#clinical mental illness

[inkskinned]

today i love the red metal crane in her long neck arching her body over the boston skyline, which means i am okay for a moment. when i am unwell, everything is a little ugly. i always tell myself look for the beauty but when it is bad, i will look at birds and sunsets and little ducklings and feel absolutely nothing.

when my brother got his puppy, i was in a deep depression. what kind of monster isn't affected by a puppy. i was gentle and kind to her - i just didn't have an emotional reaction. she's five now and i feel like i spend all of our interactions apologizing to her - i don't know why. i just didn't feel anything. how embarrassing. i feel like if i admit that, i'll seem cruel and jaded. it comes in waves. like, two months ago when i went out into the world - it was like that. life behind a pane of stormglass. a firework could go off over your head - nothing. like dead skin, no reaction. not to ice cream or rainbows or baby chickens. life foggy and uninteresting.

i love goslings again. i love their little webbed feet splayed over grass. i love good food and live music and long walks. i like puppies. i feel like some kind of my soul has been starved - i keep staring at everything with wide eyes, trying to burrow the sensation into my stomach. it's real. beauty is real. when it's bad again, remember this. i stop and smell the flowers, feeling cliche in the moment. i like the white-to-red ombre of my neighbor's roses. i like colorcoding and yoga and cold drinks. i try to pass my hands over every moment, feeling like i'm squeezing joy out of every instant. remember this. for the love of god, it's real - just remember this.

[reasonsforhope]

Story from the Washington Post here, non-paywall version here.

Washington Post stop blocking linksharing and shit challenge.

"The young woman was catatonic, stuck at the nurses’ station — unmoving, unblinking and unknowing of where or who she was.

Her name was April Burrell.

Before she became a patient, April had been an outgoing, straight-A student majoring in accounting at the University of Maryland Eastern Shore. But after a traumatic event when she was 21, April suddenly developed psychosis and became lost in a constant state of visual and auditory hallucinations. The former high school valedictorian could no longer communicate, bathe or take care of herself.

April was diagnosed with a severe form of schizophrenia, an often devastating mental illness that affects approximately 1 percent of the global population and can drastically impair how patients behave and perceive reality.

“She was the first person I ever saw as a patient,” said Sander Markx, director of precision psychiatry at Columbia University, who was still a medical student in 2000 when he first encountered April. “She is, to this day, the sickest patient I’ve ever seen.” ...

It would be nearly two decades before their paths crossed again. But in 2018, another chance encounter led to several medical discoveries...

Markx and his colleagues discovered that although April’s illness was clinically indistinguishable from schizophrenia, she also had lupus, an underlying and treatable autoimmune condition that was attacking her brain.

After months of targeted treatments [for lupus] — and more than two decades trapped in her mind — April woke up.

The awakening of April — and the successful treatment of other people with similar conditions — now stand to transform care for some of psychiatry’s sickest patients, many of whom are languishing in mental institutions.

Researchers working with the New York state mental health-care system have identified about 200 patients with autoimmune diseases, some institutionalized for years, who may be helped by the discovery.

And scientists around the world, including Germany and Britain, are conducting similar research, finding that underlying autoimmune and inflammatory processes may be more common in patients with a variety of psychiatric syndromes than previously believed.

Although the current research probably will help only a small subset of patients, the impact of the work is already beginning to reshape the practice of psychiatry and the way many cases of mental illness are diagnosed and treated.

“These are the forgotten souls,” said Markx. “We’re not just improving the lives of these people, but we’re bringing them back from a place that I didn’t think they could come back from.” ...

Waking up after two decades

The medical team set to work counteracting April’s rampaging immune system and started April on an intensive immunotherapy treatment for neuropsychiatric lupus...

The regimen is grueling, requiring a month-long break between each of the six rounds to allow the immune system to recover. But April started showing signs of improvement almost immediately...

A joyful reunion

“I’ve always wanted my sister to get back to who she was,” Guy Burrell said.

In 2020, April was deemed mentally competent to discharge herself from the psychiatric hospital where she had lived for nearly two decades, and she moved to a rehabilitation center...

Because of visiting restrictions related to covid, the family’s face-to-face reunion with April was delayed until last year. April’s brother, sister-in-law and their kids were finally able to visit her at a rehabilitation center, and the occasion was tearful and joyous.

“When she came in there, you would’ve thought she was a brand-new person,” Guy Burrell said. “She knew all of us, remembered different stuff from back when she was a child.” ...

The family felt as if they’d witnessed a miracle.

“She was hugging me, she was holding my hand,” Guy Burrell said. “You might as well have thrown a parade because we were so happy, because we hadn’t seen her like that in, like, forever.”

“It was like she came home,” Markx said. “We never thought that was possible.”

...After April’s unexpected recovery, the medical team put out an alert to the hospital system to identify any patients with antibody markers for autoimmune disease. A few months later, Anca Askanase, a rheumatologist and director of the Columbia Lupus Center,who had been on April’s treatment team, approached Markx. “I think we found our girl,” she said.

Bringing back Devine

When Devine Cruz was 9, she began to hear voices. At first, the voices fought with one another. But as she grew older, the voices would talk about her, [and over the years, things got worse].

For more than a decade, the young woman moved in and out of hospitals for treatment. Her symptoms included visual and auditory hallucinations, as well as delusions that prevented her from living a normal life.

Devine was eventually diagnosed with schizoaffective disorder, which can result in symptoms of both schizophrenia and bipolar disorder. She also was diagnosed with intellectual disability.

She was on a laundry list of drugs — two antipsychotic medications, lithium, clonazepam, Ativan and benztropine — that came with a litany of side effects but didn’t resolve all her symptoms...

She also had lupus, which she had been diagnosed with when she was about 14, although doctors had never made a connection between the disease and her mental health...

Last August, the medical team prescribed monthly immunosuppressive infusions of corticosteroids and chemotherapy drugs, a regime similar to what April had been given a few years prior. By October, there were already dramatic signs of improvement.

“She was like ‘Yeah, I gotta go,’” Markx said. “‘Like, I’ve been missing out.’”

After several treatments, Devine began developing awareness that the voices in her head were different from real voices, a sign that she was reconnecting with reality. She finished her sixth and final round of infusions in January.

In March, she was well enough to meet with a reporter. “I feel like I’m already better,” Devine said during a conversation in Markx’s office at the New York State Psychiatric Institute, where she was treated. “I feel myself being a person that I was supposed to be my whole entire life.” ...

Her recovery is remarkable for several reasons, her doctors said. The voices and visions have stopped. And she no longer meets the diagnostic criteria for either schizoaffective disorder or intellectual disability, Markx said...

Today, Devine lives with her mother and is leading a more active and engaged life. She helps her mother cook, goes to the grocery store and navigates public transportation to keep her appointments. She is even babysitting her siblings’ young children — listening to music, taking them to the park or watching “Frozen 2” — responsibilities her family never would have entrusted her with before her recovery.

Expanding the search for more patients

While it is likely that only a subset of people diagnosed with schizophrenia and psychotic disorders have an underlying autoimmune condition, Markx and other doctors believe there are probably many more patients whose psychiatric conditions are caused or exacerbated by autoimmune issues...

The cases of April and Devine also helped inspire the development of the SNF Center for Precision Psychiatry and Mental Health at Columbia, which was named for the Stavros Niarchos Foundation, which awarded it a $75 million grant in April. The goal of the center is to develop new treatments based on specific genetic and autoimmune causes of psychiatric illness, said Joseph Gogos, co-director of the SNF Center.

Markx said he has begun care and treatment on about 40 patients since the SNF Center opened. The SNF Center is working with the New York State Office of Mental Health, which oversees one of the largest public mental health systems in America, to conduct whole genome sequencing and autoimmunity screening on inpatients at long-term facilities.

For “the most disabled, the sickest of the sick, even if we can help just a small fraction of them, by doing these detailed analyses, that’s worth something,” said Thomas Smith, chief medical officer for the New York State Office of Mental Health. “You’re helping save someone’s life, get them out of the hospital, have them live in the community, go home.”

Discussions are underway to extend the search to the 20,000 outpatients in the New York state system as well. Serious psychiatric disorders, like schizophrenia, are more likely to be undertreated in underprivileged groups. And autoimmune disorders like lupus disproportionately affect women and people of color with more severity.

Changing psychiatric care

How many people ultimately will be helped by the research remains a subject of debate in the scientific community. But the research has spurred excitement about the potential to better understand what is going on in the brain during serious mental illness...

Emerging research has implicated inflammation and immunological dysfunction as potential players in a variety of neuropsychiatric conditions, including schizophrenia, depression and autism.

“It opens new treatment possibilities to patients that used to be treated very differently,” said Ludger Tebartz van Elst, a professor of psychiatry and psychotherapy at University Medical Clinic Freiburg in Germany.

In one study, published last year in Molecular Psychiatry, Tebartz van Elst and his colleagues identified 91 psychiatric patients with suspected autoimmune diseases, and reported that immunotherapies benefited the majority of them.

Belinda Lennox, head of the psychiatry department at the University of Oxford, is enrolling patients in clinical trials to test the effectiveness of immunotherapy for autoimmune psychosis patients.

As a result of the research, screenings for immunological markers in psychotic patients are already routine in Germany, where psychiatrists regularly collect samples from cerebrospinal fluid.

Markx is also doing similar screening with his patients. He believes highly sensitive and inexpensive blood tests to detect different antibodies should become part of the standard screening protocol for psychosis.

Also on the horizon: more targeted immunotherapy rather than current “sledgehammer approaches” that suppress the immune system on a broad level, said George Yancopoulos, the co-founder and president of the pharmaceutical company Regeneron.

“I think we’re at the dawn of a new era. This is just the beginning,” said Yancopoulos."

-via The Washington Post, June 1, 2023

[aingeal98]

Something about older Jason looking at the child version of himself, the innocent victim, and feeling the need to defend and avenge him the way no one else will. They'll call him reckless and try to pin the blame for his death on some unique failure of his personality, the problem isn't Robin the problem is he was just a bad fit for Robin! And then older Jason coming back to life and spits on their twisted grief. Fuck you, that innocent child deserved more. You took his memory and ruined it to make yourselves feel better. If no one will give him justice then Jason will take it himself no matter who he has to kill to get there. It's the only way he can move forward.

Something about older Cass looking at this child version of herself, this innocent who has no idea what she was doing when she was tricked into killing, and finding her irredeemable. She will forgive everyone for everything if they need a second chance but she cannot forgive that innocent child. She spends ten years wanting that child to die for their sin, a standard she holds no one else to. And in the end she does have to die. She can never forgive that child until the price has been paid and the guilty, tormented, suicidal mess of a girl is dead and never coming back. Only then can Cass live on. Only then can she smile without feeling the weight of her kill on her back. If no one will give that child the justice they deserve then she will have to do it herself. It's the only way she can move forward.

[schizopositivity]

It sucks so much that as someone with a severe and persistent mental illness it's MY responsibility to jump through hoops and be proactive in contacting people at limited times of the day just to get MY MEDS THAT I'VE BEEN TAKING CONSISTENTLY FOR YEARS

[alexandraisyes]

What is the difference between sociopath and psychopath?

OH! OH OH OH I LOVE THIS QUESTION. Also this is a massive explanation that really goes in-depth about neurology so I'll do a read more.

The main difference is that a psychopath is born with ASPD. A sociopath develops it during early (we're talking starting off as young as 2) childhood due to severe long-term (several years) abuse and neglect (generally from main caretakers).

There are also some nuances in how a socio's brain works in comparison to a psycho's. But the major difference that really determines all of the minor differences is that a psychopath doesn't necessarily have trauma related to their ASPD, and tends to have a lot less comorbid disorders. A sociopath ALWAYS has trauma that directly caused their ASPD and a fucking CVS receipt of comorbid disorders the large majority of the time.

There are also more sociopaths than there are psychopaths. The physiology of ASPD is that the brain's structure is different from an empathetic person. Specifically in the prefrontal cortex and the amygdala, because there's not enough activity in those areas for someone with ASPD. The prefrontal cortex is involved in decision-making, impulse control, and regulation of social behavior, and the amygdala is involved in emotion processing and fear response. Abnormalities in the amygdala contribute to a lack of empathy and increased aggression (aggression does NOT equal violence in this case, but rather an increased and pervasive level of negative emotion that makes you more likely to act out). Genetics have been proven to play a factor in how likely someone who was born empathetic would develop ASPD.

The difference here is that a psychopath is born with reduced blood flow to those areas. No trauma needed, that's just how they work.

On the contrary, a sociopath develops reduced blood flow to those areas because if you live in an environment that fosters the growth of anti-social traits and behaviors you are not exercising those parts of your brain. I'll go into a deep dive about the neurological aspects of how formative trauma turns into ASPD.

Chronic stress from abuse can impair the development of the prefrontal cortex; reduced activity or structural abnormalities in this area can lead to increased impulsivity and difficulty regulating emotions. The amygdala becomes hyperactive due to repeated exposure to threatening situations. This results in heightened aggression and reduced ability to empathize with others. Abuse can lead to a smaller hippocampus, impairing the ability to process emotions and increasing vulnerability to stress.

Chronic abuse elevates cortisol levels (the stress hormone), which can alter brain function and structure. Persistent high cortisol levels can damage the prefrontal cortex and hippocampus, exacerbating emotional and behavioral regulation issues. Serotonin and dopamine neurotransmitters regulate mood and behavior. Abuse can disrupt their levels, contributing to aggression, impulsivity, and difficulty experiencing pleasure or reward.

The autonomic nervous system (ANS) becomes hyperactive, leading to a state of constant alertness and readiness for perceived threats. This can cause chronic anxiety, irritability, and aggressive responses. Conversely, some individuals may develop a blunted stress response, showing reduced physiological reactions to stress. This can lead to a lack of fear or concern for consequences. (These two may combine so that safe things trigger stress and unsafe things do not).

Abusive environments can impair the development of secure attachments, leading to difficulties in forming trusting relationships. This can foster detachment, manipulative behavior, and a lack of empathy. Inconsistent or abusive parenting can disrupt normal emotional development, making it difficult for individuals to manage their emotions and impulses. This can result in volatile behavior and poor emotional control. Abusive environments often model and reinforce antisocial behaviors. Children learn to cope with stress through aggression or manipulation, which can become ingrained patterns of behavior. Abusive environments can impede moral development, leading to difficulties in understanding and adhering to societal norms and rules. This can result in a disregard for others' rights and a propensity for criminal behavior.

Trauma and abuse can also alter gene expression through epigenetic changes, affecting the brain's development and function. These changes can increase the risk of developing ASPD by influencing genes involved in stress response, emotional regulation, and social behavior.

A lot of people who went through severe childhood abuse may experience anti-social symptoms without having full-blown ASPD. When I was younger I did a genetic test that led to some very fascinating results that now that I'm older and understand my disorder I understand how my ASPD ties directly into my genetic depression, or rather my genetic depression is caused by my ASPD.

I don't process/produce Vitamin B6, B9 (Folate), and B12. These vitamins are crucial for brain function and the production of neurotransmitters. Deficiencies lead to mood disorders, cognitive impairments, and other neurological issues. B vitamins are involved in synthesizing neurotransmitters like serotonin, dopamine, and norepinephrine, which regulate mood and behavior. These are neurotransmitters that act as natural painkillers and mood enhancers. B vitamins play a role in the metabolic pathways that produce endorphins. An inability to properly absorb, process, or produce B vitamins can disrupt these pathways, leading to lower endorphin levels, which can contribute to symptoms of depression and affect overall mental well-being.

Because of how specific my issue is I had to take a specialized blend of B Vitamins. Unfortunately once I turned 18 my parents stopped buying them for me and I haven't had the funds to purchase my own at all since I was cut off (which has led to my mental health tanking). I strongly suggest anyone who deals with anti-social traits in a way that is disruptive to their daily life to look into these. You can't generally find them at a drug store, but they're on Amazon for 25-ish USD for a month's worth bottle. Which is really good because when my parents were buying them two years ago or so they were 40$ a bottle.

I have been on all sorts of mood stabilizing medications, psychosis medications, anti-depressants, anxiety medication, etc. None of them worked because we didn't know what exactly was wrong with me. All it did was make it so I couldn't feel the negative emotions properly, so I was constantly numb. What the vitamins did for me is that they let me process passive endorphin exchange and metabolism for the first time in my life, which meant that there wasn't a drastic barrier between me and positive emotions.

I strongly suggest this for anyone who is also just dealing with mood instabilities/disorders because it helped immensely. I'm bipolar two and I wasn't dealing with any major manic episodes while I was on them for about two years, so it helped drastically in that aspect too.

I know this got a little off the rails, but sociopathy is such a hard disorder to deal with, and it's so demonized by the media. Just telling someone you're a clinical sociopath is enough for them to kick you out of their life, even though it has no reflection on your character and is just an outcome of a horrible, hell-like childhood. So I think it's important for ASPD voices to speak up about the disorder when they can and try to dispel some of the awful stigmatization.

[vixensofdeath]

I want to go for a walk and never come back. I’ll walk for miles listening to my music to forget my problems, I’ll make a new life, I’ll make a new identity and I’ll never be who I was before.

[aropride]

????? got an email from my school's advocacy resource center's new intern that uses my deadname? even tho the only time that name has been used at the school is for financial stuff and u have to go to a special secret part of my student information stuff to find it. the email's about new therapy resources so im GUESSING the school gave her a list of ppl who had gone to the therapist who worked here (the anti-mask one, who's leaving lol) and asked her to email them all to let them know there's gonna be new options for therapy, and they had my deadname bc they had to work w my insurance.. still a jumpscare though

[drimmiean]

lots lots of portraits

[wvlls-roundme]

watching my close friends live their life normally hurts so much because i wanted to achive things too. seeing them study what they want and actually can do it, get what they want, not having any problems in life, good family, and etc... and then there is me whos life is just a whole failure. it makes me wanna kms more when i hear how their life is normal and good. because i will never have a life like theirs. and before eveything, i wont see the world like them again. i lost my spark. i feel empty all the time and i dont find any meaning in living. i cant enjoy even little things like them anymore. i wish i was them. but i'm not. i'll just die in this darkness, alone with my all thoughts. there is no chance for me to see the world same again.

[fl0rescer8]

[geronimomo-spd]

15 to me is a doctor that finally got diagnosed and is awear of his emotinal turmoil, and decided to instead of letting his meltdowns be internal and come out as anger, to instead attempt to let them out and cry, but to try to stop himself from actually hurting himself and or others (ie crying and stopping himself after punching that door).

also he uses his pattern recognition element like crazy, he figures out that he is in the same boat as he usually was with certin killers who fancied him before, takes one look at who Rogue is and what he represents, and immidiatly trys tyo act like he always did and it works

but also its more then the letting his meltdowns actually be meltdoans again with crying and such, its about having less control over hiding his emotions at all, laughing at the kid's disstress at space babies, laughing at Ruby with the boogers, he always has a second where he just reacts emotinly before he takes control and starts masking. and his crying!!! 15 crys like he doesn't even notice the tears are there until his voice starts cracking, its like his emotions are happening to him and he has to figure out a way to understand and mask them then he feels emotions, and i love it.

"ok! i understand i am concidered autistic by human standers (and probably by time lords standers too actually) and im completely fine now thank you goodbye!! [runs away before he learns any affective coping mechanisms]

[religion-is-a-mental-illness]

By: PITT

Published: Sep 30, 2023

Our son recently started graduate school. He began hormone therapy during his final year of undergraduate education. Because he began to identify as a lesbian, transgender woman at 20 and showed no sign of gender dysphoria before that, we never had a chance to reflect – or advise him – on his choices. Going through the published medical research on the effects of estrogen made me aware that psychologically, excess estradiol in the serum causes depression among males, and physiologically, there are potentially much more severe side effects, including some impacting the brain and the immunological system. More of that in a minute.

Fast forwarding to the present day, before our son left for graduate school at a University with one of the country's most renowned medical schools. I decided to write to their student health center and share the studies I had found and, more relevantly, the psychological history of our child. What follows is the text of the letter and, after deleting potentially identifying information, the response from a high-ranking official within the health center. They are, for the lack of a better phrase, quite revealing.

First, my letter (I have not disclosed the name of the university and have changed the name of our child here, with apologies to the real Jonathans of the world; furthermore, apologies for the triggering usage of pronouns – I did not want to be dismissed as the “usual, hateful, bigoted transphobe”; rather, I wanted to be considered as the deadly serious parent who would do anything in their power to prevent their child from coming to harm):

-

Dear Apex University Health Center,

Our child, Jonathan, who is joining the graduate program at Apex University this Fall, identified themself as transgender during their sophomore year in college (2021) and started estrogen therapy in early 2023. Since every one of these interventions is off-label, I have been looking up the peer-reviewed literature on the effect of estrogen and whether there are any risks that our child needs to be aware of as they continue on this path. My findings, which I summarize below (and link to the sources), have been alarming. Several endocrinologists – some who publish extensively – have told me they were unaware of the new literature. I have also been in touch with the Endocrine Society, and their response heightened my alarm.

While we respect our child's identification with their gender identity, we felt that they exhibited several psychological symptoms right before identifying as a lesbian, transgender woman (Jonathan was assigned male at birth and did not show any inclinations to identify as female before April 2021), and these co-occurring symptoms were not considered at all before he started on the prescribed medicines. Most tellingly, just before identifying as transgender, Jonathan's romantic advances were rebuffed by the woman of their affection. Subsequently, Jonathan also lost every friend they had, thereby remaining completely alone in their dorm room for the greater part of their last two years of undergraduate education. However, these psychological symptoms were never explored. Jonathan was recommended to start on estradiol and spironolactone immediately, which they did – and their physical and mental health symptoms have deteriorated since. Jonathan is also quite depressed, spending all their time without emerging from their room.

That is not surprising since, when it comes to the recent research on estrogen in natal males, excess estrogen in the serum in natal males has been associated with depression – studies among adult men and adolescent boys show that. Clinical studies (i.e., studies that recruit actual subjects and follow them clinically rather than rely on anonymous, online, non-probability surveys) that promote gender medicine fail to show any improvement in psychosocial outcomes among natal males. For example, the New England Journal of Medicine study from early 2023 concluded that hormone therapy is psychologically beneficial for transgender youth. However, in the main text, the study finds no improvement in depression, anxiety symptoms, or life satisfaction among natal male youth (the relevant paragraph is at the bottom of page 244 of the journal issue).

Thus, psychologically, there is ample evidence that excess estrogen is associated with depression among natal males. Physiologically, recent research shows that estrogen might have far more deleterious effects. A study showed that 12 months of estrogen treatment among transgender women leads to a decrease in serum BDNF levels. That is significant because a separate study shows that this decrease in serum BDNF level is associated with increased risks of developing MDD (or major depressive disorder).  Lower levels of brain BDNF levels have also been associated with neurodegenerative disorders and found in the brains of patients with Alzheimer's, Parkinson’s, MS, and Huntington’s disease.

A high-quality rodent study shows that estrogen therapy among adult male rats leads to changes in their brains that resemble the changes in the brains of trans women. (There have been several other studies (2 links) among trans women that have shown these changes, but the rodent study indicated the mechanism by which these changes occurred in the brain.) Specifically, estrogen seemingly reduced the water content in the astrocytes and thereby disturbed the delicate homeostasis in the brain by increasing the relative concentration of glutamate (the brain's most abundant excitatory neurotransmitter), leading to glutamate excitotoxicity. As the Cleveland Clinic informs us, an increase in glutamate in the brain is associated with higher risks of neurological disorders like Alzheimer's disease, ALS, and many other diseases like multiple sclerosis. The research also showed that estrogen decreased brain cortical thickness and volume (which other studies have linked to patients with schizophrenia and bipolar disorder and lower levels of general intelligence). Furthermore, it was found to reduce cortical white matter integrity (which is related to cognitive instability). There is also empirical evidence of the lowering of cognitive abilities among transgender women that was presented at the EPATH conference in April 2023 (in Killarney, Ireland) - the researchers noted this decline among long-term patients at Amsterdam's famed gender clinic.

Research in the last few years shows that estrogen therapy among trans women has been associated with higher risks of various autoimmune diseases, from multiple sclerosis (recall, too, the association of MS with an increase in glutamate) to rheumatoid arthritis and many others in between. It has been associated with increases in the risks of prostate cancer and breast cancer. It increases risks of cardiovascular diseases (2 links), often by as much as tenfold compared to their cisgender counterparts.

Empirically, we see a much higher incidence of many of these physical and neurological diseases in the transgender population. It is perhaps not a coincidence, therefore, that population cohort studies (2 links) show that trans women, on average, die decades earlier than either cisgender men or women.

When I approached the Endocrine Society with what I had found and pointed out that many of these findings came out after the publication of their guidelines in 2017, I received an email from their Director of Clinical Practice Guidelines that they are currently fast-tracking a revision of those guidelines. She also mentioned that their evidence evaluation criteria have changed since the guidelines were published and that they now use the GRADE criteria for evaluating evidence. This is encouraging, but I have no idea how long it will take for the new guidelines to appear.

I point all of this out because Jonathan has the chance to start afresh and be reevaluated at Apex University's healthcare system. We increasingly see them stumbling with their memory, something that we could not even think of a year earlier – Jonathan used to have a photographic memory ever since they were a child. Having heard so much about Apex's medical school, we have high hopes that Jonathan's evaluation at Apex University's medical system will be more thorough than it has been so far. Let me be clear: We have no doubt about their gender dysphoria or their intense discomfort in their traditional gender role – we worry about that all the time. It is just that we have observed that medicalization has not brought them any balm so far – in fact, just the opposite. While the absence of any upsides (and the possible significant downsides) in the literature – psychological or otherwise – heightens our alarm.

After all, it is not only a lone voice like ours, but even mainstream media like the Economist (their April 5 issue with the cover story “The evidence to support medicalized gender transitions in adolescents is worryingly weak” comes to mind) and storied institutions like the British Medical Association and the systematic reviews of the literature from national medical associations of very transgender-friendly countries like Sweden, Finland, Norway, the UK, and (most recently) Denmark that are raising the alarm on the lack of high-quality evidence of any benefits from hormone therapy. (And these reviews I mention above cover only the evidence of the psychological effects of the hormones – they do not even consider the long-term physiological consequences.)

If all the evidence from the past few years is to be believed, there is now quite a body of evidence of genuine harm from administering estrogen to the natal male body (I have not researched the effects of excess testosterone on the natal female body, and so I cannot comment on that.)

As one of the world's leading lights in healthcare to nudge society toward better outcomes through research, Apex University will be well placed to lead the march for evidence-based care in gender-affirming care.

Thank you very much for reviewing the evidence that I have found and considering our child's health as they start their journey at Apex University. Please let me know if you have any questions. I look forward to hearing back from you.

With warmest regards,

XXX

-

A few days later, I got their response. I have highlighted the relevant portions of their email and annotated them within brackets [all formatting mine]. As I said, it’s quite revealing.

-

Dear XXX:

Thank you very much for sharing your concerns about your child with us.

…Apex U's Student Health Center (Apex SHC) is not directly affiliated with Apex Medical School and we do not provide care under the umbrella of the hospital. [Is the respondent making sure that the medical school is not implicated if something goes wrong with our son?] However, we do collaborate closely with our colleagues at the hospital and medical school, including in the management of our student receiving gender affirming care.

…

Gender affirming care is a unique process in medicine in that we are not aiming to treat and eliminate a disease process. [Ah, an admission that there is no real goal of treatment through this care. Finally! But read on…it gets better.] Instead, we are using the tools of medicine to help individuals achieve very personal and sometimes nebulous [nebulous? WTF? After all these years of "settled science," all we have is “nebulous?”] physical and emotional goals. Success is not based on a clinical metric but usually involves a better quality of life balanced with potential risks including morbidity and mortality. [So, finally, an explicit admission – success is not based on any clinical metric. That makes complete sense to us inconvenient parents. After all, how can there be? There never have been any metrics, ever. At. All. All we have are some "nebulous" ideas of "better quality of life" – as decided by the patient right now, with no consideration of what might happen in the future as a result of the free dispensation of off-label medication. And oh, by the way, that "better quality of life" includes morbidity factors and dying much faster.] We at the Apex SHC make every effort to ensure that our patients are well-informed [in other words, make sure that they have signed the informed consent forms!] about each decision that they make and have time to consider these impacts without pressure [The irony of the sentence – “have time to consider these impacts without pressure.” Wow! really?]

Should your child decide to engage with us in care, our commitment to them is to prioritize their safety [oh, the irony, once more!], the elements of their well-being that we can support [the rest – whether caring for them for the rest of their lives or paying for their illnesses and hospitalizations, with a big fuck you to your dwindling retirement funds – is up to you, you bigoted parents!], and to help them make a bright future for themselves.

Very best,

AAA

-

As I read and re-read the email, all I could think was – Wow! What an amazing letter! AAA has no qualms admitting that there are no clinical goals of treatment when it comes to gender-affirming care. This is really quite convenient if you think about it—if there are no aims, any outcome is fine! No wonder these physicians get all flustered when we inconvenient parents ask them about clinical goals and outcomes.

All that these caring physicians want to achieve are some nebulous (which the dictionary defines as unclear, vague, or indefinite) goals. Oh, and please remember – once again – that those are personal goals, so please don’t ask about evidence of well-being. (An inconvenient question, though – why should such personal goals be funded by others, whether it is the government or private insurance?)

And what if, as a result of those nebulous goals, the patients go through psychological, emotional, and physical distress for the rest of their lives, as detailed in the medical literature? Really, shame on you, you bigoted parents! Always such a nag! Always the party pooper. Why do you have to ask such inconvenient questions? Haven’t these caring physicians already made it clear that these are personal goals and that it really doesn’t matter that young children who are distressed might have no idea how to make a rational choice about the future? Who cares if they become hyper-fixated about something, as young children are wont to?

But then again, really, there is no pressure. No pressure at all. These kids are otherwise well-adjusted grown adults who know exactly who they are. Probably from the time they were toddlers. (What? You want evidence? This is getting really tiring. Give it a break, will you?) These are kids who are not immersed online, who do not gulp down narratives about “gender euphoria.” They are stable, rational human beings with a very clear idea of what the future holds.

All these well-meaning saints – these gender-affirming physicians – want is to give these kids a bright future: a future so bright that it will probably include that intense bright light these pitiable young men will see when they die decades earlier than their non-medicalized peers. Who are you parents to stand in their way?

==

This is quite a remarkable admission. If there are no metrics and the objectives are "nebulous," then that's the very definition of not-scientific, not-medical. How can this be "necessary," and even "life-saving" if it's also "nebulous"? God is both real and undetectable?

How can it be "settled science"?

You're letting people self-diagnose and self-prescribe in order to chase something nebulous? What the hell?

[mochinomnoms]

Iv been having cater brain rot for the last couple days so

Cater can and has used his um to send a clone to class for him (and sometimes even to meet up with friends) if he doesn’t have the energy to put on his happy “cay cay” face for however long

Cater listening to sad music while he works

-🐝

Noooooo Cater 😭😭😭 He's an introvert at heart. He does have a decent-sized social battery, made more out of necessity rather than want, and he can keep up his happy, preppy demeanor for quite a while.

But some days…he's exhausted. He doesn't know why. It's not like he didn't go to bed at a decent time, but he can't find it in himself to pull out of bed today…

He doesn't have an excuse: he slept well the night before, he had a good dinner, his alarm went off. Physically, he's fine, but Cater just can't muster up the will to move. His body sinks into the bed, like an animal carcass being absorbed into the ground. He's rotting away, piece by piece.

But "Cay-Cay" doesn't rot away in bed all day. Cay-Cay has a healthy morning routine and comes into class on time. Cay-Cay is in the cafeteria, taking pictures of his breakfast for Magicam, too sweet for him to actually eat, so it's left to mold in the trash. Cay-Cay chats it up with his desk neighbors, not noticing the annoyance and discontent they have with him. Cay-Cay likes to use all the latest lingo and slang, because he's trendy and in the know.

Cater has a hard time getting out of bed in the morning, dreading the energy he has to muster to interact with others. Cater would prefer something more savory to eat, instead of the pretty pink strawberry yogurt parfait that looks good in pictures. Cater would rather be left alone in the back of the classroom, taking his notes and content with keeping to himself. Cater is tired of speaking like his sisters, and not being taken seriously cause of it. But no one really notices because they know Cay-Cay and not Cater.

No one will know if he used his um to send a clone in his place. As long as it puts on a happy face and chipper mood, he won't be bothered. Maybe he'll have to worry about Riddle finding out, but today he only has classes with other third-years. And they mind their own business.

No one will notice if he's not really there, they never do.

[weirdway-jester]

Mc: do you think in a different universe we escaped together

Bela: i'll try as many times as it takes to make it this universe

[werethropy]

This is all over the place, I'm sorry. Not my usual type of posting at all. Grammar may not be correct. Need to get my feelings out.

I feel so pent up nowadays. An animal was not meant to be assaulted with bright, artificial lights while obnoxious humans talk and yell and physically brush against it while walking past.

I can never live out the life I desire. I want to be free from here; live in the woods. I wish the humans could see my true form.

I stare at the full moon a lot, and sometimes I even transform a little bit — when I swipe my tongue over my canines, I can feel how they got sharper; I feel my senses highten; at times, I can feel vague feelings of fur, a tail, ears; I want to howl my lungs out; I feel so much more animalistic mentally... But something always stops me from fully getting the chance to change into my truest sense of self.

I wonder if the humans have something to do with this? Maybe, maybe not. Maybe they're keeping me like this by the food I eat?

I don't know. But I know this is not where I belong. Not my body, not my family, and not my life. I can only keep hoping that, one night, I will be able to completely transform.

I'm so sick of everything, pretending to be human, pretending to not be autistic, pretending to be neurotypical in general, 'luring myself in' to not seem 'annoying' — so many aspects of myself that I have to hide. Core parts of me. For weeks on end.

[noriartz]

Reminder to tell your loved ones that you love them. Who knows how many more of those that you get..