Beauty is in the eye of the beholder. Is it really? Let's ask chickens. No, seriously. There's a 2002 paper titled — and I am not making this up — "Chickens Prefer Beautiful Humans." Published in the journal Human Nature by a team from Stockholm University. Let me walk you through it because the methods are clever and the implications are wild. — THE SETUP — Six chickens. A touch-sensitive computer screen. And a set of human faces. The researchers created a spectrum of seven faces using digital morphing. They started one "average male" and "average female." Then they created a midpoint blend of the two, plus two exaggerated-female faces and two exaggerated-male faces. So you get a smooth gradient from hyper-masculine on one end to hyper-feminine on the other. Now here's the training phase: hens were rewarded (with food) for pecking the male face, and roosters were rewarded for pecking the female face. The opposite-sex face got them nothing. Training ran daily until each chicken directed at least 75% of its pecks to the rewarded face. Took about 11-12 sessions on average. Then came the test. The chickens were shown ALL seven faces — including the five they'd never seen before — and researchers simply counted pecks. No rewards during test trials. For the human comparison, 14 biology undergrads rated those same seven faces on a 0-10 scale for dating desirability. — THE RESULTS — The chicken preference curve and the human attractiveness curve were nearly identical. r² = 0.98. For context, that's an almost perfect correlation. The chickens didn't just prefer the rewarded face — they preferred faces that were even MORE like the rewarded face than the training stimulus itself. Exaggerated opposite-sex faces got the most pecks. And that's exactly what the human students rated as most attractive too. Statistically, chicken and human ratings for each individual face never differed significantly. Let that land for a second. Chickens — with zero evolutionary stake in human beauty — produced the same preference gradient as university students rating faces for dating appeal. — WHY THIS HAPPENS — The key concept here is peak shift (also called generalisation gradient). It's one of the oldest findings in learning psychology. When you train any organism to respond to stimulus A and not to stimulus B, it doesn't just prefer A. It tends to prefer a version of A that's even further from B than A itself. The response peak "shifts" beyond the trained stimulus. This isn't face-specific. It's not species-specific. It happens with colours, shapes, sounds, tones — across pigeons, rats, fish, humans. It's just how nervous systems generalise after learning a discrimination. The chickens learned: "this face = food, that face = nothing." Their brains then generalised: "something even MORE like the food-face must be even better." That's peak shift. And it produced a preference curve that mirrors human beauty standards. — THE BIGGER IMPLICATIONS AUTHORS PROPOSED — There are broadly two hypotheses about why humans find certain faces attractive: 1. The mate-quality hypothesis (you read that right): Attractiveness is a signal of genetic fitness — symmetry, hormone markers, immune function. We evolved specific neural machinery to decode these cues. In other words, beauty = meaningful biological information. 2. The receiver bias hypothesis: Preferences are a byproduct of how ANY brain learns to categorise. You learn "male" vs "female," and your nervous system automatically generates a preference gradient that favours exaggerated features. No special face-reading module needed. In other words, beauty = a pattern recognition artefact. This chicken study is evidence for option 2. Because if a chicken brain — which has absolutely no reason to evaluate human mate quality — produces the same preference pattern as humans do, then maybe the preference pattern doesn't require a specialised evolutionary explanation. Maybe it's just what brains do when they learn to discriminate between categories. Beauty, in this framing, isn't really about the face at all. It's about the brain looking at the face. — CAVEATS (because science) — The authors are upfront: this is preliminary. Six chickens and 14 humans is a small sample. The chickens only learned two faces, while humans have a lifetime of face exposure. They used averaged composite faces to partially compensate, but it's not the same as naturalistic experience. They can't rule out that humans ALSO have a specialised face-processing adaptation layered on top of general mechanisms. But their counterargument is sharp, and it goes like this: Evolution is efficient. It doesn't build specialised tools when a general-purpose one already does the job. If a basic learning mechanism that exists in every brain — chicken, pigeon, human — already produces these beauty preferences as a free byproduct, then there's no survival advantage to evolving a separate "beauty detector" module. Natural selection wouldn't waste resources building something the brain already does on its own. — SO WHAT? — The next time the "outer beauty vs inner beauty" debate comes up, here's a third option nobody talks about: beauty might not live in the face OR in the soul. It might live in the wiring of the observer's brain — any observer's brain, down to a chicken's. What we experience as "this person is beautiful" might just be our neurons doing what all neurons do: overshooting a learned category boundary. The chickens, of course, don't care about any of this. They just want their food. 🐔 (Ghirlanda, Jansson & Enquist, 2002. Human Nature, 13(3), 383-389.)

Ok. So here is an update. The car had an issue with its battery. It was within warranty. Battery was replaced, and car returned back with a new battery. Overall, the service execs were polite, responded to queries cordially, extended help in some practical matters. Yes, the roadside assistance can be fine tuned a bit, but overall, happy and satisfied with the service from #UnityMotors Kolhapur. @TataMotors @Tataev

No update as of yet from the service centre since Saturday. On enquiry they claim to be waiting for the battery report. @TataMotors @tata_cars @Tataev

Journal Of Stuff Beyond Psychiatry Vol 1: Issue 9 Jul 2026 The Equation Of Life In 1961, Frank Drake wrote an equation to guess how many alien civilisations might be out there. He could not solve it. That was never the point. The point was to take one huge question and break it into small, honest factors. Drake's Equation N = R* · f_p · n_e · f_l · f_i · f_c · L Let us steal his trick for a smaller, sadder question. Not how many aliens are out there. 𝘏𝘰𝘸 𝘮𝘢𝘯𝘺 𝘥𝘢𝘺𝘴 𝘰𝘧 𝘺𝘰𝘶𝘳 𝘳𝘦𝘴𝘪𝘥𝘦𝘯𝘤𝘺 𝘢𝘳𝘦 𝘢𝘤𝘵𝘶𝘢𝘭𝘭𝘺 𝘢𝘵 𝘩𝘢𝘯𝘥? 𝗧𝗵𝗲 𝘀𝘁𝗶𝗰𝗸𝗲𝗿 𝗽𝗿𝗶𝗰𝗲 You think you get three years. 1095 days. That is the price tag. It is not what you keep. Residency depreciates like any asset. It loses value every single day it is in use. What is left at the end is far less than the number in your head. Dev's equation D = N · f_s · f_c · f_ℓ · f_d · f_e D is the days at hand. N is 1095. Each factor is the share of days left after one kind of cut. • f_s Sundays. 52 × 3 = 156 days. (0.858) • f_c Commemorative holidays. 60 days. (0.936) • f_ℓ Allowed leave. 60 days. (0.932) • f_d DRP posting. 90 days. (0.890) • f_e Emergency posting. 30 days. (0.959) Multiply it all out: D = 1095 · 0.858 · 0.936 · 0.932 · 0.890 · 0.959 ≈ 699 About 𝟳𝟬𝟬 𝗱𝗮𝘆𝘀. That is your real residency. 𝗔 𝗳𝗮𝗶𝗿 𝗰𝗮𝘃𝗲𝗮𝘁 This is a model, not a verdict. In some branches some Sundays are working days. In some, DRP gives you the same exposure as your home unit, so nothing is lost. In others it is a different world. Run the factors for your own branch. The number will move. The lesson will not. 𝗧𝗵𝗲 𝗼𝗽𝘁𝗶𝗺𝗶𝘀𝗺 𝘁𝗿𝗮𝗽 Work each factor the lazy way, against the full 1095, and you get about 749 days. Fifty days appear from nowhere. They are not real. They are the same optimism baked into Drake’s original guesswork. And I have not even added the preparatory leave. The off the record month before the exam. If its more than a month, the number comes down to nearing 600! That's just about 57 of time% D · f_p ≈ 699 · 0.936 ≈ 654 𝗪𝗵𝗮𝘁 𝟳𝟬𝟬 𝗱𝗮𝘆𝘀 𝗺𝘂𝘀𝘁 𝗰𝗮𝗿𝗿𝘆 Most of those days go to service. Wards, OPD, on call, notes. What is left is an hour. Maybe two. Into that hour you must fit: • Study • Clinical skills. Interview, formulation, therapy. • Research • Networking • Finances • Health and exercise • Hobbies • Sleep Nine things. One or two loose hours. That is the real balance sheet. 𝗧𝗵𝗲 𝗳𝗮𝗰𝘁𝗼𝗿𝘀 𝘆𝗼𝘂 𝗮𝗰𝘁𝘂𝗮𝗹𝗹𝘆 𝗰𝗼𝗻𝘁𝗿𝗼𝗹 Everything above is done to you. But two terms are yours. f_a = the after-exam factor 𝘏𝘰𝘸 𝘮𝘶𝘤𝘩 𝘥𝘪𝘥 𝘺𝘰𝘶 𝘭𝘦𝘢𝘷𝘦 𝘵𝘰 𝘣𝘦 𝘭𝘦𝘢𝘳𝘯𝘵 𝘢𝘧𝘵𝘦𝘳 𝘵𝘩𝘦 𝘦𝘹𝘢𝘮? f_p = the prep-leave factor 𝘏𝘰𝘸 𝘮𝘶𝘤𝘩 𝘱𝘳𝘦𝘱 𝘭𝘦𝘢𝘷𝘦 𝘸𝘪𝘭𝘭 𝘺𝘰𝘶 𝘵𝘢𝘬𝘦, 𝘢𝘯𝘥 𝘩𝘰𝘸 𝘸𝘪𝘭𝘭 𝘺𝘰𝘶 𝘴𝘱𝘦𝘯𝘥 𝘪𝘵? Residents drive f_a down without noticing. 𝘐 𝘸𝘪𝘭𝘭 𝘳𝘦𝘢𝘥 𝘢𝘧𝘵𝘦𝘳 𝘵𝘩𝘦 𝘦𝘹𝘢𝘮. 𝘐 𝘸𝘪𝘭𝘭 𝘴𝘵𝘢𝘳𝘵 𝘵𝘩𝘦𝘳𝘢𝘱𝘺 𝘵𝘳𝘢𝘪𝘯𝘪𝘯𝘨 𝘢𝘧𝘵𝘦𝘳 𝘵𝘩𝘦 𝘦𝘹𝘢𝘮. 𝘐 𝘸𝘪𝘭𝘭 𝘧𝘪𝘹 𝘮𝘺 𝘴𝘭𝘦𝘦𝘱 𝘢𝘧𝘵𝘦𝘳 𝘵𝘩𝘦 𝘦𝘹𝘢𝘮. The after-exam self becomes a storage locker for everything inconvenient. It feels responsible. It is not. It is deferral in a nice shirt. You already know this move. You see it in clinic every day. The drinker who will stop after the wedding. The one with diabetes, postponing exercise for tomorrow. 𝗪𝗵𝘆 𝗶𝘁 𝗯𝗶𝘁𝗲𝘀 𝗵𝗮𝗿𝗱𝗲𝗿 𝗶𝗻 𝗽𝘀𝘆𝗰𝗵𝗶𝗮𝘁𝗿𝘆 In many branches, after the exam is a real place. A fellowship. A super speciality. More structured training, with teachers and a plan. So 𝘐 𝘸𝘪𝘭𝘭 𝘭𝘦𝘢𝘳𝘯 𝘪𝘵 𝘭𝘢𝘵𝘦𝘳 is not fully wrong. Psychiatry does not have that, at least not yet. For now it is an 𝘦𝘯𝘥 𝘣𝘳𝘢𝘯𝘤𝘩. You finish your MD, and that may be the last formal training you get. So whatever you skip in these three years, you skip for good. And these are slow skills. The alliance. The interview. A good formulation. They grow only with daily practice. You cannot cram them in the last month. 𝗪𝗵𝘆 𝗶𝘁 𝗺𝗮𝘁𝘁𝗲𝗿𝘀 Life after residency is harder than residency, not easier. In training, someone is always above you. A unit head. A teacher. The day you finish, that stops. The staff, the patients and the caregivers now look straight at you. The final exam is not the end of the journey. It is the start. Everything you planned to learn after the exam is exactly what the next 30 years will ask of you from day one. This is not a sermon on hard work. This is not a lecture on working 24x7 hours. Its about being smart, being pragmatic and being honest to yourself. It is a look at the arithmetic. How much time do you really have to learn to manage all this? Less than you think. 𝗪𝗵𝗮𝘁 𝘁𝗼 𝗱𝗼 𝟭. 𝗙𝗶𝗻𝗱 𝘆𝗼𝘂𝗿 𝘄𝗲𝗮𝗸 𝘀𝗽𝗼𝘁𝘀. Be honest. For most of us it is one or two of these: • Networking • Stage fright • Communication • One particular skill you keep avoiding • Fitness 𝟮. 𝗣𝘂𝘀𝗵 𝘁𝗵𝗮𝘁 𝗯𝗼𝘂𝗻𝗱𝗮𝗿𝘆 𝗻𝗼𝘄, 𝘄𝗵𝗶𝗹𝗲 𝘁𝗵𝗲𝗿𝗲 𝗶𝘀 𝗮 𝗻𝗲𝘁 𝗯𝗲𝗹𝗼𝘄 𝘆𝗼𝘂. Residency is the one time you can fail small. A senior is watching. A teacher will step in. The day you become a consultant, the net is gone, and the fall is real. 𝗧𝗵𝗲 𝗯𝗼𝘁𝘁𝗼𝗺 𝗹𝗶𝗻𝗲 Set your factors high and you walk out with a trained asset. Set them low and you walk out with the salvage value. Same equation. Same numbers. A completely different closing balance. Stop crediting the after-exam self. It may not be coming to save you. Pay yourself today. #Psychiatry #PsychTwitter #Neurotwitter #MedTwitter

The Best Burger In New York: How Marshal Met His Favourite Burger. The Journal of Stuff Beyond Psychiatry| Volume 1: Issue 8. June 2026 We keep asking the same thing. What is the best? Best college, best fund, best batter, best phone. We trust the ranking. Then we get burned. Here is the problem. 𝗘𝘃𝗲𝗿𝘆 𝗿𝗮𝗻𝗸𝗶𝗻𝗴 𝗶𝘀 𝗮 𝗽𝗶𝗰𝘁𝘂𝗿𝗲 𝗼𝗳 𝘁𝗵𝗲 𝗽𝗮𝘀𝘁. The best college this year is built on last year's results. A teacher who joined ten years ago. A name that took thirty years to build. But we use that old picture to pick for the future. And the future is not the past. The manager has left. The batter is thirty-four now, not twenty-six. We buy the name. We get something else. The ranking was true once. It is just not true now. 𝗠𝗮𝗿𝘀𝗵𝗮𝗹𝗹: 𝘁𝗵𝗲 𝗯𝘂𝗿𝗴𝗲𝗿 𝘁𝗵𝗮𝘁 𝘄𝗮𝘀 𝗻𝗲𝘃𝗲𝗿 𝗮𝗯𝗼𝘂𝘁 𝘁𝗵𝗲 𝗯𝘂𝗿𝗴𝗲𝗿 In 𝘏𝘰𝘸 𝘐 𝘔𝘦𝘵 𝘠𝘰𝘶𝘳 𝘔𝘰𝘵𝘩𝘦𝘳, Marshall spends a whole episode chasing one burger. Years before, he was new in the city. Broke. Soaked. Miserable. He ate a burger and it lifted him. He still talks about it like a holy moment. So the friends go hunting. Here is the part people forget. Everyone else is happy. The burgers are good. Marshall keeps shaking his head. 𝘕𝘰𝘵 𝘵𝘩𝘦 𝘰𝘯𝘦. For him it was never the meat. It was the moment. The story. Everyone else was eating a burger. Marshall was eating a memory. That is the trap. We tie a story to a thing. Then we call the 𝘵𝘩𝘪𝘯𝘨 the best. Then we send other people to go get it. But the story does not come with it. 𝗥𝗼𝗯𝗶𝗻: 𝘁𝗵𝗲 𝗯𝘂𝗿𝗴𝗲𝗿 𝘁𝗵𝗮𝘁 𝘄𝗮𝘀 𝗼𝗻𝗹𝘆 𝗮𝗯𝗼𝘂𝘁 𝘁𝗵𝗲 𝗵𝘂𝗻𝗴𝗲𝗿 Robin shows the other side. She has not eaten all day. She is starving. Hand her a burger at the first stop and she calls it the best in New York. Not because it is special. Because she is starving. Her hunger does the work. The food takes the credit. You do this too: A friend job-hunts for eight months, takes the first decent offer, calls it the perfect job. A student keeps searching for the best college, best tuition, best textbook. 𝗪𝗵𝘆 "𝗯𝗲𝘀𝘁" 𝗱𝗿𝗶𝗳𝘁𝘀 Last year's best rarely stays the best. It is not bad luck. Most top results ride a lucky run. Take away the luck and the next result drops back toward average. This is called 𝘳𝘦𝘨𝘳𝘦𝘴𝘴𝘪𝘰𝘯 𝘵𝘰 𝘵𝘩𝘦 𝘮𝘦𝘢𝘯. We only see the winners. The lists are built from the funds that survived and the players who stayed fit. The failures dropped out first. So the list looks safer than it is. People change, so the rankings change. Betting on today's number one is betting that lightning strikes twice. 𝗟𝗼𝗼𝗸 𝗮𝘁 𝘁𝗵𝗲 𝗪𝗼𝗿𝗹𝗱 𝗖𝘂𝗽 A team wins. They are the best in the world. Four years later the next World Cup comes. You expect them to do well. They usually do not. 1998 France → out in the group stage, no goal 2002 Brazil → quarter-finals 2006 Italy → group stage, bottom 2010 Spain → group stage 2014 Germany → group stage, bottom 2018 France → reached the final, lost it 2022 Argentina → defending the title in 2026 Four of the six winners before 2022 went out in the first round next time. The trophy was real. It was just a photo of one moment. It is never the place. It is always the person We crown the institution when the thing we loved was a person standing inside it for a while. The team was a captain who got transferred. Nameplates stay. People walk. There is an old idea in 𝘏𝘢𝘳𝘳𝘺 𝘗𝘰𝘵𝘵𝘦𝘳. Ollivander never sells you the best wand on the shelf. The wand chooses the wizard. What matters is the match between this wand and this hand. 𝘛𝘩𝘦 𝘣𝘦𝘴𝘵 𝘵𝘩𝘪𝘯𝘨 𝘪𝘯 𝘨𝘦𝘯𝘦𝘳𝘢𝘭 𝘪𝘴 𝘳𝘢𝘳𝘦𝘭𝘺 𝘵𝘩𝘦 𝘣𝘦𝘴𝘵 𝘵𝘩𝘪𝘯𝘨 𝘧𝘰𝘳 𝘺𝘰𝘶. 𝘍𝘪𝘵 𝘣𝘦𝘢𝘵𝘴 𝘳𝘢𝘯𝘬. 𝗜𝗳 𝗻𝗼𝘁 𝗯𝗲𝘀𝘁, 𝘁𝗵𝗲𝗻 𝘄𝗵𝗮𝘁? If chasing the best is a trap, do we settle for mediocre? No. There is a third option. 𝗖𝗼𝗻𝘀𝗶𝘀𝘁𝗲𝗻𝗰𝘆. Not the highest score once. A good score, again and again. 𝗣𝗲𝗿𝗳𝗼𝗿𝗺𝗮𝗻𝗰𝗲 → the batter who makes fifty nearly every innings, not the one who hammers a once-in-a-career 150 then ducks out 𝗦𝘁𝗮𝗯𝗶𝗹𝗶𝘁𝘆 → the job, the fund, the home that holds up in a bad year 𝗪𝗼𝗿𝗸 → good work done again and again beats one brilliant thing every few years; trust compounds 𝗤𝘂𝗮𝗹𝗶𝘁𝘆 𝗼𝗳 𝗹𝗶𝗳𝗲 → chasing the best is exhausting; the hunt has a price, and the price is the life you skip while you hunt The opposite of best was never worst. It is 𝘥𝘦𝘱𝘦𝘯𝘥𝘢𝘣𝘭𝘦. 𝗖𝗵𝗼𝗼𝘀𝗶𝗻𝗴 𝘁𝗵𝗲 𝗯𝗲𝘀𝘁, 𝗼𝗿 𝗱𝗼𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝗯𝗲𝘀𝘁? The fix hides inside the word. "Best" does two jobs. 𝗖𝗵𝗼𝗼𝘀𝗶𝗻𝗴 the best is picking off a shelf. You scan rankings. You grab the top one. It is passive. It is the whole trap. 𝗗𝗼𝗶𝗻𝗴 your best is effort. It is yours. No ranking can hand it to you or take it away. So here is the swap. Stop trying to 𝘤𝘩𝘰𝘰𝘴𝘦 the best. Start trying to 𝘥𝘰 your best, inside a place that fits. A good-enough place where you fit and work hard beats the "best" place where you don't, every time. Real mediocrity is coasting in a place you picked because a list told you to. 𝗕𝗲𝗳𝗼𝗿𝗲 𝘆𝗼𝘂 𝗰𝗮𝗹𝗹 𝗮𝗻𝘆𝘁𝗵𝗶𝗻𝗴 𝘁𝗵𝗲 𝗯𝗲𝘀𝘁, 𝗿𝘂𝗻 𝘁𝗵𝗿𝗲𝗲 𝗰𝗵𝗲𝗰𝗸𝘀 Does it lose its "best" rating the moment I change what I want? Think quality of life, work environment, distance from home. Will it still be the best a year from now? Or am I buying a peak that will not repeat? What is the real gap between the best and the rest? Is the difference 𝘴𝘵𝘢𝘵𝘪𝘴𝘵𝘪𝘤𝘢𝘭𝘭𝘺 significant, and is it 𝘤𝘭𝘪𝘯𝘪𝘤𝘢𝘭𝘭𝘺 significant? You want both. Pass all three and you have likely found something worth choosing. Fail any, and you are just reaching for the marshmallow in front of you, when waiting would have got you two. #Psychiatry, #PsychTwitter, #MedTwitter, #NeuroTwitter #HIMYM

धा धा दिं ता किट धा दिं ता तीट कत गदी गन धा! #IFYKY.

Such a cyanical take!

Journal Of Stuff Beyond Psychiatry. Vol 1; Issue 7 June 2026 TO TREAT, OR NOT TO TREAT That is the question. When Sadness Is Doing Its Job What Pixar's Inside Out teaches us about grief, sorrow, and when to step in. For most of Inside Out, Joy is trying to do something reasonable. Riley is 11. Her family moved her to a strange new city. She's sad. Joy's plan? Keep that sadness out of the way. She draws a chalk circle and tells Sadness to stand inside it. She treats a normal feeling as a fault to fix. Anyone who works in a clinic knows this pull. We're sometimes asked to be Joy. A grieving person sits in front of us. The unspoken request: ▪️ Make this stop ▪️ Give it a name ▪️ Give me something for it And the quiet question we carry: 𝗧𝗼 𝘁𝗿𝗲𝗮𝘁, 𝗼𝗿 𝗻𝗼𝘁 𝘁𝗼 𝘁𝗿𝗲𝗮𝘁. The whole film turns on Joy being wrong. By the end, Sadness does the one thing Joy could not. Sadness reaches Riley, names the loss, lets the grief be felt. That's what brings Riley home. ◆ I. WHY SORROW IS MEANT TO HURT Sorrow after a loss is not a flaw in the system. It IS the system working. We feel pain when we lose someone because the bond mattered. Think of fear. Fear of real danger isn't an illness — it keeps us safe. Grief works the same way. This matters, because treating too fast has a cost. When we treat ordinary grief as a problem to remove, we: ▪️ Take away its meaning ▪️ Cut short the work of accepting a loss ▪️ Push aside family, faith and ritual ▪️ Hand out medicine no one needed The pain was doing something. ◆ II. WHEN GRIEF STOPS DOING ITS JOB But we can't call every kind of suffering normal. Grief can break down. A loss can tip someone into true depression — and that's dangerous. The skill is not picking a side. It's telling the two apart, with the person in front of us. Look at the SHAPE, not the strength. ✦ Ordinary grief comes in waves. It rises and falls. It's centred on missing the person. Between waves: moments of warmth, even laughter. They still feel like themselves. ⚠️ The warning signs look different: ▪️ Sadness about the SELF, not the person — a steady sense of being worthless ▪️ Waves don't lift; mood is flat and constant ▪️ Stops working, eating, washing, living ▪️ Suicidal thoughts from self-hatred This grief has stopped working. ◆ III. THE NAME WE GIVE THE PAIN A diagnosis can help. It explains. It opens the door to care. It ends the fear of not knowing. But a name can also shape the person. People expect it. They treat the person as the label. Slowly, the person lives up to it. A label can be a handhold. But the same label can become a place to hide — a reason not to change. The person stops seeing a hard season they're passing through, and starts to feel like a patient for good. "This is me now," they think. And the room to move shrinks. ★ TWO QUESTIONS TO CARRY INTO THE ROOM ★ 1️⃣ Is there a biological disadvantage? Is the loss-response doing its job, or has it broken down? Pain alone doesn't decide it. Pain is often the system working. 2️⃣ Is there a therapeutic concern? Disproportion? Real impairment? Risk to life? ◆ WHAT JOY FINALLY UNDERSTOOD She didn't banish Sadness. She let it touch the controls — at the right moment, for the right reason. To treat or not to treat is rarely settled by how much someone hurts. It's settled by whether the hurt is working. It takes experience and skill to explain the difference between the two to the person in front, caregivers, family and those who bring them in out of worry and love. More often than not, the advice is not welcomed, resisted even. Joy learns that over one film. We learn it one patient at a time. — Dr. Devavrat Harshe · JSBP, Issue 3 @psychidiaries @JhunuDr #MedTwitter #PsychTwitter #NeuroTwitter

बडे म्याँव. #IFYKY

The Journal Of Stuff Beyond Psychiatry May 2026. Volume 1, Issue 2. THE GEOMETRY OF CONFIDENTIALITY Or: how a single sentence can collapse an entire profession. Psychiatrists, rather all doctors often worry about saying the wrong thing to a patient. Far fewer worry about saying the wrong thing to a journalist. That is strange. The damage from a careless media interaction is usually much larger, more permanent, and impossible to take back. ◆ ◆ ◆ Confidentiality is not just about "not revealing secrets." It is about protecting a boundary so absolute that patients can speak without calculating future consequences. The moment that boundary looks negotiable, psychiatry changes shape. A patient who fears exposure does not stop suffering. He stops speaking. ◆ ◆ ◆ A common myth: confidentiality is breached only when a doctor names a patient. False. You can breach it without naming anyone. ▪️ "An actor I treated..." ▪️ "A well-known politician once told me..." ▪️ "A famous cricketer with depression..." ▪️ "A celebrity from this city..." Even hinting that someone was your patient can be a breach. Confidentiality protects not just the content of treatment, but the existence of the relationship itself. "Yes, he consulted me" is already confidential information. Many clinicians believe vagueness protects them. It does not. The media runs on triangulation. Tiny fragments become identity. Age, city, diagnosis, timeline, profession, family, hospital, one quoted sentence. Each detail narrows the circle. People become recognizable once enough narrative crumbs are scattered. Journalists know this. Audiences know this. Doctors should know it too. ◆ ◆ ◆ The performance of proximity. There is another temptation. Some doctors subtly signal closeness to powerful people to borrow their prestige. "I cannot disclose names, but many celebrities consult psychiatrists." This is usually dressed up as awareness-building. Often it is advertising wearing ethical clothing. The doctor looks trustworthy while hinting at access to important people. A strange contradiction: "Trust me because I keep secrets. Here is a small sample of the secrets I keep." ◆ ◆ ◆ The safest principle is surprisingly simple. ▪️ Never discuss identifiable patients. ▪️ Never confirm or deny relationships. ▪️ Never offer "off the record" anecdotes you would hate to see on tomorrow's front page. Because they might. ◆ ◆ ◆ This matters most after suicides, crimes, celebrity deaths, divorces, addictions, or public controversies. The media urgently wants psychiatric interpretation. A psychiatrist is suddenly expected to be translator, profiler, and moral narrator all at once. That pressure produces some of the worst ethics in medicine. Doctors speculate on diagnoses from TV interviews. Comment on medications. Discuss personality traits. Analyse people they have never met. Or worse, imply insider knowledge. Psychiatry then slowly turns from a medical discipline into entertainment commentary. The audience may enjoy it. The profession rots from it. ◆ ◆ ◆ So what should a psychiatrist actually do with the media? Speak in principles, not particulars. Disorders, not patients. Patterns, not identities. Public education, not private histories. Good media psychiatry sounds almost disappointingly general. ▪️ "What can families watch out for?" ▪️ "How does addiction affect judgement?" ▪️ "What myths exist about bipolar disorder?" ▪️ "When should someone seek help?" These educate society without sacrificing individuals. ◆ ◆ ◆ A useful test. If the patient were sitting beside you while you spoke to the media, would they feel protected? Not flattered. Protected. Because patients do not just hand over information. They hand over vulnerability, trusting it will stay contained. Confidentiality is not silence. It is containment. And once containment cracks, people stop bringing fragile things into the room. That is the real cost of careless media behaviour. Not embarrassment. Not lawsuits. Not disciplinary action. The real cost is that future patients begin editing themselves before they speak. ◆ ◆ ◆ WHEN THE MEDIA CALLS ✓ Speak in principles, not particulars. ✓ Discuss disorders, not patients. ✓ Educate the public, reduce stigma. ✓ Protect identity, always. ✓ Neither confirm nor deny relationships. ✓ Ask: would the patient beside me feel protected? ✗ Do not name or identify patients. ✗ Do not hint, imply, or allude. ✗ Do not share anecdotes or stories. ✗ Do not discuss cases from your practice. ✗ Do not speculate on the diagnosis or behaviour of anyone you have not examined. ✗ Do not share "off the record" information. ◆ Confidentiality protects not only what is said, but the fact that someone is your patient. ◆ Your duty to your patient continues outside the clinic. ◆ In the age of realtime news and social media, responsibility is continuous and public. - Dr Devavrat Harshe @psychidiaries, here you go. Sorry, I forgot to upload this one as promised earlier. #MedTwitter #PsychTwitter #Neurotwitter

ओदिशा. नावातच दिशा आहे.

The Evolution of a Liar Erikson and Piaget, explained through one boy, his imaginary cat, and a lifetime of steadily improving fiction Psychiatry loves developmental theories. Every resident memorises two of them the night before an exam. Piaget described how a child's thinking changes with age. Erikson described what each age is emotionally busy with. Both tables get forgotten the moment the exam ends, because tables do not move. Children do. So here is a trick to remember both, permanently. Pick one skill and watch it grow up across the stages. We picked lying. A good lie needs almost everything the developing brain acquires: memory, the ability to imagine, impulse control, logic, and a sense of what other people know and don't know. Meet Chintu. We will follow his lies through life, and at each stage, notice the exact new skill that upgrades the lie. ◆ ◆ ◆ Age 2: The Terrible Truth Sensorimotor · Trust vs Mistrust → Hope Chintu has eaten half a box of biscuits. Crumbs all over his face. "Chintu, did you eat the biscuits?" "Yes." Said bluntly, with an innocent smile. No lie here, because he does not yet have the skill that makes lying possible. 🔹 The skill still missing: mental representation. To lie, you have to hold two versions in your head at once, what really happened and a different version you say out loud. Chintu cannot do that yet. He has only just figured out that things still exist when they are hidden (object permanence). His mind deals only with what is right in front of him. There is no second version to offer. At this age, honesty is not a virtue. It is a hardware limitation. ◆ ◆ ◆ Age 4: The Imaginary Cat Preoperational · Initiative vs Guilt → Purpose The biscuit jar is empty. Who ate them? "The cat." The family does not own a cat. But this is real progress. A whole set of new skills just came online: 🔹 Theory of mind — He now understands that other people have their own thoughts, and that those thoughts can be wrong. Which means they can be made wrong on purpose. This is the single skill that makes lying possible at all, and it arrives around age four. 🔹 Symbolic thinking — He can now let one thing stand for another. The same skill that lets a stick become a sword in play lets him conjure a cat that does not exist. 🔹 Imagination — He can picture a scene that never happened and describe it. 🔹 Language — The lie now has a little story, not just a flat "no." 🔹 The skill still missing: logic. So nobody checks the story against reality, least of all Chintu. He has the idea of a lie but no way to keep it standing. One follow-up question knocks it over: "I didn't eat the biscuits." "Then how do you know there were biscuits?" It collapses, because he cannot yet think two steps ahead or keep his story consistent. ◆ ◆ ◆ Age 8: Evidence-Based Fiction Concrete Operational · Industry vs Inferiority → Competence Chintu sneaks chocolates from the fridge. Before anyone notices, he bins the wrappers, washes his hands, and goes back to his homework wearing the face of a boy who has been studying all evening. "I don't know who ate them." Now we are seeing planning. The new skills: 🔹 Logical, cause-and-effect thinking — His mind now follows real rules about how the world works, so his story actually holds together. 🔹 Reversibility — This is the big one. He can run a sequence backwards in his head. If I say this, she will check that, so I should deal with that first. This is the same skill that lets him solve "if 5 + 3 = 8, then 8 − 3 = 5." Here he uses it to cover his tracks before he speaks. 🔹 Second-order theory of mind — He tracks not just what you believe, but what you believe he believes. So he can perform innocence, not just claim it. The lies have become less artistic and more procedural. Successful lying, he has worked out, is mostly about managing the evidence. Parents start to miss the imaginary cat. ◆ ◆ ◆ Age 15: Strategic Communication Formal Operational · Identity vs Role Confusion → Fidelity School reports poor attendance. Father asks why he was absent. "We had project work outside school." He has screenshots. He has briefed two friends. He has prepared for the follow-up questions. Every single word is technically defensible. The new skills: 🔹 Abstract and hypothetical thinking — He can now reason about situations that have not happened yet. What does Dad already know? What might he check? How do I stay one step ahead? He plays out the whole interrogation in advance. 🔹 Hypothetico-deductive reasoning — He can start from a principle and work out the consequences. He has figured out an abstract rule: a sentence with no false words in it cannot be proven false. So he switches from inventing lies to leaving things out and saying technically true things. And here is the part that matters in clinic: much of childhood lying evolves with motives, specific to each developmental stage. In the first two stages, it is about avoiding consequences. In teenage, it is boundary-drawing. An attempt to keep a private self where an identity can be built without a parent watching. The four-year-old lied to escape consequences. The fifteen-year-old often lies to protect a self under construction. Same behaviour, different job. ◆ ◆ ◆ Age 25: The Grain of Truth Intimacy vs Isolation → Love Chintu is twenty minutes late to dinner with his fiancée. "Traffic was terrible." The traffic was fine. He left late because he was watching cricket highlights. Piaget has nothing left to add. The thinking machinery was finished in adolescence. What adulthood adds is not a new skill but better calibration. This lie has a grain of truth in it, asks her to verify nothing, and protects the relationship rather than himself. Adults eventually learn that the most believable lies are mostly true, and the most forgivable ones are mostly small. ◆ ◆ ◆ Age 45: The Educational Lie Generativity vs Stagnation → Care Chintu now has a son who is avoiding homework. "When I was your age, I always finished my homework before playing." This bears only a passing resemblance to events documented earlier in this thread. The lie is no longer self-protective. It is aimed forward in time, at a child who will one day use the exact same sentence on a child of his own. It is educational. Or so Chintu claims. Somewhere, an imaginary cat smiles. ◆ ◆ ◆ The Irony We describe child development as the steady arrival of wonderful skills. Perspective-taking gives empathy. Imagination gives creativity. Planning gives achievement. Abstract reasoning gives science. Every one of those skills also improves lying. A good lie runs on the exact same parts as healthy development: 🔹 Imagination, to invent an alternative 🔹 Theory of mind, to predict what the other person will believe 🔹 Reversibility and planning, to cover the tracks 🔹 Memory, to avoid contradicting yourself 🔹 Social skill, to make it land So children do not learn to lie despite development. They learn to lie because of it. The good news: the very same skills that allow deception also allow honesty, empathy, and real relationships. ◆ ◆ ◆ For the clinic, two quick notes: 🔹 Clumsy lying around age 3 to 4 is a milestone, not a moral emergency. It is the sign that theory of mind has arrived, right on schedule. Parents who turn up worried about a "defect" can usually be reassured. 🔹 The quality of a lie is a rough readout of thinking ability. An eight-year-old whose lies still fall apart on the first follow-up question, or who cannot lie at all, may be worth a closer look. Piaget tells you what equipment the child has. Erikson tells you what the child is building with it. Chintu, meanwhile, would like it on record that he has never lied in his life, and that this thread misquoted him. #MedTwitter #PsychTwitter #NeuroTwitter @psychidiaries

Case in point. Take a look at this pitch. xitter.cf/i/status/2063531369779…

Too much talk about good and bad pitches. Here is a different perspective. Cricket is a game where the weather and the pitch play a crucial role. Let's create a system where randomly, every team will play on say, 5 bad pitches in a season. The quality of bad pitch can be standardized, just as we select the type of pitch and depth of cracks while playing Cricket on PS4. Cricket rankings will include players' performance on Good and bad pitches, with more weight to their skills on a bad pitch. Just like an entrance exam, where solving difficult questions carry more marks and weight. Because, when one says, No 1 ranked batter, they are not just talking about number of runs, or boundaries, or averages. They should also mean skills, temperament. What say, @ICC @AMP86793444 @ABsay_ek @ajarrodkimber #cricket #ranking Image courtesy Google.

Journal Of Stuff Beyond #Psychiatry June 2026. Volume 1, Issue 5 The Ollivander Phenomenon: Choosing the Right Drug for the Right Patient, and Why the Drug Sometimes Chooses the Patient When Harry Potter first walks into Ollivanders, he expects to buy a wand the way he might buy a quill. Instead the old wandmaker tells him the relationship works the other way round. The wand senses some affinity that it alone can feel, and the wand picks him. Harry tries many wands. Most do nothing, and some make things worse. Only one gives off the warmth and the sparks of a real match. It is a useful and slightly playful image for a problem that sits close to the heart of clinical psychiatry. We talk about choosing a drug for a patient as if the choice ran one way and the patient just sat there. But even the most carefully evidence-based choice can fall flat, or do harm, in a given person, while a less obvious one can suddenly come to life. In a real sense, the drug chooses the patient too. The simile is chosen on purpose. Efficacy shown in a trial population is a statement about the average of a group, whereas the patient sitting in front of us is one particular person, with their own physiology, beliefs and temperament, all of which decide whether the match holds. We use amitriptyline as our example because it captures the problem so well. It genuinely works, yet it carries so many adverse effects that it is often the wrong wand for the wizard. The candidate molecule: amitriptyline Amitriptyline is a tricyclic antidepressant (TCA) that blocks the reuptake of both serotonin and noradrenaline. It is approved for depression in adults, but these days it is used far more often off-label: for chronic pain, diabetic and post-herpetic neuropathy, fibromyalgia, migraine prevention, irritable bowel syndrome and insomnia. Its pain-relieving and sedating effects at low doses keep it useful decades after newer drugs arrived. The trouble is that its pharmacology is far from clean. On top of the intended action on monoamines, amitriptyline also has anticholinergic, antihistaminic and alpha-adrenergic blocking effects, and together these produce its familiar list of side effects. To borrow the wandlore image, it is a powerful instrument with a temper of its own. It suits some hands and fights against others. Efficacy weighed against safety Nobody really doubts that amitriptyline works. The questions are about how well it is tolerated and how safe it is. It is no longer a first-line treatment for depression precisely because its side-effect load is heavy. Instead it tends to be kept for severe or treatment-resistant depression, or for patients who also have chronic pain or insomnia, where the sedation and pain relief become an advantage rather than a problem. The common side effects are dry mouth, blurred vision, drowsiness, dizziness, constipation, difficulty passing urine, weight change and a drop in blood pressure on standing. The more serious worries include QT prolongation and the risk of dangerous heart rhythms, which make it a poor choice for many patients with cardiac disease, and overdose can be fatal. It can bring on or worsen narrow-angle glaucoma, and like other antidepressants it can tip a vulnerable patient into mania. The American Geriatrics Society Beers Criteria specifically advise against using amitriptyline in older adults because of its strong anticholinergic load. Choosing badly: the wrong wand for the wizard Amitriptyline's problem is rarely that it does not work. The problem is giving it to the wrong person. Hand it to a frail older patient, someone with heart disease, or someone at risk of overdose, and an effective drug turns into a dangerous one. Researchers are aware of this, which is why some have run systematic, placebo-controlled meta-analyses across many indications, trying to work out how much of the anticholinergic and other adverse-event burden comes from the drug itself rather than from the underlying illness or from nocebo effects. That effort is itself a quiet admission that the side effects we pin on a molecule belong partly to the patient and the setting. When the patient shapes the side effects This is where the Ollivander image really pays off. Two patients given the very same tablet can have very different experiences. Some of that is pharmacogenetics, but a good deal of it is expectation, which can produce symptoms on its own. This is the nocebo effect: expecting harm makes the harm more likely to be felt, and existing or unrelated symptoms get blamed on the new drug. What a patient expects, including the expectations we create during consent and counselling, has a strong effect on the side effects they then notice. A clinician's own doubts about a drug can make this worse. Suggestibility and expectation Several psychological traits have been studied as predictors of how a person responds to placebo and nocebo. The evidence here is mixed and should be read with care. Traits such as optimism, empathy and suggestibility have been linked mainly to placebo responses, while pessimism, anxiety and catastrophising have been linked mainly to nocebo responses. Neuroticism is the awkward case. Some experimental work has grouped it with the placebo-linked traits, but across the wider review literature it shows up far more consistently on the nocebo side, which is the finding we return to below. The practical message is simpler than the trait lists suggest. A patient who leaves the consulting room primed to expect a dry mouth and dizziness has, in part, been handed the script for those very symptoms. Personality When the focus narrows specifically to side effects and the nocebo response, the picture becomes much clearer. In reviews of nocebo risk factors, neuroticism is the trait most consistently and positively linked with the nocebo response, with pessimism and low optimism not far behind. A recent study went a step further and described how this works. People high in neuroticism report more bodily complaints even before any treatment begins, expect more side effects beforehand, and then show a stronger nocebo response afterwards. Crucially, the link between neuroticism and that response runs partly through those prior expectations rather than being separate from them. So temperament and expectation are not two rival explanations. They are two links in the same chain, and this is the sense in which neuroticism belongs on the nocebo side. The evidence is not all one way. At least one case-control study found no clear link between neuroticism, health anxiety or common pharmacogenetic variants and self-reported trouble tolerating antidepressants, a reminder that these are tendencies rather than fixed rules. Even so, the broad weight of evidence points to something we can act on in the clinic: who the patient is helps decide whether a drug will suit them. Prescribing as matching If side effects are written jointly by the molecule and the patient, then good prescribing looks more like Ollivander's craft than a transaction at a vending machine. Three practical lessons follow. First, look at the wizard, not just the wand. Cardiac status, age, glaucoma and overdose risk are firm reasons to avoid amitriptyline, while temperament and expectation are softer factors that still sway how well it is tolerated. Second, frame expectations with care. Because the wording we use during consent can itself bring on symptoms, how we explain the risks is part of the treatment, not a neutral formality. Third, be ready to try a different wand. A poor match is information, not failure, and the right fit sometimes shows up only on the second or third attempt. Conclusion Ollivander's line, that the wand chooses the wizard, is a neat reversal of how we usually imagine authority working. Psychiatry holds the same reversal. Amitriptyline is effective, but its real safety and side-effect burden mean it is the right wand only in certain hands, and even then the patient's expectations, suggestibility and personality help decide whether the match will spark or just smoulder. Our job is not only to choose a drug. It is to recognise when a drug and a patient have chosen each other. References: Columbus C (director). Harry Potter and the Philosopher’s Stone [Sorcerer’s Stone]. Warner Bros. Pictures; 2001. Based on the novel by Rowling JK. Faasse K, Petrie KJ. The nocebo effect: patient expectations and medication side effects. Postgrad Med J. 2013 Sep;89(1055):540-6. doi: 10.1136/postgradmedj-2012-131730. Epub 2013 Jul 10. PMID: 23842213. Corsi N, Colloca L. Placebo and Nocebo Effects: The Advantage of Measuring Expectations and Psychological Factors. Front Psychol. 2017 Mar 6;8:308. doi: 10.3389/fpsyg.2017.00308. PMID: 28321201; PMCID: PMC5337503. @psychidiaries