#clinical work

[inkskinned]

so one of the things that's so horrifying about birth control is that you have to, like, navigate this incredibly personal choice about your body and yet also face the epitome of misogyny. like, someone in the comments will say it wasn't that bad for me, and you'll be utterly silenced. like, everyone treats birth control like something that's super dirty. like, you have no fucking information or control over this thing because certain powerful people find it icky.

first it was the oral contraceptives. you went on those young, mostly for reasons unrelated to birth control - even your dermatologist suggested them to control your acne. the list of side effects was longer than your arm, and you just stared at it, horrified.

it made you so mentally ill, but you just heard that this was adulthood. that, yes, there are of course side effects, what did you expect. one day you looked up yasmin makes me depressed because surely this was far too intense, and you discovered that over 12,000 lawsuits had been successfully filed against the brand. it remains commonly prescribed on the open market. you switched brands a few times before oral contraceptives stopped being in any way effective. your doctor just, like, shrugged and said you could try a different brand again.

and the thing is that you're a feminist. you know from your own experience that birth control can be lifesaving, and that even when used for birth control - it is necessary healthcare. you have seen it save so many people from such bad situations, yourself included. it is critical that any person has access to birth control, and you would never suggest that we just get rid of all of it.

you were a little skeeved out by the implant (heard too many bad stories about it) and figured - okay, iud. it was some of the worst pain you've ever fucking experienced, and you did it with a small number of tylenol in your system (3), like you were getting your bikini line waxed instead of something practically sewn into your body.

and what's wild is that because sometimes it isn't a painful insertion process, it is vanishingly rare to find a doctor that will actually numb the area. while your doctor was talking to you about which brand to choose, you were thinking about the other ways you've been injured in your life. you thought about how you had a suspicious mole frozen off - something so small and easy - and how they'd numbed a huge area. you thought about when you broke your wrist and didn't actually notice, because you'd thought it was a sprain.

your understanding of pain is that how the human body responds to injury doesn't always relate to the actual pain tolerance of the person - it's more about how lucky that person is physically. maybe they broke it in a perfect way. maybe they happened to get hurt in a place without a lot of nerve endings. some people can handle a broken femur but crumble under a sore tooth. there's no true way to predict how "much" something actually hurts.

in no other situation would it be appropriate for doctors to ignore pain. just because someone can break their wrist and not feel it doesn't mean no one should receive pain meds for a broken wrist. it just means that particular person was lucky about it. it should not define treatment.

in the comments of videos about IUDs, literally thousands of people report agony. blinding, nauseating, soul-crushing agony. they say things like i had 2 kids and this was the worst thing i ever experienced or i literally have a tattoo on my ribs and it felt like a tickle. this thing almost killed me or would rather run into traffic than ever feel that again.

so it's either true that every single person who reports severe pain is exaggerating. or it's true that it's far more likely you will experience pain, rather than "just a pinch." and yet - there's nothing fucking been done about it. it kind of feels like a shrug is layered on top of everything - since technically it's elective, isn't it kind of your fault for agreeing to select it? stop being fearmongering. stop being defensive.

you fucking needed yours. you are almost weirdly protective of it. yours was so important for your physical and mental health. it helped you off hormonal birth control and even started helping some of your symptoms. it still fucking hurt for no fucking reason.

once while recovering from surgery, they offered you like 15 days of vicodin. you only took 2 of them. you've been offered oxy for tonsillitis. you turned down opioids while recovering from your wisdom tooth extraction. everything else has the option. you fucking drove yourself home after it, shocked and quietly weeping, feeling like something very bad had just happened. the nurse that held your hand during the experience looked down at you, tears in her eyes, and said - i know. this is cruelty in action.

and it's fucked up because the conversation is never just "hey, so the way we are doing this is fucking barbaric and doctors should be required to offer serious pain meds" - it's usually something around the lines of "well, it didn't kill you, did it?"

you just found out that removing that little bitch will hurt just as bad. a little pinch like how oral contraceptives have "some" serious symptoms. like your life and pain are expendable or not really important. like maybe we are all hysterical about it?

hysteria comes from the latin word for uterus, which is great!

you stand here at a crossroads. like - this thing is so important. did they really have to make it so fucking dangerous. and why is it that if you make a complaint, you're told - i didn't even want you to have this in the first place. we're told be careful what you wish for. we're told that it's our fault for wanting something so illict; we could simply choose not to need medication. that maybe if we don't like the scraps, we should get ready to starve.

we have been saying for so long - "i'm not asking you to remove the option, i'm asking you to reconsider the risk." this entire time we hear: well, this is what you wanted, isn't it?

[lotus-pear]

HIII SORRY FOR NO NEW ART have some concept sketches for the fic i'm working on instead

[faggotstump]

"he should have been at the club" he should have been at the gender clinic so he could start estrogen, actually

[lgbtlunaverse]

Considering wwx's canonical breeding kink and his general fondness for dubiously safe scientific experiments it is technically within the realm of possibility that a few years post-canon he just invents cultivation hrt and transition surgery by accident.

He just rocks up to a cultivation conference one day 5 months pregnant like "I turned my body into that of a woman! Yeah the boobs too we travel a lot and don't want a wetnurse. I'll reverse it in two years or so." And every single trans person and egg in the culivation world simultaneously sits up and goes "wait what?"

Imperical to understand that wwx still fully identifies as a cis man and does not know trans people exist. He did not know he was gay while actively being in gay love, this man is very smart but he doesn't know shit. Just a few weeks after the conference people start coming over like "hey... that thing you did... can you do that to me?" and he's like damn sure are a lot of dudes who wanna get pregnant. One day a "female" cultivator comes and is like "so you said you're going to reverse it... you think you can do that on a body that's already female? Turn my body into a man's body?" And he just goes well probably, let's find out!! It's so great all these people wanna help him perfect his techniques, isn't it lan zhan?

Years later they run into one of the trans women he first helped and doesn't even recognise her as she's thanking him and after the clarification just goes "wow! haha damn you're even wearing women's clothes! Should I start calling you guniang?" sort of as a joke but she's like yes please and he just says alright nice to see you again ma'am (still doesn't get it)

[t8oo]

[release-the-hound]

I hope this wave of of strikes pushes the veterinary industry to unionise. As corporations like VCA and Banfield (both owned by MARS, yes the chocolate company) continue to buy out independent clinics, the industry is shifting away independent businesses founded and owned by DVMs to corporate franchises.

Working conditions in the industry have been abysmal for years. But everyone working under the same company + significant staff shortages (in canada both DVM and RVT positions typically take 6+ months to fill according to a report by the CVMA) does provide opportunity both for community-building and an advantage for bargaining or, if necessary, striking. Staff are not easily replaced.

We all know we're being overworked and underpayed. It's time to fucking do something about it. Talk about your wages with your coworkers, make sure you're being reimbursed for overtime, see if you're getting enough vacation days. Find out what you want and take it.

Some clinics have already unionized, I hope more will soon.

[l3irdl3rain]

How is Joey adjusting to the loss of his boyfriend?

Tbh I think he’s happier. I feel like there must be some part of him that misses having a feathery partner in crime, but Joey and I have returned to our Pre-Chester life.

Idk how much I talked about it on here bc I wasn’t using this blog super consistently back then, but Joey and I used to be inseparable. If I was allowed to bring Joey somewhere you best believe he came along.

Then Chester moved in, instantly bonded with Joey, and complicated things. For at least the first 6 months I hemmed and hawed about whether I was doing the right thing by keeping Chester. I felt really guilty (as well as disappointed) that Joey and I’s one on one time was severely limited. I couldn’t bring Chester along when we went out bc it was too stressful for him. But it was also stressful for Chester to leave him at home without Joey.

Joey obviously adjusted and he loved hanging out with Chester, but there were also times he obviously wanted to hangout with me one on one and Chester made it very difficult if not impossible.

[luvmoonie]

stopped me in my tracks on pinterest good LORD

[feroluce]

For some weird reason, I've always been fascinated by how wildly different Sampo operates in the Underground vs the Overworld.

Sampo is present in both places and even in official sources, he's not really counted as one side or the other- now that the theory has been confirmed in-game, he's generally just lumped in with the Masked Fools.

But there really is a big difference!

Probably the most obvious and well known instance of Sampo's...business practices *cough burglary and fraud COUGH* in the Overworld is from the Belobog Museum event. In it, you don't find out Sampo is the main culprit until near the end, because Pela has to set up a sting just to catch him in the act. And that sting is necessary all because the initial suspect they arrested, Norbert, had pretty much no idea of his partner's identity. Sampo wouldn't even speak to him face-to-face.

And whereas Sampo is normally very pleasant and friendly with the trailblazer...when he thinks he's talking to Norbert here, he straight up says that they are NOT friends. Like he really shuts that shit DOWN.

There's also an Overworld NPC, Chavez, who heads the "Dark Blue Scam Support Group." And he. Really really really does not like Sampo fjkdasjklfdj

Chavez clearly wants Sampo caught, and has literally no positive feelings about him. So. Why call it the Dark Blue Scam? Why not just out him by name? Chavez obviously doesn't give a single shit about Sampo's dignity or privacy. But he never once refers to him as "Sampo," and even the pamphlets he passes out make no mention of it. No one in the entire support group seems to know how to identify him or how to refer to him except by his hair color. If the trailblazer says his name, Chavez reacts as though he's never heard it before.

(I've seen people say this means Sampo Koski is an alias and not his real name? But Ray pointed this out, and honestly I agree; even the Fools call him Sampo, after all. I think it's just that Chavez never knew Sampo's name in the first place, and given his immense distrust, immediately assumes it's an alias.)

And then there's his characters stories, where he proceeds to pull off a heist in the Overworld while in disguise as Brughel Poisson the entire time. Literally his own stories don't mention Sampo's name even once.

So anyway, all this shows that when he's up in the Overworld working cons, Sampo is incredibly slippery and secretive about his identity. The only people who seem to know him are Pela, Serval, and Gepard. He doesn't get close to anyone else, and is even surprisingly unfriendly. Nobody knows his name. No one knows his face. He has zero qualms about backstabbing or double-crossing, and even plans for it in some cases.

Meanwhile, down in the Underground, I'm pretty sure literally the worst thing we hear of him doing is scalping tickets in front of the Fight Club. Which isn't even illegal in a lot of places (although it's certainly a dick move).

In Hook's companion quest, a vagrant miner steals Fersman's equipment and tries to sell it to Sampo. Even before the trailblazer and Hook jump in and out the vagrant as a thief, Sampo hesitates to buy it because it sounds like stolen goods, which he doesn't want any part of.

Even knowing that a geomarrow detector is rare and incredibly valuable in the mines, Sampo makes no attempt to double-cross Hook or profit off of her loss, and even tells her who to go to to get it fixed.

And my favorite example of Sampo in the Underground is the Survival Wisdom adventure mission. In it, Sampo starts up a business with Peak, another miner. And like. In wild contrast to all the cons he pulls above ground, Sampo is actually super nice and helpful here.

Just the same as with Hook's quest, Sampo talks to Peak face-to-face, with no disguises or barriers. When the trailblazer finds them, they're just in the Great Mine, no secretive meeting places. Peak knows Sampo, is familiar with him, and calls him by name. It's not even a con! There's nothing illegal going on; it really is just a business partnership. Peak is more than happy with their deal, he's even pretty enthusiastic about it, because thanks to Sampo he can now make enough money to get by while also accommodating his chronic fatigue.

The only person Sampo lies to in this whole ordeal is the trailblazer, who he manipulates into getting Peak's mining equipment back from the vagrants that stole it in the first place. And when it's done, he rewards them with a legit treasure map.

So when he's working in the Underground, Sampo is MUCH more upright and lawful. Part of this is probably to do with his "business" model- Sampo only takes advantage of the wealthy, and poverty runs rampant in the Underground. When he charges Peak an extra 30% (the same percentage he charges Norbert as a consultation fee in the museum heists- Sampo seems to go by percentage instead of a flat rate, which means his prices are more fair for lower incomes) for carelessly losing their supply, Peak literally starts counting out pocket change.

Dude's working for pennies and good will down there dknsmdmd

And you can twist this into a Robin Hood thing if you want- Sampo IS technically working to feed orphans and heal the sick. He says himself he's more than happy to make up the shortfall between the greedy and the marginalized- I mean he says it in the shadiest way possible, but I doubt the people benefiting from his work really care that he's a slimeball if it means they can survive another day. Even the two heists he pulls in his character stories are literally just him stealing absurd amounts of food.

Personally though I think it is solely because of Natasha, and Sampo is hilariously well-behaved specifically for her, because she keeps him on a short leash JSKZJMSMSKS

[mayabishopgold]

Maya & Carina | Station 19 - 7x02

What about the baby? We might have to quarantine for 20 days.They're gonna place him with another foster family...

Let's cross that bridge when we get to it.

[nelkcats]

It's not kidnapping, it's borrowing

When Jazz first decided to study psychology she didn't know what she could major in, maybe child psychology? Taking into account all her experiences. Or she could go a step further and specialize in obsessions. Even ghosts, though that would probably make her look weird.

In the end, she decided on something else, and after graduating she opened a clinic in a challenging place: Gotham. She might even give superheroes appointments in the future, considering that having Black Canary do all the Watchtower sessions didn't seem like a good idea.

Surprisingly it was a success, and she got several clients, even if some of them preferred to keep their identities a secret. She was pretty sure they were superheroes or millionaires.

Interestingly, her clinic got quite a reputation and at some point, villains started kidnapping her...To receive therapy? Jazz was about to break free and destroy whoever had kidnapped her on her way out of work (of course she knew self-defense), but Killer Croc looked contrite and…shy?

It turned out that several villains required her services but couldn't make appointments due to their lack of good reputation, there was also the fact that they didn't want to go back to prison, and wouldn't talk in an environment like Arkham (Jazz didn't like the place either, despite of considering it in advance), so she allowed the "borrowing" after work. As long as they didn't invade her apartment.

When Red Hood went to rescue the psychologist from her sixth kidnapping of the week (and damn, why did she refused to report it?) He didn't expect to find Crane crying in a chair and Dr. Fenton scowling at him as she comforted the villain.

[duusheen]

[thecruel]

One will serve. I would not blind you.

HOUSE OF THE DRAGON 1.10 — The Black Queen

[brown-sugar-89]

waaarghh

[stuckinapril]

I admire girls who can pull off long nails bc it literally can never be me. I just don’t get how it works functionally

[butts-bouncing-on-the-beltway]

I was talking to a client today about "how to identify masking" as part of the process of learning how to shift masking from a reflexive coping strategy to a voluntary and conscious one and I feel like it led to a really important shift in framework FOR ME about masking and social distress.

Paraphrasing, the ideas we came to are as follows:

One of the reasons masking can be so difficult to recognize is because, essentially, masking is the act of performing "yourself" as a mirror for the other person you are interacting with. It's this idea of "I will micro-manage my own mood, affect, behavior, mannerisms, and environment in order to reflect back to you whatever version of "self" you need from me because if I don't there will be consequences". So because masking is essentially performing "mirroring" as selfhood by amplifying or minimizing aspects of yourself based on what you think the other person wants to see in you, it varies significantly from one context to another. The major commonality is that it takes up an INCREDIBLE amount of energy, mental and emotional resources, cognitive processing power, etc. So you don't identify masking by specific behaviors so much as by the feeling of "having a significant amount of your mental/emotional resources be occupied by the act of social interaction" to the point that it doesn't leave enough left-over for other cognitive tasks, or leaves you feeling exhausted and worn out, or basically by the impact that masking has on you during and after.

In this framework, part of why we get so anxious about new or unfamiliar people or situations is because we don't know how to mask in that context yet, and so until we get there and figure it out, we're basically just terrified of what could go wrong since we don't know what we're walking into.*

*This is the underlying framework of anticipatory and obsessive anxiety as well. Anticipatory and obsessive anxiety functions as the mechanism by which we conduct both predictive reasoning-basd advance planning and review/self-correctionof our mental predictive model.

Autistic aversion to uncertainty has a lot to do with our need to be able to use predictive reasoning-based advance planning to cope with "social deficits" aka how much harder it is for us to interpret subtextual/nonverbal cues, learn/meet social expectations, and work through/around disordered sensory processing. That predictive reasoning requires us to be familiar, in advance, with the stable constant factors that influence decision making in social contexts. If we aren't familiar with the constant variables than we can't plan, if we can't plan than we are more likely to make noticeable social mis-steps, and if we take notable social mis-steps there are consequences. It becomes necessary for us to be hypervigilent to observable patterns in other people's behavior in order to try to reverse engineer the social interaction playbook on the fly. That ends up making us more likely to assume personal responsibility for predicting and managing the emotional regulatory needs of people around us at all costs, replicating the behavioral/cognitive impacts of chronic traumatic stress due to the activation of our sympathetic nervous system from chronic hypervigilence.

Essentially, masking is a cognitive defense mechanism to severe and/or persistant traumatic interpersonal stressors. As the neurological impacts of chronic traumatic stress heal, we mask less frequently. But in order to heal from chronic traumatic stress, the human brain requires a safe environment that does not trigger a retraumatization episode or replicate feelings of helplessness/fear for safety. In other words, reducing/terminating masking safely requires us as autistic people to have consistent access to social environments in which we are able to utilize autistic interpersonal boundaries without fear of consequence or chonically unmet need. This requires the people around us to be able to respect not only autistic interpersonal boundaries, but also autistic self-expression/advocacy modalities and mediums.

I feel like a lot of the pieces of this framework have been rattling around in my head for a while but the flavor of words hit just right today and all the connections snapped into place.

Anyway, I'm still sort of sorting through the clinical implications of this framework but I think it's a direction I want to keep exploring for sure.