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.

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.

That “clinical experience” can usually be fulfilled by shadowing and supervised practice like medical students and medical residents have to do isn’t actually required for NPs. Also, in most places, those 4 years of clinical practice can be as an MA or CNA, not necessarily an RN. The education and certification requirements for NPs are wildly inconsistent which I think is actually more dangerous than a standardized lower level of education.

A huge piece of a physician’s medical training is knowing what questions to ask (as well as how and when to ask) to uncover the sneaky things that aren’t apparent on the surface. For example, as a 4th year medical student, I had a patient in the ER that came in with shortness of breath, fatigue, and chest discomfort. There were a couple hints of red flags, so I asked more questions that didn’t seem like they were related at all. Was he having unintended weight changes, night sweats, or changes to his bowel movements? The answer to all three was “yes”, but he had no idea why I was asking about that when he was there for breathing problems. I had a suspicion that he was having complications from metastatic cancer, and I was right. The resident I was working with hadn’t even thought to dig into those other niggling suspicions and was more focused on cardiac and pulmonary causes of chest pain and breathing problems.

I can almost guarantee that a nurse practitioner wouldn’t have asked those questions either. I keyed into some very subtle signs on his exam which prompted me to dig deeper, but NP’s aren’t even really trained on how to get a deeper history, let alone when to do so.

As a patient, you do have the right to refuse to be treated by anyone. You may have to wait for a physician to be available, but no one can treat you without your consent and you can always ask for a provider’s title and licensure.

The AI alleviates the process of critical thinking though. I make my own review notebooks for my boards and for clinical rotations by taking the time to figure out what’s important and what I don’t know to put those things in my notebooks. I write these out by hand on paper, so I have to be judicious about what is going to actually be important, and just the process of making those priorities helps me to have a better understanding of my own deficiencies.

Making a good study guide requires critical thinking skills, and if that gets outsourced to AI, that means the critical thinking isn’t being done by the human that needs to learn that skill.

Nope. They can (and these days often do) go straight from their nursing degree to an NP program with no real work experience.

The problem is that most people don’t double check or they check a couple things then think “good enough”, and turn off the critical thinking part of their brain. That’s how lawyers ended up submitting a case brief with fake case citations. The “citations” look real enough, but to verify it, you have to go read the source yourself.

This goes for people citing studies without reading them first. There are a lot of studies that squidge the numbers around to make things look better and you have to look for things like how they parsed the data for the results and conclusions. I’ve personally made pharma reps very uncomfortable by digging into things like how they did or did not parse complications by sex (ie one complication was parsed by sex, but the other was combined)

Part of my concern is that APPs like nurse practitioners that have no supervised practice as part of their training are going to become even more poorly educated. Their curriculum is already algorithm-based, and because of the Nursing lobby pushing for more and more independence for NP’s, they have dwindling physician oversight requirements (in some places a physician only needs to audit 10% of their notes and never actually lay eyes on the patient themselves.)

Our board exams can only cover so much, so there are little things that can slip under the radar. Like I said in another comment, one of my classmates in medical school used Chat GPT to summarize the reading and it swapped the warning signs for 2 different neurological conditions, one of which is transient and can be fixed with medications, the other is one that can be lethal if not recognized quickly.

Residency training will weed some of them out, but if they never see/recognize those zebras until they show up on the autopsy, that patient still suffered for their laziness and cavalier attitude towards their education.

Medical student here. Some of my classmates did the same thing with summaries and study guides and it scrambled a couple of fine but extremely important details. The mistake meant that my classmate mixed up two presentations of neurological problems, one of which is transient and fixable with medications and the other is something that can rapidly become lethal if not recognized fast enough.

RT’s are precious resources for physicians, but the stakes for us fucking up are profoundly higher. (And if the RT does something wrong and the patient suffers harm, it’s still likely to land on the physician to some extent in terms of liability.)

The problem is that the largest voting bloc is the Baby Boomers and they’re just electing their peers because they refuse to recognize that they’re old enough that they should have passed that baton about 20 years ago. Not that Gen X would be substantially better given their demographic’s track record and history of lead poisoning during developmental periods, but it would at least be a slight nudge in the right direction. It’s going to be decades before the Millenials and younger have enough votes to overcome the older, more conservative blocs, but that’s not accounting for the proportion of younger people that have been entirely brainwashed by monsters like Kirk, Tate, and Fuentes.

I’m absolutely not advocating for removing that option. However, increasing the options for male birth control is necessary for a wide variety of reasons, including allowing male partners to take the burden off of their female partner if she isn’t able to tolerate the side effects or can’t find a birth control method that actually works well for her. It is, in effect, another birth control option for women to be able to defer some responsibility to a male partner in a committed relationship.

It’s not a great option for more casual encounters or early in relationships, but for established couples that already have children and don’t want more or are in a committed, trusting relationship, male birth control opens the possibility for the male partner to ease the burden of birth control effort and side effects.

Vasectomies are a great option, but there are a lot of folks who don’t want a permanent birth control so they won’t get a vasectomy.

Women and girls end up with suicidal ideation all the time when going through the trial and error process of finding the right hormone combination. There’s dozens of different formulations of hormonal contraceptive pills and it can be extremely difficult to find the one that will work for you with the least amount of side effects.

The suicidal ideation is so common that it just gets lumped into the fast-forward list of side effects alongside the potential for life-threatening blood clots and other things.

I think men should consider the potential harms to their partner in their calculus. If a man participates in causing a pregnancy that results in serious complications or death, I would sincerely hope that he would be as devastated by the loss of his partner as he would by suffering the harm himself. If men can’t empathize with their partner enough to consider the risks to her, then he shouldn’t be having sex in the first place.