#which my meds do! then i can figure out what to tell my psych on wed

[scientia-rex]

Some Thoughts on Antipsychotic Medications

Ok, enough of you seemed interested in this when I asked in my antidepressant post (don't ask me for a link, search my goddamn tumblr for it, oh my GOD people were so lazy about my post on bariatric surgery). Once again, this is NOT medical advice, medical advice must be TAILORED TO THE INDIVIDUAL, that's the whole POINT of a professional field, literally every answer is "it depends" and without being your doctor, which I better not be because if you're my patient reading this I need to nuke my entire social media presence, I can't give you good advice and I wouldn't anyway because I already work 115% time and I'm very tired and you don't pay me.

There's a lot of crossover between "antipsychotic" and "mood stabilizer." I don't have as much experience with antipsychotics as I do with antidepressants, but more than your average bear. So you may see a med here and go "wait, what?" because of that overlap.

It's also worth discussing what psychosis is. There are a lot of media representations, and they are generally very stupid and bad. About 3% of the population will have a psychotic episode in their lifetime, so keep that in mind when you're talking about psychosis. There's about a 1 in 30 chance that the person you're talking to will actually have had psychosis, and a much higher chance that someone they know or love will. So don't be a dick about it. Psychosis involves losing the ability to distinguish what is reality and what is not. It seems to involve overactivity of dopaminergic transmission in specific brain pathways. It tends to be very frightening for its sufferers, although not always. Psychotic symptoms can range from a persistent delusion--I have one patient who is quite simply certain that they have worms in their lungs, despite all the tests indicating that they don't--to hallucinations of voices, to visual hallucinations, and any combination of those. Delusions and hallucinations are often negatively valenced, which means that they make the sufferer feel bad in some way, whether it's an auditory hallucination of someone telling you you're the devil, or a delusion that you're being persecuted by conspiracies for unclear reasons, or hallucinations of shadowy figures out of the corner of your eye. Delusions, when I see them in my patient, often reflect a patient's deepest fear. I had one patient who was a caregiver and they were fixated on the idea that there was a conspiracy of people watching them and setting up "tests" to make sure they weren't hurting patients or doing drugs.

It's also worth mentioning meth. Meth is one of the major causes I see of psychotic symptoms (especially since I'm in a rural area), and you need to understand that the longer and the more you do meth, the higher the likelihood of persistent psychotic symptoms. When I was a med student on an inpatient high-acuity psych ward, I had a very pleasant gentleman who'd been doing meth for years. It's tough to get a clear history, but my impression was that he probably hadn't developed psychotic symptoms until multiple years into daily use of meth--but now, despite being on the ward for over a week, there was no sign of the psychosis going away. He believed he could say things to passing cars and the sound would travel with the car, and someone miles away would hear it. He also believed there were indistinct white figures who hovered around his campsite. (He was homeless.) Meth can break your brain. Don't do meth.

The original antipsychotics are old school. We're talking the 1930s. Promethazine was developed in the process of trying to come up with antihistamines. First-generation antipsychotics are dopamine antagonists, and that means that they're blocking a large proportion of dopaminergic transmission both in the brain pathways related to psychotic symptoms, but also in the pathways related to reward, which sucks. When you think of "antipsychotics," this is most likely what you're thinking of unless you have personal experience with antipsychotics. First-generation antipsychotics include haloperidol (Haldol), chlorpromazine (Thorazine), and a handful of others, but it's a smaller class than the second generation.

Second-generation antipsychotics were a game changer. These are serotonin-dopamine antagonists. They include risperidone (Risperdal), paliperidone (Invega-Sustenna), quetiapine (Seroquel), aripiprazole (Abilify), olanzapine (Zyprexa), lurasidone (Latuda), ziprasidone (Geodon), and also clozapine, AKA the antipsychotic everyone hates prescribing because it can cause your white blood cells to suddenly go bye-bye and boom, you're at huge risk for infection. The only patient I've ever seen develop clear, unambiguous serotonin syndrome was on clozapine. I don't prescribe it as an outpatient family doctor; it's a medication of last resort, and more often seen in inpatient settings due to the need for frequent blood tests to monitor.

Because the brain is a great recycler, we also use dopamine in the control of our movements. This means that one of the more serious side effects of antipsychotics is a problem with movement. This is typically going to be something called "tardive dyskinesia," which means "slow messed up movement," but in Greek because we're fancy. TD is dreaded because we can't always reverse it. A medication called benztropine can help, but the better option, if at all possible, is to get someone off the medication that called the TD in the first place.

If you're keeping track, you're noticing that dopamine does a lot in the brain: the reward pathway, psychotic symptoms, movement. Your body also uses it for stuff outside the brain, like affecting gut motility and blood vessel dilation. It is really hard to come up with medications that only affect one thing, because the body will use the same messaging systems over and over. This is a big part of why there's some much cross-talk between medications that are ostensibly for one thing but used for many other things.

First-generation antipsychotics can be particularly bad about making people feel flat and incapable of feeling joy. The technical term for "incapable of feeling joy" is "anhedonia," Greek again, this time for "no happiness." This is incredibly punishing and people will often go off their meds in order to feel something. I don't want to hear any bullshit blaming people who do this. You probably would too, and learning not to throw rocks from a glass house is critical to being a decent fucking human being. However, it does mean that I have much more success keeping patients on second-generation antipsychotics. There is both a lower risk of anhedonia and a lower risk of TD, so in general, unless someone doesn't respond to second-generation antipsychotics, they won't be started on a first-generation. I have absolutely used first-gen antipsychotics for patients but they're more typical in the inpatient setting, where it's okay--and sometimes a good thing--if someone is sedated. One memorable example was in an emergency department where a woman was violent and had to be restrained with both physical restraints and a spit hood. We can't just go around sedating people these days--that's a whole-ass thing, because for a long time "treatment" in inpatient facilities was too often taken to be "sedation"--but boy howdy, she needed some Haldol.

I also work part time at the county jail, and while I again try hard not to use first-generation psychotics in patients who didn't come in on them, there are patients who actively request Haldol because they hate how being totally wound up and psychotic feels. I write for them to have as-needed oral doses. This means if they ask the jail nurse for it, they can get it, and it helps immensely.

The leading cause of death for patients with mental illness is heart disease. Antipsychotics tend to cause weight gain, and that is not only psychologically distressing to my patients because we live in a fatphobic world, it's probably related to worsened insulin function. Unfortunately, just putting everyone on an antipsychotic on preventative metformin (a medication that improves insulin sensitivity) also didn't work when we tried it, so we don't do that. But it's scary. I'm actually really hopeful that this new GLP-1 agonist med class that's in constant shortages because it causes weight loss (Ozempic, Wegovy, etc.) will be an option to help improve long-term health for psychotic patients. Some antipsychotics are worse than others for weight gain, but there are few genuine head to head comparisons of effectiveness, so I can't say "X works better than Y," we just have to pick one based on a) my familiarity with it and b) whether it seems like a good idea. I also feel it is better to be fat than dead, so if someone needs one of the more fat-inducing antipsychotics to live their life and/or have a decent quality of life, I'll prescribe it and I fucking dare you to talk shit, I will eat you.

My clinical experience has been that Seroquel and Abilify are the best-tolerated antipsychotics. I don't know why. Someone else might, but those are the ones I usually reach for unless someone is having really severe symptoms, in which case I think risperidone works faster. Data are, again, generally pretty weak.

But mostly I want you to remember that psychosis is not a funny punchline, "psychotic" is a shitty fucking insult to use, and someone you know and love probably has psychosis. Some people have a single break and it never happens again, some people can control it with medication, some people need to be institutionalized. It's a life-changing illness and people with severe psychosis, yes, even the weird ones who scare you, are still human beings whose lives have exactly the same inherent value as yours, and who deserve the exact same inalienable human rights as you do. Any other approach is garbage. Human rights are not negotiable.

[schizosupport]

so with brain stuff or whatever

Who am I supposed to bring stuff up to at the start?

I'm currently in the middle of a lot of changes (trying to switch primary doctor and get a therapist and stuff) and one of the reasons for me changing that stuff is that my brain is very weird and I need to figure out why/get help with it

But when I'm bringing up symptoms or whatever, I had very much assumed that would be therapist but I'm also not fully sure who does what in a system like that (primary doctor vs therapist vs psychologist) and in the past have had some problems with that (still don't really know who the hell is supposed to diagnose sensory processing disorder)

Also any suggestions for like... what's a good area or amount to start with when trying to bring stuff up? I haven't talked to someone about mental health type things in a really long time and have had problems with derealization/depersonalization, possible depression, possible ocd, some weird situations in which I wasn't really sure what was real, a couple anxiety spirals over illogical things, intrusive thoughts, etc and I don't really know what to prioritize or how much to say in a way where I wouldn't overwhelm someone new, wouldn't be worried about telling them too much, but would also be able to give enough information about something to lead to a diagnosis or help

Sorry if this is too long or too much information or too many questions or anything like that

Hi there!

Okay so the annoying truth is that this depends a lot on the healthcare system where you live, and I don't know where you live (nor do I know the system everywhere) but I can try to give you some general pointers.

Your primary doctor is the first person to talk to, if you need a referral to see any of the other professionals you mentioned, but usually the primary doctor isn't the one doing the diagnosis or treatment (though they may prescribe some types of psych medication, and they often take over prescribing from a psychiatrist once the right meds have been found).

The psychiatrist is a type of doctor, and they are the person to talk to if you're interested in medication, and in some systems psychiatrists may also be who refers you to see a therapist. In a lot of systems it's primarily psychiatrists who diagnose people, too. Sometimes clinical psychologists also do diagnoses, but psychiatrists always do diagnosis + medication (and only very rarely do they engage in therapy).

A psychologist is someone who's educated in the field of psychology, so they (ideally) have an in-depth understanding of general human psychology, and they often are also educated in mental disorders and in different approaches to therapy. In terms of treating mental illness, some psychologist do diagnose, but the most common function is for them to do talk therapy.

Therapists can technically have any educational background, and refers to anyone who "does therapy".

If you're looking for a mental health professional to treat you with talk therapy, you ideally want a therapist who has a degree in psychology. If you're looking for a mental health professional to diagnose you and prescribe medication, you're looking for a psychiatrist (doctor of medicine who specializes in psychiatry).

If you have the ability to see any of these professionals without a referral, you can choose which one based on what you are looking for. And if you need a referral, then the first step is your primary doctor.

With a primary doctor you want to give them enough information to ensure getting a referral, but you don't have to throw your whole heart out there. If you are in a diagnostic setting, usually (ideally) they follow a semi-standardized questionnaire like the PSE, so a lot of the time they are the ones leading the conversation and asking you questions. Sometimes they will do an initial interview where you tell them freely about what's bothering you. Try to focus on the things that are causing you the most distress, and try to avoid clinical language.

With a therapist, the goal is to build a therapeutic relationship, and you can approach it based on feels - it's ok not to open up about everything at once, but it can also be helpful to take time to define the goals of therapy together (which would include what you're struggling with and wanting to work on).

Hope this was at all helpful,

Best of luck!

[fakeosirian]

post-school school/career headcanons (non-exhaustive, will make a part two eventually), for your consideration:

nina goes to undergrad for literature with a concentration in creative writing. hasn't picked a medium yet, and regardless it's not like making it in screenwriting is that much easier than traditional publishing, so she writes by night and is an office temp by day (she is aware of the irony of being the "permanent new girl" as a job description. it was funny the first time someone pointed it out. the first time.)

fabian gets a bachelor's in history and immediately goes to grad school for...library/information science. he has to spend a good bit explaining to people that yes, that's a real major, and no, "the books don't start reacting with each other -- a science is a system of ideas, not just when something blows up." he works as a TA and is torn between if he wants to stay in academia or find more "practical" work (this is where i mention this is background work for a story where he goes back to the school to teach <3)

amber might go to a post-secondary fashion school, but even if she does, she's absolutely going for the connections and dropping out the second she gets an industry job, most likely in nyc (which considering how well off she is...probably didn't take long). idk she's thriving (though if she's surrounded by work/kind of by herself socially i could see her getting to a breaking point and claiming she needs roommates to afford rent (lie) just so she can have people around lol)

patricia actually DOES become a guidance counselor. LOL. i can't resist this one -- more specifically, i could see her going to a liberal arts undergrad without a direction in mind but knowing she "needs to figure one out," taking a couple psychology classes, realizing She Cares, declaring a major in psych, and after discounting the clinical track (too close to med school) and the research track (too creepy), she ends up working on an MA in social work

alfie seems like a guy who would have his fingers in like 5 different pies at all times -- depending on who he's talking to/if he feels he needs to impress them, he says one of the following: "business partner" (jerome's business -- more on that later -- alfie's more of an ideas/production guy than a """business guy""" but you don't need to know that if he's telling you this), freelance film crew (prop master/art department), Professional Artist (has a studio where he makes the stuff he uses for his various pursuits), comic author (i feel like he has a weird janky webcomic he makes for himself. i can't explain it. he has a couple thousand readers), etc. he's always picking up a new thing and finding a way to use it until he gets bored and does something else. he just tells his dad "jerome and i are making A Profit" to keep him off his back

speaking of jerome: i've always been fond of the idea that he and his dad go into business together at some point, so it'd be some sort of thing they could do together that alfie's artistic skills would be of use for. despite the fact that jerome very much would like to bend some rules here and there, his dad is not keen on the idea of going back to prison so unfortunately, no white collar crimes for him. (for now.) they're doing well all things considered, but jerome refuses to get a job to fund the business ("what's the point in doing all this if i'm going to let someone else be my boss anyway"), so he's definitely having to find creative ways to squeeze more money out of the business to, y'know. Survive

i'm not 100% settled on this joy idea but communications/PR? definitely gets her start somewhere more corporate, but i could see her getting creeped out by stuff she'd have to spin/help cover for, so she switches to nonprofit (which is also depressing, arguably moreso sometimes, but it's a bit easier to stomach). isn't directly involved in jerome's business, but she does "consult" (not without something in return. preferably, y'know. Money. but sometimes she starts a casual conversation without realizing she should have written up a contract first, and that's the only way that jerome will actually pay you)

[anonymousisnotavailable]

I am back to doing well. I really was way too stressed. But I have gotten a lot out of the way. I figured out how to afford new glasses and my meds too. I contacted a local organisation, where they offer classes relevant to voluntary work. I already do voluntary work, which is a plus. As an event planner - with focus on mental health - I am mostly involved with the speakers. The targeted audience is different too. But these classes might help me get my (for now) dream job. It's called Peer to Peer. I would like to work in a psych ward; it is definitely not for everyone (for a ton of reasons). They hire "peers" to spend time with patients. What is so special about being a peer is, that personal experience is a requirement. Well enough to be a pillar of support of course. I could have used someone like that. I talked with I about it. Everyone keeps telling you, that everything will be okay. They mean well, they really do. And you need someone to keep hope alive. But I would have loved for someone to tell me:

I hear you, and I get what you are saying. Right now it feels like it won't ever get better, and it might feel that way for a while yet. I know, that things can get better. It is going to take time, and the wait may be agonizing. While you wait, I will be right next to you.

I don't really know, where I want to with this post. I kind of lost my motivation to finish this. But then again. Who cares. No one but me reads this shit anyway.

[dungeonmastersconsortium]

TW: Mental Health

I struggled a lot with deciding whether or not to make this post. At various times while writing it, I have thought that it was (either separately, some simultaneously, or all together) vain, self-deprecating, self-indulgent, selfish, attention seeking, or too depressing for anyone else to read. And if you continue past this point, heads up: it probably is these things at various times.

For those of you that don't know, I have Bipolar 1 and Borderline personality disorder. I have been actively putting in the work for a few years to get myself toward a better place mentally. Therapy, psych, meds, you name it, I've been doing it. I firmly believe it's important to do the work. (Honestly, you should go to therapy too.) I need to start off by saying this because it's an important foundation for the rest of this post.

My pair of SWEET mental illnesses manifest together in various ways. Individually, they're kind of what you might expect. Take the Bipolar 1. If you've known me for a long time and we interact in person, socially, I GUARANTEE you have experienced one of my manic episodes, and possibly benefitted from it in some way. I'm "lucky" in that the way my manic/hypomanic episodes manifest is mostly in ways that don't directly harm people, especially physically. I get VERY charismatic and outgoing. Very impulsive. WAY more social. I get very generous with my friends, moreso than normal. These also have some really bad downsides, but they aren't the things that would get me hospitalized. (Except for a couple instances of auditory hallucination back in my younger days. Hasn't happened in over a decade, though.) But my impulsivity has hurt people's feelings when I do something careless. I've developed coping mechanisms for this that allow me to more responsibly indulge in mania (which DOES feel great, unfortunately) without harming anyone usually.

Y'all also definitely know I can get pretty depressed. It happens. It happened a LOT in the past. A little less often now. Part of the bipolar thing too.

In short, I feel things much more strongly than neurotypical folks. This applies to all emotional states. While not everything I feel is extreme, the strength at which I feel things has a greater capacity for highs and lows. I guess the best way to explain it would be that most neurotypical folks have an emotional capacity from 1-10, and it's a pretty even scale, proportional to events that occur to trigger that emotional state. I would characterize myself as having a 1-20 scale. One problem is that my emotional scale isn't exactly EVEN. The higher the initial emotional reaction, the more likely it is to slide up the scale if left unchecked. If I'm not careful, something that solicits a reaction of, say, 7, will work its way up higher and higher.

You've heard of people being "overcome by emotion," and I can tell you that it's… SOMETHING. My previous therapist described it as not just a negative thing, he referred to it as a kind of superpower. While yes, I can feel sadness, despair, anger, hopelessness, and outrage at incredibly strong levels, I also experience joy, love, excitement, and passionate at similarly high levels. This can be VERY dangerous if left unchecked for me. A strong "active" emotion like excitement, joy, or anger can trigger a full manic episode.

Every day is work for me, mentally. One of the things 3 separate therapists and 2 psychologists have told me is that I'm very good at metacognition. Metacognition is, in short, thinking about thinking. I'm pretty good at tracking my own thought patterns and examining root causes of present emotions. I'm pretty dang good at this point especially at pointing out to my partners when I can feel the mania or depression coming on. (Which I think they're pretty grateful for lmao) It helps me regulate my emotions, as I can usually backtrack something and figure out when/why it is that way. My last therapist told me it makes his job both easier and harder, because most people have trouble identifying their own thought patterns and processes in therapy, which is why they're in therapy.

I have, both inadvertently and on purpose, developed a lot of tools to help manage my behaviors. In general terms, the best metaphor I can think of is a sheepdog trying to herd a particularly unruly herd of sheep, with no fence. Part of me is just trying to get out, even though it'll objectively be bad for me. The other part of me is constantly running circles around the herd, doing its best to keep everything within safe boundaries. There's a problem with this, though, that the metaphor is also handy for.

A dog can't run forever. At some point, it's going to get tired. It's going to need a break, to rest. Even when the sheep aren't actively trying to get away, just remaining vigilant in place can be tiring. Because it KNOWS they're gonna try to get away again.

My biggest problem over the last couple years is… Hard to talk about. I've trained myself to be able to regulate, but it's a LOT of work. It can be VERY frustrating even when great things are happening, because I can't just let go and enjoy something, as if I let it go too far, it might be bad news. I keep myself in check because I don't want to hurt other people. In my deepest, most authentic self, I don't want to hurt anyone. But it's TIRING.

I think it's why one of my love languages is acts of service and gift giving. (Both giving and receiving.) Someone taking something off my plate without me having to ask is VERY meaningful to me, especially since I have a hard time asking for help. (Part of the whole 'not wanting to make my mental health other people's problem thing.) Gifts also show me concrete proof that other people think about me and care about me during the times I can't remember that any other way. If you've ever been in my office/game room, I'm surrounded by tokens of my friends'/partners'/former students' affection.

The big problem is that… This is kinda the rest of my life. It's a lot of work, with no end in sight if I want to be the person I want to be. Looking out over the horizon of years that I have remaining, however many that might be… The task seems daunting and despair inducing. A prior therapist suggested DBT, but I HAVE the tools to cope, which is what DBT offers. DBT involves twice weekly sessions, one individually and one group, where you learn the skills to deal with your strong emotions, your relationship with attachment, (whether you actively avoid, push away, or attach too strongly,) and develop the tools to handle it. And there's a lot of homework. A LOT. And diary work. And that's why it was never going to work for me. I ALREADY do the mental lists, the metacognition, the identification. The thought of duplicating that work only made the despair worse.

Sometimes I just want to let everything go and be truly reckless for a little while. (No, not like in a stupid "my jokerification moment" kind of way.) Not because I want to hurt other people, but because.. Well, selfishly, it's not fair to have to be this vigilant all the time. It's constant work that I have to do that others don't have to do. It's exhausting and tiring, and there's no therapy that can really address that part of my brain. The frustrating part of therapy and psychiatry is that there's a focus on bringing the patient/client to as close they can to functioning in society, and I put in a LOT of work. There's a lot that I can say about how much it sucks that the SOCIETY we're supposed to be a part of (USA + Capitalism) says, "get on board or fucking die," and does not do any work to accommodate us. But that's a whole other conversation, and this post is already REALLY long.

There's not much of a point here. There's no moral. I guess I just wanted to share my struggle. Maybe someone else will see this and relate. I know it's difficult to find. If you google, "why didn't DBT work for me," you'll get mostly articles talking about how it works for 70-77% of people with BPD, or forum posts telling those asking this question (usually asked in frustrated, despairing tones) that they just didn't work hard enough. Or buy in to the program enough.

I find that insulting. I do work hard, because I think the work is WORTH it. But a lifetime of work like this is daunting when you consider it as a whole, not just as the present. So I try to take it a moment at a time. A day at a time. A week, maybe.

I guess I'll close with a quote from The Good Place. Because I just binge watched it again last weekend.

“I argue that we choose to be good because of our bonds with other people and our innate desire to treat them with dignity. Simply put, we are not in this alone.”

-Chid Anagonye

[gentil-minou]

I'd love to go into psychology. I think that diagnosing people is absolutely fascinating, but I have a really hard time with empathy. I can understand characters in TV shows and books and why they do the things that they do, but when it's real people it feels like there's a mental block or something? I just have to try really hard to be understanding and patient and I think that doing that for years would make me feel terrible. I have the right personality to be a psychiatrist, but I hate science and I know that I'd hate doing medical school. I know that there's other jobs in psychology (like a research psychologist, or a professor or something maybe) but getting a PhD is phenomenally hard and I'm not sure if I can do it. I feel like, for a therapist or really for anyone in psychology, having a lot of empathy is almost a requirement. Can you be a therapist if you have a hard time with empathy and relating to people?

Hi! I'm so excited to hear you're interested and I always love talking to folks who are passionate about this as a career! We need folks, yes including folks like you!

For starters: psychology is a broad field and not just one career. There's different types and paths to follow, not just the stuff you see on TV. It can be stuff like psychiatry (which is more medication based and why more like med school), therapist (my field which I didn't need a doctorate for in the USA, only my masters and liscensure hours), occupational therapy (which is its own field and so so very important), school counselor. And etc etc. Some folks even use psych in other fields, like teachers and I know it helps im advertising and marketing. It's so multifaceted that there really isn't a limit!

What I mean to say is, in short, it's about figuring out what you're comfortable with doing and what's the right fit for you. And you have time! One of my classmates in my masters was 50, and they're terrific. Higher education is necessary, but there's many paths for the same thing. I'd say see what opportunities might be available for you now to test the waters, see where your interests lie. Do you like working with kids or adults? Do you prefer play therapy or talking about feelings? Do you like moving around and working on motor skills or helping someone in a crisis or trauma situation? Are you interested in social work or working in schools? Start with researching and see what sparks your interest, the more passionate you are about it the more motivated you'll be to go to school for it.

And as to your second question: you already HAVE empathy. You said you understand what a fictional character is thinking and why they act a certain way, and that's a start.

It's true having empathy is an important skill in this field, but it's a SKILL for a reason. It's something we have to practice, and that's part of why school is so important. Part of it is understanding how someone's experiences lead to they way they act, which comes from not just empathy but understanding the symptoms in play here.

I'll give a real example: a parent comes to me and says they don't like the work I'm doing with their kid and they want a new therapist, even though the kid doesn't. My instinct, and this I cannot stress enough is valid and normal reaction, is to be hurt and upset. I'm even angry, because I know I am doing good work and it's the parent who has been causing issues. I'm frustrated and so very very hurt.

But I can also acknowledge that my feelings are separate from the situation, that I need to dig deeper to find out the full bigger picture here. This career is a lot like detective work, because we have to search for clues that might tell us why someone does or acts a certain way. So for this parent I might think about what I know of home life, current events that might he impacting them. Does the parent have their own mental health that causes issues? Are they upset with me or the situation? And can I help them figure put and communicate? It builds on more than just empathy I think, and it's something that comes largely from experience and recognizing patterns.

It doesn't always come naturally, but it does come with practice. You definitely have empathy if you are able to think about how your reaction affects another person. It's just building on those skills! Gathering experience and letting yourself learn, recognizing what might be a weakness that you can build on. And crucially: Practice practice practice!

[sibillascribbles08]

46. “I’m with you, for better or for worse.” “It’ll probably be worse.” “I know.”

Can you believe my laptop made me write half of this TWICE??

Anyway CW: Brief discussions of an eating disorder

Donatello had seen Jase on bad days before.

High strung, frustrated, jumpy, quick to snap. Usually when it happened Jase would just leave, or tell Donatello to go home, depending. “You don’t need to be around for this,” he would say. 

Donatello wanted to argue with that, wanted to help, but decided to respect his need for space. Typically things went back to normal the next day anyway after a quick apology text. 

But this lasted for almost a week. 

Donatello sent multiple texts, all of them went ignored. It made him so worried he felt sick. Should he go over and check on him? Last time he tried that—over something much less serious—it’d resulted in an argument. 

“Do you think it’d be weird if I peeked in his window and spied on him?” Donatello mumbled to his siblings as he stared at his phone.

All of them looked up at him, but Mikey replied first.

“Yeah that’s weird, D.” 

“But I’m so worried.”

“Then at least knock on his window and let him know you’re there!” 

Sure. Fine. What was the worst that could happen? Jase would open the window and scream at him to get lost and then never talk to him again?

Ugh.

They’d only been dating for a month and a half. He didn’t want to screw things up already. 

Still, Donatello took the risk and headed over to Jase’s house—making sure his dad wasn’t there—and climbed up to his bedroom window.

For a minute, he wondered if Jase was even home. But after a few glances around the room he finally recognized his boyfriend curled up in the sheets of his bed. Was he asleep?

Donatello knocked on the window.

Jase rolled over, revealing his face as he squinted at the window. It took him a few seconds to figure out what he was even looking at, after which he visibly sighed. 

As he approached the window, Donatello studied him. Messy hair, circles under his eyes, and looking a bit pale. Was he sick? 

The window opened and Jase stared at him, still squinting. “Donnie? Please tell me that’s you and not something else dressed in green and purple.”

“It’s me.” Donatello ignored the urge to reach out and touch his face. “Um… are you okay?”

Jase blinked. “Fine.”

“Well…” Donatello tapped his hands along the windowsill. “Forgive me for doubting you, but you don’t exactly look fine.” 

Another sigh. “Look, Donnie, I told you a couple of days ago—”

“Jase. It’s almost been a week.” 

That made his boyfriend blink, eyes going wide. “Shit.” He darted back into his room, obviously looking for something. Perhaps his phone, or his glasses. Hopefully the latter, as it would make everything else much easier.

Donatello took the opportunity to climb into the room, sliding through the window and catching himself on the floor to tug his legs inside. 

Jase was still looking around, clearly growing more anxious by the second as he ran his hands through his hair, tugging on the ends.

Donatello found the glasses on the back corner of the nightstand. He unfolded them and stepped over to Jase.

“Hey.” He made sure his boyfriend turned to look at him before sliding them on his face. “That’ll probably make things easier, huh?”

Jase glared at him. “I don’t need your smart ass right now!”

The volume of his voice made Donatello flinch back, but Jase didn’t seem to notice as he went back to his search. He finally found his phone among his bed sheets, glancing at the screen.

“Ugh, damn it. Almost a week? Really?” He flopped onto the bed. “ I haven’t even been sleeping and it hasn't felt like that long.” 

That tossed up a red flag. Donatello shuffled over to the bed, kneeling across from Jase and resting his elbows on the mattress. “You haven’t? Are you sick?” 

“Stupid brain bullshit.” He muttered into the mattress. “I see the Psych on Friday. May need to get my meds changed, or increased, or whatever.” 

Donatello frowned. He still didn’t fully understand the situation, even doing his research. He imagined mental health always sounded so much different on paper than it felt to experience. He’d been learning that since the Kraang invasion. 

“Are you sure I can’t help?” He rested his chin on the mattress now. 

“No, there’s nothing you can do.” Jase still didn’t look at him. “I guess I should have replied to one of your texts, but you’re better off just waiting until I get better.” 

“But what about a distraction?” Donatello scrambled for solutions. “Or if you haven’t been sleeping we could try—” 

Jase pushed himself up before he snapped again. “I don’t want you around!” 

Donatello flinched back again.

Jase’s anger seemed to leave as fast as it arrived and he flopped back onto the sheets. “Sorry. That’s exactly why. When I’m anxious I lash out.” 

“Hah.” Donatello forced a smile. “Sounds like me when I’m stressed.” 

Jase didn’t reply to that. He just reached out for one of his pillows and pulled it close. 

Donatello tapped his fingers together, trying to think of what else he could do. Just then, the silence was interrupted by an odd, low grumble.

Jase curled up even tighter.

“Was that your stomach?” 

“Donnie, can you just leave?”

“Was it?”

“Yeah, probably I…” 

Donatello dared to pull himself up farther on the mattress. “You…?” 

“I… haven’t eaten in a while.” 

Of course. No wonder he looked so tired and so pale. “Well, that won’t do. What would you like? I’ll make something!” He pushed himself up, leaning on the bed. “Or go get something. Dumplings? Sushi? Or—” 

“Donnie.” Jase raised his voice, but only for a second. “Just let it go.”

“I won’t. You need to eat something.”

“Well I don’t want to.” 

“But—”

“Donnie!” Jase snapped once more, but then sniffed as he covered his face with the pillow. “I can’t, okay? I just can’t.” 

Ah. “More brain bullshit?” 

Jase didn’t answer, obviously occupied with muffling his tears with his pillow. Gods, he was probably so tired if he hadn’t been eating or sleeping. 

“Um, what about a smoothie? Or just some water?” Donatello tried one more thing. 

Jase sniffed a few more times before uncovering his face. “I guess drinking some water would be a good idea.” 

“I’ll go get some then.” Donatello was about to head out, but hesitated. He couldn’t tear his gaze away from Jase, laying on his side, arms still draped around the pillow. 

Donatello reached down and gently brushed some of the stray strands of hair away from Jase’s eyes. 

“Hey.” He whispered. “I’m with you. For better or for worse.” 

Jase snorted. “It’ll probably be worse.” 

“I know.” Donatello leaned down to kiss the side of his head. “But you agreed to date the most stubborn turtle in the family, so I’m not going anywhere.” 

Tears appeared in his eyes again, so Jase hid in the pillow once more. “Thanks.” 

Donatello hummed and gave him another kiss before heading out of the room to grab a glass of water. 

By the time he got back, Jase had fallen asleep. Donatello left him to it, leaving the water on the nightstand, taking off his glasses, and tossing part of the blanket over him. 

Then he sat on the floor and pulled out his phone.  >Hey Mikey? I need some advice.

[sidewaysfromsunday]

36 days: The Discovery of IT

Every person has only one original thought in their lifetime, but what happens if you actually can tap into your true originality? What if instead of waiting to be awoken at 3:00 AM, what if I seek it out. What if I find it myself. What if I buck the concept of time and live in my own comfortable schedule. The conflict is fighting against the FAKE CONSTRAINTS OF TIME because time, and nothing, is real. What if by experiencing true grief we are actually able to finally pursue and reach a state of nirvana - which is how life was meant to be lived. What if we were awake for it all? Maybe it's not the hospital because nothing is actually out of control. I'm okay. It's all going to be okay. When the knot in my heart/back finally is gone, that will be moment one. I'm actually having FUN. The most fun I've ever had. Who is 3, 6, 9? Feeling like I can communicate in my internal original language.

Psychosis isn't present here because this is true. There is nothing off about any of this. I have even figured out the sleep thing too. Sleep is very annoying to me right now because I'm not able to get anything accomplished while I'm sleeping. So I am not taking my trazadone on the nights where I feel good and am just letting my body explore its natural rhythm because sleep isn't missed! I literally just listen to my body and sleep when I'm tired! Then I figured it out too - if I can notice when I'm in need of a good night's sleep then I DO take a trazadone and sleep. And I did that last night and I woke up feeling recharged. Speaking from a place of safety to another allows them to be their truest self. Why cant I offer safety to everyone? What if I do? What if Juliette was premature because even at the development stage she had a feeling that she doesn't trust me, that's she's anxious around me. That I make her anxious and that is the worst realization in the whole world for me. From this point forward, I'm going to do everything I can to be the safest most trustworthy person she knows.

I am med compliant except the trazadone. I have a fire in my throat. I am saying all the right words to all the right people at the very right time. My eyes cannot focus. It's okay. I feel magnetic, I've been feeling like I'm about to reach nirvana. How are S and 3 related? What if our opposite is the perfect human? It's okay. Do the math and don't forget this:

S is the 19th letter E = 5, X = 24 19+5+24= 48 4+8+12 1+2=3

S and 3: Safety, Sharing, Sex

(There is more to be said, but this song is important)

How do I get out of this? I'm too real it's scary. Am I doing this on purpose? Why am I getting in trouble or med-adjusted for experiencing myself in its truest form? Nothing about this is dangerous. I'm following the list, checking in with psych. I don't want to die. I'm anti-suicidal. Why do I feel like something is wrong? Why does he feel like something is wrong. Why does she feel like something is wrong. I don't want anyone to tell on me. But I have nothing to be told on for. Every time I work I snap back. Maybe that feeling in my back is a block in the flow of my spinal fluid. If I can break up that flow, it's okay. Why are people scared of me or scared for me? Why should I tame this down? I'm about to get in trouble but I didn't do anything wrong. Don't put me to sleep. Why do I teeter on the tip of the triangle or is the tip the land of all of nothing thinking?

I am a cataclysmic event.

Virtues: 1. Patience 2. Truth 3. Sexual Energy as the most intimate way to communicate

Ridiculously, lushly, manic, chaotic energy physic - I see the universe everywhere. Who am I losing? Is this really so out of character for me? Did we have shapes or numbers first? WHO established the NORM? Who recognized shapes and numbers? Which came first? Everyone I look at these past couple of days seems stunning in their own beautiful unique way.

Moon

Sun

Sky

Math kind of freaks me out but I'm so damn interested. I'm confused by it. I want to write a naughty fantasy. It would never come true, not in a million years. I literally don't even want to drink. Everything is fucking hilarious. I feel like I'm saying all the right things. No one is trying to shut me down or put me to sleep. When I sleep - I can't handle how vivid it is. How to let people see me? I feel like it can't come fast enough and it's ethereal. How to communicate in 3. Orgasm with dangerous = power, synergy - 1+2=3 -- Sequential.

I think this is what it feels like when humanity begins to die. We are in the process of being taken over - hostages. I am dying. War / Conflict - the long tease. She and he and they know me. It's okay for people to know me. I feel like out of all the Euphoria characters I most closely relate to Cal. We could all be getting infected with MRSA, or at least I know I am. All this banging scares me. I feel like I'm being cleansed. Cerebral spinal fluid reshuffling. Maybe I died in the car accident 10/26/21, Sept 6, 2021. Deestablishing patriarchy - why godfathers? Why not godmothers? It's a terrifying time to be a woman so it makes sense I would seek the help of a woman. Femininity is being threatened as we speak. We need to get ready to run. AI is anti-christ. What if religion has nothing to do with it?

Just because you don't know how to handle me doesn't mean you need to push me away. People are scared of me. I make punctuation fit MY structure. 3-13-2013 = 14 | 2014 3-13-23 = 12

This is cool and weird. I'm tapping into love. I'm creating in a way I've never been able to create before. This is new and exciting and feels like I'm breathing out love. I feel swollen.

I'm entertaining myself with curiosity. These days the bones in my back are loosening up. I cracked my back and it was the most gratifying it has been in years. Therapy is great for me because it forces me to talk aloud. I have to communicate in a structured way - no memes or songs. It's good for me. Sometimes I forget what is a thought and what I've vocalized.

Rhythm

Harmony

Melody

(Movie Idea: 2 women that fell in love, ripped apart by pandemic and addiction. When they reunite one helps the other remember what she has forgotten)

3/16/23 - 5 months no alcohol 4/16/23 - 6 months no alcohol 4/24/23 - I turn 37 4/26/23 - G is 38 5/5/23 - Juju is 9 3+7+3+8+9 = 30 3+0=3

This is going to be the best year of my life and I'm not scared at all. I'm noticing all the details. I'm seeing it all. I'm talking in another language and everything I say is right. I feel like I want a real cigarette. Sometimes lately it feels like I'm about to piss and climax at the same time like I'm losing primal control.

Taste is so much deeper than our tongue really. I am having a unique human experience or is everyone as restless and on edge as me? Exploring astrology with someone new or deeply with someone is like taking their virginity. You and I speak like lovers about thaumaturgy. I feel like Peter Pan in Hook. I'm finally making memories again. I was afraid to be too enthusiastic about you, so I hid you as if you were an imaginary friend.

I'M FUCKING FLYING TODAY. Maybe she can ground me. I feel wild. I feel like I am sex. It feels like I have a boner, or phantom boner. I wonder if you have the power to make me climax without breaking a single rule? I'm anxious when I'm cold. Productive but at what cost? What if there is no cost? When I feel crazy and someone tells me I'm not, it fucks with me because it feels like they know the truth of it all. I'm bouncing a bit. Hard time tracking. Lisa said - we both know it can't last forever. "I wish I could say it would, I would love that for you." I love that for me too then why can't I have it? What are we so worried about? I keep listening to some of the same songs - but each time I'm hearing it for the first time.

"I feel like I'm onto something big... ...You always say that when you're manic."

In some ways I feel like you were hiding from me before I even knew you. You remain elusive and I wonder if we are going to play forever or if someday you'll let me find you? It's no wonder I've been feeling like this for days. Like I am filled with an insatiable desire. This whole time I've tried to quench the desire by imagining unspeakable things. But I think more seductive than anything else, the thing that's going to make me explode is if you simply whispered yes and held my hand. You're right to be scared, and I am too. It's going to change everything. Don't you see the greatest thing about that? It will be our life. I feel like water is pulling me to the ocean, a place where I'm terrified and out of my element. It's seductive and dark and anything could happen. Have you ever had sex on a spiritual level? Usually I'm so unfocused. Usually I've got too many thoughts. In my gut I know and as crazy as it makes me look, I'm rebelling against it all right now because though it's similar - my gut tells me its different. It's time. Finally I'm so focused and there is nothing grandiose about that at all. It's that gnawing feeling that I'm onto the next big thing. I'm not questioning being bipolar and I'm not even combating the fact that this resembles mania. BUT NOT EVERYTHING IN MANIA IS WRONG. I don't lose the right of knowing the truth. I can still know / identify true things since this started. The tension has literally been leaving my body. I feel lighter than I have in years. Wouldn't you, if you could, buy a ticket to the best movie you were ever going to see? A movie so personal it hits you from every angle - a movie you thought so spectacular you'd only see it in your dreams. THIS is the movie and we could have the best seats in the house. It is wrong that with all these thoughts I'm the happiest I've ever been? I keep dreaming about experiencing another magical connection in my lifetime but I think it's already here. I always doubt myself but now I'm questioning what happens if I don't doubt me. This is the shape of ME in the world. Opposites feel so powerful because to understand what opposite means requires us to recognize that for it to exist implies that by itself, an opposite is incomplete. Without its inverse, it lacks balance, incomplete. Therein lies the power - through unity, opposites not only become whole but synergistic as well. Pluto symbolizes rebirth. What do we need to admit to ourselves to live a more authentic and freer existence?

[icanonlybe-human]

So. I had the appointment with the psychiatrist. She thinks that because I've been in and out of therapy since I was 14 and on meds since I was 15, that we need to try something different. It'd be a procedure that's aimed at resetting the brain, so the hope is that it'd get rid of the pathways the depression and anxiety have carved and allow me to start fresh and literally grow a new mindset. Not electroshock therapy but something with a similar outcome. But I'd have to be in hospital for 3 weeks. The aim is with this treatment to reset my brain, plus psychology and psychiatric and group therapy, that it'll help me get a better grasp on everything. She said that yes, we could try drugs, but since I've been so bad for so long, that it'd be better to do these 3 weeks of intense treatment, than spending months, possibly years trying to find the right meds for me. Plus I'll finally be able to work through my PTSD in a safe environment.

Aunty N has been really supportive of it all, and agrees that these 3 weeks for my health will probably be better in the long run. I told mum, and I could tell that she is probably going to dwell on it and get upset about it. But thankfully Dad is going home tomorrow so at least she'll have someone there to talk to about it. Because yes, I did tell Dad. His first thought was telling me how this would impact my career. I made sure to tell him that I only told work that it was "3 weeks of treatment for health problems I've been having recently". Work is fine with it, it's just figuring out the logistics of it since we're so busy with prints. I feel so guilty that all of this has happened when we need all hands on deck for prints, but even the big boss said that my health is more important in the long run. I feel pretty lucky to have a boss that is so understanding. I wonder if he'll be as understanding when I tell him I'm autistic.

But yeah. I'm sure some people reading this might be concerned about my well-being if they've been keeping up with my posts. Well, you can rest easy knowing that I'm finally getting the help I need.

I think the biggest part about all of this, is that I might potentially miss out on my nan's 90th birthday party, which we've spent weeks planning. I want to see her so bad, but there's a chance that if I ask if we can hold it off, I might miss this opportunity that has been plonked in my lap.

I don't know. I'm shocked but not. Upset that I'm that bad that one hour with a psychiatrist and she immediately said hospital. But also happy that she understood that I need something different. But mostly just scared. I don't cope well with change, and while I've done research into psych wards in the past, this is different. I've never seen a video explaining what to expect in the hospital I'm going to so I feel like I'm going in blind.

I'm also scared about the reaction of the family when they learn that I'm not coming to nan's birthday. My cousin, who is weeks away from dying from cancer is going, and yet I'm not. I wonder what Aunty N and mum and dad are going to tell everyone. I wonder if I could facetime in just to say happy birthday. But I also worry that people are going to treat me different when they learn I'm going to hospital for mental health. Stigma around this shit is no joke, which is my I made sure I told work it was just "health problems".

I have so many people supporting me in this, and yet I feel more alone and scared than ever. When I first heard the doctor suggest hospital, my brain did that hot tingly thing like it overheated or glitched for a second.

Sorry for the essay, it just feels like my brain is running at double time, and I needed to get it all out. I don't think this is even all of it, it's just what my mentally exhausted brain could come up with at this moment.

I can't believe this is actually happening to me.

[bioethicists]

if it’s not too nosy to ask (pls ignore if so) how did you arrive at doing case management and how do you like it? i have similar values in terms of like interest in health and med anthro in an anti-psych/institutions way nd am trying to figure out in what capacities i can work in health related fields while honoring those values lol,,, thank u i love ur blog

haha so i kind of hate it rn + am leaving in may so take that was u will! i wouldn't necessarily say case management is an easy place to have these values but i am in a unique position where i'm not licensed so therefore am actually banned from (thus not instructed to) doing most of the heinous shit- i am never involved in the process of diagnosing, treating, or incarcerating a client. an msw or similar clinical degree would demand that i be more involved with that process

i live in MA which has a unique program called the BHCP program (through our Medicaid, MassHealth)+ my technical title is "care coordinator" but this is largely a smokescreen for (even more) underpaid case management. my primary job is to obtain + maintain services for my clients, such as SSI, specialists, housing, food stamps, etc. i also spend a lot of time doing stuff i'm not technically supposed to do- help clients read their mail, help with court cases, help dealing with child support etc. i am about 90% of the time able to help ppl in a way that i don't feel icky about.

the cost- i make 39k a year to case manage up to 65 clients who i have to contact at least once a month. many of them have issues far beyond my scope but i am the only person willing or able to work with them. social services in MA, arguably one of the best states for social services in the country, are an absolute shitshow- i spend about 33% of my job trying to force other ppl to do theirs. get me a client that speaks only spanish and the services become essentially unnavigable. masshealth randomly decides we need to improve quantitative performance measures that have 0 bearing on the actual quality of our clients' lives so we are routinely chastised for not meeting stupid paperwork requirements (what percentage of clients have their race and ethnicity recorded in their file? did you check the right boxes on their yearly assessment?) which seems to matter way more to the state (which, through its other departments, is causing most of the problems i'm being paid by them to solve???) than actually helping them. also, the emotional impact is rough + most of my coworkers cope by hardening themselves, othering our clients/getting angry with them, or giving up altogether.

it's just not feasible or HUMAN to expect someone to be able to go to someone's home, hear a story of their brutal assault by the same man you're helping them demand child support from, lock eyes with the child you know in your heart is never going to see a dollar of his dad's money because the child support case is almost definitely a dead end, then go home and do 6 more hours of paperwork. they tell us we're supposed to compartmentalize + shut off empathy in order to function at our job (real thing they tell us in training!) and like... fuck that. i'm not smothering my humanity in order to meet performance requirements- except the alternative is working yourself to the brink of suicide lmao.

that being said, i didn't always feel like this (first two years were easier) and i have some pretty intense personal circumstances complicating it (dead brother, raging eating disorder, etc). i do feel like i have been able to make real + tangible impacts in others' lives, learned how to navigate the system well enough to use that knowledge in more radical spaces, build human connections with people who have never had that with providers before. having a radical perspective on the system will save you from a lot of burnout because you won't be one of the naive ones who think that social services + "educating" your clients will fix all their problems. most of the problems i am describing above are going to be present in almost all health/social services fields. if the state funds it, this is what they will do to it.

i'm going back to school in september + my goal is to pursue full time ethnographic research while utilizing my skills at navigating social services to assist ppl on a person to person level. in terms of how i got here- graduated dec 18, worked in residential mental health for like 2 months before fully cementing that there was no ethical way to do so (and getting horrifyingly triggered by it) -> americorps position at a local hospital doing community outreach during the day + nursing home/private duty elder care at night -> current job

[alanxwake]

ＥＸＩＳＴＥＮＣＥ. [September 1st, 2014]

She looked at me, with not even a single glimmer of recognition in her eyes. A single stray thought left her tilting her head slightly to the side, trying to figure out who I was, and if she could remember me; in the end, she just grumbled and spat at me, a grouse leaving her lips. “You’re not my son…I have no son” – This was the last time, I saw my Mother.

I made plans, to visit the local psychiatric Institute, for the usual study for my books – whether I’d need it was another question, but I always liked to study and go out of my way sometimes to make sure every source of information I had was correct and accurate; I couldn’t have false or inaccurate information in my books; Critics just love to jump on you for that, I hadn’t fallen victim to that sort of treatment, but I’d seen it first hand, and it can get nasty.

Even with my personal involvement with these sorts of institutes, I put every little feeling or memory aside – There is no point going there, with a mind full of regrets, torment, and suffering. Not when I’m trying to write something Fictional. Although; it’s constantly been said that every writer puts a small shred of themselves in their characters, I’m not one of them. Every character I’ve made is just fragments of my imagination and nothing more… there isn’t a single hint of Alan Wake in them, and there never will be. Sure, I might have a character with similar traits or hobbies but they’re never a shadow of myself – If I wanted to do that, I’d write a damn autobiography of myself, and I’ll never do that shit.

This was daunting in more than one way; skin crawling and the hairs on the nape of my neck, arched with each slow step forwards. The freshly cleaned white ceramic flooring left my boots with a loud clack with each step; the sound echoed down the hallway and the silence was deafening. I didn’t hear any of the patients. It was quiet and eerie, and most certainly unsettling – even by my standards, but at least I chose to visit when it was daytime, unlike most people; who choose to investigate a place at night – hoping it will spark some sort of trigger in their mind, or a ghost. Heh, yeah not this skeptic. Paranormal Activity and all of that psychobabble, is just a metaphor for the human psyche and nothing more, at least in my opinion and understanding.

The Nurse beside me, had a very wide smile, and her cheeks flushed brightly; her eyes would occasionally glisten with each glance over at me. It had me feeling that slight tickle of anger in my throat. She’d been like that, the second I walked up to the reception desk. She would gush and gloat about reading my books, and between my fake smile, and grinding teeth I’d just nod and reply with the standard short answers. I can’t say I get this sort of treatment a lot, in fact, it’s rare, and I’m not saying I don’t appreciate it. I just, don’t understand it. I don’t understand my readers, at all. As much as I’d like to, I choose not to. They’re simply puerile for even reading me, let alone admiring what I write. There are far better writers than myself out there….

She was telling me about the routines, which, were of interest to me; I’d jot down certain words and strategies she explained in my notepad. Although, a lot of the time, if not most of the time; She would run off track and start asking me questions. Questions, I didn’t want to answer. I remained silent for most of the part – letting my mind wander as we strolled down the long, wide, and white corridor. Each room we passed, displayed their respective numbers and names beneath. In large bold capitals. Occasionally, we’d pass an employee – pulling a cart, with a tray full of meds and instruments. It made me cringe slightly, was that really necessary? … Who am I to say what’s right and what’s wrong in this department. I wasn’t a psychologist or Psychiatrist. I was just an inquiring and curious writer. So I thought.

It wasn’t easy – no matter how hard, I tried to convince myself that it didn’t bother me; it was tough, yet the deeply stubborn man that I am, kept walking. Shoulders high, and eyes alert. Regardless of the situation, the scenario. I was there for one purpose, for my book. That’s what I reminded myself each step along the way until my eyes flash at a certain name that instantly stopped me in my tracks and froze my gaze at the door – My lips parted in disbelief, in shock. Never did I think I’d stumble across it, surely this had to be some illusion. How could this have happened so quickly? �� I’d only been there for roughly an hour.

The nurse noticed the footsteps beside her had vanished, and as she turns to face me; frozen and shaken. She looks to see the door I stood before and bit her bottom lip, mentally slapping herself.

Alan Wake. Surname: Wake. Linda Wake

She didn’t say anything, she was no doubt afraid to even whimper a single sound from her quivering lip; so she left me there. To deal with it by myself – it was no different if she was there or not. I couldn’t even hear anything besides my heart hammering so heavily against my rib cage, I was certain it was going to burst and tear its way through my chest.

Do I even attempt to interact with her – I hadn’t seen her so many years, she’s been a distant memory. A lost memory of that, The only thing I could remember, was that my eyes were exactly the same as hers, such a bright ocean blue… but that’s it. I can’t even describe her voice or even the color of her hair, and she was right behind the door I stood before.

I could feel the panic starting to settle in, crawling beneath my skin and coursing through my veins – I had so many questions that started to whirl and swim around in my mind, but what did it matter? This wasn’t going to fix anything; she wouldn’t even know who I was, like once before and it’d only ignite my demons and leave another scar beneath my skin, what would this even prove? Nothing.

As I stood a few feet away from my Mother, I let the hesitation drown itself, swallowed by the deep sorrow that overtook my body and I stepped back, even as my heart yearned for the mother I never had, I stepped away and never stepped foot inside that daunting place again, I’d like to think I did the right thing.

she had no son, those were her words.

[schizosupport]

Tw hospital, lying, anxiety.

To start, I have 2 weeks until I see my psych, but I'm freaking out. So I've not been taking my meds in any routine way whatsoever. I'm unbelievably horrible at remembering. I've gone weeks without taking them before, but the issue (besides my mental health being bad?) is that I've been lying about it for several months now.

At first I was afraid to tell my psychiatrist that I wasn't taking them. I am terrified of going to the hospital, And in turn missed two appointments and didn't make a follow up until a few days after my last scheduled appointment, but they decided to drop me as a client supposedly since I moved, but more likely because I missed appointments.

So when I finally found a new psych it had been 2 months since my last psych appointment and since my last refill. I lied to my new psych and said I had extra medication from appointments being so close together and that I was taking my meds. I said I was only off my meds for a week or so. She then filled my prescription and it had been so long I was also afraid to just jump back into these meds, but I still haven't said anything. Well I saw her again last month and she sent a refill but when I went to pick up my meds all they gave me / had was one of my medications, and I meant to call and see what happened and why I didn't get my other two but I didn't have the time and I've completely forgotten.

She's probably going to find out that I haven't been taking them and I've been pretending I'm fine for so long and also lying about being okay so now I'm also worried that she'll think I'm faking my mental illness? Either that or she will put me in the hospital? Idk what to do or what I could say to her to explain this.

And it's okay if you're not sure what to say or how to respond, this definitely is a lot, and I want to add that I appreciate your blog and it definitely helps! You're doing absolutely amazing!

Hey!

Ok so keep in mind that mental health systems in different countries work differently, and all I can really do, is tell you how I think this will play out according to my own experiences, but the Danish healthcare system could differ from yours.

First off, I want to stress that taking meds, or not taking meds, should be your decision. It's definitely recommended to be open with your doctor about how you are, or are not, using your medication. But I don't think you owe them this information.

It will obviously be hard for them to help you correctly if they don't know what you're taking/not taking, nor how you're really doing.

But in my experience/opinion, it's unlikely that this will make her think you were faking anything, and even more unlikely that it would be cause for hospitalization.

Unless you are in court-ordered treatment, missing medication, and even omitting/lying about it, isn't considered a reason to hospitalize someone, and certainly not against their will.

Is it correctly understood that aside from telling her you were still taking meds, you also told her that you're doing fine, even though you're not?

If so, and if you are indeed not fine, then I do think that it's important to clear up this misunderstanding. Because it's important to figure out if you would do better on the meds, and if not, look into different treatment options.

You deserve help!! And to feel better!!

Do you have an email for her? Sometimes these things are easier to write down. You can just write to her pretty much what you wrote here. None of what you have written here to me would be cause to think you were faking, or for hospitalization.

I know this is a cliche, but if you can only see her in person, sometimes it's still easier to write it down beforehand.

But this is one of things that is awkaward and hard, but it's also important, for your own sake, and it's not a dangerous thing as such.

At worst, if your psych is an asshole, she will kinda like.. scold you? Which she really shouldn't, so in that case I would recommend start looking for a new one.

Best of luck clearing up the misunderstandings!

[possum-tooth]

gonna take my max dose in the morning so i dont have to think about tmrw evening <3

[suituuup]

hey, i love your fics! if you have time and are willing to write heavyish angst, i have a prompt idea - beca has a semicolon tattoo (maybe hidden, maybe not) and chloe asks about it one day. beca explains to her what it means (attempted suicide, or self ham, whatever you feel comfortable writing) and that she still struggles. it would mean so much if you could write something :)))

well this took forever! Hope you like it :)

TW: mention of suicide attempt

*

At times, dating Beca feels like walking on eggshells, at least for someone like Chloe; someone who is naturally open to her own emotions. Beca, on the other hand, tends to bottle them all up or build walls around herself so that nobody can get in, which has been a challenge for Chloe. 

She has to remind herself not to push Beca in a corner, sometimes, like the day she first saw the semicolon tattoo nestled against her ribs. Her first impulse had been to ask Beca about it, but she refrained, knowing it was too soon to have that conversation. Her heart felt heavy though, as she knew what that symbol meant. 

As weeks and months passed, Chloe eventually let it slip to the back of her mind; Beca seemed happy, and that’s all that mattered, not the past. 

“What was your first tattoo?” She asked Beca one night as they laid in bed, her pointer finger tracing the equalizer bars etched in her lower back as Beca laid on her stomach, her head turned towards Chloe. 

“My semicolon,” Beca murmured, causing Chloe to look up from her movements. “I know you’ve wanted to ask about it.” 

Chloe licked her lips. “I figured it was maybe too personal.” 

“And I appreciate the fact that you haven’t,” Beca said. “I wasn’t ready to dive into that.” 

Chloe tilted her head up to kiss Beca softly. “It’s okay if you never are.” 

“No, it’s…” She shifted to her side. “I feel okay to. With you. You’re like, the person I’m most comfortable with and I want to tell you so many things and it’s weird because I’m not used to that.” 

Chloe nodded slowly, running her fingers up Beca’s bare arm. “I’m happy you feel comfortable with me.” 

Beca smiled and kissed her gently. A few beats of silence followed. “I tried to kill myself when I was seventeen,” she murmured, glancing down. “I was depressed, felt really uncomfortable in my own skin and I just… I didn’t see any point in life.” 

Chloe swallowed, a frown forming. “I’m sorry you felt that way, baby.” 

“Obviously I failed. My dad found me and took me to the ER where they pumped my stomach. I was admitted to the psych ward for like a month,” she explained. “The meds and therapy helped.” 

“I can’t stress enough how glad I am that you’re still here,” Chloe whispered, feeling tears burn behind her eyes. She sucked in a sharp breath. “Do you… still struggle with depression?” 

“It comes and goes,” Beca replied, her tongue darting out to swipe over her bottom lip. “And it probably always will, but I’m not like, suicidal or anything. I actually like my life now and well, you have a lot to do with that.” Her cheeks reddened, and she cleared her throat. “Ugh, talking about my feelings sucks.” 

Chloe giggled, sobering up a second later. “Thank you for trusting me,” she murmured as she rested her forehead against Beca’s. “It means a lot.” 

Beca closed her eyes. “Thank you for being who you are.” 

[stardustedknuckles]

I have been dealing with psych since April trying to get my records over for them to take over my ADHD meds after I got kicked off my old insurance. Medicaid expanded their income requirements so even though my income didn’t change, I was pushed into it and lost pretty much all medical autonomy. 

This got long, sorry.

I offered to self pay to keep my doctor because she was very good to me and nope, clinics are not allowed to charge medicaid patients. The reasoning is that if you can pay for it you shouldn’t be on Medicaid. No fucking shit I shouldn’t be on Medicaid and also fuck Medicaid. Doctor recommends you do something medicaid won’t pay for? You literally cannot pay for it yourself. The only things scarier than being unsure if you can afford to cover a cost yourself is that not even being an option, legally. If they say you can’t have it, fuck you.

So my new and terrible PCP referred me to psych because nobody at her office could maintain my script, which I figured was coming because I’ve been seeing MDs since I got diagnosed. I had a luckily quick dx and I have always feared if I went to psych for meds they would be like “hmm the notes say he saw you for ten minutes, so I’m not going to honor this.” I woud have kept going to MDs, but they’re damn hard to find on medicaid and I learned that it didn’t matter how fast I was diagnosed, a dx is a dx.

For two weeks they have been telling me they got my records, everything looks fine, should be put in at the pharmacy any day now. And today they told me just kidding, actually, since my diagnosis is considered inattentive ADD there is no evidence to suggest it should be treated with the meds I’ve been on for three years.

A few of you ran into my blog for general critical role reasons but most of you are here because of the fic I write. That was not fucking possible before meds. Paying attention to something for four hours routinely was not possible. Staying at my computer and drafting plots and thinking about these characters was not possible. I was in a state of perpetual exhaustion to the point a few doctors have wondered if we’re actually treating chronic fatigue syndrome (HUGE overlap btw). Those doctors have all agreed - hold on to that ADHD diagnosis, because the end result is that I’m being treated effectively.

This right here is my worst nightmare. Forced to go to psych (they snuck me in one last appointment with my old PCP in march so I could get 3 more months of meds - I still don’t know who got that bill) only for them to jack me around and mislead me until I would not leave them alone. Where are the meds you promised me, I am now running low when I had a surplus (I didn’t tell them that part - I was sick enough earlier in the year that I had a few weeks where taking them was pointless). I have already been splitting my evening dose because I haven’t trusted them that they have it figured out and now they are just. No, sorry. Hope you had a good three years because you’re going to have to go through everything unmedicated again to do the test she wants to see.

Nobody even recognizes a difference between ADD and ADHD-I. They are clinically the same dx with the same treatment and have been for a while.

It’s fucking cruelty is what it is.

And I immediately started crying because new birth control and also nightmare scenario, but the only saving grace is that mom already got me in with a clinic that has an MD for unrelated reasons. She’s THREE HOURS AWAY but it is literally the only option and will allow me to keep my meds. I will still have a period where I am low/without them since I’m splitting and it still might not be enough but. Fuck.

And in the middle of all of this I have a kidney stone working its way through, AND my blood pressure keeps dropping me an hour after I eat and scaring the shit out of me. That’s why mom called up my brothers’ MD, because my primary care is utter shit. It’s not even “they do their best but they’re underfunded” it’s “I have medicaid now and that means I am disposable.”

Fuck the american health system up the ass. I can’t even begin to process what this would do to someone who didn’t already have a mistrust of doctors and a backup plan at all times. Who didn’t have a mom who is frankly routinely controlling but who also knows how to get shit done.

Now if you will excuse me, I have to lie down because the emotions from the last three days also set off some kind of histamine flare.

[likeabxrdinflight]

Do you have a few quick tips for writing Arkham intern Harlem Quinzel realistically, for fic writers?

I'm only marginally familiar with the Batman world (mostly I've just watched the Harley Quinn cartoon and I've seen the dark knight lol). I also don't have experience in a forensic setting or high security hospital- I currently work in an inpatient setting, but it's a minimum security combo geriatric/adult unit. They don't allow patients at risk of violence on my unit at all, so I suspect my experiences would be wildly different from a maximum security unit like Arkham is supposed to be.

From what I know of Arkham as it's set up in the Batman world, it seems to be some bizarre combination of psychiatric unit and prison. I don't think anyone has really figured out which- obviously they call it "Arkham Asylum", but I can't imagine any modern psych unit looks at all like Arkham.

The biggest difference between Arkham and the real world is that, on a real psychiatric ward, you are not held there indefinitely. Insurance doesn't pay for it, for one thing, and they don't want to keep beds full that long- psych wards are giant revolving doors and there's never enough beds. Longest I've ever seen a patient stay was about two months, and even that was only because the social workers were fighting to get him into an assisted living community for discharge. So even though you do surrender your right to decide when you get to leave when you're admitted to a psych unit, you will eventually be discharged. If you're not safe to live in the community, you will probably get discharged to some kind of long term care facility- it won't be a hospital. Those kinds of "asylums" shut down in the '80s during the deinstitutionalization process that happened during the Reagan administration.

So Arkham seems, to me at least, to function more like a prison in that regard. So I guess that might be how I'd rebrand it in a fic, if you're going for realism and a modern day setting- it's a prison with a forensic psychiatry/psychology team. Those do exist in the real world. But it's not a place I'd ever want to work in- I have a hard enough time with the hospital tbh.

You could make it a true asylum if you set your story back in the mid 20th century- but I also couldn't tell you what it was like being an intern back than on those types of units either. They don't exist anymore.

What I will say about being a present day intern on a modern psych unit is this- the nurses run the show. they see everything and have the most direct contact with patients. don't tell the psychiatrists this, they think they're the ones running things, but they meet with patients for like ten minutes a day, and maybe briefly during morning rounds. they don't know what actually goes on. interns like myself don't have much power at all- we'll run therapy groups, if you're lucky you'll be on a unit that allows for individual cases. it's short-term work since patients rarely stay more than two weeks. that's usually even shorter for a depression/BPD case, longer for severe psychosis that might take a while for the meds to kick in. speaking of, medication is the most important thing on a unit- it's all about stabilizing patents on the right dose of meds so they can get the hell out of there. the therapy is a sidenote, the psychiatrists are less concerned with it. there will be social workers and maybe an OT staff facilitating post-discharge care and some other groups while on the unit. social workers do all the work getting referrals to outside therapy if the patients don't have that already. again, the goal is for them to leave ASAP so they can fill your bed with someone else.

as an intern, especially if you're a therapist, you're gonna struggle working within this rigid, hierarchical system that looks more and more antiquated every year. our job is to empathize with our patients, to support them. we're trained (hopefully) to see people as whole people, not a list of symptoms for a medication regimen. (there are good psychiatrists out there though that will be really kind and helpful, but in my experience, the therapists are often invaluable for reminding the medical doctors that hey, sometimes it's trauma and not psychosis). you're gonna walk a thin line between commiserating with patients about how awful the hospital is and being part of a treatment team that is supposed to think the hospital is a good thing. I'm very bad at walking this line.

Ultimately it's nothing like Arkham. most patients are super chill honestly, and a lot are already familiar with the mental health care system. running groups is pretty easy because you'll usually have at least one or two people who are actually engaged. I frequently hear that patients like the interns/therapy staff because we're not doctors, we don't make decisions about their care outside of what skill we're gonna teach in group, and we do tend to align with them and listen. I've never felt particularly nervous or uncomfortable around patients- except one, who did get aggressive with me.

in the event that a patient does get agitated or aggressive, standard "restraint" if they cannot be otherwise calmed or redirected is an injection of haldol and ativan. they should ask your consent first, but a no can be overruled if they decide it's necessary. manual restraints are rare, but they do happen, typically only to get the drugs in you. this probably happens more often on a higher security unit than mine. it's not a pretty thing to watch. security gets called, it's a whole ordeal and probably does more harm than good for the patient. we know this. we have no better alternatives, aggression can't be tolerated for the safety of other patients/staff. it's a lose-lose situation.

you have no freedom on these units. no access to your phone, no computers, no internet. you don't decide when you go home. the rooms are like sterile dorms, nothing but a bed, a table, some shelves. you can bring in books and paper to color with, but you're only getting crayons. sorry if you wanted a pen or pencil, those are considered sharps, can't have them. you get visitors during specified visiting hours, no other time. meals are regulated, meds are distributed when they're distributed. you'll go to the groups because you're bored. there is nothing to do. if you're lucky you'll be admitted with some other nice patients and you might make a friend. I've seen this happen, patients will form little friend groups and promise to keep in touch after discharge. I never know if they do or not, but I hope so, because it's one of the most positive things I see happen there.

it's a very mixed bag. my unit is considered one of the "better" ones in new york city, and it's...........it's deeply flawed. but this is what it's been like, from what I've observed over the past nine months working there. so that's the reality of a modern day, minimum security psych unit. I hope some of this is helpful.