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Used when describing a person who is not all there mentally, that is inept socially etc, or appears to be a bit thick. Struggles to fit into normal society, and subsequently rejected and described to people as a bit slow. May also be used lightheartedly if someone is perhaps day-dreaming and not paying attention when asked a question. Similar to, but not quite the same"a few beers short of a six-pack", or "a few screws loose."
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