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#i know hearing loss is on a spectrum - but i guess so is identifying your disability
happy-xy · 3 years
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Chella Man is #PROUDINMYCALVINS | Calvin Klein (2020)
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subsystems · 4 years
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For DID awareness day, I want to bring awareness to the vast spectrum of DID and OSDD symptoms. I feel like the symptoms of these disorders are often misunderstood. Many people assume that DID and OSDD are such extreme rollercoaster disorders when that’s usually not the case for any mental disorder! I’ve also seen others who believe that DID/OSDD are just having alters and not liking them--which is also not an accurate portrayal!
The DSM’s criteria of alters, amnesia, and distress/impairment aren’t meant to be taken at the surface level. These are very simple descriptors for a spectrum of experiences that are the hallmarks of the disorders. Besides that, there are many, many more symptoms that are very common. No two people with DID or OSDD are going to be exactly the same; I think that goes for any mental disorder.
Below, I’ve written up a non-exhaustive list of common symptoms in DID/OSDD. It’s important to know that many of these symptoms can overlap with other mental disorders. DID/OSDD symptoms are always unrelated to other medical conditions or non-disordered experiences, such as substance use or epilepsy. Furthermore, these are common but not required; a person does not need to experience all of these things to have DID/OSDD.
(PLEASE don’t use this list to diagnose yourself. Seek a professional if you are questioning a mental disorder!)
Common symptoms of DID/OSDD:
C-PTSD symptoms
Since DID/OSDD are more complex forms of PTSD, you or other alters might experience the symptoms of complex PTSD. Check this PDF for the symptoms of C-PTSD.
Memory gaps
You might find that your memory is unreliable. You might lose a lot of details or misremember the important bits.
You might have difficulty piecing together a coherent timeline of your life. You might struggle to retell what your childhood or adolescence was like.
You might have moments where you’re unable to remember important life events, such as the day you got married.
You might find that sometimes you can’t remember important information about yourself or about those closest to you. This could include things such as your name or who your family members are.
You might find that you sometimes forget well-learned skills, such as driving or a favorite hobby.
You may find that sometimes you can’t even remember more recent things, such as what you did today or what the last conversation you had was about.
You might have moments where you discover evidence of your memory gaps, such as text messages you don’t remember sending or purchases you don’t remember deliberating.
There might have been times when you ended up in a different place but could not remember how you got there.
Someone might have told you that you did or said something that you don’t recall.
You might have moments where you don’t even remember the times you have forgotten things. Because of this, you may feel like you don’t truly know how much memory loss you actually experience.
Depersonalization & derealization
You might experience moments where you don’t feel in control of what you’re saying or doing.
You might feel like your body is unrecognizable, unreal, or doesn’t reflect who you are.
Familiar places, objects, and people might suddenly become unfamiliar or detached to you. Alters might feel things like “those are the host’s parents, not mine.”
You might have moments where you feel like you are in a dream or a fog. 
There might be times when watching your surroundings seems no realer than watching a movie.
You might have moments where you feel unreal. You might feel like you are invisible, two-dimensional, or a robot.
You might feel numbed to or detached from your body parts, thoughts, emotions, sense of agency, or even your entire self. 
You might sometimes experience heightened or muted visual/auditory distortions with no medical cause, such as blurry vision, muffled sounds, or tunnel vision.
Sometimes might you feel like you are watching yourself, as if you are having an out of body experience.
Being an alter & having alters
You might feel confused or distressed because you do not identify with the things that people associate your whole identity with such as name, personality, opinions, or preferences.
You might feel confused or distressed because you do not identify with the same age, gender, or species as your body.
You might feel confused or distressed that your physical body does not reflect how you feel you should look.
There might be other alters who feel the same way above but differently from you, and this may also confuse and distress you.
You might not be able to access same skills, knowledge, or talents that other alters have.
Others might tell you that you sometimes act very differently, almost like different people.
You might hear voices, such as voices arguing or commenting on your actions.
There might be times when you experience intrusive thoughts, visual images, feelings, or urges that don’t actually belong to you but to another alter.
There might be times where your body seems to be moving and speaking on its own because another alter is controlling it.
You might have moments where you involuntarily switch to a vulnerable alter. Sometimes this may result in an unsafe or distressing situation.
There might be alters who are be unaware of other alters’ existence or refuse to believe so.
There might be alters who struggle to communicate with other alters or refuse to do so.
There might be alters who have suicidal thoughts, physically harm the body, or engage in risky behavior.
There might be alters who dislike or lash out at other alters within the system.
There might be alters who still carry onto memories, thoughts, feelings, or behaviors related to past trauma.
The alters within the system may have contradicting thoughts, preferences, and opinions.
You might sometimes have difficulty making cooperative decisions with your system because of conflicting desires, needs, and perceptions.
You might have episodes where you feel like you don’t know who you are, like you’re a combination of alters, or that you’re just not like yourself.
Somatoform dissociation
You might sometimes experience pain or sensations that don’t have a medical cause, such as “switching headaches.”
You might sometimes go catatonic or become paralyzed without a medical cause.
You might sometimes experience the loss of a physical function without a medical cause, such as your sight, hearing, speech, or feelings of hunger.
Sometimes, it might feel like you are numbing out pain or sensations.
You might experience other conditions without any medical cause, such as pseudoseizures.
Other symptoms
You might experience hallucinations or delusions, usually related to past trauma.
You might feel afraid or shamed of the possibility of others finding out your thoughts.
When someone asks you to describe who you are as a person, you might feel at a loss for what to say.
You might experience mood fluctuations or like your moods sometimes come out of the blue.
You might have difficulty being aware of your own symptoms or describing the severity of them. This might be because you have had them for so long that you are used to navigating life with these symptoms.
Disorders that are commonly comorbid with DID/OSDD:
Borderline personality disorder
Depression
Anxiety disorders
Substance abuse disorders
Eating disorders
Sleep disorders
References
Diagnostic And Statistical Manual Of Mental Disorders: Fifth Edition
Treating Trauma-related Dissociation: A Practical, Integrated Approach
Understanding and Treating Dissociative Identity Disorder: A Relational Approach
I guess my own personal experience, too? But mostly the books above ^
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my masters thesis on how to determine the horny level of a bee gees song or, how to tell if you need to throw a bee gee in horny jail.
horny bee gees songs come in a couple of flavors. for the most part, when the bee gees sing about love, they’re really singing about love. but sometimes when they sing about love, they are really singing about Fuck, and Fuck and love are different. in order to properly evaluate a bee gees song for its horny factor, we must consider both the lyrics and the complete musical presentation. what does the song SOUND like? what do the instruments do? how fast, how slow, what tone of voice are they singing in? all of these things affect how horny any given song is. first, we examine the lyrics, looking at the meaning of the text. is it to be taken at face value, is it metaphorical, is it autobiographical, is it fictional. then, we examine the sonic presentation. how do the rhythm, instrumentation, and vocal delivery affect the text? where does the primary horny energy in the song lie? i might not be able to analyze every single bee gees song for its horny value, but we can extrapolate and use these criteria as a guide to determine the horniness of any bee gees song.
for instance, “how deep is your love” is very much really about love in general. Fuck may be part of that love, but it is not the primary focus of the song. with a gentle delivery, soft instrumentation, and lyrics that show a deep connection between the singer and their partner, “how deep is your love” is very decidedly about affection and emotional love rather than physical sexual intimacy.  “love you inside and out” is lyrically mostly about love, but it’s also very much about Fuck. it is sneaky. it is musically, especially rhythmically, an extremely humpy song. from the opening bass line, the vibe is set. barry’s delivery is more urgent here. we hear him pretty much parked in his falsetto for the entire song, singing with an urgency we simply do not hear in the album’s other big hit, “too much heaven.” lyrically, we hear the emotional toll of a relationship that lacks equal commitment--she just doesn’t feel what he feels, and it devastates him, but it also sounds like he is crying about this while poundin’ that pussy. through these two examples, we can glean a lot about how to determine the horniness of any bee gees song.
in direct juxtaposition to “love you inside and out,” we find a later bee gees song off of the remarkably horny 1997 album “still waters” called “alone.”  “alone” is musically a pretty gentle song. it’s upbeat, with bagpipes (notoriously unsexy in nature), accoustic guitar, and snare drum as the main instrumentation. lyrically, the overall message of the song is “i have done a lot of fuck, but i maybe should have done a little more love, because now i am alone, which is something i dislike.” though a cautionary tale about the importance of finding the right fuck/love balance, the opening lyrics are perhaps the most explicitly about a sexual act of any bee gees song. “I was a midnight rider on a cloud of smoke, i could make a woman hang on every single stroke” announces a 51 year old barry gibb, terrorizing me. in the following lyrics, he notes how his partner’s body began to tremble. though the text eases up on the direct references to sex, these opening lines have left their horny mark. vocally, this is not one of barry’s strongest performances. delivered in a hushed falsetto on the verses with occasional supporting harmony from his brothers, he just manages to sell the introspection, but the choruses by robin deliver a large amount of the emotional weight of the song. this sets the tone for the rest of the album, however, as even the songs on this album that are primarily about love seem to be about a very sensual, sexual love and above an emotional interpersonal romantic love. following a rejected acoustic cover album, the brothers appear to have focused on writing more mature music that they felt would feel fresh and contemporary in the late 1990s. they’d also undergone an image makeover, as 1997 was to be a very big year for them. a very big, very horny year, with their induction into the rock and roll hall of fame and the 20th anniversary of saturday night fever relaunching them into the public consciousness in north america. it was time for the bee gees to be adults, and they opted to do so by wearing black and singin’ about fuckin’.
the third variety of horny bee gees song is a song that is horny both in text and in musical presentation. songs of this nature pair sexual lyrics with sexual musical delivery. i think as humans we all instinctively know what music sounds horny--we all respond to it differently, but we can all identify that a smooth bass line, cool, relaxed beats and instrumentation, and a slow but deliberate tempo indicate a certain amount of intended sexiness. this may attract or repel us, but at the very least, we notice it. this is the kind of song of which brother maurice is most typically guilty--”dimensions,” “closer than close,” and “house of shame” all fall under this category, easily diagnosed as horny in both meaning and sound. lyrically, mo is the most explicit about his own body and sexual desires in song (the mo penis forecast for today is rock hard with a chance of drip), and his delivery is probably the sexiest and most masculine, lending even non-horny songs a bit of a sexy vibe. his solo performances were rare for the group; some albums would go by without a single mo-lead song. the relative scarcity of his songs makes their unique horniness and sexuality more noticeable. barry has hundreds of songs. if some of them are devastatingly horny, it hardly matters compared to the plethora of story songs, love songs, and songs about the invention of the lightbulb with which he has provided us. a horny barry lead is a drop in the bucket--a horny mo lead is 1/6 of his catalog. robin has very few truly horny songs, as most of his leads are a bit more introspective, melancholy, and full of longing. his voice was very well suited for conveying complex emotion. there’s a reason “lamplight” was the hill he was wiling to die on and not, say, “sensuality,” a horny disaster cut from the 2001 album “this is where i came in”. sensuality is perhaps the best...worst...strongest example of a song that is horny in both text and composition. it’s the kind of song you’re afraid of your parents catching you listening to. it’s the kind of song that i personally have to actively endure. the lyrics are deeply sensual, as could be inferred from the title, but even with the warning of the title, perhaps one is never really ready to hear robin gibb say “body worship.” recorded in 1998, this was hot off the heels of the uber-horny “still waters” and the structure of “this is where i came in had not yet been determined. i don’t know how this song eventually found its way to the public--i assume it just slithered out on its own, determined to be heard. the musical backing brings all of the horniest sounds a late 90s pop track can bring--creamy vocal harmonies straight out of a backstreet boys track, a hip-hop styled breakbeat, and sexy key-change at 4:30, all delivered with the confidence of a horny 48 year old who has seen a fuck or two in his lifetime in one convenient slow-jam. lyrically, it discusses thirsting and hungering for your partner's body, body worship, finding the “center of your universe” which i assume is code for “the clit”, mentions being a slave under an evil spell, compares sex and love with their partner to religion, and then says in no uncertain terms that god is on his side giving him the power to Fuck Good (very well, even.) it is clear to see that both musically and lyrically, this song is about fuck with a side of love, rather than love with a side of fuck.  this song is horny.
with these categories and criteria in mind, we are now free to consider the horny weight of any bee gees song. “country lanes?” not real horny. “all this making love?” incredibly horny. “one?” hornier than you’d guess on first listen but barry says he’ll be your slave. “wish you were here” is definitely hornier than a song i’d write about my baby brother but because it was styled to be more relatable and so posed as a more general love and loss song, we can consider it very low on the horniness spectrum. “esp?” that’s psychic horny. do with this cursed information what you will. i literally can’t think about this any more today or i will rip my own eyes out. the bee gees can be horny if they want and boy do they want.
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choupichoups · 5 years
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✎ Coup d’État 
“You seen the new kid yet?”
“Gangster pants, black hoodie?”
“Yeah, how much you wanna bet he’s another Ares punk?”
“Ugh, no, as if we need any more of those.” 
“Oooh, maybe Hades? He’s got the style for it.” 
“What, like he just rolled out of the dumpster?”
Or: A PJO au snippet where Eliott, son of Apollo, meets his trash baby panda of a soulmate— until he’s not (a trash panda, that is, he’s still his soulmate)
@salutmonmec
It’s so fucking hot.
“You seen the new kid yet?”
He’s going to burn if he stays a second longer under the sun. 
“Gangster pants, black hoodie?”
Hoodie? Who wears a hoodie in this weather? God, what’s the point of his father being the literal god of the sun if he’s still affected by this hellish heat? His dad’s a real jackass for not giving them immunity. 
“Yeah, how much you wanna bet he’s another Ares punk?”
“Ugh, no, as if we need any more of those.” 
Eliott splashes sadly, the lake water barely reaches his chest even when sitting down so he has to awkwardly hunch over in order to submerge his entire body into cooling off. 
“Oooh, maybe Hades? He’s got the style for it.” 
“What, like he just rolled out of the dumpster?”
A chorus of laughter. Someone snorts like a pig.
“Hey, Eliott, what do you think?”
Eliott looks up, blinking sleepily up at his half brothers. “I dunno.”
“Thank you for your input, enlightening as always.”
He flips them off, sighing as he drops his chin down and makes bubbles into the water. 
“Let’s get out of here before we start looking like raisins.”
“You already look like a raisin, Chad.”
“Fuck off, Hunter, at least my skin has room to breath. You’re one protruding vein away from being a walking block of ham.” 
“Hey!” 
The guys start dragging their dripping bodies out of the lake but Eliott lags behind, unwilling to part with his newfound home. Yes, he thinks he’ll stay here for the rest of the summer. 
“Eliott, come on bro, we don’t wanna miss the bonfire!” Hunter is the last to wade out the water apart from Eliott, turning around with wide, expectant eyes. 
“Right, don’t want them longing for your wonderful voice too much,” Eliott says blandly. 
“Damn right!” Hunter pushes dark blond strands off of his face, bending down to retrieve the clothes he’d discarded by the rocks. Evidently, the guy miscalculates as his back collides with a protruding boulder and it sends him bouncing back into the water like an inflatable mascot.
Eliott laughs so hard he tips over and accidentally dunks his own head underwater. When he resurfaces, everything is a hell of a lot blurrier than it had originally been. 
Great, his contacts got washed away again. Fucking Hunter.  
“Are you two done being morons yet or do you need more time?” Chad calls out from behind a tree, already dressed in his damp shirt and basketball shorts. 
Hunter grumbles all through slotting his legs back into his own shorts, shirt nowhere to be seen. Eliott could have sworn all of them had shirts on before hitting up the lake earlier. 
Begrudgingly, he crawls back on land, figuring he’s already left the medic bay long enough for at least one camper to probably pass out from loss of blood. From a papercut. Demigod children can get quite dramatic in the face of pain. 
He takes his time getting dressed, not minding at all when the voices of his brothers get too far from him to hear. They’re headed a different direction from him anyway and Eliott is very much not ready to leave the breezy comfort under the shade of these trees as of yet. 
There’s a rustling from the nearby bushes, followed by what sounds like the rushed footsteps of about four or five people. Eliott sticks his head out curiously, squinting to aid his vision. 
A group of Ares campers are charging towards a lone figure, led by Nathan, a particularly nasty addition to the Ares cabin. Eliott can’t clearly identify the dark blob they’re targeting from this distance but he’s guessing it’s the new kid. Fits the bill— loose dark clothing despite the heat, face obscured by the low fabric of his hood. 
Eliott moves to approach just as they have the boy surrounded. He looks tiny compared to them and Eliott can’t help it— it’s in his nature to care. He knows it’s nothing too bad, he’s all too familiar with the Ares cabin’s toilet dunking initiation rules. Many brave souls have tried to upend this ritual but to no avail. But maybe if Eliott makes his presence known, they’d let the boy off the hook for the meantime. 
Though before he could take another step, something peculiar happens.
There’s no real explanation for it— the shift in the atmosphere is subtle, but the air seems thicker somehow, smelling of something sweet. So sweet Eliott’s almost tempted to move closer, dive into it and drench himself in its presence. 
And... everything looks pink? What?
He quickly shakes his head, physically flailing his arms around as if to swat the feeling away. When he looks up, the new guy’s back is to Eliott, facing the Ares kids now with his hood down. There’d be nothing too shocking in this picture if it weren’t for the fact that Nathan and his lackeys are completely immobile. Eliott can’t quite make out the exact expression on their faces but from what his blurry vision allows, it’s pretty easy to spot them all slack-jawed, maybe even dazed.
The boy replaces the hood over his head and walks away, untouched. 
What the hell just happened there?
The other campers start gathering around the campfire almost immediately after he gets back to the medic bay, his half siblings being the first ones present, taking turns on the guitar and belting out songs to their hearts’ content. Although Eliott has always been too shy to sing so publicly, he’d normally be out there listening and laughing along with them. 
But he’s honestly feeling so gross right now. It’s probably the worst summer day of this cycle so far— he’d spilled coffee on himself shortly after his little dip in the lake, ruining the fresh shirt he’d put on right off the bat. The stain is a glaring map over the center of his chest and the many, many kids (an atrocious amount, considering there’s been less than an hour between the time at the lake and the campfire) that got sent to the medic bay in danger of a fucking heatstroke didn’t let him forget about its existence. 
Pushing his glasses up his nose, Eliott sighs, wondering if he should even bother to change or at least try to wash out the stain. On one hand, it’s late in the day and they should all be headed to sleep soon anyway while on the other hand, Eliott just wants to feel like a decent human being before hitting up the bonfire. 
The decision is made from him when a commotion starts up, the air ringing with anticipation and a few gasps from the younger kids resonating above the shocked silence from the rest. 
Eliott stumbles out, cold coffee in hand and medic coat thrown haphazardly over his dirty shirt— not that it helps any, as the thing’s unbuttoned and still showing off his spectacular stain. He stands beside Tristan and Hunter, eyes following the human shaped pink glow from across the campfire. 
But the fire rises in tandem with the campers’ heightened excitement, a golden barrier between Eliott and the occurring spectacle. Slowly, he steps to the side, long legs carrying him forward to where he can see clearly. 
And what a dizzying view it is. 
In front of him stands the new kid, except not really. The boy is surrounded by a pale pink light, and gone is the hideous hoodie and baggy pants combo— he’s dressed in a white shirt, soft and loose, showing off more collarbone than the boy is obviously comfortable with, considering how he crosses his arms over his shoulders with an audible squeak. His pants look equally soft, but fitted, dark fabric displaying a pair of legs that a part of Eliott’s brain can’t seem to stop observing. For science purposes. His skin is lightly tanned, looking like the smoothest cut of marble one might ever have the privilege of running a hand over. Eliott admits that he’d go to great lengths to prove that theory right. 
The boy takes a small step back, appearing one breath away from bolting. Eliott feels the stress rolling off of him in waves. 
Eliott must’ve twitched, breathed too loud, done something, because the boy’s eyes, wide and slightly panicked, flicker straight to him, meeting Eliott’s surely idiotic expression with a flutter of unfairly long lashes. Fuck, that pink glow is yet to fade away. He looks like an angel, it’s downright devastating. His hair’s been pushed back from his face, like a hand had brushed through it to make the most beautiful mess. Eliott’s eyes are free to wander, following the sharp cut of cheekbones down to a perfectly angled nose. He reaches dangerous territory at the sight of a pale rose lip bitten and trapped under the boy’s front teeth.
His eyes snap back up and their gazes lock, Eliott’s glasses slipping down his nose a minor occurrence that he pays no attention to. Not when he’s busy immersing himself in those eyes— a glittering pool indescribable. Eliott is a prodigy of the arts, one of the few things Apollo has done right by his children, but he feels the need to create a whole new spectrum of colour to justly describe the hue of this boy’s eyes alone. And isn’t that some food for thought. 
“Wow,” he blurts out, unable to withstand the utter beauty being presented right before him and the consequent poetry his mind is spewing all over the place.
Except he says it a little too loud and now the attention’s all on him. 
He sputters, shocked into movement like an old engine stuttering back to life. Unfortunately, he forgets about the cup of coffee he’s been holding onto so his halted flailing sends more coffee dripping down the front of his shirt, creating a new stain to keep the first one company. 
“Ah!” The cold shock of it sends him stumbling backwards and his own two feet tangle in his rush to save himself from accidentally falling into the fucking campfire. He’s thrown sideways by the force of his misbalance and he goes diving onto the ashy pile of dirt beside the fire, landing in front of his siblings’ gleeful faces. 
“Nice one, Beli.” Chad snickers, large hand coming down to pat at Eliott’s hair.
He doesn’t have the energy to protest the nickname. Instead, he pours out the rest of the coffee from his paper cup and chucks it at Chad’s head. It hits him right on the forehead, Apollo’s godly aim blessing Eliott for once in his life. 
When Eliott looks back over, a pretty flush of red has settled high atop the boy’s cheeks, spreading over his nose in an adorable show of embarrassment. Some of the others let out an infatuated sigh at the sight of it, and Eliott would’ve too, probably, if he didn’t feel like he’s gotten hit by a freight train once and then backed over twice for good measure. 
Jenna, counselor of the Aphrodite cabin, jumps up from her position on the ground and takes the new kid into her arms. “Finally!” she screeches, ruffling his hair roughly. The other Aphrodite girls happily join in to form a big group hug. They look like an overexcited party of unfairly beautiful nymphs. “Welcome home, brother!” 
Much later that night, Eliott ventures back out of the cabin— Hunter and Chad haven’t stopped yakking about the amount of protein intake they need to balance out their carbs while still maintaining an acceptable sugar level and Eliott really isn’t in the mood to join in on the conversation. The temperature’s much cooler now that the sun’s fully gone, enough that he has to change into a long sleeved shirt to keep the chill off of his skin. 
He hasn’t walked very far when he spots a figure curled up atop a tree stump, gazing up at the stars with a hopeless sorrow that tugs immediately at Eliott’s heartstrings. Being an empath is both a blessing and a curse. Over time, Eliott’s learned to temper the part of him that latches onto another’s emotions. He’s tuned it out well enough for him to ignore the impulse most of the time. 
But this boy radiates loneliness like a bird shot and abandoned, helpless yet surrendered to its fate. 
“Hi.”
He tenses at the sound of Eliott’s voice so Eliott makes sure to approach slowly, waiting until the boy is fully turned towards him, watching his every move, before he takes a seat on the neighbouring stump off the new kid’s left side. 
The boy nods but doesn’t say anything before tipping his head back up, eyes on the night sky. 
“It’s a pretty nice spot, huh? We can see the stars clearly from here,” Eliott says, tilting his head until all he can see are the speckles of stars against the black backdrop. “I’m Eliott.” 
From the corner of his eyes, he sees the boy fiddle with the ends of his sweatshirt— seems like he’s found another hoodie to hide under. “Lucas.” 
Eliott turns his head, the speed of which it happens is almost outside of his control. It’s a strange feeling, being affected by the sound of a voice. Lucas breathes out the name soft and lilting and he’s sure Lucas doesn’t mean to do it, but the way he speaks is unerringly attractive.
Oh. Eliott whips his head back up to the sky, not wanting to make Lucas uncomfortable. That must be why he’s so damn quiet all the time. 
They sit in silence for a while, Eliott privately steeling himself for the next sound coming from Lucas, who’s still curled up in his seat, legs folded in half and arms surrounding them tight. 
Under the faint touch of campfire, he glows— a supernova crafted by Aphrodite herself. Eliott isn’t sure whether it’s the effect of the goddess’ blessing at work or if Lucas, unhindered by the weight of prying eyes, simply carries the moonlight under his skin. 
“Do you see your favourite?” He tries again, hoping to get a lengthier response this time. The only way to get used to the allure of Lucas’ voice is to hear it over and over after all. 
“Favourite?” Lucas speaks faster this time, although still a little wary. 
“The constellations.” Eliott points up at the sky above them, tracing Lyra with the point of his finger. “They’re everywhere.” 
Lucas mumbles an answer but Eliott fails to catch it. His listening skill is one Eliott takes pride in but Lucas talks inhumanly low even for someone as attentive as Eliott. Lucas clears his throat when Eliott gives him a blank look. “I don’t know. I don’t have a favourite.”
A whooping two sentences. Eliott feels a sort of warmth come over him at the sound of it but it’s nothing he can’t handle. The thought brings a grin to his face and Eliott soon feels himself relax, humming as they continue to stare upward. 
“Mine is Pegasus.”
“Really?” 
The voluntary response only furthers his giddiness. “Yup, it’s cute.” 
“…cute.” 
“Adorable! See, look.” Eliott hops up and crouches beside Lucas’ tree stump so that they’re viewing the sky from the same angle. “Follow my hand, see it over there?”
“I guess.”
“Don’t guess, it’s right there!”
“Okay.”
“You see now?”
“I guess.”
“Come on, Lucas.” 
Gazing up at Lucas is quite the revelation. Lucas has to look down to where Eliott’s crouched down and from Eliott’s angle, his eyelashes are stupidly long. Or, well, not stupidly— rather beautifully, insanely, captivatingly. The blue in Lucas’ eyes are lit up with mirth and his lips, full and red and pursed, are quirked up in the corners with the smallest hint of a smile. 
At the risk of sounding like a bad romance heroine, Eliott is instantly breathless. 
“Eliott?”
His name coming from that voice quite literally knocks him on his ass. Eliott loses his balance and tumbles backwards, plopping into a seated position over dry grass instead of the careful crouch he’d opted for at the start. 
“Yeah, yes, Pegasus, the cute bastard,” he rambles, barely saving the moment. “The constellation reminds me of a kid tryina draw a horse.” 
Lucas is frowning up at the sky now and Eliott can practically hear the gears in his head turning. “That’s not cute, that’s ugly.” 
“Jesus, you’re gonna make a child cry someday.” 
He sees Lucas duck into the space between his chest and folded arms. Curiosity has Eliott subtly peeking forward and while Lucas’ smile is hidden behind his own arms, the curve of his eyes give him away— Eliott, emitting a surprised laugh at successfully making Lucas smile, wonders what he has to do to uncover that sight. 
“Cassiopeia,” Lucas says only seconds into the next bout of silence. 
“Hm?”
“It’s my favourite.” 
“Oh.” His name is Lucas and he likes Cassiopeia. Eliott thinks that’s a pretty good start. “Cool.”
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flamewyrmz · 6 years
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a late night rant from twitter im putting in one place, because its a trainwreck of several threads there. mostly copy/paste and still not proofread, but a collection of thoughts on gender, sexuality, personal identity, and love and support within the lgbtq community. i do really lay myself bare here so id like to ask that if you disagree or have criticism you do so respectfully and with that in mind, thank you <3 and if this means something to you itd mean the world to me if you shared it
dunno if ive said this here before but like. if you think you might be bi/pan but youre on the fence cos maybe youve never had a crush on a nonfictional guy or get more crushes on guys than on girls and you find yourself tied up in knots like "well im gay but im also attracted to nonbinary people unless theyre mostly woman-aligned but i dont wanna say im bi/pan because then people will think i like girls and like i like them theoretically but--" let go. just say fuck it! im bi/pan! 
try it out and if it doesnt feel right it doesnt feel right and thats fine and in the end no matter what youll have learned a little about yourself. this is actually my advice on any gender/sexuality dilemmas you might be having. go wild. try it out. see how it feels. dont feel like you have to confine yourself to something just because youve stuck with it for some amount of time. 
if youre questioning dive right into the deep end! no matter how it goes youll be a better swimmer in the end. its all not quite rigid and a little fluid anyways (for some more than others obv) so if youre unsure, man... go for it. its ok to backpedal
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this is important advice to me because ive struggled with it multiple times in the past and this has only recently clicked and i really wish it had sooner. first it was with being... not straight in general. like i was actively dating someone of the same gender and i never considered that that meant, uh, im not straight. always "do you like boys or girl?" "uhhhhhhhhh. uh. UH" 
then with being in the range of aro/ace spect. then with being nonbinary! then with being nb but primarily male. and then goddammit im just a boy. accepting that God I Love Men And Only Men (and with it that i *wasnt* aro or ace in ANY capacity) and then, very recently (like up until a couple months ago. like im p sure this year. not 2017), going back on that and admitting i was bi. it is so so freeing to just say "fuck it" and test those waters!
hell, you find something you resonate with but looks a little silly? go for it! use those bun/buns/bunself pronouns. go with stargender! ace-flux demibiromantic? hell yeah rock that shit! it can always change and you can always decide its not right and go back! h4y dudes
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all of that especially goes for teens who dont know what the fuck theyre doing. im only 20 yea and barely 20 at that but man i wish id heard this sooner
and please dont take that as me saying "well if youre a lesbian sexuality is fluid and maybe youre actually bi"! hell no. if youre a lesbian and you KNOW youre and lesbian and couldnt ever be anything else then rock on you funky little lesbian! but if you id as a lesbian but are teetering on something like "well im attracted to some fictional and theoretical men but not any real ones and maybe its just compulsory heterosexuality but im not sure and--" dont be afraid to try a different label. its all what feels right to you and theres absolutely no harm
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people bash on like. """mogai genders""" and nounself pronouns and the split attraction model and all that and like. yeah! those things can hurt people! personally i struggled with the split attraction bit combined with how broadly people define the ace spectrum. it can be used to hurt. and it is used to hurt. sometimes its deliberate, sometimes its not. but the hurt is there. but its not inherently good or bad. 
and yeah, some of it sounds silly. hell, it sounds silly to me sometimes! but to some people hearing that label makes everything click into place, even if just for a little bit, and i take that very seriously. it is one of the best feelings in the world and i want as many lgbtq people (of any age) to experience it. 
for some people it feels right to zoom waaaaaaay in and section it into lots of little bits and for others its "fuck it! i dont know shit! im just queer!" and those are both equally valid (that words been thru 12 garbage disposals but i cant think of a better one) maybe you go back n forth and thats fine too! as long as youre open to it changing or being wrong it cant hurt and, like i said, its one of the best possible feelings to have it click like that
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as an aside: being bi can *totally* mean "im attracted to men and nonbinary people are long are they arent primarily woman-aligned" or it can mean "im attracted to everyone fuck it" personally? i use bi over pan because i feel like it better encapsulates that i *do* have preferences (i say this all the time but God I Love Men) but ultimately gender doesnt really matter to me cos everyones cute and hot and generally attractive and im not leaving anyone out because im just a little more inclined to kissing boys. but thats me!
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as Another aside: i do still to some degree identify with uhh this is gonna sound contradictory but agender boy? or more like boy agender? boygender with left none? i just dont personally feel like its worth taking the time to explain over n over. but it used to be, for me, n i dont regret that a single bit! i wouldnt regret that even if i *didnt* still feel that way in any capacity. honestly? 
i dont regret any of the ways ive identified in the past even though feeling stuck and cornered into some got a little harmful to me (and if youve gone through somethin similar and DO regret it and wish youd never heard whatever term you used thats good too. im very strongly advocating for "use whatever labels you want and if it dont fit it dont fit" here but if they did hurt you and youre still hurting about it i understand 100% just dont use it to pull others down. if it concerns you say your piece and let them decide)
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this is personally a little hard to admit so bear with me here 
honestly? ANY sort of strong identity didnt start developing in me until i was.... 14 or so? and very slowly at that. like gender evened out around 18 and sexuality just a few months ago LMAO. but up until i was a teenager i didnt really feel much of anything re: gender or attraction (and the attraction thing is pretty normal for kids and even teens tbqh!) 
and i just.... didnt really think about it! i had This Name and apparently was a girl and i didnt really get what it was like to BE a girl but thats what people said and i didnt know there were other options so i went with it! the name didnt bother me either (except for when people made jokes about a Certain Historical Figure with the same one. just thinking about that i get tired) 
and when it came time to actually grapple with the whole concept of being *into* people i just kinda... slunk away! no joke until like 10th grade if someone started a rumor that i was dating x or y had a crush on me i would start to avoid them entirely. lost a friend in 4th grade that way but then in hs hed turned into a TOTAL DICK so no loss there. i think part of that was also people making the assumption that i was straight though? big shrug! 
i didnt even realize attraction was a thing i had until i got asked out and just kind of "oh wow??? that sounds so nice??? i feel the same??? yes??" and thats WHY i went thru varying aro/ace labels. cos it unfolded slowly (which again is totally normal if youre a teenager, so dont worry about it if youre going thru that. roll with the punches. and if youre a teen and youve got it figured out? thats totally normal too!) 
and the gender thing was similar once i learned that it was an actual possibility (especially being nb, and ESPECIALLY especially being agender) i slowly just... poked at it until i figured something out (fun fact: what set me off to finally go "fuck it im not a girl at all" was being stuck in an awful hair salon chair while my mom got a haircut that took FOREVERRRRRRRRR and i was having godawful period cramps. like i knew not being a girl wouldnt DO anything about them but i made that decision then n there n didnt look back!) 
and then i kept pokin at it and watching it like the seed id planted finally started to sprout and i realized i didnt actually know what kind of seed it WAS. i guess ive always been very nebulous in those aspects and its just now forming into something solid. like i said, its a little hard to admit and i... dont think ive actually talked about this in this depth before to, like, anyone? 
because the "oh ive always known" narrative is the only one you ever see in popular media and sometimes even from the community itself! and theres nothing wrong with having always known! but theres also nothing wrong with being like me! but i still feel a little anxious talking about it like it somehow means im a sham. 
hell, id even go so far as to say i WAS a girl as a kid! i WAS varying shades of agender and nonbinary and ???? as a teen, and i AM, like, 95% a guy right now! maybe in a few years ill be something else. none of those things contradict each other. things like that can change! its not set in stone (but like i said: for some people it is! or, like, set in slime that you left out for 5 years so now its pretty much a rock but if you really try it still squishes into something else?? none of these things invalidate the others! were all unique). 
i wouldnt say that at any point ive been cis or straight, cos even when i just went with being a girl and stuff it was always a little ??? but, yknow. even if i HAD been those things at some point it wouldnt matter to me? things just are the way they are and were the way they were
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im making myself really vulnerable here and my thought process is a mess and i ramble and repeat myself and my memory and attention span is like 2 seconds and i dont proofread but. its important i think. i dont have a lot of followers and fewer still thatre active but... that really doesnt matter. 
maybe someone will retweet at least one of these messy, messy threads. maybe link it to a friend. maybe screenshot it and post it on tumblr [note: LMAO YEAH AND ITS YOU DUMBASS], or to keep for themself. if any of my words help anyone out even a little then it matters and honestly? then its the most important thing in the whole danged world. if even one person sees any of the things ive said tonight and it means *anything* to them, even if just "oh, im not alone in this" then ive succeeded here. 
i dont want any of us to ever feel trapped or alone because shit! lifes too fuckin short for that! its goddamn hard being anything but cisgender and straight! sometimes it sucks! like really sucks! there have been so many times ive broken down completely over being trans and felt like, for myself, its the most awful thing in the world. its why prides so important. its why community is so important. 
because even when the pressure of the world brings you down so low you think youll never escape theres something or someone there to take your hand and pull you back up, put you on your feet, and say "i know its hard. and itll get hard again. but i believe in you, and youre strong enough for this, and im here with you through every step". that goes for anyone but especially goes for us. and im not just talking about lgbtq youth here. all of us. which is *why* im laying myself completely bare here. 
most of this stuff? ive either never talked about or only vaguely mentioned. but im putting it out there. because there was a point where i needed it but didnt have it, and even if its just one person, i want to give someone this advice so at least they dont have to deal with the same stuff i did. and if youre reading this? i love you. im here for you. im my dms are always open and if for some reason they arent its almost definitely an accident and if you say something ill reopen them. 
and if youre someone who hates me? maybe even mutually? if it came down to it id let you come to me at your lowest moment, no questions asked, no judgement held, and at the end of it still be the same kind of enemies we were before and never speak again. there are some exceptions of course but honestly ill forgive a lot for someone who needs that kind of support. and if youre one of the people this applies to, i know youll probably never take me up on it. i dont expect you to. i dont expect you to even for a second be comfortable with that idea. thats fine. but if for some reason you ever need it, its there. 
i can count on one hand the ex friends that i wouldnt give that to and thats ONLY because theyve legitimately hurt me and left lasting damage (and for some of them? its mutual. and im sorry for that, regardless of how i feel about your treatment of me im truly sorry for my actions. that probably sounds fake and anyway i digress) 
and if youre a complete stranger? someone who follows me but has never interacted with anything ive posted? a mutual i havent spoken to yet? im here. and im bumbling, and awkward, and not the best at comfort but you can always come to me if you need someone. im only one man and im under a lot of stress but i swear ill do the best i can, even if its only reading and replying 3 days later and even then just listening and offer whatever gentle comfort or reassurance youll accept. 
because thats important to me. thats the impact i want to leave on this world. i dont ever want anyone to feel as small, as scared, as worthless, as alone as i have. im no fighter. im not going to lead any revolutions and hell im too anxious to even go to protests but im here for support. im here to help and heal. and thats important too
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and if you listened to that? thank you. if you just skimmed? thank you for that too. if you shared it with someone? thank you (so much). and if you dont? thank you anyways, just for the time
just know this: i love you. i dont care who you are, if youre reading this i love you and im behind you 100%. im here if you need it. stay strong, do something that makes you smile if only for a moment. take that leap of faith. dont restrict yourself for even a second
i meant to go to bed at least two hours ago so goodnight <3 be safe, drink some water, if you have any kind of pet give it some love. take care of yourself. youre the most important person in your own world and never forget that, even if you dont think you are. even if theres something or someone you treasure above everything else. dont diminish your own worth! you are alive, and you are here, and theres nothing more important than that, really. the things you love matter more than anything else. hold them close
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archerwindsor · 4 years
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How to Up Your Skincare Game when you don’t have hundreds to spend
affordable skin care
It’s January: time for “out with the old and in with the new,” particularly for those of us glow-getters who buy the latest and greatest affordable skin care products–on the Daily. If you watched my recent YouTube video on resetting for the new year, you’d know I’m all ears for a fresh start. And what better way than to start with your skin!? Its the perfect month to refresh our mountain o’ beauty products. You know, the ones that once made us blush with anticipation?
Remember how excited you were when you bought that one awesome cream?  Taking it out of its crisp, beautifully branded box, dabbing a bit under your eyes or on your cheeks, and making it your No. 1 go-to elixir for the week? Wow. It held so much promise! It was “micro” this and “macro” that and triple detoxified the sh*t out of your face. Until, of course, the next dewy balm in killer packaging grabbed your attention, and then, the poor forgotten product became wedged behind the toothpaste and Neosporin in your bathroom cabinet for the next year–or more. I mean honestly, when was the last time you checked the expiration date? OK, skin queens. Let’s refresh. We need to ditch those outdated, and often over-priced products and give your daily skincare routine a boost with some amazing affordable skin care products that are on our radar.
We get it. There is a seemingly endless array of lotions and potions for us to slather on fine selves. But girl, we have foraged the beauty landscape to identify some awesome and affordable skin care products that we think are gonna dazzle your dermis. These pillars of skin care address all of our beauty concerns ranging from hyperpigmentation, dry skin, oily/combination skin, and sun care  — and girl, they include some super affordable skin care products, made mostly from all-organic ingredients! Together, we are gonna regenerate that damaged skin without wrecking your wallet.
Indoor Sunscreen?
And let’s talk for a sec about all the things that wreak havoc on our skin. Topping the list is too much screen time. Yeah, this past year of intermittent lock-downs and Zooming didn’t do us any favors to reduce exposure to all that blue light.  Yup, concentrated sources of blue light energy from phones, indoor lighting and computers stressed our skin right on out, causing photo-aging and hyperpigmentation. There’s this chemical in our skin called flavin and it absorbs blue light. This produces free radicals that damage our dermis. Obvs we need to step up our game to repair and hydrate our skin because, damn, we don’t need yet another age-y thing! Well, we found a mineral sunscreen to help both indoors and out!
C’est Moi Gentle Mineral Sunscreen Lotion Broad Spectrum SPF 30 ($14.99 on Amazon) is an affordable skincare product and super effective! While gently nourishing sensitive skin types, this fragrance-free lotion delivers moisture and hydration while guarding skin from free radical damage.  
We also love Cerave’s Broad Spectrum SPF 30 tinted mineral sunscreen because it’s 100% mineral and has a great blend of ceramides, niacinamide, and hyaluronic acid to keep skin hydrated and protected ($15.99 on Amazon). And it also gives you a lovely glow without a white cast.  
Cleanse + Purify
If you’ve ever looked at your skin super up close (like in one of those magnifier mirrors), you might see some gnarly stuff hanging around your pores. Imagine putting product on top of that? Eww. Starting your skin routine off with a good scrub down really helps purify your skin and allows other products to glide on easier — and absorb better. We recommend Aveeno’s Positively Radiant daily scrub ($5.64 on Amazon). Made with natural soy extract, this cleanser is great to use on the daily to wipes away impurities for softer brighter even-toned skin. 
And if you’re prone to acne, we recommend a product with salicylic acid like Neutrogena Oil-Free Acne Fighting Facial Cleanser ($15.72 on Amazon) This affordable skin care product helps fight breakouts while cleansing your skin.
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Seeing spots
One of the worst things about aging skin is hyperpigmentation. UGH. This happens when we have an excess production of melanin — that’s the pigment that gives skin its color. But sometimes due to sun exposure or hormones, these unsightly blotchy spots start to surface on our hands and face as we get older.  
Neutrogena Rapid Tone Repair Dark Spot Corrector Face Serum with Hyaluronic Acid, Retinol & Vitamin C ($17.96 on Amazon) is da bomb when it comes to eliminating unsightly pigmentation. The daily facial serum helps make your skin oh so bright and even-toned and helps ditch those stubborn dark spots and skin discoloration. Because who wants their skin looking like cowhide?
Another amazing serum you might try to maintain your skin’s buoyant appearance is The Ordinary’s Buffet ($14.80 on The Ordinary website). Their ‘Buffet’ serum is a peptide serum for morning and night use to target multiple signs of aging at once. We love how it takes on all annoying signs of damaged skin with bona fide technology… including “Matrixyl
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3000 peptide complex!” Color us impressed.  I mean a lot of people in lab coats researched the heck out of this one so you can continue to look fab. #Grateful
Hydrate your thirsty skin
We’re always telling you babes to hydrate. Well, guess what, that means your skin, too. Using a good basic hydrating lotion is a must in your affordable skin care arsenal in fighting against aging skin. One of my favs is the Paula’s Choice Replenishing Moisturizer ($29 on Amazon). This moisturizer fits the bill for an affordable everyday moisturizer with a proprietary blend of plant- and vitamin-derived antioxidants and other ingredients for instant and lasting hydration for dry skin. It’s even good for those with sensitive skin and those who have eczema. You might get all cheeky when you drench your dermis with this because your face will feel as soft as a baby’s bottom!   
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Puffy Peepers
When we look tired, one of the main culprits is dark, unsightly circles beneath our eyes. A good eye cream does wonders for smoothing away wrinkles and brightening the skin under our peepers. Because crepes belong in the kitchen, not on our face. 
A good eye cream can be an investment. We like La Roche Posay’s Redermic C Eyes Anti-Wrinkle Firming Moisturizing Filler ($49.99 on Amazon). This all-in-one eye cream addresses dark circles, free radical damage, fine lines and wrinkles, crow’s feet and firmness. That’s what we call multi-tasking! Sure, it’s a wee pricier, but a little goes a long way, and also it’s French, so. Yeah.
Saggy skin sucks
OK, so that time you looked in the mirror and saw a Shar-Pei looking back at you? Aaaack. We all know you’re still gorge! But shocking, isn’t it when gravity pulls at your face and neck and you never saw it coming because you exercise, eat right and on occasion even do those strange facial exercises? Several factors can contribute to skin sag like weight loss, pregnancy & fluctuating hormones, and of course aging. We have one word for you: Collagen. 
Skin aging has been linked to the reduction of collagen production. Good news is that there are products that help us get back our skin’s elasticity. Products with collagen pack a punch when it comes to regaining our skin’s firmness. After all, it’s one of the biggest building blocks in providing structure to our skin. And kinda bad News: Collagen can also be expensive.
Algenist’s Genius Liquid Collagen ($110 on Amazon) is made with plant collagen with added Microalgae Oil beads to hydrate and nourish, among other amazing vitamins, antioxidants, and acids to plump your skin. The company says its vegan formula helps enhance skin’s bounce and resilience in just 10 days! Woah. And if you slather on their buttery sleep mask ($85 on Amazon) on a nightly basis, you wake up looking all supple and dewy.
A more affordable skin care option containing collagen is Derma E’s Advanced Peptides & Collagen Moisturizer ($21 on Amazon). Loaded with peptides and collagen, this moisturizer is a good bet for restoring vibrancy to your skin.
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All around must-have salve
We always love discovering that one all-around great affordable skin care product that top celebrity make-up artists have in their stash. This year’s “find” is Green Goo ($24.95 on Amazon), an all in one natural salve for acne spots, scars, wrinkles, puffy eyes, sunspots, minor burns, sunburns, and sun-damaged skin. And… we can even use it to create a dewy look on cheekbones after we apply our make-up. Your friends will simply be green with envy!  We especially love this product because the company, Green Goo, is women-owned, family-run, and B-Corp certified! 
Babes, we hope we helped uncover some affordable skin care products that can invigorate your skin care regime without denting your bank account. Now go and check expiration dates, toss those old lotions and replenish your cabinet!  We’d love to hear how they work out for you! And let’s not stop the reset here! If you loved this blog, you’ll love my blog where I give you all the deets on what I’m doing to reset my life for 2021.
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kristinsimmons · 5 years
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#USMLEPassFail: A Brave New Day
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By BRYAN CARMODY, MD
Well, it happened.
Beginning as soon as 2022, USMLE Step 1 scores will be reported pass/fail.
I’m shocked. Starting around two weeks ago, I began hearing rumors from some well-connected people that this might happen… but I still didn’t believe it.
I was wrong.
The response thus far has been enormous – I haven’t been able to clear my Twitter mentions since the news broke. And unsurprisingly, the reaction has been mixed.
In the future, I’ll post more detailed responses on where we go from here – but for now, I’d like to emphasize these five things.
1. By itself, making USMLE Step 1 pass/fail doesn’t fix much.
Simply getting rid of three digit scores doesn’t improve medical education. And it doesn’t make residency selection any better, either.
It does give us the opportunity to make changes. And the importance of that should not be understated.
Put simply, this is the greatest opportunity for medical education reform since Flexner, and the greatest opportunity to re-design residency selection since… ever.
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“WHAT WILL REPLACE STEP 1?” IS A HARD QUESTION. AND MAKE NO MISTAKE, THE FACT THAT IT’S A HARD QUESTION IS ONE OF THE VERY REASONS MANY CLUNG TO STEP 1 SCORES SO DOGGEDLY.
2. The path of least resistance does not take us where we want to go.
Most of the commentary on social media thus far has taken the following form:
Now only Ivy League medical students will get into competitive specialties.
Don’t worry! USMLE Step 2 CK will just be the new Step 1.
I guess DOs and IMGs can forget about getting into top residency programs.
And you know what? Most of these concerns are justified.
If we do nothing, Step 2 Mania is the natural result of a pass/fail Step 1. And unless we give program directors more useful information – and the time to thoughtfully review all the applications they receive – they’ll gravitate to another convenience metric out of necessity.
But that does not mean it’s inevitable.
3. We all have a say in what comes next.
If the rise and fall of a scored Step 1 teaches us nothing else, it should clearly demonstrate these two things.
First, advocacy works. There is no way that the NBME’s entrenched, out-of-touch bureaucracy would have ever voluntarily changed Step 1 to pass/fail – unless their feet had been repeatedly been held to the fire by the public over the past year. Change is possible – but you have to speak up.
Students, I’m looking at you – especially those from “non-elite” or international medical schools. You have a say in what comes next. How should residency programs evaluate you? Surely, answering multiple choice questions with peripheral relevance to real patient care is neither the best nor the only way to identify your talent. It’s time to dream bigger – and demand more meaningful evaluation.
Second, medical students will rise to whatever bar we set for them.
Ask them to memorize an 800 page review book so they can excel on a multiple choice question test of basic science esoterica? Done and done. Students knew most of what they were learning was pointless – but they worked tirelessly because we told them it mattered.
So program directors, now I’m looking at you. Whatever you tell students to do, they’ll do. You want high Step scores? Students will give them to you. But what really matters to you? Do you want residents who will serve the underserved? Contribute to research? Arrive on July 1 with specialty-specific knowledge? Whatever you say, goes. If you choose to grump about the loss of the bad old days, you’re abdicating your authority to set the standards you want.
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YOU WON’T FIND ME SHEDDING ANY TEARS OVER THE DEMISE OF A SCORED STEP 1.
4. No one should mourn the loss of a scored Step 1.
Look around my Twitter mentions, and you can find touching testimonials mourning the demise of Step 1 scores. There are tales of useful factoids brought to bear on patient care decades later; of students inspired to consume as much (mostly useless) scientific knowledge as possible; of doors opened and careers launched because of one shining moment on test day years ago.
Give me a break.
The Step 1 score was the biggest false god in medical education, and no one should be too sad that it’s going away.
Was it objective? Sure. But the ability of three-digit scores to discriminate between applicants was actually fairly imprecise.
Did it test some useful concepts? Of course. But scoring highly required memorizing esoteric information that would never benefit an actual human patient.
Did some students benefit from scoring highly? Absolutely. But did Step 1 scores really “level the playing field” for students from international or non-prestigious medical schools overall? I doubt it.
Did it give program directors an easy way to screen applications? Yup. But was that way meaningful? Probably not. The main value of Step 1 was that it gave you a number. But if the content of the test doesn’t matter, why not just have medical students throw darts, or race go karts, or memorize digits of pi?
And of course, our idol worship of Step 1 came at a significant opportunity cost. The fact that most of us turned out okay doesn’t prove that Step 1 was the best way, or that that we wouldn’t have been better off under another system.
Here’s the thing:
Whether you liked a scored Step 1 or not, the current system is not what any of us would have designed if we were building something from the ground up.
In the scored Step 1 era, we sat back and watched as preclinical medical education turned into a glorified USMLE prep course with a five-figure/year tuition bill attached. We did nothing as residency applications spiraled out of control and program directors’ outsourced their most important decision-making to the NBME.
We shouldn’t be proud of any of this. And we shouldn’t mourn the loss of the three-digit score that enabled us to neglect the need for reform for so long.
More importantly, there is no turning back now.
If you opposed #USMLEPassFail, do your grieving for the scored USMLE – and then get to work. Saying “I told you not to make Step 1 pass/fail!” is a hollow victory. There is an opportunity here to engage our students in tasks that could actually lead them to be better physicians – but we have to seize it.
And if you supported #USMLEPassFail, now is not the time to dance on the three-digit score’s grave. We need to get to work, too – or this hard-won victory will go for naught.
5. The way forward… my opinion
Expect more from me on these topics in the future, but for now, let me put these three thoughts in your head.
WE NEED MEANINGFUL EVALUATIONS.
My 5th grader’s report card provides more useful information than any medical school transcript I’ve ever seen. He doesn’t get an “A” in math – I get to see a lengthy list of math skills and an assessment of where he’s at with all of them. Maybe he’s comfortable dividing fractions, but still developing proficiency with using variables to set up algebraic equations.
Letter grades are nice – but they don’t tell me what he knows and what he doesn’t. (I don’t get a histogram of other students’ performance and where he falls – because how other students performed is kind of irrelevant if my goal is to help him become better in math.)
The fact that elementary schools provide more information-rich evaluations than medical schools is shameful. In the past, we’ve justified this because of Step 1. Starting in 2022, that excuse will ring hollow.
Let’s be honest: there should never be a medical school evaluation in which a students is exceptional in every area. (If there is, it tells you more about the school than the student.)
Our goal should be to make medical school formative, not performative; to help learners maximize their potential without fearing failure; to provide and communicate honest feedback that leads to improvement and growth along the spectrum of medical education. (For their part, program directors need to focus less on relative accomplishment and more on potential to grow and thrive in that program/field.)
We don’t need another arms race. We do need more thoughtful evaluation. We should require students to engage in tasks that leave them – and their future patients – better off. And schools that refuse to participate in this process should be penalized by program directors and medical school applicants alike.
WE NEED HOLISTIC REVIEW.
I don’t think we need a one-size-fits-all metric to tell us who are the “best” applicants. Honestly, we don’t.
Certain talents and traits get you a lot farther in certain disciplines than others. Even within the same discipline, different programs have different needs and serve different missions. What makes a good doctor? It’s complicated. And trying to reduce that complexity down to a single three digit number is silly.
Holistic review is possible. It’s what we do at the residency program at which I’m an associate program director. But it’s labor intensive – and it requires human judgment. That last part makes some people uncomfortable, and I understand why. Holistic review has the potential to devolve into bias and cronyism. But that’s not a reason to not do it – it’s a reason to strive to do it well, to make decisions deliberately, and to build some checks and balances to make sure you stay aligned with your values.
WE ALSO NEED APPLICATION CAPS.
The only way to get away from screening metrics and treat every applicant as an individual is to limit the pile of applications that program directors receive.
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THE EXISTENCE OF A SCORED STEP 1 ALLOWED US TO PRETEND THAT THIS WASN’T HAPPENING.
Look, I’ve preached this sermon before. But you’d better believe I’m gonna be carrying this particular gospel to the people again in the near future.
Afraid of application caps? Worried that they’ll disadvantage students from non-elite schools? Stay tuned for a data-driven expose of the misinformation surrounding caps coming soon.
Dr. Carmody is a pediatric nephrologist and medical educator at Eastern Virginia Medical School. This article originally appeared on The Sheriff of Sodium here.
The post #USMLEPassFail: A Brave New Day appeared first on The Health Care Blog.
#USMLEPassFail: A Brave New Day published first on https://wittooth.tumblr.com/
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lauramalchowblog · 5 years
Text
#USMLEPassFail: A Brave New Day
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By BRYAN CARMODY, MD
Well, it happened.
Beginning as soon as 2022, USMLE Step 1 scores will be reported pass/fail.
I’m shocked. Starting around two weeks ago, I began hearing rumors from some well-connected people that this might happen… but I still didn’t believe it.
I was wrong.
The response thus far has been enormous – I haven’t been able to clear my Twitter mentions since the news broke. And unsurprisingly, the reaction has been mixed.
In the future, I’ll post more detailed responses on where we go from here – but for now, I’d like to emphasize these five things.
1. By itself, making USMLE Step 1 pass/fail doesn’t fix much.
Simply getting rid of three digit scores doesn’t improve medical education. And it doesn’t make residency selection any better, either.
It does give us the opportunity to make changes. And the importance of that should not be understated.
Put simply, this is the greatest opportunity for medical education reform since Flexner, and the greatest opportunity to re-design residency selection since… ever.
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“WHAT WILL REPLACE STEP 1?” IS A HARD QUESTION. AND MAKE NO MISTAKE, THE FACT THAT IT’S A HARD QUESTION IS ONE OF THE VERY REASONS MANY CLUNG TO STEP 1 SCORES SO DOGGEDLY.
2. The path of least resistance does not take us where we want to go.
Most of the commentary on social media thus far has taken the following form:
Now only Ivy League medical students will get into competitive specialties.
Don’t worry! USMLE Step 2 CK will just be the new Step 1.
I guess DOs and IMGs can forget about getting into top residency programs.
And you know what? Most of these concerns are justified.
If we do nothing, Step 2 Mania is the natural result of a pass/fail Step 1. And unless we give program directors more useful information – and the time to thoughtfully review all the applications they receive – they’ll gravitate to another convenience metric out of necessity.
But that does not mean it’s inevitable.
3. We all have a say in what comes next.
If the rise and fall of a scored Step 1 teaches us nothing else, it should clearly demonstrate these two things.
First, advocacy works. There is no way that the NBME’s entrenched, out-of-touch bureaucracy would have ever voluntarily changed Step 1 to pass/fail – unless their feet had been repeatedly been held to the fire by the public over the past year. Change is possible – but you have to speak up.
Students, I’m looking at you – especially those from “non-elite” or international medical schools. You have a say in what comes next. How should residency programs evaluate you? Surely, answering multiple choice questions with peripheral relevance to real patient care is neither the best nor the only way to identify your talent. It’s time to dream bigger – and demand more meaningful evaluation.
Second, medical students will rise to whatever bar we set for them.
Ask them to memorize an 800 page review book so they can excel on a multiple choice question test of basic science esoterica? Done and done. Students knew most of what they were learning was pointless – but they worked tirelessly because we told them it mattered.
So program directors, now I’m looking at you. Whatever you tell students to do, they’ll do. You want high Step scores? Students will give them to you. But what really matters to you? Do you want residents who will serve the underserved? Contribute to research? Arrive on July 1 with specialty-specific knowledge? Whatever you say, goes. If you choose to grump about the loss of the bad old days, you’re abdicating your authority to set the standards you want.
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YOU WON’T FIND ME SHEDDING ANY TEARS OVER THE DEMISE OF A SCORED STEP 1.
4. No one should mourn the loss of a scored Step 1.
Look around my Twitter mentions, and you can find touching testimonials mourning the demise of Step 1 scores. There are tales of useful factoids brought to bear on patient care decades later; of students inspired to consume as much (mostly useless) scientific knowledge as possible; of doors opened and careers launched because of one shining moment on test day years ago.
Give me a break.
The Step 1 score was the biggest false god in medical education, and no one should be too sad that it’s going away.
Was it objective? Sure. But the ability of three-digit scores to discriminate between applicants was actually fairly imprecise.
Did it test some useful concepts? Of course. But scoring highly required memorizing esoteric information that would never benefit an actual human patient.
Did some students benefit from scoring highly? Absolutely. But did Step 1 scores really “level the playing field” for students from international or non-prestigious medical schools overall? I doubt it.
Did it give program directors an easy way to screen applications? Yup. But was that way meaningful? Probably not. The main value of Step 1 was that it gave you a number. But if the content of the test doesn’t matter, why not just have medical students throw darts, or race go karts, or memorize digits of pi?
And of course, our idol worship of Step 1 came at a significant opportunity cost. The fact that most of us turned out okay doesn’t prove that Step 1 was the best way, or that that we wouldn’t have been better off under another system.
Here’s the thing:
Whether you liked a scored Step 1 or not, the current system is not what any of us would have designed if we were building something from the ground up.
In the scored Step 1 era, we sat back and watched as preclinical medical education turned into a glorified USMLE prep course with a five-figure/year tuition bill attached. We did nothing as residency applications spiraled out of control and program directors’ outsourced their most important decision-making to the NBME.
We shouldn’t be proud of any of this. And we shouldn’t mourn the loss of the three-digit score that enabled us to neglect the need for reform for so long.
More importantly, there is no turning back now.
If you opposed #USMLEPassFail, do your grieving for the scored USMLE – and then get to work. Saying “I told you not to make Step 1 pass/fail!” is a hollow victory. There is an opportunity here to engage our students in tasks that could actually lead them to be better physicians – but we have to seize it.
And if you supported #USMLEPassFail, now is not the time to dance on the three-digit score’s grave. We need to get to work, too – or this hard-won victory will go for naught.
5. The way forward… my opinion
Expect more from me on these topics in the future, but for now, let me put these three thoughts in your head.
WE NEED MEANINGFUL EVALUATIONS.
My 5th grader’s report card provides more useful information than any medical school transcript I’ve ever seen. He doesn’t get an “A” in math – I get to see a lengthy list of math skills and an assessment of where he’s at with all of them. Maybe he’s comfortable dividing fractions, but still developing proficiency with using variables to set up algebraic equations.
Letter grades are nice – but they don’t tell me what he knows and what he doesn’t. (I don’t get a histogram of other students’ performance and where he falls – because how other students performed is kind of irrelevant if my goal is to help him become better in math.)
The fact that elementary schools provide more information-rich evaluations than medical schools is shameful. In the past, we’ve justified this because of Step 1. Starting in 2022, that excuse will ring hollow.
Let’s be honest: there should never be a medical school evaluation in which a students is exceptional in every area. (If there is, it tells you more about the school than the student.)
Our goal should be to make medical school formative, not performative; to help learners maximize their potential without fearing failure; to provide and communicate honest feedback that leads to improvement and growth along the spectrum of medical education. (For their part, program directors need to focus less on relative accomplishment and more on potential to grow and thrive in that program/field.)
We don’t need another arms race. We do need more thoughtful evaluation. We should require students to engage in tasks that leave them – and their future patients – better off. And schools that refuse to participate in this process should be penalized by program directors and medical school applicants alike.
WE NEED HOLISTIC REVIEW.
I don’t think we need a one-size-fits-all metric to tell us who are the “best” applicants. Honestly, we don’t.
Certain talents and traits get you a lot farther in certain disciplines than others. Even within the same discipline, different programs have different needs and serve different missions. What makes a good doctor? It’s complicated. And trying to reduce that complexity down to a single three digit number is silly.
Holistic review is possible. It’s what we do at the residency program at which I’m an associate program director. But it’s labor intensive – and it requires human judgment. That last part makes some people uncomfortable, and I understand why. Holistic review has the potential to devolve into bias and cronyism. But that’s not a reason to not do it – it’s a reason to strive to do it well, to make decisions deliberately, and to build some checks and balances to make sure you stay aligned with your values.
WE ALSO NEED APPLICATION CAPS.
The only way to get away from screening metrics and treat every applicant as an individual is to limit the pile of applications that program directors receive.
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THE EXISTENCE OF A SCORED STEP 1 ALLOWED US TO PRETEND THAT THIS WASN’T HAPPENING.
Look, I’ve preached this sermon before. But you’d better believe I’m gonna be carrying this particular gospel to the people again in the near future.
Afraid of application caps? Worried that they’ll disadvantage students from non-elite schools? Stay tuned for a data-driven expose of the misinformation surrounding caps coming soon.
Dr. Carmody is a pediatric nephrologist and medical educator at Eastern Virginia Medical School. This article originally appeared on The Sheriff of Sodium here.
The post #USMLEPassFail: A Brave New Day appeared first on The Health Care Blog.
#USMLEPassFail: A Brave New Day published first on https://venabeahan.tumblr.com
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shiftyarchfey · 7 years
Text
Is making Jaal bi an issue?
Ok, so this is propably not the wisest thing for me to discuss because my thoughts are all jumbling around, but one thing about the whole biJaal debacle sticks out to me:
The argument that by making Jaal bi, Bioware is practicing erasure of straight people. This is the basic summary of some posts I’ve come across and I wanted to make something clear. This is propably going to be a longer post with rambling from yours dearly, so the rest is under the cut.
In a world where being a straight cis human being is represented in every possible media as the “norm”, is it truly erasure to make someone bi? From a wide pool of straight LIs? Of course you are entitled to feel that way. However, please think for a moment. This is not a loss for the “straight” community. Jaal is still available for a female Ryder. He is still going to have the same route and you will not be affected by it, except from the knowledge that if you had played as a male Ryder, you would be able to romance him as well. 
Your arguments against making him bi is simply that you don’t have him exclusively to you anymore, but have to “share” with the LGBT community. I’m asking this: Why do you feel that way? Because you don’t want to let us be happy without modding a game and possibly breaking it? I’m truly baffled about this argument. We aren’t taking him away from you. He’s still special, he’s still available to you. I would see your point if he was made exclusively gay, but he isn’t. He’s bi. So are a lot of other people as well and you wouldn’t bemoan the fact that they’d fall in love with you too if you were another gender.
The massive outrage against him being straight has its reasons: Firstly, I guess it was that somebody leaked some files and it was teased a lot that he would be available to both genders. The reveal that he wasn’t was accompanied by those feeling betrayed reaching out to Bioware. I admit, most of the messages sent to BW were incredibly rude and personally I do NOT approve of this kind of approach. But #MakeJaalBi got to trending and this had an impact. And a second reason was that accomplishment. You know, that one. No, not that it’s impossible to get the Nomad airborne for 30 seconds on PC because the controls don’t allow it (that is something that has to be fixed, BW). It’s the achievement for romancing 3 different people. With only 2 people available for a  m/m romance. 
Let’s compare: Suvi, Vetra (Squadmate), Peebee (Squadmate) vs Gil and Reyes (not much content anyways and/or possibly accompanied by the player opposing him, thus eliminating him from any romance possibilities). And then there’s the other romances: Cora, Vetra, Peebee (all squadmates) PLUS Keri T’Vessa and Avela Kjar (admittedly not much more content than Reyes, but they can be romanced at the same time as another squadmate without any problems) for a male Ryder and Liam and Jaal, both squadmates, plus Reyes for a female Ryder. The differences in content is massive. If I want to talk to Suvi or Gil, I have to go onboard the Tempest. If I want to hear Liam or Cora chatter, i can take them on any mission and they will be able to be at my PC’s side always.
I never heard any complaints about Vetra, Peebee, Keri or Reyes being bi. Two of the three male love interests for female pcs are squadmates. Gil is the only m/m romance available on the Tempest and his content is debatable as well (what’s up with Jill only pressuring her gay friends into having kids?). It certainly is not the problem about straight people being underrepresented here (or in any other media for that matter). This isn’t about you being erased. It’s about m/m being erased. And in a time where people are still being killed for feeling an attraction to the same gender this complaint seems to me as if a white person complains about “Reverse racism”. It’s not about you. You have the right to feel that way of course. It just doesen’t mean that it’s fair towards the people currently being underrepresented. And they are, make no mistake.
I as a person who identifies on the bi-spectrum (pansexual) am feeling disappointed in those complaining. This is a step into a direction of tolerance and not into erasure of any kind. It’s hurtful to me to not be seen as “Special” because I’m “not exclusively available”. Because, as I said, nothing is being taken away from Jaal as a character. It’s only the addition of something.
Another issue springs up that I want to talk about, that goes in the same direction:
I’ve read threads complaining that, if Jaal is bi now, it is only fair to be able to make Dorian or Sera bi too, “in exchange”. Because it’s “only fair if we have to share”. No. This is not the point. There are a lot of threads around as to why this is exactly the opposite of fair. Anders was a point as well, because in Awakening he seemed to be at ease flirting with the female characters but he’s had Karl in da2. This is the same point as I chewed through above already. He’s not lost a thing. Why do you all see the change from heterosexual to bisexual as a loss? What makes you “lose” anything? 
There was some talk about the old old stereotype of bi people cheating a lot because, um, bi? two? possibly at a time? So is it that? I might want to add here that it’s entirely possible to cheat on your LI in me:a, REGARDLESS of who you romance.  And this has nothing to do with being bi. Jaal isn’t going to cheat on your PC now, just because of that. It’s very offensive to think that way. 
I repeat myself, but if you think that way, ok. Do what you want, I don’t care. But if you feel robbed or cheated or anything, please consider. This rant was born out of personal grief and the biphobia I have experienced and I ask myself what made you feel that way? What about being able to love anyone is offensive to you? This update changes nothing for you. It changes the whole experience for people like me. You did not lose a thing. I still gained a lot. 
Cheers.
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portergreenuk · 6 years
Text
Why do we self sabotage and how to stop it
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Whether it’s relationships, personal goals (like weight loss or exercise) or projects at work, self sabotage seems to be something that many of us are drawn to.  I want to use today’s podcast to explore self sabotage – what it is, why do we self sabotage and most importantly, how to stop it.
What are self sabotaging behaviours?
So self sabotage is the thing that happens when you have a plan, and you have every intention of keeping to your plan, and you may have even told people that are following this plan, but for some reason you scupper your chances of success with your plan because you get in your own way at some point during the plan. You do the opposite of your plan, you get distracted by something that isn’t the plan, or the plan starts to freak you out and you stop following it.
Self sabotaging behaviours really do vary – they could include stopping yourself from doing the thing you said you’d do (procrastination – more on Procrastination-how to stop stopping yourself starting here), or maybe self-medicating with food or alcohol or drugs or something else addictive like TV or gaming or whatever, or even at the extreme end of the spectrum, self sabotage could actually involve self-harm. But today I’d like to focus more on why do we self sabotage and how to stop it.
The thing is that because self sabotage takes on a variety of forms, some low level like being open to being distracted and some much higher stakes like self harm, the reasons behind the self sabotage are often just as varied and complicated. But you need to understand why you’re doing it if you want to give yourself the best chance to learn how to stop self sabotage in its tracks.  I’m going to talk about self-worth, fear of failure, fear of change, beliefs we were given as kids, the perils of dopamine and the value of support.
Why do we self sabotage and how to stop these self sabotaging behaviours?
Lack of self-worth and fear of failure
In a previous blog, I talked about imposter syndrome, which is the belief you aren’t worthy of your current role, status or opportunity and so you feel uneasy and anxious about that, to the point where you can start to feel like an imposter, which then limits your happiness and performance…so becoming self-fulfilling…self sabotaging. This is almost certainly linked to your sense of self-worth.
So the underlying reason why we self sabotage in this case is often that we don’t believe we are good enough and as a result we set ourselves up to fail because at least that way we don’t have to risk failure by trying to succeed and falling flat on our faces. So we choose to be the architects of our own failure or limitations rather than risk success and set ourselves up for even higher heights and bigger challenges where the chances of failure are even greater and where we’re even more sure that we’re in the end going to spotted as a fraud.
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Wow, that is complicated. We’re really tying ourselves up in knots with the second guessing and starting-stopping behaviours there. So, how to stop self sabotage caused by this? In short, stop fearing failure by reframing it as a stepping stone to success or as part of success – failure is a great way to learn after all and it’s inevitable if you want to succeed.
There was this awesome advert with Michael Jordan in it, who was seen as the wold’s greatest sportsman at the time – check it out…if you search on Michael Jordan, Nike, failure, you’ll find it. Anyway to summarise, in it he says “I’ve missed more than 9000 shots in my career, I’ve lost 300 games. I’ve missed the game-winning shot 26 times.  I’ve failed over and over again in my life. And that’s why I succeed.”
But what about if we really don’t feel worthy of success, like we don’t deserve it, not because we feel like a fraud but because we don’t feel success is owed to us, because our life experiences have knocked our self confidence to the point that success doesn’t feel like it’s part of who we are. We are a failure and being a failure feels easier than trying to be something we don’t identify with: being successful.
That’s pretty big and runs pretty deep as a reason why we self sabotage and it will need some pretty full on soul searching. But by starting to believe that you are worthwhile, that you do make a contribution, that you can make a positive difference in your corner of the world. Then you may start to see some green shoots of self-worth that can help you to see success as something that is part of your story and identity and that you are worth it and that you are owed it.
Self sabotage and the fear of change
Another reason why we self sabotage is fear of change – us humans tend to like to keep things the same because that sense of familiarity and control makes us feel less psychologically anxious. But taken to extremes, that might mean that we rarely try anything new, rarely challenge or push ourselves out of our comfort zones because that might lead us to a place where we feel anxious and where we screw up, we might not be perfect, we might not ace it first time out. When right here in the comfort zone, everything is under control, as it should be, just right.
So again, our fear of failure may lead us to stick with the status quo and miss out on an opportunity to learn, to stretch and grow through experience even if failure may be a possible outcome when we set out on that journey.
Developing a growth rather than a fixed mindset can help with this, again so that we see growth through failure as a positive rather than something to avoid or be fearful of. Carol Dweck talks a lot about growth mindset, particularly in schools, and ways to develop it, so check her out.
Beliefs we were given as kids
And now we’re talking about schools and about kids, and indeed us as kids, there’s an awful lot that our parents have to answer for by leaking their own anxieties all over us and repeating phrases to us as we’re growing up, which can lead us to interact with the world in certain ways. Things we often hear when we’re growing up include “Hurry up”, “Be strong”, “Be perfect”, “Please others”, “Try hard” – these are described as DRIVERS of behaviour and are covered by a model called Transaction Analysis which is fascinating and also helpful.
If you heard any or all of these phrases repeated a lot when you were young, these scripts can seed beliefs and behaviours which it’s hard for you to shake off as an adult. The Be Perfect driver may well relate to self sabotage if we find ourselves fearing failure. Because it’s a lot easier to be perfect in areas we’re familiar with than in areas that we aren’t, so we may pull back from situations where we see failure as a risk and therefore not be perfect.
But if these phrases, these drivers are not helping us, then it may well be worth challenging them and deciding on new drivers that will help us.
The perils of dopamine
We should remember that a lot of self sabotage behaviours like food, drinking, drugs, gaming, app checking, all give us a dopamine hit which feels good, and is registered in the brain as pleasure. So self sabotage actually reinforces itself by giving our brains a pleasure response.
To stay on plan then, you need to remember to focus on the longer term gain rather than getting distracted by the shorter term hit.
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The value of support
A word here on the importance of support in understanding why we self sabotage and stopping this behaviour – as with so much of what we experience as humans, making big changes in our lives is so much easier if you get supporters involved. So if you know that you have a tendency to procrastinate, or that you have a fear of failing at something, or that you feel a fraud, then talking about it to people who will listen and give a damn, and who will provide you with support and ideas on what to do about it, will really help.
Last, a word on strengths – at Strengthscope, we define strengths as those qualities that energise you and that you are great at or have the potential to become great at. So here’s the thing – you may know your strengths but will you use that knowledge to strive for excellence in areas that energise and excite you? Because if you really go for it in those areas, you risk failure, and failure in areas you are saying are most energising to you, that are strengths for you. But the upside is that you level up in those areas and in the contribution you can make, learning as you go. My advice though, do it with support, and go easy on yourself, celebrate the small steps along the way.
That’s it, don’t let self sabotage stop you from achieving all that you want in life. I hope I’ve given you some ideas on how to stop self sabotage.
Did you know this blog is also available as a podcast along with some other incredible content? Check it out on iTunes, Spotify, Acast.

The post Why do we self sabotage and how to stop it appeared first on Strengthscope.
source https://www.strengthscope.com/why-do-we-self-sabotage/ source https://strengthscopecom.tumblr.com/post/183741829264
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strengthscopecom · 6 years
Text
Why do we self sabotage and how to stop it
Tumblr media
Whether it’s relationships, personal goals (like weight loss or exercise) or projects at work, self sabotage seems to be something that many of us are drawn to.  I want to use today’s podcast to explore self sabotage – what it is, why do we self sabotage and most importantly, how to stop it.
  What are self sabotaging behaviours?
So self sabotage is the thing that happens when you have a plan, and you have every intention of keeping to your plan, and you may have even told people that are following this plan, but for some reason you scupper your chances of success with your plan because you get in your own way at some point during the plan. You do the opposite of your plan, you get distracted by something that isn’t the plan, or the plan starts to freak you out and you stop following it.
Self sabotaging behaviours really do vary – they could include stopping yourself from doing the thing you said you’d do (procrastination – more on Procrastination-how to stop stopping yourself starting here), or maybe self-medicating with food or alcohol or drugs or something else addictive like TV or gaming or whatever, or even at the extreme end of the spectrum, self sabotage could actually involve self-harm. But today I’d like to focus more on why do we self sabotage and how to stop it.
The thing is that because self sabotage takes on a variety of forms, some low level like being open to being distracted and some much higher stakes like self harm, the reasons behind the self sabotage are often just as varied and complicated. But you need to understand why you’re doing it if you want to give yourself the best chance to learn how to stop self sabotage in its tracks.  I’m going to talk about self-worth, fear of failure, fear of change, beliefs we were given as kids, the perils of dopamine and the value of support.
Why do we self sabotage and how to stop these self sabotaging behaviours?
Lack of self-worth and fear of failure
In a previous blog, I talked about imposter syndrome, which is the belief you aren’t worthy of your current role, status or opportunity and so you feel uneasy and anxious about that, to the point where you can start to feel like an imposter, which then limits your happiness and performance…so becoming self-fulfilling…self sabotaging. This is almost certainly linked to your sense of self-worth.
So the underlying reason why we self sabotage in this case is often that we don’t believe we are good enough and as a result we set ourselves up to fail because at least that way we don’t have to risk failure by trying to succeed and falling flat on our faces. So we choose to be the architects of our own failure or limitations rather than risk success and set ourselves up for even higher heights and bigger challenges where the chances of failure are even greater and where we’re even more sure that we’re in the end going to spotted as a fraud.
Tumblr media
Wow, that is complicated. We’re really tying ourselves up in knots with the second guessing and starting-stopping behaviours there. So, how to stop self sabotage caused by this? In short, stop fearing failure by reframing it as a stepping stone to success or as part of success – failure is a great way to learn after all and it’s inevitable if you want to succeed.
There was this awesome advert with Michael Jordan in it, who was seen as the wold’s greatest sportsman at the time – check it out…if you search on Michael Jordan, Nike, failure, you’ll find it. Anyway to summarise, in it he says “I’ve missed more than 9000 shots in my career, I’ve lost 300 games. I’ve missed the game-winning shot 26 times.  I’ve failed over and over again in my life. And that’s why I succeed.”
But what about if we really don’t feel worthy of success, like we don’t deserve it, not because we feel like a fraud but because we don’t feel success is owed to us, because our life experiences have knocked our self confidence to the point that success doesn’t feel like it’s part of who we are. We are a failure and being a failure feels easier than trying to be something we don’t identify with: being successful.
That’s pretty big and runs pretty deep as a reason why we self sabotage and it will need some pretty full on soul searching. But by starting to believe that you are worthwhile, that you do make a contribution, that you can make a positive difference in your corner of the world. Then you may start to see some green shoots of self-worth that can help you to see success as something that is part of your story and identity and that you are worth it and that you are owed it.
Self sabotage and the fear of change
Another reason why we self sabotage is fear of change – us humans tend to like to keep things the same because that sense of familiarity and control makes us feel less psychologically anxious. But taken to extremes, that might mean that we rarely try anything new, rarely challenge or push ourselves out of our comfort zones because that might lead us to a place where we feel anxious and where we screw up, we might not be perfect, we might not ace it first time out. When right here in the comfort zone, everything is under control, as it should be, just right.
So again, our fear of failure may lead us to stick with the status quo and miss out on an opportunity to learn, to stretch and grow through experience even if failure may be a possible outcome when we set out on that journey.
Developing a growth rather than a fixed mindset can help with this, again so that we see growth through failure as a positive rather than something to avoid or be fearful of. Carol Dweck talks a lot about growth mindset, particularly in schools, and ways to develop it, so check her out.
Beliefs we were given as kids
And now we’re talking about schools and about kids, and indeed us as kids, there’s an awful lot that our parents have to answer for by leaking their own anxieties all over us and repeating phrases to us as we’re growing up, which can lead us to interact with the world in certain ways. Things we often hear when we’re growing up include “Hurry up”, “Be strong”, “Be perfect”, “Please others”, “Try hard” – these are described as DRIVERS of behaviour and are covered by a model called Transaction Analysis which is fascinating and also helpful.
If you heard any or all of these phrases repeated a lot when you were young, these scripts can seed beliefs and behaviours which it’s hard for you to shake off as an adult. The Be Perfect driver may well relate to self sabotage if we find ourselves fearing failure. Because it’s a lot easier to be perfect in areas we’re familiar with than in areas that we aren’t, so we may pull back from situations where we see failure as a risk and therefore not be perfect.
But if these phrases, these drivers are not helping us, then it may well be worth challenging them and deciding on new drivers that will help us.
The perils of dopamine
We should remember that a lot of self sabotage behaviours like food, drinking, drugs, gaming, app checking, all give us a dopamine hit which feels good, and is registered in the brain as pleasure. So self sabotage actually reinforces itself by giving our brains a pleasure response.
To stay on plan then, you need to remember to focus on the longer term gain rather than getting distracted by the shorter term hit.
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The value of support
A word here on the importance of support in understanding why we self sabotage and stopping this behaviour – as with so much of what we experience as humans, making big changes in our lives is so much easier if you get supporters involved. So if you know that you have a tendency to procrastinate, or that you have a fear of failing at something, or that you feel a fraud, then talking about it to people who will listen and give a damn, and who will provide you with support and ideas on what to do about it, will really help.
Last, a word on strengths – at Strengthscope, we define strengths as those qualities that energise you and that you are great at or have the potential to become great at. So here’s the thing – you may know your strengths but will you use that knowledge to strive for excellence in areas that energise and excite you? Because if you really go for it in those areas, you risk failure, and failure in areas you are saying are most energising to you, that are strengths for you. But the upside is that you level up in those areas and in the contribution you can make, learning as you go. My advice though, do it with support, and go easy on yourself, celebrate the small steps along the way.
That’s it, don’t let self sabotage stop you from achieving all that you want in life. I hope I’ve given you some ideas on how to stop self sabotage.
  Did you know this blog is also available as a podcast along with some other incredible content? Check it out on iTunes, Spotify, Acast.
  
The post Why do we self sabotage and how to stop it appeared first on Strengthscope.
source https://www.strengthscope.com/why-do-we-self-sabotage/
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gehayi · 8 years
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The Non-Replacement Children
I just finished reading an original story that made me more angry and upset than I can say.
The story, written in epistolary fashion, deals with autistic children.The non-allistic-performing sort who don’t speak, don’t want to be touched, etc. Two examples from the text, in fact.
Except...you know how the stories of changelings are now thought to have been about autistic children all along?
This story is written as a series of case studies by doctors and social workers who deal with the trauma of parents whose REAL children have been “replaced.” That’s what the changelings are called in this. “Replacement children.” “Replacements.” Or, occasionally, “fake children.”
Aside from the autistic kids (I’m NOT calling them replacements or fakes!) all having having silver hair--which, after all, there could be a gene for--there is no sign that they are, as their parents, doctors, and social workers believe, fae. There is also nothing in the text to indicate that anyone is truly stealing children; children (especially boys, in-universe) change, seemingly between one day and the next, and the fae are blamed.
Hypotheses pop up about where the real children might be. Some think that they are imprisoned within their own bodies--possibly within one of their organs  (don’t ask me). Others think that the real children are being held somewhere in a cellar or a shed, suffering terribly. Still others hope that the real children are ruling over a magical land filled with fairies and elves.
No one suggests that the real children have been right in front of their parents all along--or that just because the parents didn’t get the neurotypical children they expected and wanted, that doesn’t make the autistic kids that they do have any less real.
But wait. It gets worse.
See, almost no parents in this story want the fantasy-version autistic kids. They dump them--at hospitals, at “boarding schools” from which the kids never return home, even in the middle of fields of weeds (which is seen as a good way of getting the nonexistent neurotypical child back). All this is presented as being rather sad and certainly difficult for the parents, but it’s not really healthy to focus on such children. Parents are advised to have other children and forget about the autistic ones...who won’t even miss their parents. They don’t display affection in conventional ways, so that must mean that these children feel nothing...right?
Even that isn’t the worst. No, the worst are the ways that parents and grandparents use to try to banish the autistic child in the hopes that this will result in their real child being brought back from the lands of Faerie. You’ve probably heard about these methods in folklore. Some, like boiling water in eggshells, are silly but harmless. Others, like beating the child with a branch from a birch tree, putting the child on a chopping block for firewood, putting the child on a hot stove, feeding the autistic kid poisonous “medicine”, leaving the child tethered all night to a stake next to a well, pretending to throw the child in the oven, actually throwing the child in a fast river, and starving the child, are traumatizing and potentially lethal.
But again, the narrators do not criticize such actions. The most they say is accepting the child is an alternative, but it is clear that they don’t expect parents to avoid such things. Even when discussing children who have died as a result of such treatment, no one says anything about how horrible it would be to be murdered by your parents or caregivers simply because you weren’t the person that they wanted you to be. No one mentions arrest or charges of child abuse. There is not even a flicker of disapproval. 
It is clear that few people regard the silver-haired autistic children as human. Thus, their lives do not count.
At the end, the story focuses on a family that decides to accept their autistic kid...though the narrative continues to emphasize, of course, that this is only a “replacement child” and that the parents are being quite unusual in treating such a child like they matter. Naturally, this family is a privileged one (they can rent a summer cabin by a lake, they know how to sail, etc.). They take their son out for a sail on the lake. The boy lies on the deck for most of the trip, only falling out of the boat once. When he does not want to leave the boat, his mother, despite really wanting ice cream (yes, this is emphasized), suggests that they just sail back because he enjoys sailing so much. As they sail back, the reader is told that the clouds seemed to form ridiculous and beautiful animals that could never be. 
I think that we’re supposed to take this as a sign of fae approval of their parenting. Assuming that these children are indeed intended to be fae, then I am at a loss to understand exactly why those who abandoned, hurt or killed these children never merited any fae disapproval.
There is no resolution to the story. The parents and professionals never learn that there are ways of communicating with these children, or that the kids react as they do for physical and psychological reasons. No one ever so much as mildly reprimands the parents for treating their children like animals or aliens. Indeed, there is a general undertone of sympathy for the parents, while there seems to be none for the kids.
Most disturbing to me is the fact that the children are not granted identities, though the parents usually are. At best, they have initials. Amber and Clark Y. are the first parents we meet. They have a son with no name. Tina Q. has a son with no name. One mother (unnamed) has a son named Timothy; the alleged replacement, however, is not called Timothy but P.  Another replacement (one who sounds as if he would enjoy conlangs) is merely designated Q. Terri O. has an autistic child whom she takes to the park, but we learn neither the name nor the age nor the sex of the child. Susan K.’s child likes bland foods, and that’s all we learn about him. Leslie X. has a child who cries on being held, but we learn nothing about why he cries or who he is. And so on. 
A pattern emerges: the parents all have names that I could find in any predominantly white suburb, without  a Tanisha J. or Ximena R. among them. And the autistic children are all vaguely interchangeable, nameless boys. One gets a line of gibberish; the others are not given lines at all. The audience is not privy to their words or thoughts. In their world, they are voiceless. Indeed, the story itself acknowledges this:
What do the replacement children themselves think about all this?
We would guess some replacements wish to return where they came from; some may wish to stay where they are; and some must wish we not tell their story for them or, at least, that we tell a different type of story. (Emphasis mine)
I would rather hear the children’s story. I imagine that raising a severely autistic child must be difficult--but can it really be harder than being that child and knowing that your parents are willing to hurt you, even kill you, because you are not what they want? Is life valueless unless it fits a particular pattern?  Is a future in which there are more and better coping techniques for autism and where autistic people are seen as human beings rather than others from an alien world so unimaginable?
I have suspected for years that I am probably somewhere on the autistic spectrum. Knowledge of the condition simply hadn’t hit the mainstream when I was a kid; that’s probably how I avoided diagnosis. I do know, however, that I never had to deal with the label. I don’t feel that I have the right to tell the story of the kids from this fictional world.
I do know, however, that I don’t want to hear what autism looks like from the outside. I don’t want to read stories where parents of the disabled are wailing with disgust, “Pity me for having to deal with this!”  Honestly, we don’t need more stories where the disabled are either trials and burdens to the able-bodied or saints sent to teach the able-bodied. We are saturated in tales that embrace the notions of Bury Your Disabled and Inspiration Porn. I, for one, am sick of both--and have been for the past forty years.
But do I want someone who is autistic to write stories about the magnitude of such parental rejection or about futures where people aren’t dehumanized for having an identifiable medical condition? Hell, YES!  I want to know what they feel and how they think and how they would make things different. 
I want this because you can’t build a better future if all you can envision is a world that’s identical to now. 
And dehumanizing people is never a path to anything better.
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eldritchsurveys · 4 years
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922.
5k Survey XL
2051. Are more people depressed because they are alone, or are more people alone because they are depressed? >> Heh, 5k Survey Xtra-Large. Anyway, you can be surrounded by people -- people you love and who love you, even -- and be depressed. Depression does not fucking care about your actual life situation or anything else but keeping you in its mind-altering grasp for as long as it possibly can. 2052. Have you ever gotten a mug, t-shirt, key chain, etc. that was personalized with your picture? >> Nope. 2053. What was the last thing that you experienced for the first time? >> This drink from Cafe Boba that I took one sip of and instantly hated. It was supposed to be jasmine green tea with lychee, which sounded like a pleasant, refreshing drink with maybe a bit of sweetness (to counteract my very savoury and rather fatty lunch). It actually tasted like a goddamn syrup dispenser. I was pissed. 2054. If you were going to die tomorrow and you were leaving a postcard for someone to read after you were gone what would it say? >> I wouldn’t do that. 2055. If you were about to be executed what would your last request be? >> How would I know? I can’t imagine being in this situation at all.
2056. What kinds of people do you find intimidating? >> I don’t really find people intimidating. I’ve been on the receiving end of that impression many times and knowing how strange and irrational it seems to hear that from people made it kind of hard for me to experience the feeling myself, I guess. People are just people. 2057. How much conviction do you have in your feelings and beliefs? >> I don’t really care about having conviction, so not a lot, I guess. I just think what I think until/unless the time comes for me to change my mind. 2058. In your house where is the: crazy glue? I’m not sure we have any right now, but if so, it’s probably in the right-most drawer on the east side of our kitchen. flashlight? We don’t have one of those either. We use the flashlight feature on our phones. 2059. Out of everyone you know who has the most personality? >> I don’t know how to quantify this. 2060. If you could go back in time to experience a musical movement or era, which one would you choose to live through? >> --- 2061. Do you suffocate people with your love? >> I am on the direct opposite end of the spectrum from this. 2062. Do you feel your life is charmed? >> I don’t know what this means. 2063. What character do you identify the most with from Winnie the Pooh? >> Eeyore. But also Rabbit, lol. 2064. When do you do your best thinking? >> I’m not sure. 2065. What motivates you? >> I’m also not sure of this. Motivation is very hard for me to muster. 2066. Look back at all the people you’ve dated. Has there been a pattern? >> Sparrow and I were talking about “types” in dating the other day because of a conversation she had at work, and I concluded that the reason there’s been no real pattern in my dating history is because... most of the time when I dated someone, it’s because he asked me out. I just went along with it because I... assumed that’s what you do, I guess. Like, if I wasn’t immediately repulsed by a person, then I was like “yeah, sure, okay”. So it’s not like I was actively picking these people to date as much as they picked me and I wasn’t opposed to it. The first person I remember pursuing is Hallie, and that was such a bass-ackwards and awful choice that I’m surprised I got it right the very next time around (Sparrow). 2067. Things change but what will always remain the same for you? >> The fact of things changing. 2068. Is divorce something you would ever consider or do you feel that marriage is permanently binding? >> I mean, of course I would consider it, if I had to. Nothing is permanently binding except the eventuality of death. 2069. What’s the strangest movie you ever saw? >> Oh, there’s a few. Antichrist comes to mind, of course, but also Enter the Void and Beyond the Black Rainbow, neither of which I finished because they were way too esoteric for me. I find Antichrist, and Mandy and mother! and such, to be just the right kind of strange for me and I gravitate to those kinds of movies hard. 2070. If you could go into virtual reality and set up your life there to be perfect and it would seem real but not be real would you trade your life now for the virtual life? >> I’d really rather not get involved with that at all. 2071. Does it seem like life is more difficult for you than for anyone else? >> When I’m depressed, sure. That’s part of the self-focused, excessively negative worldview shit. But normally, I understand that that’s not a logical way to think. 2072. What are you grateful for? >> You know, stuff. I’m not going to make a list right now. 2073. What was a choice that you didn’t want to make but you had to? >> I can’t think of one right now. 2074. Have you ever had dental surgery? >> I had a tooth pulled, does that count as surgery... I’m not sure where the line is. 2075. At what point exactly are you grown up? >> There is no “grown up”, it’s all just... some kind of complex illusion that people create to determine when they should stop watching cartoons or whatever. ...I mean, maybe I’m being a bit harsh, but I’m sick of the whole concept because it just never meant anything to me and even in my thirties I don’t get it. 2076. If there was a weight loss procedure that would destroy your ability to taste food so you wouldn’t be tempted by junk food, would you have it done? >> I stopped at “if there was a weight loss procedure”. Just fuck off with that. 2077. What is one thing that happened that you never expected? >> Like, in general? A majority of the stuff that’s happened to me, dude. 2078. If you called one of your friends and they said “It’s nothing personal but I don’t want to talk to anyone right now,” would you take it personally? >> First of all, bold of you to think I call people. But okay, say I messaged someone or something. I would take it a little personally at first, like it’d sting, but ultimately I’d respect that boundary and hope that it just means they’re focused on something in their life right now and don’t have the time/energy, but will probably come talk some other time. I’ve zero problem with that and don’t mind waiting, I just... often have the impression that I have no value to other people so I automatically assume they’re never going to talk to me again, lol. 2079. What is your favorite girl’s name? >> --- 2080. Do you ever feel guilty for being more fortunate then others? >> I sometimes experience something that reminds me of the concept of survivor’s guilt -- I made it out of being broke and homeless in NYC like so many other young, non-white, queer people, though not through any real work of my own (unless you count maintaining a long-distance relationship for a few years as work, which, okay, yeah), and there are so many people that just... will end up falling through the cracks, or getting into progressively more fucked-up situations, or dying, or whatever. And that sucks. Sometimes I wonder if I deserve to have made it out, or whether I’m doing enough to be worthy of it, although I know that’s a really fallacious way to think. 2081. If you had to wear a shirt with one word on it for a year, what word would you choose? >> Like, if I was a cartoon character, what would my shirt be? I’m not sure, but it’d probably be something a little ridiculous. 2082. What is evian spelled backwards? >> I’m sure you don’t need me to tell you. 2083. You drop 10 pounds of feathers and a ten pound bowling ball off the top of the same building. Which will hit the ground first? >> I don’t know. I guess it would depend if the 10lb of feathers was all in a single container or just... freely falling feathers, wouldn’t it? 2084. Even though you may never get what you want, are you happy because you’re trying? >> I’m not happy because I’m trying, I’m trying because the only other choice is to stop trying at all and that’s... no longer acceptable to me, I guess. 2085. If you started a petition what would it be about? >> I wouldn’t. 2086. When was the last time you asked someone to do something and they said no? >> I don’t remember. 2087. Do bad things happen to you on friday the 13th? >> Not that I’ve paid any specific attention to. I imagine bad things can happen on that day with the same or similar likelihood as any other day, but I wouldn’t focus on the fact that it’s Friday the thirteenth. 2088. What’s your favorite:  Madonna song? Again, just picking a song I like at random. Like a Prayer. John Lennon song? Michael Jackson song?  Doors song? The End. Rolling Stones song? Gimme Shelter. David Bowie song? (Fuck, like... half of his fucking oeuvre???) Space Oddity. Elvis song? If I Can Dream. 2089. If you had started a relationship with someone and they said that it would be best if no one knew about it just to see how it goes, would you be offended? >> I wouldn’t be offended, I would just hear alarm bells in my head. Definitely not a situation I’d like to be in, period. 2090. Do you know any self defense? >> No. I’ve picked up random tips over the years, but that’s all. Nothing I’ve really practiced, per se. How about CPR? >> No. I more-or-less know how it goes, but I’m not certified or anything. 2091. If you had to look into a mirror and see your naked soul stripped of all delusions and pretenses (Never ending Story style)could you handle it? >> Damn, I don’t even remember that part from Neverending Story, really gotta rewatch that, huh. Hopefully it’s still on HBO but it might be gone by now, I think it was on the “last chance to watch this” list recently. Anyway, I don’t know if I could handle that or not. Not sure what it would even feel or look like. 2092. Are you a genius? >> No. 2093. How did you find out that Santa Clause wasn’t real? >> I was never taught about him in the first place. 2094. Which is your favorite tarot card? >> Either Death or The Sun. Or The Hermit, that’s always a good one. Oooh, the Magician’s good too... this is tough. I love tarot. 2095. Does the internet separate people or connect them? >> I guess it does a fair amount of both, depending. 2096. Have you ever written a letter to a soldier? >> No. 2097. Does pain and fear make you feel alive? >> Er... I mean, that’s... I’m not sure how to answer that. Pain and fear often make me feel like I want to stop being alive, to be honest... 2098. Are you: good looking? Not answering that. thin? Eh. Not so much. happy? Sometimes. successful? At what? confident? Not particularlyl. 2099. Are you deciseive or wishy washy? >> It depends on what kind of decision I’m making and how much energy I have to make that kind of decision. 2100. Do you feel pop stars should be morally responsible to set a good example for their fans? >> I don’t think so, no. I think at some point, young people have to learn to discern what kind of behaviour they’re going to emulate and what kind of behaviour they don’t want to emulate, and seeing people behave in a variety of ways and figuring out how they feel about those behaviours helps with that discernment. Besides, celebrities are people, not fucking... archetypes, or heroic figures, or something. The fact that we treat this certain subset of human being like they should be something “greater” than human is more than a little weird to me (although I do recognise it’s probably something we’ve been doing in various forms or another for centuries, if not longer).
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lostpensioner · 7 years
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My Feet and The Space/Time Continuum.
I have long been of the opinion that this vast universe in which we live pivots around the central point of my feet.  I know that since Einstein’s day we have come to see everything in the universe as being in motion relative to other moving objects, and that  we now believe that there are no fixed points.  But from early childhood I have been struck by the overwhelming evidence to suggest that my feet are, in fact, the centre of the universe.
 I have never, at any age, been considered a tall person. I like to think of myself as being of average dimensions, both vertically and horizontally.  And I have never had particularly large feet.  One would imagine then that the chances of any object in this mind-blowingly huge universe hitting my feet randomly would be miniscule.  I’m no mathematician.  But if you consider the smallness of my feet in comparison to the immensity of the universe you would be inclined to bet on the likelihood that if something out there is going to accidentally hit off something it must be infinitely unlikely that the something they hit will be at the end of my legs.
 Ask yourself this: Have you ever actually seen a piece of space debris fall to Earth?  I doubt it. Or do you know anyone who as ever witnessed such an event?  Again, I suspect you haven’t.  And yet, scientists tell us every day that stuff is constantly falling from the heavens. Fortunately, it seems to favour oceans and deserts as a landing place.  We seldom hear stories of people being wiped out by a piece of an old space station hurtling through space.  And who do you know who has been struck by a meteor?  I presume that scientists would argue that such events are extremely rare because of the immensity of space and the relative insignificance of any one human being located within it.
 However, it would amaze you to know that, throughout my life, from childhood to the present day, my feet have been under constant attack from stray objects, particularly from other people’s feet.  I became very aware of this problem in my teens although, in hindsight, the problem started much earlier.  My parents seemed to be incapable of walking through a room without tripping over my feet.  This was often a quite painful experience for me.  Yet those who tripped over my feet always reacted as if they were the innocent victims of my malicious pedal extremities.
 After they would regain their balance (they seldom actually fell) they would turn and give me a look of intense annoyance.  They never took personal responsibility for the injury to their dignity caused by the embarrassing trips.  Their looks, and often their words, would accuse my feet of having been in the wrong place.  It was the position of my feet in the space/time continuum which was the problem, not their carelessness.  “Tidy yourself up”, I was often admonished.  “Why did you have to leave your feet there?”   The unfairness of these remarks always irked me, although for years I struggled to fully identify the faulty logic on which they were based. But then one day, in my sixteenth year, I suddenly saw how nonsensical these accusations were.  
 It was my father who tripped over me.  He was on his way to do one of those very important things that fathers do, and therefore couldn’t spare the attention necessary to navigate his way safely through our spacious living room.  As usual, he managed to plough straight into my feet.  “For God’s sake!” he roared.  “Can you not be more careful where you leave your feet?”  So instant was my grasp of the unfairness of this remark, that I immediately burst out even more loudly than my father: “What do you mean?  My feet are down there at the bottom of my legs, exactly where they’ve been for more than a decade and a half.  I can’t think of a less surprising place to find my feet!”
 There then followed an astonished silence.  I don’t know who was more amazed, my father or me.  I’m not normally given to sudden outbursts. I’m more of a sulker than a sudden-outburster.  My father, then, had no precedent against which to bench-mark this aberrant behaviour. For my part, I had trouble recognising the expression on his face, unwonted as it was.  With the benefit of hindsight I would guess that it was Dad’s attempt at flabbergasted mixed with nonplussed with just a soupcon of annoyance thrown in for good measure.  Normally he favoured the milder end of the facial expression spectrum.  The nearest he ever got to looking annoyed was when he tripped over something with toes attached to it.  Otherwise he had his facial muscles permanently  set to a default mode of quiet optimism.
 As I’ve said, I was quite dumbstruck myself.  I am not, in my deepest nature, a bland person.  I am a sensitive soul, one who experiences emotions very intensely.  And I tend to paint my inner world using  quite a dark palette.  I’m basically quite moody, angst ridden, even gloomy.  But not many people know that.  In order to survive in an exceptionally cheerful family I’ve had to learn to curb the expression of my true emotional nature.  So as not to have to endure my Pollyanna parents and siblings trying to cajole me into a blissful state with exhortations to cheer up, or being told that it might never happen, I’ve learnt to act the part of a happy-go-lucky, devil-may-care sort of eejit.  I’d been acting this role for so long now that I was genuinely surprised to hear my true self screaming out loud about the injustice of my feet being scapegoated.
 I looked in my Father’s eyes.  He, with great difficulty, returned my gaze.  I’m not a big fan of the whole eye-contact lark.  I worry that if I direct the windows of my soul for more than a fraction of a moment towards the windows into another, more cheerful, soul, I might manage to draw all the joy, all the hope, all the innocence out of that trusting, open, kindly spirit.  And, at the same time, I might allow that other soul a glimpse into the stygian gloom of my rank inner life.  But sure anyway, I found myself exchanging a reasonably long glance with my father.  After the initial flabbergast-based expression cocktail had faded from his face, I could see that he was seriously thinking about having a go at talking. His mouth was starting to move in silent preparation for the task of  forming a few apt words.  But the words, apt or otherwise, were slow to form.  At first I thought that maybe they had encountered some sort of neural traffic jam en route from his brain to his gob.  But I gradually came to the conclusion that the words hadn’t even headed off on their journey yet.  There seemed to have been a shortage of lexical volunteers.  There weren’t loads of competing words, phrases or sentences shouting out “Please pick me!” inside in the Da’s brain.  I don’t even think the concepts which the words could symbolise had formed in his mind yet.  He was at a loss.  The mouth stopped moving.  Then it closed.  His eyes found an expression of defeat which they could both agree on and decided to stick with that for the time being.
 This was all new to me.  I’d never had this effect on my Father, or anyone else for that matter, before. This was not an enjoyable precedent. By carelessly allowing a few angry words to burst out from the depths of my petty little soul I had caused pain and indecision in the heart and mind of a good man.  I reviewed my options as quickly as I could:
 Option one:  I could apologise.  Admit that I was in the wrong (even though, strictly speaking, I wasn’t.  I had just carelessly jumped gallantly, if overzealously, to the aid of a pair of innocent, much-maligned feet.  If it had been a woman instead of a pair of feet I had stood up for people would applaud me.)
 Option two:  I could stand by the principle I so heartily championed, but express regret for the tone in which I had expressed said principle.  Backtrack on the rudeness while sticking fundamentally to my guns.
 Option three.  I could ramp up the level of emotion to a point where I began to scare my father. He would begin to fear for my mental state and try to mollify me.  He would say whatever it took to talk me back into a more reasonable state of mind, thus saving me the unmanly embarrassment of having to back down.
 In the end I opted for none of the above. Instead I looked down at my feet, then back up to the Da’s eyes, then back to the feet.  The message I was trying to convey was something like this:
 “I put it to you, members of the jury, that these feet, the left and indeed the right, are in fact innocent.  The charges are that they maliciously, and with intent did set out to impede the progress across the spacious plane that is the living room floor of a decent man of the father class whose journey had been embarked upon for no other purpose than the furtherance of the wellbeing and contentment of those with whom he shares an abode.  And that, further, the afore-mentioned feet did seek to avoid blame for their crime by enlisting the aid of a young man whose moral judgement is as yet not fully formed.”
 And so on, and so on. I won’t bore you with the details of the ensuing rounds of examination, counter-examination and legal argument. Suffice it to say that, even now, fifty odd years later, the jury is still out.
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kristinsimmons · 5 years
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#USMLEPassFail: A Brave New Day
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By BRYAN CARMODY, MD
Well, it happened.
Beginning as soon as 2022, USMLE Step 1 scores will be reported pass/fail.
I’m shocked. Starting around two weeks ago, I began hearing rumors from some well-connected people that this might happen… but I still didn’t believe it.
I was wrong.
The response thus far has been enormous – I haven’t been able to clear my Twitter mentions since the news broke. And unsurprisingly, the reaction has been mixed.
In the future, I’ll post more detailed responses on where we go from here – but for now, I’d like to emphasize these five things.
1. By itself, making USMLE Step 1 pass/fail doesn’t fix much.
Simply getting rid of three digit scores doesn’t improve medical education. And it doesn’t make residency selection any better, either.
It does give us the opportunity to make changes. And the importance of that should not be understated.
Put simply, this is the greatest opportunity for medical education reform since Flexner, and the greatest opportunity to re-design residency selection since… ever.
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“WHAT WILL REPLACE STEP 1?” IS A HARD QUESTION. AND MAKE NO MISTAKE, THE FACT THAT IT’S A HARD QUESTION IS ONE OF THE VERY REASONS MANY CLUNG TO STEP 1 SCORES SO DOGGEDLY.
2. The path of least resistance does not take us where we want to go.
Most of the commentary on social media thus far has taken the following form:
Now only Ivy League medical students will get into competitive specialties.
Don’t worry! USMLE Step 2 CK will just be the new Step 1.
I guess DOs and IMGs can forget about getting into top residency programs.
And you know what? Most of these concerns are justified.
If we do nothing, Step 2 Mania is the natural result of a pass/fail Step 1. And unless we give program directors more useful information – and the time to thoughtfully review all the applications they receive – they’ll gravitate to another convenience metric out of necessity.
But that does not mean it’s inevitable.
3. We all have a say in what comes next.
If the rise and fall of a scored Step 1 teaches us nothing else, it should clearly demonstrate these two things.
First, advocacy works. There is no way that the NBME’s entrenched, out-of-touch bureaucracy would have ever voluntarily changed Step 1 to pass/fail – unless their feet had been repeatedly been held to the fire by the public over the past year. Change is possible – but you have to speak up.
Students, I’m looking at you – especially those from “non-elite” or international medical schools. You have a say in what comes next. How should residency programs evaluate you? Surely, answering multiple choice questions with peripheral relevance to real patient care is neither the best nor the only way to identify your talent. It’s time to dream bigger – and demand more meaningful evaluation.
Second, medical students will rise to whatever bar we set for them.
Ask them to memorize an 800 page review book so they can excel on a multiple choice question test of basic science esoterica? Done and done. Students knew most of what they were learning was pointless – but they worked tirelessly because we told them it mattered.
So program directors, now I’m looking at you. Whatever you tell students to do, they’ll do. You want high Step scores? Students will give them to you. But what really matters to you? Do you want residents who will serve the underserved? Contribute to research? Arrive on July 1 with specialty-specific knowledge? Whatever you say, goes. If you choose to grump about the loss of the bad old days, you’re abdicating your authority to set the standards you want.
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YOU WON’T FIND ME SHEDDING ANY TEARS OVER THE DEMISE OF A SCORED STEP 1.
4. No one should mourn the loss of a scored Step 1.
Look around my Twitter mentions, and you can find touching testimonials mourning the demise of Step 1 scores. There are tales of useful factoids brought to bear on patient care decades later; of students inspired to consume as much (mostly useless) scientific knowledge as possible; of doors opened and careers launched because of one shining moment on test day years ago.
Give me a break.
The Step 1 score was the biggest false god in medical education, and no one should be too sad that it’s going away.
Was it objective? Sure. But the ability of three-digit scores to discriminate between applicants was actually fairly imprecise.
Did it test some useful concepts? Of course. But scoring highly required memorizing esoteric information that would never benefit an actual human patient.
Did some students benefit from scoring highly? Absolutely. But did Step 1 scores really “level the playing field” for students from international or non-prestigious medical schools overall? I doubt it.
Did it give program directors an easy way to screen applications? Yup. But was that way meaningful? Probably not. The main value of Step 1 was that it gave you a number. But if the content of the test doesn’t matter, why not just have medical students throw darts, or race go karts, or memorize digits of pi?
And of course, our idol worship of Step 1 came at a significant opportunity cost. The fact that most of us turned out okay doesn’t prove that Step 1 was the best way, or that that we wouldn’t have been better off under another system.
Here’s the thing:
Whether you liked a scored Step 1 or not, the current system is not what any of us would have designed if we were building something from the ground up.
In the scored Step 1 era, we sat back and watched as preclinical medical education turned into a glorified USMLE prep course with a five-figure/year tuition bill attached. We did nothing as residency applications spiraled out of control and program directors’ outsourced their most important decision-making to the NBME.
We shouldn’t be proud of any of this. And we shouldn’t mourn the loss of the three-digit score that enabled us to neglect the need for reform for so long.
More importantly, there is no turning back now.
If you opposed #USMLEPassFail, do your grieving for the scored USMLE – and then get to work. Saying “I told you not to make Step 1 pass/fail!” is a hollow victory. There is an opportunity here to engage our students in tasks that could actually lead them to be better physicians – but we have to seize it.
And if you supported #USMLEPassFail, now is not the time to dance on the three-digit score’s grave. We need to get to work, too – or this hard-won victory will go for naught.
5. The way forward… my opinion
Expect more from me on these topics in the future, but for now, let me put these three thoughts in your head.
WE NEED MEANINGFUL EVALUATIONS.
My 5th grader’s report card provides more useful information than any medical school transcript I’ve ever seen. He doesn’t get an “A” in math – I get to see a lengthy list of math skills and an assessment of where he’s at with all of them. Maybe he’s comfortable dividing fractions, but still developing proficiency with using variables to set up algebraic equations.
Letter grades are nice – but they don’t tell me what he knows and what he doesn’t. (I don’t get a histogram of other students’ performance and where he falls – because how other students performed is kind of irrelevant if my goal is to help him become better in math.)
The fact that elementary schools provide more information-rich evaluations than medical schools is shameful. In the past, we’ve justified this because of Step 1. Starting in 2022, that excuse will ring hollow.
Let’s be honest: there should never be a medical school evaluation in which a students is exceptional in every area. (If there is, it tells you more about the school than the student.)
Our goal should be to make medical school formative, not performative; to help learners maximize their potential without fearing failure; to provide and communicate honest feedback that leads to improvement and growth along the spectrum of medical education. (For their part, program directors need to focus less on relative accomplishment and more on potential to grow and thrive in that program/field.)
We don’t need another arms race. We do need more thoughtful evaluation. We should require students to engage in tasks that leave them – and their future patients – better off. And schools that refuse to participate in this process should be penalized by program directors and medical school applicants alike.
WE NEED HOLISTIC REVIEW.
I don’t think we need a one-size-fits-all metric to tell us who are the “best” applicants. Honestly, we don’t.
Certain talents and traits get you a lot farther in certain disciplines than others. Even within the same discipline, different programs have different needs and serve different missions. What makes a good doctor? It’s complicated. And trying to reduce that complexity down to a single three digit number is silly.
Holistic review is possible. It’s what we do at the residency program at which I’m an associate program director. But it’s labor intensive – and it requires human judgment. That last part makes some people uncomfortable, and I understand why. Holistic review has the potential to devolve into bias and cronyism. But that’s not a reason to not do it – it’s a reason to strive to do it well, to make decisions deliberately, and to build some checks and balances to make sure you stay aligned with your values.
WE ALSO NEED APPLICATION CAPS.
The only way to get away from screening metrics and treat every applicant as an individual is to limit the pile of applications that program directors receive.
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THE EXISTENCE OF A SCORED STEP 1 ALLOWED US TO PRETEND THAT THIS WASN’T HAPPENING.
Look, I’ve preached this sermon before. But you’d better believe I’m gonna be carrying this particular gospel to the people again in the near future.
Afraid of application caps? Worried that they’ll disadvantage students from non-elite schools? Stay tuned for a data-driven expose of the misinformation surrounding caps coming soon.
Dr. Carmody is a pediatric nephrologist and medical educator at Eastern Virginia Medical School. This article originally appeared on The Sheriff of Sodium here.
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