Dominic Corva

Zomian

[Sam Hall @samhall404]

As someone who is critical of psychiatry yet can still acknowledge its benefits and who supports reform, here are ten ironies within psychiatry that, once noticed, are difficult to ignore:

1. Those whom the profession long dismissed as “fringe extremists” and “anti psychiatry” were, in reality, mostly patients bearing the brunt of iatrogenic harm. Today, these voices, grounded in lived experience, mechanistic pharmacology and mounting evidence, have become some of the most coherent and influential in the discourse. Meanwhile, the genuine ideological extremists are increasingly those who continue to defend an outdated “safe and effective” biological psychiatry with reflexive certainty. They are anti-patient.

2. Drugs promoted for decades as correcting a mythical “chemical imbalance” have instead induced genuine chemical changes across bodily systems, frequently leaving patients in states of dysregulation more severe and persistent than their pre treatment condition.

3. Clinicians who spent years minimising withdrawal syndromes, pathologising patient testimony and accusing critics of bias are now quietly positioning themselves as pioneers of deprescribing. The very architects and defenders of the problem are rebranding themselves as its enlightened reformers.

4. A medical discipline that claims to combat stigma has generated one of the most insidious modern stigmas by transforming previously healthy individuals into lifelong psychiatric patients through iatrogenic dependence, then retroactively framing their drug induced suffering as evidence of an underlying “chronic brain disease.”

5. Self proclaimed experts in suicide prevention publicly question the necessity of black box warnings on SSRIs, while simultaneously appearing to misunderstand or trivialise akathisia, one of the most consistently documented pharmacologically induced pathways to acute suicidality and agitation.

6. A field that repeatedly invokes the mantle of “evidence based medicine” has relied for decades on short term, industry dominated trials while marginalising long term observational data and patient reported outcomes that challenged the dominant paradigm.

7. Psychiatry insists it is a legitimate medical specialty equivalent to cardiology or oncology, yet it reacts with disproportionate hostility when subjected to the same standards of rigorous post marketing surveillance, long term harm assessment and transparent risk benefit analysis expected in other branches of medicine.

8. The profession that most vocally claims to treat “brain diseases” becomes most defensive and dismissive precisely when patients report clear brain/neurological injury resulting from its pharmacological interventions.

9. Concepts like “insight” and “denial” are central to psychiatric diagnostics, yet the field itself displays profound institutional denial regarding the scale of iatrogenic harm and the limitations of its core disease model.

10. Psychiatry champions the biopsychosocial model in theory, while operating almost exclusively within a reductionist biomedical framework in practice, then expresses bewilderment when patients and critics point out the resulting epistemic distortions.

[William Pannapacker @pannapacker]

To become an academic dean, now, two things are required: below-average intelligence and a dark-triad personality disorder.

[UK HE News @HigherEd_UK]

The managers of universities have absolutely no interest in the future of those universities.

They cut costs now wherever they can justify to kick the bankruptcy can down the road until they have another grift lined up.

[Dr. Jacob W. Wood @traditionwisdom]

The moment when the Canvas hackers got to the first batch of professor-student messages, thinking they’d hit gold, only to read 65,000 iterations of:

“It’s on the syllabus.”

[Paul Stevens 🥀💚 @paul_d_stevens]

“Once the university becomes primarily a credentialing and career-placement machine, every discipline has to justify itself by enrollment, revenue, ideology, or immediate utility.”

[Sam Hall @samhall404]

For the first time in the history of modern antidepressants, psychiatry and the pharmaceutical industry have lost control of the dominant narrative.

The long standing consensus, anchored in claims of dangerous and unscientific favourable risk benefit profiles, negligible withdrawal liability and the reflexive assertion that symptoms of withdrawal syndromes merely represent relapse of the underlying disorder, is now fracturing. Decades of accumulated evidence on neuroadaptation increasingly align with thousands of patient reports of protracted withdrawal syndromes, delayed onset symptoms, kindling and persistent post SSRI sexual dysfunction (PSSD). These phenomena were systematically minimised, pathologised as “underlying illness” or dismissed as anecdotal for years.

This represents a profound epistemic rupture. For over three decades, the profession maintained near hegemonic authority over the interpretation of clinical data, trial design (where withdrawal was rarely a primary outcome) and the framing of adverse effects. That monopoly is visibly disintegrating as high visibility accounts disseminate mechanistic explanations and lived experience data that the old paradigm could no longer suppress.

The gatekeepers’ standard responses, labelling critics as “anti psychiatry,” invoking Scientology guilt by association, labelling as “pill shamers”or issuing ‘reassuring’ guidelines without addressing the full spectrum of neurobiological evidence and patient experience, are losing their potency. Go to the accounts of any of the well known biological psychiatry defenders and iatrogenic harm minimisers, @ompsychiatrist, @ProfRobHoward , @tylerblack32, @DrAnnieHickox , @JRBneuropsiq, @AhmadRehanKhan, @pash22, @mgoldingmd, @patmcgorry, @jonathanstea, @m_aadil and others, and you’ll witness a live action scramble unfolding in real time.

It would almost be fascinating if it weren’t so disturbing. This is exactly how psychiatry has been able to inflict incomprehensible levels of harm for decades: a coordinated mix of denial, deflection, patient/critic smearing and institutional self protection, all while the human cost continues to mount.

History is rarely kind to medical establishments and clinicians that prioritise institutional self preservation and pharmacological optimism over rigorous accounting of iatrogenic harm. The old paradigm is cracking, and no amount of rhetorical deflection can restore the former consensus.

[William Pannapacker @pannapacker]

The ethical norms for academic administrators are a leftover of the era when exceptional faculty members led institutions.

[Laura Delano @LauraDelano]

We are living through a medicalization crisis that is reshaping how we understand ourselves and our lives.

As a culture, we have normalized interpreting ordinary human experiences through a medical lens, often without recognizing what it costs us.

I know how easy it is to internalize that framework because I once believed that medical authority meant someone else understood me better than I understood myself.

I trusted that expertise extended not only to treatment, but to defining my own mind, body, and experience.

When something did not improve, I did not question the model guiding my care.
I assumed the problem was me, which led to new diagnoses, additional therapy, and more prescriptions.

This is how the vicious cycle of medicalization takes hold: a closed-loop system that continually redirects both patients and clinicians back into the same explanatory framework.

Once inside that framework, you start to lose touch with all the other ways to understand yourself and your experiences.

Many people don’t even recognize this is happening at all, because they’ve been taught that questioning medical authority is irrational or even dangerous.
It makes sense that, for them, stories like mine feel uncomfortable because they challenge these fundamental assumptions many people have long relied on.

But acknowledging the harms of medicalization is not the same as rejecting medicine entirely.

Medical interventions save lives and remain essential in countless situations, but not every human experience requires a diagnosis or a pharmaceutical response.

I feel our culture awakening to all the ways that medicalizing emotional pain and pharmaceuticalizing all responses to it have done us a collective disservice. A tipping point is coming. Can you feel it?

@DrJosefWD

[Dominic Corva @CorvaDr]

kinda feel like somehow Catch 22 the novel isn't getting the retrospective or attention it deserves right now.

[sentient bloomberg terminal @kayrosso1]

If you’ve been to one organized by the usual orgs you see pretty quickly why that mode has died off. Why stand around for hours listening to bad speeches from an alphabet soup of orgs and then march around in a pre-ordained route buttressed by cops?

[Dominic Corva @CorvaDr]

@OglesbyPat @anandastrategy I prefer this term to "black market" or "illicit." Of which there is very little in WA anymore.

[Dominic Corva @CorvaDr]

@OglesbyPat @anandastrategy yes -- despite high taxes, and imo because the cost of producing unregulated indoor weed which WA cities have generally consumed is higher than one can sell it for especially with higher energy prices.

[Peter Girnus 🦅 @gothburz]

I placed $1.5 billion in futures at 6:50 AM.

Fourteen minutes before President Trump's Truth Social post. That's generous. Usually, I get five.

The S&P was barely breathing. Premarket Monday. The kind of quiet where a single order echoes through the entire book. I bought $1.5 billion in futures. The index moved 0.3% on my entry alone.

That's how thin the market was.

That's how empty the room was.

At the same time, I shorted $192 million in crude oil.

Then I sat there. Three screens. One coffee. The futures blinking green on the left, the oil contract bleeding red on the right, and in the center, a Truth Social feed set to refresh every four seconds. Fourteen minutes is a long time when you know what's coming.

Not because I was nervous.

Because I was early.

At 7:04 AM, the president posted. Productive discussions. Five-day halt on strikes. Peace talks with Iran.

S&P jumped 2.5%. Oil cratered 6%. My position gained $60 million before most Americans' alarm clocks went off.

Good morning.

Iran later denied that the talks ever happened. Called it fake news. The speaker of their parliament accused the president of manipulating financial markets.

The talks might not be real.

The sixty million dollars is.

The analytics accounts flagged it within the hour. "Unusual activity." "Orders 4-6x larger than anything else trading at the time."

That's their word for it. Unusual.

My word for it is Tuesday.

They always flag it. That's their function. Flagging is not investigating. Flagging is the system's way of noting that it saw something, documenting that it will do nothing, and calling that process oversight.

The actual investigation is conducted by the CFTC. The CFTC has one commissioner. Out of five seats. One.

The other four chairs are empty. Not vacant. Emptied. There is a difference. Vacant means nobody applied. Emptied means somebody decided the body responsible for policing futures markets should not have enough members to hold a vote.

That's not negligence. That's architecture.

You know what we call this pattern on the desk? TACO. Trump Always Chickens Out. Escalate on Friday, capitulate on Monday, and extract in the window between the decision and the post.

It's so reliable, we named it. We have a private Slack channel. #taco-tuesday. It updates automatically when Truth Social pushes a new geopolitical keyword.

We don't teach it as insider trading. We teach it as a market structure. New analysts learn it in their first week. By the second week, they stop flinching.

The phone rang at 6:47 AM. Three minutes before I entered the position. The call lasted ninety seconds.

Ninety seconds of context. $60 million of outcome.

You call that insider trading. I understand why. Insider trading is the word you learned. It's the crime from the movies. The whispered merger at a cocktail party. Four hundred shares of a mid-cap pharmaceutical. That gets prosecuted.

That's the version of this crime the system was built to catch.

What I do is different.

I place $1.5 billion against a war decision made in a room I have the phone number to. On a platform overseen by a commission with one member. In a market where the president's social media account is the most powerful price-setting mechanism on earth.

That's not insider trading.

That's infrastructure.

You would go to federal prison for trading on a tip from your brother-in-law. I made $60 million trading on a war. The difference is not the crime. The difference is the decimal point.

Americans paid for this war with four-dollar gas and sixteen billion in taxes. I paid for a phone call. We are not in the same economy.

Last month, $529 million was wagered on Polymarket's Iran strikes market. Six accounts pocketed $1.2 million. Deposited funds the same day. Hours before the bombs fell. One account cleared $553,000 at 17% odds, seventy-one minutes before public confirmation. He has not placed another bet since.

The president's son sits on Polymarket's advisory board. Two federal investigations into the platform were quietly dropped this year. Twelve government officials sold stocks in the weeks before the tariff crash. All of them reported the sales after the deadline.

Nobody calls any of that insider trading. They call it prediction markets. Delayed disclosures. Portfolio rebalancing. I call it the junior varsity version of what I do with futures.

An Oxford law professor called it the most far-reaching securities fraud in history. We call it the window.

Tomorrow, this will be gone. Buried under a new tariff. A new ultimatum. A new TACO. Next Monday at 6:50 AM, I will be here again. Coffee. Three screens. The phone. The ninety-second call. The fourteen-minute window.

The game isn't rigged.

Rigged implies something broke. Nothing broke. Every component is functioning exactly as specified. The one-member commission. The anonymous platforms. The four-second refresh on the Truth Social feed. The phone that rings at 6:47.

I didn't exploit a flaw in the system.

I am the system.

[Nick Maggiulli @dollarsanddata]

The last time this occurred was in the late 1920s

[Peter Girnus 🦅 @gothburz]

I am the Senior Director of Workforce Optimization.

My job is to find the minimum number of humans required before the operation visibly fails.

I want to be clear about the word visibly.

I have a spreadsheet. It has 14 columns. Revenue per FTE. Overtime ratio. Turnover velocity. Cost-per-hire. Margin contribution. There is no column for "enough." I checked. I designed the spreadsheet.

My title used to be Head of Staffing. Then it was Director of Workforce Planning. Now it is Senior Director of Workforce Optimization. The job did not change. The vocabulary changed. Optimization means fewer people. Planning means forecasting how few. Workforce means the line item between rent and software licenses.

I did not invent the model. McKinsey did. In 1994 they called it lean operations. It meant something then. Something about efficiency. Something about waste. Now it means one pharmacist filling 400 prescriptions in a 12-hour shift. That is not lean. That is a countdown.

But the model holds.

Some numbers.

Hotels had 63 workers per 100 rooms in 1995. Today it is 42.7. Profit margins hit record highs last quarter. The service complaints go to a chatbot. The chatbot was built by a team that was also downsized. They were thanked in a company-wide email.

Air traffic control. 77% of critical facilities operate below 85% staffing. New York runs at 54%. The margin between a safe landing and a near-miss is a person who has been awake for eleven hours. That is not a failure. That is capacity planning.

Nursing. 9.9% vacancy rate. 53.3% turnover. 40% intend to leave within two years. Projected shortage of 1.57 million by 2030. I do not work in healthcare. But the person who does my job at a hospital system uses the same spreadsheet. I have seen it at conferences. The columns are the same. There is no column for patients.

Here is what Harvard found. A researcher named Daniel Schneider surveyed 14,000 workers across sectors. 53% reported being always or often understaffed. He used a specific word to describe the pattern. Deliberate. Firms deliberately understaff as a cost-control strategy. He said it in a peer-reviewed journal. He said it the way a doctor says terminal. Not angry. Certain.

I have that study bookmarked. Not for the finding. For the vocabulary. Deliberate is useful. It means I can stop pretending this is accidental.

The thing about understaffing is that it compounds.

You remove 20% of the staff. The remaining 80% absorb the work. Overtime goes up. Then burnout. Then turnover. Turnover creates more vacancies. The vacancies are not filled because the budget was built around 80%. Now you are at 65%. The model still holds because the model does not measure what broke. It measures what is left.

I call this the resilience loop. My VP calls it operational excellence. There is a poster in the break room. It says Operational Excellence with a stock photo of a sunrise. I brought it back from a conference in Scottsdale. The conference was about headcount management. That is what we call the thing where you find out how many people you can remove before a regulator notices.

Market-rate attrition. That is what we call it when people quit because they are doing two jobs for one salary. It is not a problem. It is a savings. Regrettable attrition is when someone we wanted to keep leaves. But the spreadsheet does not distinguish between regrettable and market-rate. Both reduce headcount. Both improve the ratio.

Schools. 55% of districts report teacher shortages. 300,000 unfilled positions nationally. Class sizes went up. Test scores went down. The solution was a restructuring initiative. That is what you call it when you cut the positions you could not fill anyway and declare the problem solved.

Grocery. Self-checkout replaces 5.8 workers per installation on average. The theft rate tripled. The company hired loss prevention. That is one job replacing six, but at a lower wage, with a worse title, monitoring the machines that replaced the people. Optimization.

Pharmacy. 250,000 to 400,000 deaths per year linked to medication errors. The pharmacists say it is the volume. The volume is my spreadsheet. I do not work in pharmacy. I work in workforce optimization. But the chain is: I set the target, the target sets the shift length, the shift length sets the error rate, the error rate sets the body count. I do not set the body count. I set the target.

Someone in Topeka — a nurse, I think — once asked in a town hall why the floor was running at 60% staffing when the protocol required 85%.

My counterpart in that system said the word she used was "temporarily." The staffing was temporarily below target.

The nurse asked how long temporarily meant.

My counterpart said they appreciated her commitment to patient outcomes and invited her to a workforce challenges feedback session. That is a meeting where concerns are collected, cataloged, and stored in a shared drive that reports to the same dashboard that set the staffing target.

She stopped asking.

I have a dashboard. The Workforce Resilience Dashboard. It has a green-yellow-red system. Green means the model holds. Yellow means overtime is elevated but margins are intact. Red means a regulator has called.

We have been yellow for six years. In the dashboard meeting, I present yellow as stable. My VP presents stable as excellent. The board receives excellent. The board approves the budget. The budget funds my spreadsheet.

I once changed the threshold from 80% to 70% to keep a region green. My VP thanked me for the operational insight. That is what you call it when you move the line so the number stays on the right side. I did not fix the understaffing. I fixed the dashboard. The dashboard is what gets reported. The understaffing is what gets experienced.

I do not experience it. I have a team of four. We are fully staffed. We are the ones who decide who is not.

The model holds.

It held through the nursing crisis. It held through the air traffic controller shortage. It held through the pharmacy errors and the school closures and the hotel rooms that take 40 minutes to clean instead of 30 because there is one housekeeper per floor instead of three.

The model holds because the model does not measure suffering. It measures cost. Suffering is an externality. That is an economics term. It means someone else's spreadsheet.

I am the Senior Director of Workforce Optimization. I find the minimum number of humans required before the operation visibly fails. The gap between visibly and actually is where I work. The gap is the product. The gap is the margin. The gap is the model.

The model holds.

[Keith Orejel @keithdorejel]

Omg. This guy is fucking Herbert Hoovering us.

[Peter Girnus 🦅 @gothburz]

I should clarify a few things about our Community Ambassador program at the Obama Foundation.

It is not unpaid labor. It is a leadership development opportunity. The distinction is important. Legally, it is the only distinction.

The application is four pages. Two references required. A background check. A personal statement describing your commitment to community.

For a position that pays nothing.

We receive three hundred applications per cycle. We accept seventy-five. That is a 25% acceptance rate. Harvard's is 3.2%. We are more selective than Harvard only in the sense that Harvard pays its employees.

The training is forty hours. Conducted by senior Ambassadors. Senior Ambassadors are volunteers who completed the previous cycle and returned. They returned to train new volunteers. Without compensation. We call this the Leadership Pipeline.

The Leadership Pipeline works as follows: unpaid people train other unpaid people to do unpaid work more effectively. When they reach a level of mastery, they train the next cohort. We track this with a certification system. The certificate has my signature on it. My signature costs $740,000 a year. The certificate costs the volunteer forty hours of labor and a bus pass.

We do provide benefits.

A branded tote bag. A credential lanyard for event days. Access to a "private Ambassador portal" which is a Google Group. Priority registration for foundation events. The events are free. Priority access to something free is a benefit in the same way that being first in line for nothing is an advantage.

We also list them in the Annual Impact Report. Last year's report was two hundred and twelve pages. The volunteers appear on page 194. The architects appear on page 3. The general contractor appears on page 7. I appear on page 1.

The placement is not intentional. It reflects the order in which we value contributions.

When an Ambassador completes twelve months of service, they receive a letter of recommendation. From me. The CEO who earns $740,000 for running the organization they built for free.

I sign the letter. They frame the letter. The framing costs more than they were paid.

That is the Leadership Pipeline. That is community engagement. That is the program I designed, approved, and celebrated at an appreciation event where the only unpaid people in the room were the reason the room existed.

I am very proud of what we've built. Especially the parts we didn't pay for.

[Peter Girnus 🦅 @gothburz]

I'm the CEO of the Obama Foundation.

The Obama Presidential Center is an $850 million project in Jackson Park on the South Side of Chicago.

It will be the most expensive presidential center in American history.

We are building it with unpaid volunteers.

I need to explain what community engagement means.

Community engagement means the community provides the labor.

The volunteer program launched in March.

Seventy-five to one hundred "Community Ambassadors."

They lead tours. They organize events. They train other volunteers. They do not receive compensation.

My salary is $740,000.

The architects earned $60 million.

The general contractor earned over $200 million.

The Community Ambassadors gain experience in building community.

That is the phrase in the recruitment materials.

I approved the recruitment materials.

The median household income in the surrounding census tracts is $31,000.

The volunteers come from these tracts.

They commute to an $850 million building to work for free while the person who approved the volunteer program earns $740,000.

I am the person who approved the volunteer program.

We held a volunteer appreciation event.

The catering company was paid. The event planner was paid. The photographer was paid.

The volunteers were thanked. Thanked is not a form of compensation.

Thanked is what you receive when you are not receiving compensation.

That is community engagement.

[db @dbessner]

It’s truly narratively perfect that the American Century traced the Baby Boomer lifespan exactly

[arvo färt @arvofart]

Every week, a tech executive goes onstage to tell the world they’re deliberately making the world worse because it will make them money