No, it’d be the Orange Cube.

It was so zoomed in and cropped that I thought this was one of those weird corner scenes in a Bosch tryptic.

I think I need to boil this down a bit. Some people lack the emotional intelligence and personal convictions to make meaning for themselves. This is not a bad thing. I do not think less of people for having shortcomings compared to others, I see it only as variance between people. Just as I do not think less of my patients with diabetes or heart disease or substance use disorders, I do not think less of people for not being able to adjust to sudden changes in their lives with perfect poise and rationality. Everyone has differing strengths and weaknesses, and there is no shame to be had for any of them.

For your argument about choices in life: There are many American children and young adults that pick their education and future career based on external influence/instruction or necessity rather than actually choosing for themselves. Most of the people I know that joined the military out of high school did so because they would have been homeless and unemployed if they didn’t. (I graduated high school in 2009, by the way). So there really isn’t all that much in the way of true free will in this country unless you come from a wealthy family or take on a lot of risks and debt forging your own path. This isn’t even touching on the rampant propaganda in our youth telling us that we will amount to nothing without a college degree.

For the point of being a physician in a post-work world, a lot of people are trying to replace physicians with AI despite the fact that these overgrown algorithms simply do not have the capabilities to do the job properly…but it’s not like they’re taking that into consideration for any other jobs/professions either.

The discussion is not centered around a post-work world that people have grown up in. This is a discussion about what happens to hundreds of millions of people when the fabric of their lives changes suddenly because the vast majority of people alive today have grown up and lived in a reality where their life is functionally defined by work. I’m not saying that this is a good thing, but it is the reality of the situation. Most people are not comfortable enough to sit with themselves and decide who they are as a person and figure out their real internal motivations because the necessity of work has made it fairly easy to avoid doing that difficult work.

It isn’t a pleasant opportunity, but the experience of being left rudderless, of having to sort things out on your own without a script or a clear path forward is one that many people don’t get, and one that many others fail to seize upon. There are enough people, particularly in America, that have been just comfortable enough to never have to really think about back up plans or contingencies for what to do with their life in the absence of its current structure.

And there are many reasons why people may not have the wherewithal to find meaning in their lives. Some people are so focused on survival that meaning hasn’t even occurred to them. Others are depressed or traumatized or otherwise miserable and it’s hard to find meaning in blinding pain. Some people have been spoon fed meaning by way of work since the day they were born and literally do not know any other way to exist. Personally, I was stuck in a blend of these things when I was still working in tech and it was in the throes of abject despair that I finally forced myself to make the changes required to pursue my life’s meaning through work as a physician. Getting into and through medical school has been a brutal process and it has been immensely painful to try to imagine alternatives after the amount of work I’ve put in to pursue this goal. I’m now within 6 months of graduating and will be starting residency next summer, but it won’t be in the specialty that I had hoped (and that I had already staked a piece of my identity to). I’ve suffered more hardship than many, but I have also been more comfortable than plenty of other people, but I would find a great deal of turmoil and misery trying to restructure my life without being able to work as a physician (and that’s not even getting into the financial nightmare of my student loan situation.)

If society really collapsed, and for some reason the post-society world didn’t leave space for me to be a physician or a healer of some kind, I would probably figure it out…but it would be so incredibly painful to do so. It would be horrible to give up on everything I have worked so hard for to have to replace it with whatever I could manage and I would be unlikely to be happy with whatever that solution ended up being for a long time until I finished grieving what could have been, because that’s what this process is. Losing everything you’ve structured your life on is a form of grief and not everyone is equipped to handle that grief gracefully and effectively while being able to carry on with their lives.

So it must be that others are capable of that too, right?

People are capable of a great many things, but most people do not accomplish everything they are capable of.

I look at it this way: hypothetically, everyone is capable of running a marathon…until you consider that most people have not had the time, resources, or opportunities to train for a marathon, or are out of shape, or have physical injuries or disabilities, or they just don’t have time to train for and run a marathon. I don’t see it as “empathy” to assume that everyone is capable of the same things or that everyone has had the same opportunities that I have. If I expected everyone to have the knowledge and experience that I have sought out and worked for, I would be an atrocious physician because I would just assume that my patients were “non-compliant” instead of understanding that there are barriers that prevent people from achieving the things they want or need to do.

This is the difference between “Equality” and “Equity”. “Equality” gives everyone the same resources, assumptions, and expectations, regardless of where people are starting from. It’s the top-down approach. “Equity” is the bottom-up approach where you adjust resource allocation, alter expectations, and make educated assessments instead of assumptions to try to get everyone to the same end-point.

“Equity” is justice is how we build a better world. “Equality” is when we assume that everyone is capable of everything that we are, regardless of the barriers that others may face. It is not pity, devaluing, or dehumanizing to recognize that some people need more help than others. Not everyone is actually capable of everything, and we succeed as a society when we work to our own strengths and help to cover each other’s weaknesses.

Your allegations of “intellectual laziness” are evidence of a lack of understanding of or empathy for the mental state of many (if not most) people. There are billions of people alive today that don’t have the mental framework to cope with this kind of change because our education systems are abysmally incapable of teaching people how to think critically, structurally, and existentially.

But occasional use for moderate pain is quite reasonable and people should not be afraid to take medications at the doses and frequency listed in the instructions. For those with liver or kidney problems, listen to your doctor about what medications to avoid and what to use in their place, but don’t suffer unnecessarily.

Taking these meds once in a while is perfectly safe if you don’t have preexisting organ damage or dysfunction.

It’s quite hard to actually overload your liver with the artificial sweeteners unless you are drinking literal gallons of zero sugar pop a day or eating nothing besides artificially sweetened foods. The stuff is used in such tiny concentrations that someone would have to deliberately seek out overdosing on this stuff to get the same effects as the experimental animals are getting (because the experimental animals are being fed pure sorbitol in doses that no human could reasonably consume.)

That’s the problem with articles like this is that they don’t emphasize that they are only seeing this in animal models and they don’t disclose just how much of the stuff they had to give to the animal for the negative effects to occur. It’s also a bad study because it doesn’t account for the differences in the physiology and biochemistry between humans and zebrafish, nor does it account for the confounding factors in humans. You know who drinks and eats a lot of artificially sweetened things? People with diabetes and people who are trying to lose weight. These are people that are likely to already have fatty liver disease and the sorbitol didn’t really have much to do with it.

Copied from another posting of this article:

The headline (and the article for that matter) are very sensationalist and I don’t think they’ve presented this in a balanced way. They are discussing how sorbitol behaves in zebrafish with limited data presented on human biochemistry, and they discuss it in a vacuum without quantifying the amount of sorbitol it takes to cause a problem. Yes, any substance in excess can be harmful, but the amount of sorbitol in food compared to the amount of high fructose corn syrup makes it the substantially lesser evil. The artificial sweeteners are vastly more potent than actual sugar, so you don’t need very much of it to get the same amount of sweetness. High fructose corn syrup is used in massive amounts in food and is much worse for you on the scale that either substance would be consumed.

The headline (and the article for that matter) are very sensationalist and I don’t think they’ve presented this in a balanced way. They are discussing how sorbitol behaves in zebrafish with limited data presented on human biochemistry, and they discuss it in a vacuum without quantifying the amount of sorbitol it takes to cause a problem. Yes, any substance in excess can be harmful, but the amount of sorbitol in food compared to the amount of high fructose corn syrup makes it the substantially lesser evil. The artificial sweeteners are vastly more potent than actual sugar, so you don’t need very much of it to get the same amount of sweetness. High fructose corn syrup is used in massive amounts in food and is much worse for you on the scale that either substance would be consumed.

What on earth do you have against paragraphs? I don’t want to read your comments just based on the formatting, let alone the actual content.

Responding to the content though: In this situation, this woman was being social at a bar with her friends. Women existing in public is not an open invitation to bother them and being unable to read social cues is probably a big part of Anon’s problems with women. Women utilize a great deal of non-verbal communication and not being able to read that or refusing to even try is a great way to plaster oneself in red flags.

I don’t think this will be a conversation you will be able to have with him, but it’s probably something you need to have for yourself for your own sanity. There is the adage that “your mental health is not your fault, but it is your responsibility”, that I think is very applicable here. I know that the manifestations of his mental illness at this time are damaging your quality of life, but I think that you are suffering additional, semi-self-inflicted harm by internalizing any amount of responsibility for his behavior. It is a bit like intentional cognitive dissonance, but I think you would benefit from divorcing yourself of any sense of responsibility for fixing this situation.

There are some good suggestions in this thread about strategies for set cleaning times with reference images of what each room is supposed to look like, and to some extent, mild parenting techniques to get some sense of order in the house. If I were in your shoes, this is the list of things I would try to implement:

• Set deadlines for cleaning tasks

    - ("dishes must be done by PERSON by end of DAY" or "living room must be clean of personal items by 10PM every night)
  

• Make a list or a calendar on a whiteboard in the kitchen

    - (columns for days of the week with check boxes for needed tasks and written communications instead of verbal)
  

• Clear delineation of responsibilities

     - ("you make the mess, you clean it up" or "wash/put dishes in the dishwasher immediately when done using them or before bed that night")
  

(The strategy for dishes can be variable, I just feel like dishes are a good example for figuring out household responsibilities.)

Also, make it clear that his actions are harming you. It may feel dramatic, but it’s true. And I think a way around the bluescreen issue is to write a letter explaining your needs and how his actions are affecting you. I would recommend hand-writing this because it will appear more personal, and be less easily dismissed. Putting it in writing makes it so that he has a physical object to refer to when his mind tries to edit out the uncomfortable thing. But still give him the letter in a conversation. I would start it with saying:

“Hey ____, I’ve tried to talk to you about this before, but I don’t think I’ve been communicating with you in a way that works. There’s some things going on in the house with your cleaning habits and behaviors that are really messing with me and it’s putting me in a bad place mentally to have the common areas this messy all the time. I know these conversations can be really overwhelming for you, so I wrote this letter for you to read when you’re ready. Please come talk to me after you’ve read it so we can work out some strategies to make living together more comfortable for everyone.”

This is my advice from having had difficult roommates and friends that don’t deal with their mental health, and from the perspective of a medical professional. I’m a medical student, but I’ve done a lot of work with mental health and substance use disorder patients and I always try to work with folks to find strategies that work for them to improve their quality of life. I see medications as an adjunct to building accommodations for oneself, but I always emphasize that the medications are exactly the same as medications for things like high blood pressure. For some folks, there’s a physiologic dysfunction that you can’t “life strategy” your way out of, and you just need to get the chemicals in your brain to behave properly so you can function.

(This ended up longer than intended, sorry for the essay)

Normally I would agree with you, but OP is living in the environment created by the roommate’s symptoms. This is obviously uncontrolled or, at best, extremely poorly managed mental illness and it is not reasonable to expect OP (who is this person’s roommate, not explicitly a friend, certainly not a family member, and definitely not a partner) to sacrifice their own wellbeing in deference to this person’s dysfunction.

OP obviously has empathy for this person, but is clearly at the end of their rope, and your pontificating and language policing from the outside doesn’t actually help OP or the roommate in any way. I work in medicine, I deal with a LOT of mental health patients, and your comment here doesn’t read as any kind of advocacy for people suffering from mental illnesses, it just reads as virtue signalling or sanctimonious tone policing.

They once tried to prove that DNPs (Doctorate of Nurse Practitioner) was just as good as an MD or DO education. They did this by taking the top DNP grads from the best programs and gave them a dumbed down version of the easiest part of the medical license exam, and only 40% passed it.

For context, to get a medical license, a physician has to have passed Steps 1-3 of the USMLE (US Medical License Exam) or Levels 1-3 of COMLEX (Comprehensive Osteopathic Medical Licensing Exam) to be eligible to apply for a medical license. Step/Level 2 is usually considered the hardest one of the three, and Step/Level 3 is the longest exam (2 full days), but generally considered to be the easiest. This DNP exam took the easiest 20% of questions from Step 3 and made a half-length version of the exam…and 60% of the DNPs still failed it.

The NP/DNP education is almost entirely algorithm-based and doesn’t meaningfully get into the anatomy, physiology, pathophysiology, and pharmacology that the first 2 years of medical school are devoted to. I have seen NPs miss life-threatening diagnoses because they were rare diseases that don’t come up outside of those first 2 years of drinking from a firehose of textbooks in medical school. Their education just isn’t long enough or in-depth enough to actually be equivalent to an MD or DO degree.

Also, MDs and DOs have almost 4000 hours of supervised medical practice where a physician is checking their work and directly observing or guiding their clinical experience before finishing medical school. Residency is, at minimum, another 8000 to 10000 hours of supervised practice in the specialties that only require 3 years of residency (it ranges from 3 to 9 years based on specialty).

NPs don’t have any standardized requirements for supervised practice to get their licenses and most programs only require 1000 hours or less of shadowing where they are just observing a licensed NP practice and not actually doing anything hands-on themselves… And they try to argue that this education is sufficient for them to be equal to physicians. There are some NPs who are amazing providers, but they’re usually the ones that were bedside nurses for 10+ years before going back to school for their NP license. The newer NPs that are going straight through from their BSN without any actual experience are the really dangerous ones.

TO BE CLEAR: I love the nurses I work with and I value their work and their input immensely. I was an EMT/ER tech before med school and it’s really sad when nurses are so confused when I help them clean up patients or reposition or whatever as a med student because most physicians and medical students don’t stop to help the nurses clean up poop. You can always tell which physicians have never had to clean up poop before, and I try very hard not to be like them.

Actually, the problem is the number of residencies. Once you graduate from medical school, you MUST complete an accredited residency program to be able to practice independently. The number of residency programs is controlled by Congress because residencies are funded through Medicare, and the last substantial increase in the number of residencies was when they added 1000 more in the Covid Omnibus bill.

It’s actually a growing crisis because more medical schools are opening and existing ones are increasing their class sizes, but the number of residencies isn’t keeping pace. This means that more and more people are going to be medical graduates with no way of obtaining a medical license without a residency and therefore no way to pay off their student loans. There’s a couple stories every year about medical graduates that couldn’t get into residency or couldn’t complete residency that end up dying by suicide, but it gets pretty effectively swept under the rug.

Absolutely report this. I was a resident assistant at a nursing home and one of the men in the memory care unit routinely made extremely inappropriate comments to female care workers when we had to clean his genitals and buttocks following accidents. He almost certainly wasn’t cognitively intact enough to have capacity, but incidents like that should be reported for the protection of the workers.

Even vulnerable adults carry some responsibility for their actions unless they lack any mental/cognitive capacity whatsoever, so if the patient/client has any decisional capacity at all, they need to be held responsible for their actions against others.

That “clinical experience” can usually be fulfilled by shadowing and supervised practice like medical students and medical residents have to do isn’t actually required for NPs. Also, in most places, those 4 years of clinical practice can be as an MA or CNA, not necessarily an RN. The education and certification requirements for NPs are wildly inconsistent which I think is actually more dangerous than a standardized lower level of education.

A huge piece of a physician’s medical training is knowing what questions to ask (as well as how and when to ask) to uncover the sneaky things that aren’t apparent on the surface. For example, as a 4th year medical student, I had a patient in the ER that came in with shortness of breath, fatigue, and chest discomfort. There were a couple hints of red flags, so I asked more questions that didn’t seem like they were related at all. Was he having unintended weight changes, night sweats, or changes to his bowel movements? The answer to all three was “yes”, but he had no idea why I was asking about that when he was there for breathing problems. I had a suspicion that he was having complications from metastatic cancer, and I was right. The resident I was working with hadn’t even thought to dig into those other niggling suspicions and was more focused on cardiac and pulmonary causes of chest pain and breathing problems.

I can almost guarantee that a nurse practitioner wouldn’t have asked those questions either. I keyed into some very subtle signs on his exam which prompted me to dig deeper, but NP’s aren’t even really trained on how to get a deeper history, let alone when to do so.

As a patient, you do have the right to refuse to be treated by anyone. You may have to wait for a physician to be available, but no one can treat you without your consent and you can always ask for a provider’s title and licensure.

The AI alleviates the process of critical thinking though. I make my own review notebooks for my boards and for clinical rotations by taking the time to figure out what’s important and what I don’t know to put those things in my notebooks. I write these out by hand on paper, so I have to be judicious about what is going to actually be important, and just the process of making those priorities helps me to have a better understanding of my own deficiencies.

Making a good study guide requires critical thinking skills, and if that gets outsourced to AI, that means the critical thinking isn’t being done by the human that needs to learn that skill.