#well me and the other people who have similar symptoms w their disabilities

[leitmotif]

got a star shaped carabiner so when it's finally cool enough out for me to actually care about how i'm dressing my butch swag will be off the charts :3

[spectrumgarden]

If you don't mind, what does visibly autistic look like

It means many things, and it does depend on context. Like, theres some nuance here that can get lost, similar to how there is actually nuance to nonverbal experiences but by having to constantly restate that people with speech loss arent nonverbal, your focus is shifted from discussing this nuanced experience to guarding it. And with that comes generalizing it a bit more, to make those arguing with you understand it more easily. I'm assuming you're asking to understand my actual definition of it, instead of wanting to argue, so I'm thankful for that! This let's me be a lot more nuanced than in a situation where my nuance will be immediated used to pick apart everything that I'm saying about it being about others perception at all.

Disclaimer that I'm not visibly autistic all the time. To me it does heavily depend on if I'm using my AAC at the time, which has increased over the last year (which is not much a choice though, I am a part time user by definition but I'm not choosing to use it over verbal speech when I do, if that makes sense.) & the general state of my autistic catatonia like symptoms at the time, which do fluctuate somewhat day to day, and a few other factors such as "how obviously is my carer / person around me to make me able to access this thing not just a 'normal' relative or friend? Is this obviously a caregiving (esque) relation in front of others?" etc. So I'm not in the same boat as someone who continously gets read as autistic, especially not someone who's HSN and/or nonverbal, and I'd suggest you try and find what some of them have said about it.

Visible autism with nuance (to me) means that the same behavior does get read differently depending on many factors, race being one of them. I'm white so this is just things I've heard from other autistics of color, especially black autistics, but their behavior that would make white autistics get read as autistic, often makes them get read at schizophrenic / on the schizo-spec instead, etc.

Similarly, sometimes other disabilities "overshadow" the visible autism. Some people with ID will only ever get read as having ID, not autism, despite both being present and obvious in different ways, especially if they have facial features associated with having ID, or other ways people can "just tell". Similarly to people with down syndrome who have the characteristic facial features, this frequently makes people go "oh everything I'm seeing is related to down syndrome / ID, got it" even if it would make them think of autism in someone without these facial features, etc. Someone w these can still be read as autistic frequently, but it's another layer that complicates it. Listing all of these influencing disabilities is impossible I think, it's just important that we know they exist.

Since visible autism is about "how do you usually get perceived by the general public? Do they think you're autistic?", this also means that it is, annoyingly, quite dependent on your surroundings, and visible autism might look a little different in different countries, because we've all grown up being conveyed slightly different images of what autism "is" (aka "looks like"). Different generations might have slightly different images of autism as well, and especially younger generations might have expanded what they consider "visibly autistic" a fair bit because of things they've been exposed to online over the last few years- what will be visibly autistic to the general public already Has Changed a bit with the "autistic genius" thing all over media for the last years, so that's interesting I suppose, but that "type" of visible autism is also very restrictive and most LSN / high masking autistics probably dont get read this way either because of how highly speicfic it is.

However for the rest of this I will ignore that part somewhat, assume that all of these can however also be read as other disabilities in that sense. I might use visibly disabled sometimes though to sort of reference it a bit.

Ok. That was a lot before I even got to what behaviors in the end are generally associated with visible autism, sorry but yeah.

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A big part often is "how does this person move?" Many autistic people, especially those who fall more towards the MSN & especially HSN area of autism, have issues with gross and fine motor skills that are very apparent and go beyond "clumsy". "abnormal gaits" for example, to the point it might result in using mobility aids to help them move around. Gait trainers being one ive seen a lot over the years, but others as well. People with certain issues with walking might also be prescribed AFO braces and the likes. How do you hold your upper body, your limbs, how do you use tools? Is it obvious you have issues with motor skills when you for example eat something with a fork or a spoon? Etc. This is basically your entire way of moving, which is complex to describe, and I struggle to define it more than "people see your (issues with) movement & categorize it as disabled / autistic, in those terms or very similar (the r slur, etc), in their head"

Motor development can also be stunted in LSN people & actually frequently is, (though this is understudied in the entire autistic population) but on average (!) as is with most autistic traits, they present more strongly in people with higher support needs & lower IQs, so they might cross the line from being read as "clumsy" to "disabled" a lot more.

Stimming is the next obvious one, which is where it does turn into a bit of a battlefield in the visible autism argument, because most people I would say are not visibly autistic do also, visibly "stim", and they know this obviously. The thing is just again, how far does it deviate from the norm until it is categorized as (stereotypical) autistic behavior in the average persons head.

Allistic people, yes even those in the fully neurotypical sense, no adhd, no anxiety, nothing, do also "stim" as in "self stimulating behavior", it just generally gets called "fidgeting" (that's also why a lot of the time, at least early on, many "stim toys" were also / only marketed as "fidget toys", in my area at least, everyone called it "fidget cubes", "fidget spinners", etc).

My allistic mother bounces her foot or leg, especially if she has to wait for something a long time. Many people with longer hair frequently play with strands of this hair, twirling it around their fingers etc. "Someone is clicking their pen over and over" is something fairly normal in any room with many people who are holding pens, and the people doing this are not automatically autistic, or read as such. The less disruptive this is, the more it will be tolerated, and allistic people usually do not struggle to redirect this into something else if they are told to stop because its annoying someone else.

A lot of LSN and / or high masking autistics have talked about masking stims, either suppressing them entirely, or redirecting them to less disruptive ones. I'll probably get more into masking towards the end, so for now that's all I'll say about it. This does result in it less and less being read as visibly autistic. Again, not about 'is this actually autistic behavior' but just, what does it get labeled as? In that case, when all I would do to stim was bounce my leg, doodle in my notebooks or twirl some hair around my finger, etc, no one thought "oh damn, that kid is autistic".

This is in stark contrast to stims that are a lot "bigger", "louder", something allistic people would generally never do to "fidget", etc. Common stims of this type, usually done by low masking, higher support needs / higher level autistics etc are: pacing (when they should be sitting down), jumping, spinning etc (when they should be sitting down, or at least stand still), flapping your hands or otherwise swinging your arms around repetitively, rocking back and forth, clapping, vocal stims that range from repeating quieter sounds or words over and over to people who straight up yell, etc. & of course, self injury behavior / stims like banging your head against a wall or similar behavior like biting yourself, hitting yourself, or scratching yourself until you bleed etc.

SIB especially is very associated with developmental disabilities in the general public, to the point many peoples way of mocking visibly DD/ autistic behavior is by acting like they are hitting themselves, often their head, amongst other things. SIB is often the reason people will be wearing protective helmets to prevent injury, and also usually the reason for putting autistic people into restraints etc.

Important: these are not masked in public or if attempted to, can not be sustained for very long at all (a few minutes, maybe?) and will usually present as differently disruptive / large stims instead of "smaller", more close to "fidgeting" appearance ones. If you somehow manage to get me stop pacing and running my hands over the walls, I will instead rock and hum and make popping sounds with my mouth, clap a bit (all more or less simultaneously), etc.

Carers and similar things are another way one might be visibly autistic. Though with absence of currently ongoing caregiving tasks that are very visible to others (helping someone with bADLs like eating, drinking, going to the bathroom, transfering, .... or communicating for them, keeping them from running into traffic, trying to redirect (harmful) stims, ...) and an absence of many other things that people read as disabled, this might not accurately get understood to be a caregiver.

I think it's fairly obvious that most people will have a largely different reaction to either a) seeing someone twirl their hair or tap their fingers onto the table in a rhythmic manner, etc or b) someone who screams or continously makes lower volume noise or repeats words over and over, hits themselves, paces up and down in situations where you're supposed to be seated, chews on their hands or specialized chewing objects, .... I'm not saying these stims are exclusive to higher support needs, but the act of doing them in public regularly is one most high masking people avoid successfully, and instead limit to spaces like their own home, etc, because they KNOW the reaction to these is far more severe.

Your eyes / gaze is another one, though I find that it does frequently only become visibly autistic in addition to other behavior / traits and severity. On good days where I manage to look into someone's vague direction & respond (verbally) to some degree, I am treated as an active participant despite missing eye contact, or sometimes letting my eyes wander across the room to look at every small detail. On days where I am fixated on the ceiling for the last 5 minutes, or some blinking lights on a screen, etc, and i dont look in your direction at all when you address me (and also respond a lot less) I am treated as someone who does not belong to the conversation. I am talked about as if I was not there, as if I could not hear them. When I am like that, and my carer says I'm autistic, no one questions it (especially in combination with the visible large stims from before).

Communication is one of those defining factors in being read as autistic by the general public. where if you are nonverbal or use verbal speech in a very limited way, often instead rely on high or low tech AAC, primarily communicate in grunts/ gestures, etc in combination with other traits like those described earlier in this post, it is very visibly autistic. Generally any communication deficits like frequent wrong grammar beyond what your peers might mess up, or simply not holding conversations (aka having no apparent interest in talking to others about things they are doing, etc. Sort of like "what are you doing ?" "..." "are you drawing?" *nods* "is it fun?" "...") while theoretically being able to talk verbally. It's part of the "being in your own world" view many have of autism. Do they only communicate about their interests and nothing else?

Its more like the existing idea of someone being disabled / autistic creates the idea that the person with them must be a caregiver, than the presence of someone who is not currently doing any visible caregiving being interpreted correctly by itself. is pretty obvious by visibly disabled people who do not need a caregiver at this time, having their friends / family / partners assumed to be caregivers constantly on the mere basis that they are around them, a visibly disabled person.

there is also general appearance: are they maybe covered in stains, etc? Very common for people with bad motor skill issues, since they might spill things daily. They might refuse to bathe frequently, or their caregivers have decided to not do it as frequently for other reasons, neglect of some form, etc. Are their clothes not picked for looks but for sensory friendliness? Are an adults clothes very "childish"?

Other "miscellaneous" behaviour like drooling, or throwing things. Meltdowns.

Are their interests "age inappropriate", like young children's shows? Do they read picture books? Do they otherwise appear childish? (Carrying around plushies, chewing things that look like teethers for babies, ...)

a lot of this is generally cumulative. Basically, having one or two things from the long list of behaviors / traits, especially in the less severe expressions, might not be enough to push someone over the line into the visibly autistic area, while a different combination or different severity of the same combination might do. Depending on where you live, etc. Again, its complicated & this isnt supposed to be a checklist or anything.

In short: disability aids, assistive tech, etc, like mobility aids, visible orthotics, AAC, specialized bottles or cutlery, ... general movement & control over your body. Limited Communication and less reactiveness to others communication. Needing carers. Drooling, stimming in loud, large or simply very "unusual" ways (e.g. chewing past a certain age & with unusual objects). Meltdowns. I'm surely forgetting some things as well.

What a lot of these have in common is that their similarity to the developmental stages of babies, toddlers & younger children makes a lot people mentally categorize visibly autistic people as either "child like" or "mentally the same as children". Because who also spills things on themselves a lot? Who chews on things? Who jumps around when they should be sitting down? Who's motor skills are not fully developed yet? Who cant speak yet, or speak more than a few words, ....? Young humans, that's who.

It's hard to make definitive statements like "only x autistics get treated x way", but pretty much anyone who observes different autistics treatment will realize that people who exhibit the above traits are on average treated a lot more like:

-they are unable to / or shouldn't be allowed to make basic decisions about their own life, including medical care, where they live (you dont want to live in an institution? Well your family wants you there though, etc) when they sleep, eat, bathe, especially if they need assistance with that, or any other thing filling up the time in their day. How they look (carers might control their clothing options, ability to get tattoos or piercings, etc), their ability to understand and consent to sex or romantic relationships, ...

- they are Not Human, they are Literally A Child (not as vague vibes deep down motivating this treatment, but frequently as direct statements) and they are not worth my attention, respect, time to understand their forms of communication, or emotional closeness such as in a friendship, because they are not my Equal

- they should not be in public at all because they are disruptive with their stims / meltdowns / communication needs / ... they should be segregated from society as much as possible, in seperate schools or classrooms, institutions, ...

- they are unable to learn the same things as their peers academically, regardless of actual academic ability. Their ability to learn how to read or write might be disregarded without any attempts at actually teaching it, etc.

[doctorbunny]

MILGRAM theory time: Haruka!

This isn't going to go super in depth (famous last words) but there's a few heavily debated parts of Haruka's MV I want to share my findings/thoughts on because I think this is my new special interest and during my quest to get best boy's song to 1 million views I have been looking over his first MV with a fine tooth comb so to speak.

Disclaimer: As the Jackalope said in the "This is the MILGRAM" trailer, we don't necessarily know everyone's crime from just the first video, its possible that a lot of things will be re-contextualized in the second MV, however I am not psychic or bilingual and thus will only be working with content released before August 20th 2021 and translated into English (which could cause some language/cultural details to be lost on me as translation is not a 1 to 1 process).

TW for discussions of ableism, child abuse, murder and animal death. Also this is really long so sorry to all the people that follow me for non-MILGRAM stuff

Firstly, I want to start on the topic of Haruka as a person. He is disabled. He does not have 'the mind of a child' (although he is 17, making him legally a minor in both North America and Japan). He is not just 'child-like'. And he is not mentally ill (well he might be, in the sense that many disabilities like Haruka's have strong comorbidities [where a person has two or more conditions but neither directly causes the other] with anxiety, depression and PTSD, but usually when I see people talk about him 'struggling with mental illness' they go on to refer to aspects of his disability). Sometimes on tumblr, people like myself, will see canonical traits written into a character and identify them as being traits associated with our disabilities/mental illness and headcanon them as such. Sometimes this even involves saying things like "It's basically canon!" Although we understand that these characters were probably not the result of a writer intending to write a disabled person. When I say that Haruka is being written as a person with a neurodevelopmental disability, I mean the writer intended to write a disabled character and wrote them in a way that they wanted the audience to pick up on. As an autistic person (which is one of many neurodevelopmental disorders and also something I probably didn't have to specify because who else would be writing an essay about a series they got into a few days ago at 11 o'clock at night) I really like how Haruka has been written so far. There's definitely some parts of him that have been exaggerated so abled normies can pick up on his disability (namely how his MV 's main motif is really child-like drawings) but the writers also included a lot of smaller details I appreciate like how it is noted he avoids eye contact when talking to other people and is depicted as nervously pulling at his sleeves in official artwork, or how he says he finds his prison uniform (which has tight straps) 'relaxing' and when he gets nervous/tense, he will dig his fingernails into the palm of his hands. (These last two potential being examples of 'self stimulation' [aka stimming] where a person seeks out specific sensory stimuli in order to help regulate their nervous system/emotions, in this case the tight uniform creates a comforting, secure feeling [you may have heard about some people preferring to sleep under weighted blankets for this reason] and digging nails into his palms sounds uncomfortable/painful but is done in an attempt to deal with a greater sensory discomfort caused by the situation/environment) I also appreciate the depth he is written with, he struggles to communicate verbally but in his MV and interactions with other inmates is shown to have insecurities, opinions and a consistent thought process (this is all basic character stuff but unfortunately not always present in disabled characters)

Also I want to add that (in terms of what we've been shown so far) Haruka did not kill anyone because of his disability/mental illness. Disabled people are not inherently more innocent than abled people. But there is no disability/mental illness where a symptom is that you kill people and real people have to live with the stigma when you speak carelessly and suggest things like "Haruka is the kind of mentally ill person who kills people as a cry for help" 🧂 (or at the very least real people have to read BS like that and cringe). TL;DR Haruka is less child-like and more onion-like (as in, he has layers) 🧅🧅🧅

Now is the actual theory stuff, oops:

Every prisoner in MILGRAM is supposed to have committed murder in some way, obviously considering Yuno just had an abortion (which i personally do not consider an act of murder) whilst Mu literally stabbed someone to death, this definition is stretched a bit. But it is not agreed upon yet who Haruka killed/how many people he killed or why he killed.

In his MV he is shown to have chased after his dog into a forest, seen something off-screen, then beaten something into a messy pulp with a rock. Some people think the dog is a red herring and that Haruka actually killed his mother/the girl from the fireworks show/his brother. I do not agree.

First: I believe Haruka when he says he doesn't have a brother. The MV literally starts by Haruka looking in the mirror and then switching between the him now

and a really similar looking younger child who just so happened to be a key feature of his memories (I don't have the vocabulary to explain it but its like cinematic parallels that establish this is the same person at different points of their life)

Its not impossible that this is Haruka's secret younger brother, but i think its unlikely. I saw someone saying they had to be different people because Haruka looks less happy than the child but like, most 17 year olds are less visibly happy than when they were 7 (or however old the child is meant to be). Life happens.

So when Haruka is shown pushing the child around and eventually strangling him, this isn't meant to be literal (homicide or suicide), but a representation of how conflicted Haruka feels about his younger self, who may have committed the murder (if you've ever been kept awake cringing at memories of something you said in the past and wishing you could go slap some sense into your former self, this is like that but 10 times more self loathing). The lyric "I am always repeating yesterday," implies he might think about this specific past event a lot.

Moving on, its pretty well accepted that Haruka's parents were abusive in some way and Haruka internalised a lot of it: he constantly apologises, he says in his interrogation questions that his one wish come true is that "[he] want[s] to be loved" and describes in his MV how when he couldn't find the words he was looking for ("you're unfair") one of his parents "would get angry at me and say “You’re hopeless.”". He seems to know its unfair but also still says he 'loves' his family, possibly mistakenly believing it is his fault, but also showing an awareness of his situation (and how his parents might behave).

Now, the MV is stylised in a way that makes certain details unclear, but there is one clear detail showing that Haruka's dog was killed

This is the first close up of Haruka and the dog. Haruka's mother is just out of frame supervising, but they look pretty happy. Notice how the puppy has a silvery chain for a collar. Somehow, this dog gets out of the house but only Haruka is shown chasing after it (whether his mother was searching elsewhere or didn't bother following her disabled son into the forest is unclear). Either way, young Haruka is now in the forest, unsupervised.

By the time he finds the dog, there is already blood, suggesting it was initally attacked by something else.

is this a sigh of relief from a boy whose finally found his beloved pet or a jealous weakling glad that nature took its course and he is finally free of that meddling mutt stealing all his mummy's attention? /j

I think this shock at the discovery that 'there is blood on his hands' could imply that rather than literally getting the blood from his dog, Haruka has seen his already injured dog and realises that if the dog got out because of him (he is previously shown to be aware his parents seem to blame him for everything) then he is the reason his dog is injured/dying and will be blamed for it. (this scene plays over the lyrics "It’s fine, though it’s really not It’s really fine, though I don’t really think so When I tried to understand it, You’ll make that disappointed face again" suggesting he is trying to avoid making his parents disappointed and letting the family pet escape into danger is something that could make them very disappointed)

now we get into rock murder (this is present-day Haruka implying that this is either: not how the scene really played out; the writers really wanting the audience to know that this was Haruka's doing and not someone else's; or this turns into a separate incident that happened much later [although note that the red sky and blue moon is the same as when young Haruka first appears at the start])

b the corpse is beyond mangled now, but its clearly the dog because the silver chain collar is still there, to the right of the body. (circled in red for your convenience :3)

My hypothesis is: Haruka didn't set out to kill his dog, but upon finding it injured (we don't know the severity aside from bleeding and also it not being able to run away from Haruka kneeling down above it w/ a big rock so it could range from treatable with a lot of vet help to already on death's door, TBH I don't think Haruka would know the difference) He knew he'd be blamed for this; made into a villain who let the poor puppy come to harm. He panicked and killed the dog out of some idea that it would make him the victim here (since he'd be found crying over a dog corpse, which might make a parent go comfort him rather than getting angry about what could've happened to the dog). This is over the lyrics: "I cried, I screamed I wanted to be a pitied and loved weakling I was in denial, I was in denial I just had to make sure I’ve become a victim, I’ve become a victim" (there's another theory that he was also jealous of the dog, which could work here too, since this is not some calculated plot; rather its a rash decision) This ties in with his Japanese song title (translated as Weakness) which is a play on a phrase sort of like "The strong eat, the weak do not" to become "The weak are eaten by society" or "The weak eat each other to survive" [once again I am reminding everyone this is based on second hand information from the youtube comments section (from users mitchki and Alphaistic) because I do not speak Japanese] This second meaning (The weak eat each other to survive) makes sense under the reading that Haruka killed his dog in order to 'survive' making his parents disappointed for the dog escaping.

Miscellaneous points:

We don't know where Haruka's necklace came from yet, it must be a gift since the most expensive thing he's ever bought was cotton candy. The younger child in the video isn't wearing it and neither is his mother or the girl in the purple dress.

Haruka's home seems quite big, at the start we can see a large flower garden outside the window and there's a forest in walking distance. This might suggest his family is quite wealthy

Haruka probably did go to school at some point as homeschooling is not a legally accepted as an alternative to public schools in Japan. (However it is estimated that up to 5000 families homeschool, this is uncommon) A lot (about 62%) of Japanese schools apparently have a 'special needs' classes and there are about 505 schools focused on educating intellectually disabled students (although I do not know which sort Haruka would've needed as whilst intellectual and development disabilities can be comorbid they aren't the same). Now, if children aged 7-14 don't go to school, their parents receive a fine, but its possible that if Haruka's parents are wealthy, they just paid it to avoid sending him to school. (This might imply they wanted to hide him or were generally ashamed of him in some way) However high school education (for students over 14) is not legally required and its likely that even if Haruka went to elementary/middle school, he hasn't been around people his own age in at least 3 years. As he seems quite lonely and glad that the other prisoners give him attention.

I don't think Haruka's parents are divorced and if they are, its not his father who left. Haruka mentions in the 30 questions that he thinks he disappointed his father. But still includes him as part of his family ("My father and mother and me"). A theory I've seen is that his father was disappointed by his son being disabled and left. but developmental disabilities (especially in non verbal and semi verbal children like Haruka) can be diagnosed before the age of 3, so I feel it is unlikely that Haruka would bring up his father if he left that early in Haruka's life

All MILGRAM prisoners have covered one of DECO*27's older vocaloid songs (DECO*27 is a well known producer who composes the music for MILGRAM) Haruka covered 'Two Breaths Walking' (https://youtu.be/puXLfVWrz2Q) which is about a boy's first relationship and how his mother's jealousy set him up for failure as the relationship becomes toxic (specifically it has some very funny out of context lines like "Whose breasts are you sucking on now?") so yeah, mommy issues: the song (Also: some people say in the song, the boy kills the girl at the end, but this isn't literal, TBW is the first of a trilogy of songs about the same relationship, it is followed by Android girl then Two Breaths Walking: Reloaded and the story resolves with the couple reuniting as adults and getting in the relationship again, although its not necessarily as abusive as before, its still implied to be codependant ending on the line 'We should live like oxygen tanks, sucking breathe from the words each of us exhale, until our last breathe')

In all seriousness, the scene where younger Haruka is walking through the city with his mother but it keeps repeating until older Haruka pulls the younger one away might indicate an attempt to focus the happier memories of his parents (since this is also over the lyrics "Why is it breaking? Tell me why? Please don’t change If I tried and couldn’t say it, You would get angry at me and say “You’re hopeless.”" which depict a worse scene) I think both his parents are still physically present but have become far more emotionally distant, not giving him as much attention, which exacerbates his loneliness from not having any friends his own age to talk to

And if one of his parents did leave? I think its likely his mother since she is shown disappearing out of his reach after the dog-incident (inferring she got angry/disappointed in Haruka anyway) This could also be where he got his necklace from: Its something his mother used to wear (although this is 100% a guess) and that's why its shown to be important to him

This one is just me, but i didn't realise until a rewatch that when Haruka is watching the younger him and the girl running together, the background has fireworks. Haruka mentions fireworks being a key memory to him so I wonder if this was one of the first/last times he got to make a friend...

On three separate occasions in the interrogation, Haruka mentions not liking animals. Despite this, he is depicted as sleeping with a rabbit plush and on his birthday art (I'd include that too but tumblr only allows 10 pictures per post, so here's a link) he is standing next to a giant blueberry and strawberry cake with two bunny themed biscuits at the side. Through my experiences of seeing Japanese fandom art on pixiv, sometimes rabbits are used to insinuate a character is cute and timid in fanart.

Meaningless details: Haruka sleeps with his necklace on; he sleeps on a bed and not a futon; at first I thought he woke up holding his plush's hand but his hand is merely next to the toy; and considering the state of the pillow and blanket, I wonder if he moves a lot in his sleep or if the is just because in this case he seems to be waking up from a nightmare about the dog incident...

Final note: I've spent so many hours writing this I don't remember if i was building up to any big finale or not but I hope you enjoyed reading this! Feel free to add on in the comments/reblogs.

[lesbeet]

Have you seen the latest discourse about if ADHD would exist under communism? I know you've talked about it before and I'm curious what your take is!

oy dfjlksjdf yes i’ve seen it, and as usual i think it’s a matter of people talking past each other more than anything else (at least from the posts i’ve seen)

i could be wrong, but my interpretation of the conversation is basically that the Communists (idk if this is even an accurate distinction bc i don’t necessarily think the “other side” is anticommunist? but ykwim) are trying to discuss the nature of “disorders”/disability in general, and how it’s a societal structure that designates people as either Able To Be Exploited By Capitalism or Unable To Be Exploited By Capitalism—in other words, if we took capitalism out of the equation and really examined what’s considered a disability vs what isn’t, it would seem like a pretty arbitrary line to draw. not because the underlying physical/neurological conditions would cease to exist, but because much of what is considered “abnormal” or “disordered” etc would not cause distress bc of a struggle to operate within the narrow and rigid confines of being “Normal” as determined by capitalism

the opposition, from what i’ve seen, seems to be, yes, less familiar with these ideas/maybe not as well-read on the topic, and are basically saying “okay, but even if a lot of my ‘symptoms’ wouldn’t cause me distress under capitalism, there are others that will—i’ll probably still struggle to feed myself, whether that’s bc i forget to eat, or i have trouble preparing food for myself, etc”

and then rather than trying to explain themselves further most of the Communists are like “under communism someone else can feed you <3 read a book <3″ which is....not at all helpful lmfao

like first off i think that’s such a bad-faith response to a bad-faith reading of these people’s concerns, and second, while nobody is obligated to educate other people etc etc, at a certain point i think that if you’re gonna make posts about stuff like this you’re kind of inviting a conversation, right? and it’s not really a conversation if the only people you’ll engage with in good faith are the ones who already agree with you.

i think the other side came across as defensive, certainly, but it’s not difficult to see where that comes from—people w adhd (among many many other things obviously, but this conversation seemed to be primarily about adhd) are used to being ignored or patronized or treated as if we don’t understand our own experiences, we’re told that our struggles don’t exist, etc. and it looked like a lot of the Communists have experienced/do experience the same thing in their real lives or whatever, so i’m not really sure why there’s such a lack of understanding and compassion on their part

so basically they’re talking about two different things. one side is saying that “people with adhd” (or, more broadly, “people with disabilities”) as a distinct category of people would not exist under communism, and the other side is saying “sure, but that doesn’t mean all of my adhd symptoms will magically disappear” and the first side is saying “but none of it will matter, dummies! you don’t understand communism!” which again, is not helpful!

and because they’re really talking about two different issues, i kind of agree and disagree with both sides. i’m fully on board with the idea that disability a distinction/class/etc would not exist under communism (ideally we’d have individualized medicine/care anyway imo), that adhd as a diagnosis wouldn’t be useful, and also that many adhd symptoms that can be completely debilitating in our current society would cause us significantly less distress, especially in our external lives

that being said....there is a neurological component to adhd which would still exist under communism. i’ll still probably struggle to have conversations without spacing out and/or taking over and not being able to get myself to shut up, which would still cause problems in my personal relationships with people. i would still probably struggle with organization and getting myself to do tasks which don’t interest me, etc. and even though i trust that the Communist Side is well aware of this, "someone else will do it!” seems like a ridiculous answer to me bc like...i have to assume that some level of personal responsibility will still exist lol

and i saw someone say "nobody's saying your individual symptoms wouldn't exist at all under communism" -- except i literally HAVE seen people say exactly that lmao

but anyways it's tough bc first of all, we were all raised in the same capitalist hellscape that made it purposely ultra difficult to imagine our lives without it, and second of all, despite knowing that there's not really a material basis for adhd as a distinct Disorder™, for a lot of people (myself included) even having the label makes a difference. like my life genuinely changed when i started looking into adhd and when i got the diagnosis and started taking meds etc, but mostly it was the sheer relief that there wasn't just something fundamentally and irreparably Wrong with me that meant i would have to slog through the rest of my life, struggling and unsatisfied with no recourse yknow?

and that can be dangerous because a lot of people don't exercise critical thinking like.... ever. but i feel like i understand myself well enough and know enough about adhd (at least based on the research currently out there) to be able to think through like, how my different symptoms manifest, how similar symptoms from other disorders i have manifest, how adhd in general affects the way i function, etc, which means it's slightly easier for me to parse like...what would still be a problem without capitalism and what wouldn't

so yeah like. without capitalism, adhd wouldn't exist, and while the biological basis for adhd WOULD still exist, there would (hopefully) be structures in place to manage or alleviate much of the distress that comes with those symptoms, which wouldn't be viewed as symptoms at all because they wouldn't be considered Disordered, yknow?

so like ultimately i agree w the Communist Side in this particular discussion (not shocking since i'm a communist lol) but i think the way the whole conversation has been approached is counterproductive and doesn't actually help people to understand what they're missing lol

[coolpyoda-blog]

Factors associated with increased  or decrease treatment use in with Major Depression

A.     The dataset used is National Epidemiologic Survey of Drug Use and Health.

B.     My topics of interest is “Factors associated with increased  or decrease treatment use in with Major Depression”

C.     A literature search on PubMed is conducted using terms: “Major Depression”, “Factor”, “Success”, “treatment”

D.     Seven relevant articles are identified:

1: Kraus C, Kadriu B, Lanzenberger R, Zarate CA Jr, Kasper S. Prognosis and

improved outcomes in major depression: a review. Transl Psychiatry. 2019 Apr

3;9(1):127. doi: 10.1038/s41398-019-0460-3. Review. PubMed PMID: 30944309; PubMed

Central PMCID: PMC6447556.

2: Kelley ME, Dunlop BW, Nemeroff CB, Lori A, Carrillo-Roa T, Binder EB, Kutner

MH, Rivera VA, Craighead WE, Mayberg HS. Response rate profiles for major

depressive disorder: Characterizing early response and longitudinal nonresponse.

Depress Anxiety. 2018 Oct;35(10):992-1000. doi: 10.1002/da.22832. Epub 2018 Sep

7. PubMed PMID: 30260539.

3: Heinz AJ, Meffert BN, Halvorson MA, Blonigen D, Timko C, Cronkite R.

Employment characteristics, work environment, and the course of depression over

23 years: Does employment help foster resilience? Depress Anxiety. 2018

Sep;35(9):861-867. doi: 10.1002/da.22782. Epub 2018 Jun 7. PubMed PMID: 29878482;

PubMed Central PMCID: PMC6123281.

4: Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with

co-occurring depression and alcohol dependence. Cochrane Database Syst Rev. 2018

Apr 24;4:CD008581. doi: 10.1002/14651858.CD008581.pub2. Review. PubMed PMID:

29688573; PubMed Central PMCID: PMC6494437.

5: Dunlop BW, Kelley ME, Aponte-Rivera V, Mletzko-Crowe T, Kinkead B, Ritchie JC,

Nemeroff CB, Craighead WE, Mayberg HS; PReDICT Team. Effects of Patient

Preferences on Outcomes in the Predictors of Remission in Depression to

Individual and Combined Treatments (PReDICT) Study. Am J Psychiatry. 2017 Jun

1;174(6):546-556. doi: 10.1176/appi.ajp.2016.16050517. Epub 2017 Mar 24. PubMed

PMID: 28335624.

6: Hall CA, Reynolds-Iii CF. Late-life depression in the primary care setting:

challenges, collaborative care, and prevention. Maturitas. 2014 Oct;79(2):147-52.

doi: 10.1016/j.maturitas.2014.05.026. Epub 2014 Jun 7. Review. PubMed PMID:

24996484; PubMed Central PMCID: PMC4169311.

7: Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H,

Roberts C, Hill E, Wiersma D, Bond GR, Huxley P, Tyrer P. Systematic reviews of

the effectiveness of day care for people with severe mental disorders: (1) acute

day hospital versus admission; (2) vocational rehabilitation; (3) day hospital

versus outpatient care. Health Technol Assess. 2001;5(21):1-75. Review. PubMed

PMID: 11532238.

E.      Abstracts and full articles are obtained. The abstracts are enclosed:

Transl Psychiatry. 2019 Apr 3;9(1):127. doi: 10.1038/s41398-019-0460-3.

Prognosis and improved outcomes in major depression: a review.

Kraus C1,2, Kadriu B2, Lanzenberger R1, Zarate CA Jr2, Kasper S3.

Author information

Abstract

Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. This literature review sought to investigate factors closely linked to outcome and summarize existing and novel strategies for improvement. The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. Potential biomarkers have been explored, including hippocampal volumes, neuronal activity of the anterior cingulate cortex, and levels of brain-derived neurotrophic factor (BDNF) and central and peripheral inflammatory markers (e.g., translocator protein (TSPO), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor alpha (TNFα)). However, their integration into routine clinical care has not yet been fully elucidated, and more research is needed in this regard. Genetic findings suggest that testing for CYP450 isoenzyme activity may improve treatment outcomes. Strategies such as managing risk factors, improving clinical trial methodology, and designing structured step-by-step treatments are also beneficial. Finally, drawing on existing guidelines, we outline a sequential treatment optimization paradigm for selecting first-, second-, and third-line treatments for acute and chronically ill patients. Well-established treatments such as electroconvulsive therapy (ECT) are clinically relevant for treatment-resistant populations, and novel transcranial stimulation methods such as theta-burst stimulation (TBS) and magnetic seizure therapy (MST) have shown promising results. Novel rapid-acting antidepressants, such as ketamine, may also constitute a paradigm shift in treatment optimization for MDD.

PMID: 30944309 PMCID: PMC6447556 DOI: 10.1038/s41398-019-0460-3

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2.

Depress Anxiety. 2018 Oct;35(10):992-1000. doi: 10.1002/da.22832. Epub 2018 Sep 7.

Response rate profiles for major depressive disorder: Characterizing early response and longitudinal nonresponse.

Kelley ME1, Dunlop BW2, Nemeroff CB3, Lori A2, Carrillo-Roa T4, Binder EB2,4, Kutner MH1, Rivera VA5, Craighead WE2,6, Mayberg HS1,7.

Author information

Abstract

BACKGROUND:

Definition of response is critical when seeking to establish valid predictors of treatment success. However, response at the end of study or endpoint only provides one view of the overall clinical picture that is relevant in testing for predictors. The current study employed a classification technique designed to group subjects based on their rate of change over time, while simultaneously addressing the issue of controlling for baseline severity.

METHODS:

A set of latent class trajectory analyses, incorporating baseline level of symptoms, were performed on a sample of 344 depressed patients from a clinical trial evaluating the efficacy of cognitive behavior therapy and two antidepressant medications (escitalopram and duloxetine) in patients with major depressive disorder.

RESULTS:

Although very few demographic and illness-related features were associated with response rate profiles, the aggregated effect of candidate genetic variants previously identified in large pharmacogenetic studies and meta-analyses showed a significant association with early remission as well as nonresponse. These same genetic scores showed a less compelling relationship with endpoint response categories. In addition, consistent nonresponse throughout the study treatment period was shown to occur in different subjects than endpoint nonresponse, which was verified by follow-up augmentation treatment outcomes.

CONCLUSIONS:

When defining groups based on the rate of change, controlling for baseline depression severity may help to identify the clinically relevant distinctions of early response on one end and consistent nonresponse on the other.

© 2018 Wiley Periodicals, Inc.

KEYWORDS:

CBT/cognitive behavior therapy; antidepressants; depression; genetics; treatment

PMID: 30260539 DOI: 10.1002/da.22832

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3.

Depress Anxiety. 2018 Sep;35(9):861-867. doi: 10.1002/da.22782. Epub 2018 Jun 7.

Employment characteristics, work environment, and the course of depression over 23 years: Does employment help foster resilience?

Heinz AJ1,2, Meffert BN1, Halvorson MA3, Blonigen D2,4, Timko C2,4, Cronkite R2,5,6.

Author information

Abstract

BACKGROUND:

Depression is the leading cause of disability and represents a significant challenge to stable employment and professional success. Importantly, employment may also operate as a protective factor against more chronic courses of depression as it can function as a form of behavioral activation and scaffold recovery by facilitating community integration. The current study examined work-related characteristics as protective or risk factors for subsequent long-term depression trajectories.

METHODS:

Relations between employment characteristics and lifetime course of depression were examined among 424 adults in the community who entered treatment for depression. The sample was followed for 23 years with assessments at 1, 4, 10, and 23 years post baseline. At baseline, participants were asked about employment history and status along with work-related events and aspects of their work environments. Depression was measured at each assessment, and three different life course trajectories of depression were identified.

RESULTS:

Employment at baseline was associated with lower levels of depression at baseline and less severe life courses of depression. Among employed participants, higher occupational prestige, a more supportive work environment (greater involvement, cohesion, and perceived support), and lower work stress (less pressure and more control, role clarity, and autonomy) may protect against more severe, intractable depression over time and may have bolstered functioning.

CONCLUSIONS:

Findings have potential to be harnessed for clinical translation to better inform vocational rehabilitation counseling and human resources programs. Specifically, clinician assessment of work setting can guide patient decision making about how to reduce vulnerability to depression and foster resilience via employment.

© 2018 Wiley Periodicals, Inc.

KEYWORDS:

depression; employment; occupational prestige; resilience; work environment

PMID: 29878482 PMCID: PMC6123281 DOI: 10.1002/da.22782

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4.

Cochrane Database Syst Rev. 2018 Apr 24;4:CD008581. doi: 10.1002/14651858.CD008581.pub2.

Antidepressants for the treatment of people with co-occurring depression and alcohol dependence.

Agabio R1, Trogu E, Pani PP.

Author information

Abstract

BACKGROUND:

Alcohol dependence is a major public health problem characterized by recidivism, and medical and psychosocial complications. The co-occurrence of major depression in people entering treatment for alcohol dependence is common, and represents a risk factor for morbidity and mortality, which negatively influences treatment outcomes.

OBJECTIVES:

To assess the benefits and risks of antidepressants for the treatment of people with co-occurring depression and alcohol dependence.

SEARCH METHODS:

We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to July 2017. We also searched for ongoing and unpublished studies via ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/).All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies.

SELECTION CRITERIA:

Randomized controlled trials and controlled clinical trials comparing antidepressants alone or in association with other drugs or psychosocial interventions (or both) versus placebo, no treatment, and other pharmacological or psychosocial interventions.

DATA COLLECTION AND ANALYSIS:

We used standard methodological procedures as expected by Cochrane.

MAIN RESULTS:

We included 33 studies in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.Comparing antidepressants to placebo, low-quality evidence suggested that antidepressants reduced the severity of depression evaluated with interviewer-rated scales at the end of trial (14 studies, 1074 participants, standardized mean difference (SMD) -0.27, 95% confidence interval (CI) -0.49 to -0.04). However, the difference became non-significant after the exclusion of studies with a high risk of bias (SMD -0.17, 95% CI -0.39 to 0.04). In addition, very low-quality evidence supported the efficacy of antidepressants in increasing the response to the treatment (10 studies, 805 participants, risk ratio (RR) 1.40, 95% Cl 1.08 to 1.82). This result became non-significant after the exclusion of studies at high risk of bias (RR 1.27, 95% CI 0.96 to 1.68). There was no difference for other relevant outcomes such as the difference between baseline and final score, evaluated using interviewer-rated scales (5 studies, 447 participants, SMD 0.15, 95% CI -0.12 to 0.42).Moderate-quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95% Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) -1.13 drinks per drinking days, 95% Cl -1.79 to -0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95% CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD -1.21 number of drinks per drinking days, 95% CI -1.91 to -0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95% Cl -1.66 to 4.34; low-quality evidence).Low-quality evidence suggested no differences between antidepressants and placebo in the number of dropouts (17 studies, 1159 participants, RR 0.98, 95% Cl 0.79 to 1.22) and adverse events as withdrawal for medical reasons (10 studies, 947 participants, RR 1.15, 95% Cl 0.65 to 2.04).There were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.

AUTHORS' CONCLUSIONS:

We found low-quality evidence supporting the clinical use of antidepressants in the treatment of people with co-occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co-occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co-occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest.

PMID: 29688573 PMCID: PMC6494437 DOI: 10.1002/14651858.CD008581.pub2

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5.

Am J Psychiatry. 2017 Jun 1;174(6):546-556. doi: 10.1176/appi.ajp.2016.16050517. Epub 2017 Mar 24.

Effects of Patient Preferences on Outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) Study.

Dunlop BW1, Kelley ME1, Aponte-Rivera V1, Mletzko-Crowe T1, Kinkead B1, Ritchie JC1, Nemeroff CB1, Craighead WE1, Mayberg HS1; PReDICT Team1.

Author information

Abstract

OBJECTIVE:

The Predictors of Remission in Depression to Individual and Combined Treatments [PReDICT] study aimed to identify clinical and biological factors predictive of treatment outcomes in major depressive disorder among treatment-naive adults. The authors evaluated the efficacy of cognitive-behavioral therapy (CBT) and two antidepressant medications (escitalopram and duloxetine) in patients with major depression and examined the moderating effect of patients' treatment preferences on outcomes.

METHOD:

Adults aged 18-65 with treatment-naive major depression were randomly assigned with equal likelihood to 12 weeks of treatment with escitalopram (10-20 mg/day), duloxetine (30-60 mg/day), or CBT (16 50-minute sessions). Prior to randomization, patients indicated whether they preferred medication or CBT or had no preference. The primary outcome was change in the 17-item Hamilton Depression Rating Scale (HAM-D), administered by raters blinded to treatment.

RESULTS:

A total of 344 patients were randomly assigned, with a mean baseline HAM-D score of 19.8 (SD=3.8). The mean estimated overall decreases in HAM-D score did not significantly differ between treatments (CBT: 10.2, escitalopram: 11.1, duloxetine: 11.2). Last observation carried forward remission rates did not significantly differ between treatments (CBT: 41.9%, escitalopram: 46.7%, duloxetine: 54.7%). Patients matched to their preferred treatment were more likely to complete the trial but not more likely to achieve remission.

CONCLUSIONS:

Treatment guidelines that recommend either an evidence-based psychotherapy or antidepressant medication for nonpsychotic major depression can be extended to treatment-naive patients. Treatment preferences among patients without prior treatment exposure do not significantly moderate symptomatic outcomes.

KEYWORDS:

Antidepressants; Cognitive Therapy; Mood Disorders-Unipolar; Outcome Studies

Comment in

Engaging Depressed Patients: An Essential Step in Optimizing Care. [Am J Psychiatry. 2017]

PMID: 28335624 DOI: 10.1176/appi.ajp.2016.16050517

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Maturitas. 2014 Oct;79(2):147-52. doi: 10.1016/j.maturitas.2014.05.026. Epub 2014 Jun 7.

Late-life depression in the primary care setting: challenges, collaborative care, and prevention.

Hall CA1, Reynolds-Iii CF2.

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Abstract

Late-life depression is highly prevalent worldwide. In addition to being a debilitating illness, it is a risk factor for excess morbidity and mortality. Older adults with depression are at risk for dementia, coronary heart disease, stroke, cancer and suicide. Individuals with late-life depression often have significant medical comorbidity and, poor treatment adherence. Furthermore, psychosocial considerations such as gender, ethnicity, stigma and bereavement are necessary to understand the full context of late-life depression. The fact that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of late-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and low-income countries. Beyond effectively treating depression, collaborative care models address additional challenges associated with late-life depression. Although depression treatment interventions are effective compared to usual care, they exhibit relatively low remission rates and small to medium effect sizes. Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Collaborative care; Depression prevention; Late-life depression; Primary care; Treatment of depression

PMID: 24996484 PMCID: PMC4169311 DOI: 10.1016/j.maturitas.2014.05.026

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7.

Health Technol Assess. 2001;5(21):1-75.

Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care.

Marshall M1, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D, Bond GR, Huxley P, Tyrer P.

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Abstract

***ACUTE DAY HOSPITAL VERSUS ADMISSION FOR ACUTE PSYCHIATRIC DISORDERS***

BACKGROUND:

Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals.

OBJECTIVE:

The aim of this review was to assess the effectiveness and feasibility of day hospital versus inpatient care for people with acute psychiatric disorders.

METHODS - STUDY SELECTION:

Eligible studies were randomised controlled trials of day hospital versus inpatient care for people with acute psychiatric disorders. Studies were excluded if they were primarily concerned with elderly people, children, or patients with a diagnosis of organic brain disease or substance abuse. METHODS - DATA SOURCES: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and the reference lists of articles. Researchers were approached to identify unpublished studies. Trialists were asked to provide individual patient data. METHODS - DATA EXTRACTION: Data were extracted independently by two reviewers and cross-checked. METHODS - DATA SYNTHESIS: Relative risk (RR) and 95% confidence intervals (CIs) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise the data. Individual patient data were therefore sought so that outcomes could be re-analysed using a common format.

RESULTS:

Nine trials met the inclusion criteria (involving 1568 randomised patients and 2268 assessed for suitability of day hospital treatment). Individual patient data were obtained for four trials (involving 594 people). A sensitivity analysis of combined data suggested that day hospital treatment was feasible for at worst 23.2% (n = 2268; 95% CI, 21.2 to 25.2) and at best 37.5% (n = 1768; 95% CI, 35.2 to 39.8) of those currently admitted to inpatient care. Individual patient data from three trials showed no difference in the number of days in hospital (combining day hospital days and inpatient days) between day hospital patients and controls (n = 465; weighted mean difference (WMD) = -0.38 days/ month; 95% CI, -1.32 to 0.55). However, compared with controls, patients randomised to day hospital care spent significantly more days in day hospital care (n = 265; WMD = 2.34 days/month; 95% CI, 1.97 to 2.70) and significantly fewer days in inpatient care (n = 265; WMD = -2.75 days/month; 95% CI, -3.63 to -1.87). There was no difference between readmission rates for day hospital and control patients (n = 667; RR = 0.91; 95% CI, 0.72 to 1.15). Individual patient data from three trials showed a significant time-treatment interaction, indicating a more rapid improvement in mental state (n = 407; c2 = 9.66; p = 0.002), but not social functioning (n = 295; c2 = 0.006; p = 0.941) amongst day hospital patients. Four of five trials demonstrated that day hospital care was cheaper than inpatient care (with overall cost reductions ranging from 20.9% to 36.9%).

CONCLUSIONS:

Acute day hospitals are an attractive option in situations where demand for inpatient care is high and facilities exist that are suitable for conversion. They are a less attractive option when demand for inpatient care is low and where effective alternatives already exist. The interpretation of day hospital research would be enhanced if future trials made use of the common set of outcome measures used in this review. It is important to examine how acute day hospital care can be most effectively integrated into a modern community-based psychiatric service. ***VOCATIONAL REHABILITATION FOR PEOPLE WITH SEVERE MENTAL DISORDERS***

BACKGROUND:

People who are disabled by severe mental disorders experience high rates of unemployment, but most want to work. Prevocational training (PVT) is the traditional approach to helping such people to return to work. PVT assumes that a period of preparation is required before those with a severe mental disorder can enter into competitive employment. Supported Employment (SEm) is a new approach that places clients in competitive employment without extended preparation. Both PVT and SEm are widely practised, but it is unclear which is the most effective.

OBJECTIVES:

The overall objective of this review was to assess the effectiveness of PVT and SEm relative to each other and to standard care (in hospital or the community) for people with severe mental disorders. In addition, the review examined the effectiveness of: (1) special types of PVT ("clubhouse" model) and SEm (individual placement and support model); and (2) modifications for enhancing PVT (e.g. payment or psychological interventions).

METHODS - STUDY SELECTION:

Eligible studies were randomised controlled trials (RCTs) examining the effectiveness of vocational rehabilitation approaches (PVT and SEm or modifications) for people of working age and suffering from a severe mental disorder. METHODS - DATA SOURCES: Relevant trials were identified from searches of the Cochrane Schizophrenia Group's specialised register, MEDLINE, EMBASE, CINAHL and PsycLIT, and the reference lists of all identified studies and review articles. Researchers who were active in the field were approached in order to identify unpublished studies. METHODS - DATA EXTRACTION: All data were extracted independently by two reviewers and cross-checked. Continuous data were excluded if they were collected by using an unpublished scale or were based on a subset of items from a scale. METHODS - DATA SYNTHESIS: For all comparisons, the primary outcome was the number of clients who were in competitive employment at various time points. Secondary outcomes were: other employment outcomes, clinical outcome and costs. The relative risk (RR) and number-needed-to-treat (NNT) were calculated for the relevant categorical outcomes. Continuous data were either presented as in the original trial reports or, where possible, combined across trials as a standardised mean difference score.

RESULTS:

Eighteen RCTs of reasonable quality were identified: PVT versus hospital controls, three RCTs, n = 172; PVT versus community controls, five RCTs, n = 1204; modified PVT, four RCTs, n = 423; SEm versus community controls, one RCT, n = 256; and SEm versus PVT, five RCTs, n = 491). The main finding was that, on the primary outcome (number in competitive employment), SEm was significantly more effective than PVT at all time points (e.g. at 12 months, SEm 34% employed, PVT 12% employed; RR of not being in competitive employment = 0.76, 95% confidence interval 0.69 to 0.84, NNT = 4.5). Clients in SEm also earned more and worked more hours per month than those in PVT.

CONCLUSIONS:

The main finding was that SEm was more effective than PVT for patients suffering from a severe mental disorder who wanted to work. There was no evidence that PVT was more effective than standard community care or hospital care. The implication of these findings is that people suffering from mental disorders who want to work should be offered the option of SEm. Commissioning agencies would be justified in encouraging vocational rehabilitation (VR) providers to develop more SEm schemes. From a research perspective, the cost-effectiveness of SEm should be examined in larger multicentre trials, both within and outside the USA. There is a case for countries outside the USA to survey their existing VR services to determine the extent to which the most effective interventions are being offered. ***DAY HOSPITAL VERSUS OUTPATIENT CARE FOR PATIENTS WITH PSYCHIATRIC DISORDERS***

BACKGROUND:

This review considers the use of day hospitals as an alternative to outpatient care. Two typesof day hospital provision are covered: "day treatment programmes" and "day care centres". Day treatment programmes are day hospitals that are used to enhance the treatment of patients with anxiety or depressive disorders who have failed to respond to outpatient care. Day care centres are day hospitals that offer structured support to patients with long-term severe mental disorders who would otherwise be treated in an outpatient clinic.

OBJECTIVES:

There were two objectives: first, to assess the effectiveness of day treatment programmes versus outpatient care for people with non-psychotic disorders; and, secondly, to assess the effectiveness of day care centres versus outpatient care for people with severe long-term disorders.

METHODS - STUDY SELECTION:

Eligible studies were randomised controlled trials comparing day hospital care (either a day treatment programme or a day care centre) with outpatient care. Studies were ineligible if they were largely restricted to patients who were aged under 18 or over 65 years or who had a primary diagnosis of substance abuse or organic brain disorder. METHODS - DATA SOURCES: Relevant trials were identified from searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and the reference lists of all identified studies and review articles. Researchers were approached to identify unpublished studies. Trialists were asked to provide individual patient data. METHODS - DATA EXTRACTION: All data were extracted independently by two reviewers and cross-checked. METHODS - DATA SYNTHESIS: Relative risks and 95% confidence intervals were calculated for dichotomous data. Standardised mean differences were calculated for continuous data.

RESULTS:

There was evidence from two of the five trials identified suggesting that day treatment programmes were superior to continuing outpatient care in terms of improving psychiatric symptoms. There was no evidence to suggest that day treatment programmes were better or worse than outpatient care on any other clinical or social outcome variable or on costs. (ABSTRACT TRUNCATED)

[bigbluebarns-blog]

ABLEISM REDUX

Well… There are so many different dimensions of disability that people can be ableist toward those with different disabilities than their own. …And it’s only in the last couple of generations (within my lifetime, at least) that Disability Rights groups have banded together in a common cause (Rather than, say: Rights groups for the blind working only for the blind, Rights groups for Cerebral Palsy working only for Cerebral Palsy, etc.).  Matter of fact, based on my own recollections, I think working together for universal access rights only really got any steam in the 1970s – when I was already a teenager.

Confession time: until relatively recently (like, the last 10 years, or so), as a physically disabled person, I was biased against those with intellectual disabilities, and would get quite insulted if anyone mistakenly thought I was “R

—–ed.”

@theborkplanet IDK HOW TO SEPARATE MY COMMENTS FROM YOURS AND COMMENTS FROM YOURS. HENCE THE CAPS. 

I WAS ALSO BIASED AND PROBABLY STILL AM SOMEWHAT, TOWARD PPL WITH INTELLECTUAL DISABILITIES(ID). I TOO USED THE R WORD. GROWING UP MY EXP WITH PPL W/ ID WERE NEGATIVE OR GROSS, AND NO ONE EVER BOTHERED TO EXPLAIN SOMEONE’S ID TO ME, SO ALL I KNEW WAS NEGATIVE BEHAVIORS EG JO GRABS STUFF AND SCREAMS; NO ONE EVER EXPLAINED HER AUTISM. MOE HAS DOWNS SYNDROME, IS OBSESSED WITH SAYING “BOOBIES” LOVES THE EFFING BEACH BOYS AND FARTS A LOT AND NEVER SHUTS UP; HOW ANNOYING; NO ONE EVER TOLD ME ABOUT PERSEVERATING, OR THAT DS CAN CAUSE GI PROBS SOMETIMES. AL MUTTERS, HE STINKS, AND HE KNOCKED OUT HIS AIDE SO I’M AFRAID THAT AL WILL GET ANGRY WITH ME AND KNOCK ME OUT; NO ONE EVER EXPLAINS HIS CONDITION, SO I GLEAN MY INFO FROM EAVESDROPPING and RUMORS. THE ABLE-BODIED ADULTS DIDN’T BOTHER TO PROMOTE UNDERSTANDING EVEN THO WE WERE ALL TRAPPED ON THE SAME SPECIAL ED BUS, SO THE PASSENGERS WITHOUT ID TALK SMACK ABOUT THE ONES WITH ID. THE ONE TIME I ASK, “WHAT’S AL HAVE?” ABLEBODIED ADULT SHAMES ME FOR ASKING AND BLATHERS ABOUT CONFIDENTIALITY. NOT TRYING TO JUSTIFY MY PREJUDICE; JUST RELATING EXP. I’M ALSO WORKING THRU IT BUT U R RIGHT; NEVER 100% DONE. 

I’m working through it, and like to think I’m getting better (and one huge part of that is learning just how deep and intertwined institutionalized ableism really is, in our societies). But as with being a White woman dealing with racism, I have to remember that it’s a case of continuing recovery, and not something I will ever be 100% over and done with.

Thanks for sharing, @aegipan-omnicorn. You’re lovely.

@bigbluebarns, I don’t personally know anything about suffering racism, being a white american myself. However, I do know a thing or two about suffering ableism, both at the hands of able-bodied people, and disabled people.

People are incredibly social animals and will band together in groups with other similar people. This is natural, and it is good. It can be healing and cathartic to hang out with people who “get it.” But this tendency can also have an extremely dark side, as we see with “isms.” This is going to get long, so I’m going to break it here in consideration of people’s dashboards. Again, I can only speak to ableism and sexism so please keep that in mind.

OMG, I LOVE THESE NAMES AND TRADEMARKS. DID U INVENT THEM?

Ableisms I have suffered at the hands of disabled people:

The Cripple Police™: These are the people who, in an overzealous bid for limited access available, arbitrarily decide who is disabled enough to use a mobility aid, bathroom stall, parking spot, and even sometimes the label of “disabled.” If you are not Crippled Enough, you can be subject to any form of social punishment they deem to be necessary.

I HATE THE CP AND I’M CONSTANTLY REMINDING PPL THAT U DO NOT HAVE TO APPEAR DISABLED IN ORDER TO USE HANDICAP PARKING. IT’S LIKE THEY WANT U TO WEAR A TAG STATING U R DISABLED SO THEN THEY CAN ASSESS IF U MEET THEIR RANDOM CRITERIA.

Example: I used to be able to walk longer distances with a service dog, but was still a high fall risk. My doctor (a licensed neurologist) prescribed me a parking placard so that none of us had to worry (as much) about me passing out in a parking lot where no one could see me, and getting run over. A lovely woman in a wheelchair, who just happened to park in the accessible spot next to me, proceeded to scream at me and my service dog all the way into the store. A manager rescued me by going along with my ruse of knowing him, and invited me into the back were I fucking hid away until they told me she had left the store. It. Was. Scary.

EGAD SOUNDS HORRIBLE. BUT YEAH THERE IS A DISABILITY HIERARCHY

The Born This Ways™ : The experience between people who were born disabled, and who acquired disability later in life, vary a great deal from one another. BTW ableist types actively minimize the experiences of other disabled people, simply because they hadn’t been baptized since birth by xyz. In other words, the suffering was not identical to their own, thus must be invalid.

Example: I became disabled after adulthood, and tried to find solace after being subjected to ableist responses from friends and family members who were unable to cope with the “broken me.” I found lots of great disabled people who helped me, but I also found people who routinely scoffed at my experiences, again informing me that I was not “disabled enough,” and suggested I was being deliberately weak, or histrionic. Sometimes it was almost eerily word for word what my ableist friends/family said. How strange…

I’VE SEEN THE ACQUIRED DISABILITY IS BETTER. TM ADIBS MIGHT IMPLY, “WELL I’M A QUAD, BUT AT LEAST I GOT TO EXP BEING ABLEBODIED; I’LL HAVE EXP U SADSACK LOSER BTWS WILL NEVER HAVE. I GOT TO BE NORMAL FOR A WHILE” MOST OFTEN I SAW IT COME FROM PARALYZED PPL WHO WISHED THEY COULD WALK AGAIN. I WAS BORN WITH CP AND AB PPL ACTUALLY ASKED ME “WOULD U RATHER BE BTW OR AD?” BEFORE I THOUGHT ABOUT IT, I SAID “BTW, CUZ THATS ALL I KNOW AND I’VE HAD IT FROM DAY1 FALSE EQUIVALENCY WHEREAS ADIBS HAVE TO ADJUST” NOW THO I KNOW THAT EVEN I AS BTW HAVE HAD TO ADJUST TO CHANGING SYMPTOMS. DO U WANT 2 BE A TREE OR A MOUSE...UHHH...FALSE EQUIVALENCY ALERT, CAN’T COMPAPARE APPLE N ORANGE.

The Faker Police™: I think anyone with an invisible illness has experience with this one. This is when people who “look disabled” refuse to believe someone who “does not look disabled,” and proceed to treat them as hysterical attention seekers instead of…well, anyone else. These people often practice double ableisms–I have noticed that many also tend to judge Disabled Enough based on mobility aids. Then, they try to chase the “fakers” out of the community, because everyone knows “fakers” are why we have additional burdens added (like further hurdles to access, government aid, etc).

ALSO IF U HAVE AN INVISIBLE DISABILITY LIKE YOURS AND ME ALSO, I SEE THE “WELL EVERYONE GETS DEPRESSED/SAD/TIRED.” I END UP FEELING LIKE I HAVE JUSTIFY THE DISABLING NATURE OF MY DEPRESSION/ANXIETY TO A WEG. 

Example: Before my condition had progressed to me needing a mobility aid, I was already facing discrimination in the workplace. I requested an accommodation to have the crappy fluorescent lights removed from above my desk, as they provoke bad neurological symptoms. You’d think it was a little thing, but when I asked for advice on dealing with skeptical and belligerent management, I met the same reactions in some disabled people, followed immediately by “Fakers like you are why we see knee-jerk reactions like the word ‘no!’ Come complain when you’re actually disabled and need to have a ramp installed! Until then suck it up!”

The Totally Qualified Disability Judges™: This one seems to arise from the natural tendency of people to compare their situations to the situations of others. If they arbitrarily judge another person’s situation to be better or more favorable, then that person is not As Disabled, or Disabled Enough, or Disabled At All. Then, based on that judgment, they try to socially punish the condemned, or to excommunicate them.

Example: Some conditions are really straightforward and don’t vary widely. People with the condition all seem to have similar limitations. My condition is the exact opposite of that. I have the chronic form of migraine disease. Lots of people get migraines, but not all of them have more than 15 a month, and migraines can last anywhere from a few hours to three days. To some people, pain is the most disabling feature of a migraine, to others, the accompanying neurological weirdness is. (Migraines are often proceeded by cortical spreading depression, a phenomenon also exhibited in epilepsy. Just for an example).

So, when people hear what my condition is, they remember that one lady they used to know who had to lay in the dark for a couple days each month, and wonder why the hell I’m in a wheelchair. It doesn’t make sense to them (who cares that migraines don’t make sense to the most brilliant neurologists in the world), so they decide that I just must not be disabled. Or, if I am, it’s hypochondria. 

 I’VE SEEN: YEAH HAVE U TRIED XYZ CURE? IT REALLY HELPED THAT 1 LADY. IF U DON’T TRY XYZ WELL THEN UR LAZY N ALSO PROBABLY FAKING THE EXTENT OF UR DISABILITY?

Fun fact: Internalizing ableism from medical doctors, and from some close friends and family, and THEN the disabled people I came into contact with later, and from whom I seeked guidance, prompted so much self doubt that I had a licensed psychologist work me up for hypochondria and other related psychological conditions. It…turns out that I am not a hypochondriac. I could not find relief from all of these experiences until I encountered a neurologist familiar with my condition, and fellow disabled people who have been around the block, and who are not so embittered by their experiences that they deigned to expose others to the same.

For that reason, I will always be vocally critical of ableism within our community. I will not sugar coat it, nor will I flatter ableist disableds by giving them another name. That goes for my own ableism, too. Now that I have worked through a lot of my own, I can use my aids with confidence and obtain a freedom that is at least emotionally similar to the one I had when I first formed my adult identity (which was as an abled person).

AH YES, IN MY CASE, INTERNALIZED ABLEISM=ANXIETY N DEPRESSION. STILL NOT SURE IF DISABLED PPL CAN BE TECHNICALLY DISABLED BUT THAT’S JUST LINGUISTIC SEMANTICS.

CLEAERLY WE BOTH KNOW DISABLED PPL ARE CAPABLE OF ASSHOLERY.

CAN SOMEONE TELL ME HOW TO BOLD TEXT IN POSTS? #TUMBLR NOOB

For an example of sexism from women, see my post Never Underestimate Old Women, in which an old lady cashier schools us for self-righteous activism.

Thanks for the discussion!

[bigyack-com]

Coronavirus and the Workplace: What if the Boss Says Stay Home?

Furloughs. Sick leave. Working from home. You could experience any of these measures as businesses try to prevent their employees from being exposed to the coronavirus outbreak that health officials warn is almost inevitable in the United States. Some companies have already taken precautions like limiting travel to affected countries or big international conferences. Others have asked employees to stay home because they visited a country with a more serious outbreak. But with new unexplained cases being reported in the United States — and the first domestic death from the illness reported on Saturday — a growing number of American workers could soon be asked to alter their routines, or just stay home. Exactly how that affects you will depend on many factors, including the generosity of your employer’s benefits and where you live. Here’s what labor lawyers and business groups say could potentially unfold in your workplace — and what rights workers have.

What are companies doing now?

The situation is ever-evolving as the virus continues to spread — and policies are being revised daily as employers monitor public health notices. Nobody wants employees to come to work if they are sick or have been exposed to the virus, but U.S. workers are less likely to be covered by a paid sick leave policy than those in other developed countries. “This can put hourly workers in a bind, and make employees in the U.S. more likely to show up for work when they are sick,” said Joseph W. Deng, who specializes in employment and compensation law at Baker & McKenzie in Los Angeles. The Centers for Disease Control and Prevention has recommended that employers establish “nonpunitive” policies, encouraging employees who are sick or exhibiting symptoms to stay at home. “We may see companies develop more flexible and generous sick leave policies,” Mr. Deng said. That could reduce the hard choices that employees have to make.

What can my employer ask me to do?

If you have recently traveled abroad, your employer may ask you to stay home for the virus’s incubation period, which is generally up to 14 days. The same goes for people who have had close contact with someone who visited an affected region. Updated Feb. 26, 2020 What is a coronavirus? It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS. How do I keep myself and others safe? Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick. What if I’m traveling? The C.D.C. has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China. Where has the virus spread? The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea. How contagious is the virus? According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures. Who is working to contain the virus? World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak. “We see that there are things that are starting to get a little more intensive in the U.S. but we are not anywhere near a state of emergency,” said Alka Ramchandani-Raj, an employment lawyer who specializes in occupational safety and health law at Littler, a large labor and employment firm. “Although numbers are going up daily.” Northwell Health, the largest health system in New York, just asked 16 people — including eight clinicians who cannot do their job at home — to take a two-week paid furlough after visiting China, said Joseph Moscola, the company’s senior vice president and chief people officer. Even if workers appear healthy at the end of the incubation period, their employers could require a medical exam. “If there is factual evidence someone has been exposed to the virus, an employer may ask that person to go through a medical exam or fitness for duty exam to determine whether they are ready to return to work,” Ms. Ramchandani-Raj said.

Will I be paid if I’m told to stay home?

This largely depends on your company’s policies, but so far many larger businesses are seeing to it that affected employees get paid, one way or another. Employees showing symptoms are generally taking sick leave or emergency leave, while those affected by quarantines have been working from home when that’s possible, according to a survey of 48 large employers with operations in the United States by Business Group on Health, which represents employers on health care and benefit matters. Sixty-eight percent of the employers surveyed said they would pay employees as long as a quarantine lasted, even if they showed no symptoms and couldn’t work from home because of the nature of their job. Twelve percent said they would pay for a fixed amount of time, such as two weeks. Twenty percent of the companies, which were surveyed from Feb. 13 to Feb. 20, said they didn’t know or hadn’t made a decision yet on what they would do. Paying workers in these situations “will serve to incentivize employees to self-identify and self-quarantine,” said Susan Gross Sholinsky, a lawyer with Epstein Becker Green in New York. But American employers aren’t obligated to pay most workers, which may affect the response of businesses — particularly smaller employers. Federal law requires that hourly workers be paid only for the time they work. Salaried workers, managers and executives will usually, but not always, be paid during a business disruption, Mr. Deng said. Employers who are not paying for quarantine periods often let workers use vacation, sick time, personal days and other available paid time off — if workers have it. Union workers should review their collective bargaining agreements because they may have provisions that provide paid time off in an emergency, according to the Society for Human Resource Management.

What happens if I or a family member get sick?

This also often depends on the generosity of your employer, labor experts said, because there are no federal requirement for employers to provide paid sick leave, even in the event of a natural disaster. Roughly a dozen states and several cities — including California, Michigan, New Jersey, Washington, San Francisco and New York City — provide paid sick leave to many workers, often including those working part-time. But the amount of paid leave will vary, and often depends on the size of the employer and how long someone has worked there. These policies typically extend to caring for family members as well. If workers are seriously ill or take a while to recover, they may be entitled to unpaid leave under the federal Family and Medical Leave Act, but that doesn’t cover an estimated 40 percent of workers. Employees could also be eligible for short-term disability benefits depending on their workplace insurance or their state’s requirements, Ms. Sholinsky said. “Or, if the illness is work-related — if the employee caught the virus while on business travel, for example — the employee may be entitled to workers’ compensation insurance” she added.

What are my rights if I’m worried about going to work?

That’s a common question as anxieties rise and even subway poles and elevator buttons appear more perilous. “Employers have to be very careful and do a strict case-by-case assessment of whether that is a valid concern or not,” Ms. Ramchandani-Raj said. Employees have a right to a safe workplace, she added, and employers must adopt neutral policies that protect everyone equally. But if pregnant women were deemed to be at greater risk, for example, and the government released guidance saying they should take extra precautions, employers would need to follow the government’s lead. You could ask to work from home, but that’s not possible for, say, a retail clerk or salesperson. You’d probably have to use any paid time off or take a leave of absence — if that’s an option.

Can my employer ask me to wear a mask?

Maybe. Let’s say you show up at work one day and find extra Purell dispensers and a box of medical masks. If your employer wants to require you to wear a mask, it would be legally required to provide training on how to use and maintain them, Ms. Ramchandani-Raj said. There are other conflicts, too: Some employees might have medical conditions that are worsened by wearing a mask. Instead, companies might make the masks available — without requiring employees to wear them.

Will my employer tell me if a colleague is infected?

The C.D.C. has said that if an employee infection is confirmed, employers should tell their co-workers that they may have been exposed to the virus. But they shouldn’t tell you that person’s name — federal law requires them to maintain the confidentiality of the sickened person. Emily Flitter contributed reporting. Read the full article

[scripttorture]

So a bit back you said something about affects of solitary confinement and how victims often had issues recognizing everyday objects. Could you talk a bit more about that? How could that aspect be portrayed well in writing? Thanks for the help!

 Ah, no, sorry but I think you’vegotten the wrong end of the stick.

Sensory deprivation cancause victims to lose the ability to recognise everyday objects (I Cobain calls this ‘severe prosopagnosia’ but this usually refers to inability to recognise faces, which the victims also suffered from).

Solitary confinementcan not.

They’re both extremebut they’re different. Sensory deprivation requires a special set up thatrestricts or masks at least four senses. Solitary confinement just requires aroom.

With prolonged solitaryconfinement and/or victims with pre-existing mental health problems, solitarycan cause hallucinations and psychosis. However these are not the most commonsymptoms. Youcan find a full list of symptoms, both physical and psychological, here.

Sensorydeprivation…well it’s something I advise writers to avoid for a few reasons.

It’s incredibly, almostuniquely, damaging. A realistic and respectful depiction of victims would, Ithink, be extremely difficult to write. Not impossible by any means, but very very difficult. 

Fiction generally does a pretty poorjob of respectfully depicting disability. The kind of multiple disabilitiessensory deprivation causes- well essentially I’ve never seen a good portrayalof mental health problems that severe.

A character who’dsurvived this for the extreme length of time we’re talking about would be incapable of doing a great many ordinary things. They’dneed a carer and would probably be in some sort of institution. That makes itdifficult to produce a plot which focuses on the victim. I personally don’tlike the idea of torture victims being relegated to the side lines; I thinkthis often risks stepping into rather unfortunate tropes.

I am not saying thatwriting a plot focusing on such a character would be impossible. But I think itwould be difficult and most of the asks I get about sensory deprivation seem towant the victim to come out of their ordeal capable of functioning in societywith some independence. In which case sensory deprivation is not a realistictechnique to use.

The technique itselfhas rarely been used in real life.The real victims were a small number of American mental health patientsinvolved in unethical, unconsensual experiments. There have been no cases that meet the legal definition torture using sensory deprivation.

Over-use of such a rareform of abuse in fiction teaches thepublic that this is what torture is like. That in turn makes it moredifficult for victims to share their stories and gain support.

I prefer to encouragereaders to write about torture techniques that were/are in regular use in theirsetting. In fantasy and sci fi I try to connect the setting to real world timesand places and suggest torture techniques that were used then.

Sensory deprivation, inmy opinion, feeds into stereotypes about torture being ‘high tech’ or‘scientific’, when the vast majority of torture is about as high tech as beinghit with a wooden plank.

And the final bigproblem with using sensory deprivation is that because it’s so rare we don’t have good information on it.

A lot of data isessentially the research notes of Dr E Cameron, the man who subjected severalmental health patients in his care to sensory deprivation in the hope of‘re-writing’ their personalities. The research was extremely poorly conducted. There are (so far as I know) no patientinterviews.

There was some work done by Dr Baldwin (who usedpeople who did not consent in his experiments) and ethical experiments using volunteers conducted by Drs Lily andHebb.

The work done by Lilyand Hebb is actually very very good, but it doesn’t by its nature talk about the more extreme lengths of time andextreme symptoms sensory deprivation can cause. Most people in Lily’s ‘tank’stayed inside for 4 hours. No one stayed in Hebb’s ‘box’ longer than six days.

Cameron kept a womanknown as ‘Mary C’ in a similar box for 35days. Most people can only voluntarily stay in one of these devices for 24 hours or less.

The result is thatwhile I can list symptoms for the more extreme time periods (ie a week ormore in box-like structures), such as the memory loss most of these people suffered and losing the abilityto recognise faces and ordinary objects which affected at least two of them*, I can’t sayfor certain how these symptoms manifested or affected Cameron’s victims intheir daily lives.

I know that they spentthe rest of their lives in care homes. Several years later other researcherspublished a further paper on them, which essentially said that none of them hadrecovered and the damage Cameron caused seemed more extensive than previouslythought.

The patients themselvesare anonymous.

If you really do want towrite about them, or a fictional character who undergoes something similar thenI think the level of research you’d need in order to portray them realisticallyand respectfully would be something like a doctoral thesis. I think you’d needto track down the doctors who had contact with them and if possible thepatients themselves and their families.

I think, essentially, aproject like that would be something akin to ‘The Immortal Life of Henrietta Lacks’.

It would take years.

Because at the moment I’m just not sure that a good nonfiction source which covers all the relevant information and focuses on the victims exists. And I think that to capture that experience the most important and useful thing is to listen to what the victims themselves have to say. Without their voices it’s very easy to misrepresent them. 

Unfortunately we’re talking about a group of people who are voiceless. For me respecting the victims means remembering what they say when I write. If I can’t find a simple resource then my instinct is to read around the topic and create my own library, my own resource. 

If that’s a project youwant to take on, for your writing or out of interest, then these are the bestsources on sensory deprivation I know of. And I sincerely wish you the best of luck.

The Search for the Manchurian Candidate,J Marks, Norton Co 1991

The Mind Manipulators, A Scheflin E Opton,1978 (I haven’t read either of these books yet, so far as I can tell from sources that cite them they cover sensory deprivation in a general way but do not focus on the victims)

A Textbook of Psychology, D Hebb 1966, 2nded

‘Effects of Decreased Variation in the Sensory Environment’ W HBexton, W Heron, T H Scott, CanadianJournal of Psychology 1954, 70-76

‘Production of Differential Amnesia as a Factor in the Treatment ofSchizophrenia’ D E Cameron, ComprehensivePsychiatry 1960

‘Effects of Repetition of Verbal Signals upon the Behaviourof Chronic Psychoneurotic Patients’ D E Cameron, L Levy,L Rubenstein, Journal of Mental Science1960

*Some of the patientssued the CIA and Canadian government over these experiments but that does notnecessarily indicate that more victims didn’t experience these symptoms.

Edit: In response to comment, yes I think prosopagonsia does generally refer to being unable to recognise faces. I took the term from I Cobain (Cruel Britannia) in his summary of case Cameron’s victims raised against the Canadian government and CIA. The victims were unable to recognise everyday objects and faces, something Rejali confirms. Cobain’s use of prosopagonsia might wlel be incorrect though, so thank you for pulling that up, I’ll edit the main text to reflect that.

Disclaimer

[marlaluster]

Emptying the cliptray on the new phone. ....

1. https://youtu.be/8YsoEcdagK4 2. Schizophrenia-Related Disability in China: Prevalence, Gender, and Geographic Location Tianli Liu, Ph.D., Lei Zhang, Ph.D., Lihua Pang, Ph.D., Ning Li, Ph.D., Gong Chen, Ph.D., Xiaoying Zheng, M.D., Ph.D. Objective: This study estimated the prevalence of schizophrenia- related disability in the Chinese population and explored factors that may contribute to differences in prevalence rates between women and men and across geographic regions. Methods: Data for 1,909,205 noninstitutionalized adults (age 18 and older) from a representative national sample were obtained from the Second China National Sample Survey on Disabilities in 2006 (participation rate of 99.8%). The sample was first screened for disability (activities of daily living and social participation ad- versely affected by the disorder) via in-person household inter- views. Trained clinical psychiatrists then administered the ICD-10 Symptom Checklist for Mental Disorders and the World Health Organization Disability Assessment Schedule Version II to all individuals who screened positive for a psychiatric disability. Results: The prevalence of schizophrenia disability was .41% in China. It was higher in rural areas (.45%) than in urban areas (.32%). In rural areas, the prevalence was higher among women than among men (.51% versus .38%), but in urban areas, the rates were similar for women and men (.30% versus .35%). The results of logistic regression analysis showed that after adjustment for variables related to socioeconomic status, the likelihood of having schizophrenia disability was slightly lower among rural residents than among urban residents (odds ratio [OR] =.92, 3. The devil torments me very bad about stuff its doing to my face n that im supposed to be aging. Its attacking me very bad as im trying to write stuff here. Its pressing im supposed to be inferior to white men that are supposed to be cool etc. But i was talking here about things being not able to be generally understood here as whats happening such as that people can have widely available for them to change things such as things w aging. Its supposed to be medically described but not everyone w a aptitude n real understanding of medical stuff n it is because it is really magic. But it is asserted as okay here n its supposed to be normal that not everyone knows the stuff of whats happening. And the stuff is supposed to be taken seriously or just as legitimate that the devil is doing. Its extremely bad. 4. 257,315 likes tombrady @tb12sports in the heart of Boston. Summer 2019. NYC, LA, San Fran, Miami, Chicago, Dallas, Phoenix and others coming soon... ps: anyone around to grab lunch while I’m down here?# cmuenster Awesome! ohmillennials Please check out my page if you can ? Thank You [***carrot symbol removed***]3 benmaxweiss @momonibs yeah, but how is a Bay Area boy going to call it “San Fran” tho smh Tom juanacevedo7773 Went is coming to NYC cirocboy_ro Dude please go get @bease11 🙏🏾 atomicblondish Looks the funny video ‘ Hey you’re from BAAAHSTUN! No I’m from California! Love that vid ❤️ chriscrossb8s I need one in Atlanta! 😩 geejayyy can we get some new bags for your protein... zipper break every single time 🙄 @tombrady pa_dill_uh @tombrady should have called it ‘The GOAT Farm’ #hugemiss lordcj_ Can we keep Patterson 😥 victoriadegruttola @annakbarker_ TB12 coming to SF! Maybe Tommy will visit 🤩 j_rodjr0712 When you go to Chicago? trist.l tom's gonna have no receivers other than edelman if free agency keeps up this way johnreplogle About time Tom! Well done christian.sunny.ever Nice...Hello!!! How was you day my dear friend? faucherchaffino I think Gisele has showed how to promote yourself and your business. How’s your Portuguese coming along ? I went to a Portuguese catholic school. stephanieannflores @lawrencetoole18 you did that for me 😍 loftisray Heck ya. 🐐=health loftisray Ask a 🐐get fit! rachel.nusky Congrats Tom! You should be very proud. Inspiration every single day! patpokemon_101 @patr1ots it’s too late lynda_raine 💙💙 lordcj_ Can we get somebody anybody ? connorcaiazzo I am 1 DAY AGO 5. https://www.instagram.com/p/BubiDs-HVdM/?hl=en 6. https://goo.gl/images/xmyDaC 7. https://goo.gl/images/vSBuWi 8. Talking more about not supporting the present way of things w only the medical like labels n defining of things. I say this reality is ruled by the devil. Its really bad. Really its not at all so possible to work as pretended w people having all these things to be described n understood only by some figures that are supposed to be really smart n superior to others n supported by the populace n society to have the means etc to have decent living situations etc n others not. Its very bad, something (the devil) asserting it as real here however. As i was writing this the devil was pretending someone (a white woman) was saying something i was saying n it was trying to pretend she was saying the next word about medical descriptions, it was saying the word "descriptions" or something n then pressing i wasnt supposed to think of another word. Then its making my under eye area look bad in this still image of the video i see on the screen now. Its started making that area look more wrinkly recently n its really bad its putting that onto the video. Its attacking me very bad as im writing. Its pressing im ugly. 9. Talking more about not supporting the present way of things w only the medical like labels n defining of things. I say this reality is ruled by the devil. Its really bad. Really its not at all so possible to work as pretended w people having all these things to be described n understood only by some figures that are supposed to be really smart n superior to others n supported by the populace n society to have the means etc to have decent living situations etc n others not. Its very bad, something (the devil) asserting it as real here however. As i was writing this the devil was pretending someone (a white woman) was saying something i was saying n it was trying to pretend she was saying the next word about medical descriptions, it was saying the word "descriptions" or something n then pressing i wasnt supposed to think of another word. Then its making my under eye area look bad in this still image of the video i see on the screen now. Its started making that area look more wrinkly recently n its really bad its putting that onto the video. Its attacking me very bad as im writing. Its pressing im ugly n pressing other stuff, a sense of something happening to my head. 10. This one is cut off also. But i tried to tell a bit more about an example of how things are inconsistent. I heard from a like frog in my mind telling about some inconsistency w supposedly bugs trying to eat produce thats being grown by people for themselves. This reality having inconsistencies yet asserted as true n some people are supposed to be dumb not to like participate in it n act like thry understand it like it really really makes sense. Well, it actually does not really make sense the way the REAL truth would. It would be consistent, the truth would be. 11. https://youtu.be/uZ2qGiPCgzI 12. https://www.google.com/search?q=lackluster&oq=lackluster&aqs=chrome..69i57j0l3.6026j1j9&client=ms-android-mpcs-us-revc&sourceid=chrome-mobile&ie=UTF-8 13. Search for a word lack·lus·ter /ˈlakˌləstər/Submit Learn to pronounce adjective lacking in vitality, force, or conviction; uninspired or uninspiring. "no excuses were made for the team's lackluster performance" synonyms: uninspired, uninspiring, unimaginative, dull, humdrum, colorless, characterless, bland, insipid, vapid, flat, dry, lifeless, listless, tame, tired, prosaic, mundane, run-of-the-mill, commonplace, spiritless, lusterless, apathetic, torpid, unanimated; More (of the hair or the eyes) not shining; dull. Feedback Translations and more definitions Web results Lackluster | Definition of Lackluster by Merriam ... Merriam-Webster › dictionary › lackluster Feb 27, 2019 · : lacking in sheen, brilliance, or vitality : dull, mediocre The actor gave a lackluster performance. ... In its earliest uses, "lackluster" (also spelled "lacklustre") usually described the eyes or face, as in "a lackluster stare." ... These example sentences are selected automatically ... Lackluster Synonyms, Lackluster Antonyms | Thesaurus.com Thesaurus.com › browse › lackluster Synonyms for lackluster 14. https://www.google.com/amp/s/amp.theguardian.com/environment/2019/mar/06/glory-hole-bird-duck-cormorant-swims 15. Support us The Guardian - Back to home News Opinion Sport Culture Lifestyle Menu Bird swims headfirst into 'glory hole' and survives – video report This land is your land Bird swallowed by giant 'glory hole' reportedly lives to fly another day Witness says cormorant survived the plunge into a 200-foot-deep vortex in a California reservoir Supported by SEJ About this content Erin McCormick in San Francisco Wed 6 Mar 2019 15.49 EST Last modified on Thu 7 Mar 2019 15.20 EST What happens when a small bird is swallowed by a gaping vortex? The fate of the unassuming-looking waterfowl was the subject of anguished debate Wednesday as video surfaced of the animal disappearing into a 200ft-deep tube in a dammed reservoir in northern California. When water in Lake Berryessa is high enough, it spills into the 72ft-diameter drain, nicknamed the Glory Hole, and is funneled 18 stories down, into a creek below the dam. Recent heavy rains have meant the hole has seen plenty of action, and the creek, which is normally about 25ft wide, now looks like a mighty river, spanning a width of about 1,000ft, said Rick Fowler, the Lake Berryessa water resources manager. Such circumstances do not bode well for the bird, which was pronounced a duck by online commentators. “From what I understand, that water is going down really fast and when things come out the other side … I don’t want to get really graphic,” said Brionna Ruff, a spokeswoman for the Bureau of Reclamation, which owns the glory hole, known as the Morning Glory spillway, in an article on SFGate. Giant 'Glory Hole' sucks in rainwater as storms swell California lake Fowler, who made the video and has worked at the lake for 11 years, had a different story to tell. He told the Guardian he was taking a video of the hole when the bird, which he said was actually a cormorant, suddenly appeared in the frame, floating near the opening. After seeing the bird disappear down the hole, Fowler said, he ran to the edge of the dam. “Thwack – it shot out of there like a bullet,” he said. “It looked like a rag doll – like it was dead.” Loading video California 'Glory Hole' drains reservoir after heavy rains - video But he said that after he watched the turbulent creek water below for a few seconds, he saw the bird fly up and land in a calm spot on the creek, shaking its head to clear the water. He hypothesized that the bird made it through precisely because it is a cormorant, a sturdy, oily-feathered diver that has been recorded at ocean depths of of 150ft. He plans to show his video to an ornithologist. The video became a talking point around Fowler’s office, in his hometown of Vacaville, and on social media. Fowler’s cousin Tori Junes Fowler posted the video to Facebook. It has since been picked up by newspapers and television stations, sparking a huge debate on the fate of the “duck”. “Nobody ever thinks of anything going down that thing and being able to survive,” said Fowler. “But he survived, all right. I watched it.” Topics California This land is your land Animals Wildlife Birds news Share on LinkedIn Share on Pinterest Share on WhatsApp Share on Messenger View on theguardian.com About us Contact us Complaints & corrections SecureDrop Work for us Privacy policy Cookie policy Terms & conditions Help All topics All writers Digital newspaper archive Facebook Twitter Advertise with us Guardian Labs Search jobs Dating Discount Codes Support The Guardian Available for everyone, funded by readers Contribute Subscribe Back to top © 2019 Guardian News & Media Limited or its affiliated companies. All rights reserved. 16. https://m.youtube.com/watch?v=m4yy0U_fHNk 17. https://www.nbcnews.com/storyline/venezuela-crisis/china-offers-help-venezuela-restore-power-n982721 18. ADVERTISEMENT SHARE THIS — LATINO China offers help to Venezuela to restore power With the blackout in its sixth day, hospitals struggled to keep equipment running, food rotted and exports from the country's oil terminal were shut down. Image: People rest at their house during a blackout in Puerto Ordaz, Venezuela, on March 9, 2019. People rest at their house during a blackout in Puerto Ordaz, Venezuela, on March 9, 2019.William Urdaneta / Reuters March 13, 2019, 10:17 AM EDT By Reuters China offered on Wednesday to help Venezuela restore its power grid, after President Nicolas Maduro accused U.S. counterpart Donald Trump of cyber "sabotage" that plunged the South American country into its worst blackout on record. Maduro, who retains control of the military and other state institutions as well as the backing of Russia and China, has blamed Washington for his nation's economic turmoil and denounced opposition leader Juan Guaido as a puppet of the United States. With the power blackout in its sixth day, hospitals struggled to keep equipment running, food rotted in the tropical heat and exports from the country's main oil terminal were shut down. Speaking in Beijing, Chinese Foreign Ministry Spokesman Lu Kang said China had noted reports that the power grid had gone down due to a hacking attack. "China is deeply concerned about this," Lu said. Venezuela power outage enters second week "China hopes that the Venezuelan side can discover the reason for this issue as soon as possible and resume normal power supply and social order. China is willing to provide help and technical support to restore Venezuela's power grid." He gave no details. Power returned to many parts of the country on Tuesday, including some areas that had not had electricity since last Thursday, according to witnesses and social media. But power was still out in parts of the capital of Caracas and the western region near the border with Colombia. Information Minister Jorge Rodriguez said power had been restored in the "vast majority" of the country. The blackout was likely caused by a technical problem with transmission lines linking the Guri hydroelectric plant in southeastern Venezuela to the national power grid, experts have told Reuters. Maduro has blamed Washington for organising what he said was a sophisticated cyber attack on Venezuela's hydroelectric power operations. FOLLOW NBC LATINO ON FACEBOOK, TWITTER AND INSTAGRAM. SPONSORED / ROOMS TO GO Anniversary Sale Living Room Deals Going On Now SPONSORED / YAHOO SEARCH Becoming A Medical Coder Can Pay Off Big Time SPONSORED / YAHOO SEARCH RNs Choosing To Become Nurse Practitioners Are Earning A Much Higher Salary SPONSORED / RATE MARKETPLACE Virginia Mortgage Customers Eligible For Huge Refunds SPONSORED / ALARM.COM Join The Millions of Homeowners Who Trust Alarm.com SPONSORED / ALARM.COM Smarter Home Security Keeps You Safer: Browse Local Providers More From NBC News 01:11 NBC NEWS / MEET-THE-PRESS MTP Compressed: Democratic divides in Congress, 2020 primary field NBC NEWS / NEWS U.S. Olympic cyclist Kelly Catlin found dead in her Stanford residence at age 23 01:57 NBC NEWS / NIGHTLY-NEWS New satellite photos raise concerns about North Korea’s nuclear arsenal THINK / OPINION Opinion | New York to Trump: Your pardon wouldn’t keep Manafort out of jail SPONSORED / THE UNITED EXPLORER CARD Get priority boarding and 2 United ClubSM passes NBC NEWS / NEWS Body of girl found in duffel bag near L.A.-area hiking trail is identified SPONSORED / SAVVY FINANCE - DEBT RELIEF QUOTES People in Heavy Credit Card Debt Are in for a Big Surprise ABOUT CONTACT CAREERS PRIVACY POLICY TERMS OF SERVICE SITEMAP ADVERTISE ADCHOICES © 2019 NBC UNIVERSAL 19. https://photos.app.goo.gl/XpcjPvAWzXkYznjE6 20. https://photos.app.goo.gl/HVDb5Ku5fKwGED417

[fibromyalgiais-blog]

hi!! i hope you don't mind this question, but i kind of want some advice? feel free to disregard, though!! i have had gradually increasing pain since i was 10. i used to be able to do 7-8 hours of continuous activity w/dog, but now 30m or even 15 is hard. i relate to a lot of the posts on here. i've seen people say they weren't diagnosed for years and after several doctors, i only tried one and believed them but i'm still so tired. 1/2

i don’t feel pain like normal people, at all. i can even turn it off or minimize it. i stabbed myself deep once on accident and only said ‘ow’ because it was involuntary, but the pain i feel throughout my body cuts through that?? like. i didn’t feel pain from stabbing, but i feel constant bone/muscle pain throughout my body?? i have bumps throughout my arm, do normal people have bumps? i know it’s a diagnostic test for fibrosis, but still, i feel fake?? like i’m abled but lazy. thank you!💜2/2

~

Hi! I don’t mind at all, so I’m glad you sent it in.

I have had similar experiences, and very much relate to a lot of the thing you are describing. I’ve had increasing pain since I was quite young, and used to be very active. As I grew older, the pain and symptoms grew and it became harder and harder to be active and do the things I used to. I have been burned really badly, or cut etc. and there have been many times where I did not even realize it has happened, or if I did, it barely registered, because the pain was easily covered up by my normal pain. I learned to push away and ignore the pain in order to survive when I was young, and so I often don’t realize the extent of the pain I am going through because my brain will minimize it. 

Now a days I have realized that I am always experiencing the pain - I just am not able to always access that awareness because I ignored/denied it to the point my brain tells me that it’s not there in order to cope with magnitude of it. That may not be the case for you, but that’s what it seems to be for me. 

My muscles are tense and knotted all the time which feel like bumps or masses under the skin, in the muscles.This is very common of people with chronic pain, especially those with fibromyalgia. I also have many cysts through out my body, and depending where they are you can actually feel them through/in the skin (depending on the type of cyst). Some of them are significantly painful, most are just as painful as my base pain level or surrounding area pain level (if that makes sense). I know that there are others with fibromyalgia that experience this as well, but I am not aware of all people with fibromyalgia having cysts, so it could be a comorbid disorder (something that frequently goes hand-in-hand with the condition).

I am not sure if either of those the type of bump you are referring to. I know that there are quite a few people with

Fibrosis is a distinct, separate symptom/condition, that is a hardening of tissue, and the type of fibrosis depends on what it is affecting (skin, liver, heart, lungs etc.). I’m not sure if you had meant to write fibrosis, or if you had intended to write fibromyalgia. I am not very familiar with fibrosis, so if that was indeed your question, I am unfortunately unable to help you there.

If you were referring to the pressure points used to diagnose fibromyalgia, there are 18 specific spots on the body that when pressed on a person with fibro, it causes them significant pain. To be diagnosed you need to have at least 11 out of the 18 present when examined by the doctor. 

As for feeling fake, I have touched on this before in other answers asks (tagged #am I faking? ) This is a very common concern for most people in this sort of situation. If you are experiencing these things, you are not faking it. End of story. I can’t say if you have fibro, but your experiences are real and valid - whatever might be causing them. Because of the stigma/ableist views our society hold, most people who have “invisible illnesses” like chronic pain/illnesses, mental illnesses, etc. have been made to feel like they must be faking because others can’t see what they are experiencing. And so it gets discredited or invalidated. 

Laziness is a word that gets used a lot to invalidate people who have disabilities. There is a huge difference between not doing something because you aren’t willing to (which is how laziness is defined), and not doing something because it’s not within your abilities/it will have a lasting negative effect. It is also important to point out that not having the motivation to do something (such as in depression where you might have used to like to go out, but you just don’t seem to be able to push yourself to do it no matter how you try), or finding something too overwhelming to do/start (such as with severe anxiety or executive dysfunction) are not the same as laziness, either. 

Most people I know with chronic illnesses are so far from lazy it’s almost funny, because of how much sheer work and willpower they put into just existing day-to-day with all the symptoms/things they go through.

I hope that I answered everything you were wondering about, and that it helps. Let me know if I missed/misunderstood anything, or shoot me a message if you have more question/want to talk. 

[ficdirectory]

The Fosters: Our Thoughts on Episode 4x14 “Doors and Windows”

Another twin recap by @tarajean621 and me.  Look for her comments in italics below:

Especially Jude, Who’s Taking Really Long Showers These Days if You Know What I Mean:  Brandon!  Ew!

You Used to Fight Us So Much About Taking a Bath and Now Look At Ya:  Hahaha!  Stef!  Now I can’t stop picturing little Brandon.

I Don’t Want to Go to School. I Don’t Want to Go to Therapy/You Don’t Want to Do Anything.  Enough With the Melodrama.  Let’s Go:  Wow, Stef.  Dismissive much?  Mariana’s obviously having a tough time.  While I get that school is not optional, she needs to feel heard.

The Last Thing I Need is More Stress:  Lena, if you, Stef, Brandon, Callie and Mariana are all upstairs and Jude left, who is downstairs with Jesus?  Also, I’m more than a little uncomfortable at the fact that this episode seems like it is going to be all about everyone else’s stress (which is, apparently, Jesus) :(

Don’t They Have College Courses in Prison/I Have an Idea!  Why Don’t You Take the SATs For Me!/Wow.  Juvie’s Hardened You:  OMG Brandon and Callie!  Hahahaha!

I Just Wanted to Be Upstairs with Everyone:  The isolation is real, guys.  We see physical isolation in that the entire family is upstairs, leaving Jesus alone downstairs.  Normally?  No big deal.  (And probably why no one thought twice about it.)  However, Jesus realizes upon attempting to climb the stairs that he is literally cut off from his family.  (Which becomes even more poignant later in the episode, when Mariana verbalizes a memory from early childhood wherein the twins were abandoned in their crib for a day or more.)

With something like a brain injury, it is impossible to come to terms with all of the ways it will impact you.  In Jesus’s mind, he is perfectly capable of climbing the stairs.  He has been able to do so most of his life.  So, being forced to confront his physical limitations here is crushing and frightening for him.

Also, the show has made sure that we do not forget about PERSONALITY CHANGES that can occur post-TBI.  AGGRESSION.  The truth is that emotions in general are closer to the surface.  So, we see Jesus cry here.  And the family rallies around him.  

Note: In real life, a subsequent head injury is a very real concern.  Technically, Jesus should be wearing the helmet we see later all the time, now that he is ambulatory (but unsteady).  If this were real, the first question asked would be, “Did you hit your head?” And even if the answer was no, a trip to the hospital would not be out of the question.

Jesus Fell Down the Stairs This Morning.  Well, Up, Technically.  I Think He Really Wants to Get Back In His Bedroom and Out of That Dining Room.  It Gets Pretty Lonely Down There:  How devastating, especially knowing what’s coming up as far as the reveal about the twins’ past.  Mariana totally gets how loneliness could drive Jesus’s actions here.  Her adding, “It gets pretty lonely down there,” shows that Jesus’s feelings are reasonable and that they make complete sense to her.  It’s not like, “Oh, Jesus was ridiculous and tried to climb stairs by himself when he shouldn’t have.”  These two don’t handle being alone well, which, given their early history, makes complete sense :(

This is About You.  You’ll See:  Mariana’s pretending hard that everything’s okay while she’s talking to Emma.  Both these girls have masks in place so hard.  Emma’s obviously nervous saying she’s not pregnant, which makes me worry that she is.  And Mariana’s just using to her Smart Voice hardcore to get through the day.

I Hate You...Shut Up:  Imagine walking into room, and not realizing that it is actually a live rock show.  The intensity of the music through the amps, so loud you can feel it.  The crowd of people.  Flashing lights.  Colors.  Smells.  Screams.  Applause.

Now, imagine that you’re expected to take a final exam while you’re there.

Seems pretty ludicrous, right? 

But this is what it is like after a brain injury.  The ability you once had to seamlessly filter information is compromised.  So, while neurotypicals like Lena and the therapist are able to carry on conversation and focus on what needs to be done, someone like Jesus struggles.

The activity in the room, extraneous conversations and other noise, the bright colors, fluorescent lights all assault Jesus’s senses simultaneously before PT or cognitive therapy even begins.

Now, lets add another layer.  Jesus is sitting on an exercise ball trying to balance while contending with his right-sided tremor.  (During a live rock show.)

He is simultaneously using free weights - again, while contending with the tremor.  (During a live rock show.)

Also, Jesus has to pick out the therapist’s voice from the sea of other noise. Listen to him.  Process what he is saying.  And follow his instructions. While sitting on the exercise ball and using the free weights.  (During a live rock show.)

Then, the therapist introduces flashcards. :/

Aphasia can also affect a person’s ability to identify letters.  And reading is also an act of filtering, believe it or not.  

1. Jesus may or may not recognize all of the letters in the word boat.  (I had trouble identifying/saying letters that had similar counterparts, like b, d, g, p, q, m, n, u and w as well as those that I did not use frequently such as x, y and z.)

2. He may experience all of the letters in the word rushing at him simultaneously. (Because of an inability to filter.)  This is understandably overwhelming, and it can impact Jesus’s ability to pause and attempt to read the word.

3. Most importantly, Jesus realizes that he should know this stuff.  Not all that long ago, he would have been able to accomplish everything asked of him easily.  He is not unaware of that fact.  So, he is understandably embarrassed and crushed.

And the live rock show plays on.

Again, we see that the stress of therapy has limited his speech:  

I hate you could mean This is hard / I hate having to struggle through things I used to do easily.

I’m done first and foremost means that for the moment, he is done and needs a break.  It could also mean I’m embarrassed to have not been able to immediately recognize and read the word.  

No means no.

Shut up (responding to Lena’s “Honey, you can do this”) could mean No I can’t / Listen to me / Respect my limits.

This is the hardest part of the scene to watch.  Lena is attempting to encourage Jesus, as the neurologist recommended.  

However, both of the adults in the scene have failed to listen to Jesus.  He drops the weights and says “I’m done” - a clear message despite limited speech - I need a break.  He is immediately countered by the therapist that not only does Jesus need to read the boat flashcard, but a full 5 sets of flashcards when he is already at his limit.

He says no, which Lena follows up with “Honey, you can do this.”  Which is well-meaning and also ableist.   He clearly could not read the card in that moment, so she is not respecting his limits or the fact that he said no. 

They take a break after Jesus yells.  Not when he says he’s done.  And the break is clearly for the adults, who promptly leave Jesus in the care of an aide of some sort, so they can procure coffee and/or vodka.  

What is Jesus’s break like?  Does he even get to leave the room? (x)

Also, I just rewatched 4A, and in particular 4x09, (the episode where Jesus finds Stef’s journal and reads what she wrote, that Lena didn’t want to adopt him and Mariana.)  We can see it affects him by how abruptly he closes the journal and tries to hide it from Mariana, and the way in which he tells Moms what is upsetting Mariana.  It is obviously affecting Jesus, too.  This discovery is in the episode before he is injured, and while we know that Lena followed through with Mariana and went into more depth about where she was coming from at the time, Jesus was not included in this conversation - though it applied to both twins.

While he is in the coma (4x12) we can see just how big his fear of being abandoned is.  He dreams his family moved and left him behind, with no forwarding address.  Little Mariana is there, cautioning and trying to protect, but there is no sign of actual Mariana, no other sibs, and notably, no Moms.  Lena plays a very specific part in his dreams, too.  She is actually physically there and he follows her, at one point, and keeps trying to get her attention, but she never turns around.  Most difficult, when Jesus dreams of being at Mariana’s funeral, Stef says, “It’s all your fault,” but it’s Lena who says, “We wish it were you.”

To me, these things indicate, Jesus has a lot of unresolved feelings and fears specific to Mama.  To have her walk away and joke about needing a drink now that Jesus has this brain injury?  It speaks so directly to his fears of her abandoning him.  It’s every (older) adopted kid’s nightmare.  To have our deepest fears of being left confirmed.  She is walking away.  And Jesus may feel like now that he is struggling with so many things, and having honest, big feelings about it, it’s gonna be too much for Mama to handle.  And maybe she won’t love him anymore.  Being disabled and adopted is so complex.  And adoptive parents are not immune from saying and / or doing things that reaffirm our deepest fears that we will no longer be loved or wanted, because that is what our experience of parents tells us is the norm. This fear always exists and being disabled (for an adopted child) can seem to give an adoptive parent a concrete reason to stop loving us.  To leave us.  Even, to mistreat us.  (x)

How Long Is He Gonna Be Like This?  Lena asking this question and being met with explanations by the PT about “outbursts” and Jesus’s “short fuse” ignore and dismiss Jesus’s perspective.  

This is also the first moment in the episode where we stay with the caregiver POV, instead of with Jesus.  We see that Lena and Tomas both dismiss Jesus’s anger as a symptom, instead of a legitimate reaction to his treatment and circumstances.  The crying earlier was not seen as a symptom, however.  Comfort was given in that moment, because crying is seen as an acceptable reaction.  Disabled people are generally pitied by society, and it is expected that we pity ourselves.  Disabled anger is rarely viewed as valid.  Our public existence is linked inextricably with how we make nondisabled people feel.  We are, in many instances, viewed as objects of inspiration.  If we cry, a nondisabled person can comfort us and feel good about that.  Being in the vicinity of anger, though, does not feel good.  And as such, it is often dismissed as an overreaction or a symptom.

$300,000/It’s a Small Price to Pay to Keep Callie Out of Prison:  Okay, but wow, Robert.  That’s so much money.  Plus, it’s gonna really suck if you end up thinking Callie should move in with you because you did her this favor or something.

Sophia and Callie Look So Similar, Maybe He Got Them Confused/Did You Break Into Doug Harvey’s House?  It just got real, Callie.  And Stef has zero patience left because if the DA finds this out she is going to jail for real and Stef thinks maybe it’s what Callie deserves.  Then she takes it back and says she doesn’t mean that.  These two are so stubborn.  Callie needs to let Stef handle this.

I’m Done/One More Time:  Oh, fine motor tasks.  How I loathe thee.  Jesus is painstakingly separating coffee beans from pennies, and I feel for him.  Because we see clearly that, with brain injury recovery, the therapy literally never ends.  Not only is the task tedious - it’s boring.  And it is complicated further by the fact that it is actually difficult for Jesus to do right-handed, which is super embarrassing in and of itself.  Never mind that Lena and Emma feel the need to hover and/or supervise such a mundane exercise.  So, something that already makes him feel excruciatingly self-conscious quickly becomes unbearable the moment he makes a mistake in front of two people he feels he needs to impress.

With so much of the day scheduled within an inch of its life, it is no wonder that Jesus jumps at the opportunity to get Mama out of there and goof off a bit with Emma.  I love seeing them able to just breathe and enjoy each other, and that Emma does not try to “parent” Jesus.  

But Mama is not happy when she comes back.  And when Jesus says, “I’m done,” it is once again disregarded.  :(  The AGGRESSION does not come out of the blue.  It is communication that Moms actually acknowledge.  

Also, it is nice to see Brandon respect Jesus’s body language and resist the urge to help him up the step when he leaves.  

Hey, You Know, I Got It:  Here we have the second time that a choice was made to stay with the caregiver POV rather than with Jesus.  Isn’t it interesting how, in this moment, Brandon is able to see that Lena needs a break by taking her nonverbal cues?  He gives her the space she needs, and even offers to further accommodate her by taking Jesus to therapy the next day. 

When is the First Time You Remember Feeling Powerless?/Jesus and I Were Babies:  We just watched a podcast about PTSD and EMDR yesterday, so it was really interesting to get to see Mariana do EMDR here.  

The therapist asks Mariana what feelings she had when she discovered Nick in her room with the gun.  Mariana says she felt scared and powerless.  He asks if she has ever felt that way before.  She says she has.  A bunch of times.  Like when the robotics team turned on her and when her mom got shot and they thought she was gonna die.

Then he asks about the very first time Mariana remembers feeling powerless and she describes at time that she and Jesus were babies.  They were in their crib, crying and calling out for their mom but she never came.  They waited a day, maybe longer.

Though Mariana and Jesus are very much separated in this episode, each dealing with their own stuff, and even though their stuff is different, it is bringing up the same feelings for both of them.  In Jesus’s case, dealing with medical trauma brought back his early feelings of being abandoned and feeling responsible for Mariana, as we saw in his dream in 4x12.  And in Mariana’s case, Nick hiding in the house and pulling a gun on her triggered feelings that date all the way back to when they were babies.  

It’s Okay.  My Therapist Gave Me Permission.  I’m Taking My Power Back:  Mariana is hanging a sheet in her bedroom doorway here because she feels powerless having no privacy, so she is changing that.  She tells Moms this is not about them, this is about her.  And that her therapist would like to meet with them tomorrow at 3:00.  Mariana assumes that they will be too busy but says that her therapist assured her that since Moms love her they will make time to come in.  Lena says they will, and Mariana says if they have further questions about her privacy, they can discuss them then.

The thing that leaps out at me the most in this scene is that how clear Mariana is about her boundaries.  Putting them up physically and making them with Moms even in terms of the conversation.  She does this, though, with her Smart Voice.  With her reflexive smile.  Both are like armor, that she is clinging to.  (Likely because she does not feel listened to when she is vulnerable and honest with Moms.)  Mariana needs them to take her seriously, so she goes over their heads here, and does not give them a choice.  It all feels a bit manipulative, too, which is not surprising, given just how little she and Jesus could trust adults to take care of them as babies.  She is used to using manipulation to get her needs met, to a certain extent.  It’s a survival skill that she has not totally lost.

I’m Not Your Bro: Brandon, your cheerleading is super annoying.  And “Actually, you are.  Or did you forget that, too?”  Inappropriate.  (But so true to life.)  A little tip for our readers?  Don’t be like Brandon.  To insinuate that someone is in brain injury rehab because they “forgot” how to perform certain tasks is so minimizing.  Because what Jesus is doing right now is not “remembering.”  He is actually retraining his brain.  Forming new connections, making pathways around the damaged areas.    

It is such a delicate balance, because you do want and need support in rehab from family and friends.  However, you feel embarrassed to your very core to be working on such basic things.  And everything everyone says feels condescending, so it’s almost intolerable having people watch you.

Jesus tells Brandon to go away, and miraculously, Brandon listens.  (PSA to the family: If Brandon can do it, you can too!)  

HEALING IS WORTH IT!  DON’T GIVE UP! We spotted this lovely (sarcasm) poster as Brandon is walking away from Jesus.  In this one, a person is standing up victoriously from a wheelchair in the sunshine. We’d like to know what it implies if an injury means you must use a wheelchair to get around?  (Giving up?  Not trying hard enough?)  Also, where is the super ableist store where these awful posters are procured?  Ew...

Senior Project/What’s It Supposed to Be Now/A Cell...Like Solitary Confinement:  The 45th iteration of Callie’s senior project and it’s a doozy...

I Didn’t Know You Knew About Construction/You Would’ve If You’d Asked:  Right, AJ?  Callie, you weren’t shy about asking Aaron what he knew about construction...

Just Wondering if I Could Ask You Some Questions About How to Help Jesus:  While I think it’s great that you’re asking about music therapy, Brandon (possible avenue for you?) how about you ask Jesus what he needs from you instead of asking everyone else how to rewire his brain?  I’m sure his answer would be much different than theirs, as well, considering that it seems like he just wants to be connected to you guys and not so isolated.  Everybody is so afraid to ask him questions and I feel like they could learn so much if they did.  Also, we are not sure how we feel about Brandon outing Jesus to the music therapy student here.  While it is assumed that patients here are recovering from TBI, and Jesus did tell Brandon to go away, I’m not sure he’d like knowing you talked about his injury to a perfect stranger...

TODAY, I’M TELLING MY TBI I’M IN CHARGE!: This is an actual poster in the music therapy room.  Because, you know, it’s that easy.  And all disabilities can be cured by the power of positive thought. (Meant to be read as sarcasm.)

You Made Detective...Human Trafficking:  Wow, this would be a shift for Stef!  Also, I’m not sure how I feel about Captain Roberts encouraging Stef to keep quiet about whatever might put her career in jeopardy but I guess for the moment I’m relieved.

Jesus, That’s Great!  Emma, Not So Much:  I love that this scene is included.  We see Jesus and Emma both engaged in playing Row Row Row Your Boat, where Brandon could have asked Jesus to play it himself.  But there is so much less pressure this way.  Brandon gives feedback to both and is not afraid to correct Emma.  Being able to succeed at a task gives Jesus a much-needed sense of accomplishment, which is rare in the days of brain injury recovery.  Also a plus?  Music feels fun and less like work.

From My Perspective, Mariana Exerts Her Will on All of Us, Pretty Much All The Time/I’m Glad You Used Those Words, ‘From My Perspective’:  Ooh, ouch, Stef.  Mariana’s therapist just got done telling you he thinks she has PTSD and that she’s reexperiencing feeling powerless at home, and that’s what you’re going to say?  I feel like Moms could probably use therapy, too, to be honest.  I’m glad the therapist is there, guiding them through this so that Mariana knows her feelings are valid.

We Can Never Assume That Our Perspective Is the Only Perspective.  Which is Why Communication is So Important:  So true.  OMG.  Her therapist is so wise.

Bedroom Doors Aren’t the Reason Kids Shut Their Parents Out.  Lack of Trust Is.  Trust That You’re Going to Hear Them.  Trust That You’re Going to Respect Their Feelings Without Assigning Your Own Perceptions to Them:  This is also so true.  Very true for me, at least.  And I’d imagine it’s really hard for parents to listen without letting their own perceptions get in the way of hearing and respecting their kids’ feelings.

We Encourage The Kids to Talk to Us All The Time/And Then You Call Me Melodramatic, and Make Me Feel Like My Problems Aren’t as Important as Jesus’s Injury...Maybe Their Problems Are Bigger Than Mine/Honey, Don’t Do That.  Nick Held a Gun to Your Head:  I love this exchange between Lena and Mariana.  How Mariana can clarify how she feels about being called melodramatic and that it literally makes her doubt the validity of her feelings in front of them.  Lena can see that and cautions her about it, reminds her that her feelings do matter.

Treat Every Child Respectfully, So We Can Earn Their Trust, and Hopefully Then, They’ll Share Their Secrets:  Do you hear this Moms?  Every.  Child.  Respectfully.  Including your son in the living room, Jesus.  (Oh, gosh, who is at home with Jesus????)  His injury does not exclude him from deserving your respect.

I Thought It Was Mariana/She’s at Therapy:  So, Brandon’s home, but doesn’t know Emma’s in Mariana’s room and Brandon doesn’t know that Mariana’s at therapy.  So he doesn’t know Moms are at therapy with her.  Again, I ask, who is with Jesus?  I get that he does not want to be stifled all the time but it seems that the only people home are on a completely different floor of the house and no one seems concerned that he has no way to reach them if he needs something.

Did Jesus Yell At You?  You Can’t Take That Personally.  It’s Just Because of His Injury.  It’s Like He Has No Filter:  Exhibit #554992 - Jesus’s anger is not legitimate.

No, He’s Never Yelled at Me:  Look at that!  Maybe it’s because you treat him like a person, Emma!

Something I Need to Tell Him and I’m Not Sure That I Should/Is It Something You Can Tell Me?/I Think You Already Know:  Emma, yes you should tell Jesus.  If it concerns him, he deserves to know.  And Brandon, just because Emma isn’t sure she should tell Jesus doesn’t mean she should tell you.  This is not your business.

Stairs: This is a blatant excuse to further the plot by having Jesus witness something he is unable to contextualize due to his physical limits.  We see him struggle to do something without proper accommodations or safety precautions.

I Don’t Wanna Be a 16 Year Old With a Baby.  Is It Horrible If I Don’t Tell Jesus?  I’m Just Afraid That in His Condition, This Would Be Too Much for Him to Handle:  So, first things first: your body, your choice, Emma.  But you are taking the choice about what Jesus can handle away from him.  Let him decide what he can take.  I’m pretty sure that lying to him is going to make him feel so much worse than the truth.  You were the one person he could count on who treated him, for the most part, like a friend and not a parent.  This is gonna be so awful.

I Think It Would Be A Lot For Jesus to Handle Even Without the Brain Injury:  Not your call to make, Brandon!  Though I do appreciate that he didn’t just cite the injury as the reason not to tell Jesus.

You Have Too Much Makeup On/God, Jesus/I’m Tired.  You Should Go:  Emma urges Jesus to read a get well card, and Jesus drives her away by saying something mean.  He is understandably too embarrassed to admit that he’s having difficulty reading.  Dream!Emma did tell him, “You’re too dumb for me,” after all...

Take Detective.  Not Gonna Give Up on Gray and Malloy, I’m Just Gonna Do It From the Inside: Well, that does not sound reassuring, Stef.

Doors Are Not Really The Issue.  Trust Is. Which We Are Working on Developing.  But No More Secrets: Stef, I’m glad you and Lena put the doors back on, but it’s not as simple as expecting the kids not to keep secrets when you guys are still working on developing trust with the kids.

Incapable of Expressing Herself/Paranoid/Dangerous/She Was Defiant:  It’s only now that I can actually see that Callie’s senior project has facets of all of her previous senior projects, which is pretty cool.  She included the pictures of herself that she gathered/has as well as the ones she took of the houses she stayed in, plus the pages of her file up on the cell wall with these words in big type.  How stark and sad.  To reduced to your behavior without taking your motivations into account.  (Kind of exactly how the family is treating Jesus.  Everything about him now is coded through “brain injury” and that stops them from considering all of the valid reasons Jesus could be reacting as he does.)

So Tired of Secrets, So Toxic, Let’s Start Telling Them:  Mariana changed her Twitter handle and she just told the whole Twitterverse that she stole her brother’s ADHD meds.  (Though, perhaps this is a separate account and more anonymous, which would be good.  Keep taking that power back, but don’t forget to respect your fam’s privacy, too.)

Card:  We finally get Jesus’s POV!  And it is so effective.  He attempts to read the card from earlier while alone in his bed, steeling himself beforehand.  And the letters on the card move, mix up and blur as he looks at them.  I hypothesized that something like this may be happening earlier in the recap, and aside from the blurring, this is very similar to how reading was for me in the beginning of my recovery.  

So little is in Jesus’s control at this point in time that he wants to rip the card up.  But he knows that destroying it will not change what he sees.  So, he resorts to physically covering his eyes while breaking down.  

No one is there for him in this moment.  He is as isolated physically as he is emotionally.  No one can understand the fear he’s feeling.  So real.  So powerful.  Jesus’s recovery is far from over, and unfortunately, there will be many more instances of loneliness and isolation to come.  Not to mention the long journey toward self-love and acceptance in the face of a life-changing injury.

For more: Fosters Recaps

[sunsetsover]

Would you ever want EE to do a proper mental health storyline for Ben, or would you be concerned they'd make a mess of it?

I say "proper" not to dismiss everything that's already happened but more... he's obviously got a mental illness but the characters and writing don't really acknowledge it properly, it's more an unnamed Thing that causes angst and drama and is just like... oh man, there'sBen being unreasonable and crazy again! Whew he tried to kill his dad and had a breakdown but anyways!!! As fans we can say this that and the other is subtext but it would be cool to have a story where he/his family and friends - and the audience - actually have to acknowledge it as something more than Just Ben Kicking Off, Again, or Daddy Issues, Again.

i def wouldn’t be opposed to it !! i mean i’ve been saying ben has bpd since i first started watching again 2019 and i still firmly stand by that lmao and to be perfectly honest i’m not NEARLY as critical of ee’s handling of delicate storylines as a lot of ppl online like tbh i think they’ve done a decent job of all the difficult sls they’ve had recently (except chantelle/gray’s but even then (controversial opinion incoming !) i think for as much of a piece of shit gray is he’s a really interesting character and in a sick kind of way i like his scenes bc the actor is really good at playing an absolutely despicable bastard so in a weird way i get why they’d milk him for all his worth but that’s another can of beans lmao) like i think bobby’s mental health sls were handled well (apart from the fact his ocd sl kind of disappeared but that’s not an issue w the sl itself) and so far imo they’ve done a p great job w isaac’s mh sl so i’m not one of those ppl who are like ‘omg no more serious/difficult sls the show isn’t good at them !!!’

if they were to do it it’d have to be some point in the future i mean w callum’s ptsd sl basically confirmed they’d have to kind of play that out and then give it a rest for a little while so maybe in a couple of years?? and imo if they were to give ben a mental health sl they’d have to have some big trigger/episode happen to kind of bring up the issue again bc like u said it’s kind of like swept under the rug for a lot of characters as ben being ben and plus aside from in the aftermath of the boat stuff last year he’s been fairly stable since he’s been w callum so you’d need some kind of catalyst to send him off the rails again for it to become an Actual Conversation. and if callum started seeing some more professionals long term for his ptsd it would make sense for him to maybe be more likely to call out issues as he sees them?? if that makes sense ??

(as for an actual bpd sl i wouldn’t be opposed to that either i mean i feel like more ppl need to know what bpd is/what it entails just in general plus all of the ground work is literally right there and has been since ben’s childhood like imo you could not get a better diagnosis for ben than bpd but that’s just me !! but on the flip side i know a lot of ppl would probably be super critical of it a) bc of ben’s past actions/behaviours w crime and his manipulation and stuff and ppl w bpd get a bad rep for manipulation anyway but i personally am all for bad/imperfect rep plus imo it would help explain some of that behaviour and b) bpd is so kind of unknown?? niche in a way ?? and like there SO many different experiences w the same disorder that there are bound to be ppl complaining abt how it’s inaccurate or whatever ?? like i’d get why the ee team would be like ‘not worth the aggro lmao x’ but like i said imo if they WERE to go that way w ben’s character there’s no better diagnosis for him than bpd so ..... and i know you didn’t ask abt this specifically but if they were to go this way this is what i would want lmao)

idk i guess a mental health sl for ben is not smth i desperately want bc in my heart him having bpd is canon as far as i’m concerned but at the same time it’s definitely not smth i’d be opposed to if ben’s mental health issues became a serious problem again u know??? like it would be really nice to be like ‘ben’s not causing this problems just for the fuck of it, there’s a reason and this is it’ but at the same time i get why as a show they might not wanna do that so ??? idk i’m not particularly bothered one way or the other bc like i said in my heart me and him are bpd twins so !!!

the ONLY reason i'd be apprehensive is bc of audience reaction. like nbf people's reactions to ben's actions last year when he was so clearly going thru a crisis were so ugly and genuinely difficult to read as a mentally ill person and i haven't forgotten or forgiven that plus seeing how ppl are already reacting to callum actually showing symptoms of his ptsd and being Obviously Mentally Ill the exact same way and it's already tiring and UGLY like honestly ??? the majority of ppl in this fandom aren't mature enough and don't have the critical thinking skills needed for such a serious sl for ben and/or callum. they didn't during callum's struggle w him coming out (it wasn't as bad then but i promise it was still there) they didn't during ben's deafness sl/his breakdown in the aftermath of that and they are already showing that they're gonna be the same during callum's ptsd sl. and it's irking bc it's like.... ben and callum are BOTH victims of traumatic childhoods and abuse and are BOTH pretty obviously dealing with mental health issues bc of the shit they've been thru but the minute they actually show symptoms or act in a way that is clearly bc of trauma and/or mental illness it's literally like the world is ending on here n the characters are being ruined and their relationship is being ruined etc and don't even get me started on the way they talk abt these symptoms completely ignoring the fact that these are actual real life symptoms of real life illnesses that affect real life ppl..... the way ppl used to talk abt ben struggling to cope w his disability used to COMPLETELY fuck w my head as someone who used to do similar things while i struggled w my disability .... aha ....

but that's neither here nor there lmao the point is it's not the show i don't trust to do a decent job it's the audience's ability to handle it for what mental illness actually entails (aka the difficult/ugly symptoms) while not be complete dicks about it or making it abt ballum. but at the same time i wouldn't be opposed to a mental health sl for ben at all !!! i'd probably just hope it's not anytime in the next year or so and then disappear off the internet while it plays out lmao

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