#| clinician's opinion :: facts |

[malpractising]

Eden has two types of crushes they are very soft / tentative affection and ' crushing and so, so mad about it '

[malpractisingarchive2024]

Eden is a shirt stealer / borrower, very sorry to crew and anyone else that shares a living space with him. Style, cut, colour, and shirt-is-too-big do not usually matter - fabric softness and texture only. He can't see what he looks like in it anyway.

He will always wash and return it though.

Extra mini headcanon is that Eden enjoys doing the washing up - it's actually his chore in the group in the campaign his base character comes from! He embroiders little tangible letters or symbols in the hems of things to help remember special instructions since he can't read tags, and so he knows who to give things back to after they're clean.

[glitter-stained]

Jason Todd Meta: My opinion on the csa headcanon

Does Jason's behaviour suggest he was a victim of csa?

There is very little, in terms of clinical signs, that’s going to point to csa specifically, because most symptoms, for psychiatric disorders, aren’t specific to one disorder or cause. One thing that’s usually a good hint would be children making very sexual statements/references/jokes/behaviours that are very inappropriate in context (a good example of this would be Roman Roy from Succession); night terrors are bed wettings amongst children/teenagers over a certain age. But that is absolutely not necessary: many, if not most victims of csa don’t display these specific signs, and a twelve years old that suffers from night terrors is not necessarily a victim of csa. The one thing that tells you for sure, in a person with trauma, that they have been a victim of csa, is that they’re telling you they have been a victim of csa. I’m insisting on that part because there’s a whole bunch of therapists (cough cough psychanalysts) that will tell you confidently that your psychiatric symptoms stem from a childhood sexual trauma (cherry on top of the shit cake if it’s incestuous) that you didn’t know about because you’ve repressed it. I repeat, that’s bullshit. If you meet a clinician who tells you that, RUN. So, a warning: this is probably the least “psychological analysis” of my “Jason psychological analysis posts”, because Jason’s symptoms do not allow us to conclude formally for or against a history of sexual abuse. But that doesn’t mean we can’t do some meta, make sure we're on the same page with what's analyzed here, some textual analysis, discuss what the csa headcanon does and does not imply in terms of his behaviour. I think it’s a good idea to start with it so we know where we’re standing with our analysis, regardless of the fact it’s maybe not the most interesting in terms of psychopathology and neuropsychology.

A couple of disclaimers:

I only talk about the comics I want to talk about. This is for two reasons, which are that 1) I do what I want and if I don’t like/don’t find something interesting, I’m not gonna waste time on it; and 2) I’ve been reading comics for a couple of months only, and there are, like, a lot of them. If there are comics you wanna see analysed under that lense, feel free to suggest them! I might not want to, but it also could be that I haven’t read them yet. Additionally, I'm not interested in questioning the morality of Jason's actions here. Ethics are fun, and I like talking about them sometimes, and morality sometimes has a place in talks about demonization but largely speaking this isn't the space for that. I separate talk about morality and psychology stuff as much as I can for a reason, so if you are looking here for excuses for his behaviour or arguments as to why he is a bad person, you're in the wrong place. Moral judgement is irrelevant here for the most part.

On the events of Red Hood: Lost Days:

Jason has, at some point in the comics, been a victim of csa. When Talia kisses Jason before pushing him off a cliff right after he got out of the Lazarus Pit, and when she initiates sex with him in Lost Days, that’s not consent!! That’s a grown woman taking advantage of a traumatized teenager who is, on top of that, deeply indebted to her. That’s a predatory act, with a steep power imbalance, it’s sexual assault, and on top of that there’s an element of suggested pseudo-incest. That decision was retconned, and thank god, because it was a brutal assassination of Talia’s character based on a good bit of racism, and also because the way it was portrayed doesn’t make it clear that Jason is a victim in a situation rather than that super annoying trope of “teenage guy gets to bang a hot MILF and hahaha lucky him”, writing a male character in a situation of SA without acknowledging it as SA or taking it seriously is one of the tropes I hate most, it reinforces stigmatisation and isolates victims. For all of these reasons, I’m not gonna include that element in my analysis, but it’s important to note that if you do include those scenes in your conception of it, then Jason is undeniably a victim of csa and everything discussed about it applies to him.

What if it were a lie?

I’ve said it before (and I’ll say it again), I deeply, violently hate headcanons/tropes where a character lies about being a victim of csa (whether it’s for manipulation, personal gain, any reason really I don’t care). It’s rare as fuck in real life, however it’s a common trope that feeds into fear of being wrongfully accused that causes push-back and increases social stigmatization. CSA is a painful thing associated with intense feelings of shame and already a deep fear of not being believed. Imagine making a considerable effort to seek help after something terrible happened/is happening to you, and you have to brave your fear of not being believed on top of that, and once you’ve made all that effort you get rejected and villainized because it’s just easier for the person you’re reaching out to not to believe it. So I’m awfully weary of this type of headcanon, and I think a general rule of thumb is “if your interpretation of what the character is saying is that he’s talking about how he was abused, especially if he’s talking about sexual assault, then it happened.” If you don’t like that, if you don’t feel like that’s good representation, then you can question the story, think it should be retconned, or rethink your interpretation of what the character says if it’s ambiguous, but hcing that the character lied about his assault is not a hypothesis we’re going to accept here no matter what. So we can start by scratching that one out: Jason never lies about being a victim of csa, or wilfully hints at it even though that’s untrue, at any point.

Two other ideas I’ve seen floating around that I think are worth mentioning:

No, just because Jason lived in the streets as a kid doesn’t mean the only way he survived was through underage prostitution. I genuinely don’t understand that idea, yes being a street kid makes you extremely vulnerable, yes it makes the risk of resolving to underage prostitution to survive higher but it’s absolutely not a fatality. That idea is, quite frankly, weird. Do you automatically assume if a real life person tells you they were in the streets for some time at a kid that they are a victim of csa? Also, I've seen the idea go around that because some people have a strong reading/hc of Jason as bi (which I have no problem with I love bi Jason), that would be an argument in favour of the csa hc. Please don’t do that. There’s no link between queer sexual orientations and childhood sexual abuse, that’s a harmful myth that we should work to deconstruct or, at the very least, not continue to vehiculate.

Another important thing to keep in mind: childhood sexual abuse =/= childhood sexual trauma.

Now, a traumagenic situation is a situation that might induce trauma (so development of, acute stress disorder, ptsd, cptsd, derealization, any traumatic pathology really). These situations exist on a continuum of probability to be traumatized by this situation. For example, a flood, a car accident, witnessing a murder and being sexually assaulted are all traumagenic situations, but the probability of developing trauma from them are very different. It hinges on personal, situational, social, and environmental risk factors (that have nothing to do with being weak, anybody can develop trauma). A definition for traumagenic situations can be found in the diagnostic criteria for ptsd in the dsm-5:

A. “Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.”

Note that the this last criteria has been added from the DSM-5 in order to explain cases of PTSD observed in at-risk jobs like cops exposed to repeated detailed child abuse, first responders collecting human remains, or, crucially, vigilantes repeatedly exposed to brutal crimes. This means that Jason, when he works on the Dumpster Slasher case, when he is horrified to find Gloria in the immediate aftermath of her rape (and later finds her dead body, because witnessing the consequences of these traumatic events is also an important component of that second-hand trauma), is being exposed to a very traumagenic situation. As I said before, that doesn’t necessarily mean you will experience trauma (thank fuck for that), but there are factors that influence that. SA related situations has an already pretty high probability of inducing trauma. On top of that, age is a big factor in that: the younger you are, the less resources, emotional regulation, development and coping mechanisms to face the traumagenic event you have (though there is such a thing as “too young to have PTSD" -when your memory is simply not developed enough for the memory to traumatize you because you will not remember the event.) At fifteen, with his memory fully developed but his brain going through so much changes because of teenagehood and his past history, Jason would be at risk. On top of that, you’re more at risk to get traumatized if you’re already stressed out when the event happens, so Jason’s mental state at this point in his robin run is also a risk factor. All to say, it’s very plausible for Jason to have sexual trauma without being a victim of sexual abuse in relation to canon events. Besides, in headcanon territory when it comes to Jason’s childhood before Robin, there are so many ways to be exposed to sexual violence : witnessing/finding his mother being a victim (considering the position of extreme vulnerability Catherine was in), witnessing assault in the streets, being the victim of attempted SA and escaping, watching street kids get picked up and later find their bodies/being told by other kids, as a cautionary tale, in excruciating detail, testimonies of their own assault… Or for example, if we’re thinking about Arkham Knight, being constantly threatened with SA, it being hinted and joked about and hanging over him like a sword of Damocles is something I could see Joker and other inmates do that could definitely induce sexual trauma even if it doesn’t happen ; what matters most, in trauma, is that the fear is real. Mechanically, when we’re looking at the way trauma works even on a biological level, the overwhelming fear is at the core of the pathology. (This is also why you can develop PTSD after a psychotic episode.) Like, my point isn’t that one of these things happened to Jason, or that he has to have sexual trauma from the events of the Diplomat’s Son or anything -mostly just that this is a possibility, something very serious that happens and an important nuance that I never see in discussions on the csa headcanon, and while it’s not exactly what the debate is about, I think it’s something important to ponder.

Do you consider the csa hc to be canon?

So, there are a lot of Jason stories, and I’m very pro “not take in account what is said in comics you dislike in your conception of canon” because if I did that absolutely no bat character would be readable, I have to believe that no character is defined by their worst writers. And boy, does Jason have a lot of bad writing… On top of the personal retcons, there are also the canon retcons: like Battle for The Cowl is retconned… Unless someone decides to reinject/revamp it into the narrative (please don’t please don’t it’s irrecuperable let it lay with the Flying Todds where it belongs). So, let’s see. There are three writers/arcs that imply/mention the csa hc: Starlin’s writing of Jason’s post-crisis Robin Run (canon though some stuff in it seems to have been retconned), Winick’s writing in Green Arrow: Seeing Red (canon as far as I know), and Battle for the Cowl (retconned). It’s worth noting that one of those are considered to be foundational works for Jason’s character (Jason’s post crisis Robin Run and Starlin’s part in it), and another was written by Winick, who wrote the other two foundational Jason stories: Under The Red Hood and Red Hood: Lost Days. On a personal level, I’m very mitigated about what I like and accept about it. I base my whole love and characterization of Jason about his post-crisis Robin Run, I love that little guy so much, Starlin’s take on Jason’s Robin Run is absolutely canon to me (which does not mean I like Starlin as a writer, thank you very much). On the other hand of the spectrum, the only reason Battle for the Cowl isn’t my least favourite comic ever is because The Killing Joke exists, absolutely not canon, get this thing away from me. And then in the middle, my feelings on Seeing Red (on the entirety of Winick’s Jason really) vary depending on the day, because I do like a revenge story that challenges the status quo with tropes of “bad victim” and it sets up Jason as a character based on love rather than morals which I adore, but there are also some elements of psychophobia in the writing that I (who approach stories through the filter of psychopathology first and foremost) can’t just look past, and also the way it intertwines with classist stereotypes. So do I consider Seeing Red to be canon? In good faith, yes, but whether I’ll accept it as such really depends on the day. In terms of the csa headcanon: it’s heavily hinted in BTFC but not outright said, it’s there as a undercurrent in Starlin���s run because of his intention (to make Jason die of AIDS). And then we have Seeing Red. Basically Jason lists elements about Mia’s life, including her past with underage prostitution (so, just to be very clear, csa), and says they’re very similar, having both lived on the streets, and understand having to do bad things when it’s necessary. This is not the same as saying “I was a victim of csa”, and what he’s saying could be interpreted differently (we know that he was stealing tires, and “only what he needs to survive”, so he could have been referencing small-time theft.) So, it could be a reference to something else, I totally understand why some people want to interpret differently. It just… Feels like such a weird and weak argument to be equating boosting tires to underage prostitution, to me it’s very ooc (in comparison to UTH Jason), and it would feel like weak writing from someone like Winick. Aka it’s not technically canon, and you don’t have to accept it as such(I understand the mentality of "I'm rejecting this interpretation because it feels like demonization of csa victims" perfectly), but personally I think it takes a lot from Jason’s character in Seeing Red and from this story in general.

[transmutationisms]

i don't honestly have any interest in therapy atp for reasons of not wanting external forces encouraging me to spend even more time thinking about myself so i can solicit a stranger's opinion on my problemsissues etc but honestly i feel lucky to have arrived at this position because if i did think therapy was potentially useful to me i would be so fucked over with regards to the fact that even among clinicians who claim to be anti-carceral there is always a breaking point at which they will consider it a professional ethical responsibility to betray client confidentiality in ways that range from upsetting to endangering. like this is not a personal failure that can be fixed by switching to a nicer therapist because it's characteristic of the clinician-patient relationship that as the patient you always have the threat of force / coercion / compulsory treatment hanging over your head. this is directly a result of the epistemological authority that defines the clinician role: the therapist by definition knows best, so reporting mechanisms are always and only for the patient's own good, and removing such mechanisms will consequently be portrayed as doing harm to the very patients most endangered by them. like there simply is no clinician role without this deference to their professional judgment...... could not be me

[quicktimeeventfull]

@deathnotably hello sorry this took me seven days to write BUT this is in fact perfect bc i think about light and his horse every single day of my life. thank you!!!! <3 <3 <3

Light had not been especially excited about the program. There was something about it that felt juvenile — horses, he felt, were for children. Or at least horses which were supposed to make you feel better about yourself were. 

He wasn’t sure what horse therapy would even entail. He wasn't even convinced that there was anything about him which required fixing. The world is a terrible place, a kingdom of rot. He acknowledges it as such, and that makes him feel bad. Frankly, he thinks it’s other people who have a problem which needs to be resolved. If he wants to spent the rest of his life in bed, not eating or sleeping or speaking to a single person, then that’s his prerogative. It is, he thinks, a perfectly reasonable reaction to the state of the universe. 

Still. When Sayu had insisted, he went. He supposed that if he didn’t have any particular opinion on what happened to him he might as well take into account his sister’s.

And so here he is, standing in the dark of the stables, looking up at a massive black animal. It is inside its stall, but its neck and head arc outwards, watching him. It has big black eyes and breath that rises white in the cold. There are other horses in the stables, but he likes this one best because it had looked at him the second he walked in and followed him with its eyes. 

The rest of the people in the program are side the barn, huddled together by the door. He’d slipped past because he hadn’t wanted to wait with them for the clinician. Some of them had looked incredibly ill. Mentally, not physically; they had seemed miserable. He doesn’t like thinking of himself in the same category as ill people. He's only here for Sayu. It doesn't count.

He holds his hand towards the hose. It’s bigger than he had imagined possible. He’s tall, but the horse has a bulk to it that he hadn’t expected. In photographs they always look so delicate. 

It smells like an animal — acrid, earthy, not entirely unpleasant but alarming nonetheless. 

Its nostrils flare. He pulls back, and then, gathering his courage, places two fingers on its neck.

Nothing happens. 

He is not healed. He does not feel okay. There is only the warm flank of an animal beneath his hand, heavy muscles and more soft fat than he’d expected. It is faintly damp.

The horse flicks its ears and then its tail, then turns its head towards him and then past him. It is so large that the movement pushes his hand with it; he pulls it away, something twisting heavy in his stomach. 

It doesn’t make sense to feel devastated by something that he hadn’t thought would work. He swallows against a heaviness in his throat, then pulls his arms tight across his chest. Clearly the experiment has failed. He might as well turn and leave now.

“They aren’t magic.” 

He spins, then startles.

There’s a man hunched beside him, standing far too close. Light has no idea how he'd gotten there so quick, or without Light's notice.

He’s got long dark hair and eyes as black as the horse’s. He is wearing jeans and a white sweater that looks too thin for the cold. 

The man blinks at him, then goes on. 

“I’m not psychic,” he informs Light, who hadn't been thinking anything of the sort. “It’s just a bit obvious.” Something must cross Light’s face, because the man pauses, then goes on. “And there isn’t anything wrong with that. Of course. We’re all connected, and so on.”

There’s something vaguely condescending in his tone, but it’s not without compassion. Light can’t decide if he prefers that. If the man had been just a bit ruder, Light could simply have told him to fuck off.

“What are you talking about,” Light says, as flatly as he can manage. 

The man jerks his head towards the horse. “They don’t generate happiness. It’s not a Hallmark movie.” 

"I don’t —" Light isn’t sure what to say about any of this. “I’m going home.” 

“That’s fine. Would you like to feed her first, though? I’m L, by the way. Now we aren't strangers anymore."

Before Light can point out that he’s slightly past horse-feeding age, the man — L —  pulls a ziplock back out of his pocket and holds it out for Light. For one wild moment, Light thinks it’s full of meatballs, but when he reaches for it — more out of confusion than anything else — he discovers that they’re actually little balls of dark sugar oats. “Molasses cookies,” L says. “You can give one to her. Don’t — ah, not like that.” Light has taken one between two fingers, which seems perfectly normal to him. He considers whipping it at L instead. He had been trying to have a quiet moment of despair, and L is not only ruining that by handing him bags full of weird horse treats but also critiquing how he handles said treats. “She can’t see forward very well, so she'll bite off your fingers if you do it that way. Just lay it on your palm and hold it out.” “I don’t want to feed something that’s going to bite off my fingers,” Light says. “She won’t, if you lay it on your palm. Go on. You’ll like it.” The whole world feels so clouded and pointless and stupid that he figures he might as well do this one extra clouded and pointless and stupid thing; these days, that's how he operates most of his life. He drops the cookie onto his palm.

It’s very moist. He wonders how it would taste. He’d skipped breakfast. He holds his hand out for the horse. She leans down, as if this were a routine she was used to and he had been invented just to facilitate it. 

For a second his stomach swoops with terror as he head drops towards him — he can see her teeth, which are dull but massive, and can't help but imagine the thinness of his bones -- but then her nose touches his palm and the world goes suddenly quiet. 

It is the softest thing he’s ever felt, and she is the biggest living thing he has ever been near, and she’s eating right from his palm. 

He looks at her, entranced. It’s sort of disgusting, actually. His palm is getting wet. He can feel her tongue all over it. Still, when she pulls her hand away and flicks her ears he reaches into the ziplock bag and pulls out another. 

He is aware, distantly, of L walking up beside him. When the horse is finished the second, L takes the bag very gently from his hands. Light looks towards him.

He still feels very hollow. Possibly more so than before, really. It's easier when he doesn't subject himself to nice things; they leave an absence in their wake. But still the softness of the horse’s nose lingers. 

“It’s difficult,” L says, very quietly. “I know it is. It’s a lot of work, to do … all of this. To take care of oneself. And it’s not fair that we have to do it, when so many other people don’t. I wish there were some sort of magic cure and I wish they were it.”

“Who are you?” Light says. This, he realizes, is what he should have asked in the first place. “Are you an instructor? Did you follow me in?” L blinks at him. “What? No. I’m a patient. It’s just very cold outside.” Light stares at him, and L stares back. At last L puts the ziplock bag back in his pocket. “Don’t go home,” L says. “Give it a shot. One day. If you don’t absolutely hate it, I’ll give you my cookie recipe and you can make your own for her.” 

“Why do you —“ Care is what he wants to ask, but it feels almost trite. “You don’t know me.” “But I will,” L says, and smiles. It’s bright, almost childish, almost embarrassing to look at. “If you stay.” 

Light breathes out. “Okay,” he says. “Fine. Yeah. Okay. One day.”

[gabrielsbubblegumbitch]

Please, elaborate more on these Hazbin Hotel headcanons. I’m very interested in hearing about them.

I would like to preface all my posts on headcanons related to psychology and mental illness with a disclaimer: diagnosing mental conditions, especially personality disorders, can be extremely challenging. It's a complicated process that relies heavily on a psychologist's interpretation of facts, making it susceptible to biases. Personality disorders cannot be diagnosed based on surface-level observations and are not just labels that we can assign to people like in the case of MBTI. Additionally, I am not a clinician with any expertise in diagnosing people. Therefore, the following post should not be taken as a reliable professional opinion. It's simply my interpretation of the internal mechanisms that may be responsible for the behavior of certain characters in my fan fiction. Furthermore, I want to make it clear that I have no intention of stigmatizing people with personality disorders by associating them with villains. A personality disorder does not determine someone's character or make them a bad person. Some characters may be evil because of the choices they make, not as a result of their mental conditions.

Since you didn't ask about anything specific, I'll just give some headcanons on Vs since I think about them the most.

> Vs are not a polycule, it's VoxVal + Velvette because she would never touch any of these losers. What's more, Vox and Val are extremely sexist (I mean it's kinda canon, we heard how they speak about women) so if she had sex with any (or both) of them, she would no longer be one of the boys and become one of the bitches.

> Vox has NPD, Val has BPD, Vel has APD.

> Vox is continuously overstimulated because he's constantly connected to his web. That's why snaps so easily and sometimes goes through 5 stages of grief in 5 seconds. He could disconnect (and sometimes he does) but he's too much of a control freak to not lurk constantly.

> During his life on earth, Valentino had a terrible, toxic father. Very much machismo who abused him relentlessly for being queer. (Not that I want to make him sympathetic, I just think that evil people are often miserable before they become evil.) Because Val is very queer, not just "man occasionally fucking other men", he's always been loud and proud pansexual and gender non-conforming. He wasn't some kind of activist, very concerned about queer issues, he just refused to stay in the closet out of spite, and because it made men around him uncomfortable. He just enjoyed being perceived as a deviant. It was one of the things that eventually got him killed.

> Vox is like a hardcore sadist. He cuts people open just to feel powerful.

> During his life on Earth, Vox used to be extremely homophobic because his bisexuality was threatening to his masculinity. He's also the embodiment of toxic white masculinity from the 50's. He actually did some personal growth in Hell, eg. He gave up racism, homophobia, transphobia, and most other -phobias, and now he despites everyone rather equally. He just bullies women more because misogynistic violence is a low-hanging fruit.

> So with Velvette I had some fun because she manifested in Hell not so long ago and happened to be as powerful as other Vs, who had much more experience and souls collected. So I assumed she must be completely deranged. I came up with the idea that she used to be a toxic influencer who built a cult-like following around her. She weaponized it against multiple people, ruining lives, and manipulating kids into committing crimes or even suicides. Her methods are very fine, Vox and Val have nothing on her when it comes to cruelty.

> Velvette is not misogynistic per se but she despises weak women who can't fight for themselves. That's why other Vs behavior don't bother her, she doesn't feel threatened by their aggression.

> Angel Dust has BPD and an eating disorder. That's why he fell for Valentino so terribly, to trust him with his soul. He used to think that Valentino is the only person fucked up enough to truly love him as damaged as he'd been. (More hc about Val and Angel here). Actually Val has a very similar backstory to him - a queer, gender non-conforming man in a very masculine environment (I'm not sure how canonic is Angel working for the Italian Mafia at this point but I stick to it until proven otherwise).

Other headcanos about Vox and Val ❤️🩵

[dxmedstudent]

in medical shows they often say that every doctor will end up misdiagnosing someone and leading to their death at least once if not more. is this true? i assume it is since doctors cannot be right all the time and everyone makes mistakes. is this something someone should prepare for if going through med school?

Hmm yes and no.

Some people will be that unlucky. But not everyone.

Medical TV shows...aren't written by doctors. They are written by writers who want to build a sense of drama and also build pathos for the medical characters as people. And they want the audience to appreciate the potential stakes. And they are good at that. Normal medical life can sonetimes be bonkers, but usually it just isn't dramatic enough for television.

It's possible for a clinician to make mistakes in diagnosis or management, and this is inevitable to some degree - we cannot know every thing, and even if we did, patients don't always present as they do in books. People can have unusual symptoms. People make mistakes.

But honestly? Most clinical decisions are not life and death... or urgent. You have time to find out more information. You have tine to get a second opinion. You have time to do more tests. You have time to accept that the initial diagnosis was not correct but that you can keep working on finding out what is actually going on. If someone is dying, even if you aren't sure what's causing it, you can still work to stabilise them!

If things are getting worse, that's a sign to keep looking! And of course, most conditions themselves aren't immediately fatal. Or even fatal in general.

I would say that I very much doubt every single clinician has misdiagnosed someone in a way that's led to that person's death. I do think most clinicians, as humans, have made multiple mistakes - but at a lower stakes level.

And most clinical decisions we make, especially in hospital are part of a wider context involving an entire team. One person may make a mistake, but that mistake is usually caught by someone else. When things go badly wrong (hopefully rare but it happens), it's normally the result of the Swiss cheese effect - i.e. multiple team members missing something important.

When a patient feels ill, they experience an entire journey. They present to a doctor, and hopefully have some investigations and maybe have an initial diagnosis based on what is known at the time. Based on the results and also how they respond to the initial treatment, we get an idea of whether the initial diagnosis was correct.

As they and the doctor or medical team get results back or the condition progresses, there is more information to base future investigations and future treatments on.

To put this in context, diagnosis can be a long and sometimes difficult process. It's often complicated by the fact that there are many conditions that are uncommon and unusual - for example there are over 8000 known rare genetic conditions alone. People with unusual presentations or rarer conditions can often experience delays in diagnosis because their teams are less familiar with their conditions. And people with some common conditions can still experience significant delays in diagnosis, particularly if diagnosis tends to require more invasive ir specialised testing. There also isn't always a test that gives you a clear answer. There isn't always a good treatment. There often isn't a cure. Sometimes even the "right" first line treatment may not be best for that patient, people can respond differently to the same drug or treatment. Some people experience a difficult journey or even poor care.

I do think it's definitely true that there's always the risk that we can cause serious harm or even death if we make the wrong call. Working our hardest to make sure it doesn't happen is what gets us through to those long hours of med school and residency. For me, I treat each patient as if they were my family and try to give the care I would hope my loved ones receive. I have to live with the risks of what could happen, if I miss something important.

I also have to navigate the world as a patient knowing that people are fallible, the system us imperfect, and that can affect me as a patient or my loved ones as patients.

[selfhealingsweetheart]

a lot of people like to begin and end their research into the possibility of endogenic systems existing by merely aggressively pointing to the DSM5 definition of dissociative identity disorder and using this to make some complex claims like:

"dissociative identity disorder is only ever formed by early childhood severe trauma, and so if you don't experience disordered symptoms of plurality, you don't have dissociative identity disorder, therefore you can't be a system."

however, if you ever bothered to look more into psychological literature, as you should before making grandiose sweeping opinionated claims with insufficient research backing, you'd know that the experience of plurality is actually, within the psychiatric community, discussed heavily.

there are plenty of paradigms where you can find things analogous in description to nondisordered, therapist-endorsed plurality, including therapeutic methods of engaging with oneself as plural as a means of Improving oneself: for example, Schema Therapy (often utilized with borderline patients and people with personality disorders), and Internal Family Systems (often utilized in general types of patients, whether or not they were severely traumatized as a child or even as an adult or adolescent)

as a side note, it's very anti-intellectual to have rabidly-held opinions that you bully people online about without even bothering to do a ton of research, especially into perspectives from academics that disagree with your personal very online opinions. any serious practicioner of psychology would be one who is open-minded and seeking to not Confirm a Theory but to learn and form new ideas based on what their clients can teach them.

it's also quite offensive towards survivors of psychiatric abuse to insist upon the psychiatric system of diagnostics as the end-all-be-all of one's existence, and it smells like major bootlicking to only ever allow oneself and others to be ~valid~ If an authority confirms it. it's not like the DSMs are these perfect encapsulations of everything ever that could happen psychologically, things are added and removed all the time, and those actions often accrue significant behind-the-scenes debate in the academic sphere, where people with write papers on why they think something should or shouldn't be there. remember, the DSM is simply supposed to be a Tool that Guides clinicians in order to help them distinguish certain phenomena from others, but at the end of the day not only is it Not supposed to focus on nondisordered manifestations of behaviors, but it's also not made to reductively simplify any active debate in psychiatry merely because one thing is canonized a certain way, just so you can be Right Online™

anyway. in schema therapy, schemas are said to be parts of people that hold certain typified negative self-belief systems, and patients are encouraged to both label them and speak to or as them, in order to convince their parts of new and more healthy or productive modes of thinking, rather than getting triggered into letting the schema take over and give them negative thoughts and emotional issues.

these parts are understood within the literature to be natural to everybody, because everyone compartmentalizes into belief + emotional structures like these; what makes them 'not dissociative identity disorder' is merely the fact that these parts do not cause amnesia when taking over the core self, and that they are often identified as 'parts' of the primary person, rather than fully separated other people with distinct consciousnesses. nonetheless, this is one of many examples of the parts work methodology wherein the self is casually understood to be multiple or have subpersonalities or parts within psychological literature, and that fact is then taken towards the conclusion of using this experience in a healing-oriented way.

here is an example of schema therapy, an excerpt of A Client’s Guide to Schema Therapy by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D. who are from the Schema Therapy Institute;

moving on, there is my other example: internal family systems. in IFS, clients are encouraged by their practitioner to personify and then actively dialogue with their various emotional states and common modes, and also to look for particular styles of parts already well-known by the IFS paradigm such as 'firefighters' and 'managers,' which are two different kinds of protector parts. with IFS becoming popularized nowadays, more and more laypeople are now becoming comfortable with the idea that they have psychological parts, which can be parts of their personal Self or parts that exist within them and hold certain emotional functions, despite perhaps not experiencing the typical heavy dissociative states definitive of disordered types of multiplicity like DID.

here are some excerpts from a book called The Others Within Us, by Robert Falconer, with a foreword by Dick Schwartz, the founder of IFS, as well as many high praise reviews from members of the psychiatric community for his writing, which breaks new grounds and is very in-depth and thorough.

here he discusses needing to have an open mind towards phenomena that are not well-studied yet, and learning to humble himself in order to do so even as a trained clinical trauma counselor in his 60s and 70s at the time of studying and eventually writing this book.

first of all, take note of his discussion of the contestation of even PTSD when they were trying to get it canonized in the DSM. an entire movement including political pressure had to be formed just to get ptsd into the literature. nowadays nobody on this website would (hopefully) contest the validity of ptsd as an experience people could have, but back then, people had to hold their ground against the psychiatric system and even the government just to prove that their experiences deserved to be taken seriously. don't think that this was the olden days either, because the academic world still tends to hold tight to its current state and not be welcoming towards experiences outside its own paradigms, so its good to keep in mind that there are histories and politics going into the making of all this psychological literature, with more room yet for even further and more uncommon experiences to be discussed.

second of all, note that he says that to clinicians working even with people with MPD/DID, it became apparent that the parts structure could be normal for people, beneficial, and even healthy, and that it was simply the severely dissociative aspects of it that they would work to heal, rather than viewing the entire experience of plurality as inherently disordered or solely a product of trauma.

i hope its clear by now that there's a lot of discussion surrounding this issue, but that plenty of it involves the normalization of nondisordered plurality, that plurality can be even healthy and a good, therapist-approved means of self-exploration for people, and that you should not cherry-pick literature while using intellectually dishonest argument techniques online.

endos are valid imho. i myself am a dissociative system, but at least i don't claim that my opinion is the standard opinion based on just that, i actually try to do my research. hopefully this was interesting to you, and please don't discourse on my post. kthxbai

[khaire-traveler]

Hey, so I know people want to help their friends and stuff, but it can actually be really harmful when someone has told you that they don't have an illness or disorder, and you continuously push the idea that they do, in fact, have that illness or disorder. Some illnesses and disorders share a lot of symptoms! PTSD and Autism are a great example because even clinicians can misdiagnose these for one another, meaning your average Joe would have a difficult time trying to diagnose, say, their friend without proper training and education.

Suggesting something is perfectly fine, but as I mentioned, pushing your diagnosis of someone else onto them, especially when they seem very resistant and disagree, is not always helpful or respectful. Sure, someone may be in denial of a diagnosis; that is their problem, and they will need to come to terms with it on their own. Suggesting someone might have something, especially if they ask for your advice or opinion, is more than ok - in fact, I encourage getting second opinions if you're unsure about something - but please do not force what you've decided is the truth onto someone who is extremely unwilling. If the same were repeatedly done to you, you may not appreciate it either.

Obviously, it is more than ok to want to help a loved one get the treatment and diagnosis that they need, but please, PLEASE remember that you are also most likely not a clinician/physician, and while self-diagnosis is totally valid and understandable, diagnosing someone else is a little bit not.

[thistlecatfics]

do you have opinions on cbt

Hahaha everyone has opinions on CBT. For the radical queer trauma therapist circles I run in I’m actually pretty pro-CBT. For the average person involved in mental/behavioral health, I’m probably anti-CBT. 

[For context, Cognitive Behavioral Therapy is a famously evidence based type of therapy which works by targeting thoughts/cognitions. It theorizes that thoughts cause behaviors which cause feelings which cause thoughts all around and around in a spiral of doom for which the easiest intervention is targeting the thoughts. It can be very regimented, hence it’s easily studied, hence why it’s so “evidence based.” You basically identify “cognitive distortions” like catastrophizing (I failed my exam and so I’m going to fail out of school and live in a cardboard box) and reality-check them (it’s one exam in one class and I can still pass the class if I get a decent grade on my final). You also identify the thought/feeling/behavior spiral (thought=I failed -> I will be homeless, feeling=fear, shame, behavior=avoiding the professor and anything associated with the class.) It’s definitely bigger and more complicated than that, but you get the idea.]

For a lot of people with anxiety and with OCD especially, it can be so life changing. 

For a lot of people, especially people who are trauma survivors or whose presenting problems are connected to trauma, it can feel like gaslighting. 

(Fun fact! Part of the reason TF-CBT (trauma focused CBT) has such solid evidence behind it is that it ignores the wild survival bias in its studies. People who have a lot of trauma or really intense PTSD tend to drop out. Those who stay mostly have success with it and provide happy little data points)

I think certain parts of CBT can be so useful – noticing thoughts, identifying cognitive distortions, checking in with reality – and I think using the triangle with clients (the little triangle of “thoughts,” “emotions,” “behaviors”) can be super useful, and I do it fairly often.

Personally, I find a lot of my clients can do (most of) the mental/cognitive work on their own – what they really need help with from a trained professional is actually a felt sense of safety and emotional processing which require therapeutic flexibility and other modalities -- and a longer period of work.  

Some people like a very concrete, structured approach, especially if they’re new to therapy or skeptical of the value of therapy. Also, a lot of people only can access therapy for a short time and a lot of people only want to be in therapy for a short time, and you can make changes quickly with CBT. Also, from the therapist end, there are a million free CBT trainings and workshops you can do vs. most other modalities where you have to pay $1000s for trainings (on top of getting a graduate degree). 

Insurance companies and payers in general LOVE CBT because it’s structured, evidence-based, and short-term. You also require clients to do homework, which is basically like extra therapy time you don’t have to pay the clinician for. You can also train people in it pretty easily. I think it’s important to understand *why* CBT is held up as the best/standard therapy type now, and it has a lot less to do with CBT itself and more to do with service provision and structural factors around paying for therapy and with what can be effectively researched. 

I’m reading Richard Schwartz’s “No Bad Parts” right now about Internal Family Systems therapy, and I’m now thinking of CBT within that framework. Basically, CBT is an effective part of the overall therapy system but it’s being asked to do too much, and so is overfunctioning and causing problems. We really should just let it settle into its own niche. 

It’s not my therapy niche! But it has a place. 

(If you were asking about Cock and Ball Torture therapy that would probably fall under the category of “experiential” therapy. Not sure it’s really been studied, but I’m sure there would be enthusiastic participants.)

[malpractising]

Sometimes when Eden doesn't know how to work something or how to solve a puzzle / problem, or if he doesn't know what to do / where to go next he sometimes petitions the group for advice - meaning the Others, the other vengeful spirit victims of the same killer that collectively power his weird little body.

Imagine being one of 16+ other aggressively vengeful spirits stuck in spectator mode, being stuck to this kid that can't see and doesn't want to hunt down his killer like a proper vengeful zombie but too bad because he controls the flesh vessel for the moment.

[malpractisingarchive2024]

Eden is not often too bitter about losing his vision - he also died and it didn't really take, so he feels he could be worse off. Maybe it will come back eventually, missing eye notwithstanding.

However.

Sometimes ' I have no idea what [ friend / loved one ] looks like ' hits him really hard.

[3liza]

What's more, "some women may not respond to the medication at all or very minimally," says Dr. Butt. In fact, those who receive laughing gas decide to get an epidural most of the time, according to findings from the American Society of Anesthesiologists. "The scientific literature looking at nitrous oxide use for labor pain is poor, so many of the recommendations come from clinician experience and expert opinion," elaborates Dr. Butt. "The general consensus is that neuraxial anesthesia, like an epidural, is more effective."

[granulesofsand]

I have opinions about a post (https://www.tumblr.com/justanothersyscourse/715275783016448000/looks-like-the-tulpa-studies-might-finally-be).

🗝️🏷️ psychosis, invalidation, syscourse? (It’s a link to an anti-endo review of a study, with my endo-neutral commentary)

The reblog options makes it huge, and I care more about the bottom highlighted part. I look forward to finding the whole study, but I want to share strategies I use for reading academic papers.

Things to keep in mind:

Clinicians and researchers typically don’t have lived experience. They can learn from formal education or people who do have whatever they’re looking at, but can take many years to communicate in community (system-specific social settings) spaces effectively, if they ever get to that point.

Language develops separately in different contexts. There are barriers on both sides that prevent conversation; psychologists don’t know community terms, and the community doesn’t know how to decode academic phrasing.

Some researchers are snooty. There are professionals that approach community members believing they are lying, wrong, or confused. Words like “experience” and “feel” are used, both to make the professional appear more neutral and to imply unreality. Plenty of papers on DID also say things like “The patient experiences herself as a young child” when admittedly describing what the community calls “littles”.

This doesn’t mean that the study will prove anything either way. I haven’t seen the abstract, but it looks like they’re trying to reject or fail to reject that tulpas (among other audial experiences) are symptoms of psychosis. I can’t really tell what their base hypothesis was, but science doesn’t actually prove anything; it explains, it experiments, it observes, but it cannot definitively say that something is fact. Even things we’re pretty sure about, like gravity, can’t be known for certain. I have no personal investment in this study either way, but I do believe that harassing people is not okay — including people who are spreading harm. I have yet to see an endogenic system cause harm solely due to their identity as endogenic. Misinformation and poor etiquette suck, but there are methods to try before harming people back.

🗝️🏷️ same but also mild RAMCOA mention

(I also don’t understand why the willing creation of other selves is bad aside from the name “tulpamancy”, especially as a member of a traumagenic system that still splits somewhat intentionally. Is it different cause we were forced to do it? Or just because we have trauma? I will not accept being called bad for surviving as a small child, so why are they different?) - 🪡

[religion-is-a-mental-illness]

By: Andrew Amos

Published: May 11, 2024

Gender medicine is the field developed to manage patients distressed by their biological sex, a condition called gender dysphoria.

Gender identity is a theory, not a fact

The field of gender medicine is dominated by the gender affirming care model, which relies almost entirely on opinion, because of the lack of high quality evidence. Gender affirming care is based on the idea that every person has a gender identity that is independent of their biological sex. There is no widely accepted theory of gender identity, in fact most doctors don't have a clear idea of what it is, so gender affirming care recommends that doctors simply accept patients' report of their gender identity without question.

The only role for doctors in this model is to assess whether patients have the capacity to understand the nature of affirming interventions. If they do, the model says doctors must provide interventions whether or not they believe this will improve or worsen patients' health.

Gender affirming care reinforces non-traditional gender

The main impact of gender affirming care has been to prevent the investigation of the healthy and unhealthy causes of gender dysphoria. Because all major gender services follow this model, we still have very little idea of the different pathological processes that cause gender dysphoria, how long each of these persist without intervention, and the best treatments to reduce distress in each case. While it's been argued that investigating the psychopathology of gender dysphoria harms patients, we now know this is simply false.

In addition, while there's no systematic research on this, it's undeniably true that gender affirming care is ideally designed as a powerful form of behavioural shaping. Unconditional affirmation is likely to significantly increase the number of people who report a gender identity different from their biological sex. Gender services take confused and vulnerable children who're extremely dissatisfied with their social situations, encourages them to understand all their distress with reference to gender, and provides strong social rewards every time they report non-traditional gender experiences. In addition, the children know that they'll lose this unconditional support as soon as they stop reporting these experiences. It's difficult to imagine a system more likely to artificially increase reports of gender diversity.

Summary, and a point on suicide

In sum, then, the simple truth about gender medicine is that it's based on the theory of gender identity, which is not widely accepted, it's purposely avoided understanding the causes and best treatments of gender dysphoria, and the most likely effect of current gender services is to significantly increase the number of people subjected to life-altering, often life-long social, medical, and surgical treatments which have not been shown to improve health.

As a final point, the most damaging myth in gender medicine is that helping children to accept their biological sex is likely to result in suicide. This is completely untrue, and it's unethical for any clinician to claim otherwise.

[gabrielsbubblegumbitch]

DROP YOUR DX FOR VOX !!!!! Please and thank you.

I would like to preface all my posts on headcanons related to psychology and mental illness with a disclaimer: diagnosing mental conditions, especially personality disorders, can be extremely challenging. It's a complicated process that relies heavily on a psychologist's interpretation of facts, making it susceptible to biases. Personality disorders cannot be diagnosed based on surface-level observations and are not just labels that we can assign to people like in the case of MBTI. Additionally, I am not a clinician with any expertise in diagnosing people. Therefore, the following post should not be taken as a reliable professional opinion. It's simply my interpretation of the internal mechanisms that may be responsible for the behavior of certain characters in my fan fiction. Furthermore, I want to make it clear that I have no intention of stigmatizing people with personality disorders by associating them with villains. A personality disorder does not determine someone's character or make them a bad person. Some characters may be evil because of the choices they make, not as a result of their mental conditions.

(I've already posted some stuff here so I'm not going to repeat myself.)

Okay, so, Vox has Narcissistic Personality Disorder (NPD). It's crucial to distinguish this from "common narcissism" (people often described as "narcissists" by others just because they are egotist assholes; kinda ableist, you shouldn't do it because it's extremely stigmatizing towards people suffering with actual NPD) . While those individuals typically function well, those with NPD exhibit all the traits – grandiosity, egocentrism, attention-seeking, intense power fantasies – but as it's a disorder, these traits lead to inflexible and maladaptive patterns of behavior and cognition.

NPD has its roots in intense feelings of shame, low self-compassion, and self-loathing. In my interpretation, Vox has always felt inadequate. His father inherited an enormous amount of money, establishing a media conglomerate in the 20's. Vox's mother, captivated by the world of movies, used them to escape her reality as a trophy wife. Despite her dreams of becoming an actress, Vox's father, possessive and protective, prevented her entry into the entertainment industry. As a compromise, he made their son a child actor, with the condition that it would be temporary. When Vox grew older, he was expected to transition to learning business and other skills, ultimately to take over the family's empire.

So, Vox was never enough for either of his parents. His father thought of him as annoying and unserious due to his talkativeness and exaggerated behaviors, attributing it to growing up surrounded by actors. As for his mother... Vox turned out to be a terrible actor, struggling to convey emotions that weren't bombastic and over-the-top. Being a teenager is humiliating enough, but imagine being a teenager bad at something and forced to do it for a worldwide audience, when the whole production crew is annoyed with you. Fortunately, he grew up to be devilishly handsome (not to be a simp, I just believe someone must be handsome to endure the ethereal punishment of having their face swapped for a TV screen) and entertaining, leading them to make him a TV host and media personality.

Anyway, NPD is all about creating a perfect self and projecting it to the world when you're deeply ashamed of your true self. It means that, no matter what you're doing, you're constantly concerned about how it looks to other people. You constantly play an exhausting game, trying to win gold stars of social admiration for every-fucking-thing, guided by superficial ideals of wealth, perfection, beauty, and, above all, power. One reason Alastor's existence bothers Vox so much is the fact that he cannot comprehend the idea of someone choosing radio over his "objectively better and correct" medium. Vox lacks the ability to understand nuanced sentiments, which ironically makes him thrive in Hell. In this anarchocapitalist, lawless society, survival of the fittest prevails, and this is a game he excels at playing.

Generally, the best approach for individuals with NPD is to pull them out of delusional thinking by confronting their beliefs about the world and themselves with reality (it should be performed by qualified therapist, especially when someone hasn't completed any kind of therapeutic process yet). However, in Hell, Vox's behavior was no longer in violation of social norms; on the contrary, it was highly rewarded. Consequently, he completely lost his shit, became unhinged, and began acting on all his previously suppressed urges. He finally fulfilled all narcissistic power fantasies and became (almost) untouchable. Now, he's ready to kill anyone who questions him, seeing it as threatening to his fragile image of the perfect self.

He exhibits strong bipolar tendencies. Most of the time, he's power-tripping in a semi-maniacal state. Periodically, he undergoes deep, depressive episodes, locking himself up in his apartment and avoiding interaction.

Constantly guarding this fragile image of the perfect self that he built is exhausting. The bigger this image gets, the more fragile it becomes, like a house of cards. And guarding it becomes more and more exhausting. But there's nothing scarier than the idea of the facade falling apart and people seeing him as he is: imperfect and vulnerable, damaged and ashamed, rotten and evil. Deep down, he knows he's unlovable, and it hurts. He knows that true love exists; he craves this ultimate form of admiration and devotion, but it requires vulnerability and honesty, which he's not capable of. He's only vulnerable with Valentino, and only occasionally when he's intoxicated or when Val fucks every last thought out of his body. He's very much a controlling top insecure about his masculinity, so the latter happens rarely.

Also, drugs. Oh, do this man enjoy some coke. Other drugs and booze, not so much; they make him feel less in control. But getting coked up, going out, causing a scene, killing some poor souls, and relishing this feeling of being completely untouchable? Feels so good.

When it comes to Alastor, he hates him because he's jealous. Despite all his efforts—building a perfect persona, a perfect company, perfect entertainment—this stinky, outdated, and boring radio demon gets so much attention and admiration that should be his. Moreover, he feels that Alastor can see right through his bullshit. He's so paranoid about it that he's almost certain Alastor knows about his childhood traumas, about his death, about all his truths, and could one day broadcast it for all people of Hell to hear. So, he needs him dead.

Note: these headcanons (especially Vox's past) are very important part of my fanfiction. Please feel free to use them in your fics but I'll appreciate if you tag me 🩷

Velvette hc | Valentino hc | Vees + Angel hc | VoxVal hc