April 29, 2014 5:44 PM | Posted by mopedenthusiast: | Reply

FIRST

April 29, 2014 6:00 PM | Posted by Peter Wiggin: | Reply

"Frantic activity as a defense against impotence. There is a term for that, but you can bet your career it won't be on the test."

Where were you the summer before I went to university?

April 29, 2014 6:03 PM | Posted by johnnycoconut: | Reply

I've only skimmed this so far but I already know I love it. Thanks, Alone.

April 29, 2014 6:09 PM | Posted by johnnycoconut: | Reply

Again, thanks, "Edward Teach."

April 29, 2014 6:47 PM | Posted by Anonymous: | Reply

Where is the porn book?

April 29, 2014 6:52 PM | Posted by DannyGoldberg: | Reply

Edward Teach. Clever.

en.wikipedia.org/wiki/Blackbeard

April 29, 2014 6:57 PM | Posted by Derek: | Reply

-- Switch to an IT career; end up writing the same article, replacing CME with CCNA or MCSE. Although, in IT the teachers help you cheat. Every. Time.

April 29, 2014 7:07 PM | Posted by boo radley: | Reply

Losing your anonymity is like learning how a magic trick works. But at least we now know why you like rum so much.

April 29, 2014 7:30 PM | Posted by almost did a psych residency: | Reply

Thank you, Alone. You saved me many years of wading through shit. I stumbled onto your blog right as I began to apply for residency. I ditched psychiatry (but not the blog, obviously) and never looked back!

April 29, 2014 7:35 PM | Posted, in reply to boo radley's comment, by Anonymous: | Reply

Man, I was SO excited to see the person behind the mask (even though I understand that it doesn't matter!). I unmasked batman just to find blackbeard underneath!

April 29, 2014 9:42 PM | Posted by Thin-Skinned Masta-Beta: | Reply

Dr. Teach,

I'd like to book an session.

Are you taking new patients?

How about a bit of analysis about the education and training the good doctors undergo before they are licensed to take patients?

April 29, 2014 10:46 PM | Posted by Anonymous: | Reply

Didn't even bother looking at the journal, I knew Alone would never be so silly to reveal his identity on this blog like that. If you could go to the site's server and figure out the IP address it was uploaded from that WOULD be interesting.

April 30, 2014 1:00 AM | Posted by VainSaints: | Reply

Premise 1: All deeds are both reality-oriented (e.g. the good deed genuinely to help others) and ego-oriented (the good deed to feel good about oneself).

Premise 2: Social Hyper-Organization and bureaucracy tend to disqualify the individual qua individual (the Self, basically) from making any inference about reality, expropriating rationality and making it the exclusive business of qualified 'experts'.

Result: Inscrutable realities preclude people from orienting their behavior towards an incomprehensible 'real world' and increasingly evaluate their actions on the level of self and of fantasy.

Consequentially: But these individual fantasies can only be corrected by reality-testing, and incomprehensible realities cannot yield clear tests with clear results, so fantasies become robust and ultimately self-referential: a closed system whereby the Self determines the whole of the outside world in relation to himself and his purposes. He has no anchor-point outside the self, no ultimate reference against which to evaluate the 'reality' his fantasy world. His fantasy is self-sufficient. So long as he is constantly secure and in no danger of having to fend for himself, addressing the Outside World on its own terms, he never lets go of the fantasy.

The institutions that presume to deal with the Real World 'scientifically' are unfortunately staffed with these hollow individuals, and thus lose that capacity. No one in the CME (for example) wants to confront reality. No one feels the need to. Their validation does not ultimately come from reality, but is rather imputed by whatever the self can be made to interpret as validation (e.g. credentials). The matter of whether the credentials mean anything cannot register. Of course they mean something! They validate me! Action has become completely self-oriented, the real world consumed in fantasy.

Thus, the institution loses contact with reality and ceases to function, but its members, who continue to need it for validation, and who have no sense of outer-reality beyond this validation (and thus no hint as to its emptiness), are completely unaware of it. They seek only to preserve the forms of their institution to the most bitter end, lacking any other sense of value or identity. They will go down with the ship, since it's the only ship they've got.

April 30, 2014 1:54 AM | Posted by Mayday: | Reply



April 30, 2014 2:00 AM | Posted by RichieD: | Reply

So now does upward mobility depend on your self-confidence being partly delusional? Reality is divorced from that which quantifies it, so while cynics and realists stay planted firmly on the ground smugly being right and smoking weed to get high, all those who grind through the right motions and swallow all the justifications can rocket through the stratosphere to professional status.

April 30, 2014 2:07 AM | Posted by Socialist Gumshoe: | Reply

This isn't the kind of article I was hoping for, especially since I've (mostly) already seen it. But I guess I can give it a read.

Full disclosure: I think I'm still mad about True Detective (not your posts about it but the show's direction) and maybe coming here is bringing back bad feelings. I may need to write it out. Hope you don't mind when I link to you.

April 30, 2014 2:17 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Rather than asking "Who is the author?", a more interesting question is "Why do I need to know?"

April 30, 2014 3:58 AM | Posted by Student: | Reply

Thank you for speaking against this. I wouldn't be so quick to call it a fetish, but just another barrier we use to strengthen cartels and restrict unlicensed competition from taking away business.

We require recertification so we can pay those certified a lot more so we can pay residents and those uncertified less so we can get students to drop $300k on a medical education. It's the 21st century's version of a pyramid scheme. That $1500 exam fee is a small price to pay for your raise. So what if it makes you a worse doctor. It makes you a richer doctor.

I too would think psych is more immune to the MOC, not due to knowing of defense mechanisms, but having the ability to hang a shingle, open their own cash practice, and not have to deal with being hired or insurance reimbursements. Let the free market decide his reimbursement. But somehow board certification became a marketable asset over the years, hence that $1500 exam fee is well worth the types of clients you can now attract.

April 30, 2014 4:15 AM | Posted by johnnycoconut: | Reply

The difference between your recent posts, your old posts, and your Web-Archived 2004-5 posts is the difference between Warsaw and Joy Division. Happy ~10th anniversary of your blog!

April 30, 2014 6:25 AM | Posted by Anonymous: | Reply

...Same problem with my EMT cert. We have to get re-certified every two years, even if working full time in the field. CPR has to be requaled as well, both of which are obvious ways to cheat already overworked, underpaid public servants out of some beer money. Imagine if you had to retake english 101 or basic math every two years to 'recert' a college degree or high school diploma.

April 30, 2014 6:50 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Or even "Why do I care so much?" / "Why do I think it matters so much?" Such is in order when content interpretation/analysis is set aside to judge character.

April 30, 2014 10:21 AM | Posted, in reply to Anonymous's comment, by Fitzgerald: | Reply

Precisely. We are looking for a way to dismiss the content, and it's absurd that our brains work this way.

April 30, 2014 10:22 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I read his article on that and I do realize that knowing the author only helps us heap our own bias and detracts from the objective analysis of his posts. In hindsight my comment was silly and motivated mainly by the first 10 which made reference to his identity, aslo see: Narcissism.

April 30, 2014 1:38 PM | Posted by RPLong: | Reply

Great article. This part really resonated with me:

"...a flawed system isn't better than no system at all, it is worse than no system at all, because at least with no system we are forced to be accountable to ourselves..."

April 30, 2014 1:49 PM | Posted, in reply to RichieD's comment, by VainSaints: | Reply

At a price.

It is, in a sense, a false choice. The problem is the demoralization of anyone who has some sense of reality, doctors who care about health, teachers who care about education, judges who care about justice, police who care about order, etc. They quickly come to understand that the road of real effectiveness is a hard one that involves risks: you can't simply 'go through the motions' i.e. submit your autonomy entirely to the institutional will.

In a sense, this is to be expected. The institution can only give you so much. It can only brand you in its terms. Narcissists thrive in such an environment, as it gives them the easy, riskless validation that they crave, the self-promotion that is their constant drive without the self-assertion that terrifies them.

The Real Person has to navigate this terrain, and meet the challenges that go with it on his terms, TLP's site is a fairly successful example of this.

April 30, 2014 4:15 PM | Posted by Taft: | Reply

Those interested in unmasking Alone are not simply grasping for ways to debase his/her arguments.

In fact, what those individuals are doing is exactly the behavior so lucidly defined in this post: they are fetishizing his/her "real identity," an object that serves, and I quote, "as a substitute for something missing which saves us from confronting the full impact of its absence."

The self-deluding logic being, if this person has a real identity then so do I.

April 30, 2014 5:09 PM | Posted by Nobody Atall: | Reply

Great column, as usual.

Why did you choose to out your identity now?

April 30, 2014 5:09 PM | Posted by Curio: | Reply

Seen this way, these tests, whether Harvard government exams or MOC exams, are nothing more than fetishes: a substitute for something missing which saves us from confronting the full impact of its absence.

When I first read this in Psychiatric Times, it prompted me to look at other definitions of "fetish". Does this come from Marx, or Freud, or what?

April 30, 2014 5:14 PM | Posted, in reply to Taft's comment, by Fitzgerald: | Reply

Interesting, but I don't think it logically holds. The notion of identity can still be reified without Alone needing to be "unmasked", since his "Alone" name is still referred to as an identity and thoughts are still attributed to him as if he were a real person with a real identity. In other words, there likely isn't any doubt among the "self-deluded" about if he has a real identity.

April 30, 2014 5:29 PM | Posted by Curio: | Reply

Another question, for Alone (it's worth a shot)

You say you were asked more than a few questions about DBT. What do you make of this whole Mindfulness phenomenon?

April 30, 2014 5:42 PM | Posted, in reply to Nobody Atall's comment, by J: | Reply

Edward Teach was the pirate better known as "Blackbeard;" this is just a pseudonym that maintains a nice thematic unity with the pirate flag and the rum scattered throughout TLP's posts.

April 30, 2014 7:04 PM | Posted by Paul Kempen, MD, PhD: | Reply

See this anti MOC page for information and join the fight!
http://www.communitysynergy.com/cc/public/display/1474b05afa

April 30, 2014 8:53 PM | Posted by Joey bed a Foucault: | Reply

Here’s what we know: The central core of TLP’s project can be elaborated by tracing the connection between the following two quotes from Alone

[1] Fetish: a substitute for something missing that saves us from confronting the full impact of its absence. In less abstract terms, these tests allow us to believe NOT that we learned something, NOT that we know something-- but that there is something to know.

[2] Narcissism IS an ideology, it is NOT a pathology. An ideology is "the body of ideas reflecting the social needs and aspirations of an individual, group, class, or culture. What’s important is that you aren’t afflicted with narcissism, or born with it – you choose it because it meets your “social needs."

…and then comparing the logic of their relationship to the following quotes from Karl Marx in the first volume of Capital (sorry about the length; “TL;DR” to follow):

[1] There it is a definite social relation between men, that assumes, in their eyes, the fantastic form of a relation between things.…This I call the Fetishism which attaches itself to the products of labour, so soon as they are produced as commodities, and which is therefore inseparable from the production of commodities….This Fetishism of commodities has its origin, as the foregoing analysis has already shown, in the peculiar social character of the labour that produces them….Since the producers do not come into social contact with each other until they exchange their products, the specific social character of each producer’s labour does not show itself except in the act of exchange. In other words, the labour of the individual asserts itself as a part of the labour of society, only by means of the relations which the act of exchange establishes directly between the products, and indirectly, through them, between the producers. To the latter, therefore, the relations connecting the labour of one individual with that of the rest appear, not as direct social relations between individuals at work, but as what they really are, material relations between persons and social relations between things.

[2] Hence, when we bring the products of our labour into relation with each other as values, it is not because we see in these articles the material receptacles of homogeneous human labour. Quite the contrary: whenever, by an exchange, we equate as values our different products, by that very act, we also equate, as human labour, the different kinds of labour expended upon them. We are not aware of this, nevertheless we do it.

(TL;DR -- “Fetish” and “Narcissism” are two sides of the same coin. Marx explains this phenomenon with reference to the mutually exclusive domains of production and exchange. He talks about “material relations between persons and social relations between things,” and goes on to explain that the belief constituting the commodity fetish, the belief in commodities as the rightful bearers of value through abstract labor, is an OBJECTIVE BELIEF. In other words, “social relations between things” is a way of talking about how things believe in the place of individuals. That’s the origin of Marx’s famous phrase defining ideology: “We are not aware of this, nevertheless we do it.”)

The crucial step, however, lies not in a “step forward,” but rather in a “step outside,” a properly dialectical recognition of the way that a question can begin to function as its own answer. In addressing the displacement of belief from people to things, the question, “How is displacement possible?” or, “When does displacement occur,” must be turned around, so to speak. Rather than viewing the belief embodied in commodities as a reified form of direct human belief, the paradox must be maintained that there is no such thing as direct human belief. Rather, displacement is primary and constitutive, belief is from the outset cast in terms of “an other supposed to believe.”

So when Alone talks about narcissism being an ideology that you choose “because it meets your social needs,” s/he is talking about the needs that arise from belief embodied in the Other. It’s not a conscious choice because it it’s not a conscious belief. Since the belief is objective, therefore so is the choice. “We are not aware of this, nevertheless we do it.” Lacking any alternatives, we choose the ideology that meets our social needs, and thus the fetish returns full-circle: our narcissism is a substitute for something missing that saves us from confronting the full impact of its absence.

What’s missing is precisely any notion or sense of society other than that effected by exchange. The consciousness formed through the actions of a society that has as its synthetic principle exchange rather than production is necessarily false, and adopts as its only recourse a position from which it assumes not that it knows something, but that there is something to know.

As a society, we choose – everyday – narcissism over oblivion.

April 30, 2014 10:37 PM | Posted by KarlYoung: | Reply

I don't know if that's who he is, but Penn and Zaya makes sense. Hipster.

April 30, 2014 10:37 PM | Posted by COMM FLAGG: | Reply

I love how you name yourself the "end to the silliness" as if there were some huge commotion which required your post as an intervention. I guess that makes you feel better than not being able to sit on something the minute you find it. Such self-control.

None of us were sitting around seeking out his identity, we were discussing the absurdity of our desire to know it and you just went and rewarded (positively reinforced) that desire while simultaneously trying to play it down as if you didn't do anything.

"Hehe, see guys? His identity checks out so we can't dismiss him. Oh and btw your desire to want to dismiss him is totally valid! High five!"

Protip: Most of us know how to use Google. Nobody is proud of you, retard.

April 30, 2014 10:44 PM | Posted, in reply to COMM FLAGG's comment, by Silliness is silliness, not stupidness: | Reply

Just check through the archives and you'll find plenty of people wanking about it, Internet Fighting each other about whether the author is male or female or a cat or a famous actor. It goes against his entire thesis.

However, a reread through the comments section does show my misunderstanding. Edward Teach was, indeed, a pseudonym. My apologies.

April 30, 2014 10:52 PM | Posted by RichieD: | Reply

Damn. I suppose self-awareness, as we talk about it, is a trait which demonstrates that existence is to always be on the outside vainly looking in. To say "I know how I am" is logically undifferentiable from "I know how others see me".

When what speaks value are consumables, the consumables animate. We can know a character by what they wear, all for sale. We expect certain interactions to happen between different social sets of clothes. Individuals begin in our mind as a point in 2D space where x is a scale from hot to ugly and y is effort measured from "authentic person" to "poser wannabe". Acquaintanceship is the process of overcoming that initial form of clothes talking to clothes. No longer comrade talking to comrade, or neighbour to neighbour, or parishioner to parishioner. Art, with its artist inside, talking to another piece of art also obscuring its own artist. And the medium comes from a mall or Amazon, the terminals of the globalistic supply-line.

I admit, knowing what shows another person likes based on their t-shirt helps me want to watch less television.

So the world is becoming one giant live-action role play. Before, perhaps economically-essential role-playing was just while you were on the clock. Just for cops and soldiers and judges and mechanics and servers and, I suppose, actors. Off the job, you were "yourself" as defined by society's code.

But then the hippies came along. So now the remaining social code is free, truly unhinged. Where before God, or the revolutionary spirit was animate, now clothes and cars and LinkedIn profiles are animate. And where churches or political parties were once socially important institutions, now a big recursive cyclone of mass-media and billions of delusional individuals feeding in to each other is forming the society in which our businesses have no choice but to compete. Our economy now depends entirely on learned helplessness through loss of people-value. In times of need we turn first to professionals and products. And we've done it long enough that if we stopped the first world would collapse.

I don't even mind if Alone's cover was just blown after so many years. I feel like I can see the large-scale view for the first time. Cheers, Alone!

April 30, 2014 11:02 PM | Posted, in reply to Silliness is silliness, not stupidness's comment, by Radar: | Reply

Comm-Flagg's reply was a bit dramatic, but I can't help being a bit disappointed myself. It's like, you found his identity and you just had to share it. You couldn't respect Alone's desire for anonymity and keep it hush hush.

Whatever, I'm not trying to gang up on you, this was bound to happen. Relevant song: http://www.youtube.com/watch?v=vEiTynTFqAA

May 1, 2014 1:24 AM | Posted by Anonymous: | Reply

And cheers to Joey bed a Foucault and VainSaints too, of course!

This makes me think about our upcoming employee feedback poll at my retail job. Its got a bunch of questions I'm supposedly legally-forbidden to reproduce verbatim, but my new manager explained how the the precise wording for each was selected by the polling firm.

While I am thoughtfully considering how my manager treats me or whether I get along with my coworkers or find fullfillment on a scale of one to five, the questions are actually just yes-no questions. Sometimes 1-4 is no and 5 is yes, and other times 1-2 is no and 3-5 is yes. They optimize the wording of the questions so that all the responses put together are, on average, as polarized as possible. They might ask, for instance, not if you have a friend at work, but a BFF. Nobody answers 3 out of 5 for 'do you have a BFF?'

In a small hierarchy where everyone knows everyone else there are always specific, idiosyncratic things happening. But we spend time and money paying a third-party to deliver metrics to home-office so that they can think they know what is going on. And, sort of, they do, because this past year in response to our dismal polling last time the VP of our multinational corporation came and listened to us in a town-hall meeting with no locally-based management present.

To be honest, it wasn't really warranted, albeit a huge indulgence to our egos. The confluence of economic downturns, a rapidly changing market and the scale of our local retail operation overwhelmed about 4 different area managers who were fired or quit, in quick succession, in a very short time. Now we have three area managers, each judged against the other two and against former managers from better times not long ago.

All this and reduced staffing has resulted in lower moral and so last year lots of employees agreed to vote mostly 1 on the stupid poll nobody cared about. Of course, faraway in head-office-land there are bonuses and quarterly reports that live or die on this stuff. And when the VP showed up you better know we were all completely authentic in our thorough disparagement of management and self-righteous sense of injustice. Because things must be as bad as we had said! Look, the VP is here!

The real problem is largely a breakdown of discipline due to lack of respect for management (and sometimes a lack of respectable management), and a total reset of all well-established, tried-and-true standard operating procedures due to staff cutbacks and the 3-years-delayed deployment of a new, fully-integrated inventory-tracking, order-automating, sales-tracking enterprise-level proprietary software platform + new, more diffuse paperwork + web portal.

Three years ago stores ran like optimized clockwork and all the UPCs had prices on the POS.

Now those who train new hires have no tried-and-true daily routine to prescribe, and can only explain how the POS works and suggest odd jobs. Not only is there dust everywhere, but also now opening the web-portal on the POS to enter an product that isn't scanning into the corporate issue-log will block you from being able to make a sale on that POS. And all the keyboard hot-keys have been removed. And no automated orders are yet being made, but it seems that the fine-grained sales feedback is great and has resulted in much fixture re-arranging and shelf re-organizing. So that's nice.

Maybe corporations are being seen most reliable when they function by trusting the competence of everyone in them as little as possible. It astounds me that modern companies really actually needs to pay another company to get employee feedback in lieu of any sort of vertical in-house communication. It must be that the chain of command is always functionally assumed to be rotten and maybe it is when inspections are pre-announced, and thus, rigged. So feedback has to come from a 3rd party, as tallied via a dozen-or-so yes-or-no questions answered on a spectrum.

Maybe spectrumizing a question makes it take more thought to answer. Maybe my answer, being more deliberate, feels more personal and valuable. I have a voice, yeah!

Dependable businesses perhaps must depend on that worst-case scenario of all their employees sucking. Everyone really just plays their pre-ordained part when the time comes. So, while talking about connections and understanding and being a team, let us slowly, painfully, pay dearly for and implement inhuman, technocratic business solutions to take control of our companies and provide plenty of data for the Matrix.

"Yes we want to make money, but more importantly we need to know that we are making money, in every possible way, so we can show everyone we are making money so that our stock goes up, even if it costs us money. Then I will get my bonus. Look, our poll numbers are up!"

And no one person in the company sees it this way. Except sales-representatives at the bottom, like me, I suppose. And I acknowledge that my smugness must be worth to me the difference between what I'm paid and what I might be if I took on some more responsibility. Although that value is dwindling fast. I think I'm ready to relent, finally, at the age of 25, to trying to live by my own code and just start reading up on stoicism.

Maybe the solution to finding personal agency is a grounding outside of yourself, regardless of what it is. I just started Meditations">http://classics.mit.edu/Antoninus/meditations.mb.txt>Meditations by Marcus Aurelius, which reddit says is the best. Since I can't be my own cheerleader without gloating (or becoming a cult-leader), if I instead scream and shout and praise some 2000-year-dead Roman with full gusto can I finally build enough inertia to work toward my true ambitions and leave my shitty job?

May 1, 2014 3:40 AM | Posted by DensityDuck: | Reply

I don't think it's a fetish for certification. I think it's a healthy respect for the fact that nobody trusts individual judgement anymore. If you have a certification to point to, a standard, some training, then you can say "well, it might *look* like all I do is prescribe opioids to black single mothers on welfare, but I'm actually following clinical guidelines. You can't go telling me that I'd do more to solve their problems if they were white--I'm following established practice! Don't believe me? Here's my certificate." You're not a racist; you're just following orders.

May 1, 2014 12:03 PM | Posted, in reply to J's comment, by Anonymous: | Reply

Also, "TLP" is an acronym for Tractatus Logico-Philosophicus, the most famous work of Ludwig Wittgenstein and the blog's tagline is the closing quote of the very same book.

May 1, 2014 12:49 PM | Posted by johnnycoconut: | Reply

I agree that knowing who he is doesn't change anything, in this case. (Though I'm suprised that people have argued about his gender/age/etc. but not his ethnicity.) Although you are AFAIK the first person to disclose his identity on this blog (and I'm not saying that's good, bad, or neutral), he's revealed some things about himself here already, and in other places as "Edward Teach." And knowing who he is, you can read more of his insights in other places.

P.S. Check out the Web-Archived 2004-5 stuff from this site. I guess maybe he changed his blog software/server in 2005 or 6 and the old stuff got deleted. I haven't gotten to it yet but I'm thrilled to have found it and it looks just as insightful as his other stuff. It turns out his "If France Gets Its Way" article (which I haven't fully read yet, but which he said was the turning point that made him really want to keep blogging) was first posted in 2004.

May 1, 2014 12:50 PM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

*surprised

May 1, 2014 1:05 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

TLP is short for "the last psychiatrist" which is a Nietzsche reference.

May 1, 2014 1:09 PM | Posted, in reply to johnnycoconut's comment, by Anonymous: | Reply

It certainly changes a lot for the author given the obsessives who want to contact him, nevermind how his opinions could affect his job/reputation. The person who outer him, and those who don't mind it, don't seem to care about any perspective other than their own.

May 1, 2014 2:00 PM | Posted, in reply to Anonymous's comment, by johnnycoconut: | Reply

Crap, that's a good point. I hope that doesn't happen.

May 1, 2014 2:15 PM | Posted by johnnycoconut: | Reply

OK, I e-mailed Alone about the comment. I didn't report the comment, though I wouldn't object to someone reporting/not reporting it. I'm sure, though, that the commenter had good or at least not bad intentions.

May 1, 2014 2:20 PM | Posted by johnnycoconut: | Reply

(If you want to report it, click the yellow triangle with the exclamation point. Though voting on comments hasn't been working lately, so I don't know if that would get through or not.)

May 1, 2014 2:25 PM | Posted by RPLong: | Reply

I would like to point out that the author was not "outed" by "silliness" above, but rather by the AMSA.org article. If the assumption is that "outing" TLP is a sin, it certainly wasn't a sin committed by someone who posted a link to a publicly accessible webpage.

It is entirely possible that no one was "outed" at all, for how did the author of the AMSA article discover who the author of TheLastPsychiatrist.com was? Likely she was told by the person she was interviewing. If so, then one can only assume it wasn't a carefully guarded secret.

Which means: TLP didn't tell you who he was because you had no special reason to know, even though it's no big secret. Sort of like how I don't walk around the grocery store, waving my driver's license around and introducing myself to everyone.

So maybe the next time he writes about the fact that he uses a pseudonym to keep you from being distracted by his autobiography and instead focus on the message, maybe then you can just take him at his word and read what he has to say. It's not like you're going to meet him. Just like, you know, you're not going to meet Oz Mehmet or Sanjay Gupta or Drew Pinsky or any other person who writes publicly about the medical field. It's their business to write about your health, so read their articles and learn what you can.

And by the way, Mark Twain was really Samuel Clemens. OMG this changes everything.

May 1, 2014 2:29 PM | Posted by johnnycoconut: | Reply

Though, then, why was his name ever attached to TLP in the first place (e.g. in the article linked in the comment)? Was he responsible for that? I guess that was before his following really became large. He might not really want his identity revealed now. I dunno.

May 1, 2014 2:31 PM | Posted by johnnycoconut: | Reply

(Note: I started writing my last comment before the other one was posted saying pretty much the same thing.)

May 1, 2014 2:40 PM | Posted, in reply to RPLong's comment, by Anonymous: | Reply

Deflect guilt all you want. You're just the messenger, the information was out there, etc. That still doesn't mean that directing people to the information has no ethical weight of its own. "OMG this changes everything." It certainly would have changed a lot for Clemens himself, something you keep ignoring because you only care about deflecting your guilt.

It is possible that Alone doesn't give a shit, but note that the AMSA article was published seven years ago in a journal, which may not have always published its content online.

May 1, 2014 2:42 PM | Posted, in reply to Anonymous's comment, by RPLong: | Reply

I have only two questions:

1 - What am I guilty of?

2 - Why do you think Samuel Clemens used a pen name?

May 1, 2014 2:43 PM | Posted by Axe to Grind: | Reply

Maybe the exams should deal with more situational questions?

(
http://www.kezi.com/victim-details-apparent-pick-ax-attack/
“Before yesterday, Tom never exhibited any violence. Never. People would be very afraid of him because he was very intense in his beliefs,” said Thomas’ mother, Mary Murphy.
Mary says her son suffers from schizophrenia and he’s been off his medication.
But she says what happened Tuesday afternoon is the result of a mental health system that’s failed her son.
“They put a civil commitment on Tom that was supposed to be for six months at the Heeran Center which is a lock down psychiatric facility,” said Mary Murphy.
Mary says she tried on three separate occasions to get her son help, but officials told her he wasn’t severe enough for treatment.
“Tom would either have to commit suicide or harm someone like he did yesterday,” said Mary Murphy.
As Mary sits on her front porch agonizing over what her son did she says if he wasn’t turned away from treatment Tuesday’s incident may have never happened and the victims like Lynette Sellers wouldn’t be left frustrated and traumatized.
“It doesn’t just make me angry at him, it makes me angry at the system. I just don’t understand how the system can bypass you for 34 years,” said Sellers.
)

I wonder how many straight-A graduates can tell her whether she's right or wrong...

May 1, 2014 2:43 PM | Posted by Anonymous: | Reply

Had I known Alone's identity all along, I would not have been obsessed with it. Why is that? For Alone's sake, someone should go through and hack the relevant systems, shading the identity right? I don't know how to do that though.

May 1, 2014 2:52 PM | Posted by johnnycoconut: | Reply

Here's a great article about medical research flaws:

http://www.mercatornet.com/articles/view/most_medical_research_is_flawed_says_leading_medical_editor

May 1, 2014 3:00 PM | Posted, in reply to RPLong's comment, by Anonymous: | Reply

Assuming you posted the links, you're guilty of actively seeking out the identity of a man who wanted it kept secret and then sharing that information with the lunatics who comment here. I realize moralizing like I have been isn't going to change anything, but it is amusing that you think there are no ethics involved in the sharing of information.

Clemens says he "needed" one as a fresh journalist. However you spin that, he clearly didn't want to publish under his own name. He also isn't the only person to use a pen name in the history of writing. The more relevant one to grab for would have been Kierkegaard.

May 1, 2014 3:03 PM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

(In reply to my earlier comment, I just found that for some reason mercatornet.com seems to be against gay marriage. I did not know that. This has no bearing on the article I linked in itself, but it explains the comments.)

May 1, 2014 3:06 PM | Posted, in reply to Anonymous's comment, by johnnycoconut: | Reply

What if "An end to the identity silliness" is actually Alone?

May 1, 2014 3:06 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

No I didn't post the links and I wouldn't post the links. I would actively seek out and destroy the links if I knew how. That was some other Anon

May 1, 2014 3:09 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

But I am one of those lunatics who would seek him out. I'm a medical student. Wouldn't even be that difficult or far fetched to do so.

But, I won't.

That mercatornet article is fascinating!

May 1, 2014 3:15 PM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

By the way, the "Scandal of Poor Medical Research" journal article (short, barely over 1 page) is available for free at (PDF warning):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539276/pdf/bmj00425-0005.pdf

May 1, 2014 3:20 PM | Posted, in reply to Anonymous's comment, by RPLong: | Reply

Let me see if I properly understand your theory:

You think I pseudonymously sought out and revealed TLP's identity, then switched over to using my real name to post follow-up comments arguing that it's just a pen name, all the while referring to myself in the 3rd person, by my pseudonym?

I honestly don't know what more to say. Back to work I guess.

May 1, 2014 3:22 PM | Posted, in reply to RPLong's comment, by Anonymous: | Reply

Just bear in mind, the 2:46, 3:06, and 3:09 PM posts (eastern time? not sure if that matters?) were made by me, a different Anon

May 1, 2014 3:27 PM | Posted, in reply to RPLong's comment, by Anonymous: | Reply

I don't think spelling out his "theory" came out as incisive as you wanted it to. Posting inconsistently with/without a name isn't exactly uncommon, especially when the name field doesn't fill in automatically.

May 1, 2014 4:22 PM | Posted by Way to go: | Reply

Wow, there are some really good comments in there. Too bad they're now buried beneath a small mountain of crap. Fucking amateurs.

May 1, 2014 6:25 PM | Posted by el puerco: | Reply

Marx explains this phenomenon...

How much irony is there in fetishizing Marx as someone we must consult before we may understand the world?

All the Marx reference does is show your religious bearing, it doesn't clarify anything for anyone but a fellow Marx-fetishist, which latter person now can identify you as one of his tribe.

May 1, 2014 6:28 PM | Posted by forks: | Reply

Ah, but I do blame the students, and with good reason-- but not for cheating.

When I realised the nature of the game, I quit playing. And because I chose a field without legally-required "qualifications", I saved hundreds of thousands of dollars AND have a better grasp of it than my compatriots who did go to school.

Life's funny like that.

May 1, 2014 6:55 PM | Posted, in reply to el puerco's comment, by Dissenter: | Reply

I disagree, I think the Marx passages were helpful. It's not a "fetishization," it's a sounding board, another way of thinking and talking about similar ideas. No one said we had to consult Marx to understand the world. And even they did, does that necessarily make them wrong? We consult TLP to understand the world, why not Marx?

May 1, 2014 9:32 PM | Posted by John: | Reply

The revelation matters. Had it been a teenage girl or a black/latino guy or a celebrity (even the Cheetos guy from a comment above) things would be different.

It is a white guy with a good job and this is not enough. He needs Twitter and a blog with a following to be an intellectual pirate.

The batman comparisons by some of his female fans in this blog are hilarious.

The only thing left to see is how TLP will deal with Chris and viceversa now that both worlds have collided.

My money is on even less posts, and if any, less controversial/insightful claims. Ultimately it is not that we now know him, but that they are now aware of each other.

May 1, 2014 9:46 PM | Posted, in reply to John's comment, by Andrea: | Reply

I have believed for a while TLP is a multi-level, multi-author experiment designed to show how much importance we place on "the writer." The old Hipsters on Food Stamps series was essentially about this, and that's around the time Alone started hinting he was something else (right)? Maybe that's not the primary point - the psychiatric posts go way over my head - but with all the archived discussion about postmodernism on the other blog, would it really surprise you?

May 1, 2014 10:38 PM | Posted, in reply to Andrea's comment, by Beth: | Reply

That TLP is "a multi-level, multi-author experiment designed to show how much importance we place on 'the writer'," is a conspiracy theory. It has very little to do with the message.

May 1, 2014 10:47 PM | Posted, in reply to RichieD's comment, by Anonymous: | Reply

I suppose self-awareness, as we talk about it, is a trait which demonstrates that existence is to always be on the outside vainly looking in.

Not "existence," per se, but subjectivity, which is always historically determined.

May 2, 2014 2:14 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Oh, come on, it's not that hard to find his real name. Googling is easier than figuring out IP address.

May 2, 2014 1:13 PM | Posted, in reply to John's comment, by Anonymous: | Reply

Actually, as mentioned previously here in the comments, anyone who wanted to know Alone's identity could have known for around a year now. So if there was going to be a mighty struggle between Chris and Alone, then would have already happened.

Or maybe some people did notice, but we are all rather preoccupied by the porn book and we have been warned that it is sapping time from blog posts. Perhaps the thunderous battle slipped under the radar while we silently pondered what it would sound like if a psychiatrist were to describe cunnilingus.

May 2, 2014 1:33 PM | Posted, in reply to Andrea's comment, by John: | Reply

Yes, it would. Although approval for such an experiment would be easy to obtain as everyone here is anonymous and nobody can get hurt, the data collected is elusive as little to nothing is known regarding the audience demographics.

May 2, 2014 1:35 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I don't care what pastabagel says, that would make a hell of a comic book.

May 2, 2014 1:47 PM | Posted, in reply to Anonymous's comment, by John: | Reply

Good point. I suppose it is ongoing then. There might be a porn book or not, that is a separate issue. Certainly people knowing who he is would deeply affect such a book. It is undeniable though that TLP is posting less and his core message has been assimilated by some and reinterpreted in other circles.

Like TLP on behalf of Chris quoting Mr. Smith says: "It is inevitable."

Furthermore, he linked to Edward Teach, not Chris, this is why I suspect he doesn't want to have this conversation.

Another alternative could be that Chris met someone who has changed him, hence the beginning of the end for TLP. The fact that he might not need this anymore sucks for us but might be best for Chris (He gets nothing from this, we all take).

I'm sincere in thanking the author for his passionate writing and stimulating ideas regardless of source of inspiration and eventual abandonment.

May 2, 2014 1:53 PM | Posted, in reply to John's comment, by johnnycoconut: | Reply

Whatever this is for us, it's been a diary for him. I hope he's gotten something good out of it.

May 2, 2014 1:57 PM | Posted by johnnycoconut: | Reply

Will he put his real name on the porn book?

May 2, 2014 2:29 PM | Posted by Borderline: | Reply

I love that he used the name Edward Teach. Lol. He's great. Wish he would post more often.

May 2, 2014 5:41 PM | Posted by Anonymous: | Reply

He addressed why he's posting less in the "Still Alive" post: he's working on the book. And I have no doubt that that's true. In fact, there's no reason he shouldn't have several books published by now. He's a writer at heart with plenty to say. I hope the time he is taking is more due to work/life constraints or leisure rather than self-doubt. And if it is self-doubt, I hope it isn't doubt inspired by the idiots who think he's a bad writer.

Either way, the Alone-as-author era is well overdue. Here's to the porn book and many more.

May 2, 2014 7:37 PM | Posted by el puerco: | Reply

I disagree, I think the Marx passages were helpful. It's not a "fetishization," it's a sounding board, another way of thinking and talking about similar ideas. No one said we had to consult Marx to understand the world. And even they did, does that necessarily make them wrong? We consult TLP to understand the world, why not Marx?

Obviously the Marxists and Marx scholars and Marx fetishists you know are far different from the ones I've known over my lifetime.

You don't seem too far off the ones I've known, though, with your rush to defend Marx and your mitigation of the current cultural posture Marx and Marxists seem to occupy rather enjoyably -- one which is condescending and, in a great irony, reactionary in its refusal to move forward from the mid-1800s.

If it's possible to see without Marx, then why do we need Marx? My suggestion that he's unnecessary moved you enough to try to ...err, ahhh... correct me. That's curious.

May 2, 2014 9:21 PM | Posted, in reply to COMM FLAGG's comment, by Anonymous: | Reply

That link doesn't actually say that though. It's the right profile, but if you click the link the person doesn't mention the blog at all. If it matters one way or the other, you would have bothered to check the source.

May 2, 2014 9:29 PM | Posted, in reply to Anonymous's comment, by COMM FLAGG: | Reply

There are two links, retard.

May 2, 2014 9:51 PM | Posted, in reply to el puerco's comment, by Dissenter: | Reply

your mitigation of the current cultural posture Marx and Marxists seem to occupy rather enjoyably -- one which is condescending and, in a great irony, reactionary in its refusal to move forward from the mid-1800s.

Make an argument or shut the fuck up. Oh, wait, you can't because you don't know the material well enough to disagree with it. Dumbass.

May 2, 2014 11:25 PM | Posted by KarlYoung: | Reply

Why don't all you assholes yapping about *who* he is, just take the fucking lessons and forget the rest?

+This is a message from a real drunk, mail ordered diploma psychiatrist.

May 3, 2014 12:28 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

If you Google the entire bio paragraph (including the TLP attribution) it will take you to the same doctor's bio but a few years back, before he edited out his self-disclosure. This happens because google keeps a record of deleted or changed websites in its cache (I think).

This shows he did not want us to know. I suspect it is easy for Chris to separate himself from his Alone alter ego as long as the audience doesn't know who he really is.

May 3, 2014 12:46 AM | Posted, in reply to Anonymous's comment, by John: | Reply

The bio comment was mine.

It looks like he is writing the book. The bio calls it a novel about the internet.

Somebody asked if he would publish under his real name. I suppose it is in the cards.

To summarize my position, this is a guy who was effective in separating the two people living inside of him. It is interesting to me to see how he handles it given the factors at play (effects on self-image, possible effects on professional life, how will my family handle this book? Etc.)

May 3, 2014 1:14 AM | Posted by johnnycoconut: | Reply

Any chance that Alone will comment on the revelation of his identity? I kind of doubt it. I do think he still reads some of these comments--e.g. he referenced the "you could use an editor" thing. But he hasn't intended for his identity to be all that relevant to his posts--hence his referring to himself as a man, a woman, a 15-year-old girl, a pirate, an alcoholic, a voyeur, not-a-psychiatrist, etc.

May 3, 2014 1:26 AM | Posted by johnnycoconut: | Reply

I love how inoffensive he tried to be in his HealthCentral.

May 3, 2014 2:30 AM | Posted, in reply to johnnycoconut's comment, by Anonymous: | Reply

I would be shocked if he talks about himself. He chooses to attack things he understand deeply. His identity and losing anonymity don't strike me as topics he is comfortable with at all.

May 3, 2014 8:26 AM | Posted by bravo: | Reply

"A personal plea: figuring out who I am isn't going to be that hard.  But I am asking that you don't, or at least don't publish the answer.  You might imagine it wouldn't be great for my career; there's an awesome probability of stalking, and what if I have kids? And etc.  Again, the Internet is free space and I can't stop you, but..."

Edward Teach/Alone/TLP answer to the question "Do you object to having people try to figure out who you are in real life?" - Quora - May 2011

source: http://www.quora.com/Edward-Teach-Do-you-object-to-having-people-try-to-figure-out-who-you-are-in-real-life

(click on the "1 Answer collapsed" link)

May 3, 2014 9:15 AM | Posted, in reply to bravo's comment, by Andrea: | Reply

:(

I hope he removes that comment and the following comments, then. It still sucks that it's published elsewhere on the Internet, in a place/places that he has no control of.

May 3, 2014 11:37 AM | Posted by John: | Reply

I can't bring myself to feel bad about this. When he began blogging it wasn't a secret that maintaining anonymity is impossible when achieving an impact. Also, his views on the world surely warned him that soon some people would take pride in unmasking him.

The deeper question becomes why he would do this to himself. Why risk so much considering who he really is.

Certainly having ads on the site are rationalizations to post post post unless they pay enough to justify the risk which I doubt.

May 3, 2014 12:12 PM | Posted, in reply to John's comment, by johnnycoconut: | Reply

Good point. I guess this blog has been a failsafe source of income for him. I'm not sure if he (thinks he) needs that anymore. He's always been financially savvy.

May 3, 2014 12:36 PM | Posted by johnnycoconut: | Reply

I dunno. Maybe someone would've still raised the identity topic if I hadn't posted the "thanks, 'Edward Teach'" comment near the beginning. I can't bring myself to feel bad about it. I'm surprised it took this long for him to get identified here, as he'd been already identified elsewhere. I just hope it's not my fault.

(P.S. I'm different from "John.")

(P.P.S. Before anyone notes the use of first-person singular pronouns in this comment--yes, acknowledged.)

May 3, 2014 12:38 PM | Posted, in reply to John's comment, by Anonymous: | Reply

I can't bring myself to feel bad about this.

How surprising.

When he began blogging it wasn't a secret that maintaining anonymity is impossible when achieving an impact.

And yet if his impact were truly made to any degree, those who found the information would restrain themselves from sharing it. But of course whatever desires you people have should be acted on right away. It's all about how you feel in the moment.

The deeper question becomes why he would do this to himself. Why risk so much considering who he really is.

Do...what? Have faith that the kind of people who would find the posts on this site interesting would also understand how unimportant his "identity" is? Okay, sure, you give into the perversion of wanting to know what you "shouldn't" want to know and you find out who he is, but then why post it? Many people found that link a while ago, but that's only one part of the equation. The next part, actually sharing it with others, involves the assumption that 1) other people want this information, 2) other people will properly handle this information, and 3) you were justified in seeking this information because other people are going to be satisfied with the fact that you gave it to them.

It is surprising that the readers of this particular site continue to try to reduce this. "The information was out there", "it was bound to happen", "this changes nothing!", etc. No use crying over spilled milk, I get it. But it is these "tiny" acts which show who we are and of which we should be most critical. It doesn't feel like a lot because you're simply copying and pasting a URL, but perhaps the fact that it's become so easy for you to feel so detached from responsibility is something we should think about.

I'm not saying the link should be removed and we should all pretend this never happened, the floodgates have been opened. I'm just disappointed in the defensive thinking surrounding the act. It was a stupid, selfish, and inconsiderate thing to do. We're all capable of doing it, and I'm not above the person who did it, but we should at least agree on what it is. Instead, I'm seeing rationalization after rationalization.

May 3, 2014 12:40 PM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

OK--feeling a little bad at the moment. But maybe, "It [was] inevitable."

May 3, 2014 12:47 PM | Posted, in reply to Anonymous's comment, by johnnycoconut: | Reply

It's all about how you feel in the moment.

Damn, that's the problem, isn't it.

May 3, 2014 2:12 PM | Posted by JonRedcornMF: | Reply

Red Herring anyone?

The internet exists for our entertainment. There exists no actionable data or information anywhere in any form of media. Furthermore our collective learned helplessness prevents action even if the information existed at all. The beauty of this facet of "the system" is that we can leave comments and pretend as if we have contibuted some meaningful data, and not deal with the reality of our helplessness. Remember when we used the term "surf the net?" Daring a metaphor, I assert that no amount of skill in riding a wave will ever stop the wave from crashing into the shoreline. What does this have to do with testing you ask? The answers have and always will be insignificant data....non-actionable. The answer is the question itself. For by asking the question, we establish the narrative, thereby influencing the outcome. Doubts?.........Does your mom know you're gay?

May 3, 2014 2:29 PM | Posted, in reply to Anonymous's comment, by J: | Reply

I'm not saying the link should be removed and we should all pretend this never happened...

On the other hand, I think the link should certainly be removed, and we should definitely pretend this never happened.

I don't understand the binarization of this issue, as if he's suddenly switched from anonymous to known. Surely all that's happened is the number of people who know both names has increased; even most readers here probably still do not---these comments are a nightmare to read, and there's a million of them.

But from the Quora post:

A personal plea: figuring out who I am isn't going to be that hard. But I am asking that you don't, or at least don't publish the answer. You might imagine it wouldn't be great for my career; there's an awesome probability of stalking, and what if I have kids? And etc. Again, the Internet is free space and I can't stop you, but...

I would be more irked by the inhabitants my his regular life seeing the blog, rather than anonymous commenters learning about my regular life. Not that I think he's somehow ashamed of the views expressed---he said he was planning on originally starting sans pseudonym---but because I'm not sure I'd want each new patient who Googles me to to first find eight years of vitriol on a variety of subjects. Often, well, them.

So the lower this blog is on a Google search of "Dr. REDACTED REDACTED," the less that becomes a problem, and the less the name REDACTED is mentioned in the comments, the more that will be true. :D No?

May 3, 2014 3:55 PM | Posted, in reply to johnnycoconut's comment, by Anonymous: | Reply

It is likely he makes next to nothing off this blog. Maybe these ads make him enough to pay for a year's hosting. Just plunking ads on a site isn't particularly lucrative, even if you have reasonably high traffic.

May 3, 2014 5:07 PM | Posted, in reply to Anonymous's comment, by John: | Reply

To your gobbledygook I only have this to say: His identity being revealed was as inevitable as seeing his widows and battered wives crying in the comment section regarding his identity being revealed.

May 3, 2014 5:18 PM | Posted, in reply to J's comment, by John: | Reply

If you have been reading this blog you must know that the author is very much in favor of binary thought.

You wrote: "I would be more irked by the inhabitants my his regular life seeing the blog"

???

May 3, 2014 5:39 PM | Posted, in reply to John's comment, by Anonymous: | Reply

I apologize for assuming you actually had something to say.

May 3, 2014 5:51 PM | Posted, in reply to John's comment, by D: | Reply

>crying

You engaged him in a conversation and are now backing out when he makes better points than you?

May 3, 2014 5:58 PM | Posted by D: | Reply

Actually, I guess you didn't engage him in conversation. Oops. Either way, he made some pretty solid points. I don't see any "crying" in there. "Widows" and "battered wives" reeks of PUA blog droning.

May 3, 2014 6:54 PM | Posted, in reply to D's comment, by Anonymous: | Reply

Fine. Let me say the same thing in a different tone: it was predictable that his identity would be revealed. It was also predictable that his closest admirers would jump to his defense.

May 3, 2014 7:32 PM | Posted, in reply to Anonymous's comment, by johnnycoconut: | Reply

And you're an admirer trying to get the other admirers not to feel bad about this. What are the consequences of now having someone tangible to admire (who looks almost exactly like my mental image of him, by the way)?

May 3, 2014 7:49 PM | Posted, in reply to johnnycoconut's comment, by Anonymous: | Reply

I don't know what the consequences would be for you. For him? He is probably going to get annoying emails and text messages showing support along with negative messages or insults.

Fan or not, this is how the game is played. Right now there are people being beheaded in a Mexican blog while commenters applaud. Nobody should be surprised if someone who does not like his ideas sends his most explosive quotes and a link of his bio to the entire hospital and university where he is known.

May 3, 2014 7:52 PM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

And how does this relate to the novel about the end of the Internet that he says he's working on?

May 3, 2014 7:58 PM | Posted by Fuck you all: | Reply

This comment is a vent.

Fuck you all. Bunch of goddamn lemmings.

A site where someone says something, and you nitwits choose to focus on something else entirely. Who gives a fuck who TLP is? Who fucking cares? It has nothing to do with anything.

May 3, 2014 8:04 PM | Posted, in reply to Anonymous's comment, by johnnycoconut: | Reply

Yeah, I hope he doesn't get shamed for something that he'd be applauded for in a fair world. He could quit his job(s) and daytrade, but what would be the consequences for those he works with/for? And the people he may no longer be able to help? And hopefully people don't try to mess with his family.

May 3, 2014 8:11 PM | Posted, in reply to Fuck you all's comment, by johnnycoconut: | Reply

I pretty much agree.

May 3, 2014 8:15 PM | Posted, in reply to Fuck you all's comment, by johnnycoconut: | Reply

I think most of us pretty much agree.

May 3, 2014 11:46 PM | Posted by johnnycoconut: | Reply

I believe the version of the blog that he was thinking of starting under his own name (but didn't) was an older version, which has since been deleted. I won't post the link, but you can find it in the Web Archive (up to November 2005). There was some good stuff there.

It was purely a psychiatry blog at the time. The first posts seem to have been from June 4, 2004. Its style was different: it was more activist, I guess I'd call it, and less resigned, with not such much of the nonlinearity that would later distinguish him. Even the grammar was different, for the most part. He started the site over, in November 2005 or later, and that's the version that's still up today. (For some reason, the earliest post in the current version of the site is dated July 5, 2005.) He reworked some of his old posts, like the France post, the APA gay marriage post, the Vioxx risks post, and (I think?) the antidepressants and mania post, and republished them at some point in the next couple years, on the current version of the site.

The tagline may have originally been "the tide of insanity grows," but if that's the case, he changed it to the familiar "Wovon man..." on February 25, 2005 or earlier and kept that tagline when he started over. (Fun fact: he changed the spelling of the couple of those words (to include German characters), and put a period at the end, some time between April 11 and April 25, 2012. There'd been multiple comments hounding him about the spelling before then; I don't know if that's why he made those changes.)

May 4, 2014 12:36 AM | Posted, in reply to johnnycoconut's comment, by Anonymous: | Reply

Impressive.

I find this information much more important than any comment lecturing me on anonymity or on what TLP is all about.

Thanks.

I suspect he created TLP as he realized he wasn't going to be able to say what he wanted to say on his own. For a blog that completely ruined Fight Club, there seems to be an awful lot of Tyler Durden.

Still, he is not immune to what others say as your example suggest.

May 4, 2014 12:57 AM | Posted by VainSaints: | Reply

The frantic hand-wringing over TLP's identity may be of some research value for students of obsessive behavior; otherwise, it is amongst the most bizarre and pointless spectacles I have ever witnessed.

I will venture an opinion as to the prospects of TLP retaining anonymity. I doubt, first of all, that it would be any more than a nuisance to him if his identity were to become well-established, and like anyone else, TLP has the right to minimize nuisances.

On the subject of his blog having an impact, and the adverse effect anonymity would have to that purpose, the tenor of this blog should diminish this issue.

I paraphrase TLP himself when he called upon the artists to ask grocery store managers to allow them to hang up their work, and if they say no, to hang it up anyway. Just so. If this is something that TLP wishes to do, he will and should do it. If he cares for TLP to have some impact, he will understand that retaining anonymity will be impossible to reconcile with the first imperative, and will choose one way or the other.

(The incapacity to make such a choice, by the way, is characteristic of You-Know-What-ism. (I say this merely to make a *purely parenthetical* observation that I consider apropos, not to accuse anybody of anything *at all*.) That state of mind can never commit to one course of action over another; it would require a sense of self that is more robust than a hologram. You-Know-Whats prefer that other people to direct their behavior while allowing them to pretend that they are living out their own lives, and to enjoy the kudos that come from it.)

May 4, 2014 1:34 AM | Posted, in reply to VainSaints's comment, by Anonymous: | Reply

You've got johnnycoconut trawling webarchive.com every three posts and you're referring to the conversation about the author's anonymity as obsessive? Please. That was just ethics. What's amusing to me is how defensive everybody gets the minute basic principles or matters of respect are discussed at a "meta" level. "You're a lemming!" Uh huh. Cue the blasé responses with double assurances that everything will be fine as if that was ever the point of contention.

May 4, 2014 10:19 AM | Posted by Anonymous: | Reply

The author is correct! There is a myriad of certification exams that exist as an industry unto itself within medicine. Bloodborne pathogens, HIPAA, CPR (just in case someone forgets how to do chest compressions??)--the list goes on. Each certification costs hundreds of dollars, but you get unlimited attempts to pass them. Oh, and they also teach you nothing.

May 4, 2014 12:05 PM | Posted by el puerco: | Reply

Make an argument or shut the fuck up. Oh, wait, you can't because you don't know the material well enough to disagree with it. Dumbass.

Nice reading incomprehension.

I made the argument: Marx = unnecessary, subsidiary argument: Marxism = reactionary. I left out: Marxism is ouroboros, seizing power by proletariat will yield no different ends than non-Marxist centralized power.

Marx's observations that were/are useful, about power and its dispersal or not via labor valuation, are easily seen and understood without once encountering Karl Marx's work or the observations of scholars who study/pontificate on Marx, or the hanger-on religious fanatics who worship Marx in coffee shops or on the internet.

Making a prior consultation of what Marx said, that's fetishizing Marx and rendering him a deity.

I find that funny, and for some reason, that bothers you.

May 4, 2014 6:17 PM | Posted, in reply to el puerco's comment, by Dissenter: | Reply

I find that funny, and for some reason, that bothers you.

No, what bothers me is that your setting up straw men, criticizing a caricature, etc., instead of grappling with the message (which, in my opinion, is only tangentially related to most of the ideas that usually come pre-packaged as "Marxism", and much more closely related -- as Joey bed a Foucault took the time to actually argue-- to TLP).

I find that interesting, and for some reason that bothers you. Say what you want about it, but at least take the time to respect the ideas and the forum enough to say it in an educated and informative way instead of being a dismissive asshole.

Marx = unnecessary, subsidiary argument: Marxism = reactionary.

OK, if that's you're argument you need to improve it. You can't just start with "Marx is unnecessary." You haven't even defined your terms, and therefore you beg the question, making a dismissal based on a preconceived notion. If you want to dismiss Marxism, be my guest. But we're not actually communicating until we're using terms in the same way, and you've demonstrated no understanding, therefore I can only assume that you're dismissal is, again, premature, naïve, etc.

On top of that, you act as though you are unique in opposition to those whom you refer to as Marx fetishists. "All of these damn Marx fetishists!" You realize that sounds ridiculous to most people -- no one gives a shit about Marx. He's been written off, historically condemned, and so on. But now you're here to officially inform everyone that this fetishizing of Marx has got to stop.

May 5, 2014 1:51 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Yeah.

Hint: There is no porn book, so stop asking.

And since you don't get the joke, try reading his original sources to find out what the never-[finished/started/real]-porn-opus-thing is all about. It's interesting stuff.

But until then, let it go.

May 5, 2014 2:43 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

See: https://thelastpsychiatrist.com/2013/07/still_alive.html

I'm all for a good metaphorical joke, but it doesn't seem likely given how straightforward the above is.

Kind of curious as to what exactly you think "the joke" is, though.

May 6, 2014 11:29 AM | Posted by el puerco: | Reply

Dissenter,

if you're imagining yourself a great purveyor of ironic pseudo-intellectual snark, I must tell you that you're not reaching the goal of your feeble imagination's projections.

You don't even know what a "straw-man" is but you accuse others of using "straw-man" tactics. That's supposed to be "ironic" I guess, which is supposed to mark you as a great hipster comic not unlike Tosh 2.0 or some other unfunny hipster smug-itarian like maybe Fred Armisen. Sure.

Meanwhile, there's no reason to prior-consult Karl Marx's writings on any issue. Marx got so much wrong, and wrote so poorly, and was stuck in the mid-1800s and had no clue what the world would look like in 2014, so why should we consult him? What would it gain us? What does his work reveal that you can't see on your own without him?

To you, this is "setting up a straw-man" -- but, as I said above, you don't even know what is a straw-man because I'm not setting up any sort of triangulated false-focus. You are.

Keep your day job. You're not even a 10th string Gervais, and Gervais isn't even that funny.

May 6, 2014 11:34 AM | Posted by el puerco: | Reply

But now you're here to officially inform everyone that this fetishizing of Marx has got to stop.

I'm not "officially" anything, you simple projector of fragile-ego-based paranoia.

The main essay by TLP above is about fetishizing credentialism, and apparently you missed the points I've already made clearly, where I japed at some clown who fetishized credentialed Marxists and credentialed Marxism.

It's a pretty common occurrence to have some idiot know-nothing on the internet spew with such brave rectitude while being so clusterfuckingly wrong, but you seem to have done a yeoman's job of it in this thread, so -- kudos to you for your ignorant arrogance on display.

May 7, 2014 7:56 AM | Posted, in reply to Curio's comment, by Anonymous: | Reply

"Fetish" doesn't have to be a sexual term, if that's what threw you off...

May 7, 2014 10:15 AM | Posted, in reply to el puerco's comment, by Dissenter: | Reply

The main essay by TLP above is about fetishizing credentialism...

Holy shit, you're myopic. The article is hardly just about "fetishizing credentialism," it's much more about HOW FETISHIZATION WORKS and, subsequently, why "credentialism" fulfills the inclination. The difference, since you appear to need it explained to you, is exactly opposite: "fetishization" is primary -- not simply the "effect" of elevating some thing (credentials, for example) into a fetishized place, "fetishization," is actually the cause. Marx was the first one to talk about it in this way, which is why I referenced him.

But you don't give a shit; you'd rather be right. Thanks for the history lesson, though, you self-aggrandizing tool. "Marx wrote poorly." In English? Oh, so someone translated poorly? Maybe it's the German language's fault? I hope someone slits your throat and cums down your gob.

May 7, 2014 10:21 AM | Posted, in reply to el puerco's comment, by Anonymous: | Reply

Go ahead and take another couple of days to formulate your response, fucktard.

May 8, 2014 2:15 PM | Posted, in reply to Anonymous's comment, by Curio: | Reply

Yes, I know. Alone aka Edward Teach, M.D explicitly defines it in a broader way. I was just curious where he got that definition from. The term has a long history in both psychoanalytic and philosophical thought.

May 8, 2014 11:50 PM | Posted by Anonymous: | Reply

To all you "outing" folks out there, I would like to take a moment and say thank you...

...for reminding me how much of a shitty place this world is.

May 12, 2014 3:05 AM | Posted by Anonymous: | Reply

I know Alone doesn't respond in the comments section anymore, but with all this Marxism talk going on I'd be interested in getting an opinion on Slavoj Zizek, and more importantly Jacques Lacan (because Alone often refers to concepts of Lacanian psychoanalysis in his writing). Zizek's Marxist leanings seem suspect, but then again I know next to nothing about Marxist theory and I've never read anything by the man myself.

Here's one of the few videos where Lacan makes an on-screen appearance:

http://vimeo.com/21031617

You can watch any documentary with Zizek in it (there's a handful), or alternatively there are several lectures by him available on Youtube.

Another interesting topic of discussion is Sam Vaknin. The man has a monopoly on internet writings based around narcissism, but he has zero formal education and the degree he does have is from a diploma mill and has nothing to do with psychology / psychiatry. He's written hundreds of pages on the subject of narcissism and if you actually take the time to scroll through his website, it's often rambling, imprecise, and without proper citation (I.E. he's either speaking completely from personal experience / projection, or he's making it up). The kicker is that he's a self-proclaimed "narcissist", although if you watch the documentary "I, Psychopath" in which he gets tested for both psychopathy (for which he passes, I.E. he has it) and narcissism (fails, I.E. doesn't have it), it's clear there's a strange overlapping of things going on here. Clearly based on the MRI scans he went through he does suffer from sort of psychopathy (which, like anything else is a spectrum, and various people fall on different parts of the spectrum). But his complete outrage at being told by the clinical psychologist that he doesn't show strong symptoms for narcissism leads me to believe that maybe he is a narcissist, and this is bolstered by his childish, vindictive antics during the shooting of the documentary. Then again maybe it was all part of a ruse to try and convince people that he is one, because who would listen to a man who has written so much on the topic of narcissism, allegedly from the viewpoint of one, if he turns out not to actually be a narcissist?

In any case it's fascinating.

May 13, 2014 1:12 PM | Posted by el puerco: | Reply

Holy shit, you're myopic. The article is hardly just about "fetishizing credentialism," it's much more about HOW FETISHIZATION WORKS and, subsequently, why "credentialism" fulfills the inclination.

Which is exactly what I said, though I didn't need 20x the syllables to say it, because unlike you, I'm not a pretentious knob who uses internet comment forums to feel like Debate Champion.

Since credential fetishes are counter-productive, and since I said fetishizing Marx is a type of credential fetish, you choose to make a formalist (hair-splitting semantics) argument which you think ...uh... somehow "shows I'm wrong."

My favorite thing about internet comment forums is the irrationality of people who think they're "debating" when they're just snarking with a superior tone. Snark doesn't count in debates, unless you're at the local gay bar debating whose snark is best.

May 13, 2014 1:15 PM | Posted by el puerco: | Reply

Go ahead and take another couple of days to formulate your response, fucktard.

So in addition to being immature, destructively self-centered, delusional about rectitude, and fantasy-bound about superiority, you also predict the future and have a witty sense of putdown ("fucktard")?

Now, you're almost twice the Internet Loser I imagined before. Well done. You "won" because I didn't keep refreshing my browser and keep sitting at my computer until "Dissident" posted a comment.

May 13, 2014 1:49 PM | Posted by Dissenter: | Reply

You "won"

Works for me.

May 13, 2014 2:58 PM | Posted, in reply to el puerco's comment, by Anonymous: | Reply

Also, I'm just going to throw this old Alone quote from a comments section up here for your consideration:

Alone's response: of course. But the point here is that Kerouac created a book he hoped would be timeless, but instead sparked an idea everyone associates with the book and him, but which is neither the book nor him. I'd expect him to be one bitter man, with so many "agreeing" with things he never wrote nor believed. Hey, Marx is like that.

May 13, 2014 4:27 PM | Posted by el puerco: | Reply

Your onanism regarding Marx, has it yielded all-time record jism volumes?

Because that's what matters most.

What exactly do you think you "proved" (quotes intentional, and not scare-quotes) with that quote? Please share. If the proof is that when you saw the bolded name in a search of this website's essays, did you have that historically significant orgasm?

May 13, 2014 4:31 PM | Posted by Anonymous: | Reply

el puerco,

Do you think you could just let it go and stop shitting up the comments?

Signed,
One of The Few People You Aren't Currently Arguing With

May 13, 2014 4:57 PM | Posted by Froot Loop: | Reply

This post demonstrates how the education system is absurd. The education system seems to be about making the things they teach as little about the world outside education as possible and not demonstrating that education has any value.

You get a A+ with extra credit,it has little value outside the classroom. It honestly doesn't have any value to anyone except what the student makes of it.

Employers don't care about your 3.8 GPA, they don't even care about your degree, because employers rather hire older people with experience who may have grown up in a time when you didn't need a degree for everything, vs the inexperienced and green college students who's degree doesn't say much about them.

If there is one thing I definitely learned while going through school is that people had many different reasons for being smart. Kids who's parents rode them hard about getting good grades,extra curricular activities, constant studying, so they see education as a means to a end. They see school as a game to be played.

Then their are the kids who actually like learning and learn outside the class room. Good for them, thumbs up.

Then there are the kids who really buy into the education system. They actually make the mistake to think that what they learn in education matters.

So these kids have a very rigid understanding of intelligence. This is bad because education system doesn't teach you how to apply the things you learn outside of school.

They teach you to speak on command. To speak in a formal way and that intelligence can only be conveyed in a boring,impassive,unflinching,unfun way. That learning cannot happen between friends and "fun" people. That learning doesn't occur outside of the school room. That learning isn't fun period.

So these types of people have no ability to talk about this stuff outside the classroom. Don't take what they learn outside of school and apply it to school. Don't take what they learn in school and apply it outside.

These people never develop a eye for the things happening around them. They become very narrow minded, task oriented, the type of blind obedience our culture seems to be organized around.

Most students don't fit neatly into these boxes, a few do, most change from box to box throughout their school life.

I started out as a kid in the third box, never really touched the first box* but at the end of college I ended up in the second box.

What was the point of learning all these stuff if I wasn't going to apply it to my life? I was just going through the motions. So I decided to drop the "speak on command, use big words to sound smart" and actually start being smart. I was dumb. I admit it. But the point is that I realized I wasn't learning in the proper way, the good way. That learning can improve your life, that I can apply the things I learned outside of school too my life.

I think I'm on the ways to approaching something that resembles reasonable smart. It's not till you say the subject matter in your own words that you feel the things that you learn actually sink in. The subject matter becomes real.

Education systems like what TLP describe often stifle true learning, they prevent people from having the education stick. Education systems like this reward people for keeping the education in the classroom and not applying them to their daily life.

May 13, 2014 5:22 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I'm not arguing with anyone.

Your gay snark stylings are impressive, though. May I suggest you visit Jake Backpack and Tarzie for more enlightened snark that truly shows your superiority (in your own mind)?

May 17, 2014 1:04 AM | Posted by Heisenberg: | Reply

I saw the original by "Edward Teach" on the psych. website and remember thinking how similar his/her writing style is to TLP's. Well....

May 17, 2014 6:14 AM | Posted by Mister Ducky: | Reply

Please become anonymous again :(

Seriously though, thanks and all the best.

May 17, 2014 6:32 AM | Posted, in reply to Mister Ducky's comment, by Broseph: | Reply

Edward Teach is another pseudonym, look it up on google. Another allusion to piracy...

May 17, 2014 8:08 AM | Posted by Anonymous: | Reply

Reddit completely ruins something and runs it into the ground, once again, just like it always does. Anyone who wants to find it can now find it.

And no, I'm not talking about Edward Teach. Anyone who isn't a complete moron knows that Teach is a (somewhat) clever pseudonym. I'm talking about karma-hungry Reddit whores looking to out someone for a bit of gold and internet fame.

A case of Divine Karma maybe? Without getting all Buddhist, I hope not. Please continue writing, Alone. And to the cancerous Redditors who aggregate OC across the internet, I hope those dubloons were worth it.

Aaaarrrgggh.

May 17, 2014 11:59 AM | Posted, in reply to Froot Loop's comment, by Anonymous: | Reply

I agree. It's the system, the teachers, the parents, everybody--EVERYBODY but you.

May 20, 2014 5:35 PM | Posted, in reply to VainSaints's comment, by Anonymous: | Reply

Vainsaints, you should look up a book called Systemantics (by John Gall). It has a lot to say about the scenario you describe here.

(also definitely in my top 3 favorite books on the planet, for many reasons.)

May 22, 2014 11:45 PM | Posted by friv 3: | Reply

American Board of Psychiatry and maintaining certification is important and what can be brought. Towards Everything for improvement.

May 23, 2014 10:11 PM | Posted by Rob: | Reply

Can y'all please stop trying to armchair analyze the people who are curious about TLP's real identity? There's a really simple reason why people do it, and it's not because they're hyperfocused on his identity to the detriment of his message, or whatever silly "gotcha" you think you've caught them in. It's because the persona he's built on this website is intriguing, mysterious, and it's BASIC HUMAN NATURE to be curious about stuff like that. Doesn't mean they're not also listening to him or that they're guilty of any fallacy or pathology. It's possible to have a primary appreciation for what TLP's saying and a secondary interest in who's actually saying it.

>Rather than asking "Who is the author?", a more interesting question is "Why do I need to know?"
No. It's not an interesting question at all.

May 23, 2014 11:41 PM | Posted, in reply to Rob's comment, by Anonymous: | Reply

You and those interested in TLP ipso facto ought to go indulge in tabloids instead--the blog is not for "y'all."

It's "HUMAN NATURE" to be an asshole? Geez, tell us something we don't know.

May 24, 2014 6:29 AM | Posted, in reply to Anonymous's comment, by Rob: | Reply

Odd, somebody once told me that if I was reading it, it was for me.

I admit at first I was a little perplexed where your hostility was coming from, so I went up and reread the thread. Apparently on first pass I missed that somebody (in a now-deleted post) outed TLP's real name, which, yeah, I agree, is pretty distasteful. To be clear, I've never made any attempt to discover that for myself or to invade TLP's privacy and I certainly wouldn't have posted about it if I had.

I'm just identifying with those who've expressed entirely passive curiosity as to who he is. TLP has an intriguing persona and it's a pretty typical, understandable impulse to wonder about it, and the insinuation that there's something "wrong" with their attitudes or their psyches for wondering is ridiculous. Like I said, I read this blog because it's entertaining and frequently thought-provoking and insightful. I hope you'll agree those are pretty good reasons. That doesn't preclude feeling occasional curiosity about the author, which in no way occupies my thoughts or distracts me while I'm reading.

I was going to write something snarky here because you called me an asshole, but I guess I did miss a good chunk of the comment thread which makes your anger more understandable.

June 2, 2014 9:15 PM | Posted by el puerco: | Reply

Here's Rob, doing a Janus:

Can y'all please stop trying to armchair analyze the people who are curious about TLP's real identity?

...which seems a sound observation until you watch him turn around and post:

I admit at first I was a little perplexed where your hostility was coming from,....

and

...which makes your anger more understandable.

I'm always amused by people who think they can discern another commenter's mental and emotional status via an internet comment. Double the amusement when the person complains of "armchair diagnosis" distractions.

June 3, 2014 2:08 AM | Posted, in reply to el puerco's comment, by Rob: | Reply

What, no, what the fuck are you talking about?

I got called an asshole for what I thought was a relatively harmless comment. I did some rereading and realized I'd inadvertently defended someone who had posted something objectionable. So I posted admitting my mistake.

I think that's a pretty fucking reasonable inference to make, but I'm not claiming any special insight here, the way you seem to think I am. If that's not why the anonymous commenter called me an asshole he's more than welcome to correct me, though I clearly never tried to use his apparent anger to make any kind of rhetorical point or suggest anything about his character. I was simply admitting in a conversational way that I fucked up.

June 3, 2014 9:05 AM | Posted, in reply to Rob's comment, by Anonymous: | Reply

I got called an asshole

Which is a statement wherein you claim it was about you.

I did some rereading and realized I'd inadvertently defended someone who had posted something objectionable

Still a dick move, my friend.

So I posted admitting my mistake

Followed by declaring your initial intent was to post a "snarky comment," followed by letting us know that your cooler head prevailed. Am I supposed to thank you for catching up on the thread or something? Or would you like me to apologize that "do-overs" don't happen outside of recess to the benefit of all?

...which makes your anger...

Sure, it's anger if you imagine I'm speaking in the style of
Team America giving a speech to an international assembly involving one particular word in common. In all seriousness, though, when in doubt, less is more: i.e. assumptions.

Odd, somebody once told me that if I was reading it, it was for me.

Omission of context. The point is that if you continue paying attention to something--reading or otherwise--the next step is to ask yourself why you care so much. It is a step in the direction of (hopefully) becoming a better person. Asking "Why do I need to know" is just as relevant, too, in that context. WHEREUPON YOU HAD SAID:

No. It's not an interesting question at all.

June 3, 2014 2:33 PM | Posted by Rob: | Reply

You understand, right, that we're having a (presumably adult) conversation here, not participating in a debate club? There's no imaginary points at stake here. When one person in a discussion realizes they've misrepresented or overlooked something, it's common courtesy to admit it. That's real basic social skills, dude.

To answer our question,
>Am I supposed to thank you for catching up on the thread or something? Or would you like me to apologize that "do-overs" don't happen outside of recess to the benefit of all?

The polite thing to do in that case is to accept their apology and move on. You've already blown that, though.

And to be clear: when I referenced your "anger" above, it was simply an informal way of referring to the fact that you called me an asshole. It was quite clearly not an attack on you or a genuine attempt to divine your emotional state. Hyperfocusing on that one word isn't going to accomplish anything here besides make you look immature and waste both of our times.

>The point is that if you continue paying attention to something--reading or otherwise--the next step is to ask yourself why you care so much. It is a step in the direction of (hopefully) becoming a better person. Asking "Why do I need to know" is just as relevant, too, in that context.

No clue how that has anything to do with what you quoted (which wasn't a serious remark, by the way, but what I felt was a fairly obviously flippant one-liner) but it would be nice if you'd stop talking past me. I've clearly said, I don't "need to know" or care "so much." I feel (like many of TLP's readers, I assume) mild, manageable curiosity.

June 3, 2014 8:19 PM | Posted, in reply to Rob's comment, by Anonymous: | Reply

In one eye, out the other...

June 3, 2014 11:14 PM | Posted by Taylor: | Reply

photograph speaks of the difficulties of the previous generation and we need to preserve it. Kizi 10 | Friv 3

June 4, 2014 12:01 AM | Posted by Selena: | Reply

you have brought the most rewarding and wonderful, thanks
kizi 1 | kizi 4

June 4, 2014 4:04 AM | Posted by Anonymous: | Reply

So, does this perhaps, in part, explain why an industry of "medical specialists" whom had until to the previous two years of my direct experience with them as a patient (ie ignorant & stupid human being incapable of reading & understanding the same studies that they [psychiatrist] COULD equally, if not much MORE accurately read & understand IF ONLY they had not sold out to the 100% FAULTY value of such a CE test) well could it EXPLAIN (in part) why I am now meeting nothing but psychiatrists, whom rife with the unhealthily & indirectly confronted & expressed insecurity arisiv of the suppressed awareness of the stagnation in usefulness & evidence based medical practices which has become the norm in psychiatry, ... well could it possibly (as in COMPLETELY) explain how it is is now EVERY doctor I see want to try and force cold turkey me off 8 years of non-addictive, non-abusive physician prescribed use of Xanax under the EXCUSE of "the DEA does not want doctors putting people on that type of medication due to its addiction potential".

Well, eh-hem! Cough, gag, choking down bile: WTF does the DEA have to do with the fact Tha 8-2 years ago EVERY psychiatrist wanted me on Xanax DESPITE it side effect profile & DESPITE its addiction POTENTIAL, & so, now here I am, POWERLESS under their godlike ability to write prescriptions, being told I need to get off not just the Xanax but that "dirty" & "dangerous" & "ineffective" Lithium along with the Xanax & try a "newer & cleaner drug"
..... Long question short: - Why TF am I & my ability to function & be a productive semi stable & thus valuable member of society & my needing to stay on the SAME medications I have taken for years & had good results from, now suddenly being looked at as a bad thing? As if (& I mean this in the MOST sarcastic way possible) AS IF throwing a bunch of new meds with even shorter track records & known/understood risk to benefit ratios ALL WHILE ATTEMPTING TO COLD TURKEY ME OF MEDS THAT HAVE HELPED MORE THAN ANY OF THE 20+ PREVIOUS COMBINATIONS TRIED WILL SOMEHOW DO A-N-Y-T-H-I-N-G OTHER THAN CAUSE A MENTAL ILLNESS MELTDOWN FOR ME?

But no, oh NO, do NOT EVER, EVER mention these concerns to your psychiatrist cause he/she WILL brand & labell you as an "addict" who suffers from "paranoid delusions" & "OCD" because it could NEVER be their own intellectual inability to see beyond their PATHETIC EGO MASTURBATION & using POINTLESS, unscientific, completely lacking in any evidence based protocols

June 4, 2014 4:44 AM | Posted by Anonymous: | Reply

But completely (or near completely) aside Fromm previous post, if I could just have a psychiatrist whom I 100% KNEW was never going to fuck up my mental health & stability & try to change the meds that best helped me achieve that & NEVER EVER AGAIN HAVE TO DEAL WITH DOCS TRYING TO "fix what is not broken" just cause they buy into the ego masturbatory effects of such tests. &. "Qualifiers" as these.: I would 100% allow that doctor to WILLINGLY do ANY DEGRADING SEXUAL ACT UPON ME JUST TO FINALLY KNOW THAT I WOULD NEVER AGAIN BE FORCED TO GO THRU THE LIVING HELL THAT IS UNECCESSARY MED CHANGES JUST BECAUSE THE DOC HAS LOW SELF ESTEEM & is a narcissist prick.
Seriously I'm down with ANY nasty kinky shit I never would normally do IF that could just guarantee I can get my 600mg Seroquel, 450mg Lithium, 150-200 mcg synthroid and 1mg Xanax/3x's day (& that my dose after 8 years of being on this treatment with good results) CAUSE MY BODY IS JUST THE VESSEL I HAVE TO LIVE IN, my mind however is what decides if that body should bother continuing to exist. & so.... Hooray for psychiatry, now your patients are willing to become whores for barter to get the meds they need and ALL because you're too pussy (excepting what i presume of alone) to THINK FOR YOUR FUCKING SELVES, LISTEN LIKE YOUR PATIENTS MIGHT EVER HAVE ANY INSIGHT OR RIGHT TO HELP GUIDE THEIR OWN TREATMENT, INSTEAD you all bend over & pay to waste your time on WORTHLESS BIASED "continuing education" AS IF it has any value besides placating your own fears that NOT A DAMN ONE OF YOU HAS ANY BETTER AN IDEA OR "clue" AS TO WHAT YOU ARE DOING IN PRESCRIBING PSYCHOACTIVE SUBSTANCES SO FAAAAAR & LOOOONG BEFORE ACTUAL MEDICAL SCIENCE HAS EVEN BEGUN TO APOROACH AN UNDERSTANDING OF BRAIN BIOLOGY, & still exists & PRACTICES "medicine" without even ONE iota of a clue about the mind.
FINE: you want me to shut up as a patient so I don't threaten your fragile and FALSE ego? Then YOU SHUT THE FUCK UP & write me for the meds I need WHILE I SUCK YOUR DICK, & that way neither one of us has to pretend that the doctor patient relationship in psychiatry is anything but WHAT IT ACTUALLY IS
Email me if you're interested in such an HONEST & far far from indecent proposal. We all win: my insurance pays you $100 & I pay you $20 AND YOU GET YOUR DICK SUCKED & I LEAVE WITH AN RX TO THE MEDS THAT TRIED & true WORK FOR ME....& instead of having the taste of homicidal rage to cleanse from my mouth over some INCOMPETENT ASSHOLE TRYING TO PLAY GOS WITH MY MENTAL & EMOTIONAL WELLBEING, I just have the taste of scumbag cum to listerirne out of my throat.
Here's my email SCUMBAGS
[email protected]

Now go fucking hang your collective heads in shame that THIS IS what it ALL boils down to when psychiatrists (aka doctors who faint at the sight of blood & panic at the though of ever having to practice REAL medicine ) decide to PRETEND/ACT like they are REAL doctors & use PATHETIC MINDGAMES & POWERPLAYS to DISEMPOWER THE PATIENTS RIGHT TO BE THE END ALL SAY ALL - as in a FREE human being- ABOUT THEIR BODIES & right to take or not take certain treatments.

JUST BE FUCKING HONEST & COERCE US ALL INTO DEGRADING SEX ACTS BEFORE YOU WILL RX WHAT WE NEED & quit being such limp dick "blame everyone else" LOOSERS, cause, well, WE ALL KNOW ITS NOT THE DEAS FAULT YOUR A PUSSY, it's the fact you will use ANY excuse to PRICE YPUR POSITION OF POWER & CONTROL, even if it is to play the victim all while hoping the real victim, your patient, will suck your dick & give you your sick (as in suicide is painless.... Maybe more p docs should try it) DISGUSTING SADISTIC PATHOLOGICALLY NARCISSISTIC FANTASIES

June 4, 2014 5:13 AM | Posted by Anonymous: | Reply

Hopefully someone will take me up on that offer because none of those adds are meant for me, nor are they meant for anyone who I have ever found worthy of any legitimate level of respect. This culture that I was unfortunately born into has gone competely insane & in the MOST shallow way that any entity can suffer from a pathologically unidentifiable yet catagorically "disorderly defined" & this is something which I have known since I was seven years old. I am simply so sick & disgusted by all the lies, the self delusion, the "it's the other guy, what an asshole he is" utter & complete SUPERFICIAL bullshit. & I am outraged not only to be born into the age of "self-centered" yet COMPLETELY LACKING IN ANY AUTHENTIC CENTER OT SELF, arrogant & equally ignorant a-holes, that due to also being born with manic depressive/bipolar illness THAT I AM TREATED, 98% poorly to completely incompetently, by those very same deluded fucks

June 4, 2014 5:49 AM | Posted, in reply to Anonymous's comment, by Yahley: | Reply

I take a tremendous amount of amusement imagining the voice of Garrison Keillor reading the last three posts above. Are you ready to finally fit into your red dress there, Lake Wobegon?

June 4, 2014 11:39 AM | Posted by Anonymous: | Reply

Holy rambler. The comments section has really gone to shit around this place.

June 4, 2014 3:33 PM | Posted by el puerco: | Reply

What, no, what the fuck are you talking about?

your sad hypocrisy revealing you think you can conclusively determine the presence of "anger" (your word) and "hostility" (your word) in another's outlook simply because you concluded the person is "angry" and "hostile" and failed to consider other options, of which their are many, which probably explains your lazy default to the projected emotions that enable you to feel superior in the accusation -- since, y'know, accusation is proof.

June 4, 2014 8:06 PM | Posted, in reply to Rob's comment, by Shambledon: | Reply

To hell with your sanctimony already.

June 6, 2014 12:52 AM | Posted, in reply to el puerco's comment, by Anonymous: | Reply

>your sad hypocrisy revealing you think you can conclusively determine the presence of "anger" (your word) and "hostility" (your word) in ... lots more words

I don't think that, man. At the risk of repeating myself (twice now), I am not actually claiming to know whether he felt "angry" or "hostile" or not. Maybe he was merely mildly annoyed! Maybe he felt amused, or nothing at all. Certainly I've experienced that whole gamut of emotions when I've insulted people online. I don't give a shit how he felt, the word "anger" was never meant as a statement of fact and has literally nothing to do with the point of what I was saying (nor did I feel "superior" for writing it. I don't know why you'd assume that.)

I guess it's all moot now though since our conversation has apparently been upstaged by the guy who wants doctors to do degrading sex acts to him, or whatever, I skimmed. But maybe you're still reading.

>To hell with your sanctimony already.

And you can fuck right off too.

June 6, 2014 3:27 AM | Posted, in reply to Anonymous's comment, by jonny: | Reply

I am simply so sick & disgusted by all the lies, the self delusion, the "it's the other guy, what an asshole he is" utter & complete SUPERFICIAL bullshit. & I am outraged not only to be born into the age of "self-centered" yet COMPLETELY LACKING...SELF...that due to also being born with manic depressive/bipolar illness THAT I AM TREATED, 98% poorly to completely incompetently, by those very same deluded fucks

I feel your pain. They're not selfish, they're just too stupid to realise their Self was eroded by their abusers for love. Trauma wiped but they love their mothers much more now than before.

The treatment might be malicious, not merely incompetent. We live in a world where those who Supply relief manufacture illicit Demand by inflicting pain (women, for example). Our oppression will last until we stop rewarding those who make us suffer.

I had blood circulation problems with my legs last year; by the end, my feet were swelling up like watermelons. As I've never been frugal when in pain (sigh), I just handed over my CCs every time without blinking. I don't want to think about how much. For a year, things steadily got worse. In frustration, I went to nine hospitals. I paid $40 at the last. Effectively overnight, a year of suffering came to an end. But I paid a lot of money for that pain.

Money can't buy happiness? Money can't even buy pain relief. When you pay for relief, you pay for pain. The last hospital wasn't even ethical, I don't think (or how would they compete?); I just hadn't shaved in a week, wearing a shirt I'd just spilled lunch on, shorts & thongs. I think I was cured because I looked like a bum.

Inquirer: Mother Kills 13yo Raped By Brothers, For Honour

The shame was unbearable, Qaoud said. Relatives and friends refused to speak to them. Killing her sixth-born child took 20 minutes, Qaoud tells through a stream of tears and cigarette smoke. "She killed me before I killed her," says the mother of nine. "I had to protect my children."

She eases her pain by doting on the three still at home. The youngest, Fatima, 9, she lavishes with kisses. The children say they have forgiven her and return her affection. Leaning into Qaoud's arms, Fatima adds: "I love my mother much more now than before."

Not a bad racket for a dead woman. Down to 3. Once you traumatise humans, they love you much more than before.

Options:
1. We need not to need.
2. We need to shut it down.
3. Exponential increase in pain, until we run out of relief.

They chose 3. There will be horror. Naturally, they Know Best.

June 7, 2014 2:03 AM | Posted, in reply to Yahley's comment, by Anonymous: | Reply

LMFAO, refreshing.... that there is the type of comedic relief I can appreciate, & seeing as it is comedic relief at my own expense, the sorts I have come to cherish as it truly is the only way to make it thru this crazy world as a person living with a mental illness.
IF CHOSEN to play my own "part" I would gladly squeeze my three sizes two large figure into a low cut & ONLY SLIGHTLY inappropriate sized red dress, for anyone of my definitively non-supermodel and apparent enough non-athletic body type, & pranced about the stage to my position at the mike ("check, check, nigaaa") whilst his sound effects team of wizards made impolite noises regarding how awkward and silly it is to have an unshaven, not even pretentious enough to own a pair of Birkenstocks style hippy/lunatic degenerate.

It WOULD be entertaining, yes indeed i agree. (btw, love that show. Good memories & good humor)

June 7, 2014 4:01 AM | Posted, in reply to jonny's comment, by Anonymous: | Reply

100% agree. It is so hard. So hard & discouraging to try to find a doctor, ANY doctor, who will actually EFFECTIVELY treat you as a patient based upon your history of experiences with the various medications and treatments you have tried.

Why are the patients histories the LAST resort (in my experience) for AT LEAST 40% of GP doctors 30% of specialists (OTHER THAN PSYCHIATRISTS, who are worse see =>) and with 80-90% OF PSYCHIATRISTS whom, due to the lack of verifiable objective testing (blood, brain, immune etc) to use to HELP diagnose their patients in any MEANINGFUL (ah, ugh, DUH: ACTUALLY USEFUL & EFFECTIVE) way due to the lack of these sorts of reliable objective tests, IT LOGICALLY FOLLOWS THAT LISTENING TO THE PATIENT AND GETTING AN ACCURATE CASE HISTORY IS THE ONLY TRUE RELIABLE AND RELEVANT MEANS A PSYCHIATRIST HAS TO FIGURE OUT WHAT TREATMENT PLAN IS BEST, SAFEST AND MOST LIKELY TO ACTUALLY TREAT AND IMPROVE THE PATIENTS CONDITION?
Am I crazy? A ranting lunatic to point this out? Or perhaps, if you take offense to what I said: YOU SHOULD NEVER BE ALLOWED WITHIN 30 FT OF ANY OTHER HUMAN BEING WHOM YOU MIGHT BE ABLE TO MISREPRESENT YOURSELF AS A HEALER AND HEALTH PROFESSIONAL TO.... because I am only stating what a larg-ish MINORITY of psychiatrists ALREADY KNOW about HOW their "specialty fails those that come to them for help... and what a much more inclusive MAJORITY of patients treated by these same doctors and "healers" KNOW AS TRUTH.

It is absolute nonsense to blast out the gates so self assured. It is ego and nothing else to discount the fact that many patients with a psychiatric illness (if studied would be at the VERY VERY LEAST 25%) choose AGAINST seeing a psychiatrist and instead go with a GP or PCP, & 85-98% COMPLETELY due to the FACT that their GP or PCP ACTUALLY LISTENS TO THEM AND TREATS THEM AS IF THEIR PERSONAL MEDICAL HISTORY IS RELEVANT TO THE TREATMENT CHOICES WHICH SHOULD AND SHOULD NOT BE OFFERED.

Both my own personal observations over a lifetime (which the numbers of my own experience all very closely related to the AVG numbers of others whom I have asked to break it down in this fashion of %'s between GP/PCP, specialties -other than psychiatry- and psychiatric "specialists" & who they, THE PATIENT, felt treated them with the most respect, dignity and RIGHT to be involved in their own care) Alluded strongly to the FACT that psychiatrists DO NOT CARE ABOUT YOUR SUBJECTIVE... (yet medically documented & thus documented by 3rd party medically trained MD's or other staff, so, as close to objective as psychiatry at this point can achieve, fully verifiable)... Experiences OF WHAT MEDS HAVE HELPED, HARMED OR DONE NOTHING TO YOU, WHEN MAKING THEIR DECISIONS..... really? It is it as irrelevant as so many "professional """""HEALERS""""" CLAIM?

GET A CLUE

IF YOU ARE A PSYCHIATRIST

AND YOU EVER, as in EVER, roll your eyes at a patient who comes to you saying "I had to go thru the side effects, adverse reactions, let downs & LOSS OF INCOME of trying 10+ medication combinations before I found THE ONE that FINALLY gave me some relief, enough relief that I am willing to live with the side effect and I JUST WANT TO BE ALLOWED TO CONTINUE TAKING WHAT HAS WORKED FOR ME AND NOT BE PRESSURED INTO CHANGING MY MEDICATIONS UNLESS, HEAVENS FORBID, I GET WORSE AGAIN AND THUS HAVE A REASON OF UTTER COMPLETE DESPERATION TO RISK ADDING NEW MEDS THAT NO ONE CAN GIVE ME ANY TRUE FORESIGHT INTO KNOWING HOW POSITIVELY, INEFFECTIVELY OR HOW BADLY THEY COULD EXACERBATE MY CONDITION." Well my dear doctor (in degree and name, but not in practice) you are either a BURN OUT, a sociopath, OR A MALIGNANT NARCISSIST who as soon as they realize that their/your patient cannot fulfill their/your need to feel like this persons sanity and well being COMPLETELY rely upon your DESIRED & DELUSIONAL IDEALIZED SELF IMAGE of "being the godlike hero & dictator of their (the patients) sanity" by way of their(the patients) willingness (an ignorant, desperate & OFTEN ABUSED ignorance based willingness) to "bow down" to your ALMIGHTY treatment "suggestions" ... you dear doctor, might I suggest, ingest somewhere around 200 hits of LSD, follow that up with a good steady dose of an MAOI with a looong half life, smoke of DMT, then some salvia, and ingest enough THC containing food products that YOU WILL BE HUMBLED ENOUGH BY THE EXPERIENCE OF GETTING OUTSIDE YOURSELF, being forcibly hospitalized & "not being in control" that the next time you even THINK about rolling your eyes at a patient becuase they DARE threaten your sad, WEAK, pathetic little FALSE EGO, that you WILL VOMIT IN SELF DISGUST, refuse to charge us for the judgmental, useless and clearly demeaning session.

JUST SAYIN. Because SHORT OF THIS SORT OF DRASTIC ACTION:

YOU, your profession & its desirability amongst patients, and validity amongst EVERY other medical specialty ARE ALL LOOSING AT THE VERY VERY LEAST 25% OF YOU POTENTIAL PATIENTS TO GENERAL PRACTITIONERS, & WHY?....
.... Well, because with them we only have to take a 40% RISK that we are WASTING OUR INSURANCE BENEFITS AND COPAYS on PhRma sponsored dicks that ALWAYS try and force us to do things/try "great, new & safer" meds BEFORE we have been able to get enough information from them about the drugs they want to switch us to (often when we are already currently stable on the meds we are already on) for us to even give anything anywhere near approaching PROPER INFORMED CONSENT. Maybe with IQ And those patients, THEY DON'T SEE PSYCHIATRISTS: THEY SEE R-E-A-L doctors.
SO get the fuck over yourself.
It's OUR MENTAL HEALTH AND WELL BEING TO SAFE GUARD AND TAKE CARE OF FOR OUR OWN PROSPERITY IN LIFE, & those of us smart enough to make it even thru junior college KNOW what a sham you game is... & eventually, you might have to face us in the streets outside your homes as EVERY time another asshole with a god complex tries to fuck with our ability to function is one more straw on a camel's already strained back.

And YES, I DO mean in regards to those of us that have repeatedly run into this problem that it is those of us who have moved from our prior cities of residence &/or lost previous health insurance and are thus FORCED to have to find a new psychiatrist, (ie NOT dropped by a doctor due to some bs aside note of: "treatment non-compliance" or "combative attitude")... because the FACT of the matter is that no person, I don't care HOW "crazy" or CRAZY they are, would EVER purposefully end a doctor patient relationship with a psychiatrist who (THANK THE HEAVENS IF NOT GOD HIMSELF -if you believe that sort of thing) - a psychiatrist who JUST prescribes and monitors the CORRECT usage of the medication or combo of medications which have made that person as well as they can ever expect to be.

hmmmm, Yes, debate this: You psychiatrists are the specialists, and so far as my California HMO insurance is concerned I can see a new psychiatrist every week indefinitely, & can do so in order to try and find one that I can actually TOLERATE -AND & AND- also feel isn't just an incompetent douche that will rx anything I want without having RELEVANT UNDERSTANDING of the PSYCHO-PHARMACOLOGICAL aspect of his practice. ie., a doc with an ability for compassion for his patients AND some level of ACTUAL COMPETENCY IN HIS CHOSEN FIELD OF SPECIALIZATION... and whereas I can try out a new psych doc every week and ONLY CHANGE GP/PCP once a month MAX, I STILL USE A GP TO GET MY PSYCH MEDS. WHY? Because the GP/PCP TREATS ME LIKE A HUMAN BEING & DOES NOT, upon EVERY visit, try to FORCE (ie coerce by LIES about FACTUAL & EASILY OBTAINED & FACT CHECKED INFORMATION -you know like the TOTAL misrepresentation or lie about the info contained in the existing STANDARD PI sheets of meds being suggested - which is, I dunno, MAYBE THE EXACT OPPOSITE of informed consent, OR by THREATS of hospitalization, THREATS of contacting insurance companies and having my coverage dropped due to non-compliance -AKA pure abuse of a position of power & AND & harmful mental & emotional abuse of an already vulnerable population.... amongst OTHER THINGS which make me feel that if I just offered blowjobs up front I could make out with MUCH less emotional distress & rx's to the meds that ACTUALLY help me if I would just start every FACADE of an initial visit with a BJ, than to sit thru the fumbled, stumbled, idiotic session of ego masturbation and metaphorical pearl necklacing of my innermost being, only to be told "I'm sorry there is nothing I can do for you because of "EXCUSE EXCUSE EXCUSE"... as in "well maybe next time you shave your legs and we have a party, and maybe then I can help you.)
It's bullshit & I would think that ALONE, with his focus on psychiatry and narcissism would CARE to EXPLAIN this SAD STATE OF AFFAIRS FROM HIS OWN PERSPECTIVE... because as it is I am a nobody, and I am 100% fine with that so long as the people THAT I PAY GOOD MONEY TO BE A "SOMEBODY" ON MY BEHALF, under their ADVERTISING GIMMICK of being one dedicated to helping those who truly are SUFFERING from mental illness, ACTUALLY COULD GET THE FUCK OVER THEMSELVES & THE GAME OF EGO MASTURBATION THAT IS THEIR PERSONAL LIFE JUST LONG ENOUGH TO EVEN APPROACH BEING ABLE TO BE A PROFESSIONAL AND PROVIDE THE SERVICES I PAY THEM TO PROVIDE.

But hey, If you want psychiatry to be a thing of the past, 100% replaced by genomic profiling, imaging machines and GP/PCP's just as qualified IF NOT MORE SO to interpret the results of these tests AND TO MAKE THEIR PATIENT FEEL AS IF THEY ARE A VALID HUMAN BEING DESERVING OF BEING TREATED WITH RESPECT, and for psychiatry, YOUR CHOSEN "specialty" TO BECOME A DISCARDED THING OF THE PAST, well then.... DON'T CHANGE A THING! and you will see that within one dozen or perhaps just a decade years passed our current age:
YOU - PSYCHIATRY - WILL - CEASE - TO - EXIST - AND - EVERYTHING - ANY - FRAUDULENT - SOCIOPATH - MALIGNANTLY NARCISSISTIC - DICK WILL BE LEFT COLD AND WORTHLESS TO A SOCIETY WHICH OUTGREW YOUR CHILDISH CHILDISH PATHETIC LITTLE EGO GAMES

And people wonder why I would say I would rather give a good honest decent blowjob and have a psychiatrist that would have a REASON to take my case history into account above and beyond the suggestions made by the phrma reps who are NEVER going to actually blow them.... really? Are you that far in DENIAL that you cannot see how a patient would be willing to give up just that much dignity in order to be ALLOWED by a psychiatrist to JUST STAY ON THE MEDS THAT ARE WORKING FOR THEM, and to not try and FORCE the patient change anything UNLESS the patient becomes unstable on the current meds first. ... ???

IF YOU CAN'T UNDERSTAND IT IS BECAUSE YOU ARE IN DENIAL, OR OUT OF TOUCH, OR BOTH, WITH THE REALITY OF WHAT YOUR PATIENTS GO THRU TIME IN AND TIME OUT WHEN YOU "ROLL YOUR EYES" AT US AS IF WE OURSELVES HAVE NOTHING PERTINENT TO ADD TO THE CONVERSATION OF OUR OWN MENTAL HEALTH.

The offer still stands.
email me
[email protected]

I have always said that I will take an honest punch to the face over a knife in the back any day of the week.... in this case, I'll take and honest load blown in my face over a dishonest dance of narcissistic SADISTIC power & control games over my mental health any day of the week.

Course I know no one with a license and Rx pad will take me up on that offer cause you're all too scared covering your own asses... but the point remains: YOUR FIELD OF "SPECIALTY" WITHIN MEDICINE IS SO EXTREMELY fucked up that if any one of you were not just trolling loosers but legitimately willing to take up such a offer, I would jump on it right quick, and I don't even enjoy giving blowjobs anymore.... I just happen to enjoy giving blowjobs (about as much as changing a shit filled diaper and having it discharge its load across my face) MORE than I enjoy the GAMES, PRETENSES and utter and complete BULLSHIT of trying to find a psychiatrist that isn't just a coked out, empathy lacking, power tripping, mentally and emotionally abusive WASTE OF TIME AND MONEY where I don't even end up with my EFFECTIVE FOR EIGHT YEARS med cocktail being Rx'd for having bothered.

Yours, sincerely, chick in central Cali willing drive 3 hrs each way JUST to get a doctor who isn't a worthless phrma/secretly-supressed-victim-of-their-own-self-loathing + can SHUT THE FUCK UP and rx the meds I KNOW WORK FOR ME & NEED TO FUNCTION, unless the meds stop working and I have to try something new.

UGH!

June 7, 2014 4:37 AM | Posted by Eat My Silky Psychotic Snatch... "Doctor": | Reply

Seriously

WAKE THE FUCK UP ALONE AND WRITE ABOUT THIS TRAVESTY.
YOUR COCK HAS METAPHORICALLY PROVEN CAPABLE OF CREATING MYTH OF IT'S OWN STURDINESS HERE IN THIS BLOG THRU YOUR RUTHLESS HONESTY REGARDING THE FIELD IN WHICH YOU PRACTICE.
... can even you not start a conversation that betters the lives and likelihoods of positive outcomes for patients?
OR
Is it as I have feared, you yourself are a narcissist, one who uses anonymous blogging to NOT stand up for the patients you treat (because truly how could they ever matter to a narcissist?)but simply to flaunt your colors and peacock while being too weak to ever tackle the harsher realities?
Or is that up to "others" those of us that no one follows or takes seriously because we are the insane, and the insane tend to make either brilliant yet unreliable bloggers, or suffer from hypergraphia to an extent it makes all our valid points mute in a sea of banality.

In the last eight years I have followed you I always thought it comical and a sign of your supremacy in intellect that you could leave every other psychiatrist with at best a semi-chub, oh so wishing you could achieve a full hard on dick of the quality and endurance of your own (metaphorically of course as I lack hands on experience with either your own, or any commentators chub, or for that matter any commentators silky slit, worthy of praise.

I don't mean to offend, but sometimes to gain attentions, well, you made your game a public affair. So, ALONE, & your faithful followers... what is the price to admission to truly play on your turf?

I, as would surely millions of other patients, could appreciate more than Mozart, any efforts made to out the HORRORS of bedside manner, amongst other things mentioned, in the way that only one as skilled, sarcastic and insightful as you yourself can deliver.

June 7, 2014 4:40 AM | Posted by Eat My Silky Psychotic Snatch... "Doctor": | Reply

OR, you can just shoot me a dick pick... Whatever. I'm bored and pissed. I'll imagine hate fucking you until you explode in a supernova of sexually ecstatic self destruction

June 7, 2014 10:36 AM | Posted, in reply to Anonymous's comment, by jonny: | Reply

It is absolute nonsense to blast out the gates so self assured. It is ego and nothing else...

That's what gives their scam away. No one who is competent has ever, in all of history, ridiculed or belittled or became hostile towards a frightened patient who nervously asked questions before taking drugs to alter their brain chemistry. There aren't many emotionally stable psychiatrists. They do NOT like being asked questions. I couldn't remember where I'd come across their type before, then it hit me; they're like priests.

Alone's well aware of the situation. He's written a lot already, this blog has a decade of posts. Another site you'll like, I think, is the brilliant Daniel Merckler's blog. Daniel was a psychotherapist for a decade and he has only contempt for the corruption / incompetence in the industry.

June 7, 2014 3:43 PM | Posted, in reply to jonny's comment, by Eat My Silky Psychotic Snatch... "Doctor": | Reply

LOL. You're right! They are like priests that way (well catholic priests). I never would have clued it up myself because I haven't had much use or experience with priests partly because of this very issue with the attitude, and partly with my being a non-religious sort (spiritual yes, religious no) I've not had much reason to keep bothering with them unless it was for help with a religious family member or out of curiosity. I have to say though I have had a few encounters with rabbis of the Jewish religion and they were very open in discussing philosophical questions.

Thank you for the blog link, I will check it out.
I'll also check out the archives here. See what I find. It's likely I have missed some things alone has written and am raging on a bit unfairly. Mostly I'm just venting due to yet another encounter with psychiatric incompetence and this blog always seems to offer the more entertaining and useful responses than many of the other mental health/psychiatry blogs out there. Seems there tends to be a higher quality of intellectual capabilities amongst the readers of this blog.

June 8, 2014 5:47 AM | Posted, in reply to el puerco's comment, by paddleship: | Reply

If its impossible to infer tone or emotion or anything else from a written post then why the fuck are you spending paragraphs analyzing the character and motivations of some random dude based on exactly that, some completely banal exchange on an internet forum?

June 8, 2014 7:47 PM | Posted by Samson J.: | Reply

I have not read through all the comments, but skimmed most of them. I apologize if what I'm about to say has already been mentioned.

The OP makes a number of good points, yet ultimately comes across as a bit sophomoric. To be frank, the article sounds like it was written by someone young, perhaps still a naive resident; someone who isn't cynical enough and hasn't yet been disillusioned by "the way things really work".

As a physician myself (not a psychiatrist), I can say that I agree that the CME system is broken and stupid. I agree that we should simply be trusted to maintain our skills. But - we aren't. The "public" wants to know that we are self-policing; self-governing. The purpose of the CME system is so that we can tell the public, who don't know anything about medicine, that we have the capability to remain self-governing.

"Look! We're self-governing! We even MAKE OUR PHYSICIANS do EXTRA LEARNING to make sure they don't become incompetent!!" The public doesn't have to know (as indeed they don't know) that this system of physician verification doesn't really work all that well. If it's a charade, well, that's the price we pay to have the public leave us alone. That's the real reason we do CME. I'm surprised that a seasoned physician would not realize this.

June 8, 2014 8:40 PM | Posted, in reply to Samson J.'s comment, by Anonymous: | Reply

*Sigh* Resident, eh, you presume? The author has been (FACT) faculty at a certain number (read: at least one) of the United States' 141 AAMC institutions.

The purpose of the CME system is so that we can tell the public, who don't know anything about medicine, that we have the capability to remain self-governing.

Why is this necessary? Bonus points if it's from a legalistic perspective.

June 9, 2014 3:28 PM | Posted, in reply to Anonymous's comment, by Pelt: | Reply

Because it makes lay-people relax a bit I guess.

Seriously, my profession (engineering) does it as well. We have special accreditation for institutions that pass a minimum set of requirements, and a special exam to make sure people are ethical before we let them take responsibility for a design (stamping). And sometimes another special exam that makes sure we're good enough at actual engineering to be engineers.

But the thing is that an institution will basically make a conscious choice as to whether or not they even want to be accredited (a college probably wouldn't for example, so they can have lower entrance requirements and tuition) and once you get it, there is minimal effort involved in maintaining it. It turns into a survey we have every six years (if I recall) that basically says "grades high enough?" "Yup" "tests hard enough?" "Yup" "Curriculum changed at all since last time?" "Nope" "Good to go, see you in a few years."

The ethics exam is probably the most clearly useless part. Anyone smart enough to get through four years of schooling on engineering topics is smart enough to lie when responding to an ethical question. The test basically checks your reading comprehension and nothing else. The practice exam is alright I suppose, although it tests textbook questions and not real life ones. It's one thing to design a building on a fully explored, well understood patch of land with a single contact and clear requirements, but in real life that happens like 10% of the time and the non-standard situations are where all the people die anyway.

But we do it anyway because it is really important that the public trusts us. Doctors are pretty inefficient honestly, they can kill maybe two people at once, we can take em out by the busload on a bad day. So we have to add stuff in to reassure the public at large that we are trying to avoid murdering large batches of them. Not that they would DO anything if they felt they couldn't trust us, after all I doubt the odd sinkhole has convinced people in the states not to use roads. What it DOES do is keep people from going to Shady Estivans Building Design and Car Wax shop because there is a perceived (and no insult to Estivan, but I hope to god real) difference in quality and safety of design. The more exams we add the more legit we look, even if Estivan is a really cool dude and his designs are absolute bargains.

June 12, 2014 1:23 PM | Posted by MedsVsTherapy: | Reply

Regarding the TLP identity question and answer: I don't think the answer(s) alluded to in these comments is correct.

I do think there was an indicator in a post several years ago. It was not obvious.

I am not gonna give my opinion about who TLP is because as long as I have special knowledge, whether accurate or not, I have some trumped-up reason to feel special about myself.

Actually, I just don't want to discourage TLP from blogging. I believe he is totally accurate regarding the role of disability benefits in our society. Also, some of the psych receptor stuff has been great.

In the 1950s, as everyone kept developing labor-saving and time-saving machines, futurists speculated that "we" all would eventually have to work very few hours each week in order to enjoy a decent quality of life.

That has come true. But not quite as dreamed.

TLP's posts have helped me see how this political system has worked out, and how everyone's support gets elicited.

So, I want to hear more. So, I won't reveal my opinion of TLP's identity.

June 12, 2014 1:28 PM | Posted by Anonymous: | Reply

To the Anonymous who keeps posting about not being able to get the meds she wants:

I may have missed this, but can you disclose what those meds are?

In one of my varied positions working in mental health, we had a client with a psych history and we decided the most opportune diagnosis we might apply wold be "bipolar disorder." He had a history of raising calamity that kind of fit that dx.

He had tried lithium and would not adhere.

He argued that the best med would be to just prescribe him Valium. We could give him a week at a time, he said, and we could pill-count him somehow, and have his significant attest to proper use.

Somehow, we eventually did this. As far as I was in this situation of monitoring this guy's care - I believe well more than six months - he did just fine.

But that was a rare case for us in this psych outpt care setting.

June 12, 2014 2:17 PM | Posted by Anonymous: | Reply

If its impossible to infer tone or emotion or anything else from a written post then why the fuck are you spending paragraphs analyzing the character and motivations of some random dude based on exactly that, some completely banal exchange on an internet forum?

Why the fuck indeed? Why the fuck?

I could answer your fuck-laden question if its premises were accurately describing what I'm doing here. But it's not, so I can't. Please continue to read my mind from afar, as you're obviously inerrant when doing that.

June 12, 2014 2:21 PM | Posted by el puerco: | Reply

that was me directly above ^^^^^

but anyway, I agree with this:

In one eye, out the other...

June 13, 2014 8:26 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I'm not the person you've been having this back-and-forth with, but judging by every single one of your comments, it's become clear that you're either a really bad troll or just genuinely an idiot.

One instance of "fuck" doesn't really make a post "fuck-laden". And he is describing exactly what you're doing, whether you realize it or not.

June 14, 2014 10:27 AM | Posted by el puerco: | Reply

Thank you for your sock puppetry version of looking in the mirror and telling the reflection that he/she/it is: (choose one)

* smart
* funny
* clever
* sexy
* king- (or queen-)like royalty embodied
* the ultimate arbiter of Internet Truth

It would appear you have chosen the last pick. Congratulations. You have convinced yourself that your view is the only view worth reading. This is a healthy narcissistic response to ego-bruising, ego-fracture, or other ego-trauma. But mind the contours, sometimes narcissism can be socially destructive.

And isn't that a fine irony?

June 14, 2014 6:41 PM | Posted, in reply to el puerco's comment, by Anonymous: | Reply

Ah yes, the good old attempt to discern motive and emotional/psychological state from an internet comment.

Funny, I swear to god someone was just bitching about people doing that in this very thread...

June 16, 2014 12:12 AM | Posted, in reply to el puerco's comment, by Rob: | Reply

I'm not sure who you're accusing of being a sock puppet, dude, me or paddleship or the Anon or all three, but I can promise you I haven't posted in this thread for over a week. My last post was the anonymous one on June 6, 2014 12:52 (I also forgot to enter my name.)

June 16, 2014 5:14 PM | Posted by el puerco: | Reply

Ah yes, the good old attempt to...

You got that much correct. Well done. Unfortunately, the remainder of your comment is just doing a yeoman's job of ironic over-investment in an accusation made. I suppose you might earn 1 comedy point for that, but please be reminded that we award such points on a 0 to 100 scale, per comment. We regret having to be stingy with our points, but in the absence of such standards we find the humor degrades quickly to a subjuvenile level while at the same time such comic deficiencies are over-saturated with tones reflecting hubris.

If that's your goal, though -- perhaps you'll earn a blue ribbon.

June 16, 2014 5:18 PM | Posted by el puerco: | Reply

I'm not sure who you're accusing of being a sock puppet

Well if you're not sure, why assume the mantle as if solidly and directly accused of it?

Assuming the victim role suggests you're guilty of it, or suggests you'll eagerly adopt the victim stance when it proves advantageous for your attempts at self-righteous lecturing of others who have, in your paranoid mind, accused you of something. But it may be strategically wiser to simply step back and let those who are playing the puppet's game feel the accusation sincerely.

June 16, 2014 8:13 PM | Posted, in reply to el puerco's comment, by Anonymous: | Reply

Sorry, not going to subject myself to reading your transparent ego defenses. Figure it out in silence.

August 6, 2014 8:13 AM | Posted by John Peter: | Reply

I do assume there was Associate in Nursing indicator in a very post many years agone. it had been not obvious.

August 16, 2014 8:50 AM | Posted by Anne Clark: | Reply

No mention of the PIP requirements? It's clear that even the ABPN has trouble figuring out the usefulness of this (note how many times they've moved the target)!

August 19, 2014 12:09 PM | Posted by Anonymous: | Reply

When I grow up, I want to put out fires, not start them. On my spare time, I'll nurse, not curse.

August 20, 2014 3:23 PM | Posted by John: | Reply

First I'd like to say that I love your insights and writing style. Don't you think you're about due for another post/article? Do one about the ALS ice bucket challenge and narcissism!

August 21, 2014 7:48 PM | Posted, in reply to John's comment, by johnnycoconut: | Reply

I'd say this is an example of good narcissism because of all the money raised and lives that can be saved now. That said, I haven't done the challenge or donated (my excuse is that I lacked the resources), so I guess that's a different kind of narcissism on my part

August 29, 2014 10:12 AM | Posted by Maroon: | Reply

Author received undergrad degree from University of Chicago sometime in 90s and is female.

Of all schools, she mentions Chicago the most. And Chicago is one of the few schools that teach this in-your-face don't-fuck-with-me writing style. Met a lot of female Chicago grads who write with similar rhythme, tone, flow.

August 30, 2014 2:58 AM | Posted, in reply to Maroon's comment, by johnnycoconut: | Reply

Interesting guesses!

August 30, 2014 11:44 AM | Posted, in reply to johnnycoconut's comment, by Maroon: | Reply

And she's Asian.

Guessing English Lit major, followed by law school?

August 30, 2014 6:22 PM | Posted, in reply to Maroon's comment, by Lupus: | Reply

Damn, not even a psychiatrist?

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August 30, 2014 7:48 PM | Posted, in reply to Lupus's comment, by Anonymous: | Reply

It's easy to spot that Alone in a sense is a force for goodness and progress.

With more distance to _current_ events it would be easier to expand on it. It's not black and white. Hoping for new legislation soon, a new code. Current legislation is old school. It's not fair.

Now, do me a favor.

August 31, 2014 7:49 AM | Posted, in reply to Anonymous's comment, by jonny: | Reply

Now, do me a favor.

Aha, nice try. But the favour was done for you by allowing you to do us a favour.

You still owe us for that.

September 1, 2014 9:02 AM | Posted by Anonymous: | Reply

I have been following the Certification Industrial Complex and the regulatory capture of medicine for some years now. I have recently embarked on the issue of Conflict of Interests and journal publications, which may be of interest to you as well. Prime example is the this article from JABFP (http://www.jabfm.org/content/27/3/383.long), which is Pubmed indexed although it is clearly a proprietary publication of the Am Board Fam Practice. Many such "peer reviewed" journals including Academic Medicine are published by the corporate sponsors of this "testing" industry. Please see the referenced PDF for proof- I have contacted JABFP directly with a letter for publication and have been simply "blown off" after they acquired self-serving "peer review":

As the paper stated (1):
“From: …. and the American Board of Family Medicine, Lexington, KY (LEP, JCP).
Funding: none.
Conflict of interest: none declared.” (1)
James C. Puffer, M.D. was identified as Senior author. (1) He is also known to be the current President and Chief Executive Officer of the ABFP and the EXECUTIVE EDITOR of Journal of the American Board of Family Medicine. Dr. Puffer earned between $607,885 (2011) and $699, 831 (2009) from the ABFP as disclosed on the respective corporate IRS 990 forms (part VII).

It is further very clear that in the USA, corporate certification is a widespread reality for all of us. You cannot buy a stereo without the Underwriter's Laboratory "UL" pasted on the side and THEY do not physically evaluate all products. From Angie's to Criag's list and multiple physician review sites living off of advertising space we find"referral/certification" rampant throughout our society and at great cost to the public. In Europe, professional and industrial certifications are greatly limited and often limited to government sites that are accountable. The international journal "ethics organizations" are "paper Tigers" and have no recourse except to refer complaints back to the editors who committed them (www.icmje.org.) Self serving publications from the corporate side like JABFP appear to present "science" as peer reviewed journals-but publish opinion/advertisement as fact!!!
Perhaps it is time to review the industry of certification because of the huge financial drain throughout the whole American economy (crane operators to massage therapy) (easily $800 million a year for medicine alone!), because it duplicates the whole licensing control of government agencies.
Perhaps we should all drop the white coat and join the army of carpetbagging leeches "certifying/advertising" just about ANY aspect of American life for BIG profits as our enterprenual objectives!

I look forward to comments from the USA and abroad! Please correct me where I am wrong/off target!

September 11, 2014 6:54 PM | Posted by Shick Ahgot: | Reply

Of all schools, she mentions Chicago the most. And Chicago is one of the few schools that teach this in-your-face don't-fuck-with-me writing style. Met a lot of female Chicago grads who write with similar rhythme, tone, flow.

Confident provocation isn't the exclusive domain of Chick-a-go-go, it's something you can pick up without even going to college or grad school. Aside from that, anyone who can write halfway well should be able to imitate writing styles of others, and/or imagine him/herself as a different person and write in-character.

Your Chicago guess is like this: A person (let's call her Solo) goes to St Louis MO on business and visits a pub where she samples breaded, deep-fried jalapeno pepper rings. The waiter tells her this appetizer is a specialty of the pub and more broadly a specialty of St Louis MO cuisine. Solo ends her business trip and returns to Scotts Bluff NE. Several weeks later, she attends a dinner party in Scotts Bluff to which she was invited by her date, the dinner party is hosted by someone Solo doesn't know -- but her date does.

At the party, during the dinner, Solo asks her hosts if they are from St Louis, claiming "I assume you are, since you served breaded deep-fried jalapeno rings as appetizer and I know those are a St Louis specialty." No fewer than 3 other guests pipe up to say they have eaten such rings at various places around the nation. The conversation continues to reveal that the hosts are not from St Louis nor have they ever been there.

Solo's error was in believing the pub waiter who gave the spiel about specialty rings and St Louis cuisine, and further, in locking into that spiel as the only version of reality. Solo hadn't ever eaten such rings previously nor seen them anywhere. Her conclusion isn't exactly stupid, but it's not very informed or holistic either.

That's what your Chicago conclusion is like. Worse, it's not edible.

September 14, 2014 12:29 AM | Posted, in reply to Shick Ahgot's comment, by johnnycoconut: | Reply

lol

That's actually hilarious. I think I love you.

September 17, 2014 10:31 PM | Posted by anenemyofthepeople: | Reply

Overall this post seems valid but something made me pause.

¨The astonishing truth is that despite millions of dollars and hundreds of academic careers psychiatry has made no progress in almost 20 years, let alone ten, a claim no other medical specialty can make,¨

Ok. Can you show us some empirical evidence? Site any sources other than your own opinion?

November 11, 2014 4:39 PM | Posted by : | Reply

Homosexuality.

It has crossed my mind how much weight and attention many christian communities throw on it. Not just homosexuality, but sex in general.

Would you mind if I posted "Homosexuality and Christ for dummies"?

November 11, 2014 4:44 PM | Posted by : | Reply

It entered my mind a while ago. I'll be honest: it was at a meeting at the academy.

It's not just "christians". Humans in general. Religions people aren't more human than others.

November 11, 2014 5:47 PM | Posted by : | Reply

It's easy. If you trust the signal from Christ through his representatives, heterosexual monogamous relationships is best for you. If someone prefer something else, it is none of no-ones business, which is also clearly signaled.

I'm struggling here - what more is to say about it?

The apostles was trained yes, inspired yes, but it still is their personal version of the same powerful message. Some of the letters are written in a particular context. From what I've heard Paul had to deal with situations...out of the ordinary. When Christ, or his representatives, say "do this" or "do that" it is never because "I said so" - the intention is your well-being.

Why is heterosexuality best for you?

I honestly don't know.

November 11, 2014 5:55 PM | Posted by : | Reply

It's interesting though, the attention sex draws, both within religious communities and secular media inclusive social media.

Humor, ads, metaphors, even in politics sex seems to play a role although sometimes it is subtle, I think.

November 21, 2014 4:45 PM | Posted by Child: | Reply

If we're going to discuss moral/mental health, I'll say out loud what you are already thinking:

Free will is the ability to take the decisions which serve your best interest. It's obvious, isn't it?

It fits. We desire good things for ourselves, all of us. We try, and fail - either because we don't know how to, lack of knowledge, or because we're being influenced, controlled, dominated.

November 22, 2014 2:39 PM | Posted by ServileSelfless: | Reply

I don't want to believe it, but think there are some individuals out there who basically has lost their independence completely, their will. In worldly terms it might be "powerful" individuals, or not. They preach a gospel of strength and independence but are themselves completely subjugated. It's a matter of training, I believe.

November 22, 2014 9:48 PM | Posted, in reply to ServileSelfless's comment, by johnnycoconut: | Reply

Thank you, [Nicknames]! I've been thinking about similar things, and I find this helpful.

There's so many judgments that are inherently moralistic, subtly or not--when really one could evaluate morality from first principles.

November 22, 2014 11:12 PM | Posted by Division: | Reply

I wonder whether it will stay true, the perception that some have crossed a point of no return, that nothing can help them to start desire independence.

I hope God plan to exterminate them without my help.

November 23, 2014 9:10 AM | Posted, in reply to Division's comment, by johnnycoconut: | Reply

Is that an ephemeral wish?

November 26, 2014 1:51 PM | Posted by Caretaker: | Reply

Question. Do you really believe a spiritual war can be won merely by words on the internet? I mean, if it for example controls internet, and it feels threated enough, it will simply make virtual adjustments as necessary.

It might merely be a technical error, but some funny stuff is happening to my facebook account (not to mention my blog stats). Not that these individual cases necessarily imply something about the general case.

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July 23, 2015 1:31 PM | Posted by Dr Radium: | Reply

I used to be one of the academics working in this field so I can say with considerable certainty that:
"The astonishing truth is that despite millions of dollars and hundreds of academic careers psychiatry has made no progress in almost 20 years, let alone ten, a claim no other medical specialty can make, and the truth which cannot be spoken out loud."

isn't true. No progress in 20 years? More like 30 or 40yrs.