#clinical data validation

[clinionplatform]

Clinical Data Validation with AI

In today’s complex clinical trial landscape, maintaining data integrity is paramount, as it underpins scientific discoveries and patient safety. With increasing data volumes and trial complexities, traditional validation methods are falling short. AI is emerging as a powerful solution in this context. The Importance of Data Validation in Clinical Trials Data validation is essential in clinical trials to ensure that collected data is accurate, consistent, complete, and reliable through rigorous checks and procedures. As trials become more complex and data-intensive, traditional methods fall short and tend to be expensive and time-consuming. AI tools enhance the efficiency and effectiveness of validation tasks, employing advanced methods to ensure that collected data is accurate, consistent, complete, and reliable.

Read More: Clinical Data Validation with AI

[drchristophedelongsblog]

The integration of artificial intelligence (AI) into medicine is profoundly transforming practices, and this raises important questions about the ability of geriatricians and general practitioners to adapt.

Here is an analysis of the issues

Growing complexity of medicine with AI

Preventive and predictive medicine

AI can analyze huge amounts of data to identify individual risks and predict disease occurrence.

This requires a deep understanding of algorithms and their interpretation.

Diagnosis

AI helps in interpreting medical images, analyzing biological data and detecting complex patterns.

This requires an ability to validate and integrate AI results into the clinical context.

Therapeutic

AI personalizes treatments based on individual patient characteristics.

This involves knowledge of AI-based therapeutic options and an ability to monitor their effectiveness.

Capacity of geriatricians and general practitioners

Continuing education

Continuing education is essential to keep physicians up to date with advances in AI and its applications in medicine.

Interdisciplinary collaboration

Collaboration with AI specialists, data scientists and other healthcare professionals is crucial for effective use of AI.

Decision support tools

AI can provide decision support tools to support physicians in interpreting data and making clinical decisions.

Specificities of geriatrics

Geriatrics, by its holistic nature, is particularly concerned with the management of multiple pathologies and fragility.

AI can be a valuable asset in synthesizing complex data and personalizing care plans.

The role of the general practitioner

The general practitioner, through regular monitoring of the patient, is on the front line to detect changes and refer to specialists.

AI can help refine its diagnosis and monitoring.

In summary

AI represents a challenge, but also an opportunity to improve the care of elderly patients.

Continuing education, interdisciplinary collaboration and the use of decision support tools are essential to enable geriatricians and general practitioners to adapt to this evolution.

General practitioners and geriatricians will have a key role in using AI as a decision-making tool.

Go further

[pharmaconnections01]

Managing Clinical Trial Data With Computer System Validation CSV

Managing Clinical Trial Data with Computer System Validation (CSV)

In the realm of clinical trials, ensuring the integrity, accuracy, and compliance of data is paramount. This is where Computer System Validation (CSV) comes into play, offering robust solutions to manage clinical trial master data effectively. CSV not only guarantees data accuracy and security but also ensures adherence to regulatory standards, optimizing the entire clinical trial process.

Understanding Computer System Validation (CSV)

Computer System Validation (CSV) is a documented process that helps ensure that both new and existing computer systems are fit for their intended use and operate in a reliable and consistent manner. For clinical trials, this means that the systems used to capture, process, and store data meet stringent regulatory requirements.

The Importance of CSV in Clinical Trials

Data Integrity: CSV ensures that the data collected and processed during clinical trials is accurate and reliable. This is crucial for making informed decisions about the safety and efficacy of new treatments.

Regulatory Compliance: Clinical trials are subject to strict regulations from bodies like the FDA and EMA. CSV ensures that all data handling systems comply with these regulations, reducing the risk of non-compliance and the associated penalties.

Data Security: Protecting sensitive patient data is a top priority in clinical trials. CSV includes measures to safeguard this data from unauthorized access, ensuring confidentiality and integrity.

Key Components of CSV in Clinical Trial Data Management

Validation Planning: This involves creating a detailed plan outlining the validation process, including objectives, scope, and responsibilities. A well-structured plan is the foundation of successful CSV implementation.

Requirement Specifications: Defining user and functional requirements is critical. These specifications serve as a benchmark to ensure that the system meets all necessary criteria.

Risk Assessment: Identifying and assessing risks associated with the system helps in prioritizing validation activities and implementing appropriate controls to mitigate these risks.

Testing and Documentation: Thorough testing is conducted to verify that the system functions as intended. All tests and results are meticulously documented to provide evidence of compliance.

Ongoing Monitoring and Maintenance: CSV is not a one-time activity. Continuous monitoring and periodic re-validation are essential to ensure that the system remains compliant and performs optimally over time.

Benefits of CSV in Clinical Trial Data Management

Enhanced Data Quality: With CSV, data is consistently accurate and reliable, which is crucial for the validity of clinical trial results.

Improved Efficiency: Automated systems validated through CSV streamline data management processes, reducing manual errors and saving time.

Regulatory Readiness: Systems that undergo CSV are always prepared for regulatory audits, ensuring smooth and compliant operations.

Increased Confidence: Stakeholders, including regulatory bodies, sponsors, and patients, have greater confidence in the trial outcomes when data is managed through validated systems.

Implementing CSV for Successful Clinical Trials

To successfully implement CSV in clinical trials, organizations should:

Develop a Comprehensive CSV Strategy: This should include a clear plan, defined roles and responsibilities, and a focus on continuous improvement.

Invest in Training and Resources: Ensure that all team members involved in the validation process are well-trained and have access to the necessary resources.

Leverage Technology: Utilize advanced validation tools and software to streamline the CSV process and enhance accuracy.

Engage with Experts: Collaborate with CSV experts to ensure that all aspects of the validation process are thoroughly addressed.

By embracing Computer System Validation, clinical trial organizations can ensure the integrity, security, and compliance of their data, ultimately supporting the success of their trials and the advancement of medical research.

[batmanisagatewaydrug]

i have asked this before on a different page and i CANNOT get an answer but can someone pls explain how porn addiction isn’t real??

like we had someone during sex ed in school bring it up as a topic and explain that (primarily a penis haver) you can train your brain to only be able to get hard/cum to porn and not be able to with a real person… and like sex addiction is real? but porn addiction is not? r there people just using “porn addiction” as a reason to ban porn all together and demonize it? like is that why?

i’m sorry if this comes across ignorant in any way. i am genuinely asking and open minded about this. if u take the time to answer thank you!! 🙏🏻

hi anon,

so it's actually helpful, and interesting, that you mention sex addiction, because that's also on pretty shaky ground as an actual thing that can be meaningfully diagnosed. which isn't to say that no one in the world exhibits maladaptive sexual behaviors, of course, but whether those behaviors can be accurately characterized as addictions is actively debated. in many cases what's casually described as "sex addiction" (which includes the use of pornography) would more accurately be classified as compulsive sexual behavior disorder, or CSBD, which has much more in common with obsessive compulsive disorder than addiction. to my knowledge, CSBD is rarely treated as a primary diagnoses, but rather part of a larger pattern of compulsive behavioral issues.

put this way: in many cases, saying that someone is a "sex addict" is sort of like saying someone with OCD is "addicted to washing their hands," in that it's misrepresenting a symptom as the primary issue and misunderstanding the cause of the behavior to boot.

now, talking about CSBD gives us a great segue into something that I think is really important when discussing the validity of porn addiction, which I'll lead into with this quote:

In their study, Grubbs, et al., analyzed data from about 15 different studies by varied researchers (and reviewed many more), comprising nearly 7,000 different participants. Studies were conducted in-person and online, in the United States and Europe. The team found that, first, religiousness was a strong, clear predictor of moral incongruence regarding porn use. This is important, as it indicates that we can and should use a person’s religiousness as an indicator of the likelihood of moral conflict over porn use. Not all people who are morally opposed to porn are religious, but it appears that religiosity captures the majority of people who feel this way. Given that the WHO and ICD-11 recommend an exclusion of moral conflict over sex from the diagnosis of Compulsive Sexual Behavior Disorder, this finding suggests that when diagnosing CSBD, a person’s religiousness is a critically important factor.

put more simply: high levels of religious guilt contribute to so much self-reported "porn addiction" that it can make it hard to figure out who's experiencing actual, verifiable compulsive behavioral issues.

this quote comes from an article called "Science Stopped Believing In Porn Addiction. You Should, Too," in which the author argues that porn addiction is essentially an outmoded understanding of problematic consumption of pornography that's failing to take into account other factors, in this case the moral incongruence or sense of conflict that many people feel about viewing pornography that causes them to feel shameful, dirty, or "out of control" when the use it. it can be read here:

porn addiction is problematic as a classification for other reasons as well; Dr. Devon price elaborates very neatly on many of them here:

again, I don't point out any of this to argue that no one ever has a relationship to sex or pornography that's detrimental to them and their ability to function, only that branding that as addiction is a.) inaccurate b.) unhelpful and c.) deeply loaded in a culture that so often stigmatizes addiction as a matter of weakness and poor character rather than recognizing it for what it actually is. many people grow up in a cultural context that profoundly stigmatizes sexuality, which makes a lot of people worry that they're aberrant and dangerous for doing anything that brings them sexual pleasure. trust me, my own inbox is a testament to that; I spend an enormous amount of time reassuring people that they're allowed to partake in utterly benign sexual behavior.

your example of people training themselves to only get off with porn is actually a great example here. the simple truth is that it's possible for people to train themselves into all kinds of sexual behaviors whether porn is involved or not, because if you only get off one way then your brain and body will simply learn to associate that particular type of stimuli with sexual pleasure and have a more difficult time with anything else.

people with clits who have spent a lot of time getting off by putting a vibrator smack on their clitoris benefit hugely from taking breaks and varying their masturbation style, especially since human partners are rarely able to provide the same type of stimuli as a toy. folks who are accustomed to only getting off in one position, whether it's on their back or humping a pillow or whatever else, can struggle with orgasming in other other position. people who have spent years masturbating before having partnered sex for the first time often find that it's a difficult adjustment—and I can attest to that one personally, because I had trouble for YEARS finishing with partners and almost always had to touch myself to make it happen. you can't even accuse porn of being responsible for that, because I've never particularly enjoyed watching porn and can probably count on one hand the number of times I've used it to get off.

to your final question about whether people are just claiming the existence of porn addiction as a reason to ban it—absolutely yes, many are. if you dig a little beneath the surface you'll find very quickly that many of the most vocal and well-funded anti-porn groups are run by deeply conservative religious groups and other far right wingnuts who stand to benefit tremendously if they can a.) ban porn and then b.) define "porn" as "anything that includes any kind of depiction of sexuality that I personally think is yucky." you see this deployed frequently with challenges to books in schools and libraries and subsequent book banning, which frequently target books about sex education, books featuring information about sexual abuse, and LGBTQ+ books of all stripes as "pornographic."

tl;dr I'm certainly not arguing that nobody on earth has a bad relationship with porn, but I do think the words we use to talk about that are important and porn addiction is a largely unhelpful way to do so.

[literaryvein-reblogs]

Understanding a Scientific Article

Abstract

A brief description of the key points you will find in the paper. This can include:

Objectives: What questions the researchers hope to answer.

Methods: What type of study the researchers used to conduct the study.

Results: What the researchers discovered.

Discussion/conclusion: What the results mean and/or the author’s interpretation of the results.

Look at the date of the study.

Was it conducted in the past year? 5 years? 15 years? As new information is learned, scientific standards and techniques change, and practices evolve.

New research may support results from older studies as well as lead to new methods to diagnose and treat conditions and diseases.

New research can, at times, also contradict other research, which may require additional research to explore and resolve these differences.

Research can separate the good results from the bad results. In this way, the scientific method is self-correcting, which is reassuring.

Looking at the date can provide insight into how the study fits into the larger evidence base on a particular topic.

Methods

Detailed information on the type of research or approach used, the study’s design, the participants, the measurements or outcomes recorded, and steps taken to avoid bias.

Types of Research

Basic research: Scientists ask questions about theories or concepts, and test hypotheses to improve scientific knowledge. It’s the first step in any research.

Translational research: Researchers build on the observations and results of basic research to develop and test new ways to prevent, detect, or treat conditions and diseases.

Clinical trials: Well-planned clinical trials are done with people and may vary in size and type. Clinical trials give the clearest information about whether a treatment or a lifestyle change is effective and safe in humans. However, because they are complicated, lengthy, involve many research participants and can be very expensive, they are usually done only after smaller preliminary studies have been completed.

Systematic reviews and meta-analyses: When researchers review each other’s research to check for quality and look for converging evidence among studies, they may write systematic reviews and meta-analyses. These look at different studies on the same topic. When many studies come to the same conclusion, it helps us know that the results are reliable and valid.

While all research studies are important and contribute to our knowledge base, clinical trials are the types of studies you probably hear about most often in the news. They can have the most immediate impact on improving health and treating disease.

Results

What the study showed.

The data, summaries, and analyses of the study are presented in this section. Tables, graphs, and charts that show the results are often included.

To better understand the results, you can ask these questions:

How do these results compare with previous studies?

A single study rarely provides a final, definitive answer.

Repeating a study using the same methods with different volunteers and investigators helps us know that the results are reliable and valid.

What do “statistically significant” and “clinically significant” mean?

Statistically significant means the differences observed between the groups are real and not likely due to chance.

Clinically significant is a measure of the size of the effects observed in the study, which shows the impact of the treatment.

A study can find statistically significant differences between two treatment groups, but the differences may be so small that they are not clinically significant in terms of usefulness for patients.

Are there potential conflicts of interest?

Did the study sponsor or the investigators have any financial or reputational "stake" in the outcome?

Most medical journal articles include information about relevant financial relationships.

Discussion

What the results mean.

This is where you can often find out how the study relates to your own health.

This section includes the authors’ explanation of, and own opinions about, what the results mean.

Since the conclusions are the authors’ own, others may or may not completely agree with their explanation of the results.

References

Previously published articles the authors used to review what related research was done before, to help design the study and interpret its results.

Source ⚜ More: Notes & References ⚜ Writing Resources PDFs

[cobbled-peach]

˗ˏˋ જ⁀➴ camisado

"can't take the kid from the fight, take the fight from the kid, sit back, relax, sit back, relapse again"

Part 1 | [Part 2]

cw: GN!reader. Pure angst for this one baby, literally zero comfort (I'll make it up to you in pt 2 xx). Talks of addiction, taking drugs, anxiety + panic attacks and withdrawl symptoms. (pls let me know if i missed something!!!). Both reader and Spencer sort of cannot communicate and are not slaying but they mean well a/n: this started as just a character study but I kinda fell into the deep end and got quite caught up in it so its inadvertantly a LOT more than just a character study, sand so I divided it up into something more cohesive. w/c: 5.4k

It’s impossible to prove a hypothesis.

You can run an experiment a thousand times, collect a thousand successful results, only to watch the 1001st experiment fail. Empirical data only takes you so far, giving the illusion of certainty. Until it doesn't.

Science deals in probabilities, assumptions – not guarantees. Spencer Reid knows this better than most.

It’s hard to pinpoint exactly when he started thinking of his addiction like a science experiment.

Maybe it was easier that way. A coping mechanism – reduction as self-defence. He could lessen the weight of it, condense something so vast and devastating into variables and charts and numbers in a feeble attempt to soften the struth. An attempt to strip it of its emotional weight and file it away under “manageable.” As if the cravings could be measured or quantified. Understood.

He frames the parameters in his mind with clinical precision. Independent variable: the drug. Dependent variable: his behavior. Control group: the version of himself from months ago, when the spiral hadn’t yet begun. Before the late nights. Before the secrets. Before the lies.

Addiction is just a problem like any other. A system which he can study, decode and master.

He creates his hypothesis: he can control it. He can use one more time, and still be fine. Each addition to his hypothesis only strengthens his willpower:

If I time it right, no one will notice. If I maintain structure, I won’t lose control. If I’m careful, my life will reman intact.

But addition doesn’t care for logic, nor does it follow the rules of scientific inquiry. It doesn’t operate within a sterile lab, patiently waiting to be measured.

There are no constants. No peer-reviewed journals to validate his pain or explain it away. There’s only the truth: the shaking in his hands, the crawling of his skin, the nausea that comes in waves, the sleepless nights that stretch into oblivion. Only the raw data of his descent: chaotic, unquantifiable and unforgiving.

The data never replicates, and the experiment keeps failing.

Again. And again. And again.

The variables start to mutate. The outcome blurs. The method falls away.

Still, he clings to the process. Records the collapse like data points, hoping objectivity will save him.

Day 6: Forgets to eat.

Day 9: Lies to Garcia about the bags under his eyes.

Day 12: The first time he brings it into the building. Doesn’t use. Just wants to know its there.

Day 16: Snaps at Prentiss mid-briefing. Doesn’t apologize.

Day 19: Blanks on a case. Morgan has to cover for him.

Day 22: Tells you it’s “just anxiety.”

Day 25: Uses before a profile. Feels sharper. Lies to himself and says it helps.

Day 28: Uses again. No excuse this time.

By now, he knows he can’t control it.

Fine. He can create a new hypothesis.

Compartmentalization. He tells himself he can seal the chaos in a box, keep the infection contained. Let the rest of his life remain untouched.

His work. His friends. You.

Especially you.

He tells himself that love and addiction can coexist, as long as they don’t overlap. As long as the two worlds remain separate. He can maintain the boundaries.

But love isn’t a constant either.

And addiction… it leaks. It slips through the cracks to taint everything it touches.

He forgets to reply to your messages. Forgets what day it is. Forgets to tune in when you speak.

He tells himself he’s tired. You tell him you’re worried. He smiles. Lies. Makes promises. You both watch as love falls into the contamination zone, becomes tangled in the variables he can’t control.

Watch as it starts to fail.

It starts like most mornings.

Spencer wakes to sunlight bleeding in through the blinds. Amber-toned light, catching dust motes in midair – it makes the room look almost serene. The sun streaks across the hardwood, illuminating coffee stains and the faded outline of where a rug used to be. Gentle, unassuming. The morning is pretending like nothing is wrong.

Outside, early traffic hums. A low, steady drone overlayed with birdsong and the sharp, impatient honk of a horn. Somewhere inside the apartment, a faucet drips in an uneven rhythm. He thinks of it like an erratic metronome, counting down time he doesn’t want to acknowledge.

He shivers. The sheets are tangled low around his legs – his doing, no doubt. He’s been tossing again. Restless, even in sleep. Maybe even more so in sleep. Dreams come with sharp edges now. Inescapable.

Your leg is resting lightly over his calf. Casual. Trusting. As if your body still believes in him, even if your mind has started to doubt.

You stir beside him, just a stretch. Your fingers graze his hand in a featherlight gesture, asking a question without a voice. He curls away in response. Rolls onto his side. Pretends to be asleep.

You don’t press. You never do. Not anymore.

You just rise, silent and soft, padding across the cool floor toward the bathroom. There’s the familiar clink of your toothbrush, a muffled yawn, the gentle hum when you finish. He used to join you for this. Brushing teeth side by side, heads bowed under the mirror light, elbows bumping and smiles shared. He always thought that was one of the most intimate things a couple could do – a quiet, unspoken routine shared between two people.

Today, he just stays in bed, weighted by guilt. Anchored to the mattress, hoping it’ll keep him from drifting. The drug is still in his system, softening the world and smoothing the edges that keep cutting him open.

You move to the kitchen next. Cupboards creak and mugs clink. The coffee machine whirs, beginning its little dance. The scent of coffee reaches him moments later. Overly sweet – his favorite. You always remember. He never asks.

He pushes himself upright, legs over the edge of the bed and feet meeting the cold floorboards. He imagines walking into the kitchen with you. Imagines wrapping his arms around your waist and resting his chin on your shoulder the way he used to. Imagines you leaning into him, whispering a song under your breath.

Instead, he stays where he is. Elbows on knees, head in hands. The light seems colder now that he’s facing it directly. Less gold, more white-blue. Less morning, more mourning.

He strains to hear you. The soft thud of your footsteps, the sound of cups and cabinets, your soft breath. The peaceful repetition of a ritual he used to be a part of, but now avoids and observes from afar.

Spencer wishes you would hate him. It would make things simpler. Cleaner. He wishes you’d scream, or cry, or slam the door and tell him to go to hell. Wishes you’d throw a mug just to watch it shatter.

But you don’t. You never do. You just remain; quiet and present.

Hopeful, maybe. Or resigned.

Last night had been bad.

The tremors came again, starting in his fingers and crawling up his hands and arms like static. He blamed the case. Said he felt “off.” The lie came so easily, as they all did lately. He crawled into bed, trying not to vomit or shake the mattress.

You didn’t say a word. You left a glass of water o the nightstand. Crawled in beside him. Pressed a kiss to his shoulder. The gesture broke him a little more.

He could hear the unspoken questions, the palpable worry in your body despite you saying nothing.

But what help can you offer someone who won’t accept it? How can you save a man who insists he isn’t struggling?

His mind feels quiet now, though. Usually spinning in overlapping questions and unrelenting memory, it’s finally still. False peace. A chemical silence.

He tells himself that his planned retreat is love. Letting you go before he destroys you completely.

He’s rehearsed it in his mind like a script. Over and over. A breakup: surgical and precise, a clean and final incision.

Version one: He says, “I can’t do this. It’s not your fault.” You cry quietly. Nod. Let him leave. He walks away without looking back.

Version two: You already know. You’ve known he was planning this for weeks. You tell him it’s okay. That you understand. That you love him. He ends up on the floor, sobbing. Can’t let go. Doesn’t leave. Prolongs the pain even more.

Version three: You scream. You throw something – maybe a glass. You call him a coward. He welcomes it, embraces the heat. It makes him feel real. Makes the leaving easier. Makes him feel like he isn’t the only villain in the story.

He’s practiced every scenario.

A thousand internal rehearsals. Different lines. Different outcomes.

Only one of them will break the cycle.

He doesn’t hear you come back in, but suddenly you’re there, setting his coffee down on the bedside table with the softest clink, like you’re trying not to wake him even though he’s already up, stiff-spined and quiet.

‘Spence?’

Your voice is thick with sleep, but still laced with warmth. It twists something deep in his chest.

He swallows. His mouth is dry, like he’s been breathing through it all night. Almost like his body is trying to cough out whatever truth he keeps trying to choke down.

‘Sorry,’ he says, though he doesn’t know what for. A pre-emptive apology, maybe. A reflex. ‘What time is it?’

‘Almost eight.’

The sheets rustle as you sit beside him. The mattress dips beneath your weight, and he feels the subtle pressure of your presence before your chin touches his shoulder. Light and familiar, just resting against him.

He flinches. Barely, but enough.

You feel it. Don’t pull away.

‘Is everything okay? Is this about the case?’

It’s not. You both know its not.

He considers lying anyway. Considers giving you numbers. He could offer up statistics about trauma and cognitive decline. Something familiar and in the realm of fact, clean and clinical and easy to categorize.

But nothing comes out.

Silence answers for him. It stretches between you, getting thinner by the second.

He counts seven seconds exactly before you shift away from him. He records it like a data point, adding it to the line in his ever-growing graph of failure.

You lean back against the headboard, wrapping your fingers around your mug. You sip it slowly. The smell of his own coffee reaches him again. Sweet and familiar. Grounded in a time before everything broke.

Your movements are careful. Each shift, every breath, calibrated around him like you’ve mapped his problems and have built your mornings around avoiding them. You’re not naturally quiet in the mornings. He knows that. You’d sing sometimes, badly and too loud, and bang drawers open without care. But now you measure each movement, minimizing the noise because you know it unsettles him when he’s wound too tight.

Another thing he hates. You adjust, without even being asked.

He joins you after a long moment, settling beside you. Not close enough to feel the warmth from your body. His eyes fall to the mug you selected for him. His mug, in your apartment. The faded yellow one, that’s more a dull cream than anything now.

He left it here by accident over a year ago, when weekends were tentatively spent in each other’s presence. Fresh and new. He remembers when he first found noticed it tucked in your cabinet between your own mismatched sets. His chest had gone still and warm.

Now it just feels like a piece of evidence. Proof that he’s infiltrated a life he doesn’t belong in. An outlier in your apartment.

He doesn’t reach for it right away. When he finally does, his hands tremble.

Your eyes flick down. That’s all it takes.

And suddenly you’re both back there. Three months ago. His apartment. Your hand wrapped around his wrist. Eyes wide with something deeper than fear. You were crying, but so softly that he almost didn’t register it. The needle had been on the counter, hidden beneath a tissue like something sacred and shameful all at once. A relic he didn’t know how to bury.

There had been begging. On both sides.

You telling him that it was dangerous. That you were scared. That he was killing himself slowly.

Him promising (over and over and over) that this was the last time. That he’d stop. That you couldn’t tell his team.

You’d desperately searched for solutions, tried to jump hurdles and find ways to help without exposing the situation to his team, to the world. You’d lost count of how many times you’d hit dead ends.

He continued with his promises. Seemed to get better for a while, but inevitably sunk down again. You wanted to believe he could get better. Maybe part of you did.

‘So,’ you say, voice softer now. It drags him back to the present like a lifeline, though he wishes he’d remain drowning. ‘You didn’t sleep?’

It’s phrased as a question, but it’s not. It’s a gentle accusation.

‘I slept some,’ he lies.

You don’t believe him. How could you? The evidence is all there. Red-rimmed eyes, sunken cheeks, a slow, syrupy fatigue that not even coffee can fix.

You nod, but your silence screams.

He sips his coffee. Too sweet. Perfect.

It tastes of normalcy. He watches the sun paint your shoulder – still cold, but warmer now it’s touching you. For a second he wants to pretend. Pretend this morning is just like any other, that he’s still the man who deserves your soft kindness.

But then you say, suddenly and very quietly:

‘I found something this morning.’

You don’t say what. You don’t need to.

He freezes. The blood drains from his face. The bathroom bin.

He’s been sloppy lately. Too tired to be cautious. Except this time it was perfectly planted. An excuse to initiate the end.

‘Do you hate me?’ he asks.

‘No.’ It’s immediate. Truthful. Your voice cracks anyway.

Your body folds in on itself, curling your arms around your knees, mug forgotten on the nightstand. Forging a shield around yourself. It makes you look smaller than usual. More fragile.

And in that shape, he sees it. Not anger. Not resentment. But heartbreak.

A slow, dull heartbreak. Bruised and tarnished. Despite it, you’re still here. Still hoping. Still loving him through the destruction.

Spencer stands abruptly. The weight pressing down on his chest has become too heavy, the consequences of his actions gaining in on him. Your apartment suddenly feels too small, Suffocating. He escapes to the kitchen, clutching his coffee mug.

‘Spence—’

You rise immediately and follow him. The way you say his name is tentative and fragile, like the first crack in a piece of glass. The first real fluctuation in his carefully controlled experiment.

He ignores you, pretending not to hear, and allows himself to be carried by the momentum of his own restlessness and panic. The ceramic of his mug feels too heavy, his nerve endings too attuned to the realness of it. When he sets it down, the sound echoes unnaturally loud. A shout in the silence.

‘Spencer.’

Your voice holds more weight this time. It’s a deliberate attempt to break through the barrier he’s created.

He exhales sharply through his nose. ‘What?’

You take a cautious step forward. Not accusing, just trying to close the ever-widening space between you.

‘Talk to me. Please.’

‘I am.’ His words are hollow as he gestures between you. ‘We’re talking.’

‘No, you’re avoiding,’ you correct, unwilling to back down. ‘I want to know what I can do for you. I can find you a new support group—’

His hands rise as he blocks out the rest of your words, pressing his palms firmly to his eyes. An attempt to press his feelings back inside. He fights the rising tide of panic and shame. Fights all the words threatening to spill out. Fights himself.

Fails.

‘I’ve tried!’ The calm snaps as his voice cracks, a sharp edge to his words that surprises even him. He pulls inward again, as if shielding himself from his own confession. It’s out in the open.

He feels sick – whether it’s the drug wearing off, or the anxiety squeezing his chest, he can’t tell.

‘I know…’ you begin, gentle, trying to reach him.

‘I tried,’ he repeats. His voice is softer. Desperate now. Raw. ‘I really did try. You think I wanted this? I don’t—’

‘Then let me in,’ you cut in, voice measured despite the frown on your face. ‘Let me help. Stop trying to get through this on your own.'

He grits his teeth. ‘I’m trying to protect you.’

‘From what? From you? You’re not the danger here, Spence. The silence is. Your lack of communication is. I don’t want to get you in trouble but you’re not leaving me with many options—’

He shakes his head. Starts pacing the kitchen like an animal in a cage. ‘You don’t get it.;

‘Then help me get it.’

‘You can’t!’ His voice cracks, and his hands tremble at his sides. He worries that he’s going to start crying. They already feel glassy, starting to sting, but he refuses to break down so early on.

‘Can’t what?’

‘You can’t understand what it’s like in my head. It’s loud. All the time. Noise and chaos and—’ His voice falters. He blinks away the building tears. ‘And I can’t get it to be quiet. The only time it’s silent is when I—’

He cuts himself off too late. The words hang in the air.

When I have it in my veins.

It’s not news. It never is. But it still hears to hear. Still lands like a punch to the gut.

You close your eyes, steading your breath and swallowing the sting of it. A moment to process, and then you exhale shakily.

‘I love you,’ you say, voice trembling. The truth, used as a mechanism to get him to see reason. A desperate attempt to pull him back to safety.

‘Don’t.’

‘What?’

‘Don’t say that right now.’

‘Why?’

‘Because it makes this harder,’ he says.

‘This?’

He doesn’t answer.

The fierceness that takes over you then is startling. Shocking even to him.

‘No.’ You straighten, and your hands ball into fists at your sides. ‘Tell me. Tell me what you mean. Because I’m so tired of trying to decipher your half-sentences and prematurely ended conversations.’

He swallows hard. The silence suffocates the two of you.

‘I think we should break up.’

The wors fall like shards of glass. Sharp. Brutal. Irrevocable.

No rehearsed sincerity. No apology. Just the brutal truth. The 1001st experiment – failing harder than he could’ve ever predicted.

‘You’re really going to do this?’ you ask, voice breaking as you stare at him like he’s morphed into a stranger in just a few seconds. ‘You’re really going to do this now?’

Behind the hurt in your expression is confusion. You don’t understand. How can he push you away when he needs you the most? When he needs the support and guidance?

He nods once. Empty. Silent. The air seems to vanish, completely sucked from the room.

‘You think walking away is protecting me?’ It comes out as a demand, bottom lip trembling so hard it’s difficult to speak. ‘That—what? Making me sit here alone, wondering what I could’ve done differently—is going to help me?’

‘It’s not about you.’

‘That’s bullshit.’ The words bite, and he feels like he’s been struck by a whip. ‘Everything you do affects me, Spencer. Every time you lie. Every time you shut me out. I’m constantly hoping you’ll throw me just a scrap of truth. Just one honest thing.’

He takes a moment to look at you. To observe the cracks in your armor, the exhaustion behind your eyes.

And he knows: he’s breaking you.

‘I’m trying to protect you,’ he repeats. His voice holds no weight now, feeling threadbare.

‘Then talk to me,’ you plead, your voice breaking around the edges. ‘Let me in. Let me be in it with you. That’s what a relationship is, Spencer.’

‘I can’t.’ His jaw tightens. ‘I don’t want you to watch me fall apart.’

‘I already am watching. I have been. For months.’

The words land like a punch. He doesn’t outwardly flinch, but you see something change behind his eyes. It’s like the breath has been knocked out of him, and he’s trying not to show it.

If he could rewind time, he would.

Five minutes – so he could stop himself from saying the words that fractured this moment.

Five weeks – so he could prevent himself from taking and erase every relapse he never told you about.

Five months – to a Monday morning where he didn’t curl away from your touch, but welcomed you against his chest with open arms.

But time isn’t a variable he can control.

So he stays frozen. Like the stillness will ground him. If he doesn’t move, maybe the moment won’t progress forward.

Your face is unreadable now. He hates that. That’s what cuts deepest, he thinks. He used to be able to read you like a book. Once, he could even name every emotion before you even spoke it aloud – guilt in the twitch of an eye, love in a half-formed smile. Now, all he sees is distance. A stranger across the room. A closed door where open windows used to be.

‘I don’t want to fight,’ he says quietly. Final.

A beat of silence.

‘So that’s it?’

‘I can’t keep pulling you under with me,’ he says it. That line is rehearsed. It comes out sounding practiced, like it’s been spoken too often in the mirror. Even so, it lands jagged and half-shattered, just like everything else he’s touched lately.

There’s no screaming. No slammed fists or doors. Just something hollow. A quiet devastation. You feel it crack open your chest, the silence louder than any argument.

You take a step back. Not from anger, but from instinct. A recoil. He watches the moment with a clenched jaw, eyes misty like he’s already halfway gone.

Maybe if he yelled, things would make more sense. Maybe if he cried, you could believe that breaking up was hurting him too. But he just stands there. Still. Detached. Resigned.

‘Breaking up…’ You say the words carefully, like it physically hurts to speak them. ‘You don’t mean it.’

‘I do.’

‘No, you don’t.’ He’s unsure if you’re trying to convince yourself or him. ‘You’re just scared.’

He shrugs. Defeated. ‘Maybe. But that doesn’t make what I’m saying untrue. I’m breaking up with you.’

‘I don’t need you to be perfect, Spencer,’ you say, stepping toward him. ‘I just need you. The you who spoke to me. The you who let me carry even a little bit of the weight.’

He shakes his head. The words fall out bitter and painful. ‘You think this—’ he gestures vaguely between you, hand faltering mid-air, ‘—is a relationship? This is a time bomb. Every relapse, every lie – I drag you with me. And I can’t keep doing that to you.’

‘You don’t get to decide what I can or can’t handle.’

‘Yes, I do,’ he says. His voice cracks under the strain and his hands tremble now. ‘Because when you look at me like I’m breaking your heart by just existing—’ He stops. Swallows hard. ‘It kills me. I’m not putting you through that again.’

You throw your hands up. Not angry, just wrecked. The tears come slow at first, before you can even realize you’re crying, like your mind is still trying to pretend things might be okay, but your body knows it’s not.

‘Stop acting like what you’re doing is noble, Spencer,’ you whisper. ‘Stop weaponizing love to justify walking away.’

‘I don’t want to hurt you.’

The silence after is deafening.

You don’t say what you’re thinking. Too late. You already have.

Instead, the two of you just stand there, not touching, not moving. The faucet drips lamely behind you. The birds continue singing outside. Oblivious, out of place – not caring that your world is falling apart.

‘Please.’

It comes from you finally. Your voice is so low it nearly disappears into the air between you. You aren’t begging. Not really. It’s something smaller than that. A final chance.

‘I don’t know how to be better,’ he admits, voice as quiet as yours. ‘I want to. I swear, I want to. But I don’t know how.’

‘Then let me help.’

You close the gap between you. A few fragile steps that feel like miles. When you stop, it’s with your heart wide open and bared. Your hands lift, almost touching him, but not quite. He leans in, forehead resting against yours.

His hands remain clenched into fists at his sides. He knows that if he touches you, really touches you, he’ll stay. And if he stays, he’ll keep breaking your heart into smaller, sharper pieces.

‘I’m sorry,’ he murmurs, tone just shy of grief. ‘I wish there was a gentle way to leave you.’

And that’s when you feel it. The subtle shift. The air in the room changing. A certain ending.

It doesn’t end with a scream. It doesn’t end with a slammed door. It ends in the space between your bodies. In barely held restraint. In the inch he keeps between your hands.

Then he steps back, and the moment breaks.

You don’t follow. He doesn’t look back.

When he leaves, you let him go.

He doesn’t slam the door, though he wishes he could.

He wishes there was a clean, decisive sound. Something loud enough to match the shattering in his chest. Something final.

But there’s only a soft click as the door eases shut behind him, the apartment trying not to wake the grief sleeping in its corners.

He stands in the hallway. Motionless. It smells faintly like burned toast and over-watered plants. A dog barks from a floor below. The banality of it – the normalcy – makes him want to scream.

He counts his steps, just to drown out everything else in his mind.

Seven to the elevator. Ten seconds down. Twenty-four more to the front door of the building. The mundanity makes him cringe. Something should be stopping him from walking out. It shouldn’t be this easy.

He catches his reflection in the glass of the door. A brief flicker. He looks away before the mirror can accuse him, before he can see the guilt in his eyes.

You’re still upstairs. Maybe on the couch. Maybe still standing where he left you. He hopes you’ve stopped crying. Knows the tears are probably still falling.

When he steps out onto the street, the morning hits him harder than expected. Too bright. Too warm. The lightness feels unfair. A child is laughing down the block. Somewhere, a child laughs. A care radio blasts a pop song. The world is still going, indifferent to how he’s feeling.

The world hasn’t ended. Not for them.

He takes a deep breath, hoping the air will ground him. Fill his lungs and center him. It doesn’t. So he walks. Not fast, and not with purpose.

He just moves, one foot in front of the other, and hopes the momentum will save him. Like distance will undo the damage.

Still no particular destination. Work, maybe. He’s due in, he thinks. He just knows he can’t go back to you, even if that’s where his heart wants to go.

The air bites at is skin. Colder now that he’s moving. Maybe it just feels that way because he’s raw, stripped of the warmth that lived in your voice, your touch, your home. He starts to move faster, hoping the breakup won’t catch up with him.

Halfway down the block, it starts.

A too-shallow breath. A heartbeat that comes too fast. A tremor that doesn’t start in his hands, but originates from somewhere deeper. Somewhere ungraspable. He blinks rapidly, trying to control the way his chest won’t open up properly.

He rounds a corner too sharply. His vision warps at the edges. Every footstep feels like it echoes, the street unstable beneath him.

His own name flickers in his mind like static. He tried to ground himself in language, in familiarity, pleading for it to pull him back from whatever this is.

I’m not okay. I’m not okay. I’m no okay.

His pulse thuds unevenly. His ribs feel like they’re contracting, his chest turning to stone. The air won’t come in properly. He opens his mouth, gasps in ragged drags of oxygen. It feels like he’s breathing through a piece of gauze.

Somehow, though he doesn’t remember the walk there, he finds himself outside the BAU building.

He grips the brick wall beside the entrance like it’s the only thing holding him upright. His knees buckle and his slides down, curling in on himself. His arms brace across his knees – still clothed in soft pajamas – and he hangs his head low.

He’s trying not to fall apart in public. Trying not to be a problem. But the breaking inside is too loud. He looks insane, probably. Can’t bring himself to care.

He gasps again, and presses a hand to his chest. The other grips at his hair.

Parasympathetic regulation. He knows the terms. Tells himself he can breathe. Four-count inhale. Five-count exhale. He keeps losing count.

He digs his palms into his eyes. He wants to vanish into the dark behind his eyelids, wants the pressure to stop the noise. He wants to erase the world. Wants to go back.

A sound escapes him. One that is part breath, part sob. Low and fragile and unfamiliar.

Then:

‘Reid?’

He doesn’t respond. Just keeps breathing – or, trying to.

Footsteps. Quick and purposeful.

The voice again, closer. ‘Spencer?’

He hears it clearer this time. Morgan.

And then Morgan is there, crouched beside him without hesitation. Morgan doesn’t say much. He doesn’t freak out of panic. He just stays. Solid and steady.

‘Hey,’ he says gently. ‘Breathe. You’re okay. You’re right here with me, alright?’

Spencer wants to nod. Wants to speak. But his breath stutters again, getting caught. Morgan mirrors a breath. Slow. Deliberate. Exaggerated.

‘In and out with me, Pretty Boy. One—two—three—’

A pause. Breathing in unison.

‘That’s it,’ Morgan says, voice softly coaxing. ‘Keep going. I’ve got you.’

Spencer latches onto the rhythm. Not perfectly. Not easily. But slowly. His heartbeat begins to come down from its frantic pounding.

He leans his head back against the cool brick wall. Lets it ground him. Still shaky, but better.

‘I can’t… I can’t go in,’ he rasps. His voice sounds foreign in his own mouth. Dry and hoarse and cracked.

‘That’s okay,’ Morgan says immediately. ‘We don’t have to move. We’ll just sit here.’

And they do.

The silence between the isn’t empty. It’s full of everything Spencer can’t say yet. He grips his knees until his knuckles turn white.

‘I think…’ He swallows. ‘I think I broke it. Whatever I had, I ruined it. I told them…’ his voice catches as he takes another gulp of air. ‘I just left them.’

Morgan doesn’t ask questions. He just listens.

Spencer closes his eyes again, not to shut Morgan out, but to try and hold something inside. He feels it cracking anyway. Slowly. A quiet and ruinous cave-in.

No tears fall. He doesn’t have the energy left for that. He just sits with the ache. The guilt. The weight.

Someone walks into the BAU behind them. The buzz of the door opening and closing. Footsteps fading away. Spencer keeps his head down throughout.

Morgan rests a hand on his shoulder. It’s not heavy. Just present. And Spencer doesn’t flinch. Doesn’t recoil. Just breathes.

They sit like that as the sun rises higher, casting long shadows on the sidewalk. The world keeps going. The day unfolds without waiting. They remain together. Breathing in sync. Still and unmoving, because motion might shatter what’s left of Spencer’s composure.

Spencer thinks about his hypothesis again.

You can run the experiment a thousand times and get the same result.

But it only takes one failure to prove you were never in control.

if you made it this far, thank you for reading!! I rewrote and edited this so many times i think i went crazy and decided this was the best it would be!!! I have a taglist now! Please comment if you want to be added, or go to this post here. taglist: @abbyy54 @curatedbylucy @cynbx @enchantedtomeetcoffee @goobbug @internallysalad @jeuj @leparoleontanee @mrs-cactus69 @readbyreid @redorquid @santinstar @shortmelol @thoughtwriter @whitenoisewhatanawfulsound @written-in-the-stars06

[sysmedsaresexist]

NEWS FLASH ⚡️

Six-year follow-up of the treatment of patients with dissociative disorders study

In the attached study, 12.8% of patients reached final fusion, and 12.8% of patients were considered resolved with functional multiplicity.

61.7% did not complete therapy.

A portion of these patients are dead or missing. A moment of silence for those lost. Never forget the suicide rates in our community.

This article is from 2017, and the ISSTD guidelines are from 2011. Both say that functional multiplicity is a valid treatment option.

The authors of the 3 phase treatment talk about how it's okay to stop at functional multiplicity.

Don't let anyone tell you otherwise.

Treatment goals are personal, some of you need to mind your own goddamn business

Further reading:

Critiquing the Requirement of Oneness - Kymbra Clayton

CDS UK Treatment

A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified.

There exists no published, empirical data demonstrating that direct intervention with self states worsens DID, although there is clinical literature that describes negative outcomes of inappropriate interventions with self states (Kluft, 1989a).

Whether or not unification takes place or the extent to which it endures, most severely dissociative patients, even those in the lowest functioning group, can improve during specialized focuses on dissociation.

[X]

CTAD Clinic, a multi part series on integration, fusion, and personal choices

[iatrophilosophos]

"Everyone" is not "worse at driving now" because of long covid. Yall.

Long covid is real, it is fucking people up, it seems relatively common, and that is precisely why everyone needs to stop attributing everything under the sun to it and actually adopt a sense of interrogative vigor*, especially among people who are 20-30 and have, lbr, SO MANY reasons to be miserable and ill including:

Shitty moldy apartment buildings & similar environmental hazards of slum&overcrowded housing

Dietary deficiencies/cheap mass-produced and fast food (no judgement! Eat what you can get down! But not eating vegetables WILL make you sick and crazy)

Onset of chronic illnesses folks would've gotten anyway &/ may be caused by factors like air & water pollution esp wrt environmental racism

Getting older 🤷 and conversely, being a young adult struggling to take care of oneself in a world that doesn't prioritize teaching you those skills & is often actively hostile towards using them

*by interrogative vigor i mean looking for information about why something ISNT covid or isn't long covid: lots of ppl are doing gr8 keeping up on the releases around covid! But yknow, when ur hammered you wanna nail everyone. Everything deserves a good faith effort to try on several explanations, you will learn a lot more even if it turns out to be your first thought.

I'm not saying any of this to try to downplay or deny anyone's suffering and im not interested in arguing with specific individuals about whether or not they personally have long covid (idk you! Idk ur history! Not for me to say! Lots of people definitely do!). I also understand that when doctors say things like the above^ it can feel really shitty and be really unhelpful. No one wants to feel like they're miserable and dying for months, finally get in a clinic visit, and be told "idk clean ur apartment, thatll be $400. Come back in six months to pay me another $400 when it doesn't work". That sucks!

What i can say is that whether or not any given individual has long covid, you almost definitely have at least one(1) other problem. this...really ain't my first rodeo. I have been watching especially younger adults who are breaking down & being disabled by the weight of The Everything get a pathology diagnosis, apply it as the root cause of most of their problems, proselytize how everyone, actually, probably has this pathology, and watch it catch on as the definitions get vaguer and the symptoms pool gets bigger. It almost always happens with diagnoses of exclusion & diagnoses that are very subjective: ADHD, autism, crohn's disease, hEDS...

Pathologies are most useful when they define a problem in a way it can be solved. I think in a lot of spaces, especially online, they can be leaned on as a source of validation or emotional support: it's the explanation that makes your misery make sense and justifies it to others. I would suggest that, as disability activists have been saying for decades: we do not have to justify our misery. We don't need an excuse to feel. We don't need an excuse to need help.

What we do need is a) a political critique of the state of disability that doesn't let the rest of the everything off the hook in favor of yelling about individual actions, and b) a personal and community scale understanding of misery that is useful to remediating misery AND!!! GATHERING BETTER DATA about the things that are making people miserable so we can fucking! Work on it!

One of the main things I do like, with my life tbh, is help disabled people understand their health and be less miserable, and when i work with clients in a more professional setting or just chat with friends, we don't start with a pathology: we start with a map. We look at housing, we look at food access, we look at environmental conditions, all in really granular detail, because everyone has so! Many! Problems! And we start work on solving like, two of them. How are we gonna beat the mold in your home back? How are we gonna get more food into you? & this starts to clarify things. One, regardless of what's wrong with people, these kinds of steps almost unilaterally help ease the burden p immediately, and two, fixing as much junk-data misery as we can gives us a WAY better understanding of what's going on and like, lets my clients have more productive relationships with their doctors because they can work up a smaller and more detailed list of complaints to investigate (& that are more within the realm of what those docs are actually trained to handle, most medical professionals just do not have skills for helping ppl with shit life syndrome.)

Caring about long covid as a mass disabling event (which i do, very much so!) should be pushing us to define DOWN the criteria for long covid by building a deep & rich understanding of the multiple other sources of misery and disability and using real tactics to help ourselves&eachother live with that misery. This in turn lets us build more concrete models of the things that are not currently well defined and thus strategize to figure out how to deal with those; rather than lumping everything into the nonspecific symptoms disease de jour and continuing to rot six deep in apartments where everyone's literally allergic to the fucking walls.

[spr1ngpvrinbwunnie]

Another headcanon request: How would Harley do his interviews with the test subjects (children)? Is he gentle with them? What is he like? Like with the paper recording his and Quinn’s interactions, especially with y/n in the room

🧠 Harley Sawyer’s Interview Style With Test Subjects (Children) - Headcanon 👁️

📽️ Setting: Clinical but “friendly” façade

The interview rooms are always monitored with cameras and audio.

A child-friendly set design: warm lights, toys scattered subtly, maybe even posters.

On the surface, it’s meant to look like a safe space — to build trust. But it’s all fabricated. Every element in that room was calculated by Harley to manipulate response and compliance.

🧊 His Demeanor When Alone with a Subject

Unnaturally calm, with a slow and measured tone.

He smiles — but it’s too perfect. Too practiced. Like a predator learning the mask of a father.

Speaks in simplified language, almost as if reading off a script, but his eyes are too focused — not on the child, but on the results.

Often takes notes during their speech, but not in response to what they say emotionally — only in reaction to useful data: "vocal strain," "emotional resistance level," "immediate trust factor."

If the child seems nervous or shy, he’ll lean in and drop his voice to something soothing, almost fatherly. But it’s mimicry — he’s studied how empathy looks. He doesn't feel it.

🧪 When Testing Psychological Boundaries

Subtly introduces unsettling or leading questions:

“Do you ever feel lonely here?”

“Would you like it if you could stay like this forever?”

“Do you think people forget children who don’t do special things?”

He’s not just looking for answers — he’s measuring attachment styles, emotional vulnerabilities, and how far he can push loyalty.

🧍‍♀️ When You Are in the Room

And this is where things really change.

His tone becomes noticeably more performative.

He watches you more than the child — as if your perception of him is more important than anything the subject says.

If you disapprove or flinch, he’ll cover his more manipulative lines with sarcasm or dry humor:

“Don’t give me that look, I’m just asking questions. You’re the one who said I needed to work on my people skills.”

He’ll reign in his darker impulses if you’re visibly uncomfortable — for the moment.

You are the only person who’s ever made him question if he’s gone too far. And even then… he gets defensive.

“I’m not hurting them, Y/N. I’m understanding them. If you want to make something perfect, you have to take it apart first.”

🧒 Harley + Quinn (Yarnaby) Interactions on Paper

Quinn’s case file is thick, and most interviews with him were one-on-one, without oversight — except for a few where you insisted on being present.

In those earlier transcripts:

Harley’s questions with Quinn are oddly encouraging, even doting in a way: “You’re doing so well, Quinn. See? I knew you were special.”

Quinn often responds hesitantly at first, then more eagerly over time — Harley feeds him praise like candy, deliberately making himself the only source of validation in Quinn’s life.

Subtle red flags litter the files: isolating language, dependency conditioning, manipulation cloaked as mentorship.

If you’re in the room during those interactions:

Quinn often looks at you for reassurance, sensing something is off. Harley gets tense when that happens, his smile tightens.

“Eyes on me, Quinn. We’re working. Y/N’s just observing.”

If you challenge him after, he’ll deflect:

“You want me to stop now? After how far he’s come? Don’t act like this is cruel, Y/N. You’ve seen how happy he gets when he feels useful.”

💔 When Harley Is Feeling the Pressure

If his methods are questioned by higher-ups — or even by you — his interviews become sloppier, more emotionally volatile...

He might snap if a child doesn’t answer correctly. His voice sharpens. He might end the session abruptly.

He WON'T hurt them during interviews — but the psychological pressure rises fast.

If you confront him afterward, he’s either:

Coldly detached: “They’ll survive. The data’s clean.”

Or explosively defensive: “If you don’t like what you see, leave. But don’t stand there and pretend you understand what I’m doing.”

🧸 Personal Notes in His Files (Private)

Hidden between the formal recordings are pages of deeply personal, conflicting thoughts about certain subjects (especially Quinn).

Notes scribbled in a rush: “Why is he still scared of me?” / “Dependency reached. Don’t fuck this up.”

Mentions of you: “Y/N distracted subject. Too soft. Too… much.”

One margin note reads:

“If I’d had someone like them when I was his age... Would I have turned out the same?”

Harley is not gentle — but he knows how to act gentle. His interviews are manipulative, emotionally strategic, and designed to gain loyalty or extract data.

With you in the room, he modulates himself — sometimes even pretends to care — but it’s not fully altruistic; it’s because you see through him and that unnerves him more than he admits.

Despite himself, part of him wants you to believe he’s good. That he’s not a monster. But under that mask, it’s still Harley: desperate for recognition, control, and the illusion of love through obedience.

[drchristophedelongsblog]

The integration of artificial intelligence (AI) into medicine is profoundly transforming practices, and this raises important questions about the ability of geriatricians and general practitioners to adapt.

Here is an analysis of the issues

Growing complexity of medicine with AI

Preventive and predictive medicine

AI can analyze huge amounts of data to identify individual risks and predict disease occurrence.

This requires a deep understanding of algorithms and their interpretation.

Diagnosis

AI helps in interpreting medical images, analyzing biological data and detecting complex patterns.

This requires an ability to validate and integrate AI results into the clinical context.

Therapeutic

AI personalizes treatments based on individual patient characteristics.

This involves knowledge of AI-based therapeutic options and an ability to monitor their effectiveness.

Capacity of geriatricians and general practitioners

Continuing education

Continuing education is essential to keep physicians up to date with advances in AI and its applications in medicine.

Interdisciplinary collaboration

Collaboration with AI specialists, data scientists and other healthcare professionals is crucial for effective use of AI.

Decision support tools

AI can provide decision support tools to support physicians in interpreting data and making clinical decisions.

Specificities of geriatrics

Geriatrics, by its holistic nature, is particularly concerned with the management of multiple pathologies and fragility.

AI can be a valuable asset in synthesizing complex data and personalizing care plans.

The role of the general practitioner

The general practitioner, through regular monitoring of the patient, is on the front line to detect changes and refer to specialists.

AI can help refine its diagnosis and monitoring.

In summary

AI represents a challenge, but also an opportunity to improve the care of elderly patients.

Continuing education, interdisciplinary collaboration and the use of decision support tools are essential to enable geriatricians and general practitioners to adapt to this evolution.

General practitioners and geriatricians will have a key role in using AI as a decision-making tool.

Go further

[copperbadge]

Hey Sam! Would you mind sharing the research (or if you're not comfortable with that, your general search terms) you found on children of parents with emotional disregulation? That's been a theme in my own life, but I haven't found good papers about it myself, so I'd be interested in learning more.

Truly, it is a fucking quest.

So, when I initially searched I only really found one good article on what I think of as the "pop psych" side of things:

The Emotionally Dysregulated Parent by The Curious Nerd

It suffers from the problem a lot of pop psych books do, which is that it offers a highly relatable checklist and very few concrete solutions, but I don't want to criticize that because it's also not claiming that offering solutions is the goal. The article is more of a "Hey is this what I'm dealing with? Yes? Okay" kind of a situation.

Also, to preface: there is a fairly fine but visible line dividing "emotionally dysregulated" from "emotionally immature" which I think is why Adult Children Of Emotionally Immature Parents didn't resonate with me as much as it has for some. Dysregulated parents can have a fairly high level of emotional maturity, they just have wildly unpredictable reactions at times because their emotions overwhelm their self-control. So the impact on the child is less visible, and looks less like the forms of abuse or neglect that we're accustomed to.

More research under the cut but also a warning at the very end for some discussion of some pretty heavy stuff -- I'll put a little bold header before that bit so folks know when to stop reading if they want. (No personal accounts of abuse, just a discussion of abusive behaviors.)

I was looking for more articles like the one above and more research papers about the issue, but the problem was that Research came in three flavors:

All our data comes from surveys that parents took about their own dysregulation and the dysregulation of their small children. This is...interesting, I guess, but it's not good data because it's all self-reported and only by the parents.

We are studying emotional dysregulation's impact on the relationship between parents and adult children...but only in situations where the adult child is the dysregulated one. Obviously this isn't helpful and also what the fuck.

A study that affirms that emotionally dysregulated parents raise emotionally dysregulated children. I know these are necessary in order to build a framework for further research but also, you know, water be wet.

What actually helped me was stumbling across a different term during this research: "High Self-Monitoring". This refers to people who, as children, experienced unstable or irregular behavior from their caregivers and who thus developed the habit of constantly monitoring others' behavior, and others' reactions to their behavior, to ensure that they are accepted and approved of.

I never felt comfortable with thinking of myself as hypervigilant because the behaviors of hypervigilance don't match mine, but the behaviors of high self-monitors do, because they're specifically focused on the behaviors of other people in social situations. Remember how I was literally diagnosed as extremely charming? Yeah, high self-monitoring is a huge part of that.

I haven't had a chance to explore this as much. I hesitate to say the below link is helpful, because I think a lot of his suggestions aren't really valid for people with any flavor of neurodiversity, but I do think his exploration of self-monitoring is generally informative:

How to Become Less Self-Conscious by Matt Norman

Relative to high self-monitoring is another term, "Parentification", which refers to a parent investing their child with the responsibility of parenting a sibling or becoming a caregiver for said parent. This is akin to "eldest daughter syndrome" that you may have seen discussed on Tumblr, but more clinically defined and intense (and less gendered). Again, I haven't had a chance to dig into Parentification, so I don't have more to recommend yet.

Discussion of childhood trauma below, specifically incest. Skip to the next bold header if you don't want to read this.

I will say, very frequently you see Parentification paired with another term, emotional incest, which refers to a parent putting their child in the position of a romantic partner but without the physical aspect of incest. It can involve venting to the child about romantic partners or work problems, depending on the child for emotional support, preventing the child from peer activities or age-appropriate friendships because of jealousy, and sometimes physical contact that's not sexual but also not parent-child appropriate.

I think "emotional incest" is a real behavior but also a really ugly term for that behavior, and Therapist agreed. It feels like the term adds stigma simply because incest is such a loaded word. It's something I have seen people use to refer to their own experiences and that's absolutely their call, I am not going to step to anyone who needs it or feels it applies to their situation. But if the term makes you uncomfortable I think that's also justified. In talking about it, Therapist and I reframed it as Boundary Breaking, but I think with a bit of work I can come up with something a bit more specific.

So, just, if you see a discussion of emotional incest I do recommend you have a look because it's an advanced form of parentification and may be something you want to deal with, but be aware the name may feel like it sucks and be ready to uh, deal with that.

Okay, here's the second bold header, you can come back now.

So yeah, my research has been very surface level, in part because once I found all this I wanted to bring it to Therapist for guidance in further research. But I do think that "emotional dysregulation and parents" is sadly not a great search term. You're better off searching for "high self-monitor" or "parentification" and keeping a keen eye out for additional keywords those searches may generate. Good luck...

[pharmaconnections01]

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[covid-safer-hotties]

Reference saved in our archive (Daily updates!)

Plain language summary Some children and young people infected with SARS-COV-2 experience impairing symptoms long after infection; this is known as ‘Long COVID’. We used data from the Long COVID in Children and Young People (CloCk) study to describe symptoms and how much they impact children and young people’s lives 24-months post-infection. We found that 7.2% of children and young people consistently meet the ‘Long COVID’ research definition at 3-, 6-, 12- and 24-months post-infection. These children and young people reported around 5-to-6 symptoms at each time-point. Reinfected children and young people had more symptoms than children and young people who report one infection; those who report no infection had the lowest symptom burden. When researching Long COVID, we need to consider clinical impairment and the range of symptoms reported.

Abstract Background Some children and young people (CYP) infected with SARS-COV-2 experience impairing symptoms post-infection, known as post-COVID-19 condition (PCC). Using data from the National Long COVID in Children and Young People (CloCk) study, we report symptoms and their impact up to 24-months post-infection.

Methods CloCk is a cohort of CYP in England aged 11-to-17-years when they had a SARS-CoV-2 PCR-test (between September 2020 and March 2021). Of 31,012 eligible CYP 24-months post-PCR test, 12,632 participated (response = 40.7%). CYP were grouped by infection status: ‘initial test-negatives; no subsequent positive-test’ (NN); ‘initial test-negatives; subsequent positive-test’ (NP); ‘initial test-positives; no reported re-infection’ (PN); and ‘initial test-positives; reported re-infection’ (PP). The Delphi research definition of PCC in CYP was operationalised; symptom severity/impact and validated scales (e.g., Chalder Fatigue Scale) were recorded. We examine symptom profiles 24-month post-index-test by infection status.

Results 7.2% of CYP consistently fulfil the PCC definition at 3-, 6-, 12- and 24-months. These CYPs have a median of 5-to-6 symptoms at each time-point. Between 20% and 25% of all infection status groups report 3+ symptoms 24-months post-testing; 10–25% experience 5+ symptoms. The reinfected group has more symptoms than the other positive groups; the NN group has the lowest symptom burden (p < 0.001). PCC is more common in older CYPs and in the most deprived. Symptom severity/impact is higher in those fulfilling the PCC definition.

Conclusions The discrepancy in the proportion of CYP fulfilling the Delphi PCC definition at 24-months and those consistently fulfilling the definition across time, highlights the importance of longitudinal studies and the need to consider clinical impairment and range of symptoms.

[probablyasocialecologist]

The idea of transgender “social contagion” was first proposed in a 2018 paper by Dr. Lisa Littman, a researcher who has pushed the theory heavily. The article, entitled “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” proposed that social contagion was leading to an increase in trans identification. To support her claim, Littman solicited interviews from anti-trans websites such as Transgender Trend and 4thWaveNow. She used data from those interviews to claim that transgender youth “suddenly” develop gender dysphoria through a process known as “Rapid Onset Gender Dysphoria.” Her paper was immediately withdrawn with an apology by the journal for correction after the data collection methods were revealed, with the republication stating that the research “does not validate the phenomenon” of transgender social contagion. "Rapid Onset Gender Dysphoria" is derived from interviews with parents who report their children "abruptly came out as trans" without any forewarning. For numerous parents on these websites opposed to transgender rights, they claimed their children’s coming out was too sudden to be genuine. Coupled with conservative media exposure asserting that being transgender results from factors ranging from TikTok to alleged "grooming" in schools, parents frequently sought alternative explanations for their children's trans identification, instead of acknowledging the possibility that their children were authentically transgender. A pivotal study published in The Journal of Pediatrics in 2021 entirely debunked this concept. Professionals who work closely with transgender populations frequently observe that individuals harbor dysphoria for an extended period before revealing their feelings to loved ones. Upon coming out, these individuals often swiftly embrace their transgender identity, motivated by the liberation that comes with acknowledging one's true self. To determine whether transgender identification is genuinely "rapid," researchers sought to pose a direct question to transgender teenagers: How long have you known you were transgender? The results were stunning. Transgender teens knew they were trans for an average of 4 years before coming out as trans and getting their first clinical visit. The study did not stop there, however. It also analyzed the few transgender teens who indicated their gender dysphoria realization was more recent. It found no linkages among those groups with depression, online support, having transgender friends, or any other proposed mechanisms for “rapid-onset gender dysphoria.” To put it simply: transgender people often know they are trans for a long time before coming out, and having transgender friends does not influence you to “become transgender.”

[phoenixblaze1412]

I love the child reader stuff you make a lot! how do you think the segments and dottore would react if child reader now a bit grown up into teen years came out as queer/trans?

Dottore (Prime/Zandik)

At first, Dottore’s reaction might seem detached. He’s not the type to outwardly emote much in any situation, but his mind would immediately start analyzing. Not in a dismissive way, he genuinely wants to understand.

“Interesting,” he might say, with his usual sharp tone, but he wouldn’t mean it mockingly. To him, it’s simply a matter of identity, and the mechanics of gender or orientation fascinate him from a scientific standpoint.

Beneath his cold demeanor, he respects you deeply, so he wouldn’t dismiss your experience.

If you needed reassurance, he would provide it in his own way: practical support. He would ensure you had whatever resources, clothes, or tools you needed to feel at ease.

He’s protective, so anyone who dared disrespect you over your identity would face his wrath in full force.

The Omega Segment

Omega is logical and pragmatic, so his response would be straightforward and nonchalant. “If that’s who you are, then so be it.”

He wouldn’t make a big deal out of it and would treat it like any other personal revelation, continuing to work or experiment while listening.

However, he has a soft spot for you. While he doesn’t show it often, he would adjust his behavior if it made you more comfortable, switching to new pronouns or offering affirmations subtly in his interactions.

He’d also offer guidance in a calm, steady tone if you seemed uncertain about yourself, always grounding you when emotions ran high.

The Iota Segment

Iota’s reaction would be more overt. He’s loud and proud of you, hyping you up immediately. “That’s my kid!” he’d exclaim with a wide grin, clapping you on the back.

He might be overbearing with his enthusiasm at first, insisting on helping you in ways that could verge on embarrassing, like marching off to intimidate anyone who might have ever been cruel to you.

“You tell me if anyone’s giving you trouble. I’ll take care of it.” His protective instincts go into overdrive.

Iota is a bit brash but very genuine. If you needed support, he’d jump into action without hesitation, even if he didn’t fully understand at first.

The Epsilon Segment

Epsilon would react much like Prime but with a more inquisitive, academic lens. He might bombard you with questions not to belittle, but because he’s fascinated and genuinely wants to learn how best to support you.

“So, how does this impact your perception of yourself? What can I do to accommodate your needs?” His tone would be clinical, but his intention kind.

He’d research queer or trans topics extensively, likely overwhelming you with resources and information. “I’ve compiled some data you might find helpful.”

He’s a bit socially awkward, so his attempts to express support might come across as stiff or overly formal, but his care is evident in his actions.

The Theta Segment

Theta is playful and teases everyone, but his reaction would surprise you with its sincerity. “Really? That’s awesome! Now, let’s mess with everyone else by confusing them about your pronouns for fun.”

He’d lighten the mood with jokes, but they’d never be at your expense. Instead, he’d use humor to make you feel at ease and ensure you knew he accepted you wholeheartedly.

Theta would also go out of his way to validate you, casually working affirming comments into conversations without making a big deal out of it.

“You’re already the coolest person here; this just cements it.”

The Zeta Segment

Zeta doesn’t say much, so his reaction would be subtle but deeply supportive. A nod of acknowledgment, a small smile, these gestures would say everything.

He’s not one for grand speeches, but his actions speak louder than words. He’d ensure you felt respected and cared for without making a fuss.

If anyone tried to disrespect you, Zeta would be the silent enforcer, using his presence to intimidate them into backing off.

As a collective, the segments might bicker over the best way to support you, each with their own approach. But the one thing they’d all agree on is that you’re their kid, and they’d defend you fiercely.

Prime would eventually step in to coordinate their efforts, ensuring that they didn’t overwhelm you with their differing reactions.

The lab might become a bit chaotic at first as they adjust to any changes you’ve shared, but their love for you is unwavering. Whether you’re queer, trans, or simply figuring yourself out, they’d all stand by your side.

[darkmaga-returns]

If a moratorium happens, it will not only validate everything I and many other “dissident” physicians have tried to do for over 4 years but it also inspires us to further document the immense, enduring, and increasingly recognized harms of that campaign into the historical record.

In this post, I will highlight what I feel is one of (not the only) critical variables that allowed the mRNA vaccine catastrophe to occur and that is the cowardice, silence, and complicity from “nearly” everyone in health care. Sorry, not sorry.

Back in 2023, I received a call from a friend and colleague named Louis Conte regarding a “contact” of his with knowledge of the inner workings of Emergency Medical Services in Westchester County, New York.

Louis’s contact had been monitoring EMS dispatches in Westchester County and saw, subsequent to the jab rollout in early 2021, what he felt was a frightening number of calls from vaccine clinics or homes where general or specific “vaccine reactions” were cited as the cause of the need for an ambulance.

Last year, the contact decided to submit a FOIL (Freedom of Information Law) request—similar to a FOIA—to the Westchester County EMS (and the adjoining Dutchess County EMS) asking for a record of all calls whose transcripts mentioned either the word “vaccine” or “Covid-19 vaccine” in 2021.

Louis asked me to look at the documents. As difficult as it was to further distress me with data on the toxicity and lethality of the mRNA platform, the dataset still managed to do this.