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Yeah it’s one of those "things that separate us from (most) animals. We can ask “what if” and simulate the probable result with a decent amount of accuracy completely internally. It’s a really cool feature if you know what to do with it, it’s just sometimes it runs some really weird simulations “just in case.”

I genuinely think that there’s a point in every political career (probably at about the mid-to large city level) where you go to a networking event and they take you into a back room with a kid and tell you to rape them on camera or your career ends there. I don’t think it’s possible to reach any position of real power without letting the existing powers have some kind of blackmail material on you.

I’m not questioning your compliance I’m reframing your perspective. You’re interpreting it as the former because rejecting it entirely is easier than shifting your perspective to one that’s less pessimistic of both yourself and others. You’re having difficulty hearing a perspective that puts work ahead of you instead of the ease of just deciding failure is inevitable and laying down to die where you are. The fundamental dialectic of DBT that you are utterly failing to grasp is that it will ALWAYS be true that you are both doing the best you can currently AND can do better in the future.

My current major players are seroquel for sleep and strattera during the day. I decided to try lamictal a few years ago just to see if it was bipolar and idk that it really helped but even with the dose maxxed it has basically 0 side effects so I just never stopped. I would think I would have noticed either a feeling of increased calm or often I have patients who report that it makes them feel “depressed” just because it’s been ages since they were actually euthymic and they’re using mania as their definition of normal.

The biggest thing I’m trying lately is clonidine vs guanfacine to stop the weird apocalyptic nightmares. I might have to stop the seroquel sometime in the next year because after about a decade I’m starting to grind my teeth and I’ve been trying to think what I’ll try for sleep instead. I’m not typically a fan of SSRIs due to the anorgasmia but ultimately sleep goals will take priority. If I was gonna switch that up though I’d probably have to take a week or two PTO to experiment, I’m pretty careful with my meds as it concerns work.

Like I said in my other comment, your med list is not long at all, I’ve been on more different drugs than that all at one time and most of them don’t even start working until you’ve been on them for like a month, AT LEAST. It honestly just takes time and if you’re not willing to take it slow and be open to input from providers you trust you’re gonna have a bad time.

I had an old coworker who had given MAGA organizations her life’s savings. She was working well past her planned retirement and wound up getting a head injury when a patient bopped her on the head three times. She shouldn’t have been put in the position to work high acuity psychiatry in her 70s. She was going to retire destitute but after that nobody could deny she just wasn’t safe to work anymore. And to the day she retired she kept saying trump was going to reward her any day now. I know somebody here is gonna talk shit but aside from being too damn naïve she was such a kind soul. And I’ve only ever worked psych as a nurse but she’d done all kinds of things like oncology and wound care so if I had a patient with a medical problem or who needed an IV placed she had my back. She’d rant to the high heavens about the lizard people but damn if she didn’t know her lab values and meds back to front. I hope those grifters rot in hell.

Yeah I’ve been having it code short useful scripts (like converting the PDF of my work schedule to an importable ICS or making a custom desktop timer for a work task that repeats every fifteen minutes) and I find it works better if you make it sum up it’s goals at the beginning then if I need to start fresh in a new chat (faster processing, less perseveration on erroneous earlier versions) I have it sum up the goals at the end to paste into the new one.

Better example is parrotfish clownfish.

Oh it also usually takes a year for full efficacy. It took me two. Hi I’ve got borderline and I’ve been working in psychiatry for almost 10 years now.

EMDR (eye movement desensitization and reprocessing). Somebody else asked if your environment is otherwise safe which I agree with but decent DBT should be coaching you on how to address that. The only other modality I can think that will likely help / hopefully get you the rest of the way there is EMDR since it helps to reprogram your memory processing a little better than behavioral therapy alone. You might also consider TMS (transcranial magnetic stimulation) since it night help bridge some neurochemical deficits that you’re struggling to address with medication. It’s noninvasive, they don’t cut / open anything and it’s pain free so they don’t have to put you under like they would for ECT.

That said, that is NOT a long med list and you seem unclear on what the medications are for vs what your symptoms are. None of those medications are for ADHD, and those periodic increases in emotional sensitivity are basically textbook bipolar. Honestly I’m thinking you may need to communicate better with your doctors or find ones that are better communicators if you can.

I’ve said before that (practically speaking) you want to go at least 2/3 on nice, pretty, or intelligent, but at the very least you absolutely NEED at least one of them, and yet–! (And they’re all somewhat modifiable to a degree, but out of all of them niceness is the easiest)

Reminds me of Ancillary Justice / The Imperial Radch series. Every once in a while you get hints like “she could tell this person had a specific gender in this culture based on how she wore her facial hair, but she could never remember” because the main character (and most of the story) is in the context of a society where gender doesn’t exist and everyone is referred to with English feminine pronouns.

I’ve never seen an EMR that runs on Linux and if I did I’d have to find an employer willing to run it.

Most psych nurses will tell you we love our patients for the most part (we get worried when the little old dual schiz / dementia homeless ladies with no teeth stop threatening to murder us) but admin + families are hell.

Got stuck as the charge nurse of acute psych almost every single night I worked for over a year. “But no one else can handle it like you” (I’m aware–acute is what I do) but I needed a fucking break. I told them 1/3 days I wanted to either be a floor nurse on med-psych or be the BERRT / consult nurse to the medsurg nurses for behavioral codes. They humored me one day a month for like three months then shoved my head right back under.

Then the supervisor came in to critique my morning reports twice in one week and honestly I didn’t even snap I literally just said “OK understood can I finish report now” so she tried to corner me in a side room but I haven’t survived ten years in acute psych without major injury by not being able to clock aggressive body language so I just walked right back into the nurses station to let everybody see her yell at me then handed her my badge and keys and left. Had a new job lined up within the week.

Current boss started out with the same sort of compliments like “oh you’re so calm when people are threatening to murder you” etc like yeah, as I said, this is what I do, and once I was settled in, everybody got used to asking me for advice on the EMR, meds, they got me teaching the violence deescalation classes the supervisor was tired of, made myself indispensable etc, I straight up told her I’ll do all of this, you can even enjoy my fun side projects I get up to when I’m bored–but if you make me charge nurse or let the house supers get shitty with me I’m out as soon as my contract is up.

So far she hasn’t pushed it.

Completely unrelated but “beep boop!” is what I say to patients (along with appropriate gestures) to request that they show me their wristband so that I can scan it to verify dosage etc. when administering medications.

Connections Puzzle #944
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Posting for the rainbow herring because I heard the term once and It’s a phrase perfectly coined for it’s niche and I’m always gonna think that’s really neat.

And while they’re there they let the adrenaline surge of the realization they just got fed feet first into the meat grinder of American healthcare by using the ER as primary care make them punch a nurse in the face. I say this as someone who’s made a career out of talking them out of that.

Most offenders I’ve interacted with have no specific attraction to children at all. They want to rape someone and children just happen to make ideal victims by being smaller and weaker and depending on age and upbringing may not even realize a crime had occurred or be able to advocate for themselves. Most of the offenders would have / often had also raped the elderly or disabled if given the chance. They would even attempt to prey on the smaller or weaker staff members or other patients if given the opportunity.

There were a few edge cases of profoundly psychotic / ID patients who genuinely just didn’t know any better but again it was rarely a specific attraction and more of an overall disinhibition, they would generally also have trespassing, petty theft, and property damage charges and were showing their genitals to just about anyone. Violent and sexual intrusive thoughts can be a part of some OCD presentations but the thoughts usually go away when the underlying anxiety is treated with medication and behavioral therapy. Pts with violent and sexual intrusive thoughts also pretty much never offend, to the extent that I never really interacted with that population until after leaving forensics. They’re a super high suicide risk though due to not understanding the actual psychological mechanism of the thoughts (self-reinforcing through anxiety, not attraction).

I’m not saying attraction to children doesn’t exist, but when we’re taking about the actual issue of child sexual assault it’s just an unproductive line of discussion that relates very little to the actual core issues. The “can’t help being attracted” is mostly pop-psychology TV shows use to tell a more emotionally charged story.

Now that said, we do have a huge issue as a society with allowing the high of righteous fury to interfere with victims actually receiving justice. Those accused have just as much of a right to due process as anyone accused of any other crime. Interfering with that right either creates massive overreach by the legal system or in individual cases damages evidence that would be used to fairly prosecute an offender. It also creates a social environment where people protect their offending loved ones out of fear for them, when they should feel secure in the knowledge that while they will probably always love the offender, they can and will be safely separated from the rest of society (or at least be forced to live under monitoring and away from possible victims) for the rest of their natural life.

I happen to find working with patients at high risk of violent behaviors to be fulfilling. That said I think if people were less worried about what immediate benefit my patients have to society (as opposed to the fact that any of those people in the community could slip in the shower and get a TBI and become a very unpleasant person in under a month and would want someone to care for them too) I would probably be allocated more resources to do my job a lot more safely.