rogue therapist ✨

“CBT is the most researched and evidence-based form of psychotherapy”

In 83 seconds, Grok 4.3 produced sharp critical analyses and summaries of these three journal articles on antidepressant efficacy and side effects. Every clinician should be using this. Absolutely incredible. (Fact check as needed, obviously.) grok.com/share/bGVnYWN5…

I wonder if Louisiana has the infrastructure to provide the care needed to ethically uphold this legislation. Many of these people are too mentally ill to ever maintain housing on their own.

I say this line by Cormac McCarthy in my head at least twice a week

A parasite that has been eating people for 3,500 years is about to be wiped off the planet. It infected 3.5 million people in 1986. Last year, it infected 10. And I have not seen it make a single front page. It is called Guinea worm. You drink contaminated water from a pond in a poor village. A year later, a worm up to three feet long starts coming out of your leg through a burning blister. There is no pill that stops it and no surgery that works. You wrap the worm around a stick and pull it out slowly, over days or weeks, inch by inch. If you rush, the worm breaks inside you and causes a fresh infection. Guinea worm is ancient. Preserved worms have been pulled out of Egyptian mummies from around 1000 BCE. The Ebers Papyrus, an Egyptian medical scroll from 1550 BCE, describes pulling the worm out with a stick. For three and a half thousand years, that was the best humans could do. Then in 1986, public health workers decided to kill the parasite off. They had no vaccine and no drug. What they had was cheap cloth water filters and a small army of volunteers willing to walk from village to village for decades. The plan was simple. Give everyone who drinks from a pond a cloth filter to strain out the tiny water fleas that spread the parasite. Then send volunteers walking house to house, year after year, teaching people how to use the filters and keeping anyone with an emerging worm out of the water. It worked. From 3.5 million cases a year to 10. Four were in Chad, four in Ethiopia, two in South Sudan. The other four countries where the worm used to be common, Angola, Cameroon, the Central African Republic, and Mali, had zero human cases for the second year in a row. The World Health Organization has already certified 200 countries as Guinea worm free. Six are left. The last hurdle is dogs. Cameroon had 445 infected animals last year and Chad had 147, so a lot of the remaining work is on animals, not humans. Strays get leashed, and crews treat ponds to kill any remaining worms. The campaign keeps watching until the number hits zero. When Guinea worm hits zero, it becomes the second human disease ever erased from the planet. The first was smallpox. It will also be the first parasite humans have ever wiped out, and the first disease ever ended without a single dose of medicine. Volunteers walked village to village with cloth filters for 40 years. Now a plague from the age of the pharaohs is about to be gone.

There can never be a helpful depression treatment algorithm because depression is not a single condition. Depression is most helpfully understood as the psychic equivalent of fever. Fever is a NON-SPECIFIC physiological response to an enormous range of underlying conditions, from the common cold to Ebola. Likewise, depression is a NON-SPECIFIC psychological response to an enormous range of underlying causes which may be psychological, social, biological, or a complex interaction between them. In other words, depression is an effect, not a cause. The DSM diagnosis is merely descriptive, not explanatory—and not as basis for treatment decisions. Algorithms that incorrectly assume the diagnosis “depression” defines the problem will always lead to poor care. P.S. love your videos

If you want people to stop leaving public schools in droves, insulting parents’ intelligence for taking their beloved children out of failing schools rife with violence and political extremism doesn’t seem like a winning strategy.

@DrKrisEdward My point of disagreement is the lack of evidence for sustained symptom reduction following CBT treatment. CBT inherently lacks depth and, without getting into the depth of psychological and interpersonal dysfunction, meaningful change for serious problems is unlikely.

I'm...bewildered. I've met multiple patients with confirmed IQ>160 with abundant psychosocial dysfunction who are greatly helped with the CBT toolkits. Yes it is theoretically possible for a high IQ individual to figure out CBT on their own, but not everyone does. Think of it like this: the cognitive distortions are made more complex and intense by the fact of having an elevated IQ. Understanding a model of cognitive distortions makes it possible to navigate them but without the model the simple fact of having an elevated IQ is certainly no defense against these distortions.

I've noticed this recurring theme about whether therapists need to be smart enough for certain patients. There's absolutely no doubt in my mind that it is one of the factors about the fit. But it goes beyond that because intelligence is almost a frame issue. Yes in many cases patients who require a highly intelligent therapist have significant let's say narcissistic traits, to a significant extent it is really true that understanding someone who is more intelligent requires more intelligence. The internal world of a very intelligent person in some cases is decidedly quite different and the way that reality is viewed also. In my experience, there are certain very intelligent people who are so intelligent that it's hard for them to understand the world. This is not a neurodivergence issue,

Bipolar disorder is grossly over-diagnosed in addicts and people who are too newly sober to identify the cyclical mood patterns without the influence of substances. This reckless medical practice discredits the existence of a debilitating and empirically validated disease.

“The CBT toolkits will all work, but the higher IQ patient is better served simply learning the toolkits and practicing on their own.” Any patient over ~100 IQ could learn CBT principles on their own. Thankfully, meaningful psychotherapy is much deeper than that. If CBT was the best we had, our profession would be quite meaningless indeed.

It is extremely enlightening to ask Grok about the sensory, emotional, spiritual, mental experiences of the world in various IQ brackets between 60 and 160. A therapist within 20 points is probably adequate. A therapist more than 20 points above or below the patient is simply not going to work out. A therapist 20 points above the patient might work out if the therapist understands the IQ difference and what it means for their patient's internal and external experiences. A therapist 20 points below the patient is never going to work out. And anyone who thinks it will, doesn't understand the qualitative and quantitative differences in internal and external experiences. The CBT toolkits will all work, but the higher IQ patient is better served simply learning the toolkits and practicing on their own.

One unit at the hospital where I work treats housekeeping like they are part of the team of nurses and CNAs. They even throw a “housekeeping week” party every year and chip in for gifts. The difference in job performance is remarkable, but they’re still the only unit to do this.

Principal Kirk Moore, who tackled the school shooter, walked into prom a few days later to a huge celebration from the students and was named prom king.

Because we get asked a lot. The Technological Republic, in brief. 1. Silicon Valley owes a moral debt to the country that made its rise possible. The engineering elite of Silicon Valley has an affirmative obligation to participate in the defense of the nation. 2. We must rebel against the tyranny of the apps. Is the iPhone our greatest creative if not crowning achievement as a civilization? The object has changed our lives, but it may also now be limiting and constraining our sense of the possible. 3. Free email is not enough. The decadence of a culture or civilization, and indeed its ruling class, will be forgiven only if that culture is capable of delivering economic growth and security for the public. 4. The limits of soft power, of soaring rhetoric alone, have been exposed. The ability of free and democratic societies to prevail requires something more than moral appeal. It requires hard power, and hard power in this century will be built on software. 5. The question is not whether A.I. weapons will be built; it is who will build them and for what purpose. Our adversaries will not pause to indulge in theatrical debates about the merits of developing technologies with critical military and national security applications. They will proceed. 6. National service should be a universal duty. We should, as a society, seriously consider moving away from an all-volunteer force and only fight the next war if everyone shares in the risk and the cost. 7. If a U.S. Marine asks for a better rifle, we should build it; and the same goes for software. We should as a country be capable of continuing a debate about the appropriateness of military action abroad while remaining unflinching in our commitment to those we have asked to step into harm’s way. 8. Public servants need not be our priests. Any business that compensated its employees in the way that the federal government compensates public servants would struggle to survive. 9. We should show far more grace towards those who have subjected themselves to public life. The eradication of any space for forgiveness—a jettisoning of any tolerance for the complexities and contradictions of the human psyche—may leave us with a cast of characters at the helm we will grow to regret. 10. The psychologization of modern politics is leading us astray. Those who look to the political arena to nourish their soul and sense of self, who rely too heavily on their internal life finding expression in people they may never meet, will be left disappointed. 11. Our society has grown too eager to hasten, and is often gleeful at, the demise of its enemies. The vanquishing of an opponent is a moment to pause, not rejoice. 12. The atomic age is ending. One age of deterrence, the atomic age, is ending, and a new era of deterrence built on A.I. is set to begin. 13. No other country in the history of the world has advanced progressive values more than this one. The United States is far from perfect. But it is easy to forget how much more opportunity exists in this country for those who are not hereditary elites than in any other nation on the planet. 14. American power has made possible an extraordinarily long peace. Too many have forgotten or perhaps take for granted that nearly a century of some version of peace has prevailed in the world without a great power military conflict. At least three generations — billions of people and their children and now grandchildren — have never known a world war. 15. The postwar neutering of Germany and Japan must be undone. The defanging of Germany was an overcorrection for which Europe is now paying a heavy price. A similar and highly theatrical commitment to Japanese pacifism will, if maintained, also threaten to shift the balance of power in Asia. 16. We should applaud those who attempt to build where the market has failed to act. The culture almost snickers at Musk’s interest in grand narrative, as if billionaires ought to simply stay in their lane of enriching themselves . . . . Any curiosity or genuine interest in the value of what he has created is essentially dismissed, or perhaps lurks from beneath a thinly veiled scorn. 17. Silicon Valley must play a role in addressing violent crime. Many politicians across the United States have essentially shrugged when it comes to violent crime, abandoning any serious efforts to address the problem or take on any risk with their constituencies or donors in coming up with solutions and experiments in what should be a desperate bid to save lives. 18. The ruthless exposure of the private lives of public figures drives far too much talent away from government service. The public arena—and the shallow and petty assaults against those who dare to do something other than enrich themselves—has become so unforgiving that the republic is left with a significant roster of ineffectual, empty vessels whose ambition one would forgive if there were any genuine belief structure lurking within. 19. The caution in public life that we unwittingly encourage is corrosive. Those who say nothing wrong often say nothing much at all. 20. The pervasive intolerance of religious belief in certain circles must be resisted. The elite’s intolerance of religious belief is perhaps one of the most telling signs that its political project constitutes a less open intellectual movement than many within it would claim. 21. Some cultures have produced vital advances; others remain dysfunctional and regressive. All cultures are now equal. Criticism and value judgments are forbidden. Yet this new dogma glosses over the fact that certain cultures and indeed subcultures . . . have produced wonders. Others have proven middling, and worse, regressive and harmful. 22. We must resist the shallow temptation of a vacant and hollow pluralism. We, in America and more broadly the West, have for the past half century resisted defining national cultures in the name of inclusivity. But inclusion into what? Excerpts from the #1 New York Times Bestseller The Technological Republic: Hard Power, Soft Belief, and the Future of the West, by Alexander C. Karp & Nicholas W. Zamiska techrepublicbook.com

Ibogaine sounds too good to be true but I’d love to be wrong about that. Either way, glad people will have the opportunity to try it in the U.S.

One day, people will look back with horror on the women who supported this without ever waking up. When teen girls are banding together to get boys out of their locker rooms and bathrooms, you know adults have failed.

This is a massive and growing problem for American national security. Unbelievable amounts of sensitive and classified information is captured, scraped, and sent back to foreign nations. And users have no idea. Nobody expects that their TV or monitor is a surveillance tool. When I have joked that Smart TVs should be illegal, I am only half-joking.

When a culture gets rid of traditions they tend to gain back what those traditions protected against.