Starting my day off with a bit of cleanup in Internet drama Aisle 9.

1) I do not support the public doxxing of anyone. In fact I call it out. It's wrong.

2) I do support someone, feeling harrassed, privately doing what they can to deal with it officially.
3) there are really really good reasons to be anonymous on the internet, for example, people who might be marginalized or victimized because of who they are can gain strength in anonymity. I support anonymity.

4) anonymity does not give someone a shield to violate rules
5) old man internet beard here: If you are anonymous, there is no way to hold you accountable for your words or phrases or identity and history is rife with faked siblings, stories, identities, genders, and even races. Anonymity comes at the cost of credibility.
6) more old man internet here: drama on the internet is as old as the twinkle in Al Gores eye. A great recommendation of you want to have a better internet experience is going to follow. Don't take internet drama personally, but don't tolerate harrassment.
6 cont: you will know it's harrassment because after you assert a boundary, they will go around it to continue to communicate with you.

So. Tips for a better internet life:
A) try to read or interpret other people's words, especially on twitter, with charity.

B) some people bluster on the internet and act probably 50-200% more jerky online, so it's best to ignore jerks

C) use blocking, muting, locking, "block unblock" to force an unfollow, etc.
D) learn how to apologize when you say or do something wrong, and dont do it half-assed.

E) when someone gives you daylight of understanding or commonality, take it and go with that. Sometimes it's hard to do but it's worth it
G) twitter amplifies things. Too many people will agree with you and make you feel like you've got a lot of support, and too many people will disagree with you and make you feel like you're wrong. They are fickle and can't be relied upon. Spend time figuring out who you are.
H) sometimes the best way to win is to not reply

There :) I love most humans on this planet and that likely includes you.

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More from @tylerblack32

3 Feb
1/ Suicidology 🧵, "why rates matter"

A news article in Bengaluru (Bangalore), India, shows that suicides have increased and "Experts blame COVID."

2,081 in 2019
2,162 in 2020
(up 3.8%)

The headline (with a disturbing "toe tag" graphic, not shared), is that suicides are up. Image
2/ However, Bengaluru has had an incredible population explosion, with an average yearly increase of 3.6-4% per year for over decade now.

The net result: the suicide rate is essentially unchanged. 17.5 per 100k (up about 0.16%)
3/ So while the headline is a toe tag graphic with a chilling statement about increasing rates, the actual news for the year is "suicides increased proportionally to the population growth, such that the rate is unchanged."

**Expertise matters to tell the right story**
Read 6 tweets
30 Jan
Because it's actually much more likely to be transient, and its severity usually wanes, I would prefer to see this diagnosis termed not as a personality disorder at all. It is no more stable in prognosis than depression.

"Trait and Transient Emotional Instability"
Ten year longitudinal
psycnet.apa.org/record/2018-31…

In adolescents/young adults
journals.sagepub.com/doi/abs/10.117…

Which symptoms may be more stable
journals.lww.com/jonmd/Fulltext…
If we as clinicians can see depression and anxiety -- both which can progress into chronic but usually attenuated conditions -- as episodic, we can damn we'll see "bpd" as episodic
Read 4 tweets
28 Jan
To all health trainees, there is an important lesson to be learned that will one day present itself to you, and if you aren't met with wisdom, kindness, and experience, can crush you.

"Not everyone can be saved."

/1
This lesson doesn't care if you work with children. The lesson disregards motherhood. The lesson disregards kindness or generosity or even fairness. It can disregard your effort or even following all the best advice.

Medicine, unfortunately, is cruel in this way.

/2
Your efforts should always be directed at the core of:
* Providing the best care with best effort
* Advocating for your patients needs
* Reducing barriers
* Respecting autonomy

But, unfortunately, all of these things are not magical, and they do not negate the lesson.

/3
Read 6 tweets
22 Jan
Canadian Suicidology:

Summing BC and Alberta, 2020 has seen a 14.8% decrease in suicides from 2019 to 2020 (+/- 8.6%).

In Canada, there has been no "COVID effect" increasing suicide rates, in fact, our evidence thus far suggests a decrease.
The Chicken Littles of the media will always be quick to proclaim that the sky is falling with respect to a new stressor and suicides, but @StanKutcher and I were right to call publically for all to "settle down" about the "tsunami of suicide"

thestar.com/news/canada/20…
Huge thank you to @rachelmendleson who was one of the only reporters to speak with me at the time about my position of cautious optimism/"let the data tell us" approach. Pushing back against moral panics requires the media's assistance.
Read 4 tweets
22 Jan
Japan 2020 Suicide Rates have now been reported (there will likely be slight changes in a few months). Overall, suicide rates mostly the same, however a subgrouping shows an increase in female suicides (+15%), whereas males decreased slightly (-1%).

/1
The female suicide rate increase is the 2nd largest increase, following the massive spike in suicides in 1998 (largely attributed to decade-long Japanese economic hardship). However in 1998 the increase was larger in men. (39% in one year!) vs. women (23%)

/2
Breaking down the deaths per month, there was a significant decrease in suicides in the first half of the year, contraindicated by an increase in suicides in the second half of the year. Overall, it averaged out, and clearly later "effect" seems to be levelling off.

/3
Read 10 tweets
21 Jan
Game Theory for the "left":

2 choices
You can choose 1
1 of the 2 will happen
No viable alternative
1 OF THE 2 WILL HAPPEN

Foolishness:
I won't participate, its not good enough

Smartness:
I will choose the option that gets me CLOSER to what I want.

/1


slate.com/news-and-polit…
The above doesn't happen if you don't vote for Biden.

The above doesn't happen if a few in a few states wrote in for Jill Stein or Bernie Sanders or stays home in spite.

/2
I really hope the awfulness of the Trump era, made only possible by a coalition willing to do ANYTHING THEY COULD to get their political agenda accomplished, teaches the drivers of the awful purity test dynamics of the "American Left" something.

/3
Read 6 tweets

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