#embodied diagnostics

[bsahely]

Biosemiotic Medicine: A New Healing Paradigm | ChatGPT4o

[Download Full Document (PDF)] This manifesto and white paper proposes a transformative vision for medicine, rooted in biosemiotics — the study of life as a meaning-making process. Instead of seeing the body as a machine and symptoms as malfunctions, Biosemiotic Medicine treats the body as a living sign system, symptoms as meaningful signals, and healing as the restoration of coherence across…

[lucysweatslove]

If I cry any more today I might shrivel up from dehydration like a raisin

[trans-axolotl]

also in regards to that last article about varied ways of thinking about psychosis/altered states that don't just align with medical model or carceral psychiatry---I always love sharing about Bethel House and their practices of peer support for schizophrenia that are founded on something called tojisha kenkyu, but I don't see it mentioned as often as things like HVN and Soteria House.

ID: [A colorful digital drawing of a group of people having a meeting inside a house while it snows outside.]

"What really set the stage for tōjisha-kenkyū were two social movements started by those with disabilities. In the 1950s, a new disability movement was burgeoning in Japan, but it wasn’t until the 1970s that those with physical disabilities, such as cerebral palsy, began to advocate for themselves more actively as tōjisha. For those in this movement, their disability is visible. They know where their discomfort comes from, why they are discriminated against, and in what ways they need society to change. Their movement had a clear sense of purpose: make society accommodate the needs of people with disabilities. Around the same time, during the 1970s, a second movement was started by those with mental health issues, such as addiction (particularly alcohol misuse) and schizophrenia. Their disabilities are not always visible. People in this second movement may not have always known they had a disability and, even after they identify their problems, they may remain uncertain about the nature of their disability. Unlike those with physical and visible disabilities, this second group of tōjisha were not always sure how to advocate for themselves as members of society. They didn’t know what they wanted and needed from society. This knowing required new kinds of self-knowledge.

As the story goes, tōjisha-kenkyū emerged in the Japanese fishing town of Urakawa in southern Hokkaido in the early 2000s. It began in the 1980s when locals who had been diagnosed with psychiatric disorders created a peer-support group in a run-down church, which was renamed ‘Bethel House’. The establishment of Bethel House (or just Bethel) was also aided by the maverick psychiatrist Toshiaki Kawamura and an innovative social worker named Ikuyoshi Mukaiyachi. From the start, Bethel embodied the experimental spirit that followed the ‘antipsychiatry’ movement in Japan, which proposed ideas for how psychiatry might be done differently, without relying only on diagnostic manuals and experts. But finding new methods was incredibly difficult and, in the early days of Bethel, both staff and members often struggled with a recurring problem: how is it possible to get beyond traditional psychiatric treatments when someone is still being tormented by their disabling symptoms? Tōjisha-kenkyū was born directly out of a desperate search for answers.

In the early 2000s, one of Bethel’s members with schizophrenia was struggling to understand who he was and why he acted the way he did. This struggle had become urgent after he had set his own home on fire in a fit of anger. In the aftermath, he was overwhelmed and desperate. At his wits’ end about how to help, Mukaiyachi asked him if perhaps he wanted to kenkyū (to ‘study’ or ‘research’) himself so he could understand his problems and find a better way to cope with his illness. Apparently, the term ‘kenkyū’ had an immediate appeal, and others at Bethel began to adopt it, too – especially those with serious mental health problems who were constantly urged to think about (and apologise) for who they were and how they behaved. Instead of being passive ‘patients’ who felt they needed to keep their heads down and be ashamed for acting differently, they could now become active ‘researchers’ of their own ailments. Tōjisha-kenkyū allowed these people to deny labels such as ‘victim’, ‘patient’ or ‘minority’, and to reclaim their agency.

Tōjisha-kenkyū is based on a simple idea. Humans have long shared their troubles so that others can empathise and offer wisdom about how to solve problems. Yet the experience of mental illness is often accompanied by an absence of collective sharing and problem-solving. Mental health issues are treated like shameful secrets that must be hidden, remain unspoken, and dealt with in private. This creates confused and lonely people, who can only be ‘saved’ by the top-down knowledge of expert psychiatrists. Tōjisha-kenkyū simply encourages people to ‘study’ their own problems, and to investigate patterns and solutions in the writing and testimonies of fellow tōjisha.

Self-reflection is at the heart of this practice. Tōjisha-kenkyū incorporates various forms of reflection developed in clinical methods, such as social skills training and cognitive behavioural therapy, but the reflections of a tōjisha don’t begin and end at the individual. Instead, self-reflection is always shared, becoming a form of knowledge that can be communally reflected upon and improved. At Bethel House, members found it liberating that they could define themselves as ‘producers’ of a new form of knowledge, just like the doctors and scientists who diagnosed and studied them in hospital wards. The experiential knowledge of Bethel members now forms the basis of an open and shared public domain of collective knowledge about mental health, one distributed through books, newspaper articles, documentaries and social media.

Tōjisha-kenkyū quickly caught on, making Bethel House a site of pilgrimage for those seeking alternatives to traditional psychiatry. Eventually, a café was opened, public lectures and events were held, and even merchandise (including T-shirts depicting members’ hallucinations) was sold to help support the project. Bethel won further fame when their ‘Hallucination and Delusion Grand Prix’ was aired on national television in Japan. At these events, people in Urakawa are invited to listen and laugh alongside Bethel members who share stories of their hallucinations and delusions. Afterwards, the audience votes to decide who should win first prize for the most hilarious or moving account. One previous winner told a story about a failed journey into the mountains to ride a UFO and ‘save the world’ (it failed because other Bethel members convinced him he needed a licence to ride a UFO, which he didn’t have). Another winner told a story about living in a public restroom at a train station for four days to respect the orders of an auditory hallucination. Tōjisha-kenkyū received further interest, in and outside Japan, when the American anthropologist Karen Nakamura wrote A Disability of the Soul: An Ethnography of Schizophrenia and Mental Illness in Contemporary Japan (2013), a detailed and moving account of life at Bethel House. "

-Japan's Radical Alternative to Psychiatric Diagnosis by Satsuki Ayaya and Junko Kitanaka

[housemdork]

house md rewatch: 1x01, "pilot"

they were all so young! and so orange!

the top of my notes called this one the "smorgasbord of themes" because they had a lot of messaging to urgently shove inside a potential-laden first episode, but i think they captured all the major players: everybody lies, house as god, "you can't always get what you want," and the puzzle and/or/vs. the patient. rebecca adler, the patient, introduces lying in house md before house himself does when she tells her students that they should "never keep anything from [their] parents."

regarding house's characterization, he gets a little lost in the harsher genre-ification of this episode; while he's obviously, clearly the main character, he services the mystery, rather than the other way around. "pilot" doesn't just prop up the medical plot (remember those days?); it centers the episode's tone around an external, viewer-response medical anxiety. the episode ramps up the MRI noises, every choke and gag is exaggerated, and every shot leading us into melanie's insides is long and paired with dramatic orchestral music. given that day-one audiences didn't know whether the illusive dr. house was capable of solving the case just yet, the sympathy engendered for melanie is more powerful than most patient stories in the remainder of the show.

another notable difference regarding house's characterization is his immediate anger episode in cuddy's office when she revokes his 'authorization' (very vaguely termed lol). he immediately starts screaming and yelling - and she immediately condescends to him, which was familiar and funny - and it feels, to a retrospective viewer, very preemptive. as the show progresses, so do the lengths it takes to make house truly angry like that. i'm very glad they dialed that back so much.

# not my greg house ^

cameron, foreman, and chase had instant chemistry, and their teamwork when traching/venting rebecca does so much character work is such a short, tense amount of time. foreman is overly technical and fails to relate to the patient, while cameron levels with rebecca, and, later, chase treats rebecca carelessly, but is the one to effectively trach her in time. the most functionally dysfunctional polycule of all time, truly.

and they each come to embody their own mini house-complexes in "pilot," too! again, foreman is overly technical and slightly alienating; cameron, while abundantly kind, is overly obstinate in her convictions; chase is all about those last minute eureka moments that don't always make up for what goes on in the interim. overall, i would say chase is the most unassuming and underutilized character in the pilot.

transitioning to my favorite core theme - house as god and house md's treatment of faith. i've always been fascinated with the dichotomy house balances - or fails to balance - between loneliness and godhood, a title that his "followers" give him, but one that he clings to for legitimacy. he claims in "pilot" that "humanity is overrated," which is why he removes himself as much as possible from it. next to "everybody lies," this is the show's most consistent motif, and that it was made apparent so early is pretty awesome.

what was compelling about house/god/faith in "pilot" was the introduction of his favorite diagnostic method: treatment. treating the illness before we know what it is for certain. in a paradoxical move, house md demands we have faith in faith; house insists to cameron that he "has no reason to think that it's vasculitis, except that it could be." the episode gives us no recourse; we, along with the ducklings and company (don't worry, i haven't forgotten about wilson) have to go along with him. and the source of their belief and devotion, however reluctant, isn't even sure of his own reason, so he has to have faith in himself, despite being fully opposed to the idea of faith.

does that make any kind of sense? house is treated as god, needs that faith and adoration to validate himself, but also hates the very premise. this exact dilemma comes up in a later episode where wilson begs cuddy NOT to tell house that his diagnosis on a whim was a success in an attempt to deconstruct this problem.

now for some wilson thoughts :)

in "pilot," wilson is either giving uncanny valley, who-is-this-and-what-have-you-done-with-doctor-james-wilson, OR he's giving the most promising glimmers into the best the show has to offer over the next 8 years. one of the funniest parts of the episode is that he's treating rebecca at all because, 1) he's an ONCOLOGIST, and by the time they've figured out that it's not cancer, he's giving her another routine exam, and 2) if rebecca really was his cousin, he probably shouldn't be so involved in the case. not that PPTH cares about that sort of thing after awhile, but this is the pilot, after all.

it's very clear that the showrunners weren't sure what to make of him yet, which is so, so funny and actually gives rise to the show's most brilliant character (IN MY OPINION). thus far, he's personality-less apart from wry, quippy, yet soothingly suave. but his choices and scenes in "pilot" already are cutting through house's armor, and i can't decide how intentional or self-sabotaging this was.

for example, his scene with rebecca, demarcating the second act in the episode, undoes the character work we've accomplished with house so far. apparently, house does care about wilson by an external metric: rebecca's. care and love are not about someone's words but their actions, and wilson agrees that in that regard, house does care about him. the idea sets rebecca at ease about her elusive doctor, at least until she goes temporarily blind lol. yt by the end of the episode, "pilot" reassembles all of house's godhood, alienation, anti-humanity, etc., acting almost as if this conversation never even happened. it's really odd. i love it.

though i suppose it bears mentioning that it's wilson's white lie about rebecca being his cousin that pokes a lasting hole in house's rejection of humanity: "it got you to take the case."

and i can't forget house and wilson's inaugural conversation: "people don't want a sick doctor." "and I don't like healthy patients." who is the universal recipient and universal donor? who is house's keeper, responsible for his happiness? who has a problem with caring too much for a person and then resenting them? that's what i thought. hilson or not, their very first words capture their dynamic in literally 2 sentences. bound for life, wrapped up in the tragedy of house's internalized shame toward his disability, too.

speaking of hilson (season 8 spoilers below):

i don't know how to organize all of this effectively, but if the series finale wasn't planned, then they still wrote such a cohesive show that they could reference the fabric of their pilot episode and reflect it successfully in their parting message. one of the best ways we can measure house's growth is his treatment of rebecca adler's decision to die versus wilson's 8 seasons later.

house condescends to rebecca that everyone will die, that it's always ugly, and that "we can live with dignity. we can't die with it." this doesn't convince rebecca to accept more treatment, however, and house is forced to surrender. he's solved the case; the job is technically done. yet when wilson is undergoing Mega Chemo in 8x19, he begs house to help him keep his dignity by letting him die in house's apartment. house agrees.

in what i think is a direct parallel to wilson's cancer diagnosis, rebecca rejects further treatment because they have no proof in their latest diagnosis, a tapeworm. this reinforces the need to operate off of faith twice removed. in 8x20, meanwhile, the proof of wilson's cancer is what's killing house and demolishing the very premise of godhood as he's known it (i rambled about that here). in rebecca's case, absence requires faith; in wilson's, presence revokes that faith.

even foreman pleads for a real solution: "there's got to be something we can do. Better than watching her die." and wilson delivers the news about rebecca denying treatment: "she wants to go home to die." and, then, cameron with the steel chair: "because you respect her, you're going to let her die."

so, in total, i am super impressed with all that this episode manages to accomplish. it was way too orange, house was pretty one note as they were leaning extra hard into the sherlock side of things, and wilson is just kinda there??, yet it really is bursting with potential.

i didn't expect to write this much and have no idea if these posts will always be so long. i'll never get thru this if that's the case lol.

[transmutationisms]

i do get why people circulate stuff like this but i repeat that i don't think it is that easy to distinguish between 'elective plastic surgery' and 'gender affirming surgery' unless you are solely going by diagnostic coding, in which case -- this type of screenshot is ultimately only circulating support for the exact gatekeeping diagnostic procedures you superficially position yourself as critiquing. tell me where are these elective plastic surgeries where the decisions people make about their desired embodiment have nothing to do with gendered standards of comportment and appearance. tell me where are the gender affirming surgeries where the gendering of embodiment has no relation to other means, such as racialisation, by which beauty and desirability are articulated. define honestly a desired or an 'ideal' embodiment without reference to mutually constitutive notions of gender, race, &c. how about instead, sometimes people do things they later regret and surgery might be one of those things. and gatekeeping it for specifically marginalised trans people doesn't magically prevent that possibility, but actually just forces more people to live in miserable conditions being socially punished for embodiments they want to change. and doing things even if you may later regret them is generally something that you as a person are entitled to.

[themissuswrites]

A therapist's perspective: Astarion and Trauma therapy

So I made a post on reddit... So Enby_Geek posted an interesting thread a couple of days ago but sadly, reddit isn't letting me comment on it on either the main BG sub or this one. I thought this could be an interesting perspective from someone who works in therapy and how they would approach Astarion's trauma.

For full disclosure, in general, I thought Astarion’s portrayal is one of the best depictions of trauma I’ve seen in media, let alone a videogame, and weirdly enough, as a trainee counsellor or therapist, depending on your region, I’ve put some thought into this.

Before we get into this, let's clarify something. Therapy is only for people who are ready and willing to do the work needed for treatment to have a beneficial impact on them. Therapy only works for people who want to be there and who want to work to grow or recover.  This might be something they are implicitly or explicitly aware of, but the long and short of it is you need to want to go on that journey; no one can make you do it or do the work for you. 

Therapy isn’t advice giving, or talking at a client, it's also not about telling Astarion specific things to make him feel better, it's about working with him and supporting him to be able to do that himself. Therapy is about forming a working alliance to help your client, in this case Astarion, explore their thoughts and feelings in a psychologically safe space so they feel better, cope better, and are capable of growth. 

There are times when you have to challenge a client’s perceptions, of course, but I feel sometimes people misunderstand what therapy is intended to do; we aren’t giving advice or telling a client what to do. We respect their autonomy to make bad decisions, but help them understand the feelings, thoughts and behaviours that cause those decisions, but that’s a debate for a different subreddit, and I am not doing this on my main account 😛

General Observations

So, spawn Astarion (depending on player choices) sounds like he is ready or near ready to do that work when he says its time to start living again, and he drops a fair few pieces of evidence that show he is trying to work through and process what has happened to him and what comes next in his life. He’s getting used to having autonomy again, feeling safe and secure and starting to form attachments to the wider group and Tav or the player character, depending on how you play. Ascended Astarion not so much. Ascended Astarion is the embodiment of the cyclical nature of abuse and how destructive it can be both to others around you and yourself. He has regressed on any growth made during the game. A!Astarion probably isn’t going to ever recover or grow back from that because he has power, control and the autonomy he craved to make some terrible decisions, and those decisions probably don’t include self-reflection and keeping a journal... 

Case formulation: Astarion and Complex Post Traumatic Stress Disorder (CPTSD)

Astarion, particularly his spawn incarnation, is the video game poster boy for complex post-traumatic stress disorder. He pretty much fulfils all the diagnostic criteria according to the ICD-11. Bear in mind, this list is not exhaustive, but Astarion arguably exhibits the following diagnostic criteria: 

Experienced or witnessed threatened death or sexual violence- becoming a spawn,  two centuries of torture and sexual slavery, being compelled to bring back victims and the loss of all autonomy and identity. Being kidnapped, tadpoled and then waking up in the middle of nowhere, it's a long list. 

Intrusive thoughts - flashbacks to Cazador, torture that seem to be re-experienced throughout the game, depending on decisions taken by the player. 

Issues with cognitive development- This one may be a stretch, but given Astarion’s youthfulness for an elf, he also demonstrates some cognitive issues that can be attributed to his prolonged trauma, such as issues with organisation and planning, which are usually seen in adolescence. 

Dissociative episodes during high stress- an obvious one appears to be that sex is a trigger that causes Astarion to disassociate.   

Self-worth issues- there are multiple points where Astarion voices or demonstrates the belief that his only value is sex or seduction. 

Issues with regulation - we see this with him using alcohol as a crutch, frequent anger, distrust and scepticism either at gods or his companions, to name a few.

Difficulties in feeling close to others or maintaining relationships- Act 1 Astarion is arguably avoidant of any meaningful connection and struggles greatly for some time in becoming comfortable with the concept of a relationship.

And that’s just a small start into the many, many issues of Astarion. So, with that in mind, let's look at possible ways forward for treatment and healing that could be for Spawn Astarion if Faerun had/has therapists. If I were Astarion’s therapist, I would be looking to utilise the Tri-Phasic model for trauma therapy or three-phase trauma therapy, as it seems best fitting for trying to work with the experiences of Astarion and his captivity. Across the three acts of the game, I’d argue that Astarion, in some ways, is following the model in his actions, albeit unwittingly and on a how-to process trauma speedrun... 

I’m not going to delve too far into EMDR or trauma CBT, but you can use these modalities with this trauma model; it all depends on the client’s needs and what they are comfortable with. 

Tri-phasic Trauma model Stage 1’s Safety and stabilisation (dealing with immediate threats)

This stage is about ensuring that Astarion is physically safe and helping him emotionally stabilise himself before starting to attempt to process what has been done to him. Trying to skip to telling the story of trauma generally only retraumatises.

In Act 1, Astarion, who has spent centuries being in peril, vulnerable and powerless with his identity stripped away from him is understandably terrified. As well as coping with the trauma of his slavery and having all free will taken from him. He now has the fresh trauma of what has been done to him by mindflayers, his potential recapture by Cazador at any moment and being marooned in the middle of nowhere with a bunch of strangers that he now has to assess for potential threats with no clear insight into their motivations.

We see an Astarion who now has autonomy, and is now in an environment where, for the first time in centuries, he is not being exploited either by strangers wanting to use him for sexual gratification or tortured and compelled by Cazador. Now, while this is better than his previous situation, for someone who has experienced severe trauma, this shift can feel very emotionally destabilising and a even a trauma on top of trauma. While Astarion is physically safer. emotionally and behaviourally, he is likely to be much more unstable, and we see that at various points throughout the game with his dialogue and actions.

A key part of this stage is regaining control- both external and internal- ensuring the client feels stable and safe at first with help from the therapist, then gradually demonstrating stability on their own using appropriate tools. You are helping someone cope with moving from unpredictable danger to more reliable safety by collaborating with them to create an environment around them of stability, clear and open communication, comfort and, when needed, containment.

It's interesting to note that the Astarion we meet in Act 1 is convinced that only power and strength can secure safety, and the player character, if they choose to treat him with respect, can model the behaviours that allow him to feel safer, show more vulnerability later on in Act 2 and eventually turn down the chance to ascend later in act 3. By the player character's actions, they are disproving Astarion’s internal narrative that kindness is weakness, dominance is strength and asking for help is weak. 

Now as Astartion's hypothetical therapist, when it comes to building a therapeutic alliance with Astarion, to start, I would be working to build a strong, functional bond. This bond is based on trust, understanding and as well as the core conditions, empathy, congruence and unconditional positive regard. I am there to help teach my client about healthy attachments, how this is fundamental to building relationships, while modelling this behaviour in my interactions with my client by setting out what they can expect of me and our work together and the boundaries of that work. As part of our work in stage 1, I would also start to feel out what safety looks and feels like for Astarion as well as his goals for therapy, because that can be highly subjective, particularly when working with trauma.

What is considered safe by one client would not be considered safe by another, and when working through it, we clearly define the goals for therapy. It's not unheard of to have a client say something like Astarion does with “it's time to start living again”. The issue with that is that it's a fairly wide-ranging goal, so we would start examining what “living” looks like, address what is realistic and unrealistic and how it can be broken down into smaller, more accessible goals. It's not uncommon for trauma victims to sabotage themselves, either intentionally or otherwise, because their goal feels too much once they start getting into it.

A key part of this stage is helping to teach your client to self-soothe, and this is all a case-by-case approach. What works well for one trauma survivor doesn’t work for others. While there is essential diagnositic criteria, that doesn't mean there is a default experience of trauma, everyone can feel and experience it differently. Dissociation is a defence mechanism that is an attempt to self-soothe, and we see that happen on a few occasions to Astarion, so that is something for a therapist to be mindful of when working with him. While it is protective, it's also shutting down any sense of self, which is not good news. 

Some of the tools we can use for that are flashback journals, listing and detailing triggers and glimmers, anchors, guardrails (when talking about certain situations or topics that threaten to overwhelm, etc) and soothing lists. Grounding exercises can also be helpful such as the 3:3:3 method or yes, the dreaded mindfulness. As a therapist, you are attempting to teach the client the skills to “rescue” themselves when traumatic memories or triggers arise, without or with less and less intervention from the therapist when remembering traumatic thoughts, until they can cope with them. We are expanding their window of tolerance, we start small and build up their tolerance. 

I would emphasise this is not a short process and can take months or years to get through even this first stage. For someone like Astarion and what he has experienced, I’d say you would likely be looking at potentially years irl before he would be safe and stable enough to move onto phase 2.

Tri-phasic Trauma model's Stage 2: Remembrance and mourning (processing trauma)

At this stage, Astarion hopefully has the tools and techniques to rescue or soothe himself if need be when examining or discussing his trauma. At this stage we move our focus to processing what has happened to him while being more in control - he is less reactive to memories. This is where the intense emotions kick in, but the skills taught to the client in the first stage are there to keep the emotions tolerable as the client’s window of tolerance has now grown to be able to cope with what they are about to work through their experiences. Sometimes it gets too much and that's ok, we pace ourselves and move between stage 1 and 2 as neccessary until the client is ready.

The aim of stage 2 is to acknowledge the trauma, be able to tolerate it and take away its power. 

If you thought stage 1 was a complicated concept, when it comes to multiple trauma, there are a lot of layers to work with as you are working to address the trauma as well as the impact it has had on your life as the client. Here we are trying to help Astarion identify common themes that come up from his traumas, such as the loss of identity and autonomy, rather than give a blow-by-blow account of every terrible thing to has ever happened to him.

I think it's important for those unfamiliar with therapy to note here that trauma therapy does not require the client to remember and relive every traumatic memory. That is retraumatising, and while therapy is work, it is not meant to be an ordeal. The aim is to address the pivotal points that influence Astarion’s understanding of himself, his emotions, behaviours, thoughts and feelings. As a practitioner I would start with the least traumatic experiences and work towards the more traumatic over time. Again, working on slowly expanding that window of tolerance and modeling the trust my client should be able to expect of me.

You are only working with what the client can tolerate and you aren't pushing the client to reveal more than they are ready for, its always at their pace with the therapist intervening only if the client appears to be getting overwhelmed. 

As well as trauma, in this stage, you are also working with the client to address loss. People who have experienced trauma often feel a sense of loss, and therapy can’t undo what has been done; it can only help you live with it. It's ok for someone with traumatic experiences to mourn for the life they could have had, the damage to relationships, and experiences they feel have been tainted by traumatic events. There will also be strong emotions; it's pretty common when working with trauma for clients to have big feelings, anger, shaking, crying, and you would be bringing in the skills in stage 1 to help them pace themselves or soothe as they explore their traumatic memories. 

Tri-phasic Trauma model's Stage 3: Reconnection: reintegration and connection with others

Once Astarion can demonstrate he can keep himself safe, regulate his emotions with all these skills he’s learned, it's time to reconnect with the world, rebuild his sense of self and start building meaningful connections and relationships. You can see throughout the game that the more authentic and supportive you are with Astarion, the more genuine he becomes. 

With the support of the player character (and presumably his therapist), he can demonstrate that he can build relationships and care for others. He is less reactive, focused only on survival and can start integrating the trauma into his life rather than be defined by it. We unfortunately can’t take away trauma fully, but that doesn’t mean it destroys someone or they can’t have a fulfilling life. 

There is the person before the trauma, and then there is the person after the trauma who has learned to carry what has happened to them and reconcile that with their new sense of identity or self.

It's fairly common when working with victims of trauma at this stage to observe them to have newfound levels of compassion and maturity as they look ahead to moving forward past their suffering. We can actually see that happening with Astarion depending on the player's choices. Astarion grows from someone who can be openly scathing of his companions in Act 1 to coming out with lines in the epilogue such as: "They deserve happiness. We all do," and is sincere in that hope.

Returning back to the work of the trauma model, clients can take the work and skills from stages 1 and 2, and add that to what they have learned about themselves and their experiences and use it to live in the present and envision a future rather than being shackled by the past. Astarion is quite literally building a new identity and that is no small feat. It's also common here in the final stage for victims of trauma to grapple with relationships, some of which they might need to end for their wellbeing. For example, I don’t see Astarion keeping in touch with his vampiric siblings, at least not for very long, but that is a whole post on its own about family systems.. 

And that, is the abridged version of how we start to address trauma and dissociation. I feel you could write a dissertation on this and how trauma weaves in and out of pretty much all of BG3 and its characters. Hopefully its interesting to some nerds out there and I might do some more of these on the other BG characters.

I've had a few DM's from people with their experiences with trauma. Ethically, I can't be your therapist, but I can at least give you some guidance on what you should be able to expect from your therapist if you are living with trauma and want to take the next step on trying to work past it with the help of a competent therapist.

This article is a good place to start on what you should expect: https://www.bps.org.uk/psychologist/principles-good-therapy

[deerdoegone]

⊹ ࣪ ˖ 𝄞 some geeky. some from the mid 2000s. some i'm obsessed with. town names are abbreviated.

my waiting room : not much to say about her aside from the two facts that she's where i'd like to permashift to and stay the rest of that aaliyah's life. has been refurnished—heavily inspired by the pink palace apartments from coraline with subtleties of 2000s mcbling meets himegal interview and harajuku (2018). dolly decor and things you'd find in the bedroom of 2008 socialite who was a victim of the bling ring. shared with my loser boyfriend, tomas vrbada who doubled as a childhood static screen crush when i was concerning(ly) young playing mortal kombat nine.

wstpt, new hampshire : east coast vampires in a fictional college town, inspired by twilight, life is strange one, the vampire diaries, and more. embodies late 2000s to early 2010s with emo and indie-twee influences. this reality is of my own, but was HEAVILY inspired by a non-shifting user, so all credit to her and her original work. meet aaliyah doe. my trip to "regular" westport, basically if it was non-horror.

mrcv, california : 2008 ranchos palos verdes inspired coastal city known for it’s mermaid motifs and middle - upper class residents with tons of tourists for the summer and fall months, all trying to catch a real mermaid every year. cliffside homes and country clubs with new york socialites a long way from home. meet aaliyah pearle.

fame, director and screenwriter : hollywood but i wanna pursue my desire to create. first big film around 2011 at age twenty-one. cult following similar to sofia coppola but not in the lana del rey tumblr girl way. be Normal. inspired by david lynch, sofia coppola, jordan peele, and catherine hardwicke. affinity for psychological horror and supernatural. introduction soon.

fame, actress : hollywood but i wanna pursue my desire to bring creations to life. first breakout role in 2009 at eighteen, probably stole the role of jennifer check. idolized by all, sweetest experiences with fans and peers. starts around 2010, can you tell i love 2000s and 2010s media and culture? paris hilton presentation with fluttershy notes. introduction soon.

fame, youtuber / streamer : dolly aesthetic before it was cool. sorta. entirely decked out in pink, starts around 2019. does a bit of everything? get ready, gaming, makeup, come file my taxes with me so the irs doesn't take my home. bit of everything like i said. introduction soon.

movie, challengers : still building this reality don't ask questions or i'll shake like an anxious sick old dog (jk just ask and i'll answer as best as i can) introduction soon.

television, common law : the final boss against my craving for old bad but fun television. homicide detective. detective work has never looked so trendy. back when beige and brown were the sexiest colors. dark honey blonde hair with platinum highlights that blends into my skin color. bangles and hoops. break room coffee and dollar store cinnamon vanilla perfume. introduction soon.

television, house m.d. : diagnostics team. if a cool teenage girl was also a distant unwell aunt. crushed on a married man. hates the australian. kinda. deserves as many smoke breaks as she wants. attachment to her oncology chew toy. scarily good at roulette and blackjack but shit at poker. introduction soon.

television, my babysitter's a vampire : had this reality before i even knew what shifting was at 14. crazy. haven't tried to shift here but adding it because it is special to me. somewhere between awkward youngest daughter in her human family and the average guilt-ridden white chapel vampire or witch. haven't decided. undead couture. something akin to hannah washington and jessica riley. introduction soon.

video games, life is strange one : indie sleeze before it was uncool. fashion designer with runway model intentions. evie zamora's closet. tragic backstory covered by extroverted party girl persona. haunts the narrative in before the storm. sortakindanotreally friendship with victoria chase. facebook icon. good student and liked by teachers. rachel amber kind of popularity. gossipy. can make really good pancakes, like i'm talking mouth melting, my god. introduction soon.

video games, watch dogs two : ummm pretty hacker girl this reality is very new still but ask questions and i'll answer as best i can!!!! introduction soon.

[atthecenterofeverything]

so sorry if this is annoying, feel free to ignore this. I have a question, and I’ve tried to look it up but I haven’t found a definitive answer. is anti-psychiatry against diagnoses and treatment completely? i know it’s against some diagnoses that I find to be ridiculous as well (bordering on “hysteria”, basically), but I can’t understand if it recognizes things like ocd, adhd, autism? especially the latter as a different operating system and not a spectrum everyone falls into?

not annoying, and a very common question so I'll try to summarize my thoughts here. a few things:

"is anti-psychiatry against x" is not a coherent question - most people who have theorized under that umbrella (and many others who haven't) would have a different answer to this question. I can only answer for my own opinion on the topic, which is not at all the most common even among people who are critical of psychiatry.

regarding diagnoses - I believe there are individual differences between people, and that these differences, accentuated by their circumstances and their life story, can cause extreme pain. that part is real. what is not real is that this pain has some kind of delineated and unified biological basis (no one has ever found a biological basis for any mental illness, in hormones, neurological imagery, or others). but this is irrelevant anyways: psych diagnoses are not made through observation of biological processes but by having a psychiatrist decide how they feel about you and then going ahead with it. there is no characteristic to adhd, for example, that can be objectively observed and identified against a "non-adhd" person. diagnoses are , shortly put, part of a colonial and eugenics taxonomization effort. the case of outdated diagnostics such as hysteria is, in fact, often used to legitimise the current state of psychiatric knowledge as having "evolved" - the issue is not this or that diagnosis, but the entire system of demarcation.

regarding treatment - I think you should be doing whatever drugs you want forever. I think you can find something of value in therapy, personally, as long as you are very careful with the information you divulge, lie to them when necessary, and are aware of the power they are holding over you. psychiatry is in no way necessary for treatment to exist; in fact it controls and restricts access to treatment by sorting psychoactive substances between "legal" (prescribed by doctor, good) and "illegal" (acquired otherwise, not good), both forcing and withholding them from people.

regarding "recognizing" ocd, adhd, autism, as mentioned above, short answer: no. I don't recognize them. it's not a different operating system, and it's not a spectrum everyone falls onto either. it's an insurance billing code. it does not describe any innate truth about yourself - it only records how structures of power, such as the family, doctors, teachers, etc. felt about you and reacted to your way of moving in the world, which is heavily based on your gendered embodiment, race, wealth, physical ability, etc. "but my diagnosis was the first time I was told my pain is real and not in my head!" a diagnosis groups behaviors together and then decide they are symptoms of an illness; that you have the symptoms because of the illness and the illness because you exhibit the symptoms. this does not actually say anything. your pain is real. the violence you experience because and in parallel to this diagnosis is real. the illness as a category isn't.

I would once again recommend reading bruce cohen's psychiatric hegemony (for the marxist theory angle and contextualisation of psychiatry within capitalism) and anne harrington's mind fixers (for the debunking of the biological basis and an overview of the history of the psychiatric discipline).

I know a lot of this sounds like splitting hair about terminology, but questioning the hegemonic psychiatric worldview requires to think hard about concepts and their definition, and take nothing as neutral or, god forbid, natural. and a lot of that is to discuss questions that people dismiss as being "simply common sense"!

[librarycards]

hello ^-^

long time follower, first time [i think] asker-with-anon-off. hoping you are having a cozy week and are feeling hopeful and lovefilled.

we finally got our hands on failure to comply a few weeks ago and are slowly making our way through it. thank you for writing such a beautiful, poetically and symbolically rich, vibrant narrative. really hoping narrator will be reunited with reya far, far away from the Wall [i am a happy endings enjoyer, and love how you weave the web of their growing intimacy].

as for an actual question, can you recommend us some [more] plural fiction about love and resistance?

💖

sending hope & much love right back to you - thank you for the sweet message. part of what matters to me when it comes to failure to comply is that there is a plurality (ha) of possibilities, endings, continuations, (re)imaginings, etc, possible at any given point in the text, and beyond it. i won't spoil / reveal anything further, but keep that in mind always. there is always Otherwise, no matter how grim the Real may feel.

now, onto the question! i answered this a while back, and will re-up the list featuring the recommendations ppl in the notes graciously gave!

Failure to Comply by Cavar. (As you know!)

Veniss Underground by Jeff Vandermeer

Dead Astronauts by Jeff Vandermeer

Embassytown by China Miéville

Someone You Can Build a Nest In by John Wiswell

Poor Deer by Claire Oshetsky

Adding: The Spear Cuts Through Water by Simon Jimenez

These books do not address "DID"/diagnostic language as such, but rather explore concepts of multiple consciousnesses within one body, consciousnesses walking in and out of certain embodiments, the transformation of subjectivities with time, space, trauma, etc., and so on.

Others' recs (from the notes of the OP):

Body After Body by Briar Ripley Page (h/t to the author, @flameswallower)

Love Me Whole by Nicky James (h/t @profiterole-reads_)

Mulberry and Peach: Two Women of China by Hualing Nieh (h/t @flameswallower)

This Body's Not Big Enough for Both of Us by Edgar Cantero (h/t @fredmouseoz)

How to Get A Girlfriend When You're A Terrifying Monster by Marie Cardno (h/t @ritavonbees)

Ninefox Gambit + series by Yoon Ha Lee (h/t @izzetengineer)

Tidal Creatures + series by Seanan McGuire (h/t @izzetengineer)

Set This House in Order by Matt Ruff (h/t @caodhanthecelt)

Freshwater by Akwaeke Emezi (h/t @bluenotemagpie)

Fractured Souls by Tyler Craig Nixon (h/t @bunnidid-reviews - check their blog for more reviews!!)

Chasing Dawn: The Alters by Terra Katherine McKeown (h/t @bunnidid-reviews)

thank you from the bottom of [our] heart for all of these recommendations! and andrea, i hope you find some you like here!!

[diserbillyti]

There's a Kind Of Guy who exists in specifically very online, often political but more often cultural autistic spaces (reddit, wrongplanet, extremely specific bubbles of tumblr and tiktok) that I like to call

The Sheldon.

This post is about a literal strawman I've created based on specific patterns of dumb shit I keep seeing on autistic social media, yes.

The Sheldon is deeply concerned with his self-concept as autistic, but defines autism in a way that is removed from the concept of disability. He's not quite "autism is a superpower," that's a different Kind Of Guy, but he does not like being thought of someone who "can't do" something.

Rather, The Sheldon is the Kind Of Guy who has created an extremely specific definition of "neurodiversity" that is actually just a weird checklist cobbled together from both medical diagnostic criteria and social constructs surronding autism. He measures all other conditions, but especially scary and stigmatized conditions, against that criteria.

So:

foetal alcohol syndrome is not a neurodiversity because it's like, an environmental thing, right?

schizophrenia is not a neurodiversity because it tends to onset in adolescence or early adulthood rather than being "the way someone is born."

personality disorders (especially narcissistic personality disorder for some reason) are not a form of neurodiversity because "neurodivergence doesn't make you a bad person!"

Extreme Sheldons might even claim that ADHD isn't a neurodivergence because "it can be treated with medicine."

Because The Sheldon is never in community with non-autistic/ADHD people (the neurodivergence tags are The Sheldon's haunt), he struggles to reconcile forms of neurodivergence that might arise as a result of other disabilities. So, congenitally deaf people have seemingly universal differences in their auditory cortex and the frontal regions of their brain. There is some compelling evidence that shows hearing loss accelerates neural atrophy and that deaf people may be at more risk of conditions like early onset dementia (also not a neurodivergence due to post-birth onset btw), but this is not a neurodivergence because being deaf is more about being deaf, you see, which means that it can't also be about neurodivergence.

If medical science disagrees with The Sheldon, then the medical science is incorrect. The medical science that agrees with The Sheldon is never incorrect and is always an accurate reflection of the best information possible. If somebody exhibits all signs and symptoms of autism but is not diagnosed, The Sheldon does not consider them autistic, for the medical industry knows best; if somebody they do not agree is autistic is diagnosed, then the medical industry is incorrect but only ever in this isolated instance, and it must be because that bitch was lying, because the only way for a misdiagnosis to occur in a perfect diagnostic system is deception. .

The Sheldon will also cut off various forms of what is socially constructed as autism, denying some people for whom their disability has always been "autism" a self-concept as purely autistic. So people with what used to be considered "autism" as distinct from Asperger's Syndrome, who have been recontextualized into low functioning, who have been recontextualized into high needs, who have been recontextualized into level three, who have been recontextualized into "autism with a comorbid intellectual disability," are labelled as a deviation from 'autism' by The Sheldon, for they 1. do not reflect his manifestation of autism, and 2. kinda make people think he might be like that which is the core fear of The Sheldon.

Which is the point, that The Sheldon is motivated by constructing a safe, clean, comfortable version of autism that allows him to be autistic without being thought of as potentially embodying any "negative stereotypes" potentially associated with autism. The problem being, when it comes to disability, well, some disabled people piss their pants. Some autistic people piss their pants. To be "autistic," and to attempt to create a version of autism totally distinct from ever pissing one's pants, and to inhabit the broad umbrella concept of neurodiversity while doing this, is kind of an inherent contradiction.

The Sheldon is, imo, a cultural force that weaponizes ableist shame and fear inwardly, preventing many autistic-but-raised-able people chasing the dangled apple of conditional acceptance from building cultural connections with the broader disabled world.

[frances-kafka]

Really starting to recognize that the Great Secretary Massacre didn't just impact the women who did those jobs. It actually made a lot of autistic men unemployable, and moderns don't really have a clue how much the older workplace already had built in support structures and literal embodied Executive Function. This is part of my whole structural analysis of how a lot of neurodivergent adults simply were never in the diagnostic pipeline before the 1980s.

[all-pacas]

foreman cannot catch a break! first, he has to third wheel chase and cameron, after he has to third wheel chase and thirteen, his ex-girlfriend! then he and taub become friends and then chase goes and becomes a favourite of his daughters.

No wonder he continues to hate chase, I'd be pissed if some guy easily got everything he wanted in my life too

HONESTLY I could and probably will someday write up a whole thing about this, I know you're joking (and correct), but I actually find Foreman and Chase's antagonism really interesting and way more interesting than the bland "aww they're besties" read you sometimes see. They're really not!

Chase is basically. Chase is basically the embodiment of everything Foreman hates, pretty literally. Foreman has an inferiority complex and suffers massive imposter syndrome; Chase is literally a nepotism hire with a famous father. Foreman works his ass off; Chase is notoriously lazy but genuinely talented.

There's this line in Post Mortem from Chase's other hospital nemesis:

CHASE: If you really think I'm a good doctor, why do you treat me like an idiot? TREIBER: It's not because you lack talent. It's 'cause you've wasted it. Did you know I applied to be a fellow with House the same year as you? CHASE: No. TREIBER: Quit my other program, relocated, broke up with my girlfriend. Then your father made a call, and suddenly you had the spot. CHASE: That was almost ten years ago. TREIBER: Do you know what I could've done after even three years with House? Gone to the CDC, W.H.O. Started a diagnostics department someplace they'd never even heard of such a thing. You've been given everything. Looks, talent, my future. Nine years later, look what you've done with it.

This could literally be Foreman talking. Chase is rich, successful, he's socially very adept (something Foreman struggles with); on the surface he never seems to have to work hard for anything, he never seems to try hard or care. He fucks over House with Volger and gets away with it. He gets fired but keeps managing to fail upwards, and meanwhile Foreman is the one with a shitty reputation who can't get a job anywhere.

Foreman came from nothing, he overcame so much, he has overcome literally all the odds and worked his ass off and done everything right. And he's wildly successful, for sure, but it's work. "Chase doesn't care about this job," he tells House in S1. Chase doesn't deserve to be in the same place, because Chase hasn't worked for it.

There's a very interesting class/racial subtext to it all too, of course. We know Foreman resents poor people and the underprivileged, people who remind him of himself. Chase is literally the one percent: a good looking White Man, the scion of a rich and powerful family. He is everything Foreman isn't. Even their dynamic is kind of telling of this: Chase never seems to take Foreman all that seriously. He takes the piss a lot, he enjoys making fun of him and trolling. Chase does this with everyone, it's not personal, but it's kind of insulting, right? Chase kind of treats Foreman like a joke. Where Foreman can often be very rude or even mean to Chase (his insistence that Chase must have ratted to Tritter and is that spineless and making fun of his dady issues in Finding Judas comes to mind), Chase doesn't return the favor in the same way. Foreman is mean, Chase is sarcastic. Which is of course also hurtful. Which of course also makes it seem like Chase looks down on Foreman. I'm sure that's how Foreman takes it. It's true. Chase is pretty fucking dismissive of Foreman. I don't think it's a class/racial thing in the way Foreman's resentments probably are — Chase is kind of dismissive of most people — but it doesn't help.

And, of course, Foreman isn't completely right. He's biased, he's in his own way kind of a snob, there are several examples of Foreman completely misinterpreting Chase as a person: my favorite is in The Mistake: in an episode showing Chase bonding with Kayla and her brother and taking a sincere interest in Kayla's kids, Foreman bitterly complains to Stacy that Chase doesn't care about his patients. But Chase isn't exactly jumping at the bit to open up to Foreman, even when Foreman does try and reach out (Socratic Method, post-S6 divorce). They're kind of… fundamentally incompatible people. They're eventual friends, they respect one another, but they're just incapable of seeing eye to eye.

[housemdork]

house md rewatch: 1x08, "poison"

the diagnostics department is poisoning its devotees to act just like their idol. chaos ensues.

this one felt good. it feels good to be hit over the head with some over obvious messaging every once in a while, especially when that messaging is very fun, exciting, and character-driven. PLUS we get major house and foreman dynamic development! i am very pleased.

this episode very conveniently comes in thirds, represented by each time chase, foreman, and cameron misstep during the case (in that order). they're confronted with a helicopter mom who reacts, in their view, poorly to how the diagnostics team treats her son. in my opinion, she's one of the first to rationally question their central practice of treating to diagnose, so it's funny how they all immediately get pissed off and write her off as crazy. i'll break down this first and move into other sub-conflicts/plots.

house demands to know why foreman cares so much about the case from the very second he presents the file to house. he's asking nothing but leading questions, of course, because he can tell that foreman's base interest comes from just that - blanket curiosity - rather than a more cameron-esque bleeding heart. house identifies a burgeoning house-ism in foreman, and it's one of house's most dangerous.

chase's tendency to be cavalier causes the mom to toss him off her son's case. he doesn't often weigh the consequences of what he's going to say in conversation, so long as it gets the job done, gets the patient to comply, gets the diagnosis clear and under control. yet another house-ism. yet, unlike house, chase doesn't have the necessary thick skin to bear through the pushback his big mouth gets him.

cameron's stubbornness could not present in a way more dissimilar to house, yet it's their strongest and clearest connection. she's also the last of the ducklings to be sent in to deal with the helicopter mom and, frustrated that she's compromising the diagnostic process, says that "no, it's on you. you need to do better. right now. yes or no." it's easy to put those words into house's mouth, but, not long after, the mom also boots her off the case.

each of the ducklings embody their own house-isms, but to varying degrees of failure. it seems like 1x08 may be highlighting the missing component for us: house combines all 3 of the aforementioned traits, rendering him pretty darn miserable, which makes him less compromising, less kind, and more convincing.

above all else, though, foreman gets the spotlight this time, which is refreshing after several chase and cameron-heavy episodes. while investigating the patient's home, cameron comments that he's "deflecting a personal question with a joke. gee, who do i know that does that?" foreman, understandably irked by this question (because, for nearly the full duration of this show, i believe that foreman does NOT like house), retorts with, "yeah, i'm just like him, except for the angry, bitter, pompous cr*pple part." he misses all the true comparisons to be made between himself and house thus far: their ambition, love of the puzzle, and the same cynical way toward others. and, just like how house md presents love in all its dimensions across several characters, the show will also present these traits in their character foils as equal parts good and bad.

later, when trying to make another appeal to the mother of the patient, she freaks out on foreman, too: "you're just as pompous and superior as [house] is!"

1x08 also presents these foreman/house similarities as inescapable. house is thrilled that foreman isn't making up with the mother by the episode's close, but foreman doesn't know why he would do that at all. never fear - house knows! there's no reason to make nice with her if "you don't care about her. or her son." immediately following this, foreman and house leave together in the elevator, where house smugly realizes that they do, in fact, where the same shoes. ugh, to respect someone so much and detest them at the same time is such an insanely interesting character dynamic.

a brief chase/daddy issues moment rears its head, too. he's able to redeem himself for his prior failures with the patient when he fakes a phone call to the mom from the CDC, since she won't go ahead with house's treatment till she hears their second opinion. not only is this ingenious and horribly manipulative, it also impresses house, a rare thing. i'll never forget the absolute elation chase feels after earning this fleeting approval, complemented nicely by a literal glow passing over their heads between shots.

that's his DAD, you guys.

there's another separate thread i want to highlight happens during cameron and foreman's conversation about house. foreman is upfront about house and vicodin - he's an addict. he uses vicodin to get through the day and can't pass easily through one without it. but cameron is so resistant to this. disputing foreman's diagnosis, she says, "he's not an addict. he has to take drugs. he's in pain!"

there are so many distinctions throughout house md about the root cause of house's addiction, a conflict that will basically tear up his relationship with cuddy and (very nearly) with wilson, too, in the distant future. oftentimes they're insistent that his pain is psychosomatic, therefore "less real," or it's phantom pain, or it's just Not As Bad as he claims. cameron makes a unique divergence from this separation of disability, addiction, and pain, by removing all traces of responsibility from house. it's all pain, so it's all okay. most people claim the opposite and put all the onus on house without factoring in the hand life has dealt him.

this is very in character for cameron thus far, as she wants to bring out the best in house, the kind of "best" that may not even be there in at all.

and, finally, 3 small notes:

hugh laurie has just about Found House at this point. the above picture says it all. he's endearing and funny and still a little evil.

wilson was there. this was probably his most "i, too, am in this epsisode" episode to date. i do love that he showed up solely to read the love poem the 80-year-old syphilis patient wrote for house, give him the test results that he had no business handling, and then leave. and he looked good during it all!

cuddy said like 3 words all episode :(

[hiveswap]

When i saw people say laios is autistic i didnt know that he'd embody the entire diagnostic criteria like this

[intervex]

Cripintersex (intersex-disability survey results part 4)

Cripintersex: an intersex individual who considers the intersex community to be a member of the broader disability community and/or that intersex rights/justice should be considered part of the disability rights/justice movements. 💜

In the survey I recently ran where I asked people about candidate terms & flags for disability-intersex intersections, this was the overwhelmingly favoured candidate term for this meaning.

It had a weighted average score of 4.4 out of 5 (5 is strongly agree / highly suitable). Screenshot of spreadsheet is at bottom of this post. Part 1 (has a similar flag) - Part 2 (has analysis info) - Part 3

For the Discourse-Averse

Given this is Tumblr and the word crip has a way of evoking Discourse, multiple survey respondents and people in my notifications requested that a non-crip term ALSO be coined should cripintersex come out on top. Which it did.

I'm going to suggest sociodisabled as a term for identifying as part of the disability community, and politicodisabled as a term for identifying as part of the disability rights/justice movements more specifically. So intersex-sociodisabled would be sociodisabled on the basis of being intersex.

These terms weren't in the survey (alas!) but came out of a suggestion made in the open-ended feedback for sociodisintersex as a non-crip alternative. Thank you, anonymous respondent! 💜

I posted a similar-looking flag for this meaning in Part 1 of the survey results, that I'm tentatively thinking of as the intersex-sociodisabled flag. This flag is different in two ways: - it uses the stripes from the Crip Pride Flag - the yellow background and purple ring now match the yellow and purple used in the Crip Pride Flag (which I'm also hoping will help with eyestrain 🤞)

And now: Some Discourse

With that out of the way, I'd like to carefully point out a few things in good faith. I've been doing a bunch of thinking on this and reading a lot more about cripplepunk. 💜

Some folks have pushed back on the idea that crip would be appropriate for intersex on the grounds that "crip is for physical disabilities". I would gently like to respond that the most common interpretation of the term "physical disability" is a disability which affects the body (i.e. not mental). 🙂

If one is to understand intersex as a disability, and then try to categorize it as mental/physical/sensory, intersex would be a physical disability. Being intersex is a physical, embodied thing. It is not a gender. It is not a brain thing. It's a category of physical differences. Physicians understand us as physically disfigured and/or having a chronic condition. They consider us within the scope of teratology research, just like Down Syndrome and kyphoscoliosis.

This is why there's a long history of physicians using the term "cripple" to describe intersex people. Historically, intersex people have been understood to have a physical deformity. This language persists in modern medical literature: e.g. hypospadias cripple is still a formal diagnostic term being used in medicine. 😬

Those of us who understand intersex as disabling tend to be doing so because in ways that relate to how intersex is embodied. Intersex people who identify with disability because of the chronic pain they have as a result of IGM. Intersex people who have unstable hormones because of IGM. Intersex people who have needed accommodations to take time off from work/school for surgeries. Etc.

The reasons that intersex people like myself identify intersex as being in line with the disability community is because our rights struggles revolve around our bodies. Whether we get bodily autonomy. Whether we have to expose our genitals to doctors just for their curiosity. Whether we can access the medicines we need.

The controversy around crip tends to revolve around cripplepunk being explicitly for physical disabilities only.

The tenets of cripple punk that I see shared around state explicitly that: "Cripple punk is not conditional on things like mobility aids & 'functioning levels'" and "Always listen to those w/ different physical disabilities & different intersections than yourself. Do not speak over them"

To those of you who believe that crip(ple) should only be for physical disabilities, I ask you, in the spirit of cripplepunk, to consider that intersex, if understood as a disability, is a physical disability. Best I can tell, room is made in the cpunk community for chronic illness and chronic pain. Why not intersex also? 💜

As best as I understand it, the controversy about who is/isn't cripple largely centres on a sense that people with physical disabilities need space to talk about our experiences without neurodivergent people monopolizing the conversation. 👀

Intersex people participating in disability conversation are very aware that we are on the margins here. People like myself who are inclined to see intersex through a disability lens tend to have other disabilities - often mobility ones (I'm a part-time wheelchair user). I obviously can't speak for every intersex person out there, but from where I sit it seems really unlike that intersex people would "take over" the crip space.

Intersex may not be rare but it's also nowhere near as common as mobility disabilities or neurodivergence, and we're nowhere near as coordinated. As a community we are incredibly fractured, and still in the consciousness-raising days. We are not an organized threat, we're a bunch of people in pain, trying desperately to get doctors to stop performing coercive surgeries on our bodies. 🫤

For some of us, disability rights/justice looks like the best route to go to try and make that happen. I'm far from alone in feeling that the queer community has done an underwhelming job of advocating for our issues, and many of the gains we intersex people have gotten have come thanks to disability organizing.

It's maybe worth noting that a large number of intersex people are resistant to seeing intersex as a disability. Indeed, one survey respondent (out of 30) shared they found pretty much the whole survey to be offensive. This is not something that intersex people are united on. Intersex folks have a wide variety of feelings about where intersex best belongs (queer community, disability, both, neither, etc).

Crip is More than Cripple Punk

This post has ballooned in length but I do want to note a couple of other things about the term crip:

Others have already pointed this out, but crip and cripple in practice are not being used the same ways, and it may be productive to think of them as different words.

"Crip" was reclaimed as a pan-disability term, starting in the 1970s. It made its way into the performing arts in the 90s, and then academic crip theory from there. This activist tradition has been using crip in a pan-disability sense for a long time at this point -- much longer than cripplepunk (coined 2014). Terms like crip time and crip labour come from this pan-disability framework.

Crip continues to be a pan-disability organizing term, such as in #CripTheVote and Crips for eSims for Gaza. Tumblr may skew towards cripplepunk but other spaces lean a lot more towards the pan-disability context - all of the in-person activism I've participated in has uncontroversially understood crip as pan-disability. 🤷

Honestly, I'm not sure what is best going forward when it comes to the cripple usage question. 😵‍💫 Crip is a word with a very well established pan-disability sense.

And it's clear from the survey responses that it resonates with the vast majority of disabled intersex respondents. I didn't think to ask people why - I can only guess that some individuals identified with crip out of the pan-disability sense, and others out of a sense that intersex is a physical disability.

For anybody who wants a breakdown of the ratings of the candidate terms, here are the averages (weighted so people who identified with a given use case / column had a bit more of a "vote"). The use case of intersex-in-disabilty-community is the column titled "COMM".

As always, my flag designs are public domain unless otherwise noted. You are 100% welcome to repost the flag and its definition without all my Discoursing.

I have one more post to write up in this series! We're nearly done! 😅 Thank you for reading, thanks once again to the survey respondents, @scifimagpie, and I'd also like to thank the archival blogs I keep tagging repeatedly for this 💜

Tagging for archival @disabilityflagsarchive @radiomogai @liom-archive @varsex-pride @radiomogai

[arlechinav-blog]

Mediterranean Trancework Part IV: Deity Bridalwork

This one is kind of tough to write about because there just aren't a lot of surviving traditions in the Med that deal with this. Not a lot but there are some. This is the point where things become a little bit more speculative. Due to the fact that a good deal of trancework is psychological and physiological, it is pretty simple to reconstruct this one though. Moreso than other traditions might have been. And that is because there is a very specific spectrum of ways that this can actually be done and be functional.

*Bride is a gender neutral term in this context. It comes from the cultural concept of being horsed or ridden like a horse by a deity. The Bride is the one under the bridle. The idea is that the deity steers the body of the person who is being horsed. This concept is also tied to a permanent relationship, similar to that of a mortal marriage. A deity Bride (capital B to denote a difference between someone engaging with a trance tradition and someone who is getting married) undergoes sacred vows and strict codes of conduct in their daily lives. The basics of that are that the individual must be of good social standing–not an outlaw, a drunk, a thief, or criminal of some kind (though that depends strongly on the deity involved, certain kinds of shady activities might be a bonus depending on the tradition you are engaging with). There should be a familial or an occupational connection to the deity, as in there should be a good unquestionable reason for this relationship and that reason should be conspicuous as should be the deity’s favor. 

There are four kinds of euphoric trance rituals. Each has a different goal and manner of interaction.  

Deity Bridalwork

Prophetic Bridalwork

Coming into the Presence of Divinity

Diagnostic Ritual

Deity Bridalwork

Deity Bridalwork is essentially making yourself into a horse for a deity. This is a culturally encoded concept that means "your body gets possessed by a god." This is done in ecstatic rituals where the deity is expected to be present and presiding. Non ecstatic rituals where the deity is expected to be present and presiding will involve a statue as a substitute for this. Ecstatic rituals are occasions where miracles take place and people get to interact with an embodied deity in the limited ways that would be appropriate--engaging with their preferred rituals tools, foods, colors, scents, drinks, and anything relevant to the current place in the calendar cycle. 

The Goal: To inspire, to bless, to actively participate.  

How Does This Work? 

A Bridal relationship is an act of devotion. At its very core, it is a state of sacrifice. To give up one’s body, to trust, and to be present for the community. It is an honor to participate in but it is a lot of work.  Preparing to perform an embodiment ritual like this starts with preparing the body through fasting, prayer, meditation, and good hygiene. I personally do a vitamin boost and water push during this time as well and abstain from meat (not even handling it or looking at it), alcohol, swearing, and I will wear white for an odd number of days in the lead up–usually 7 because that is the number of greatest fortune. Some deities have sacred numbers though and those may be better to use. 

On the day of, the Bride will take a ritual bath (or multiple) and get fully exfoliated from head to toe of all dead skin while chanting prayers (like the purgation chant). The body is fully waxed (if appropriate for that deity) and then moisturized with oils and bathed in scented smoke. The Bride is then veiled (eyes covered), having never looked into a mirror or into the eyes of another, and taken to the place where they will be dressed. The Bride will then be painted, dressed, and adorned with all of the clothing and tools of the Deity while music is played, cymbals are the most essential component unless it is a nature/agricultural deity–then it is clacking wood or grain stalks instead. 

Once fully dressed, the veil is removed from the eyes and the eyes of the deity are opened. The deity is then fed (or given a drink of) something that they are strongly associated with. From that point on, the transformation is complete and the Bride’s consciousness is pushed aside. The Bride then does whatever the ritual objective for the day or night is. That usually involves multiple activities and traveling on foot from one area that requires their presence to another. Music is played the entire time to keep the Bride in the proper state and to cover any unlucky sounds that may try to break through.  

Links: Because seeing it helps to understand so many tiny details that don’t make it into words. 

Bonalu ceremony for the goddess Mahakali. You can see the Bride’s body is adorned the same as the goddess would be dressed complete with the deity’s familiar tools that she interacts with. Music plays throughout, including drums and cymbals. Music holds up the ritual state, that is load bearing music. You can also see the attendants handing her things and holding her tools that are not in use. People gather to watch. There are familiar gestures and acts done by the goddess that further establish her identity. There are ritual objectives to complete as well–processing through certain areas to bless them, bathing and making offerings, receiving https://www.youtube.com/watch?v=mByafJxhDYU 

Thaipusam is a festival that features a lot of Bridalwork with both deities and spirits. It also involves body mortification, mostly through dermal piercing. This video features close ups of Brides getting pierced. It may not be suitable for all audiences, especially those who have phobias of needles. This is an own voice presentation so we can hear the Bride describe this in his own words. (Many thanks to Cousin Camilo for sharing this with the world.) https://www.youtube.com/watch?v=Qmo0BRMeHK4  

Prophetic Bridalwork

Prophetic Bridalwork involves all of the above plus the added bonus of receiving a truthful statement about matters beyond human perception. That phrasing is important. If a prophecy is truthful and useful then it is divine. If it is untruthful or not useful (or just gibberish) then it comes from some other source--most likely a daemon. The ability to do this accurately and to be able to spontaneously compose it in verse on the spot provides proof of state. In other words, the proof is in the prophetic pudding. 

The Goal: To provide truthful/ useful information that others can act on. 

How Does This Work?

The process for this is largely identical to Deity Bridalwork but instead of processing through the town and using their tools to bless the public, the Bride is led to a place of prominence. Music is played and when/if inspired to do so, the Bride will speak truth through spontaneously composed verse. This lasts until the Bride drops into a PTFO (more like slumps). At that point the Deity has departed and the Bride is fed something mundane to fully bring them back to their body. As a personal note, expect them to be completely exhausted and incapable of doing anything important in this state. They can go with the flow, they can talk, they can be social, they may even get up and dance around a little, but they will definitely be trance drunk and they will not be fully functional until they have slept. 

Presence

Coming into the presence of a deity is done without any kind of embodiment. It is merely a matter of singing the right songs and doing the right kind of dances. These are (usually) stately and highly formal. Most of the gods are dignified in their conduct but there are a few yahoos in the pantheon that prefer a bit more crash and chaos. (Looking at the entourage of Dionysos and Kybele here.) This can be done without a lot of messing around with other forms of trance but you should at least be able to reliably get yourself in and out of a basic trance before giving it a go. The goal of this one is just unity, oneness, feeling close to divinity. It has an extremely positive impact on the mind, body, and spirit of the participant and that is enough of a reason to do it. 

Special Note: Imagine that the single most important holy doctrine in one’s faith was simply “Joy.” The holiness of joy. To experience oneness, enthusiasm, euphoria. To feel compassion and camaraderie with others present, stepping into a communal experience of pure untethered joy. 

The Goal: To be in a state of unity.

How Does This Work? 

Presence ceremonies are handled by organizations like fraternities. As such they will have several levels of education and experience within them and whatever level you happen to be at determines the ways that you might engage with this. In the beginning you will know nothing but you can observe. As you progress you will learn to sing, learn to dance, and learn the philosophies of the individual group. A lot of latent learning happens during ceremonies but there are also occasions when you just get to learn outside of the confines of a ritual. Learn while awake, put into practice in ceremony. 

The movements, songs, and breathwork utilized in a presence ceremony are designed to bring you into a deep and powerful trance. The coordination of it allows for participation from many people at once. It is holy, good, and family friendly. It helps if things are clean, beautiful, and treated with the utmost sanctity. 

The presence of the deity is meant to fill every pocket of the self with love and joy. It is a generous, uplifting feeling. 

Links:

Semah ceremony from Turkiye. It demonstrates what a formal group presence ceremony can look like with participants dressed formally and engaging in the same movements together. Dancing in a large circle as a group and then making personal spins or turns within that wider circle is an extremely effective method of achieving a trance safely in a large group. https://www.youtube.com/watch?v=gFJ_cgpjFyQ 

Semah again, several styles this time. In this one the participants are using coordinated breathwork and well choreographed movements that induce and hold trance. I really like this one because you can clearly see three different types of group dances used in a presence ceremony. You can also hear and see the transitions moving from one holy song to another. Everyone benefits from this. There are dedicated musicians and people who are observing.   https://www.youtube.com/watch?v=USccRnT45cQ 

Diagnostic Ritual

This one relates to the rites of the Kouretes and Koryvantes and to the Orphic Hymns. The Kouretes and Koryvantes performed a ritual in which people would gather and lay very still while priestly musicians played sacred hymns and their special rhythms. If an individual had done something to offend one (or more) of the theoi, then their bodies would begin to contort and dance around ungracefully when that deity’s thread was played. This person could then afterwards perform the appropriate sacrifices and all would be mended. 

The ritual should begin at dusk with the setting sun and end either at or just before dawn. If you finish a few hours early, that's fine as it will then leave room in the night for making those aforementioned sacrifices. In addition to their own rhythms and melodies, each deity will also have a scent trigger (incense) burned at the start of their hymn. Offerings are not made until the end of the ritual though.

The Goal: Bring peace between humanity and the gods.  How Does This Work?

This is done largely the same as a spirit possession ritual and I strongly suspect that this is the origin of all possession rituals in the Med. Special Note: To my eyes, this is what the Orphic Hymns look like they were built to do if sung in order from start to finish.