[ExI] pistols

Stathis Papaioannou stathisp at gmail.com
Fri Apr 23 01:17:11 UTC 2021


On Fri, 23 Apr 2021 at 09:58, Rafal Smigrodzki via extropy-chat <
extropy-chat at lists.extropy.org> wrote:

>
>
> On Wed, Apr 21, 2021 at 9:38 PM Stathis Papaioannou <stathisp at gmail.com>
> wrote:
>
>>
>> Sometimes they are just suicidal gestures, but often the patient really
>> intends to die at the moment they make the attempt, but change their mind
>> when they wake up.
>>
>
> ### How do you know that the patient really intends to die? By listening
> to what they say? If they are really trying to die, why wouldn't they use a
> method that's guaranteed to work, like hanging, fall from height, gunshot
> or drowning? Why do the OD suicides so often message others before the
> attempt, if not to reduce the likelihood of dying and to increase the
> psychological impact on the intended target?
>
> According to:
>
> https://www.hsph.harvard.edu/means-matter/means-matter/case-fatality/
>
> the CFR for gun suicides is 82% but the CFR for poisoning (i.e. drug
> overdose) is 1.5%. This is an enormous disparity. Sure, a lot of suicides
> are dumb people who wouldn't think about looking up the doses of
> medications they would need to take to achieve a lethal effect but really,
> shouldn't the use of a method that works only 1.5% of the time be a clue
> that many if not most of ODs are not serious?
>

There are multiple factors to take into account in deciding if a patient is
telling the truth about their intention to suicide, and the perceived
lethality of the attempt is one. But a significant proportion of
presentations to the ED follow the pattern of had a fight with the
girlfriend - got drunk - took all the tablets in the bathroom cabinet -
woke up in ED the next day and made up with her. These people might have
died if they had a high lethality means of suicide at hand, such as a
tricyclic, lithium carbonate or a gun. In a cost-benefit analysis, it might
still be worth prescribing a tricyclic or lithium despite the risk of
overdose. But if the gun at home is intended mainly as protection against
being killed, rather than because you just enjoy owning and using guns, the
risk of death from accident, suicide or converting a burglary into a
murder, should be factored into the calculation.

Call me a cynic but after 20 years of being a neurologist I developed a
> fair amount of skepticism about what the patients are telling me. As a
> neurologist I have methods for detecting some types of medical lies that
> are not available in most other situations, which is why I find liars all
> the time. "No, I haven't missed my medications!" - your valproate level is
> 0, so yes, you did. "No, I haven't done cocaine in a year" - your urine
> drug screen is positive for cocaine, benzos and opiates, so yes, you did.
> "I am having a seizure" - no, after seeing 1000 fake seizures I know you
> are not. "I am paralyzed!" - no, after seeing 1000 fake strokes I can see
> you are faking it.
>
> Earlier this week I consulted on a 36 year-old morbidly obese man who
> developed complete amnesia. A day before he was supposed to start an actual
> job he claimed he forgot everything - his name, age, address, whether he
> has a family and all of his life so far. I asked him - Do you remember how
> many legs you have? "No, not really". But maybe just approximately? More
> than three? "No, I don't think so, maybe one or two". Laughable. I gave him
> the diagnosis of psychogenic amnesia, or dissociative amnesia but maybe I
> should have called it malingering. After all, in this way he avoided
> dragging his 448 lb to work.
>
> Rafal
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-- 
Stathis Papaioannou
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