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[erg923]

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Dude, you have to work on your reading comprehension. You frequently jump to conclusions that were not said. Insult people because they don't think like you.



Just because you can't see patterns in human behavior doesn't mean they don't exist. Your inability to see patterns may explain why each case is "de novo" for you.



Yeah right. Which is why instead of discussing about the idea you attack the person who expresses the different idea. Get off your high horse. Next time if you want to explore ideas, you may want to review the fundamentals of therapy 101 so you're not so offensive.

Save yo drama fo yo momma!

 

[FlowRate]

If that is what you think crystallized intelligence is then, then you're using the terms wrong. Since you use more fluid intelligence as a clinician, you peak in your 30's or 40's. I won't peak until I'm a geriatrician.



Rapport building through open-ended questioning, labeling, summarizing. Most patients respond well to that. Those skills aren't exactly ground-breaking and are better developed through experience. And why would you call people's response to a slap trivial? If you slapped people during your therapy sessions, their response surely isn't trivial.

You think what you want. I don't care about changing your opinion. I won't change my opinion. Convincing people I'm right isn't going to enrich my life in any way.

FWIW my impression is that Clausewitz is discussing this with you in an effort to help with things you asked about in this thread--ways of feeling generative/creative in this field. Many of us find therapy to require generating a lot of new ideas both on the fly in session and also after more careful consideration outside of session. If your opinion on therapy were to shift a bit to where you felt more curious and open about discovering these aspects of therapy that we find fulfilling then perhaps you would find fulfillment in it, too.

Dude, you have to work on your reading comprehension. You frequently jump to conclusions that were not said. Insult people because they don't think like you.



Just because you can't see patterns in human behavior doesn't mean they don't exist. Your inability to see patterns may explain why each case is "de novo" for you.



Yeah right. Which is why instead of discussing about the idea you attack the person who expresses the different idea. Get off your high horse. Next time if you want to explore ideas, you may want to review the fundamentals of therapy 101 so you're not so offensive.

Also, you're being extremely defensive in response to what Clausewitz already explicitly labeled--and I've taken as--a genuine attempt at discussion. I haven't read anything as an attack on you.

 

[calvnandhobbs68]

Dude, you have to work on your reading comprehension. You frequently jump to conclusions that were not said. Insult people because they don't think like you.

Uh so you didn’t say this?

I think treating patients is quite rote. Even in therapy. After all, people are predictable as a whole. You can see this in business (marketing) and politics (psyop)

It sounds like you’re kinda running out of responses to valid questions about what you were saying before...and the whole premise of this thread.

 

[psychacad]

FWIW my impression is that Clausewitz is discussing this with you in an effort to help with things you asked about in this thread--ways of feeling generative/creative in this field. Many of us find therapy to require generating a lot of new ideas both on the fly in session and also after more careful consideration outside of session. If your opinion on therapy were to shift a bit to where you felt more curious and open about discovering these aspects of therapy that we find fulfilling then perhaps you would find fulfillment in it, too.

Also, you're being extremely defensive in response to what Clausewitz already explicitly labeled--and I've taken as--a genuine attempt at discussion. I haven't read anything as an attack on you.

I'm not here to analyze people's intentions but this poster's responses are littered with statements like these:

"If that is all therapy is for you i am not surprised you find it extremely dull and unrewarding."

As we are all psychiatrists here and know something about communication, I'd be surprised if people didn't consider the above as an offensive way of talking with another colleague. Especially when OP already pointed out that he felt attacked. Maybe it says something how this board operates.

On the topic though, crystallized intelligence is not how well you do on trivia (not sure if it's being confused with declarative memory). It has more to do with accultured intelligence, so I'd consider psychiatric practice and therapy by and large a good example. There's nothing wrong with that. Most doctors, including psychiatrists and especially therapists, do indeed peak towards the end of their careers. It's hard to find an example where experience is more paramount.

This thread has been littered with hostility since the first post. Very interesting as the topic is fairly benign. Clearly it ticked people the wrong way. I've no personal stock here, just reading it the way I see it.

 

[clausewitz2]

On the topic though, crystallized intelligence is not how well you do on trivia (not sure if it's being confused with declarative memory).

"Crystallized intelligence (gc) refers to learned procedures and knowledge. It reflects the effects of experience and acculturation. Horn notes that crystallized ability is a "precipitate out of experience," resulting from the prior application of fluid ability that has been combined with the intelligence of culture."[7] Examples of tasks that measure crystallized intelligence are vocabulary, general information, abstract word analogies, and mechanics of language.[6]"

Fluid and crystallized intelligence - Wikipedia

en.wikipedia.org

I agree with you completely that it is more than just trivia. It was a pithy example that sprung to mind and I can see how it would be misleading; my apologies for that. It is however the application of established, routinized or otherwise rote procedures. You figure out what slot the thing fits into, then you pull the lever and the machine of What You Have Previously Learned does its thing.

I think @erg923 made the best point about this in this thread, though - we are reifying a construct at this point.

 

[psychacad]

"Crystallized intelligence (gc) refers to learned procedures and knowledge. It reflects the effects of experience and acculturation. Horn notes that crystallized ability is a "precipitate out of experience," resulting from the prior application of fluid ability that has been combined with the intelligence of culture."[7] Examples of tasks that measure crystallized intelligence are vocabulary, general information, abstract word analogies, and mechanics of language.[6]"

Fluid and crystallized intelligence - Wikipedia

en.wikipedia.org

I agree with you completely that it is more than just trivia. It was a pithy example that sprung to mind and I can see how it would be misleading; my apologies for that. It is however the application of established, routinized or otherwise rote procedures. You figure out what slot the thing fits into, then you pull the lever and the machine of What You Have Previously Learned does its thing.

I think @erg923 made the best point about this in this thread, though - we are reifying a construct at this point.

I'm still not sure why you object so much on therapy being largely crystallized intelligence? You're mostly drawing on the experience of you and others in the field and utilizing techniques that we know from experience that have worked, mostly in context of applied theory. Sure, there's always some room for "innovative thinking", but this is not how one usually progresses treatment. I agree that people aren't all that predictable, but it's not like you can solve their behavioral puzzle like you solve a matrix puzzle. This seems in line empirically which is why we value experience so much in medicine, and especially in therapy. If you have a chance to go to a 20 something genius innovator vs a seasoned 65 year old therapist, would you choose the first? The fulfillment comes for me at least from the empathic connection and the relationship, not exactly the level of innovation and originality.

 

[clausewitz2]

I'm still not sure why you object so much on therapy being largely crystallized intelligence? You're mostly drawing on the experience of you and others in the field and utilizing techniques that we know from experience that have worked, mostly in context of applied theory. Sure, there's always some room for "innovative thinking", but this is not how one usually progresses treatment.

It would be deeply silly of me to say that there is no use of established techniques or knowledge base in doing psychotherapy, and if that is the impression I conveyed, I again must apologize. I am rarely if ever doing full-on MBT these days but I think the "not-knowing" stance espoused by it is foundational to how I approach things. I strive to genuinely hold any ideas I might have about a particular patient as a hypothesis only, to be actively put to the test and poked and prodded to see how well it holds up. Theory is kind of a jumping off point but it develops in each individual case so much from there and at any given time one is making a multitude of decisions that are not obviously selectable by what theory or your wise old mentor's adages might be able to dictate.

I agree that people aren't all that predictable, but it's not like you can solve their behavioral puzzle like you solve a matrix puzzle. This seems in line empirically which is why we value experience so much in medicine, and especially in therapy. If you have a chance to go to a 20 something genius innovator vs a seasoned 65 year old therapist, would you choose the first? The fulfillment comes for me at least from the empathic connection and the relationship, not exactly the level of innovation and originality.

Agreed about the relationship being critical. That's why I'd have to answer your question with "it depends on what they're like." The 20 something genius innovator might be a Steve Jobs type "c**kwaffle in a turtleneck" or might be a very inquisitive and curious person who is genuinely open to whatever might be coming up in the room. The 65 year old could be a terrifically wise and thoughtful master who never assumes he knows anything until he actually learns it or he could be a crusty dinosaur permanently stuck in another era.

I guess I'm curious as to whether we are talking about innovation/generativity as "can publish a paper on" or "feels like you are contributing to your growth as a person and expanding your clinical horizons". I am more about the second.

 

[AD04]

Uh so you didn’t say this?


It sounds like you’re kinda running out of responses to valid questions about what you were saying before...and the whole premise of this thread.

You need to work on your reading comprehension too. And re-read the first post to see what the premise of the thread is.

It's funny you talk about out of response as your contributions is about taking jabs at me.

 

[AD04]

I'm still not sure why you object so much on therapy being largely crystallized intelligence? You're mostly drawing on the experience of you and others in the field and utilizing techniques that we know from experience that have worked, mostly in context of applied theory. Sure, there's always some room for "innovative thinking", but this is not how one usually progresses treatment. I agree that people aren't all that predictable, but it's not like you can solve their behavioral puzzle like you solve a matrix puzzle. This seems in line empirically which is why we value experience so much in medicine, and especially in therapy. If you have a chance to go to a 20 something genius innovator vs a seasoned 65 year old therapist, would you choose the first? The fulfillment comes for me at least from the empathic connection and the relationship, not exactly the level of innovation and originality.

Very well said.

 

[AD04]

This thread has been littered with hostility since the first post. Very interesting as the topic is fairly benign. Clearly it ticked people the wrong way.

What I noticed about SDN psychiatry is that lots of people are playing a status game. It is about making oneself look good at the expense of others. Which is why personal insults are often thrown into the mix. Sometimes with thought as in @clausewitz2 case and sometimes without thought as in @calvnandhobbs68 case.

And it's easy to gain status in an echo-chamber so when someone is expressing an unpopular idea, each person who can attack the person with the unpopular idea gets a "like" and it keeps snowballing. In the past, other posters have been driven from this forum due to status game.

It is kind of like an online version of high school and no matter how intellectual a person may be, the primitive aspect is still there.

 

[Mass Effect]

Dude, you have to work on your reading comprehension. You frequently jump to conclusions that were not said. Insult people because they don't think like you.



Just because you can't see patterns in human behavior doesn't mean they don't exist. Your inability to see patterns may explain why each case is "de novo" for you.



Yeah right. Which is why instead of discussing about the idea you attack the person who expresses the different idea. Get off your high horse. Next time if you want to explore ideas, you may want to review the fundamentals of therapy 101 so you're not so offensive.

You need to work on your reading comprehension too. And re-read the first post to see what the premise of the thread is.

It's funny you talk about out of response as your contributions is about taking jabs at me.

You're quite sensitive to perceived insult, even when someone has told you repeatedly they're not trying to insult you, but simply disagree with you. Nothing that @clausewitz2 has said qualifies as a "jab". In fact, I find your responses way more prickly.

 

[Mass Effect]

I'm not here to analyze people's intentions but this poster's responses are littered with statements like these:

"If that is all therapy is for you i am not surprised you find it extremely dull and unrewarding."

As we are all psychiatrists here and know something about communication, I'd be surprised if people didn't consider the above as an offensive way of talking with another colleague. Especially when OP already pointed out that he felt attacked. Maybe it says something ho

Nothing about the above sentence is offensive to me. The OP made a statement and the poster is saying "if that's how you feel about it, I'm not surprised it's boring to you". The OP's responses have been the ones littered with hypersensitivity, personal attacks, and jabs.

 

[AD04]

You're quite sensitive to perceived insult, even when someone has told you repeatedly they're not trying to insult you, but simply disagree with you. Nothing that @clausewitz2 has said qualifies as a "jab". In fact, I find your responses way more prickly.

Maybe you're just not sensitive enough. You have no skin in the game since they are not directed at you.

If a someone told you they felt you were offensive, do you keep on doing the same thing or take a different approach? If you keep on doing the same thing even though you were warned, what does that make you?

 

[calvnandhobbs68]

You need to work on your reading comprehension too. And re-read the first post to see what the premise of the thread is.

It's funny you talk about out of response as your contributions is about taking jabs at me.

You keep posting without actually saying anything and without actually responding concretely. Responding “you need to work on your reading comprehension” without actually explaining HOW you think I should be working on my reading comprehension is a non answer. Unlike the specific example I just gave you that the previous poster (who you responded to in a similar way) was referring to.

making a bunch of non-posts and then complaining about how mean everyone is to you isn’t really helping your cause.

 

[AD04]

You keep posting without actually saying anything and without actually responding concretely. Responding “you need to work on your reading comprehension” without actually explaining HOW you think I should be working on my reading comprehension is a non answer. Unlike the specific example I just gave you that the previous poster (who you responded to in a similar way) was referring to.

I gave you the same quality response that you gave me. But in reference to that sentence you referenced, it is about people as a group. Examples I included were for targeting people as a group.

 

[calvnandhobbs68]

I gave you the same quality response that you gave me. But in reference to that sentence you referenced, it is about people as a group. Examples I included were for targeting people as a group.

Haha got it so people as a whole are “quite predictable” but your individual interactions with them aren’t? I’m assuming that’s what you’re trying to backtrack yourself into?

If that’s the case, considering we treat individual patients and not uniform groups of people “as a whole” as you say, I’m not sure where the boredom in your individual patient interactions is coming from.

 

[AD04]

Haha got it so people as a whole are “quite predictable” but your individual interactions with them aren’t? I’m assuming that’s what you’re trying to backtrack yourself into?

If that’s the case, considering we treat individual patients and uniform groups of people “as a whole” as you say, I’m not sure where the boredom in your individual patient interactions is coming from.

Even though each individual responses may vary, overall they are similar. Outliers are the exception. Therefore, the process of obtaining the responses either through psychiatry or psychotherapy are similar (i.e. systemized).

The restlessness is from doing something different and I just wanted to see what else people are doing. It doesn't have to solely fall within the realm of therapy but for some reason that has been the focus.

 

[Mad Jack]

I think you're misunderstanding fluid intelligence. It's about creating something new and pushing boundaries. Like creating new music or writing new book or starting a start-up.

Knowing how to treat, mainly in a defined system, even though facts are not well-established falls within wisdom -- crystallized intelligence.

Fluid intelligence is specifically the ability to manipulate data to determine relationships in an inferred manner, as well as to recognize patterns and the like. Crystalized intelligence is specific recall. Being able to recall two stories about heroic mythical figures is crystallized intelligence, being able to infer how these mythical figures relate to one another based upon these stories would be fluid intelligence. While your examples are consistent with things that require fluid intelligence, they are not the totality of it, nor even the majority of it.

 

[Mad Jack]

Even though each individual responses may vary, overall they are similar. Outliers are the exception. Therefore, the process of obtaining the responses either through psychiatry or psychotherapy are similar (i.e. systemized).

The restlessness is from doing something different and I just wanted to see what else people are doing. It doesn't have to solely fall within the realm of therapy but for some reason that has been the focus.

You seem to be systematizing the human experiemce and your response to it. Perhaps that is a reflection upon yourself and your pre-conceived notions of the field and the individuals you interact with?

 

[AD04]

Fluid intelligence is specifically the ability to manipulate data to determine relationships in an inferred manner, as well as to recognize patterns and the like. Crystalized intelligence is specific recall. Being able to recall two stories about heroic mythical figures is crystallized intelligence, being able to infer how these mythical figures relate to one another based upon these stories would be fluid intelligence. While your examples are consistent with things that require fluid intelligence, they are not the totality of it, nor even the majority of it.

I think that's fair. But patterns which you are already exposed to, such as stove = hot, wouldn't you say that is crystallized intelligence?

 

[AD04]

You seem to be systematizing the human experiemce and your response to it. Perhaps that is a reflection upon yourself and your pre-conceived notions of the field and the individuals you interact with?

Skillfully done as a therapist.

 

[Mad Jack]

I think that's fair. But patterns which you are already exposed to, such as stove = hot, wouldn't you say that is crystallized intelligence?

That's much too simple of an association, it requires no analysis of the situation at hand. It's far too reductivist, and far different from understanding how, say this

May function in a given patient based upon their tolerance of medications with similar or dissimilar receptor profiles given their underlying conditions and your understanding of the research regard to each receptor system. And that's just the medication side of things- therapy requires substantially more subjectivity if you aren't using a manualized approach. Further refining your approach to each medication, combined with therapy, in each individual patient based upon their psychiatric and medication history is infinitely more complicated than stove=hot

 

[Stagg737]

The fact that therapy is systematized (such as in manuals) is proof that people respond predictably on the large part. If there is no predictable response, there wouldn't be a system. But go ahead and say I'm wrong because of "scientific literature". I prefer to do my own thinking based on what I see.

Sure, but this is hitting a nail with a sledgehammer. It's certainly not wrong, but it misses the nuances which help optimize the treatment of individuals. If this were the case, we should just stick to specific algorithms and to hell with clinical judgment, no?

The restlessness is from doing something different and I just wanted to see what else people are doing. It doesn't have to solely fall within the realm of therapy but for some reason that has been the focus.

Yes, individual forms of therapy are manualized, but how often are we really utilizing one form of therapy with a patient? My most successful therapy patient started with CBT which led into psychodynamic with further history throughout sessions and eventually (unknowingly by me at the time) morphed into more of an ACT + MI approach. Individual forms of therapy may be crystallized, but deciding what direction to take with individuals' therapy by obtaining and analyzing the information you're given requires much more of a fluid approach. Maybe you/others would feel more actualized in therapy (no idea if that's an interest to you) by expanding mastery of different modalities and integrating them within individual cases. The same could be done with medications or really any aspect of treatment. I've found the best solution to mental restlessness to be engaging in further learning to expand and integrate new knowledge into what I already know. This hasn't really led to any career-altering changes, but has helped with feeling self-actualized.

I hear you right there. Medicine really pigeon holes you and makes pivots and changes very costly which I think is really sad.

But psychiatry has much more flexibility in our ability to expand our careers. In IM, once you've done a cards fellowship you can further sub-specialized, but changing fields is more risky and very time-consuming. Transitioning from gen psych to addictions to geriatrics is completely reasonable and even common. I'd argue that for those in medicine who do not want to be pigeon-holed (like myself), psychiatry is a pretty ideal specialty.

Just because you can't see patterns in human behavior doesn't mean they don't exist. Your inability to see patterns may explain why each case is "de novo" for you.

Of course patterns exist, but with human behaviors the patterns can be far more entangled in psychological factors than just "identify pattern, apply therapy" can accommodate. I agree that it tends to be more simple in cases of BPD or PTSD, but I find depression and anxiety to often require a much less rigid application of techniques.

it's not like you can solve their behavioral puzzle like you solve a matrix puzzle.

Would this not infer the use of fluid intelligence as opposed to crystallized?

 

[Stagg737]

"If that is all therapy is for you i am not surprised you find it extremely dull and unrewarding."

As we are all psychiatrists here and know something about communication, I'd be surprised if people didn't consider the above as an offensive way of talking with another colleague. Especially when OP already pointed out that he felt attacked. Maybe it says something how this board operates.

I don't find the above offensive at all and wish more people were as straightforward as this. This honestly seems like a very benign observation and I'm certainly far more blunt with my colleagues (even attendings) than this...

If a someone told you they felt you were offensive, do you keep on doing the same thing or take a different approach? If you keep on doing the same thing even though you were warned, what does that make you?

That depends. Is someone offended because I'm defining them in a specific way that's based on my opinion without strong concrete evidence of truth, or are they offended because they don't like my opinion? If it's the former, I'll certainly try to take a different approach or at the very least try to understand why they find it offensive. If it's the ladder, I honestly don't care if they're offended as they're offense is based on a lack of tolerance to the opinions or beliefs of others and they should learn to grow up. I don't complain when I'm offended by a statement when it's someone's opinion with a reasonable basis as long as it's not directly harmful to anyone, and I expect others to share that common decency.

 

[Stagg737]

Fluid intelligence is specifically the ability to manipulate data to determine relationships in an inferred manner, as well as to recognize patterns and the like. Crystalized intelligence is specific recall. Being able to recall two stories about heroic mythical figures is crystallized intelligence, being able to infer how these mythical figures relate to one another based upon these stories would be fluid intelligence.

As usual you've given a solid explanation in 1/10th the words I would have used. Also, I'm stealing this example.

 

[calvnandhobbs68]

Even though each individual responses may vary, overall they are similar. Outliers are the exception. Therefore, the process of obtaining the responses either through psychiatry or psychotherapy are similar (i.e. systemized).

The restlessness is from doing something different and I just wanted to see what else people are doing. It doesn't have to solely fall within the realm of therapy but for some reason that has been the focus.

I think the focus shifted to therapy because it ended up coming up early in the thread and was responded to specifically with the generalization I quoted above about treating patients being "quite rote".

I also think the reason you're getting jumped on so much is because you made a very broad statement of fact about the field as a whole at the beginning ("Psychiatry relies more on crystallized intelligence rather than fluid intelligence") and then stated that you felt you must be stagnating as a direct result of wanting to apply more "fluid intelligence" to what you do day to day. People then responded by noting that psychiatry as a whole really has a good mix of fluid and crystallized intelligence, if not more reliance on fluid intelligence, so maybe the root of your problem doesn't really have to do with your statement made at the beginning. You then doubled down and started talking about how treating patients is "quite rote" and how people are so "predictable as a whole" and kept asserting that you're correct about the "crystallized vs fluid" intelligence thing. Then started talking about how you were being attacked.

I mean here's the thing, you're also the same person who was asking about CBT manuals recently but then assert that treating patients in therapy is so "rote"? So you don't even have a favorite CBT manual that you use consistently (which to me would indicate an overall lack of mastery in the modality) but you're ready to make broad assertions about types of intelligence needed in the field and then use those assertions to support why you think you're bored in the field. I'm no expert in CBT myself and I could definitely use suggestions on CBT manuals but I also wouldn't go out on a limb and say that the reason I'm bored with patients is that the encounters themselves are so routine and predictable rather than a deficiency on my own part.

I think part of this is about finding out what you actually like about your work, not trying to impose your own ideas of what types of intelligence you need to do a type of work to justify why you're feeling unhappy in the work. As someone who came from a specialty which truly relied much more on crystallized intelligence/algorithmic thinking, I think psychiatry is one of the fields who relies the least on this type of intelligence. Now, admittedly, the immediate stakes are much lower in psychiatry and so I do think it is much easier to do the bare minimum in psychiatry without seeing any terrible outcomes. ACLS/PALS/NRP is nothing except rote algorithm memorization, but the stakes are extremely high. Many high stakes conditions in other fields (DKA, status epilepticus, hypertensive emergency, septic shock, etc etc) are extremely algorithmic but necessary to master to avoid bad immediate outcomes. There are also highly algorithmic/rote treatments in many other fields with less immediate outcomes but still very well studied/evaluated and necessary to master in order to achieve best results. This actually ends up being what draws a decent amount of people to psychiatry, the uniqueness of many of these encounters and trajectories and ability to individually tailor what you think is best for each trajectory, especially in the outpatient setting.

 

[Mad Jack]

I think there may also be a bit of romanticization in the posts by @AD04 that comes from being an outsider to the creative process of fields that aren't his own. The teams at SpaceX, for instance, are easy to romanticize as engineers working on challenging new problems every day, but the reality is much less interesting. Engineering is a process, and each person is generally working on one individual part or procedure in an iterative fashion. The same goes for writing, and works of art. To those that do not write, paint, or craft they seem as if they are plucked from the ether. However art is often an iterative process, doing much the same thing over and over again, be it re-writing and editing, building on old ideas, or refining one's painting/drawing/crafting techniques.

I have fallen away from writing, but it was one of my first loves. That is partly due to grinding nature of the creative process, the constant refining and editing and rewriting. SDN has been a bit of an outlet for me in that regard, as posts let me skip over making a fine product to just dumping my unedited words into the void. While I occasionally romanticize the idea of going back to writing someday, remembering the reality of it makes it so much less appealing. If you talk to individuals in tech companies, engineering firms, etc, they will tell you much the same- most of the work they do is fairly unfulfilling, fairly rote in nature. They may romanticize medicine imagining we are a bunch of House, MDs running around solving incredibly complex puzzles every day, becauase things always seem so much more appealing from a state of blissful ignorance.

 

[AD04]

And that's just the medication side of things- therapy requires substantially more subjectivity if you aren't using a manualized approach. Further refining your approach to each medication, combined with therapy, in each individual patient based upon their psychiatric and medication history is infinitely more complicated than stove=hot

This really is a none-answer. To reach the state where you can tackle novel situations, you need crystallized intelligence as the base. Sure, the human behavior is more complex than stove = hot, but there is still a pattern that can be crystallized so treating an individual isn't as innovative as you make it sound like.

If this were the case, we should just stick to specific algorithms and to hell with clinical judgment, no?

Are you saying you don't use clinical judgement when you use manuals?

That depends. Is someone offended because I'm defining them in a specific way that's based on my opinion without strong concrete evidence of truth, or are they offended because they don't like my opinion? If it's the former, I'll certainly try to take a different approach or at the very least try to understand why they find it offensive. If it's the ladder, I honestly don't care if they're offended as they're offense is based on a lack of tolerance to the opinions or beliefs of others and they should learn to grow up.

This statement here is concrete evidence you're less skilled at therapy than @Mad Jack

I mean here's the thing, you're also the same person who was asking about CBT manuals recently but then assert that treating patients in therapy is so "rote"? So you don't even have a favorite CBT manual that you use consistently (which to me would indicate an overall lack of mastery in the modality) but you're ready to make broad assertions about types of intelligence needed in the field and then use those assertions to support why you think you're bored in the field.

It is quite an assumption you made. It is as if a person asking about movies other people watch doesn't have a favorite movie himself. The other possibility about asking what resources people use is to measure what I'm doing compared to what other people are doing and see if I missed anything.

So are you saying the only way a person feel bored in a field is if he attains mastery? Children constantly feel bored without being a master in anything. Do you attack kids? I can't feel therapy is rote? I don't mind talking about ideas but when people constantly assume things about me that are incorrect, that's quite offensive.

I think part of this is about finding out what you actually like about your work, not trying to impose your own ideas of what types of intelligence you need to do a type of work to justify why you're feeling unhappy in the work.

I didn't impose anything on anyone. In fact, the discussion about the types of intelligence was imposed on me. And who said anything about me being unhappy at work? You jump to a lot of conclusions that weren't made.

The teams at SpaceX, for instance, are easy to romanticize as engineers working on challenging new problems every day, but the reality is much less interesting.

Very insightful. So why can't that (reality being less interesting) be applied to psychiatry and therapy as well?

 

[Stagg737]

Are you saying you don't use clinical judgement when you use manuals?

Not saying it's not used at all, but it's far less/minimal compared to other forms of therapy/treatment. Though I don't have the experience to truly address manualized therapies outside of CBT/DBT.

This statement here is concrete evidence you're less skilled at therapy than @Mad Jack

My persona in therapy is very different than my persona with the rest of the world, but I'd be shocked if I were more skilled at therapy that Mad Jack, or really anyone at my level of experience or beyond.

 

[Alemo]

Here's an interesting question; why do these "on the meaning of" discussion topics always devolve into "no u" arguments?

I think it has to do with the nature of the conversation logistics in which ideas aren't clearly enumerated, followed by varying qualities of responses. Then the matter gets misinterpreted and sub-debates over separate, tangentially related ideas and semantics break out. Then sides are chosen. It's a pattern I've seen everywhere (reddit, facebook, etc).

Discuss!

 

[AD04]

My persona in therapy is very different than my persona with the rest of the world, but I'd be shocked if I were more skilled at therapy that Mad Jack, or really anyone at my level of experience or beyond.

You're a cool guy. Don't worry, I think @Mad Jack beats us all in therapy.

 

[AD04]

Just to close on a positive note and to pivot back to the point of the thread, here's a good and free book about wealth and philosophy by a tech entrepreneur / investor:

Almanack of Naval Ravikant

www.navalmanack.com

It helped clarify my journey to the next level. If you read it and would like to discuss, feel free to PM me.

 

[tortuga87]

Mathematics, theoretical physics and computer science are really fun, particularly at the advanced levels when you can create new things, because you get to think outside the box. I hear some areas of electrical and mechanical engineering are also very fun, although I am not too familiar with them.

Medicine is mostly crystallized intelligence, but the above fields are more heavily weighted towards fluid intelligence, so it can provide a nice balance if you can do both sides.

 

[dl2dp2]

Just to close on a positive note and to pivot back to the point of the thread, here's a good and free book about wealth and philosophy by a tech entrepreneur / investor:

Almanack of Naval Ravikant

www.navalmanack.com

It helped clarify my journey to the next level. If you read it and would like to discuss, feel free to PM me.

I find this to be wholly unimpressive. There are thinkers in our own field who are both smarter and more relevant. There are businessmen in our own field who are wealthier and more successful. Tech bro wellness is a boring genre, especially to a psychiatrist.

 

[hallowmann]

I find this to be wholly unimpressive. There are thinkers in our own field who are both smarter and more relevant. There are businessmen in our own field who are wealthier and more successful. Tech bro wellness is a boring genre, especially to a psychiatrist.

Having been in the field previously, having multiple people in my family in the field, including my spouse, and virtually all of my close friends in computer science and electrical engineering working in a lot of the tech giants and startups alike, I would say that I agree. The idea that these fields are dealing in some kind of revolutionary or particularly engaging exercises in fluid intelligence and physicians aren't is probably due to mysticism associated with not knowing much about the field. Kind of like how people outside of healthcare view physicians as almost having omniscience, and skill in this field that seems incredibly complex or foreign.

As demonstrated by this thread, you can engage in psychiatric practice that involves both crystallized intelligence and fluid intelligence depending on how you practice. The same is true about computer science and engineering. There's lots of innovation, but also lots of routine.

 

[AD04]

I find this to be wholly unimpressive. There are thinkers in our own field who are both smarter and more relevant. There are businessmen in our own field who are wealthier and more successful. Tech bro wellness is a boring genre, especially to a psychiatrist.

The book isn't about technology and isn't advocating for someone to be a tech bro.

I am interested in better books, especially from businessmen in our field. Do you have suggestions? Or do you have additional insight from these businessmen that the book missed?

 

[dl2dp2]

The book isn't about technology and isn't advocating for someone to be a tech bro.

I am interested in better books, especially from businessmen in our field. Do you have suggestions? Or do you have additional insight from these businessmen that the book missed?

Why do you think people write books? I find reading books to be low yield. Books are usually aiming at a large, general, median IQ audience. Talking to people is much more high yield. Why are you so against this? Are you socially anxious?

If you really want "book" recommendations it would depend on what your interests are. The "books" I like are all very technical in nature. E.g. recently I finally buckled down and read Jeffrey Young's schema therapy manual and thought it was very illuminating. The book prior which I liked is Sean Caroll's Spacetime and Geometry. Before that it's a textbook on mathematical finance. I assume none of these are in your interests.

 

[Stagg737]

Why do you think people write books? I find reading books to be low yield. Books are usually aiming at a large, general, median IQ audience. Talking to people is much more high yield. Why are you so against this? Are you socially anxious?

If you really want "book" recommendations it would depend on what your interests are. The "books" I like are all very technical in nature. E.g. recently I finally buckled down and read Jeffrey Young's schema therapy manual and thought it was very illuminating. The book prior which I liked is Sean Caroll's Spacetime and Geometry. Before that it's a textbook on mathematical finance. I assume none of these are in your interests.

Is this what you're referring to:

Amazon product ASIN 1593853726

 

[dl2dp2]

Is this what you're referring to:

Amazon product ASIN 1593853726

Yup!

 

[michaelrack]

Why do you think people write books? I find reading books to be low yield. Books are usually aiming at a large, general, median IQ audience. Talking to people is much more high yield. Why are you so against this? Are you socially anxious?

If you really want "book" recommendations it would depend on what your interests are. The "books" I like are all very technical in nature. E.g. recently I finally buckled down and read Jeffrey Young's schema therapy manual and thought it was very illuminating. The book prior which I liked is Sean Caroll's Spacetime and Geometry. Before that it's a textbook on mathematical finance. I assume none of these are in your interests.

except for the schema therapy, that sounds pretty interesting

 

[calvnandhobbs68]

The book isn't about technology and isn't advocating for someone to be a tech bro.

I am interested in better books, especially from businessmen in our field. Do you have suggestions? Or do you have additional insight from these businessmen that the book missed?

No you’re right this book it’s filled with such insightful quotes as:

“If you don’t know yet what you should work on, the most important thing is to figure it out. You should not grind at a lot of hard work until you figure out what you should be work- ing on.”

Don’t worry it gets better.

“Productize” and “yourself.” “Yourself” has uniqueness. “Productize” has leverage. “Yourself ” has accountability. “Pro- ductize” has specific knowledge. “Yourself ” also has specific knowledge in there. So all of these pieces, you can combine
them into these two words.”

I mean I agree with the posters above. This is just mindless drivel posing as insight and “philosophy”. Go throw a dart in the self help or business sections of Barnes and Noble and you’ll read pretty much the same thing.

Someone who claims to be a psychiatrist should be able to see through this crap pretty quickly, unless you’re just purely impressed by techno-wealth. We won’t even get into the reasons behind why and how this kind of wealth develops….

And before you counter with how unproductive I am with not telling what I’m reading, my most recent three “fun” books are “The Warmth of Other Suns” recently, then just finished “The Splendid and the Vile” (pretty good if you liked The Devil in the White City). Currently started up reading Stephen Gould’s “The Mismeasure of Man”.

 

[erg923]

No you’re right this book it’s filled with such insightful quotes as:

“If you don’t know yet what you should work on, the most important thing is to figure it out. You should not grind at a lot of hard work until you figure out what you should be work- ing on.”

Don’t worry it gets better.

“Productize” and “yourself.” “Yourself” has uniqueness. “Productize” has leverage. “Yourself ” has accountability. “Pro- ductize” has specific knowledge. “Yourself ” also has specific knowledge in there. So all of these pieces, you can combine
them into these two words.”

I mean I agree with the posters above. This is just mindless drivel posing as insight and “philosophy”. Go throw a dart in the self help or business sections of Barnes and Noble and you’ll read pretty much the same thing.

Someone who claims to be a psychiatrist should be able to see through this crap pretty quickly, unless you’re just purely impressed by techno-wealth. We won’t even get into the reasons behind why and how this kind of wealth develops….

And before you counter with how unproductive I am with not telling what I’m reading, my most recent three “fun” books are “The Warmth of Other Suns” recently, then just finished “The Splendid and the Vile” (pretty good if you liked The Devil in the White City). Currently started up reading Stephen Gould’s “The Mismeasure of Man”.

Does this guy “tramp” in the morning too to get his nodes goin....

 

[sloh]

No you’re right this book it’s filled with such insightful quotes as:

“If you don’t know yet what you should work on, the most important thing is to figure it out. You should not grind at a lot of hard work until you figure out what you should be work- ing on.”

Don’t worry it gets better.

“Productize” and “yourself.” “Yourself” has uniqueness. “Productize” has leverage. “Yourself ” has accountability. “Pro- ductize” has specific knowledge. “Yourself ” also has specific knowledge in there. So all of these pieces, you can combine
them into these two words.”

I mean I agree with the posters above. This is just mindless drivel posing as insight and “philosophy”. Go throw a dart in the self help or business sections of Barnes and Noble and you’ll read pretty much the same thing.

While I do think some books are great and are not pandering to the median IQ, man....

“Here we focus on pseudo-profound bull****, which consists of seemingly impressive assertions that are presented as true and meaningful but are actually vacuous. We presented participants with bull**** statements consisting of buzzwords randomly organized into statements with syntactic structure but no discernible meaning (e.g., “Wholeness quiets infinite phenomena”). Across multiple studies, the propensity to judge bull**** statements as profound was associated with a variety of conceptually relevant variables (e.g., intuitive cognitive style, supernatural belief). Parallel associations were less evident among profundity judgments for more conventionally profound (e.g., “A wet person does not fear the rain”) or mundane (e.g., “Newborn babies require constant attention”) statements. These results support the idea that some people are more receptive to this type of bull**** and that detecting it is not merely a matter of indiscriminate skepticism but rather a discernment of deceptive vagueness in otherwise impressive sounding claims. Our results also suggest that a bias toward accepting statements as true may be an important component of pseudo-profound bull**** receptivity.”

On the reception and detection of pseudo-profound bullshit

 

[AD04]

Why do you think people write books? I find reading books to be low yield. Books are usually aiming at a large, general, median IQ audience. Talking to people is much more high yield. Why are you so against this? Are you socially anxious?

I don't understand the jab. I'll take this one on the chin just because I thought your posts in the past were really helpful. I don't know psychiatrists who are worth over $50 million by their 40's. If I knew them, I would certainly talk to them. A lot the psychiatrists I speak to are very successful but are not worth $50 million. You say there are people in our field who are more accomplished so I asked for insight you may have gleaned from them. Are you willing to share any insight from them?

I don't mind one-upmanship or criticism from you if you can back it up. So far, you provided little pertinent details when prompted. Your posts on this thread so far aren't as good as the ones from the past.

No you’re right this book it’s filled with such insightful quotes as:

“If you don’t know yet what you should work on, the most important thing is to figure it out. You should not grind at a lot of hard work until you figure out what you should be work- ing on.”

Don’t worry it gets better.

“Productize” and “yourself.” “Yourself” has uniqueness. “Productize” has leverage. “Yourself ” has accountability. “Pro- ductize” has specific knowledge. “Yourself ” also has specific knowledge in there. So all of these pieces, you can combine
them into these two words.”

I mean I agree with the posters above. This is just mindless drivel posing as insight and “philosophy”. Go throw a dart in the self help or business sections of Barnes and Noble and you’ll read pretty much the same thing.

Someone who claims to be a psychiatrist should be able to see through this crap pretty quickly, unless you’re just purely impressed by techno-wealth. We won’t even get into the reasons behind why and how this kind of wealth develops….

And before you counter with how unproductive I am with not telling what I’m reading, my most recent three “fun” books are “The Warmth of Other Suns” recently, then just finished “The Splendid and the Vile” (pretty good if you liked The Devil in the White City). Currently started up reading Stephen Gould’s “The Mismeasure of Man”.

Your responses are getting better and better. I can actually have a discussion. I like how you're willing to share what you're reading.

How are the parts you quoted crap? Even the Bible has a verse about you shouldn't start the project until you count the cost.

Can you give examples of things (concepts) you don't consider to be crap? How have you applied those concepts to be more successful than the guy who wrote the "crap" book?

 

[Liquid8]

Fascinating thread, although every time I’ve tried to post I’ve been hit with maintenance/downtime, and each time there are new things I want to address.

Have spoken to various business types who take on the philosophy that if you’re not progressing upwards, you’re going nowhere (essentially stagnate and die) – so if you hit a ceiling in one organisation, making a sideways movements to a different one which might have more upward opportunities is common. But for doctors, our progression is consistent – we start as students, then become interns, residents, registrars, fellows, consultants, and similar pathways are well trodden across the western world. I’d see the completion of specialist training and independent practicing rights as the peak, and what lies beyond that stage can vary - one might aspire to run their own business or further academic research, but it’s also not a requirement either as most doctors should be able to eke out a very comfortable existence.

While there’s lots of routine stuff in our day to day work, there’s also enough slack in the system to allow for some challenging cases to keep things interesting. I certainly feel that I’ve been influenced by the attitude of some of my seniors, some who were very confident in taking on any referral (sometimes even unsighted). The newer psychiatrists coming through seem a bit less confident, but I put that down to changes in our exam system. Recently I can remember discussing a case with a colleague, and the first thing they said was “that doesn’t sound like a suitable private patient”. When I reflected back, on the day I’d been border and the referral sounded interesting but there were plenty of red flags to point to a potential minefield.

On the business side of things, at the moment I rent out a room for one payment that includes everything from meals to excellent administrative support. I could try and setup my own clinic and I suppose in the long term it would financially pay off, but there’s a lot of hassle and stress involved that I’m not really sure I need right now. It also helps that I am not getting a raw deal from my current workplace and there isn’t any really impetus to up and change. I think on the whole doctors by nature can be quite conservative, and psychiatrists even more risk adverse which might stop us taking on unnecessary risk.

 

[dl2dp2]

I don't understand the jab. I'll take this one on the chin just because I thought your posts in the past were really helpful. I don't know psychiatrists who are worth over $50 million by their 40's. If I knew them, I would certainly talk to them. A lot the psychiatrists I speak to are very successful but are not worth $50 million. You say there are people in our field who are more accomplished so I asked for insight you may have gleaned from them. Are you willing to share any insight from them?

There are few psychiatrists who are worth 50M by their 40s. This is not one of those jobs. LOL I'm not sure why this is a metric. How old are you? Group heads at bulge bracket banks make MAYBE 2-3M a year--that's if you are lucky with deal flow: base salary is 450k. It's not that easy to get up to 50M from 2M based on pure salary and market return at 30 even if you run a group of MDs at Goldman Sachs or run a large team at Google.

There are a decent number of psychiatrists who are worth 10M+ in their 50s. But I guess that's just too garden variety for you.

If you want to make 50M by 40, you might already be too old. Still, in order to make 50M by 40, reading books is clearly not enough. I would suggest you start your conversation with people who are in the financial services industry or maybe tech industry. Start by Googling keywords on mental health behavioral health investment services/ digital therapeutic startup, etc. Construct a well-thought-out cover letter, and/or contact the management team directly to arrange a conversation to articulate what might be value-add services that you can provide. And start from there.

It's not a jab. You need to *talk to people*. You really do sound socially anxious--lots of negative energy there. People who make 50M by 40 are usually very socially extensive--not really a surprise because generally, the way to make 50M by 40 is by RAISING money. To raise money you need *relationships*. This also involves generally, taking on significant risk. I.e. let's assume you have 2M and 10 years. If you want to make 50M you want 25x. This typically means at least late venture level multiples, which means you are expected to put in a substantial skin in the game (say 20-50%, or, much more commonly, full ownership). Anything later than that (mezzanine) does not have 25x multiples. Funds (i.e. hedge funds) generally aim to MATCH the market (12% a year!) with UNCORRELATED returns WITH leverage and have a smaller skin in the game (~10%). This means if you want to make 50M REVENUE you need to raise 2 BILLION in AUM for 2 and 20 fee structure assuming no net gain on market. And 50M revenue at a hedge fund gives you maybe 2-3M a year profit as the owner, so we are back to square one vs. group head at Goldman. So if you want to make 50M pure profit from nothing you need to raise about 50 billion AUM in 10 years. Citadel has 35B AUM. People don't make money by having a job. It's the 20 in the 2 and 20 that gives you the 50M. Do you understand how the math works now?

You also need to move to a major market. It's not easy to make 50M in 10 years in the middle of nowhere unless there's a specific industry niche.

 

[clausewitz2]

There are few psychiatrists who are worth 50M by their 40s. This is not one of those jobs. LOL I'm not sure why this is a metric.

The best and most consistently successful way to be a psychiatrist worth 50 M in their 40s is to be named "Sackler", but, uh, please don't copy their strategy.

 

[clausewitz2]

How are the parts you quoted crap? Even the Bible has a verse about you shouldn't start the project until you count the cost.

I think you would be genuinely and truly better served by just reading Ecclesiastes than what you linked to. Ecclesiastes at least has genuine insights and an appropriate skepticism of platitudes.

 

[AD04]

There are few psychiatrists who are worth 50M by their 40s. This is not one of those jobs. LOL I'm not sure why this is a metric. How old are you? Group heads at bulge bracket banks make MAYBE 2-3M a year--that's if you are lucky with deal flow: base salary is 450k. It's not that easy to get up to 50M from 2M based on pure salary and market return at 30 even if you run a group of MDs at Goldman Sachs or run a large team at Google.

There are a decent number of psychiatrists who are worth 10M+ in their 50s. But I guess that's just too garden variety for you.

If you want to make 50M by 40, you might already be too old. Still, in order to make 50M by 40, reading books is clearly not enough. I would suggest you start your conversation with people who are in the financial services industry or maybe tech industry. Start by Googling keywords on mental health behavioral health investment services/ digital therapeutic startup, etc. Construct a well-thought-out cover letter, and/or contact the management team directly to arrange a conversation to articulate what might be value-add services that you can provide. And start from there.

It's not a jab. You need to *talk to people*. You really do sound socially anxious--lots of negative energy there. People who make 50M by 40 are usually very socially extensive--not really a surprise because generally, the way to make 50M by 40 is by RAISING money. To raise money you need *relationships*. This also involves generally, taking on significant risk. I.e. let's assume you have 2M and 10 years. If you want to make 50M you want 25x. This typically means at least late venture level multiples, which means you are expected to put in a substantial skin in the game (say 20-50%, or, much more commonly, full ownership). Anything later than that (mezzanine) does not have 25x multiples. Funds (i.e. hedge funds) generally aim to MATCH the market (12% a year!) with UNCORRELATED returns WITH leverage and have a smaller skin in the game (~10%). This means if you want to make 50M REVENUE you need to raise 2 BILLION in AUM for 2 and 20 fee structure assuming no net gain on market. And 50M revenue at a hedge fund gives you maybe 2-3M a year profit as the owner, so we are back to square one vs. group head at Goldman. So if you want to make 50M pure profit from nothing you need to raise about 50 billion AUM in 10 years. Citadel has 35B AUM. People don't make money by having a job. It's the 20 in the 2 and 20 that gives you the 50M. Do you understand how the math works now?

You also need to move to a major market. It's not easy to make 50M in 10 years in the middle of nowhere unless there's a specific industry niche.

Normally, you're good at profiling but in this case you got it wrong. Negative energy is from tit for tat.

But overall, this is the type of post that made me respect you when I was a resident.

I chose the 50 million by 40's as it is the approximate net worth and age of the author of the book.

 

[AD04]

I think you would be genuinely and truly better served by just reading Ecclesiastes than what you linked to. Ecclesiastes at least has genuine insights and an appropriate skepticism of platitudes.

That is a good book. I do ponder about it a lot. Good pick.