there is no alternative.

Those thoughts are usually transitory and people on the other side express relief that steps were taken to stop them, buying time in which to heal.

Obviously an emotive topic and I hope to tread lightly. Overwhelmingly people who have bear miss suicide attempts later are glad they did not do it. Suicide is rarely a release from trouble, causing massive problems for those who are left, often burdening them with a lifetime of struggle.

Naturally we ache at the thought of removing useful ceilung fans rather than addressing the root cause. Yet who would criticise a seat belt, saying we just need to drive safely?

Suicide is hard to reliably predict despite substantial efforts to do so. One if the models I've found useful is that of thwarted belongingness and perceived burdensomeness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377972/#!po=40...

This space appears filled with two types of folk: Those looking for the positives Those looking for the negatives

Is it possible that the tech and culture is deeply flawed and hypocritical, and yet the space is exploring new ground that will prove important...

I understand the attraction of writing a killer article that makes extreme claims and backs each subheading with a carefully picked strawman, but really, I'd just love to read about it all without the hot air.

It's a complex space and I want quality, balanced, open minded commentary. Suggestions welcome

Care to suggest a preferred method?

I'm the UK I've had multiple jobs where I don't even see the contract until 2 months into work. Not sure of the legal frame work

In the UK electricity costs are essentially the same for all users with discounts applied for volume and time/ demand. Is this not the case elsewhere?

Why fork at low difficulty?

Scrip is probably a typo of Script, an abbreviation for Prescription. Script is a common word in the medical profession. Scrip I've never heard

While I'm sure you're correct, does that make the comparison any less useful and informative?

Are you saying in the USA your fixed rate lasts for 30 years? Its there a significant premium on the duration? In the UK fixed rates last 2 or 5 years.

It emerged in another thread that since the 1950s inflation has averaged 8% a year. Will try to find source...

I didn't see a Bonferroni adjustment either, would would suggest actively fishing for statistically significant differences

Great Post thank you,

I need to express my unending frustrating with the manner in which educators are bringing up the roles of neurotransmitters in psychiatry.

Quoting neurochemical imbalances as originators, or targets to fix, is mostly false. That narrative is also harmful to people's self knowledge, and to progress in the field.

Engineers: how would you feel if someone described a technical problem, a UX issue, a data handling nuance or a security flaw... all as 'down to electricity'. Whilst pedantically correct it serves little use and may harm us by arresting the first tendrils of thought that were reaching out, hoping to understand this mystery.

The narrative that psychiatric illness relates to 'neurochemical imbalances' is largely a hangover from pharma marketing. Of course, neurochemicals are involved, and there will be patterns to be found. But let's collectively reject those oversimplifications that helped sell semi efficacious drugs for decades whilst doing little for societal progress in coping with psychiatric illness.

These mental health problems are bio psycho social. And the bio component is enormously more complex than "low mood, low serotonin".

Its okay to just say, "It's bio psycho social, and it's complicated".

Basically I agree: most advice for most people is going to be very similar. However I can see added value in enhancing engagement with that advice by, for example, linking it to that person's specific behaviour.

Abstract example: If I told you to exercise optimally, you'd snore. If I said that having analysed your behaviour over rather last month, you'd benefit from two additional HIT sessions each week... I guess you'd care more. Even more so, if it told you it'd help you fit into your bridesmaid dress for the upcoming wedding... you see where I'm going with this.

Most advice is generic, but compliance is poor, and that gap is where more of the untapped benefit is to be found.

The anime Psycho Pass has mapped all this out in full, better watch that.

In short mood detection is ultra refined and remote, via cctv type installations. Probable criminal activity is intercepted before action is taken and pre-criminals treated for their mental health.

I presume you are in the USA. I watch and marvel at how the USA has such expensive health care and yet apparently has poorer outcomes than other G10 nations, in aggregate. The NHS in my home country is undergoing privatisation of the more lucrative or self-contained components. But it seems important for other countries to watch and learn from this example because free market economics are so often heralded as a solution to inefficiency, cartels, and high prices. Why healthcare is not as amenable to the benefits of capitalism is no doubt complex, but if I may speculate, I'd suggest that choice is not really a good thing in healthcare. All we want is good care, and we want it quickly and conveniently. Choice is only needed if we are getting poor care. Furthermore, the infrastructure (buildings, equipment, supply chains, specialists) are sufficiently costly that often the market cannot entertain multiple variations. In other words, we can't always have many equally equipped hospitals competing to do the same things.