medgremlin

I don't think this will be a conversation you will be able to have with him, but it's probably something you need to have for yourself for your own sanity. There is the adage that "your mental health is not your fault, but it is your responsibility", that I think is very applicable here. I know that the manifestations of his mental illness at this time are damaging your quality of life, but I think that you are suffering additional, semi-self-inflicted harm by internalizing any amount of responsibility for his behavior. It is a bit like intentional cognitive dissonance, but I think you would benefit from divorcing yourself of any sense of responsibility for fixing this situation.

There are some good suggestions in this thread about strategies for set cleaning times with reference images of what each room is supposed to look like, and to some extent, mild parenting techniques to get some sense of order in the house. If I were in your shoes, this is the list of things I would try to implement:

• Set deadlines for cleaning tasks

    - ("dishes must be done by PERSON by end of DAY" or "living room must be clean of personal items by 10PM every night)
  

• Make a list or a calendar on a whiteboard in the kitchen

    - (columns for days of the week with check boxes for needed tasks and written communications instead of verbal)
  

• Clear delineation of responsibilities

     - ("you make the mess, you clean it up" or "wash/put dishes in the dishwasher immediately when done using them or before bed that night")
  

(The strategy for dishes can be variable, I just feel like dishes are a good example for figuring out household responsibilities.)

Also, make it clear that his actions are harming you. It may feel dramatic, but it's true. And I think a way around the bluescreen issue is to write a letter explaining your needs and how his actions are affecting you. I would recommend hand-writing this because it will appear more personal, and be less easily dismissed. Putting it in writing makes it so that he has a physical object to refer to when his mind tries to edit out the uncomfortable thing. But still give him the letter in a conversation. I would start it with saying:

"Hey ____, I've tried to talk to you about this before, but I don't think I've been communicating with you in a way that works. There's some things going on in the house with your cleaning habits and behaviors that are really messing with me and it's putting me in a bad place mentally to have the common areas this messy all the time. I know these conversations can be really overwhelming for you, so I wrote this letter for you to read when you're ready. Please come talk to me after you've read it so we can work out some strategies to make living together more comfortable for everyone."

This is my advice from having had difficult roommates and friends that don't deal with their mental health, and from the perspective of a medical professional. I'm a medical student, but I've done a lot of work with mental health and substance use disorder patients and I always try to work with folks to find strategies that work for them to improve their quality of life. I see medications as an adjunct to building accommodations for oneself, but I always emphasize that the medications are exactly the same as medications for things like high blood pressure. For some folks, there's a physiologic dysfunction that you can't "life strategy" your way out of, and you just need to get the chemicals in your brain to behave properly so you can function.

(This ended up longer than intended, sorry for the essay)

Normally I would agree with you, but OP is living in the environment created by the roommate's symptoms. This is obviously uncontrolled or, at best, extremely poorly managed mental illness and it is not reasonable to expect OP (who is this person's roommate, not explicitly a friend, certainly not a family member, and definitely not a partner) to sacrifice their own wellbeing in deference to this person's dysfunction.

OP obviously has empathy for this person, but is clearly at the end of their rope, and your pontificating and language policing from the outside doesn't actually help OP or the roommate in any way. I work in medicine, I deal with a LOT of mental health patients, and your comment here doesn't read as any kind of advocacy for people suffering from mental illnesses, it just reads as virtue signalling or sanctimonious tone policing.

They once tried to prove that DNPs (Doctorate of Nurse Practitioner) was just as good as an MD or DO education. They did this by taking the top DNP grads from the best programs and gave them a dumbed down version of the easiest part of the medical license exam, and only 40% passed it.

For context, to get a medical license, a physician has to have passed Steps 1-3 of the USMLE (US Medical License Exam) or Levels 1-3 of COMLEX (Comprehensive Osteopathic Medical Licensing Exam) to be eligible to apply for a medical license. Step/Level 2 is usually considered the hardest one of the three, and Step/Level 3 is the longest exam (2 full days), but generally considered to be the easiest. This DNP exam took the easiest 20% of questions from Step 3 and made a half-length version of the exam....and 60% of the DNPs still failed it.

The NP/DNP education is almost entirely algorithm-based and doesn't meaningfully get into the anatomy, physiology, pathophysiology, and pharmacology that the first 2 years of medical school are devoted to. I have seen NPs miss life-threatening diagnoses because they were rare diseases that don't come up outside of those first 2 years of drinking from a firehose of textbooks in medical school. Their education just isn't long enough or in-depth enough to actually be equivalent to an MD or DO degree.

Also, MDs and DOs have almost 4000 hours of supervised medical practice where a physician is checking their work and directly observing or guiding their clinical experience before finishing medical school. Residency is, at minimum, another 8000 to 10000 hours of supervised practice in the specialties that only require 3 years of residency (it ranges from 3 to 9 years based on specialty).

NPs don't have any standardized requirements for supervised practice to get their licenses and most programs only require 1000 hours or less of shadowing where they are just observing a licensed NP practice and not actually doing anything hands-on themselves.... And they try to argue that this education is sufficient for them to be equal to physicians. There are some NPs who are amazing providers, but they're usually the ones that were bedside nurses for 10+ years before going back to school for their NP license. The newer NPs that are going straight through from their BSN without any actual experience are the really dangerous ones.

TO BE CLEAR: I love the nurses I work with and I value their work and their input immensely. I was an EMT/ER tech before med school and it's really sad when nurses are so confused when I help them clean up patients or reposition or whatever as a med student because most physicians and medical students don't stop to help the nurses clean up poop. You can always tell which physicians have never had to clean up poop before, and I try very hard not to be like them.

Actually, the problem is the number of residencies. Once you graduate from medical school, you MUST complete an accredited residency program to be able to practice independently. The number of residency programs is controlled by Congress because residencies are funded through Medicare, and the last substantial increase in the number of residencies was when they added 1000 more in the Covid Omnibus bill.

It's actually a growing crisis because more medical schools are opening and existing ones are increasing their class sizes, but the number of residencies isn't keeping pace. This means that more and more people are going to be medical graduates with no way of obtaining a medical license without a residency and therefore no way to pay off their student loans. There's a couple stories every year about medical graduates that couldn't get into residency or couldn't complete residency that end up dying by suicide, but it gets pretty effectively swept under the rug.

So we should ban every cleaning product, gasoline, diesel, basically every other fluid that goes into a car, potting soil, fertilizers, every item that can be used as a weapon, every actual weapon, and water because those can all be used to harm oneself?

Your argument here boils down to "either everything needs to be completely freely accessible to everyone with no restrictions or every substance on the planet needs to be confiscated and controlled because people could use something to harm themselves"....and I'm only exaggerating your position by a smidge.

Do you also think the FDA should stop having standards for food and drugs? After all, if people want cheaper weight loss supplements, they're way cheaper to manufacture if they're contaminated with lead and toxic substitutes for the advertised herbal ingredients.

Bleach and ammonia are cleaning chemicals that were never intended for human consumption, not OTC medications. Nicotine should be banned entirely, and ethanol needs to be heavily reined in, but again, they are not OTC medications.

Besides acetaminophen (Tylenol) which I have already addressed as being problematic in its packaging and advertising, which other OTC medications are you talking about?

Here's a list of medications that are available OTC (and not behind the pharmacy counter) that I think should be more restricted in terms of packaging, quantity limits, or accessibility (i.e. put them behind the counter with the Sudafed so they're available without a prescription, but there's a strict limit on how much you can buy.)

• Acetaminophen/Tylenol
• Diphenhydramine/Benadryl (and the "PM" version of other medications)
• NyQuil/DayQuil/Robitussin (and other cocktail medications that contain more than 2 active ingredients)
• Oxymetazoline/Afrin
• Aspirin
• Excedrin
• Ibuprofen/Naproxen/Motrin/Aleve

Among many, many others.

There's also a huge list of vitamins and supplements that shouldn't be as freely available in such high doses, and others that shouldn't be allowed at all because of safety risks. Not to mention the fact that a bunch of energy drinks out there contain enough caffeine in a single can to cross the threshold of caffeine toxicity if consumed in under an hour. (Celsius is a good example)

Absolutely report this. I was a resident assistant at a nursing home and one of the men in the memory care unit routinely made extremely inappropriate comments to female care workers when we had to clean his genitals and buttocks following accidents. He almost certainly wasn't cognitively intact enough to have capacity, but incidents like that should be reported for the protection of the workers.

Even vulnerable adults carry some responsibility for their actions unless they lack any mental/cognitive capacity whatsoever, so if the patient/client has any decisional capacity at all, they need to be held responsible for their actions against others.

I think that uneducated or gullible people deserve full bodily autonomy, even if that means bad results from their choices.

There is a difference between safety regulation and paternalism that I think you are failing to parse. As a society, we share a collective responsibility to build safeguards and fail-safes into the structures of our environment for the protection of those among us that need help. Unfettered freedom and rugged individualism with "full bodily autonomy" is a recipe for disaster.

many countries have OTC HRT and do not have significantly higher morbidity or mortality rates

And many of those countries have wildly different healthcare systems and health culture. The American population is so utterly bombarded with misinformation (including from our own government and regulatory bodies now) that I don't see phenomena or results from other countries as fully applicable to Americans. There are tons of studies about vastly different outcomes of treatments or interventions in other countries (especially Scandinavian countries) that I do not apply to my clinical practice because a lot of those results are heavily confounded by factors that the study doesn't account for like cultural diet, healthcare access, amelioration of poverty, and genetics that would skew the results into uselessness in America. So, I'd love to get a list of these countries you're talking about because if they're civilized countries with accessible healthcare, it's not even an apples to oranges comparison; more like apples to chunks of concrete.

Elsewhere in this thread I talked about a couple patients I have actually treated. One was a woman in her 60's that got mystery doses of estrogen from implanted pellets that now has to take blood thinners for the rest of her life because she got a DVT and pulmonary embolism because of the excessive estrogen. She's also at much higher risk for uterine and breast cancer too. Another was a man in his 50's that had to get coronary stents and start a pile of medications to try to mitigate his heart and liver damage from taking the doses of testosterone recommended by body building influencers. I actually care about HIPAA, so I won't be giving you any more specific information about these cases.

It really isn't the trans folks I'm worried about when it comes to HRT, but if it's freely available to trans folks, that means it's also freely available to cis folks that are more likely to do it wrong and suffer severe consequences.

I am concerned for the population at large, and unfortunately, safety regulations have to account for the lowest common denominator unless you think that uneducated or gullible people deserve to suffer. Prescriptions are a way to make sure that people are getting the medications they need in the appropriate doses for the correct indications. There's enough trouble with people hurting themselves with the medications that are already OTC. I don't think more OTCs (HRT or otherwise) are a particularly good fix for the disaster that is American healthcare.

I think you are severely underestimating how much education is actually required to fully understand how medications work and how they can interact with each other. The internet is full of quack grifters like the "Hims" and "Hers" sites that will give people unregulated compounded semaglutide (that doesn't undergo actual health inspections) to people that are likely to be seriously harmed by it because they don't do their due diligence of actually screening for comorbid conditions that could lead to serious health consequences.

I just got home from a shift at the hospital where two medical students, two resident physicians, and an attending physician couldn't find the information on how to adjust dosing for a couple of medications to prevent dangerous interactions so we had to go ask the pharmacist. She responded with more questions about the patient's clinical condition so that she could give us appropriate recommendations. If we had gotten that medication combination wrong, our patient could have easily ended up with a pulmonary embolism or a stroke.

Point being: even physicians have to phone a friend to figure out medication safety sometimes and I do not think it's reasonable to put the responsibility of medication safety on patients who don't have over a decade of study and training to know what the risks are.

On the other hand, when I've worked in emergency departments I've seen patients that have been severely harmed by medications that they got on their own. A perfect example was the man that thought he had a rare parasite from a continent he had never been to because Chat GPT told him so and it also told him that the treatment for that parasite is Ivermectin. He went and got the horse paste version from Tractor Supply and turned up in our emergency department with fulminant liver failure because he didn't know how to do the dose conversion correctly (and didn't know the safe human dosing anyways).

Your model of "total bodily autonomy" with every medication being OTC would drastically worsen the Darwinian hell caused by medical misinformation. I don't want to see my patients harmed by dangerous medications even if I wasn't the one that prescribed it.