#i'm assuming most people had short term symptoms

[suncaptor]

(this is purely anecdotal and should be noted people misclick or lie on polls all the time and does not serve to imply the results are accurate. the reality is there is a small chance of severe symptoms from covid vaccination that is much smaller than that of long covid, and it is even smaller if you've not had long term effects already from previous vaccination. op supports vaccination for those who can tolerate it and treats the covid pandemic seriously as well as people harmed by covid vaccination and long covid and loved one's lost from covid)

also if you do have any long term effects would love to discuss about it!

[fryandleelasbigfling]

I’d love to hear you ramble about CPTSD Leela as someone who doesn’t know much about it

so a lot of this is actually inspired by @uleavemebreathless and her experience with CPTSD and how she sees it in leela. i did independently come to the same conclusion through researching symptoms but my angle is more of a psychologist lens than a personal lens.

so CPTSD is complex PTSD and emerges from long-term trauma as opposed to a short-term traumatic experience. this could include war, domestic violence, or child neglect/abuse. so growing up neglected and bullied and told you were worthless and unlovable fits the criteria for the sort of trauma that creates CPTSD.

now a lot of this is pure headcanon because we don't have much evidence of leela having flashbacks and nightmares or dissociating in the manner typical of PTSD. but CPTSD severely affects the way one handles relationships and emotional regulation.

we know that leela has serious trouble regulating her emotions, particularly when it comes to anger, as she's outright said she uses "violent outbursts" as a coping mechanism ("lethal inspection"). she has a particular tendency to struggle with self-regulation when talked down to and told she can't do something -- "the sting," "bender's game" and "mobius dick" have her get overdefensive and ramp up her impulsive defiant behavior because she's told she can't do something and i interpret this in part as a trauma reaction. she has a compulsive need to prove herself. we also see her instinctively fight off people crowding her in "hell is other robots" and she's generally hypervigilant and defensive. because nobody else looked out for her so she learned to look out for herself.

i think she also has a wonky sense of self as part of this trauma, at least early in the series, because she grew up not knowing what her species even was. i think part of why she commits to unhealthy relationships (adlai, alcazar) is because she's desperate for stability and family when she thinks she otherwise has no chance at it. she's better at dumping chaz because by that point she's got a better support system (her parents and fry). but she struggles a lot with trusting fry and sometimes assumes the worst of him because (on top of fry giving her some decent reasons to be suspect pre-character-development) she can't really accept being loved for who she is, she's been manipulated multiple times in relationships and doesn't want to take that risk with fry until she's absolutely certain he loves her.

we also see in the most recent episode she really struggles to make friends and it likely doesn't come naturally to her because she was bullied and isolated for a lot of her life and didn't even want to try until she had something more controlled to practice with (i.e. chelsea). she's very awkward and repetitive in these friendships because it's not natural to keep a relationship for her.

in general i think she's struggling a lot more than people acknowledge compared to characters like fry and we really ought to take that into consideration when discussing her arc. she's come a long way from an awful beginning! i'm proud of her!

[alanaisalive]

The symptom of cPTSD and depression that has probably fucked my life up the most is the one they call "sense of foreshortened future," where you just baseline assume you are going to die sometime soon, so planning anything long term is pointless.

I studied whatever was easy for me in college because I'd never have a career anyway. I took whatever job would pay the rent because I was going to be dead soon, so career trajectory didn't matter.

But most people with a sense of foreshortened future have suffered severe trauma resulting in near death. Mine is not that type. Mine is mostly the result of living in diet/weight loss culture as a depressed fat person.

As a teen, "If you don't lose weight, you'll die before you see 35!" Okay. I'm depressed anyway, and that'll save me a lot of planning.

I kept my end of that deal and didn't lose weight, only to see the goalposts pushed back every time I crossed them.

"You'll die by age 35!"

"I'm 37 now."

"I meant 45!"

I'm 46 now and the whole imminent death from fatness thing was always bullshit. I had 3 fat grandparents and 1 thin one. The thin one died first, and two of the fat ones lived to their mid 80s.

My life is wasted and worthless because I was promised that at least it would be short by people who didn't care about the truth of their claims. They just wanted to scare me into conforming with empty death threats. (You can't scare me! I'm into that shit!)

And yeah, I still could die relatively young. That's the kind of self-fulfilling prophecy that can happen when a person is convinced that long term health planning is pointless. Someone who thinks they're going to die soon doesn't want to waste their limited remaining time jogging and eating kale, do they?

[stiffyck]

So someone who was spewing the tcd angst said something about tcd scar having short term memory loss, and sure. It was probably from some kind of head injury, perhaps the one that gave him his signature scar across the bridge of his nose. And even if it wasn't that particular injury, I'm sure he sustained a few concussions while trying to stay alive.

Like most people who've had any kind of brain/ head injury in the ensuing time he's learned how to cope, though a signature symptom is when he forgets or fumbles his words. Most people who don't know the whole story just assume those fumbles are either a) on purpose for the lulz or b) just scar being scar. They tease him, he takes it with a smile, they move on.

The people who found him when he spawned into Kingdomcraft, who remember when he'd sometimes spout entire paragraphs of gibberish, growing visibly frustrated at his inability to communicate, know that smile never reaches his eyes. They tend to just ignore the misspeak, ask for clarification if needed or, in Ren's case, redirect attention away with a well timed 'that's what she said'.

Someone said there were sad headcanons and angst to be had, so I had to appear and take part.

OH THATS SO GOOD. THATS SO GOOD OH MY GOD.

Scar having trouble saying what he wants to and getting frustrated and when people make fun of it, giggling at him being silly it hurts.

Scar tries so hard and they think its funny.

[possthrowaway4q]

I've learned/realized a lot about my health issues recently, and I... really need some opinions. Particularly from people with traumatic brain injuries. So I'm gonna share my story.

Major Trigger Warning: birth complications, asphyxiation, seizures, child endangerment, medical neglect

(Sorry this isn't under a readmore I have literally never been able to use them on mobile without breaking the post)

I was lied to about my birth story. I was told by my mother that I came into the world a beautiful and perfectly healthy baby (and in her defense she very well could've convinced herself of this). This is, according to what my dad told me now that I'm an adult, completely false. My mother and I both almost died. The doctors didn't believe she was in labor yet. Called it Braxton Hicks for multiple days. Wasn't until one of them actually checked and saw my head that they believed her. Came out completely blue with the umbilical cord wrapped around my neck and was totally silent when they unwrapped me. Had to spend multiple days in the NICU in one of those oxygen tents. Don't know a lot of the details because apparently it wasn't discussed much. No idea if the doctors said anything about potential long-term issues and even if they did, there's no guarantee my parents kept an eye out properly. Didn't find out until a few years ago that I had hallucinations and frequent vivid nightmares as a young kid and the person mentioning it clearly didn't think much of it, despite me vaguely remembering seeing two separate child therapists around that age. Like, early elementary, I think.

That's not the only event though. Summer between 5th and 6th grade I had a drug-induced seizure. I was being watched by a family member who was kind of notorious for hoarding all sorts of medications. Including ones she was no longer prescribed. She didn't keep everything in their proper bottles either, moving pills between and re-labeling them. Including putting prescriptions in OTC containers. I asked for something for a headache. She gave me a pill saying it was Tylenol - didn't even see the bottle it came out of - and left me be again. Wasn't long before I knew something was wrong. Thankfully, I had my phone in my hand and was able to text her before I lost complete control of my muscles. Dunno how long exactly the seizure lasted, but it must've been at least ten minutes because that's how far away my parents lived and they were there with me when it ended. Remember my dad picking me up and holding me until I could talk and move again. We never did go to the hospital. Idk if it's because we all assumed I was fine once it was over or if it was because no one wanted to get the family member in trouble. Would explain why she called my parents instead of an ambulance, I suppose.

Been thinking about that tonight. Realized I was never really the same after that. I went from all As in school to completely unable to keep up with most subjects. I couldn't think or focus, I was in a fog most of the time, was losing large gaps of time and couldn't remember both short and long term things, and shortly after that was the beginning of my three year long psychotic break. Everyone remembers how the start of middle school is when all my mental health symptoms went into overdrive and I was just. Notably worse. And to top it all off, I always have said that my memory of my past seems to only go back to a few substantial memories in 5th grade and everything prior basically doesn't exist most of the time.

So I guess my question is just... could I have brain damage? Birth asphyxia is bad enough, but a 10+ minute long seizure as a child? I'm pretty sure that's way past the threshold of a medical emergency/when permanent brain damage can start. But every time I mention the idea to anyone, it gets brushed off. Either because I "don't need another thing wrong with me" or "does it really matter?" or because neither thing are your typical ideas of a TBI.

Sure, I've got a bunch of other reasons I could have these symptoms. Even just on the mental health side, ADHD, autism, psychosis, dissociative disorder stuff, and it's been too long for any doctor to say definitively one way or the other if they even take me seriously. But... I don't know, could those have contributed? Hell, could that be the root source of some of it that no one connected to because we never talked about it after the fact? (I even completely forgot for a long time. Didn't think it was a big deal. Didn't really understand seizures at the time.) I can't emphasize enough how drastically my health changed after that seizure. But maybe it was just puberty or the increase in difficulty/stress from going from elementary to middle school.

Surely it's possible though that those things at least exacerbated underlying issues or something? I guess the root of my question is whether the traumatic brain injury community would have me. I don't think I'll ever be able to fully, publicly identify that way, but I still desperately want to know if I'd be welcomed if I tried. Could I really have brain damage or am I just being dramatic or a hypochondriac or something? I just wanna know why I'm so fucked up in the head.

[scripttorture]

I came across your Torture in Fiction tab where you reviewed a Doctor Who episode and mentioned your love of the show so I'm going to mention exactly what I'm writing. It's basically a Bill/Heather story after they leave together and I'd like to accurately take into account the type of consequences (short term and long termr) of the entire turned into a cyberman ordeal. So any input would be highly appreciated.

Anon, I think I love you. Lesbian romance in the stars with one of my favourite characters, you are too kind.

 Let’s start at the beginning.

 For those unfamiliar with Doctor Who, the Cybermen are a recurring foe. The idea behind them is that they are people, cybernetically enhanced people with all the ‘unnecessary’ bits removed. Like the ability to feel pain or hope or love. The ultimate aim of the Cybermen is to make everyone else like them. They believe that not having emotional connections makes them superior.

 And in one of Bill’s stories she gets turned into a prototype Cyberman. Except due to some unique circumstances the programming doesn’t quite take. Bill is left with a Cyberman body but her thoughts, personality and ability to feel are intact.

 Through more unique circumstances (which depending on your interpretation may include Bill dying and being resurrected-) Heather restores her body as it was pre-Cybermen.

 We’re never told exactly what happens to Bill. But it’s clear from the context that the procedure is painful and not consensual.

 We do see Bill for a few days afterwards. She struggles to accept that she’s a Cyberman and doesn’t seem to know how to process what she’s been through. She seems more or less OK, but given the short time frame we see her for it’s difficult to say if this is a bad portrayal or not. For some people it takes a while for things to sink in and for symptoms to become apparent.

 Going forward I’m going to assume that’s the case for Bill.

 I’m going to make a couple of other assumptions because there isn’t anything in reality which lines up that well with the Cybermen.

 There is not anything that can really 'take away' all emotions. Some drugs can result in emotional blunting as a side effect, but less intense emotion is not the same thing as no emotion. The intense, invasive surgical procedures that are implied to make a Cyberman are completely fictional, and probably wouldn't be survivable in reality.

 It's a scenario that you'd expect to be traumatic: an extremely painful, invasive act that re-structures the entire body and is done without consent. Given the particular circumstances in Bill's story, it's tempting to compare it to non-consensual medical procedures.

 As a black, lesbian woman who is aware of both modern politics and history it wouldn’t be unreasonable to assume Bill can make the same comparisons I have. Black women have been subjected to forced sterilisation and used for medical experimentation within living memory (see The Immortal Life of Henreitta Lacks for a discussion of unethical experimentation in the recent past).

 Heather is less likely to be aware of this history and these issues.

 As I said there isn't anything that lines up exactly; I keep thinking of forced sterilisation, though this often doesn’t cause lasting physical pain. It also brought to mind some of the… less ethical ‘treatments’ and ‘experiments’ in recent history.

 We’ll assume that Bill has a realistic memory of what happened, that the experience was traumatising and that she isn’t in physical pain.

 I’d also make the argument that turning someone into a Cyberman could be considered torture in the legal sense. It’s done by a group that effectively controls territory, to people who are under their power. It causes suffering and in Bill’s case it is arguably done to punish the Doctor.

 You’ve read the blog before so you probably know the drill when it comes to the common long-term symptoms of torture. Here’s the Masterpost should anyone else want to have a look. I’ll get back to symptoms in a moment.

 In the short term I think that it’s likely Bill would experience something similar to modern survivors of ‘clean’ tortures.

 ‘Clean torture’ is a term Rejali uses to describe techniques that don’t often leave obvious external marks. These are no less dangerous then other methods; people can still be seriously injured, disabled or die because of clean torture techniques.

 But the lack of obvious marks makes it harder to prove a person was tortured. And when the public perception of torture is that it always leaves scars many survivors find they’re dismissed, belittled and denied services.

 People don’t believe they were tortured. Because we are taught that torture ‘must’ leave marks.

 And Bill has just come out of the Cyber-conversion process unscarred. In a world where most people believe that turning back once you’ve been made a Cyberman is impossible.

 This is likely to be a factor if she tries to get professional help as well as in everyday interactions.

 Bill herself might assume that her symptoms are overblown or somehow put on; that they’re not warranted because her body has been perfectly restored.

 When it comes to more long term symptoms, the right choice will always depend on the characters and the story you want to tell.

 Personally I wouldn’t want to give Bill suicidal tendencies or an addiction because I feel like those are symptoms that could shift the story away from the central relationship. I think they’re symptoms that usually demand more focus and that can make balancing them with the central story more difficult.

 I usually suggest that authors try to include memory problems in a realistic way and I think they’d be an especially good fit here. (The Masterpost summarising the most common forms of memory problems survivors have is here).

 Essentially I think that you could use memory problems to highlight how Bill’s time as a Cyberman has affected her mind. So much of our identity and self-image is rooted in our memories. Finding flaws in them, especially around important things, can shake our sense of self.

 And that ties in to the way Cybermen are consistently used in Doctor Who to denote the loss of self. All of the common memory problems could be used to raise these philosophical questions and tie Bill’s symptoms more firmly to the plot.

 Insomnia is a symptom I always find a little difficult because it has so many knock on effects.

 The worsening of reaction times, alertness, coordination, combined with the pain and shakes and occasional visual hallucination or micro-sleep means that insomnia isn’t a symptom I’d recommend for a character like a superhero. If you want the character to consistently win fights then it’s not a good pick.

 Similarly the long term effects on creativity, reasoning, concentration, emotional processing and learning mean it’s a bad pick if the character is supposed to be an inventive genius.

 One of the nice (but underutilised) things about Doctor Who is that the way the stories are typically structured means that not every character has to be exceptional at everything. Bill’s strengths were not superhuman physical combat or exceptional genius (even though she was incredibly intelligent); they were compassion and her ability to form fast, strong friendships with just about anyone she meets.

 Insomnia could fit your story but I think it depends on what you want the characters to do on a regular basis.

 Chronic pain could be a good fit.

 The conversion process radically changed Bill’s body, a change that she more or less refused to accept was real during the story. In those circumstances physical pain can be an interesting addition: it simultaneously acts as a reminder of what Bill suffered and ties her to her restored body now.

 And since chronic pain in torture survivors can be psychological, or a combination of psychological and physical, there’s no reason why Bill’s body couldn’t be perfectly healed while experiencing chronic pain.

 This is also a symptom that characters can be more proactive about. She can try things and find solutions much more quickly then she might be able to for something like depression. Stretches, exercise, mobility aids, organisation, painkillers and forward planning can all be helpful. And early success could help you to show the character feeling more empowered, reclaiming her body.

 I’m not sure if difficulty relating to others would be a good pick, considering Bill’s canonical strengths. However social isolation could be interesting as an obstacle to gradually overcome.

 Going beyond the usual symptoms- Have you read any of the Doctor Who comics? Because I keep thinking of The Flood, which was a Cyberman story with the Eighth Doctor.

 It had a rather wonderful Cyberman design and had the Cybermen attempting to persuade large numbers of people to volunteer for Cyber conversion. They did it by chemically manipulating the emotions of an entire city; making feelings unbearably intense and then offering the conversion process as a solution.

 Bill kept her feelings but she would have known she was supposed to lose them. And she’d go from that to having incredibly intense feelings. Because she’d have developed trauma symptoms.

 She might be tempted to view her symptoms as the ‘natural’ consequence of regaining full capacity for emotion, rather then due to trauma. Latching on to a physical, rather then psychological, difference.

 I’d also consider whether all of this changes Bill’s relationship with her own body. Relief at getting it back might be accompanied by a heightened awareness of changes, even natural ones.

 I think if I was writing this I’d be tempted to add in little details, triggers or self-soothing behaviours tied to her body.

 The Cyberman chest unit for that design looks heavy. Does compression around her chest make her panic? Do rubber gloves feel horrible? Does the sensation of something going over her face, like the ‘mask’ on these Cybermen, prompt intrusive memories?

 The ‘handles’ on the head were supposed to suppress emotion in this version. Could Bill reassure herself that they’re gone by touching her own hair? Do short sleeves feel ‘better’, because she can feel the sun, wind or rain against her skin? Does she wear her earrings more often, because the weight of them and the way they move is comforting?

 Good luck with your story. I hope this helps. :)

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Disclaimer

[activelyautistic]

Have you ever heard/read anything about the biomechanical pathways of autistic burnout? I'm trying to figure out what might be causing my fatigue, and all the lists of burnout symptoms match up pretty well with my symptoms. It'd be interesting if it had a cellular/immuno cause like ME/CFS, or a nervous system cause, etc.

(╯°□°)╯︵ ┻━┻

Aight Admin S is finally back from the depths of spoonless hell to try to answer this. I really do apologize for how long this took.

Truth be told, I have yet to see any extensive research done on the correlation between these two things, however, I genuinely would not be surprised if there was a strong correlation between the two.

Having said that, I am not certain that it would be exactly the same, CFS, by definition, is a much more long lasting condition than what burnout could ever inflict upon a person. I do think that they would both show up in similar patterns if we were to take brain scans and compare them side by side, though. Because yes, you can literally see fatigue affecting the brain.

My theory is that if we were to take brain scans of two people (in an ideal environment mind you) that were exactly the same except for where one has CFS, and the other experienced burnout, we would see most parts of the brain responsible for processing external stimuli, short term memory, sensory processing, and fatigue would probably look mostly the same. The difference I would assume we would see, mind you, is that in the short term, or at the peak of stress, the person who experiences burnout may show a sharper increase in activity, or it would look as if things may be more severe initially. 

At this point I would also mention that we would have to take into consideration how people process neurotransmitters and hormones as well. People with both conditions process these differently in comparison to abled people, so regardless of which person you look at, they would be processing serotonin, cortisol, dopamine, and various other essential things differently which also can contribute to the difference in brain activity.

And finally, we “take a look” at the brain scans of the person with CFS. I’m sure you’ve done some research of your own if you’ve decided to ask this question in the first place, so I’m hoping you have a basic grasp on the description of the condition. For the sake of anyone else reading my babbling, I’ll explain it shortly.

Chronic Fatigue Syndrome is, in short, long term unexplained fatigue that is not remedied with sleep, rest or breaks of any sort. The typical requirement for it to be considered “chronic” is 3 months or more. Other symptoms that can accompany this are as follows: muscle pain and/or fatigue, weakness, headaches, and brain fog.

So this is where things get interesting. So remember how I said initially things might show up as more severe or as more extreme in the brain scans from someone showing the signs of burnout? The reason behind this is because someone with CFS would have a constant. A constant level of activity (or lack thereof in some cases) in different areas of the brain because of how the condition makes the entire body work and function differently. A person with CFS will always have a base level of activity (again or not) in the brain, and in this example, maybe the part of the brain responsible for fatigue is already fried, so it’s just kind of...there. So it’s unable to show more activity because literally the whole body is just that tired.

Okay, I rambled. A lot. I’m going to put a TLDR: I think there would be a very strong correlation in the neuropathways for showing signs of burnout and CFS alike, however I believe they would manifest and last very differently due to the nature of how they work.

I’m also going to say that I’m not a professional, and I don’t know anything for sure. This is just my theory based on observation.

[angaranexpansionproject]

Hello! I was trying to learn more about the Angaran’s stance on talking about illness and it sounded like sickness isn’t something openly discussed in their society. However, I'm assuming that stance revolves around chronic illness and disabilities rather than something like the common cold or flu. Would appreciate your take on the topic as I'm working on a fanfic where Evfra catches the 'Angaran Flu'. Thanks!

Torvar hesitates, a flicker of tsiddvfira down their jinesh indicating discomfort. “Well, no. The opposite. Especially with firialo (an angaran equivalent to the flu). The Moshae required that we discuss this in an ethics class once, and it was the most bizzare experience... Anyway. Angara do not frequently fall ill to minor diseases. Those who do, they usually recover quickly.” 

They huff out a short breath, then continue quickly. “We do not talk about being sick because anyone who is noticeably sick should not be out and being talked about. They should be at home or with their family’s physician, getting well. If they are not, then they are putting others at risk.” Torvar’s voice deepens in emphasis. “This is not done. People protect each other, they do not casually threaten their safety! If it can make one person sick, then it is severe enough for concern, and should be addressed properly.”

“If I felt that one of my javegara (friends and family), or even a lamik (colleague) seemed ill, I would talk with them privately.” Torvar shrugs. “Sometimes it is only stress. Other times they would thank me for noticing what they ought to have seen. It is often this way with Rollu, my haavolan (partner/spouse). I had not known them a month, and they were infected by a parasite from the lakes that gave them the krits (shits/diarrhea)! Spent a week at our home recovering, in Jaal’s old room actually.” A wide grin splits their face at the memory, and they lean back against the workbench, finally relaxing. “They are from Kadara, and had no family here to care for them.”

“Some sickness is not this way, I know.” They laugh, voice a softer rumble than Jaal’s, but just as deep. “That head-splitter we all got from that Drokaalen (Remnant) stasis field, for example. That was a mean one, but no one else was going to be harmed by it. Or kinnonew, that afflicts some of our sages on Mithrava. Their tsiddonew fails them, but it will harm no one else. We care for them well, but there is no shame in discussing their condition openly, or of them spending time with healthy angara.” 

Torvar claps you on the shoulder companionably @fromathelastoveritaserum. “Come, I will send you something on the topic later, we have much to do.”

firialo - a general term for a flu-like disease among angara that is contagious. It causes difficulty breathing, sneezing, congestion, coughing, all around feeling like crap (like the flu!). Hence the name, "violent breath"

tsiddonew - photosynthesis, generating energy from light or otherwise using light for a biological process. Lit: energy light within

kinnonew - terminal degnerative disease where angaran photoreceptors no longer properly absorb energy, so they lack tsiddonew (similar to photosynthesis). Lit: without light within

krits - diarrhea, the shits; a disease symptom

[ficsinhistory]

Sharly - An Analysis

Hello! As I said, this is a post analyzing my favorite couple from The Good Doctor, Sharly! Believe it or not, I've seen them as a couple since 'Mont Rushmore' and the end of the second season made me thrive! I wanted to make this post because besides talking about my babies, I want to show that although surprising, the writers already showed that it would be possible to happen. Making it clear that my intention here is to speak my point of view, if you are not ship is ok, we can all have different opinions. Second, I am a neurotypical person, so I will explore more Carly for reasons of knowledge, not leaving Shaun aside, of course.

I, at least, since the first time I saw Carly, I've been shipping she with Shaun. I like her personality as we saw in the incredible episode between her and Claire, for example when Carly said that guilt shouldn't always fall on the lab every time some sample was lost, but also not insisting on it after the search (besides the fact that a duo between these two is iconic by itself) and how Shaun feels comfortable around her, which is very important in any relationship.

When they met, their interaction already showed how reasonable Carly is. Shaun is wanting to accomplish the tasks in the best possible way, including wanting the exam as quickly as possible as Melendez asked. But of course he has to wait and Carly makes this very clear, besides explaining that he can't tabulate the samples in degree of importance as he wanted. That's when he says he's gonna throw a rock in her window. However, I love how her reaction wasn't to get angry or offended, on the contrary, Carly, although initially surprised, followed Shaun's line of thought saying that she really wouldn't like it and in the end said that the test would come out in 15 minutes, making it easier for him to wait.

Despite being firm, she is also a balanced girl who knew, in the short period she had with him in the first season, to understand and understand Shaun, so much so that in the same episode, even if visibly confused, she heard Shaun ask for a series of tests, even if in the series they seemed unnecessary at the time, still trying to alert him that he could stay in trouble, or in "trampoline", where he had scenes that I will comment on after they made me melt.

Carly has always been a kind and worried person, "Intangibles" also shows how much she knows how to work in a team and gets along with other people, including Claire, with whom Carly showed a very great affinity, and now that her character has been promoted to the main cast, I really want to see more of the friendship of these two! She, like Shaun, heard Claire vent while she was still looking for the sample. Besides having an A+ sense of humor!

After that, unfortunately, there are no more appearances of her in the first season, however, Carly comes back at the end of the second and in ways that made me ship Sharly even more. As soon as Shaun gets to pathology, I just absolutely love how excited Carly is about the fact that he works there! She gets him excited and says she doesn't need to be called Dr. Lever, showing that she wants him to feel comfortable and seeing him as someone accessible, besides understanding that it must be all too new for Shaun, it's 'like going to Disneyland for the first time'.

I also like very much how it pays attention when Shaun sees a biomass printer and uses the term "we", not only to say that it also works in pathology, but to show that it is including in this world and that it is part of a team, which makes him happy. She also asks him if he wants to test the machine and comfort him by saying how important and vital their work is. This reveals that Carly imagines how much Shaun loved being a surgeon and does everything in her power to make him more comfortable on the spot.

Much of their interaction in this episode is Carly trying to help Shaun move on, which due to the short time they had and because she is not part of a more immediate circle of Shaun's coexistence, she can't cope with the fact that he insists so much on going back to surgery. Even so, he doesn't get angry at her, thinking she doesn't understand, on the contrary, Shaun has a positive view of her, so much so that in "Breakdown", while talking to Lea, he remembers her after a comment and speaks of several quality of her, saying that Carly is intelligent, nice and aggressive, also casually commenting that she wants him to stay in the department because Carly thinks that they are a good team.

I love it, very much, because Shaun doesn't like the pathology, he doesn't want and doesn't like the idea of being there, but, he likes the presence of Carly, he feels good in her presence and, when he talks to Lea, he visibly already shows that he is slowly falling in love with her and that's very cute! Shaun has difficulty with some parts of the social interaction and, he's working on it including, so I think it's sweet and touching how quickly he came to the conclusion that Carly likes him, and how she makes a point of showing that too, revealing a great dynamic of friendship, which later evolved into a romance, where both express affection and are open about it.

"Trampoline" for then, was the peak of their two this season and showed how much they both care. When Claire is helping Shaun practice flirting (the scene was iconic with Claire advising him, she is a roll of cinnamon too pure for this world), it is clear how scared he is of being rejected, due to previous experiences and shows how much he really wants to try a relationship, showing that not a bit one-sided this romance, at least when it comes to Shaun.

They'll talk to Carly later, who makes it clear she misses Shaun in pathology. He, on the other hand, don't miss the pathology, which she responds with a smile, however, showing that she understands it. Later, Shaun begins to get a more serious picture due to the injuries and tries to get an exam, he goes straight to Carly, and it is in this scene that I may have had a fangirl outbreak.

Carly says Shaun can't order more tests, saying that he doesn't work in the hospital anymore and can't have a patient, already suspicious of the situation. Shaun says said it's from a Claire's patient, but once again, she doesn't buy the idea and says the sample has no name. Shaun realizes that Carly already knows the truth and assumes that she won't be able to do anything, and that's when she does it:

She pulls the sample, and that's when you know she really cares. Carly is attached to the rules to some extent and what he's about to do can get her into trouble, however, she will not only take the test but also ask more to know what Shaun has, referring to him as "the patient", respecting the fact that Shaun wants to do everything with discretion. When he says he's coughing up blood, her face says it all:

She's worried. This is a serious symptom and this fact stirs her up, which then claims it will do the tests. Later, with the results ready, she finds him in the cafeteria and tells him what it could be, when Shaun said he was induced by Trauma. And that's when, for the first time on the show, she interrupts him. Again, Carly shows that she cares about Shaun. She sits next to him and, still referring to him as "the patient", says that the symptoms will get worse and that he needs to take a medicine, which she writes a prescription, to improve. And what follows is a series of cute Screenshots. My favorites are how Shaun looks at Carly and how she watches him leave.

After Shaun passes out, he recovers, Claire manages to save the patient, he gets his job back. The end of the episode without a shadow of a doubt and the most incredible and kind part regarding these two.

Shaun's gonna ask Carly out, who's pretty surprised and stunned. He asks if she would like to go out to dinner and she asks if this is a romantic date, which she agrees to go on. With this, Shaun goes away cheerful and the scene gets even softer with the fact that Carly was watching him go away with a smile.

And that's it. I really wanted them to be the endgame, they have a great dynamic and complementary personality, but that's for the writers to decide. For all intents and purposes, this was my analysis to show that Sharly was always possible and that I can't wait for the third season. Until the next pals, I'm out!

[fallxnprxnce]

How affected would Nuada be if his sister Nuala had the iron malady. Also if that happened, how do you think that would affect Nuada's plans through out the film? You got this! Continue working hard online and offline and I'm sure things will work out! Have a frabjous day!

Okay first of all I just want to saythat you get 1,000 positive karma points for even mentioning my own fictionalillness that I came up with in your ask? Like wut? Thank you for payingattention and even caring about my little brain children? You’re awesome? =)

And again, sorry for this taking a ridiculousamount of time for me to finally answer, but I wanted to really give it somethought and not just write a tiny thing. Today is the first day I’ve had bothtime and motivation to write in like a week.

Also omg, I am trying to muddlethrough these last couple months of work but both my jobs are kicking my assright now. Mid-May, they both will end, and then I’m off until the end of June,so I just need to make it that far, heh.

Now let’s get down to business. XD

If you are reading this and you’re newto this blog or you just haven’t ever heard anything about the Iron Malady, it’s a fictional illness Icreated for one of my literary worlds. I made it more to deal with theissue of high or forest type elves being taken as prisoners of war by humans orsubterranean elves and placed in cells, or to deal with how they feel when theyare very far from home, away from their home forest, not in a forest, or areotherwise around a lot of human technology and civilization. Building on the common headcanon in a numberof fandoms that elves’ emotions are so potent as to have the ability to directlyaffect their longterm mental and physical health, the Iron Malady is an illnessthat arises from the intense feeling of hopelessness or dread that all thatthey have known is lost, that they will never see their home again, or that theworld is changing around them too fast for them to handle. A feeling of beingleft behind, becoming obsolete, or “homesick” for times and places they feelthey can never recapture. That’s a veryquick and general synopsis, but for those who wish to read more, I will directyou to this post where I describe itin more detail, discuss symptoms and stages of disease progression, and discussremedies to ease suffering and/or cure it.

So… how Nuada would react to Nualagetting the Iron Malady would depend upon whether their soul bond would conferthe illness onto him as well. I feellike if she was laid up with the Iron Malady, Nuada would be too, or at leasthe wouldn’t be far behind her. This is for two reasons: 1) they are physicallylinked, so all physical symptoms would be experienced by Nuada in real-time, 2)he would feel her emotions through the bonds, and the very definition of theIron Malady is that it’s brought about by intense feelings of sadness, grief,and hopelessness… which I think would massively affect him, and 3) just knowingshe had that illness would devastate him because I headcanon that that’s whatthe twins’ mother died of, and also just because he would know if Nuala hasthat illness that she must be suffering very badly emotionally. So my veryshort answer would be that he would become ill too, and without anyone to takecare of him, he would die, so both twins would die. If he returned to hispeople and got help, he could be in recovery for weeks if not months, so allother plans of his would be delayed by that amount of time.

Of course, having said all of that,that even assumes Nuala can get theIron Malady, which I believe she can’t. It begins as an emotional illness, afeeling  of intense dread, grief,sadness, etc., and Nuala seems incapable of that sort of emotion. (Disclaimer: Iwill insert at this time for those of you who were just like whaaaaaat? at thatstatement that I am not a fan of Nuala and I tend to have very harsh andpessimistic views of her. If you like her, I do not mean any insult and you arefree to love her if you want. Just take what I say within the context that Ihave a rather low opinions of her as a person haha.) I am not certain exactly the reason why she has a flat affect most ofthe time with regard to the fate of her people, but it has to be one of thesethree:

1) She doesn’t care. It could be possible that Nuala really just doesn’t care whether elves fade or not.If I wanted to be really mean and wallow in my pessimistic views of her, Imight want to say this, but I actually believe this is the least probable causeof her apparent apathy.

2) She can’tcare. It could be, and I think this isentirely likely, that Nuala has just been alive long enough, has seen enoughsuffering, has felt enough pain, and has pondered this subject long enough thateverything has… well… kinda… broken her brain a bit, heh. Not to say she’scrazy or anything, she’s not. But just in the sense of… sometimes you feel somuch that you redline and end up not emoting at all? Does that make sense toyou all? Like if everyone is pushing and trying to get through a doorway but theyall get jammed, then nobody gets through. What if her mind is the door and heremotions are the people pushing to get through? If she could emote, it would bevolatile and explosive, just like Nuada, but she can’t anymore.

3) She’s too wise to care. This sounds nasty, but it really isn’t. Truewisdom is seeing the big picture. It’s stepping outside of yourself, yoursituation, away from material things, away from trivial everyday things, andseeing the grander scheme of everything. Often times when one reaches truewisdom or enlightenment or whatever you want to call it, it involves not onlyan understanding of the greater picture and a detachment from personal desires,but also patience and compassion for others. This results in an enlightenedperson viewing strife and war and suffering as if they are watching TV. Notthat it isn’t real, not in that sense… but as if they are outside lookingin. They don’t place themselves in the situation or empathize, but rather theypractice patient compassion. What’s the difference? Empathy is when I identifywith what you’re going through because I’ve been through it myself or Iunderstand what it must be making you feel, and that makes me either sad foryou or really want to help you. I become personally emotionally involved inyour suffering. Patient compassion is very calmly looking at someone who issuffering and saying, this is difficult for you but you will get through it,and I understand that until you do, you will be upset and not yourself. It’sattributing all suffering to want, desire, and a lack of getting what you wantas far as the material here and now. It’s looking at someone who is in a rageand very calmly saying, I understand that this angers you, and I recognize thatyou are not wise enough to know that this too shall pass. I understand that itwill take time for you to work through this, and that until then, you may beunfit to live with.

I think it is very likely that Nualahas this very serene, wise, enlightened way of looking at the world. It rendersher not really able to get overly excited about much, because to be excited,upset, angry, etc., you have to be invested emotionally. She is an observer,watching life but not overly participating in it except in a few ways she feelsfurthers or maintains the greater good. Nuada and Nuala truly are yin and yang,for she is temperance, patience, understanding, and long-term, and Nuada isvolatility, impulsiveness, intolerance, and short-term. But I feel that that’sbecause Nuada never removed himself from the emotional equation. He’s allowedhimself to feel centuries of injustice, death, loss, and degradation of hispeople, and that has done very damaging things to his mind. Nuala may seem likea whole and better person on the surface, but that is because she has declinedto become emotionally invested in her people’s struggle, which I find shameful.But… it would protect her from falling victim to the Iron Malady.

Alright, SO… Now that we’ve gottenthat out of the way, IF… Nuada did not immediately come down with the IronMalady just by association with Nuala and IF… Nuala was actually capable offalling into the emotional valley that gives rise to the illness… now what?

In the HellboyII universe, I say the Iron Malady arose in elves who feared that their wayof life was falling apart, that it would fall apart forever, and that theywould fade. That despairover their situation of having to live underground, or seeing the humansoverpopulate and all of that, gave rise to this wasting illness that, even whenproperly treated, some simply do not recover from. Nuala and Nuada’s mother wasa kind, loving, and gentle soul, but she was also a fragile one, and she wasnot able to recover. Nuala… I believe would recover with the proper treatment,but that’s anybody’s guess. But even if we’re going to say that Nuada wasn’tphysically affected by the illness, he would still be aware that she had it.Actually, you could argue that he might be able to stop if before it happens,if he really wanted to, because he would be able to sense her emotionally goingdown that path long before it manifests itself in illness. He’s used to beingshunned and shut out by his sister, but if he felt real sadness from her? Ifshe reached out to him for help? You can bet your ass he’d be there for her.

So… I do not ship Nuala and Nuadaromantically or sexually. Yes, I know it’s canon. Yes, I don’t care. XD Butjust because my Nuada isn’t in lovewith Nuala does not mean he doesn’t love her. He loves her like a sister,certainly, and like anyone bonded to someone by their soul for the whole of his life would be. Nuada and Nuala do not have a traditional sense of self because of thisbond. They may exist apart from each other, but never knowing anythingother than feeling each other’s joy, pain, illness, sadness, happiness, wounds,etc. as their own… makes for a bondthat really can’t have any clear labels. That’s part of the reason why Nuada isso angry with and resentful of Nuala, because shunning him is like shunning apart of herself and like denying him a part of himself. It’s as if Nuada was awart on her finger and she decided to, quite literally, cut him off. But…having said that… because of the nature of this bond and Nuada’s own very openand emotional nature, there is no way for him to cut her off completely. So if she came down with something like theIron Malady, all bets would be off at that point. Fights wouldn’t matter.Differences wouldn’t matter. Insults, slights, grudges, bones to pick, none ofthat would matter to him anymore. All that would matter is being there for herand seeing her get well again. He’d worry about the rest later.

His plans for the humans would absolutely takea back seat to being there for his sister.He would return to the “palace,” assuming this is happening before he killsBalor, and would stay there with his sister until she was well again, and basicallywould not accept no for an answer. It isn’t like he would forget about what hewanted to do as far as assembling the crown, gaining the Golden Army, or exterminatinghumans, but rather his sister’s life and well-being would supersede all of thatin his mind. I can’t say that he would be surprised necessarily if she was toget the Iron Malady, but it would only strengthen his anger for humans. He’s alreadypissed off that they killed his mother, the way he sees it, but now his sisteris ill? Hell no.

Also, on a very basic and selfishsense, he would realize that if he doesn’tmake sure Nuala is cared for in a suitable manner and she dies, he would diealong with her. So if he ever intends on going through with his plan, heneeds to make sure he’s alive to do it. I can see this creating an even widerrift between Nuada and Balor, simply because he resents his father for hismother’s death. He feels he did nothing to save her, or at the very least, didnot provide her with enough support in life to prevent the illness fromhappening. Nuada would make sure the same thing doesn’t happen with Nuala.

He would make sure that Nuala was notjust feeling better but had been feeling better for some time before herevisited his plan again. This isn’t like a… take two Advil and call me in themorning sort of illness, heh. It takes weeks or months for a person to recover,and even after they do, they are prone to relapse if they are not taught how tobetter manage their depression or are not left with enough of a support system.I suppose if Nuala really wanted to discourage Nuada from his plans, the bestway would be to tell him that she needed him to stay with her in order toprevent a relapse. But that would assume he’d believe such a thing, heh.

But those are like… ultimate “I getthe Army and then I dead the humans so hard” plans. What about other supportingplans along the way? There are a fewthat I think would be either put off or nixed entirely if Nuala was sick withthe Iron Malady…

He wouldn’t kill Balor. Perhaps that whole thing might have gonedifferently if Nuala hadn’t been there to give consent for Balor’s death decreein the first place, but if she had the Iron Malady, Nuada would right suspectthat killing their father wasn’t what would bring Nuala out of her sadness. Infact, that would only exacerbate it tenfold.

He wouldn’t use the forest god in the way hedid. If anything, he might have brought itto Nuala first and shown her look, one of these still exists and I’m incubatingit, to make her happy. Not… “and then I’m going to use it to kill the hoomins,”haha… but just… “look, there is hope yet.” Maybe the poor forest god would havehad a better ending (or beginning?) and a much deeper meaning if it had beenused in that way. Great. I just gave myself a sad.

He wouldn’t care as much as Abe trying to makemoves on Nuala. Nuada doesn’tlike Abe for a lot of reasons, and he doesn’t think he is worthy of his sister,but… just like with Balor, now is not the time to attack someone she clearlycares for. For the sake of her recovery, I could see Nuada allowing Abe tovisit her. Supervised visits, ofcourse. XD

Nuada’s biggest problem during this timethough, would be not falling victim to it himself. Seeing his sister with the same illness hismother died from would take Nuada to a very rough place in his mind, and Ireally think it would be difficult for him to not fall into a depressionhimself. He would most likely want to stay in her room, sleep by her beside,basically never leave her. He would start regretting things he said and did toher, would start wishing they had been on better terms, all of that. So therewould be a great deal of regret and guilt involved in addition to just thesadness of seeing someone he loves laid up like that. So I think he’d be luckyif he remained entirely healthy himself during this time.

But yeah, that’s my 2 cents… of 5dollars, since this was long as hell, haha… but I hope I answered everythingwell enough! Thank you for sending  thisin!

[t1dlikeme]

Sofie's Story

“When you recognize that failing doesn’t make you a failure, you give yourself permission to try all sorts of things.” ~ Lauren Fleshman, is one of my favorite quotes, and something to remind myself in terms of diabetes management, training, and life! 

Diagnosis 

As a shy high school multi-sport athlete (track, soccer, and skiing) in Albuquerque, NM, I was diagnosed with Type 1 Diabetes at age 16. I went from 2nd in state in the 800 my Sophomore year, to struggling to staying awake in class as a 4.0 student and barely making it through practices and workouts. With no history or knowledge of T1D in my family, we didn’t recognize the symptoms—I had a head-to-toe rash after swimming in waterfalls in Hawaii (may have triggered it) followed by months of losing weight despite eating jars of peanut butter and food each week just to keep energy—which my doctor at first thought “she’s a growing athlete” but we got bloodwork anyways. A week later, after yet another frustrating track meet, I was in the hospital with a blood sugar of 586, and was pumped to finally figure it out (until about 3 hours later when I remember eating a pear and seeing my blood sugar skyrocket, I burst into tears realizing how much of a change it would be!) 

Fast Forward…A Few Years 

After basically wanting to forget about high school (hiding in the bathroom to take shots, self-conscious and developed anxiety about weight gain post-diagnosis and just wanting to fit in), I needed something different. Although being a perfectionist and being shy / hiding from others gave me time to master my A1C early, it wasn’t sustainable and I internalized it all—until I got to college. 2000 miles from home, I chose Marquette 1) for the biomedical engineering program, and 2) for receiving a D1 Soccer Scholarship as a goalkeeper, but what I didn’t realize, is it would teach me to open up about my diagnosis and become a better athlete and advocate. I confided in my athletic trainer, who helped me with check-ins during practice (which could sometimes go 1-2 hours over the scheduled time!), and realizing we needed about ½ cup of gatorade + water every hour, supplemented with pedialyte during preseason. It was nice having my trainer, since I could get around going straight to the coaches (at first I didn’t want it to be seen as a weakness!) and she could carry around my gear for me, if needed.  

While goalkeeping allowed for easier access to management during games, practices, etc. I continued to find myself gravitating towards running, strength, and conditioning. My senior year, I began to go for runs while we were on away trips and started to become hooked—I found new ways to manage my BG’s and low intensity running basically was ‘insulin in my back pocket.! After finishing my collegiate soccer career, I joined the ‘Run with the President’ running group at Marquette with Dr. Michael Lovell (our MU President). It was around this time that another faculty member, John Klika, took me to coffee and was fascinated by my thesis research of designing a lifestyle computer algorithm and model to predict glucose and hormonal levels based on activity, stress, diet, etc. It turns out he was Type 1 himself—and a multi-ironman athlete.  

With a newfound confidence and support group, I gradually built my mileage and learned so many things from John about management, who also joined the running group and convinced me to run my first half marathon. It went really well—until, the group said next step: “the marathon.” I was like absolutely no way, I came from sprints up and down the field and have Type 1 Diabetes—I'm not sure I’m ready for that!  But, I’m not one to step down from the challenge, and I had the group helping me through the whole way. I remember my first 18-miler—5 miles from the end, I couldn’t run more than 5 steps as I couldn’t keep my blood sugar up, even with having the proper supplies, and I was just defeated. My body wasn’t used to this, having to rely primarily on glucose as fuel, instead of an intensity and fuel mix. But, I kept going—my track workouts got faster, and my next long run, 20 miles, no stopping! (It’s also important to note that I was also doing some triathlon training too, which helped keep a balance).  

I was ready and excited. Dexcom in my shorts pocket, 3 gels and gummy bears (of course), and friends cheering every step of the way! It couldn’t have been more perfect—flat line BG’s, fuel every 45 min to steady, the adrenaline rush at the 22-mile mark (the furthest I’d ever run in my life!), all propelling me to a 3rd place finish in 2:52. That was one of the best beers, post-race, I’d ever had in my life. This finish created numerous opportunities for me, including becoming a founding member of Diabetes Sports Project, JDRF Keynote talks, and more training—I wanted to try and qualify for Olympic Marathon Trials (2:45).  Unfortunately, along with these positives, came a very long string (~2-3 years) of off and on injuries—I walked 13 miles of the Boston Marathon in 2017 with a tibial stress fracture, the first of a few, and just could not catch a break. These times had a lot of lows, but taught me the resilience of having other outlets, support communities, and managing my diabetes without the ability to exercise all the time (I had started to rely on this as a form of natural ‘insulin’ all through college and into running).  

Looking back, these years of ups-and-downs were crucial to my development of outreach and community, my career, and finding the right balance of strength and running to stay healthy (turns out, soccer weight training had a lot to do with my injury free 25 years of my life!). I like to call this time falling not failing, something my therapist came up with (yes, I was seeing one, for anxiety and some low grade depression, which is something I will talk about now, since I think it is incredibly important that if you have any of these feelings, especially as a T1D, you are not alone!).  I took a job as a medical device engineer at Dexcom and moved to San Diego, CA, acting as a liaison between clinical, regulatory, quality, design and systems engineers, which was the perfect place for me as a T1D! I started the Dexcom Running Club, and from that, have some of the fondest memories. San Diego is also where I joined Prado Racing Team (PRT), and found my coach, Paul Wellman, who I still work with today.  PRT helped me find the love of running again, and I PR’d in every distance while training with them, and having a lot of fun doing so!  

My time in San Diego culminated with making an attempt at running an Olympic Trials qualifying time at CIM 2019, which I just missed in 2:49. It was such an incredible experience, however, even with missing my goal—3-minute PR, running with teammates, HEALTHY and injury-free for an entire training period, and friendships. I did have a diabetes learning experience, though, which I will take forward with future races—not all nuun is ‘carb-free’! It was on the course, and I assumed it was the zero-carbs flavor, so I took it at almost every aide station, causing me to sharply rise at about Mile 11 (especially coupled with adrenaline), which unfortunately caused some cramping around Mile 15 and slowed me off my 2:43 pace. Luckily, I was able to power through, and I will be more prepared next time.  

Current:  

I have recently moved back to Albuquerque, NM, where I grew up.  After looking for an opportunity to grow my career and move into management, this was the right move for me, and is now allowing me to explore altitude training and new heights, literally and figuratively! My family is still here, and with COVID, it has been nice to be close (and living with my boyfriend, Steve). While I am not training for any races in particular, I’m making attempts at a sub 5:00 mile (currently at 5:05 at altitude) as a ‘mini’ goal, and just trying to enjoy the simplicities of running! I am getting back into the volunteering scene, particularly with my non-profit, Diabetes Sports Project, and of course, JDRF.  

Some Tips, Tricks, and Life Lessons! 

Always be prepared—gummy bears in my sports bra are my favorite! I’ve learned many lessons along the way, including one of my first solo long run experiences with a low blood sugar and having to ask gas stations for a Gatorade that I would come back and pay for later (not my finest moment, but turns out, people can be very helpful!). Always carry a card or cash and know your numbers. Plus, some great times of having snacks on hand: my running buddies favorite line is “Hey Sof! How’s your BG?” “Great!! Why?” “Can I have some of your snacks….).” They need it too, and are thankful for it when they bonk! 

Train with people who know you at your best and at your worst, and your symptoms—those are the ones that can push you through tough workouts to the end when you don’t think you can run one more rep or mile, or can more importantly, tell you when you need a break and to take a step back. It’s often trial and error in knowing what intensities affect your blood sugar the most, but with a community, you can’t fail—you learn. As unpredictable as it is sometimes, Type 1 actually can give you an athletic edge. You have to know what your blood sugar is at all times, and how your body is feeling. No one else has to do that! 

Sofie Schunk

[americanpsycho1991]

hi, this might be way too personal a question and if it is I'm really sorry, but my psychiatrist recently brought up ECT as a possible treatment option for me and I was just wondering what it was like for you, and did it help at all. it feels like such an intense thing to go through but he says it can really help (but i know things work differently for each person). thank you so much, I'm sending you lots of love

Long answer, it’s under the cut

Hi. No need to apologize.  Let me give you one of my classic, incredibly long answers where I say the same thing a hundred different ways and do minimal editing before I post it.

ECT is a lot to think about, and I don’t feel that I was given the proper amount of information to make a well-rounded decision at the time.  In addition to this, if you search online, you’ll find a lot of people writing about their personal experiences.  These can be intimidating, as the accounts that appear online are often the very negative ones, where people feel they were pressured into the treatment and/or sustained significant memory impairment afterwards.  You’ll find people comparing ECT to lobotomies, and saying it shouldn’t be allowed except in the most extreme of cases.  I truly don’t believe that those accounts accurately represent the procedure, but I do recommend you read a few, so that you’re aware of the kind of worst-case scenarios that hospitals won’t tell you about.  I can give you an overview of my experience, and list what I believe are the main things that are important to consider before you make any decisions.  My biggest recommendations are that you a) gather as much information as you possibly can, and b) try TMS first.  I’ll talk a little more about TMS later on.

I got a course of ECT starting at the tail end of an inpatient stay at McLean hospital, through a 2-week residential DBT program on the same campus, and after I went home as well.  I don’t recall exactly how many treatments I was intended to get; I got quite a ways in, but didn’t end up finishing the entire course.I was 19 at the time.  Some of the patients in my inpatient ward felt that the hospital was a little too enthusiastic about performing ECT - while their treatment providers weren’t pushy per se, they suggested it to a lot of patients, and didn’t seem to share the typical view of ECT as a last or extreme resort that many treatment providers have.

McLean - while certainly not perfect - is considered one of the best psychiatric hospitals in the country, and is very much oriented towards research and trying out new and modern techniques.  As such, they’re more than happy to sign up patients for ECT and TMS (which is a less extreme option that I’ll bring up later).  My memory is foggy, but I definitely remember taking several surveys and approving them to be used for research purposes.

I specifically asked for ECT, because I was feeling desperate after two previous hospitalizations and a long list of failed medications.  They gave me a basic overview of ECT and TMS, and signed me up immediately once I confirmed that I did want ECT.

The hospital absolutely did not give me enough information.  I don’t think they fully conveyed the risks, and I think they are far too eager to sign up anyone with any interest in ECT as long as they’re old enough to medically consent.  I was 19 for christs sake, and no one asked me twice.  Honestly, even if they had properly prepared me, I probably still would have chosen to go forward with it, but that’s not an excuse.  And when I say I feel like I wasn’t properly informed, that’s after I took it upon myself to ask extensive questions beyond what was on the pamphlet they handed me.  I still didn’t get full answers.  If you’ve ever been put on a medication by a doctor who didn’t even list the most common side effects, you know how that feels.  Except instead of getting a headache and not being able to orgasm, you can get permanent brain damage.  So.

I don’t fully agree with many of the people online who say that patients are pressured into being lab rats, but I do think that the hospital’s mission to make progress in the psychiatric field is sometimes placed above their duty to provide a responsible level of care to their patients.  So basically the lab rat thing, but a little more forgiving.  And again, my experience is just from one hospital.  There are far worse places to be than McLean, and I’d imagine many of them offer ECT as well.

the procedure: one of the main issues with ECT is memory loss, so my memory of the actual procedure is a little fuzzy, but here’s what I do remember: you’re either wheelchaired to the ECT waiting room, or you walk there, depending on whether you’re inpatient or not. The first time I went there, and I think once or twice afterwards, they had me sit at a little computer station and fill out a basic survey on my symptoms (rate how true each statement is from 1-4, “I feel hopeless about the future,” etc.). Once it’s your turn, they take you to a small room where you lie down on a stretcher.  They might take your vitals, and they have you take off your jacket or roll up your sleeves so they can put little electrode stickers on you. I don’t think they have you change into a gown unless you’re wearing clothes they can’t get out of the way, like skinny jeans or something. They roll you into another room, and they put an IV in your arm and put you out with anesthesia.

You wake up shortly afterwards, in a long room with full of other people waking up in their stretchers, with medical gel in your hair. That’s one of my most vivid memories; always needing to shower afterwards to get the gel out of your hair.  Someone comes over and gives you some water or juice, or crackers, makes sure you’re feeling okay, and after a little while they clear you to go back to the waiting room.  If you’re inpatient, you’ll be wheeled back up to your ward, and if you’re outpatient, they have you sit in the waiting room for a little while longer before they let you walk back out. I always felt fine - well rested, even - after waking up, but some people get more nausea and whatnot. It’s unusual to have severe symptoms. I couldn’t give you a time estimate, but it’s a surprisingly short procedure, and most of your time is spent in the waiting room or the recovery area.

Afterwards, you’ll be very tired and sometimes spacey for the rest of the day. Once I was outpatient, and getting driven to and from my appointments, I would often fall asleep in the car on the way back.  Sometimes I wouldn’t remember things that had happened that same morning.

At first, it seemed to work. On my non-ECT days in inpatient, I found I had more energy, and felt less depressed.  After a few weeks, though, it petered out and I stopped feeling positive effects from it.  I forget who was monitoring my process, but it was mutually decided that there was no point in finishing the full course.

That was about a year and a half ago. Since then, I’ve noticed that I’m more forgetful than before. I’m trying to work out my brain these days (which I probably should have done right away) to try to restore my memory, and many people who do experience short term memory damage say it fades after a few months to a year.  Even if it sticks around (like mine seems to have done), it’s seldom a level of damage that significantly impairs quality of life.  Like I said, though, there are plenty of horror stories online from people who suffered significant, permanent brain damage and have definitely been impaired by memory issues.  Just because it’s uncommon doesn’t mean it can’t happen.  I assumed that because I was young and in relatively good health, I wouldn’t have as many issues as I ended up having.

In addition to the short term memory impairment, I lost the majority of two years of memories.  If you asked me to tell you about the college courses I took during that time, I could only give you a few course titles, a vague impression of what one or two professors were like, and absolutely none of the information I learned.  I had a major confrontation with a family member during that time, that I only remembered happening because my dad brought it up recently. I still only have a vague idea of what was said.  Even my memories before that time are more blurry and distant than they used to be, and many memories that used to be present in my mind are only familiar once someone else reminds me.

Which brings me to some points to consider before making any decisions (in no particular order):

1. Being put under general anesthesia multiple times a week isn’t good for you.  This was a risk that wasn’t even mentioned to me.  It’s not like I didn’t know anesthesia isn’t good for you, but as a desperate, suicidal 19 year old, I was understandably not making the most balanced choices.  And for all the hospital knew, I could have been a very uneducated person.  I don’t blame the hospital for the decisions I made, but it should have been their job to educate me about the risks, make sure I fully understood them, and to the best of their ability, make sure that I was making as rational a decision as a suicidal 19 year old in her third inpatient ward can be expected to make.

I don’t actually know, but I assume the dose they give you for ECT is lower than it might be for surgeries.  I would still recommend you do some research on the long term effects of general anesthesia, because they can be quite concerning.

2. You can lose a significant number of memories and sustain damage to your working memory.  One of the reasons ECT is often considered an extreme resort is because of how common, how profound, and how permanent the side effects can be.  It’s like looking up a new medication that you’re taking on drugs.com and discovering that some of the most severe side effects that you’d expect to be under less common or rare are actually among the most common.  Older people or those with pre-existing neurological issues are more prone to damage from ECT, but it truly can happen to anyone. There is no way to predict it beforehand, and there is no way to tell what damage you will sustain based on how you feel during the treatments.  I sort of subconsciously assumed that, because I often felt fine and recovered more quickly than those around me in the treatment, that I wasn’t getting the bad side effects at all.  Nope.  You’ll often feel loopy, sleepy, or spaced out during the course of the treatment, and you’ll lose a lot of your immediate memories during that time, so it’s impossible to tell what kind of effects you’ll end up with in the long term.

Then again, the treatment does wonders for some people.  It’s a difficult question - do I try a treatment that may or may not help me at all, which may or may not give me long-term memory damage, but which has the potential to make a massive improvement or cure me altogether?  No one can answer that for you.

3. It’s likely you won’t be given an accurate impression of the treatment by the facility providing it.  Stories on the internet will give you the worst impression of ECT.  The hospital that provides it will give you the best impression of ECT.  In my opinion, the “truth” is somewhere in the middle.  Still, ASK.  Be irritating.  Drill whoever you’re talking to.  Ask them what the worst case scenario is.  Ask them at what point in psychiatric treatment they feel it’s appropriate to introduce that kind of risk.  They’ll tell you about the people whose lives were changed by ECT, but ask them about the people whose lives weren’t changed.  Ask them about the people like me, whose lives weren’t ruined, but weren’t saved either.  Ask how likely it is that you’ll end up with a moderate amount of damage and no benefit.  Remember that you can always have ECT in the back of your mind, but once it’s done, you can’t undo it.

Looking at websites like mayoclinic and whatnot does not provide an accurate impression of the risks. It just doesn’t. There’s no one source - except me, of course :))) - that will give you a truly accurate, balanced impression of what ECT is like.  I just googled a few sites to see what they had to say, and their descriptions make ECT sound like a walk in the park.  It’s not.

It’s not a decision that you need to make quickly.  Again, if I had been told I wasn’t allowed to get ECT until I was out of the hospital and judged to be a little more stable, I still probably would have done it.  But again, everyone is not me.

4. How will you feel having ECT as a possibility in reserve vs. having tried it and failed?  Before ECT, the stakes of my psychiatric and theraputic treatment weren’t quite so high.  They were worth a solid try, but there was always this mystical treatment that I could get if my depression got to the point where all that was left was this “extreme resort.”  I always thought it was strange and probably for insurance reasons that ECT was only for extreme cases, if it had such potential to turn my entire life around.  Why wait year after year, wasting my life trying every class of antidepressant and driving 45 minutes once a week to tell a woman I paid to listen to me that yes, I was still depressed?  Clearly I needed help, so why waste all this time making sure nothing else could possibly work first?  It gave me a sense of hope, but it also put me in a mindset where I found it difficult to fully commit to the therapy I had at the time.

The aftermath of ECT required coming to terms with some tough truths.  It was never a miracle cure.  There were perfectly legitimate reasons why it was reserved for extreme cases.  With that sense of hope gone, I felt crushed, but in a sense, I’m better off.  I feel hopeless very often, and I feel desperate, but at least I’m desperate enough to throw myself into the therapy I have, rather than wonder about the possibilities of what I don’t have.

Of course, there’s no guarantee that ECT would fail for you.  It might change your life.  A lot of people who are helped by it will go back every 6-12 months for a “tune-up.”  But I think it’s a significant enough decision that you need to evaluate how not getting ECT could affect your attitude towards other treatments, as well as being prepared to cope in case you try it and it fails.  You need to enter the treatment with the mindset that ECT failing does not mean you’re a lost cause.  It’s an extreme resort, but it’s never your last resort.  Many things - even the effectiveness of different medications - can change with time.  You can even have another go at ECT years down the road, because sometimes it works differently once you’ve had even more time to age and mature.

5. It’s not considered an extreme resort because it’s a risky-but-potentially-miraculous cure.  Like I said in the last point, I’d held misconceptions about ECT and the reason it’s not done more often for a very long time.  It’s considered an extreme resort because it’s an intense procedure, that most people don’t need, and which doesn’t have the greatest track record.  Some people have life-changing experiences with ECT.  That’s fantastic.  But I’ll bet the reason they don’t advertise the statistics is because an awful lot of people don’t.  Medication and talk therapy has a much higher success rate and much less severe or permanent downsides than ECT.  I know I’ve said it a million different ways, but it’s an awful lot of risk for something that doesn’t seem to have a particularly high success rate.

6. TMSTMS (Transcranial Magnetic Stimulation) is like a less extreme, and much more recently invented version of ECT.  I don’t know the exact details of the treatment, but my roommate at McLean (a woman in her 40s, who had gone up and down during the years but still hadn’t given up) was getting it at the same time I was getting ECT.  Instead of shocking your brain and triggering a brain seizure, TMS is a constant electrical pulse. You stay awake the whole time. It also has potential negative side effects, but they’re generally less extreme than those of ECT.  If you’re in the US, many insurance companies have already approved coverage of TMS.  Many patients who were receiving TMS at McLean were doing so as a less extreme alternative to ECT, with the plan that if TMS was ineffective, they would be open to moving up to ECT.  If TMS can help you, it’s much better to avoid undertaking the risks of ECT altogether.  I was desperate at the time and didn’t see the point of going for the milder treatment, but in hindsight I think it’s a much wiser idea.

I’ve actually thought about TMS for myself.  I don’t know what the likelihood of it working for me now, a year and a half after ECT not working, and I’m concerned that it would make my mild tinnitus worse, but it might be a possibility.  Again, it’s a more extreme treatment than most psychiatric medications and talk therapy, but it’s not on the level of being put under general anesthesia and having a brain seizure two or three times a week.

[scriptshrink]

I'm writing an apocalypse. Society essentially ends. One of my protagonists is bipolar (as I am). Part of his struggle for survival involves trying to get hold of medication. Personally, I am not sure how I'd do at world's end if I was also unmedicated. My personal experience does not really include extreme tragedy and threats to my survival. So the question: do people in life-threatening situations find that their illness sort of takes a backseat for a while, or do they make things worse?

(part 2) Would having bipolar disorder make my character more susceptible to PTSD or other issues? Would his learned coping skills or meds kind of insulate him? What are some withdrawal risks if he can’t get the meds?

The Scriptshrink consultants answer after the jump!

Charlie 

I’m gonna answer the questions about meds specifically because I have a lifetime of experience with them and I used to study pharmacology, but I’ll leave everything else out because it’s a bit of a tricky question for me to answer.

Theoretically, the medication could have somewhat of a “numbing” effect (common for mood stabilisers) which would make it less likely for PTSD to develop, but I don’t know if this is a thing that’s actually been studied. I know that my memories from when I was on my first medication are vague and distant, as I felt like there was somewhat of a disconnect between my feelings, thoughts and my actions - but I don’t know if this would be enough of a disconnect to stop PTSD from developing, should I have been exposed to anything traumatic in that time. Also, traumatic memories are processed differently from nontraumatic memories, so its a bit up in the air. 

 As for withdrawal, it depends on the medication, a few different classes of meds are used for bipolar and all have different side effects and withdrawal symptoms. It also depends on the dosage, whether the person is tapering or going cold turkey, and the individuals physiology. We’ll assume, given the scenario, it’s cold turkey. 

So, the common withdrawal symptoms from lithium include: anxiety, headaches, nausea and emotional dysregulation (very rapid, uncontrolled mood swings). Lithium is pretty forgiving in terms of withdrawal compared to other drugs, which I’ll get into. 

Anticonvulsant drugs (valproate, lamotrigine, carbamazepine etc.)  are a lot less forgiving in terms of withdrawal. Mild symptoms include tremors, irritability, dizziness and vertigo. I came off of a drug of this class and I was so dizzy I nearly fell, multiple times. This was at a fairly low dosage too. The main risk with discontinuing anticonvulsant medications is that it can cause seizures. It’s not super common, but it is a risk.

Finally - antipsychotics. These include aripiprazole (abilify), olanzapine (zyprexa) and quetiapine (seroquel) among loads more.  I’ve luckily not been through antipsychotic withdrawal but it’s apparently a special kind of hell. Symptoms like anxiety, depression, confusion and difficulty concentrating are common. Nausea, loss of appetite and diarrhea are also not unusual. It’s also possible for someone to develop psychosis, or at least start to hallucinate, when coming off of an antipsychotic even if they didn’t initially have psychosis. Sudden changes in the dosage of antipsychotics also increases the risk of neuroleptic malignant syndrome, which is really dangerous. 

As well as all these symptoms, there’s the most obvious thing - that the meds are being used to treat a disorder, and now he doesn’t have the meds. It’s common for someone to relapse (usually into mania) while going through withdrawal.

NaamahDarling

You have wiggle room. You can decide on the severity of his bipolar, how well he responds to medication, how well he handles adversity. I would totally believe it if a bipolar character melted down under life-threatening circumstances.  I would also totally believe it if they buckled down and handled it as long as there were consequences.I’ve had withdrawal from Seroquel and it was, indeed, a circle of hell. Tremors, severe insomnia, several episodes of depersonalization/ dissociation.  The worst was the random twitching every minute or so.  Hypnic jerks were terrible.  

Basically, if you WANT withdrawal to be a factor, it sure as heck can be.  You might also consult @scriptpharmacist​ for details on withdrawal from specific drugs.Immediate catastrophes absolutely can drive everything else to the back of your mind. It might be short term, though - days, a couple of weeks at most. And after that, as the acute stress fades, it starts to take its toll, and you can wind up worse than before, needing more intensive treatment. 

Even non-mentally-ill people react to life-threatening situations in different ways. Also, some react really well to, say, a medical emergency (broken leg, kidney stone) but not so much to a natural disaster (tornado, house fire, earthquake, etc.). So there’s a lot of variation within healthy populations.  And even totally healthy people may navigate a disaster and then, once the danger has passed, totally break down.  That’s normal, even for healthy folks, and mentally ill/bipolar folks are the same.How well your character handles pressure is more of a general character trait that you can decide on than one derived from whatever mental illnesses he might have.

Also, bipolar disorder is frequently comorbid (happening together) with a lot of other psych issues.  It would not be unusual at all for your character to have/be more susceptible to PTSD. 

Learned coping skills can help under pressure, but those take effort to deploy and as things become more stressful, coping strategies become harder to implement and may not work quite as well.  It’s rough even if you’re good at it. 

I have a procedure mapped out for panic attacks and even a severe attack is always going to be of limited duration.  Dealing with something like the bipolar depression is harder because it’s not limited in duration.  I have strategies, but it’s harder to take on something so large. 

I would kinda expect a character like yours to have some self-care stuff he’s found that he CAN do, and for those things to be VERY important to him.Trying to get meds even TODAY when they are can be harrowing. My Seroquel generic is HARD to get, but withdrawal from it is AWFUL, so I don’t have a choice. I HAVE to fight to get it. Finding my right generic Wellbutrin was so hard and I do well enough without it, that I just went off it because the stress of fighting to get it was so absolutely atrocious.  

So his meds would have to work WELL and have manageable discontinuation effects to make it worth trying that hard to get them.Readers who HAVE mental illnesses might appreciate a nod in the direction of “he’s tried other meds, and it didn’t work out, it’s THIS ONE that is SO HELPFUL he will PUNCH MUTANT ALLIGATORS to get it!” Trying several meds is common, and it’s also relatable and would be an easy detail to slip in. You don’t have to name them.Check also to see if it’s a drug you have to work up to a full dose of (like Lamictal), so you know whether it’s realistic to have him go right back to taking it like nothing happened.

Disclaimer 

[karasunovolleygays]

That doesn't disqualify you! I currently have an F in all of my classes. I mean, it's not because I'm not smart, but I seriously just can't do the work. I don't get distracted from it, but when I try to sit down and do it, it's like my brain is just going "no no no" over and over, and I just stop immediately because I can't. Do you ever experience anything like that? I don't know if that's my ADHD or something else, y'know?

God yes. This is my constant state of being going through life, and just so you know, it’s not the way it’s supposed to be. Just the constant stress of things needing done that you know perfectly well you can do, but just Starting It or even Thinking About It seem so daunting. It casts such a long shadow over everything you do to the point where it’s hard to enjoy things you love to do because sometimes, you can’t even manage to do that. Then getting overwhelmed by being so easily overwhelmed is another layer of sludge over your already taxed willpower.

For instance, take writing as an example. When my ADHD is in a chill stage, I can sit down and laser focus on writing for hours and hours, putting put 10-15k worth of writing in eight hours or less. That’s actually one of the perks of the type of ADHD I have*. (*assuming my self diagnosis according to studies and questionnaires is correct)

But then Something throws everything off. A change of schedule, an unexpected task of the most mundane sort, and it all falls apart. I rapidly become incapable of anything more than the barest necessities because I’m too bored to get out of my chair or off the couch. Too bored to eat. Too bored to sleep. Too bored to enjoy things I know in my mind give me pleasure (tv, movies, writing, reading, drawing, listening to music, hanging out with friends, sexytime stuff…stuff like that I usually embrace). Too bored to go to work (that has happened to me before and it Sucks).

The worst part about these types of mood swings is how stupid and worthless they make me feel sometimes, especially since I also have depression and anxiety (those ARE diagnosed). I don’t know if it’s something you struggle with, as well, but it’s a cocktail of Can’t Do Anything, Worrying About It, and Hating Myself For It.

In short, I’m not a professional, but if you see adhd symptom posts and identify with even a couple of those factors, it’s worth getting checked out because you more than likely do. About 4% of all American adults have it, after all. I’d dig more for a comprehensive study in multiple nationalities, but the ultimate irony is that my brain got bored and itchy doing the search. >.>

Choose your medical professionals wisely because not all of them are qualified to help you through it, yet they still carry the power to send you down an even worse path with incorrect diagnosis or the wrong meds. If a visit to a professional isn’t in the cards for you for whatever reason, there are things you can do. 

Talk to the people around you and let them know that you have a problem and what it looks like/feels like when this problem surfaces. Teach them to recognize the signs so they understand why you are the way you are when your ADHD takes over. I had a VERY awkward conversation with my boss one day, explaining why I miss so many days of work and why I act the way I do sometimes. It was not the best day of my life, but it was a relief because I didn’t have to worry about hiding it so I could focus on working through it.

Know your limits! If you’re in an upswing and feel like you could punch a comet, try to make sure you don’t pile obligations onto your future self which might not have the same drive or stamina to keep up with all of that stuff. Think carefully before signing up for long-term obligations, and if it becomes too much and it’s something you can pull out of without negative repercussions, learn how to let yourself do that, too.

Lastly, give yourself a break. Does being too bored to do anything but veg make you feel like a lazy piece of crap? Well, screw that. It isn’t your fault, and feeling guilty for something that you can’t help will do precisely 0% to improve your cause. Just do what you need to do to get through downswings and make sure you don’t go off to too many races when things are peaking for you. 

I hope this helps. I’ve had my own fair share of troubles dealing with my* ADHD, and if any of my experiences can help you, then chalk it up as time well spent. Sorry about the wall of text, because those are daunting for me, at least. But if anything here helps you (or anybody), then it was time well spent.

[scripttorture]

I read your ask about eyes and I braved this little medical ask that can possibly change a bit of my plot... I have a character who's kept in a cellar (spacious, toilet, sink, mattress) and it's usually well lit, with a working heating system. They're kept confined for about a year, kept in contact with only their abductor who visits for a few hours a day. I read your solitary confinement post and the effects are taken care of. But I'm wondering what a punishment like turning off... (1/2)

(2/2) Turning off the electricity can do to them physically? Their torturer punishes them whenever they misbehave by turning off the electricity, keeping them in pitch darkness and freezing climate. I honestly have no idea how that can affect them during the abduction period and after, so if this isn’t too medical, would you give advice on this type of scenario? Thank you..

-

This isn’t too medically. :) I haven’t covered temperature torture in a while.

 So this actually maps pretty directly on to some real world abuses in prisons, both modern and historical. Though I’m unaware of it being done specifically by cutting off electricity.

 Generally it was done by simply not turning the heating on in the first place, rendering the heating system unusable, depriving prisoners of blankets and warm clothing. The British also enforced regimes of ice cold showers in some prisons and didn't provide towels.

 Given the sort of set up you seem to have I’d saying doing it by turning off the electricity seems realistically simple.

 I am honestly unsure what the effect of prolonged periods of darkness would be. There are a few accounts of things like this happening to people but I’m unaware of any sufficiently detailed analysis.

 It isn’t sensory deprivation so the effects are not going to be that extreme.

 But it would be incredibly distressing for most people.

 I think the best way to imagine it is in terms of increasing the character’s stress and hence adding to the long term psychologically symptoms. Basically making those symptoms worse.

 The feeling of helplessness and lack of control over their own life/circumstances- it’s the kind of thing that feeds into conditions like depression, anxiety and so forth.

 I think that it’s possible that over the long term it could damage the character’s eyesight. But I’m unsure how long the character would have to be kept in the dark (or dim light) for that to happen.

 The lack of heating is an easier one. It’s well studied.

 The last ask I had on low temperatures is this one, I think you’ll find it useful.

 The impression I get from accounts is that most temperature tortures stop at the first stage of hypothermia. It can go much further but that means the victim is much more likely to die.

 I think given the set up you have so long as the heating isn’t turned off for days or weeks at a time the character is unlikely to die from cold. Though- that does depend a little on the climate. There’s a significant difference between no heating in an Arctic winter and no heating in the south of France.

 I think you can probably use common sense to tell how at risk your character is over a short period of time.

 Assuming the character doesn’t go beyond the first stage of hypothermia-

 They’ll be in pain. Initially they’ll experience- well things you’re probably familiar with from ordinary levels of cold. Shivering, pain, feeling cold to the touch. Some people appear visibly paler. I get joint aches, I’ve never really adjusted to the cold.

 The heart rate increases, people breath faster and blood vessels contract to limit blood flow to the extremities. Those are all adaptions to conserve heat. This is part of early stage hypothermia.

 As this progresses they’ll get tired and start to become more confused. The character might also struggle with complex motor skills, anything fiddly using their hands. Their movements will slow.

 Some people report that rewarming is painful. But a lot of people (especially with more severe hypothermia) experience some degree of delirium and memory loss.

 I’m not sure whether there’s any clear evidence on whether repeated exposure to cold actually increases infection rates or not. Anecdotally a lot of people assume it does. But I’m not sure whether this is true or not.

 Beyond the physical, there are the general long term effects of torture. I get the impression you’ve already looked at them but here’s the Masterpost again.

 The main thing this scenario keeps making me think of is the way it emphasises the victim’s lack of control over their situation. That feeling of helplessness, and things that encourage it, is something that comes up again and again in accounts of solitary confinement.

 I can’t say with any certainty whether this would make symptoms worse then hypothermia produced another way. My instinct is that any clinical difference wouldn’t be significant.

 But this sort of thing stays with survivors. Sitting in the dark shivering, not knowing when or if the power will come back on, not being able to do anything about it- It’s the sense of powerlessness so many survivor accounts focus on and return to.

 How they go on to process the experience is up to you. You could turn aspects of this scenario into triggers, although you don’t have to (triggers are impossible to predict). You could keep it as a moment of terror, waking up in the dark years later and thinking for a moment they never left that room.

 You could also turn into something they actively try to fight against. Because it’s predictable. They can learn to navigate their cell in the dark. They can learn how to do everything they can to keep warm. And they can keep those behaviours later, long after they cease to be empowering.

 I think I’m going to leave it there. You’ve got a strong scenario. It’s possible and it has a lot of narrative potential.

 I hope this helps. :)

Availableon Wordpress.

Disclaimer

[scripttorture]

Hi! You've talked a lot about the details involved in 'pumping' someone full of liquids, and I've considered subjecting a character to this - a healthy soldier in their late 20s. I'm curious about how to write the recovery process provided they're rescued a day or so after the torture and taken to a hospital. How would this be complicated if the liquids the victim was given included things like human waste, mud, salt, laxatives etc., and if the captors had beaten them after they were 'full'?

WhelpI’ve asked @scriptveterinarian and the good news is it’s highly unlikelytheir organs would rupture. Which is good because I’m not sure whatthe treatment for a popped stomach or intestine would look like.

Rupturingthe oesophagus ispossible especially when something like a tube or metal funnel isinserted into it while pumping. But drowning on the liquid is morelikely.

Accordingto ScriptVet the level of dissension can put pressure on thediaphragm making it difficult to breathe.

Anyone of those things can be fatal.

Thefact that pumping usually isn’tfatal suggests to me that for whatever reason most of the time thesethings don’t happen.

Anda big part of the reason why is probably that vomiting is the body’snatural response to this huge and unnatural level of stretching inthe stomach. If it’s getting to the point where the stomach ispainfully swollen, there’s pressure on the diaphragm and so forththe body expels the excess. If torturers were to keep going at thispoint there’s a good chance the victim could drown in their ownvomit.

So-my educated guess is that pumping is survivable because torturersgenerally stop when the victim starts to vomit large amounts ofliquid.

Thediarrhoea, which can come at the same time but will definitely show up later, is due to taking in more liquid than the body canabsorb. As far as I can tell.

Assumingthat the torturers start beating the victim around the time theystart vomiting; well the victim is probably going to vomit even more.It would cause a lot of pain. It shouldn’trupture the stomach because the torturersaren’t really capable of hitting with that sort of force (you’retalking car-collision force).

Thevictim accounts I could find aren’t clear on whether this wouldalso trigger diarrhoea. They describe feelings of weakness,light-headedness, shakes. Which aren’t unexpected when you’recoupling a large amount of pain with nausea and a prolonged period ofvomiting. Especially as most torture victims are already dehydratedand/or under fed.

I’mnot entirely sure what hospital treatment would look like. Thistorture is still used but is a lot less common than it was 80 yearsago. As a result I’m not really finding any medical articles ontreating it now.

Isuspectthat he’d probably have expelled most of the excess fluid by thetime he’s rescued. Which means his treatment would probably focuson any wounds he has and re-feeding/re-hydrating. That would probablybe done via a drip.

Eachof the things you’ve suggested adding to a pumping mixture wouldhave different effects. Some of them are pretty risky for thecharacter.

Humanwaste is going to cause an infection. Probably not in the stomach butin the throat. Stomach acid is generally pretty good at killing theinfection-causing microbes that would be present which is why I thinkthat’s less likely (it would still be possible).

Thethroat seems most likely to me because the implements torturers useto force liquid into the stomach generally cause small cuts in thethroat and mouth. Things like plastic tubing, metal funnels and thelike are forced into the mouth and to the back of the throat. Whichcreates a lot of small injuries and a lot of likely sites forinfection.

Idon’tthink this would be lethal in the time frame you’ve got. Thecharacter is at the hospital in plenty of time for the infection tobe treated. As the infection takes hold his throat may swell, makingbreathing difficult. But if he’s already in hospital by that pointhe should be alright- it’s something modern medicine can deal with.

Itwould also cause diarrhoea, there are some sources I’ll quote laterthat would help you with that. This would be dangerous, probably evenlife threatening. But it would also be relatively easy to treat in ahospital. 

The combination of the two however could result in a pretty life threatening condition. I think he’d need to be kept on a drip for quite a while to make sure he has enough fluids and ensure a constant delivery of antibiotics.

Mudis likely to be much more dangerous.

That’sbecause the big exception to the ‘stomachs are hard to rupture’stuff I was talking about earlier is...when the digestive tract isblocked by something solid and indigestible. Like mud.

Evenif the character’s stomach didn’trupture while the torturers were beating him pumping with mud wouldgive him incredibly serious digestive problems later on. It can inessence clog up the system. It’s not a substance the body canreally remove any way but physically and it is physically difficultto shift.

Thecases that are coming to mind are famine victims. Sometimes in themiddle of famine people will start to voluntarily eat mud. That’sbecause the pain from hunger is so bad that they just want to ease itany way they can. Mud can provide a very short term relief, anillusion of fullness. Until it passes a bit further and completelyblocks the intestines causing an agonising death.

I’mnot 100% clear on all the dangers and risks that are applicable whena character eats mud. ButI can give you an idea where to search. The technical term for eatinginedible things is ‘pica’, searching for that in relation tofamines in particular should help you find sets of symptoms andhopefully a treatment profile as well.

I’munsure how it could be treated or indeed if there’s a treatment andthat’s part of the danger. Hospital staff may not spot just how badthe situation is until it’s too late and something’s ruptured.

Outof all your suggestions my instinct is that mud is the most dangerousand would require the longest hospital stay. Possibly involving multiple surgeries.

Saltis easier. It would encourage the character to vomit more and leavehim even more dehydrated.

That’sa horrible feeling and a pretty lasting form of pain. But it iseasily remedied.

Dehydrationtends to cause headaches, light-headedness, tiredness and thesensation of a dry mouth. It can cause fainting, confusion andblurred vision. In extreme cases it can cause seizures.

I’vebeen dehydrated enough to faint and not be able to see straight anymore. In that state water tastes sweet and drinking it causes a sortof euphoric rush, almost like the early, pleasant stage ofdrunkenness.

Treatment would concentrate on rehydration.

Laxativeswould also cause the character to become more dehydrated.

I’mnot sure how long common laxatives effect people for. I thinkthey’re relatively short-acting but it would be best to check.There’s a big difference between the effect of a substance thatwould give him diarrhoea for a day and one that would give him it fora week. The first isn’t too worrying though it would likely beincredibly painful for the character. The second is much moredangerous even if he’s in a hospital.

Diarrhoeacan kill. In fact it is stillin the top ten causes of death world wide. Though it has fallen from5thto 9th(from 2000-2016), showing that we have made progress against thediseases that cause it.

Themajor risks if the character has diarrhoea for a long period aredehydration and lack of nutrition. He might need to be kept on a dripfor a while and it might be a long time before he’s back to fullstrength. I’m not sure exactly how long it would take or what thattreatment would look like.

Thereare resources on diarrhoeal diseases that would probably be a goodstarting point for working out what the treatment he’d receivewould look like. I’m not a medic so I can’t really give muchadvice myself. Butthe WHO has a page here which serves as a pretty good starting pointon diarrhoeal diseases, their prevention and treatment.

Noneof these substances would effect the pain the character feels whilehe’s being tortured. The initial period would be pretty similarwith each. It’s the longer term physical recovery that theseeffect. They’re each causing a prolonged period of sickness aftertorture, but they’re doing it in different ways.

Ithink that if you’re unsure which, if any, substance to pick thebest way to approach it is to think about how long you want thecharacter to be in hospital for. Salt will likely give the shortesthospital stay. Laxatives with a short term effect would also means ashort hospital stay.

Longerterm laxative and human waste would mean longer hospital stays- I amguessing here but I think 2-4 weeks wouldn’t be unreasonable.

Mudis likely to mean he’d be sick for a prolonged period of time.There are a lot of possible complications or things that could gowrong. He might need multiple surgeries. He might be in and out ofhospital for a much longer period of time.

Ihope that helps. :)

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