#and lobotomies were not used to “treat” people with (just) depression or anxiety or other more sociablly acceptable mental illnesses | Explore Tumblr posts and blogs

belzinone · 5 years ago

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How would Bel treat someone who was diagnosed with Anxiety Disorder and Depression? In both medical and everyday senses?

// OMG OK I LOVE THIS QUESTION ; soz i took awhile, i wanted to do some big thinks on this one~♡

// i feel like mental health isn't something people think too much about in the SnK world, it being more of a modern thing or a quack-like practice if it existed at all since the technology to physiologically map the differences in brain function wouldn't be a thing yet. that being said, Bel did get her hands on progressive medical practices from her childhood mentor's contraband knowledge, so she'd at least have some awareness of neurodivergence if she didn't already empathize with people who showed symptoms of depression and anxiety, which she would.

// though knowledge / awareness wouldn't be very common in the universe, it would be almost rampant within the Scouting Legion as well as the Underground, i'd think, almost exclusively compared to the other branches / other more affluent areas of Paradis. since anxiety disorder and depression are circumstantial as well as genetic, i can see intergenerational trauma and inheritance persisting and growing throughout higher impact populations, especially thise who lack the ability to improve their circumstances. in this sense, Bel's probably grown up around very many people who suffered from those things. witnessing the effects of anxiety & depression first hand (and probably experiencing some bouts of her own) from birth very likely does a lot to foster her empathy on the matter as a future healer. she also probably read a lot about it on a superficial and highly speculative level, too, along with case studies of early, primative practices first used in attempt to treat neurodivergencies, such as lobotomies, drilling holes into the skull, etc. as well as Phineas Gage-like phenomena that were documented. (imagine if something like that happened during Paradis railroad construction though oh my god)

// i highly doubt she'd ever put brains under the knife (or drill), opting to try and help people through counseling and MAYBE psychiatrics in desperate situations. she'd "treat" these things for the most part just by being a friend: learning the signs, providing support by any means she can (physical, emotional, even sexual if she was close enough to them and they responded well to the distraction), doing what she can to limit uniquely triggering scenarios, as well as putting necessary words in with Erwin if she thinks a soldier isn't ready for an expedition. everything she does around this field would be a learning experience, though a lot moreso than her more physically tangible practices.

// if any of her soldiers begin to severely succumb to the debilitations of anxiety / depression, she definitely would kick into gear and start searching for more information / resources. after the battle of Trost, her mother is hospitalized in an institute for a number of neurodivergencies written off as hysteria, so mental health would be a really personal issue for her. instead of using her days off for herself, she'd use them to visit the hospital / asylum (whatever they'd call a mental health institute in the SnK world) to do more research and maybe even talk to Erwin about directing some Scouting Legion funds into medication to help soldiers recover. in especially severe cases, she'd do her best to be there for her soldiers every step of the way, maybe even to the point of staying behind with them during expeditions if they didn't have family to care for them. as she learned things, she'd share them with other officers.

// other simple things she'd do to help soldiers struggling with depression would be helping them maintain, such as bringing them food when they can't manage to leave their bunks in the morning, helping them with hygeine, etc. if they're having a panic attack, she'd help ground them, guide their breathing, give them something to do with their hands if that'd help, etc. there are a lot of little things she could do and she'd do as many as she could, but above all she'd want them to recover. Bel's painfully aware that there's a lot in the world she can't control or fix, but for sure she'll do her damndest to make life with anxiety disorder and depression at least bearable, even if it means insisting they retire as a soldier and adopt a more comfortable lifestyle.

#// wow ok this turned out big fnsnfsngkdv #// thanks for this though mental health really is a slippery slope and i liked talking about her attempts to do smth about it~♡#purple flare . emergency responding // ask response #wolfstillhasclaws #rings a bel . trivia #the heart of everything . key characterization #// this makes me wanna do more research of my own gndjfjdfj #// ♡

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if-you-fan-a-fire · 6 years ago

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“There was a time when an unconstitutional government policy was not something lamented then simply rebranded. Once a court found it unconstitutional, the practice just ... ended, especially when politicians had campaigned against it. Not so solitary confinement – an old practice that today’s Parliament loves to hate, hates to love, but just keeps on doing.

Reading the latest court decision on solitary confinement (R v. Prystay, from Alberta), one doesn’t know whether to sigh with relief that another court got it so right, or cry over what took place. How could it be that a person in our country was held for 400 days in the deplorable conditions and extreme isolation that make up solitary confinement?

Justice Dawn Pentelechuk held that placing an inmate in solitary confinement for 400 days – where he suffered physical and psychological harms – was cruel and unusual punishment in violation of Section 12 of the Charter of Rights and Freedoms. She wrote:

"Societal views on what is acceptable treatment or punishment evolve over time. Forced sterilization, residential schools, lobotomies to treat mental disorders, corporal punishment in schools and the death penalty are all examples of treatment once considered acceptable. Segregation ravages the body and the mind. There is growing discomfort over its continued use as a quick solution to complex problems.”

And yet our federal government intends to maintain the practice of solitary confinement – now rebranded as “administrative segregation.” While the recently introduced Bill C-83 declares that it would “eliminate the use of administrative segregation,” the actual provisions of the bill would do no such thing. It is true that Bill C-83 would change the name of the “segregation unit” to the “structured intervention unit.” It would add a few daily hours out of cell for some inmates. And it would offer most inmates a shower and a few other minor improvements. However, Bill C-83 also would allow our penitentiaries to keep people in conditions of extreme isolation for at least 22 hours a day for undefined, perhaps indefinite periods.

But Bill C-83 has not yet been passed. The government can amend it, or better yet, introduce a new bill that truly eliminates solitary confinement. In doing so, the government could still seek to include any exceptions it thought necessary. If the government had evidence to support specific, rare, and very brief situations of isolation, this is something reasonable people could discuss.

Instead, unfathomably, Parliament is doubling down on Bill C-83 and fussing over what kind of independent review process is needed to keep someone in the newly named structured intervention units. To be sure, the concern about independent review is important, and is no doubt the government’s response to court decisions that struck down the administrative segregation regime in two recent constitutional challenges by the Canadian Civil Liberties Association and the B.C. Civil Liberties Association, respectively. The courts in Ontario and B.C. took issue with the lack of an independent review process when determining if someone should stay in solitary. However, this was not the only constitutional issue before the courts. CCLA and BCCLA also challenged the long, indefinite durations, segregation of people with mental illness, youth and those who simply asked to be safe, and the discriminatory use of segregation against Indigenous people. Many of these issues were accepted by the B.C. court. Most are back before the courts on appeal.

In striking down the administrative segregation regimes, the Ontario and B.C. rulings spend pages detailing the many harms, sometimes irreversible and permanent. These include hallucinations, depression, anxiety, loss of control, paranoia, self-mutilation and suicidal thoughts. These harms were researched and established by doctors and psychologists over many years.” - Noa Mendelsohn Aviv, “Rebranding solitary confinement doesn’t change what it is.” The Globe and Mail. January 21, 2019.

#solitary confinement #administrative segregation #canadian prisons #charter of rights and freedoms #canadian politics #canadian civil liberties association #bill c-83 #british columbia civil liberties association #penitentiary system of canada #effects of solitary confinement #crime and punishment #crime and punishment in canada

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nerdylittleshit · 7 years ago

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Thoughts about Spn 13x05

SPOILERS! SPOILERS! SPOILERS!

Content Warning: mentions of suicide

What an episode. There was a lot in it, a lot. Even though the case was rather simply, it was so full of layers over layers you might call it puff pastry. And as much as last week’s episode was about Sam and Jack, this week was all about Dean, from every angle. And as painful as it was to watch all of Dean’s despair the episode gave us one of the most beautiful, hopeful endings. Steve Yockey continues to be one of the currently best writers (I’m still amazed with all the talent to new writers brought to the show). So, let’s take a closer look.

The Cure

It was an unusual long teaser this week, but it did the job right, because even though I knew what was coming (or maybe because of it) I sat anxious in front of my screen. The actual ghost story was rather simple and something we saw quite similar back in 1x10. What is interesting about it is how both the victims and the ghost of the doctor inform Sam and Dean’s story. We start the story with two boys, thinking of them as a unit, only to learn later about a third friend, and that the three of them were inseparable. They split up and in the end two of them died. Parallel to that we start the episode with two Winchesters and end it with three. The last time the three of them weren’t on the same page one of them ended up dead.

Dean is mirrored with Shawn. After the traumatic event of seeing his best friend die Shawn became mute, the same way Dean was mute after his mother died (and Lucas in 1x03 who was back then a Dean mirror as well). Shawn tells Dean in the veil that he misses his mom and he wants to go home. Dean of course longs for a home as well and misses his mother. Dean lost his mother and Shawn’s mother loses her son – two parents and children separated by death.

The most interesting parallel though is the fact that Dr. Meadows tried to cure his patients by performing a lobotomy. He did it to treat mental illnesses such as depression and anxiety. Not only did it result in the death of many patients, but it is also the wrong treatment by modern medicine standard. And even though Sam of course doesn’t try to lobotomize his brother, his cure/treatment for Dean is wrong as well. This episode is a great example of how Sam sees/reads his brother, or rather the performance Dean puts on, and the layer underneath. Sam is aware that Dean is not ok, that the fact that he no longer believes in anything is a warning sign, and his intentions might be good (reading reviews for a strip-club, my heart), but the ways he tries to cheer up are as effective as trying to fix a missing limb with a band aid. He only sees the tip of the iceberg, but the fact that Dean so casually killed himself might have given him an idea how bad it really is for Dean.

The Wounded Hunter

Oh Dean. Dean, Dean, Dean. Partly responsible for Sam’s blindness when it comes to his big brother is of course Dean’s willingness to participate in the performance. He tells Sam that he will be ok, that he will get through, with “bullets, bacon, booze” (interestingly no women), and we can’t blame Sam that he wants to believe that. Especially as Dean actually goes to the strip-club, though it appears only to get drunk. But we see how deep Dean is buried in his grief the moment they start to work the case at the abandoned hospital. He seems almost apathetic when the doctor attacks him, as if he is willing to risk it (dying). The most heartbreaking moment is though he calm he was when he talked about killing himself in front of Sam. It is the third time Dean killed himself in order to get to the veil. In 6x11 he did it because it was the only way to talk to Death and get Sam’s soul back. In 11x17 we see how messed up he really is, demonstrating the whole ugly truth about his co-dependent relationship to Sam. But here? It is just a means to an end, another hunter-tool. Dean is fully aware of the risk and even then it seems like part of him wants to die. Of course there is difference between actively wanting to die (because Dean’s goal is to talk to the ghosts) and choosing death, which he later does in his conversation with Billie.

We already talked about the absence of deals in this season (even though Dean asked Chuck for help), which in general is a good thing and progress. We see this theme continued here, with Dean offering a deal, but he neither asks for his own life or for Billie to bring back Cas and/or Mary, but only the ghosts of the victims to be freed (though technically Dean knows that Billie doesn’t have the power to bring back Cas). On the surface it looks like an altruistic act, but Billie sees right through Dean’s act.

Billie: […] You have changed, and you tell people it's not a big deal. You tell people you'll work through it, but you know you won't, you can't, and that scares the hell out of you or am I wrong?

Dean: What do you want me to say? It doesn't matter, I don't matter.

Billie: Don't you?

Dean: I couldn't save Mom. I couldn't save Cas. I can't even save a scared little kid. Sam keeps trying to fix it, but I just keep dragging him down. So I'm not gonna beg, okay. If it's my time, it's my time.

Billie: You really believe that. You wanna die. Dean, every notebook on this particular shelf tells a version of how you die. You specifically. Heart attack, burned by a red-haired witch, stabbed by a ghoul in a graveyard, and on and on. But which one's right? That depends on you. On the choices you make.

Dean: Well I guess I made my choice.

This huge pile of angst is so revealing when it comes down to how Dean’s purpose in life has changed. He defined himself over his job, both hunting and protecting his brother. But what is the purpose of a hunter if he no longer can save the people closest to him, the people he loves? If he can’t even save strangers? If he only seems himself as a burden to his brother, as someone whose actions no longer have any value?

Both Sam and Dean make a small step in the right direction in the end, with Sam refusing to let go and forcing Dean to talk, instead of trying to be nice, and with Dean opening up. Dean who admits that he is not ok, that even though he has lost people before (John, Bobby), this time it is different. He needs a win, and it is no coincidence that he echoes Cas’s words from 12x19 here. Cas’s desperation for a win has led him to make all the wrong choices (releasing Lucifer, betraying the Winchesters etc) and got him killed in the end.

The last two or so minutes of the episode were a thing of beauty. The music choice was great (Steppenwolf’s “It’s never too late”) and even though we all expected the “Hello Dean” I really liked that they choose the show the return of Cas without words. Kudos to Jensen and Misha, and John F. Showalter, for acting and directing the scene the way they did. (And did you all notice that giant neon cross in the scene? They couldn’t have made it clearer that Dean has found his faith again.)

Death Becomes Her

Remember all that speculation if Billie is the new Death? Guess what, you were right guys. Well, somehow. But as much as I am delighted that Billie is back (as the big boss) I have two questions: Does that mean that in the time between 10x23 and 12x09 there was no Death? Who was in charge? And did Billie got herself killed on purpose knowing that she would get a promotion? (Ok, three questions). Because making deals with the Winchesters is a fool proof way to get yourself killed. She also says that killing her is what got Cas killed (in a way), confirming that the cosmic consequences of breaking the deal were indeed Cas’s death and possibly the opening to the alternative universe.

Speaking of, I wonder why Billie is interested in the multiple worlds (and if she perhaps has her own agenda regarding Jack). My only speculation is that opening the rift between the worlds could cause cosmic imbalance. If people (especially those who are dead in one world and alive in another) travel through the worlds it will cause chaos. We already saw that with Mary, who wasn’t supposed to be alive, and the ripple effect her actions caused.

I found it rather amusing that Billie had her table in her huge office right in front of the “W” section (though I admit I thought the Winchesters would have a whole shelf for themselves by now). The fact that multiple notebooks exist with all kind of possible deaths for Dean (and Sam as well) confirms that the future isn’t set in stone (something Missouri already told us and is in stark contrast to the idea of Jack seeing the future in 12x19). (Also, a red haired witch? Rowena?)

With her new job Billie sees the bigger picture and knows now why the old Death has brought back Sam and Dean so many times. She tells Dean that he and Sam are important, that they got work to do, without telling them exactly why. Just as Chuck Billie puts a massive amount of responsibility into the hands of Sam and Dean, something that at least Dean has admitted he has no interest in. It is possible this is related to Jack, as I can imagine that he will play a bigger role on a cosmic scale in the future (he could be the one to bring balance).

Some other things:

- The PB&J. Remember how we all speculated who would be the one Dean is making it for (Jack or Cas)? And none of us considered that Dean would make it for himself. Interestingly enough the PB&J is tied to both Mary and Cas. Mary is the one who used to make sandwiches for Dean; the PB&J is a childhood memory and comfort food. On the other hand though we all associate PB&J with Cas since 9x11, and in hindsight we could say the PB&J foreshadowed Cas’s return. (I’m sure there is crack meta already out there, explaining how it was the PB&J that brought Cas back and that @elizabethrobertajones has written already 10.000 words about it <3)

- Jack digging through Sam’s old DVD’s, becoming a full time nerd. (Please let the two of them make awkward references soon).

- Dean living out his cowboy fantasy with his boyfriend next week. (It is the cowboy boots that make him sexy)

#supernatural #spn 13x05 #advanced thanatology #spn meta #spoilers #my meta

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thebibliosphere · 8 years ago

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✨Stay afraid but do it anyway.✨

And perhaps I’m a little touchy on the subject and maybe I hold Carrie a little too dear to my heart, but the reason I do is because Carrie Fisher helped me realize I was mentally ill.

Oh I knew I was crazy, in the same vague way you worry that you've left the stove on at home, despite not having cooked yourself a meal in weeks because you’re too depressed to eat a proper meal. (Except you don’t call it that, you call it “laziness” and maybe try and convince yourself it’s a new diet called “whatever requires the least amount of effort to put calories into my face”.)

Something was “off” inside my head, but no one seemed to care about it too much. Even when they threw me into eating rehab for a perceived eating disorder—despite lacking several of the vital criteria on the checklist to have typical eating disordered behavior—no one gave too much of a shit. I was just a girl who was “too nervous”, “too in touch with my emotions”, “too fragile”, I was “attention seeking”. And their remedy to this was ignore me and wonder why I crashed and burned at regular intervals, blame me for being selfish, then go back to not giving a fuck until it inconvenienced their life again.

I was crazy. But maybe I wasn’t. Maybe if I just tried harder...so I learned to cope. I became the one who Coped. I was There For Everyone. I became Reliable and above all else, I learned to be Funny and make It funny.

My mother still hates that. She thinks it’s crass for women to be funny. Personally I think I’m fucking hysterical, but then what do I know, I’m fucking nuts.

Later, now with hindsight and being able to look at my life from a safe(-r) mindset surrounded by people who care and want to help, I realize that what I was going through was (and is) untreated PTSD. Whether or not the PTSD caused the other issues, like the depression, the anxiety, the compulsive behaviors or the ADHD I think I might have, I don’t know. I likely will never know, because the Thing happened and shot my still developing child brain into a million tiny fragmented pieces of unparalleled terror and poor coping mechanisms. It doesn’t really matter at this point, all that matters is dealing with all of it as best as I can, however I can. But there’s a very real chance I might never have gotten to this stage if I hadn’t found out that Princess Leia, my childhood icon who helped me feel brave and strong while my world was ending, had written a book about living with mental health issues.

I wasn’t sure what to expect from it to be honest. I knew vaguely, that Carrie Fisher had issues. The word “junkie” had been used by my father—while unironically taking a drink from his self-medicating poison of choice and my mother tutted and tisked about how some people just ought to pull themselves together.

Ten, maybe twelve minutes into the book locked away in my room, I can’t even tell you anymore whether I was crying because I was laughing so hard or if I was laughing because I was crying my heart out, but I was having a fucking revelation.

This was me, holy shit this was me, this was me, this was me, an unboken mantra in my head pounding to the beat of my heart, this was me, this is me—I do exist.

That’s a weird thought to have, right? I do exist.

It wasn’t, “I’m normal”, because normal is not this. It’s not feeling like your mind is running a million miles a second in circles while simultaneously wading uphill through treacle and juggling chainsaws while trying to keep all your Life Plates spinning and oh gods someone just handed you a kitten to look after. What it is however, is fairly common, and suffered with varying degrees of severity by a rather sizable chunk of the world’s population. I mean, who knew? I sure as shit didn’t. I thought it was all in my head.

You know what I mean.

I’m told some people get up in the mornings and go through their entire day without once having an intrusive thought or struggling to do basic shit like take a shower and manage to remember to feed themselves. I know, seems fake right? It certainly does to me.

And here was Carrie, my Princess Leia, laying out her issues past, present and probable future, in what remains one of the funniest, most brutal attempts at self-lobotomy on paper I have ever had the privilege to read. I consumed that book in mere hours, I devoured her words and breathed them in like inhaling steam in a sauna and breathing out fire in their wake and moved onto her next book, then her next, then her next, and by then there was this blessed thing called Twitter and it should be impossible to be hilarious and poignant through 140 emojis or less, but that was the kind of brilliant she was. And this was me, this was someone like me. And she was witty and brilliant and funny and yes, things were difficult for her and yes, some parts of her life were an absolute clusterfuck of mistakes, addiction and general all round fuckery leading up to that point...but she was still there, y’know? She was still there.

And it breaks my heart a little every day, knowing that I’ll never be able to tell her how important that was to me. And to thank her for it.

So instead I try to pay it forward. Every day, from one day to the next, I try to be a little kinder, a little brighter—a little more like Our Lady Carrie—and throw two loving sparkly middle fingers up at the world that tries to stamp out and demonize the notion that mentally ill people like me, like you, exist.

And we deserve to exist, and more than that, we deserve to be treated with human fucking decency.

And if you are of a mind that the latest news surrounding Carrie’s death means that she was any lesser of a vital energy force in this world, that she mattered less, that her words were less important or that she “deserved” to die because they found drugs in her autopsy report, it is with my profound and heartfelt best wishes, that I invite you to cordially:

✨🖕✨🖕✨🖕✨ Go Fuck Yourself ✨🖕✨🖕✨🖕✨

Don’t bother to RSVP.

#personal #carrie fisher #space mom #mental health #addiction #positive representation matters #long post

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xaviercote · 5 years ago

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RECHERCHE THÉORIQUE 5 - Article scientifique

Cet article traite sur les anciennes méthodes de traitement des maladies mentales.

A History of Mental Illness Treatment: Obsolete Practices

Posted October 14, 2016 | By Tricia Hussung

Mental illness affects many individuals in the United States. According to the National Alliance on Mental Illness, approximately one in five American adults experience mental illness each year. That’s 43.8 million people, or more than 18 percent of the population. Children are affected as well, with about 13 percent of those ages 8 to 15 experiencing a severe mental disorder at some point during their lives.

With data like this, it’s no surprise that attitudes toward mental health have changed for the better in recent years. Though stigma still exists, CNN reports that 90 percent of Americans value mental and physical health equally, according to a 2015 survey by the American Foundation for Suicide Prevention (AFSP), the National Action Alliance for Suicide Prevention and the Anxiety and Depression Association of America. “People see connection between mental health and overall well-being, our ability to function at work and at home and how we view the world around us,” Dr. Christine Moutier of AFSP told CNN. This change comes as mental health approaches continue to focus on community-oriented, holistic care.

This hasn’t always been the case, however. Mental health treatment has undergone extensive change over the years, with some strategies being ineffective and even dangerous: “Many of the treatments enacted on mentally ill patients throughout history have been ‘pathological sciences’ or ‘sensational scientific discoveries that later turned out to be nothing more than wishful thinking or subjective effects’” rather than actually benefiting patients, History Cooperative says. The following are just some of history’s strangest obsolete mental illness treatments.

History of Mental Illness Treatment

Trephination

As one of the earliest forms of mental health treatment, trephination removed a small part of the skull using an auger, bore or saw. Dated from around 7,000 years ago, this practice was likely used to relieve headaches, mental illness or even the belief of demonic possession. Not much is known about the practice due to lack of evidence.

Bloodletting and Purging

Though this treatment gained prominence in the Western world beginning in the 1600s, it has its roots in ancient Greek medicine. Claudius Galen believed that disease and illness stemmed from imbalanced humors in the body. English physician Thomas Willis used Galen’s writings as a basis for this approach to treating mentally ill patients. He argued that “an internal biochemical relationship was behind mental disorders. Bleeding, purging, and even vomiting were thought to help correct those imbalances and help heal physical and mental illness,” according to Everyday Health. These tactics were used to treat more than mental illness, however: Countless diseases like diabetes, asthma, cancer, cholera, smallpox and stroke were likely to be treated with bloodletting using leeches or venesection during the same time period.

Isolation and Asylums

Isolation was the preferred treatment for mental illness beginning in medieval times, so it’s no surprise that insane asylums became widespread by the 17th century. These institutions were “places where people with mental disorders could be placed, allegedly for treatment, but also often to remove them from the view of their families and communities,” Everyday Health says. Overcrowding and poor sanitation were serious issues in asylums, which led to movements to improve care quality and awareness. At the time, the medical community often treated mental illness with physical methods. This is why brutal tactics like ice water baths and restraint were often used.

Insulin Coma Therapy

This treatment was introduced in 1927 and was used for several decades until the 1960s. In insulin coma therapy, physicians deliberately put the patient into a low blood sugar coma because they believed large fluctuations in insulin levels could alter the function of the brain. Insulin comas could last anywhere between one and four hours. Patients were given an insulin injection that caused their blood sugar to fall and the brain to lose consciousness. Risks included prolonged coma (in which the patient failed to respond to glucose), and the mortality rate varied between 1 and 10 percent. Electroconvulsive therapy was later introduced as a safer alternative to insulin coma therapy.

Metrazol Therapy

In metrazol therapy, physicians induced seizures using a stimulant medication. Seizures began roughly a minute after the patient received the injection and could result in fractured bones, torn muscles and other adverse effects. The therapy was usually administered several times a week. Metrazol was withdrawn from use by the FDA in 1982. While this treatment was dangerous and ineffective, seizure therapy was the precursor to electroconvulsive therapy (ECT), which is still used in some cases to treat severe depression, mania and catatonia.

Lobotomy

This now-obsolete treatment won the Nobel Prize in Physiology and Medicine in 1949. It was designed to disrupt the circuits of the brain but came with serious risks. Popular during the 1940s and 1950s, lobotomies were always controversial and prescribed in psychiatric cases deemed severe. It consisted of surgically cutting or removing the connections between the prefrontal cortex and frontal lobes of the brain. The procedure could be completed in five minutes. Some patients experienced improvement of symptoms; however, this was often at the cost of introducing other impairments. The procedure was largely discontinued after the mid-1950s with the introduction of the first psychiatric medications.

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tuckinpodcast-blog · 8 years ago

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EPISODE 2: THE HAYS CODE AND OTHER BAD IDEAS.

LISTEN: SOUNDLCOUD / ITUNES / GOOGLE PLAY (coming soon!)

NOTES: minimal note-shuffling, I promise. Google Play is reviewing the podcast as we speak, so we should be up soon!

SOURCES: listed at end of transcript

TRANSCRIPT:

Hi! I'm Jack, and this is Tuck In, We're Rolling: Queer Hollywood Stories. This week's episode is titled 'The Hays Code and Other Bad Ideas'. This is gonna be a long episode, but it's a really important one, because it lays down the basis for a lot of our future discussions.

Let's start off with the basics. The Hays Code came about in 1930 but it wasn't really enforced until 1934. Basically, what happened was way back in 1915, the Supreme Court heard a case called “Mutual Film Corp. V. Industrial Commission of Ohio”, and voted 9-0 that free speech didn't extend to films. The courts kind of reasoned that, as a form of mass media, movies could literally be used “for evil”, and for some reason this decision also applied to circuses? I don't know, not entirely relevant, but I thought it was a weird aside. The decision by the court was what drove the studios to more closely regulate their content, and the decision was eventually overturned in 1952 with the hearing of the “Joseph Burstyn Inc. V. Wilson”, also known as the “Miracle Decision” because of the short film “The Miracle” that the case was heard over, and it really kind of marked a decline in movie censorship in the US, but by this time, the damage had already been done.

So, what was the Hays Code?

The Hays Code was basically the theaters and the studios agreeing to self-censor in order to avoid losing money from religious-led boycotts or local governments refusing to show so called “immoral” films. As I've mentioned, times were kinda tough in Depression era Hollywood, and a lot of studios went under or cut their contract stars to save money or try to cut costs somehow. The Code is actually called “The Motion Picture Production Code”, but it's known as the Hays Code after William H. Hays, who was the head of the Motion Picture Producers and Distributors of America, and it's basically the racist grandfather of the MPAA ratings system we all known and love today.

How does this come back to queer history? Thanks for asking, all six of my followers on SoundCloud! Let me read the entire section of the Hays Code pertaining to what it calls “impure love”:

“In the case of impure love, the love which society has always regarded as wrong and which has been banned by divine law, the following are important:

Impure love must not be presented as attractive or beautiful.

It must not be the subject of comedy or farce, or treated as material for laughter.

It must not be presented in such a way to arouse passion or morbid curiosity on the part of the audience.

It must not be made to seem right and permissible.

It must not be detailed in method or manner.

I've included a link to a copy of a Hays Code pamphlet and the transcript of it that I just read from so you can go check out the kind of stuff it talks about. And it talks about a lot. No interracial marriage or romance, no adultery, no white slavery. No boobs, no disrespecting the American flag, no dissing the clergy. It's kind of intense, and it explains some of the weird wholesomeness and out-of-left-field endings you get with a lot of the movies from the 30's and 40's.

Now, there were, obviously, stereotypes and stigma around being queer before the Hays Code, but it really cemented this feeling of “othering” – extending beyond queer people as well.

Pre-code, you had a lot of movies that used drag or gender role reversal for laughs. In 1915, Charlie Chaplin dressed in drag for his movie A Woman, and so did Fatty Arbuckle in Miss Fatty. Early films used the “sissy” or “pansy” stereotype – you know, and you've seen it today, the flamboyant, effeminate gay man who had no real humanity to speak of but was only there for a laugh. It was kind of the beginning of that stereotype, and even if it wasn't harmful – and still is – it wasn't as overtly hateful as some of the things we'll see later on.

I've done a lot of digging into what was going on with pre-code lesbians, and I found some movie titles and a few references, but not a lot. Lesbians weren't shown nearly as much as their gay “pansy” counterparts – but if they were shown, they were butch crossdressers for the audience to laugh at, or they were weirdo older spinsters who were dead by the end of the movie – huge surprise, right? Some notable portrayals of lesbians, overt or implied, include Louise Brooks in the 1929 German film Pandora's Box, this is one where the romantic relationship is implied. There's Marlene Dietrich in Morocco in 1930 – and we're gonna talk about in detail in a later episode. There's a girl-on-girl dance scene in 1932's Sign of the Cross, and a butch lesbian in 1933's Women They Talk About. And of course, there's Greta Garbo kissing another woman in Queen Christina in 1933. Of course, it's kind of difficult to find these references, so I want to point out that people have been dismissing lesbians and women who love women as just 'gals bein' pals' for a really, really long time.

After the Hays Code, a lot of this overt sexuality got swept under the rug and buried in subtext. Culturally, you're looking at a time – again, going back to what we talked about with masculine panic – when men are looking at homosexuality as a direct attack on their masculinity. During the Depression, men were already feeling emasculated because they were losing their jobs and they couldn't afford to take care of their families. They're looking at effeminate men and masculine women, and they start to freak out even more. So even though pre-code movies were using shock value – things like queer people or prostitution and violence – to get butts into seats and boost ticket sales, there was still this pervasive anxiety from men getting scared about their masculinity, and from religious groups that were worried about the effects of on-screen sinning on polite society.

The Code essentially killed the pansy, and buried queer people in hints and subtext. So in the 1930's and 40's, if you were queer in a movie, you were either really vaguely defined like Joel Cairo in The Maltese Falcon, who is explicitly gay in the source material, or you're a villain, also like Joel Cairo in The Maltese Falcon. Censorship evolved a little to say, basically, you can show perversion of almost any kind, but you can't show it in a positive light. And this sort of gels with the feelings of the time. You have characters running around committing crimes because of their sexuality, because back then people thought that being gay drove you insane as well as being a sin. People thought of being gay as being a disease or a defect and police were running around raiding gay bars and harassing women dressed in men's clothing, and it's really not a great time to be queer.

In 1948, Hitchcock's Rope comes out, and he's very obviously skirting the censors with the two antagonists. It's very thinly veiled that they're in a romantic relationship, but they're also still murderers. But that kind of moves us along into the 50's, when that 'Miracle Decision' has the courts saying that, no, films are protected by the first amendment and they're an art form, and this is really when censorship in film starts to decline. This is also about the time that its ruled that the studios can't own the movie theaters that distribute their films, so the monopoly on the film industry is broken up and the power of the old studios is drastically reduced.

There's still a censorship code at this point, of course, but it's really loosening up in the mid-50's. The code at that time allowed for hints of queerness as long as it was used for humor or if the person was punished for their “deviance”, which eventually led to 1959's Suddenly, Last Summer, starring big names like Liz Taylor, Katherine Hepburn, and my favorite actor Monty Clift. This movie is a landmark because it has what's considered to be the first movie with a named, explicitly gay character.

Now, that's great and all – but the shitty part comes from the plot. Basically, this guy is murdered violently and his cousin, played by Katharine Hepburn, sees it and goes nuts, so the mom – played by Liz Taylor – tries to bribe Monty Clift's character into giving her niece a lobotomy so that no one finds out that her son was gay. And don't worry, I'm going to talk a lot about Monty in a later episode and we'll talk about what kind of effect the movie had on him as closeted gay man, but this movie basically proved to the public that being a “mama's boy” or being controlled by your mom led to being gay, and it was sort of implied that violent murder was the inevitable fate of gay men, and that they kind of deserved it.

This is sort of a trend, moving into the 60's. You've got a lot of subtext in the 1959 remake of Ben-Hur, a lot of covert themes and implications. But at the same time, audiences aren't so interested in boycotting a film because of religious leaders, and movies with “questionable content” didn't really need production code or religious approval anymore. But even though we've got the code loosening to compete with television and the rise of the indie studio after the break-up of the old studio monopoly, you've still got a lot of queer characters who are miserable and depressed, or suicidal and homicidal. A lot of them are still dead by the time the credits roll.

In 1965, a movie called Inside Daisy Clover comes out, and there's a gay man in it. He isn't miserable or struggling, and he survives the entire movie – but he's never really explicitly named as gay. It's all still buried in subtext. In 1967, we get Marlon Brando and Liz Taylor in Reflections in a Golden Eye, starring Brando as a repressed gay Army major – a role that was supposed to be Monty Clift's, but he turned it down due to his declining health, supposedly. This is kind of an interesting, weird movie about sexual repression, both heterosexual and homosexual, and the violence it can spark. I'm going to talk in detail about this movie when I do my Brando episode, so I'm gonna put a pin in this discussion for now.

The sixties also brought us the beautiful weirdness of Andy Warhol, Kenneth Anger, and other people like them who were giving us fully realized and complex queer characters, but we don't see any movies marketed towards a gay audience until the 1970's. In 1968, the final death knell of the Hays Code came with the introduction of the MPAA rating system we're all familiar with today.

So, why the long history lesson? I wanted to talk about this bit of film history for several reasons.

First of all, chronologically it makes sense in the context of the show. Last week, we talked about noted vampire Rudolph Valentino – I finished American Horror Story: Hotel, by the way – and he died before the Hays Code was even written, a whole year before, to be exact.

Second of all, it's important to talk about all of this to give context to our future discussions about Hays-era movies and about the environment that actors were working in. Next week, we're going to be talking about some ladies I mentioned this week – Marlene Dietrich, Greta Garbo, and Katherine Hepburn, women who's work snapped from pre to post-code, and we're going to pick this thread of queer representation post Hays Code in a few episodes, but for now, you have some background on the subject.

And third of all, and most importantly, now you can look at some of the stereotypes that we still have today and be able to trace them back to their origins. You see these harmful stereotypes all the time, on TV and in the movies. So we have like, Buffalo Bill in Silence of the Lambs, and we can draw a straight line back to Joel Cairo in The Maltese Falcon. None of this is an excuse or anything – it was wrong then and it's wrong now – but now we have context. We can ask Hollywood, “Why haven't you changed? Why do these offensive things still happen?” You know, back in the 1950's, it was playing into toxix masculinity and that same fear of independent women that was driving criticism of Valentino in the 20's. And for whatever reason, we still have caricatures of queer people on screen as well as this same pervasive toxic and performative masculinity. We have a lot of trouble finding fully realized queer characters that don't end up dead or alone, or even still hidden in subtext.

There's this great moment in the last season of True Blood, maybe the only great moment other than Ryan Kwanten and Alexander Skarsgaard's sex scene – when Lafayette lashes out at Jessica after she catches him and her current boyfriend hooking up, and it's so good and sums up what I want to say so well, that I'm going to leave you with it:

“Everybody else in this fucking town is falling in love and getting engaged and having babies! Has it ever occurred to you that Lafayette – that queen that makes all you white heterosexuals laugh and feel good about yourselves – has it fucking ever occurred to you that maybe I want a piece of that happiness too?”

Thank you for listening to Tuck In, We're Rolling: Queer Hollywood Stories. This episode was researched, written and recorded by me, Jack Segreto. You can find a transcript of this episode and all of our episodes, along with some fun facts and photos, on our tumblr, tuckinpodcast.tumblr.com. You can also give us a like on Facebook at facebook.com/tuckinpodcast. We accept messages on both of those platforms, so feel free to shoot us suggestions for future shows and comments. We upload new episodes every Wednesday and you can find us on iTunes, Soundcloud, and now Google Play. Don't forget to rate and subscribe so more people can find us! Thanks for listening. We'll see you next time.

SOURCES:

The Motion Picture Production Code (PDF)

The Hays Code - Arts Reformation

From Sissie to Secrecy: The Evolution of the Hays Code

The Hays Code: Censorship, Sexism, and the Code that Built Pop Culture

Homosexuality in Film

Gay and Lesbian Characters in Pre-Code Film

History of Homosexuality in Film (yeah, I got lazy and used Wikipedia. SUE ME, OKAY, I WORK 40+ HOURS A WEEK)

True Blood Wiki: ‘Lost Cause’ Synopsis & Quotes

OKAY BYEEEEEE

#queer history #queer history podcast #lgbt history #lgbt history podcast #the hays code #history of lgbt characters in film #hollywood podcast #( TRANSCRIPTS & SHOW NOTES. )#( EPISODE 2. )#[ friends #i haven't done this much research on a thing since before i got my degree #it's in mortuary science btw #if anyone was curious THOUGH I DON'T THINK YOU WERE ]

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0100100100101101 · 8 years ago

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How did a Massachusetts woman end up with two electrodes implanted into her brain? Why is the Defense Advanced Research Projects Agency developing a controversial, cutting-edge brain chip technology that could one day treat everything from major depressive disorder to hand cramps? How did we get to deep brain stimulation and where do we go from here?

In 1848, a rail foreman named Phineas Gage was clearing a railroad bend in Vermont when a blast hole exploded, sending the tamping iron he had been using to pack explosives through his left cheek, his brain’s left frontal lobe and finally out the top of his skull before landing 25 yards away, stuck upright in the dirt. Despite his pulverized brain mass, Gage went on to make a full recovery, with the exception of a blinded left eye. It was, by all accounts, miraculous.

But while Gage could walk and talk, those who knew him found that after the accident he seemed, well, different. A local physician who treated him the day of the accident observed that “the equilibrium ... between his intellectual faculties and his animal propensities seems to have been destroyed.” His friends put it more simply: Gage, they said, “was no longer Gage.”

Gage’s case was the first to suggest the link between the brain and personality—that the brain is intimately connected to our identity, our sense of self.

Since then, science has frequently exploited that link in the name of (sometimes misguided) self-improvement. Change the brain, and change the self. Once-common but in hindsight abhorred lobotomies were the first treatment to offer relief from mental illness by disrupting the brain’s circuitry, severing the connections to and from the prefrontal cortex. Electroconvulsive therapy, a once-cutting edge treatment now reserved for extreme cases, sends a shock of electric current through the brain for a near-instant change in its chemical balance. Antidepressants target neurotransmitters like serotonin to affect mood and emotions.

As we have unpacked more thoroughly the mysteries of the brain, we have become better able to precisely target the changes we want to affect.

This is how Liss Murphy wound up with two 42-centimeter-long electrodes implanted deep within the white matter of her brain.

For years, Murphy had suffered from severe depression that seemed untreatable—rounds of Effexor, Risperdal, Klonopin, Lithium, Cymbalta, Abilify, electroshock therapy and even an adorable new puppy failed to get her up out of bed. Then doctors offered her a new option, something called deep brain stimulation.

On June 6, 2006—6/6/06—doctors at Massachusetts General Hospital drilled two holes into Murphy’s skull and implanted two electrodes into a dense bundle of fibers within her brain’s internal capsule. The axons here carry signals to many of the brain’s circuits that have been linked to depression. Those electrodes were then connected to two wires that ran behind her ears and under her skin to her clavicle, where two battery packs just slightly larger than a matchbox were implanted to power them. When turned on, the hope was that the electrical signals emitted by Murphy’s new implants would in effect re-wire the circuits in her brain that were causing her to feel depressed.

It worked. Murphy became one of the first people in world successfully treated for a psychiatric illness using deep brain stimulation, in which electronic neurostimulators are embedded deep within the brain to correct misfiring signals. Like Gage, the experience changed her, but for the better. She got out of bed, had a kid, and went back to work part-time after years of being able to barely leave the house.

“My greatest hope the day of the surgery was that I would die on the table,” Murphy recently told Gizmodo. “I can cobble together a regular day now. It truly gave me my life back.”

Deep brain stimulation is the bleeding edge of mental health treatment. Originally developed to treat the terrible tremors that patients with Parkinson’s disease suffer from, many researchers now view it as a potentially revolutionary method of treating mental illness. For many patients with mental health disorders like depression, therapies like drugs are often insufficient or come with terrible side effects. The numbers are all over the place, but doctors and researchers generally agree that significant numbers of people don’t respond adequately to current treatment methods—one often-cited study pegs that number somewhere around 10%-30%. But what if doctors could simply open up the brain and go directly to the source of a problem, just as a mechanic might pop open the hood of a car and tighten a loose gasket?

Now, the same team that implanted electrodes into Murphy’s brain is halfway through a five-year, $65 million research effort funded by the Defense Advanced Research Projects Agency to use the same technology to tackle some of the trickiest psychiatric disorders on the books. The goal is ambitious. DARPA is betting that the research teams it is funding at Mass. General and UCSF will uncover working therapies for not just one disorder, but many at once. And in developing treatments for schizophrenia, PTSD, traumatic brain injury, borderline personality disorder, anxiety, addiction and depression, along the way their work also aims to completely reframe how we approach mental illness to shed new light on how it flows through the brain.

This is a radical departure from traditional neuropsychiatric illness treatment,” said Justin Sanchez, the director of DARPA’s Biological Technologies Office. “We’re talking about being able to go directly to the brain to treat people. That’s transformative.”

Unfortunately, it’s not quite as simple as all that.

For starters, psychiatric illnesses are complicated, and often not all that well understood in terms of where they exist in the brain. For more than a decade, DBS has been used in patients with Parkinson’s disease, but targeting the brain’s motor cortex to manage Parkinson’s violent trembling is a lot less complicated than targeting, say, depression. A diagnosis of major depressive disorder requires that a person exhibit five of nine symptoms, but two people could be depressed and have almost no symptoms in common. That means that for those two people, treating depression with deep brain simulation might require stimulating entirely different regions of their brain. And there is still disagreement about what those regions even are.

Then there is the array of ethical questions that brain technologies like DBS inspire. Does inserting a chip into someone’s brain to mediate their brain circuitry change their identity? Might it, eventually, lead to the ability to simply treat ourselves when feeling blue, a sort of high-tech take on Aldous Huxley’s soma? Could you use a DBS device to hack into someone’s brain? Or control them? Or enhance them? Is it potentially dangerous in the wrong hands?

Rumors have swirled that the DARPA’s real goal in all this research is to create enhanced super soldiers. The agency has several other brain computer interface projects, which seek not just to use chips to treat mental illness, but also to restore memories and movement to battle-wounded soldiers. A 2015 book about about the history of DARPA, “The Pentagon’s Brain,” suggested that government scientists hope that implanting chips in soldiers will eventually unlock the secrets of artificial intelligence and allow us to give machines the kind of higher-level reasoning that humans can do, or allow soldiers to perform feats like waging war using their thoughts alone. DARPA, though, has maintained that its main goal is to develop therapies for the many thousands of soldiers and veterans with wounded brains.

Murphy was among the first mental health patients to be successfully treated using DBS, but the idea that we might use electrical signals to right our sometimes faulty wiring is by no means a new one. In the 1970s, a Yale University neuroscientist named Jose Delgado implanted radio-equipped electrode arrays—he called them “stimoceivers”—into cats, monkeys, bulls and even humans. His work demonstrated that electrically stimulating the brain could elicit movement and on occasion even particular emotions.

In one now famous experiment, Delgado agitated the temporal lobe of a young epileptic woman while she calmly played the guitar, prompting her to react by violently smashing the guitar against the wall in rage. Less sensational, but more promising for clinical purposes was Delgado’s research that found stimulating a part of the human brain’s limbic region called the septum could invoke euphoria strong enough to counteract depression, and even pain.

In 1970, The New York Times Magazine hailed Jose Delgado as the “impassioned prophet of a new ‘psychocivilized society’ whose members would influence and alter their own mental functions.” They also called it “frightening.” His work eventually became engulfed in controversy. Strangers accused him of having secretly implanted stimoceivers into their brains. Delgado, who was Spanish, left the U.S. shortly after Congressional hearings in which he was accused of developing “totalitarian” mind-control devices. His work receded into the archives of history.

More recent forays into deep brain stimulation began in 1987, when a French neurosurgeon named Alim Louis Benabid was preparing to remove a piece of the thalamus in a patient who suffered from severe tremors, a then-common practice known as lesioning that aimed to calm problematic areas of the brain by surgically damaging them. While probing the thalamus to ensure he didn’t accidentally remove something crucial, he inadvertently discovered that jolts of electricity could stop the tremors, no brain damage necessary. A little more than a decade later, the U.S. Food and Drug Administration approved DBS for use in patients with Parkinson’s disease. Today, there are over 100,000 Parkinson’s patients with tiny chips in their brain to control their symptoms. Parkinson’s is still the most common use of DBS. In 2009, the FDA approved a humanitarian exemption to allow patients with severe obsessive-compulsive disorder to receive implants. All other uses of DBS are considered experimental.

Case studies of patients who have received the treatment have shown that those implants sometimes have severe side effects.

In one case study, a 43-year-old man suffering from debilitating Tourette’s Syndrome received DBS. His doctors targeted well-known areas of the brain considered safe for treatment in order to relieve his tics. And it worked. But a year after the operation, he began to dissociate from his previous self. Doctors observed that increasing the amount of electrical stimulation in his brain resulted in him “anxiously crouching in a corner, covering his face with his hands” and speaking “with a childish high-pitched voice.” When it was decreased, he went back to normal, with little memory of what had happened. A 2015 review of cases using DBS to treat Tourette’s found that Tourette’s patients seem more likely to experience post-DBS complications, but ultimately concluded the treatment still seemed promising, citing successes.

Another study found that 20% of 29 Parkinson’s patients reported experiencing an altered body image due to a DBS brain implant, telling researchers things like I “feel like a machine.”

In some cases, DBS seems to bring on side effects like a decline in word fluency and verbal memory, depression, increased suicide tendencies, anxiety and mania. In other cases, like Murphy’s, though, there seem to be really no changes in personality at all.

A common argument is that DBS, unlike a lobotomy, can be turned off by switching off the electric current flowing to the brain. A patient could always simply let the battery run out. But some evidence suggests it actually does cause long-term, irreversible effects, like damaging brain tissue. The full extent of those effects are yet unknown.

For patients like Murphy, for whom depression was a debilitating lifesuck, those risks might be a worthy trade-off. But interest in using DBS to treat all manners of conditions is growing. In addition to disorders like depression and Tourette Syndrome, it’s been used to treat chronic pain, headaches, morbid obesity and even writer’s cramp that had not responded to other treatments. The controversial Italian neurosurgeon Sergio Canavero has made the case for using psychosurgery procedures like DBS on criminals and drug addicts, reasoning that “psychopathic behavior is a purely biological epiphenomenon and can be induced.”

“With any treatment of any brain disease we risk trying to make everyone the same, and treat any variation from the norm as sickness,” Karen Rommelfanger, a neuroethicist at Emory, told Gizmodo. “We want to have magical thinking. But are we going to eradicate depression? No, and we shouldn’t. Being human means the full spectrum of experience.”

Doctors who treat patients with intractable conditions make the case that DBS is a much-needed treatment only being used to treat patients for whom it is their last resort. Many neuroethicists, though, counter that its negative effects are still poorly studied and often downplayed in both academic literature and the press.

“Is the extreme that we have a kind of neuro-eugenics with only one correct brain? Well, yeah.” said Rommelfanger. “We are already moving towards a right way of being in society at large. That’s kind of what consumer culture relies on.”

Really, at this point it’s hard to know what might happen. Gage is often trotted out as cautionary tale of what might happen when messing with the brain. But recent historical work has begun to suggest that eventually after his accident, he actually returned to a basically normal life, weird personality tics and all. One scientist who studied him throughout his life observed that he “quite recovered in his faculties of body and mind.” A recent book about Gage suggests that, over generations, his story had been embellished to tell the legend of a man who suffered a brain injury and saw his humanity vanish. Instead, it may really be a tale about the brain’s incredible ability to heal itself.

Perhaps a more immediate risk, though, is that deep brain stimulation will simply not be as effective as we dream it will be.

Dr. Emad Eskandar, a neurosurgeon at Mass. General and one of the lead researchers on the DARPA project, has been working on using DBS to treat mental illness for over a decade. He was the one who implanted those two electrodes into Liss Murphy back in 2006. But while for Murphy and many other patients the treatment seemed to work, a clinical trial revealed that the treatment had a significant placebo effect. In a study of 30 people conducted in the mid-2000s, participants who received DBS did not improve at a rate much better than those who did not, and the FDA halted the trials.

Eskandar told me that they eventually realized that they were thinking about it all wrong.

“Depression is not one thing,” he said. “It sounds obvious in retrospect, but at the time it really wasn’t.”

That was the aha moment that moved them to reframe their research entirely. Instead of trying to treat a psychiatric diagnosis, like depression, they decided to focus on treating the particular symptoms that a person exhibited.

“It’s much more tangible for us to measure things like ‘Are you cognitively flexible or rigid? Are you emotionally flat?” he said.

Two years in, their work has identified patterns of activity in certain areas of the brain that seem to correlate with specific traits, but they still need to home in on exactly which frequency band is the right signal to target.

One recent revelation at Mass. General was that cognitive flexibility, decision making and approach avoidance—traits associated with several disorders—are all located in one part of the center of the brain known as the striatum. Luckily, it was a region of the brain already known to be safe for electrical stimulation.

Some traits, though, are easier to locate in the brain than others. Impulsivity, for example, a major trait in most people with addiction, is easier to pinpoint than symptoms like fatigue or physical pain.

“The 30,000-foot view is that we have pretty good data for the set of domains we are treating,” said Darin Dougherty, a psychiatrist at Mass. General and Eskandar’s long-time collaborator. Ahead, though, are still likely years more of fine-tuning.

Their second hurdle, on top of figuring out where in the brain to target, will be to design a plan for how best to stimulate that spot.

Murphy’s implant is what’s known as “open loop”— her electrodes send out signals to her brain, but the brain isn’t sending any signals back. Her implant works in some ways much like a drug, delivering a single, constant electrical stimulation, albeit one targeted at a specific area of the brain.

In hopes of targeting the brain more precisely, the Mass. General team has enlisted Boston’s Draper to design a “closed loop” implant to replace the old system. A closed loop system would work much more like the brain itself, both sending and receiving information to multiple sites of the brain in a natural, dynamic fashion. This would allow the electrodes to only fire off a signal when necessary, meaning patients would only receive treatment when their brains are sending out the signal responsible for unwanted behavior.

“What’s turning out to be most important for us is timing,” said Alik Widge, the engineering lead for the DBS project. “If you hit the right region at just the right moment you can nudge a decision. It’s all about knowing when the brain is the right state.”

Last November, I visited Mass. General, where Widge showed me the fridge-sized machine that housed the algorithms behind the team’s DBS technology. Draper will have to figure out a way to fit those complex algorithms onto a device smaller than a cellphone.

With the new system, the entire DBS unit, including rechargeable batteries, will be implanted on the back of the skull. The implant will contain five electrodes, with 64 points of contact allowing them to target the brain with incredible geographic specificity. Those electrodes will gather data from the brain, process it, and then administer the appropriate dose of stimulation accordingly.

In January, the FDA gave the Mass. General team approval to, for the first time, hook a prototype up to a patient. Right now it’s still about the size of a brick, far too big to implant permanently. The plan is to hook it up to the patient and test it temporarily, at first for a few hours, and eventually a few days. The goal is that by the end of DARPA’s five year contract, they have both a device and protocol ready to be put to the test of an FDA clinical trial.

Widge told me that he imagines their device one day being sophisticated enough that patients could control some settings via an app, giving them control over how much psychiatric assistance they receive on a day-to-day basis.

Listening to patients like Murphy describe their experience—a sudden lightness, an immediate surge of warmth—it’s hard not to wonder whether, in tweaking a person’s circuitry, we aren’t also altering something at their core.

Murphy, though, disagrees. She actually finds the term “cyborg” offensive.

“People think that when you have something implanted, it changes who you are,” she told me. “It’s like another body part. It’s just part of me. The device didn’t change anything about who I am.”

#cyberpunk #攻殻機動隊 #ghost in the shell #ブレードラーナー #blade runner #neuromancer #william gibson #when gravity fails #acronym #acrnm #neuroscience #philosophy #consciousness #darpa #science #technology #health

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nancygduarteus · 6 years ago

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Psychiatry’s Failed Quest

In 1886, Clark Bell, the editor of the journal of the Medico-Legal Society of New York, relayed to a physician named Pliny Earle a query bound to be of interest to his journal’s readers: Exactly what mental illnesses can be said to exist? In his 50-year career as a psychiatrist, Earle had developed curricula to teach medical students about mental disorders, co-founded the first professional organization of psychiatrists, and opened one of the first private psychiatric practices in the country. He had also run a couple of asylums, where he instituted novel treatment strategies such as providing education to the mentally ill. If any American doctor was in a position to answer Bell’s query, it was Pliny Earle.

Earle responded with a letter unlikely to satisfy Bell. “In the present state of our knowledge,” he wrote, “no classification can be erected upon a pathological basis, for the simple reason that, with slight exceptions, the pathology of the disease is unknown.” Earle’s demurral was also a lament. During his career, he had watched with excitement as medicine, once a discipline rooted in experience and tradition, became a practice based on science. Doctors had treated vaguely named diseases like ague and dropsy with therapies like bloodletting and mustard plasters. Now they deployed chemical agents like vaccines to target diseases identified by their biological causes. But, as Earle knew, psychiatrists could not peer into a microscope to see the biological source of their patients’ suffering, which arose, they assumed, from the brain. They were stuck in the premodern past, dependent on “the apparent mental condition [his emphasis], as judged from the outward manifestations,” to devise diagnoses and treatments.

The protracted attempt to usher psychiatry into medicine’s modern era is the subject of Anne Harrington’s Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness. As her subtitle indicates, this is not a story of steady progress. Rather, it’s a tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster.

Norton

Some of the episodes Harrington recounts are familiar, such as Egas Moniz’s invention of the lobotomy, which garnered him a Nobel Prize in 1949, at just about the same time that the psychiatrist Walter Freeman was traveling the United States using a surgical tool modeled on an ice pick to perform the operation on hapless asylum inmates. She has retrieved others from history’s dustbin. In the 1930s, for example, insulin was used to render mental patients comatose in hopes that they would wake up relieved of their psychoses. And in at least one case—the deinstitutionalization of mental patients in the 1960s and ’70s—she has given an old story a new twist. That movement, she argues convincingly, was spearheaded not by pill-happy psychiatrists convinced that a bit of Thorazine would restore their patients to full functioning, but by Freudians. They saw the antipsychotic drugs invented in the 1950s as a way to render patients suitable for the outpatient treatment that psychoanalysts were equipped to provide.

From ice baths to Prozac, each development Harrington describes was touted by its originators and adherents as the next great thing—and not without reason. Some people really did emerge from an insulin coma without their delusions; some people really are roused from profound and disabling depressions by a round of electroconvulsive therapy or by antidepressant drugs. But in every case, the treatment came first, often by accident, and the explanation never came at all. The pathological basis of almost all mental disorders remains as unknown today as it was in 1886—unsurprising, given that the brain turns out to be one of the most complex objects in the universe. Even as psychiatrists prescribe a widening variety of treatments, none of them can say exactly why any of these biological therapies work.

It follows that psychiatrists also cannot precisely predict for whom and under what conditions their treatments will work. That is why antipsychotic drugs are routinely prescribed to depressed people, for example, and antidepressants to people with anxiety disorders. Psychiatry remains an empirical discipline, its practitioners as dependent on their (and their colleagues’) experience to figure out what will be effective as Pliny Earle and his colleagues were. Little wonder that the history of such a field—reliant on the authority of scientific medicine even in the absence of scientific findings—is a record not only of promise and setback, but of hubris.

That word does not appear in Mind Fixers, despite its repeated accounts of overreach by enthusiastic doctors who are often the last to recognize the failure of their theories. As Harrington tells us at the outset, she is committed to restraint. “Heroic origin stories and polemical counterstories may give us momentary emotional satisfaction,” she writes. But the result—“tunnel vision, mutual recrimination, and stalemate”—is not very useful. By presenting a just-the-facts narrative of the attempt to find biological sources of mental suffering, particularly in the brain, she hopes to get the “fraught” enterprise of psychiatry back on the path to progress.

Harrington is right to sigh over what has too often proved to be a yelling match between equally deaf opponents—members of an ambitious profession convinced that psychiatry is making strides toward understanding mental illness, and critics who believe it is at best a misguided attempt to help suffering people and at worst a pseudoscience enabling social control at the expense of human dignity. Indeed, since the sides first squared off, more than half a century ago, they seem to have learned little from each other.

As Harrington ably documents, a series of fiascoes highlighted the profession’s continued inability to answer Clark Bell’s question. Among them was the 1973 vote by the American Psychiatric Association declaring that homosexuality was no longer a mental illness. The obvious question—how scientific is a discipline that settles so momentous a problem at the ballot box?—was raised by the usual critics. This time, insurers and government bureaucrats joined in, wondering, often out loud, whether psychiatry warranted their confidence, and the money that went along with it.

The association’s response was to purge its Diagnostic and Statistical Manual of Mental Disorders (DSM) of the Freudian theory that had led it to include homosexuality in the first place. When the third edition of the DSM came out, in 1980, its authors claimed that they had come up with an accurate list of mental illnesses: Shedding the preconceptions that had dominated previous taxonomies, they relied instead on atheoretical descriptions of symptoms. But as Harrington points out, they did have a theory—that mental illness was no more or less than a pathology of the brain. In claiming not to, she argues,

they were being disingenuous. They believed that biological … markers and causes would eventually be discovered for all the true mental disorders. They intended the new descriptive categories to be a prelude to the research that would discover them.

The DSM-3’s gesture at science proved sufficient to restore the reputation of the profession, but those discoveries never followed. Indeed, even as the DSM (now in its fifth edition) remains the backbone of clinical psychiatry—and becomes the everyday glossary of our psychic suffering—knowledge about the biology of the disorders it lists has proved so elusive that the head of the National Institute of Mental Health, in 2013, announced that it would be “re-orienting its research away from DSM categories.”

The need to dispel widespread public doubt haunts another debacle that Harrington chronicles: the rise of the “chemical imbalance” theory of mental illness, especially depression. The idea was first advanced in the early 1950s, after scientists demonstrated the principles of chemical neurotransmission; it was supported by the discovery that consciousness-altering drugs such as LSD targeted serotonin and other neurotransmitters. The idea exploded into public view in the 1990s with the advent of direct-to-consumer advertising of prescription drugs, antidepressants in particular. Harrington documents ad campaigns for Prozac and Zoloft that assured wary customers the new medications were not simply treating patients’ symptoms by altering their consciousness, as recreational drugs might. Instead, the medications were billed as repairing an underlying biological problem.

The strategy worked brilliantly in the marketplace. But there was a catch. “Ironically, just as the public was embracing the ‘serotonin imbalance’ theory of depression,” Harrington writes, “researchers were forming a new consensus” about the idea behind that theory: It was “deeply flawed and probably outright wrong.” Stymied, drug companies have for now abandoned attempts to find new treatments for mental illness, continuing to peddle the old ones with the same claims. And the news has yet to reach, or at any rate affect, consumers. At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success.

Harrington’s dispassion as she chronicles the rise and fall of various biological theories of mental illness will make this book of value to historians of medicine. It may even allow critics and advocates of biological psychiatry alike to gain a deeper appreciation of the historical stream in which they are swimming, and to stop trying to drown one another. But her restraint carries a risk: that she will underplay the significance of the troubles she is reporting.

Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension. To say which of our travails can (and should) come under medicine’s purview is, implicitly if not explicitly, to present a vision of human agency, of the nature of the good life, of who deserves precious social resources like money and compassion. Such questions, of course, aren’t always pressing; the observation that a broken leg is a problem only in a society that requires mobility seems trivial.

But by virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain.

In this sense, the attempt to work out the biology of mental illness is different from the attempt to work out the biology of cancer or cardiovascular disease. The fact that the brain is necessary to consciousness, added to the fact that the brain is a chunk of meat bathing in a chemical broth, does not yield the fact that conscious suffering is purely biological, or even that this is the best way to approach mental illness. Those unresolved, and perhaps unanswerable, moral questions loom over the history that Harrington traces here. The path she has chosen may require her to steer clear of such knotty concerns as the relationship of mind to brain or the relationship of political order to mental illness. But her account doesn’t just skirt the polemics she decries. It also overlooks the consequences of psychiatrists’ ignoring those questions, or using scientific rhetoric to conceal them.

At the risk of being polemical, let me suggest that Harrington’s word disingenuous fails to describe the cynicism of Robert Spitzer, the editor of the DSM-3, who acknowledged to me that he was responding to the fact that “psychiatry was regarded as bogus,” and who told me that the book was a success because it “looks very scientific. If you open it up, it looks like they must know something.” Nor does ironic accurately describe the actions of an industry that touts its products’ power to cure biochemical imbalances that it no longer believes are the culprit. Plain bad faith is what’s on display, sometimes of outrageous proportion. And like all bad faith, it serves more than one master: not only the wish to help people, but also the wish to preserve and increase power and profits.

Harrington ends her book with a plea that psychiatry become “more modest in focus” and train its attention on the severe mental illnesses, such as schizophrenia, that are currently treated largely in prisons and homeless shelters—an enterprise that she thinks would require the field “to overcome its persistent reductionist habits and commit to an ongoing dialogue with … the social sciences and even the humanities.” This is a reasonable proposal, and it suggests avenues other than medication, such as a renewed effort to create humane and effective long-term asylum treatment. But no matter how evenhandedly she frames this laudable proposal, an industry that has refused to reckon with the full implications of its ambitions or the extent of its failures is unlikely to heed it.

This article appears in the April 2019 print edition with the headline “Psychiatry’s Incurable Hubris.”

from Health News And Updates https://www.theatlantic.com/magazine/archive/2019/04/mind-fixers-anne-harrington/583228/?utm_source=feed

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ionecoffman · 6 years ago

Text

Psychiatry’s Failed Quest

Norton

This article appears in the April 2019 print edition with the headline “Psychiatry’s Incurable Hubris.”

Article source here:The Atlantic

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grimecrow · 8 years ago

Text

On Thursday March 2nd I Nearly Succeeded In Killing Myself

So less than a week ago I nearly succeeded in ending my own life. How do I quantify the concept of nearly succeeding in such an action? I ended up about twenty feet from the water’s edge of Lake Ontario. Now you may say; twenty feet from the water? That’s not nearly succeeding at anything!

Well allow me to explain my beliefs regarding suicide. If a person wants to kill them self they should have the right to do it. Have I talked people out of committing suicide before? Yeah, sure lots of times; I have also at times said my good byes and left them to their own devices. Most people that say they want to kill themselves honestly don’t; no matter how much they may say the words, there is some piece of subconscious holding them back. That is why they sit there and look at the gun, or hesitate instead of automatically jumping or pour pills onto the table. Something has made them believing that they believe that this is the answer but they honestly know it isn’t. This sounds like I am making light of those people, or talking down about them but I am not. They have issues, they need help, they are lost in some manner and it is up to us to help them be found. Also remember no matter how uncertain a person is; we humans can psych ourselves up for a minute to do just about anything. So even though they don’t want to kill themselves for whatever conscious or unconscious reason they are most likely not fully aware of they can still convince themselves to do it. Jumping from bridges, ledges, balconies, or in front of trains are the biggest exit these people will successfully used as you don’t need to take an action you simply need to stop taking an action.

I believe if you want to kill yourself, make sure to do it in a slow and agonizing way. My preference is drowning it takes a lot of time and effort to set yourself up to take the action and accomplish it. First there is the drowning checklist; leave bank cards others need; make sure I have no electronics, find a way to lock the door after I go but have the keys be safe at home things like that. Then I have to walk thirty to forty minutes to get to the water front; then find a place where there are no people as forcing people to watch another person die is a cruel and selfish thing to do if it can be avoided and there is a lot of lake front; it can be avoided. Also if people see you do it they will want to stop you from doing it for whatever reason. The whole process takes an hour or more of relentless, methodical action and if I have doubts I stop because I know I don’t want to do it no matter how much my conscious mind may fleetingly think I do.

On Thursday night, I didn’t hesitate for one second; every barrier, every trick, all of it...nope I was done and to be honest it would have been wonderful. The night was so cold, the water even colder; with a surface temperature of 5 degrees (40 for you Americans) jumping in would have after the first few moments been like simply falling asleep.

Yet here I am; so apparently I didn’t want to do it right? Wrong! I was snookered the same way you can snooker anyone who is a good or caring person. I was guilted into surviving by Mitch. I shouldn’t live for wanting to live; I shouldn’t live for any reason of my own but I should live because it would hurt others too much. I shouldn’t free myself from my difficulties because of the momentary difficulty it would inflict on others. It is a shitty thing to do to a person, it is selfish, and unkind everyone I’ve talked to who wanted to kill themselves, really and truly and still do but got snookered with the ’Don’t be selfish, think about me’ play all agree. If you haven’t been in the other side, the suicidal side of that play then you won’t understand but I will explain.

First off; it resolves nothing. I still want to kill myself, that feeling won’t go away now but seeing as I let the ‘live for others’ card trump me going off and killing myself immediately after is an impossibility. If I kill myself right after then instead of them being selfish, I’m being the selfish one as I agreed to continue an existence for them but decided ‘Nah, it’s all about me after all’ ALSO the wounds inflicted on everyone would be ten fold. The wounds of the death plus the wounds of failing to prevent the death stacking on top and such double down hurt can start a chain reaction that only goes exponentially. So now I’m stuck here. Secondly; the person who does the snookering cannot always solve the problems of the person who wanted to end their life. So not only do I get to not resolve my suicidal feelings, I am forced to just mask them but I still get to go through all the pain that lead me to that point WITH the added bonus of knowing that freedom from those issues was within my grasp which of course can potentially be a breeding ground of resentment and regret.

So why did I want to kill myself? The automatic answer is depression, because society has wrong white washed the issues of suicide with the depression brush. I personally believe the companies paid a lot of money to set that in motion to sell depression medication to as many people as possible whether they actually needed it or not; anyone familiar with how kids were diagnosed and treated in the 90’s can see the merit of my belief. I am not depressed. Some times I get depressed but I don’t suffer from depression; my head doctor tried every way possible to find proof of depression when I talk about wanting to kill myself but she admits when I am truly wanting and willing to kill myself; depression as it is clinically known is no where around.

Growing up I knew a lot of people who killed themselves for reasons other than depression; Mary and Ursula were an older lesbian couple. Mary was diagnosed with untreatable lung cancer Ursula suffered from a nervous system disorder that confined her to a wheelchair and she couldn’t live on her own. The system had failed her multiple times resulting in many horrible things happening to her, on her own her benefits would not give her enough to live and hire someone who would take care of her without suffering terrible things and she only had a couple of years left anyhow so...they had a nice dinner, gave out some gifts to friends, went home watched an episode of a show they loved and together jumped from their balcony onto the roof of the Food Basics at the top of Winchester ave. There was a gay man who loved books named John, he had AIDS and the time came where he had to keep an oxygen tank near by cause his lungs would kick out. He was going blind, no longer had control over his bathroom functions, and was in constant pain. He told me that one day he may not reach for the oxygen tank when his lungs gave out; I was young at the time and didn’t know if I believed him or not but with no cure; minimal function of body I understood why he wanted to end his suffering. A couple of days later he died. I don’t know if it was just the natural end of life with AIDS or his choice but I will not lie I hope it was his choice. I hope he got to end his own suffering.

We put down our pets when they reach a point when they are going to suffer for too large of the time they continue to live; or suffer fiercely by the act of living. Plenty of people believe and support assisted dying bills and yet suicide is a terrible concept. One that has to be able to be solved by pills of Cognative Behavioral whatever its called. Don’t get me wrong both those things have their merits and on a case by case basis they can help solve issues but they are not the be all and end all. No amount of happy thoughts will stop my body from twisting and cramping up if any type of sheet is placed on me. Sometimes I have to sleep on the couch and use Zayne’s comforter; there is pain I just push through it. I can’t say “Today I am going to get up and have two functioning legs!” and have it happen; I can’t say; “I am not going to see things!” and have it work because I still see them; I know they are not there and that doesn't stop them from not appearing, not having me question what is or isn’t real. No anti-psychotic, no anti-depressant, no anti-anxiety medication will make my hands work right all the time, allow me to sit or stand or lay down with no pain. Actually there is one that could solve all the problems and if this was as late as the 1970’s I definitely would have been put on it. Lithium; the beautiful gift of a chemical lobotomy; my brain would be destroyed so I wouldn’t have enough awareness to know if I suffered at all and I could be tucked in a corner so as not to wound people by actually dying.

So what made me want to kill myself? Well my laundry list of physical and mental issues are rather long but a body that doesn’t function or is in pain about 80% of the time denying me the ability to sit, stand, sleep, walk, hold things. Assuming I’m not striking myself in the head, seeing things, unaware of reality, having night terrors, screaming fits and all the other gifts of anxiety and PTSD. I have a medical system that notes all my symptoms are real but has never found a fix; just nodding their heads and running the same circle of bullshit as things degenerate. There are also other issues I won’t get into on a public forum that exasperate the conditions and issues. So yes, last Thursday I decided I had enough; I was tired, not just physically tired but mentally and emotionally tired and I didn’t see the point in continuing this existence. Now there are the standard talking points about loved ones and happy moments; allow me to answer those talking points now. A happy moment for me can be that my physical and mental issues (which may be physical in origin due to misfiring something or other) are dormant enough that I can simply exist with a functioning body and a basically functioning mind free of large amounts of pain or defect. That percentage of time has dropped to be roughly about 20% of my time; or a hair less. All you pet owners, and people who know the general cultural understanding of pets if someone said to you; “This creature will be in some form of suffering 80% of the time” what is our answer? It’s always the answer of those that allow themselves to hurt for the sake of doing the humane thing no matter how much it destroys you; you put them down.

After ten years of documentation, tests trials, prescriptions, treatments, etc there is no sign that anything can or will get better and the degradation scale has been increasing rapidly the last five or six years. I will never work again, apparently you need mobility of steady hand functionality or the ability to be around people without having an uncontrollable freak out of some kind. If I publish Kaw it will take far longer than it should because of my huge swathes of lack of functionality. I can sit here and stare at it knowing that I should be doing something and be frustrated, and hate myself and my situation that I can’t. But I go out now you say? I play Heroclix once in a while, I go on walks, things like that and at some points I was so psychotically unstable I couldn’t leave the house without having melt downs beyond my functional control. Yes, yes I do those things, and the stress of doing those things either aggravates my body ailments or ruins my mental stability. A Heroclix tournament is a guaranteed trip to “Night Terrors” or “Nightmares That Erase My Ability To Process Reality”; a Pokemon Go walk will definitely twist my legs up; they will pop and be unable to not be tense, twitch and cramp mind you not going on the walk means I get torso issues along with lesser leg issues. Hand functionality, the processing ability and stability of ears, and eyes is hit or miss with any scenario. I have a hard time reading a book cause the book ends up shaking from the prolonged effect of using my hands to hold it, same with game controllers, and typing, my one hand is killing me at the moment. Listening to music, watching videos, sleeping all also come with their own costs that will be paid whether I kick and scream against them or roll with them. Oh what a fun existence I have to look forward to!

What about loved ones? Well most of the time I can no longer handle interacting with you in person without paying for it later. My schedule is so erratic in terms of wellness that I just put my shoulder in it and let what ever costs come once everyone is gone and there are always costs. Now I could avoid the extra costs by not interacting with people outside my ever changing schedule so I get to sit home alone and do nothing. I love interacting with you all by the way when I can or do but if you notice there are far less events, far less get togethers and there is a reason for that.

Hell, all food regardless of what it is, how much, when I eat how I eat it basically is just an unpleasant experience that has blended together and sits like a lump of wet paper mache in my system being unpleasant till it has been processed enough. So yes I decided after years of this, with the progression of things and the loss of Zayne (yes, my dog) who was something that I could simply exist with in a way that I cannot exist with any other thing, including my husband. Those other issues came up one more time and I was so tired I decided that because things would never get better; that it was a majority of pain, and uncontrollable crazy, and all of that I would finally grant myself the same right to mercy that I hate myself for granting to Zayne because of how much I have hurt while ensuring he wouldn’t. Yet because I am NOT a selfish person, I could have easily honestly pushed Mitch aside and been on my way but after the conversation we had I knew it would be too damaging I am still here. He even apologized at the time because he knew what he was doing was a cruel trick but he had to do it anyhow.

So here I am, and will be for quite awhile more reminiscing at how wonderful it would have been to let go and plodding along wondering how long the next severe bought of whatever will last. Hating myself for wanting to do so many things that are simple for the majority of the rest of you that I can’t do or will stumble through crudely. Here I am continuing to live for the others that want me to.

Some of you may want to say; “If you need to talk I’m here” and some of you may say; “You need to talk to me more” but what am I supposed to say. The same things I have been complaining about for years; that have been getting worse for years and still have zero chance of going away are still happening? Just say that over and over again, the same news of what hurts, what my current crazy has rotated back to, and what’s my degree of functionality? There is nothing to talk about anymore though I will say I love everyone who wanted to say those words because they care that much.

Anyhow that’s what happened last Thursday night, I felt my friends would want to know and didn’t want to give the same details and answer the same questions over and over and over again so here we are. I am telling you and answering the questions and concerns I expect you to have because they are always the same questions and concerns people have in times like these. If I didn’t tell people and they found out later they would get angry and offended because they always have and always will.

If some of this has seemed bitter and negative I actually do apologize I’m still swallowing a pill that has left a bitter taste in my proverbial mouth.

#suicide #trigger warning #trigger warning suicide #trigger warning: suicide #tw: suidice #tw: sucide mention #tw

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