#i think tumblr blacklist gets op's tags as well as reblogs so im not gonna bother tagging this.

[irrealisms]

a couple additional facts about this collage (i've said these before but not ~collected):

“This report is confidential and should not be released without the expressed written consent of the parent or guardian” is from my diagnosis papers when i was 19 and legally an independent adult. they were sent to my parents and not to me.

while i use it now, with none of these providers did i use the name "Casey"

this is collaging material from many years and at least 5 providers, including a therapist, a psychiatrist, a neuropsychologist, an inpatient hospital, and an IOP center. this is not a problem of "one bad apple".

i call this collage "quitting therapy"

[ID under cut]

Image ID: a collage made from excerpts of my psychiatric medical records and reports. The excerpts are small black text on a white background and are pasted all over the image, creating a less organized collage look. The excerpts are small black text on a white background and are pasted all over the image, creating a less organized collage look. This ID will record each excerpt as it appears from left to right and top to bottom, with a couple noted exceptions where I felt the order mattered.

“This report is confidential and should not be released without the expressed written consent of the parent or guardian”. This text is in all capitals and bolded in the middle of the image, at the top.

“eye contact was sometimes prolonged or avoidant.”

“Casey has struggled with psychiatric symptoms since childhood.”

“She identifies with the pronoun “they”.”

“Casey’s gender and sexual confusion has been supported by her parents.”

This excerpt is a table labeled “Grooved pegboard test”, with the headers of “Z score”, “Percentile Rank”, “Drops”, and “Descriptor”, with rows labeled “Dominant (right) Hand Speed” and “Non-Dominant (left) Hand Speed”. The Z score for their right hand is -4.0, and -3.2 for their left hand. Both hands have a percentile rank of <1%, 3 recorded drops, and a descriptor of “Extremely Low”.

“Casey’s insight into her role in relationships was limited”

“Her affect was otherwise relatively flat”

“Deficits in theory of mind”

“Appearance/Behavior: calm and cooperative”

“poor eye contact”

“Casey’s interpretations of others’ thoughts/feelings was often immature or markedly incorrect.”

This is a table excerpt, listing “Activities of daily living”, followed by the scores “28**”, “1%”, and “Clinically Significant Elevation”.

“To date, Casey is quick to reprimand others for not following the rules. For example, she will reprimand her mother and father for removing their facemasks in public amid the COVID-19 pandemic.”

"age appropriate"

“Casey’s performance fell far below that which is expected of a younger teen.”

“fairly good insight into her weaknesses”

“insight: superficial”

“judgment: impaired, based on recent behaviors”

“insight: poor”

“Casey tended to talk at the examiner and talk over the examiner. Casey only once inquired about the examiner’s own experiences, when it related to her interests (“Do you like podcasts?”). She tended to dominate conversation.”

“therapist called the police and Casey way given the choice of going to a psychiatric hospital voluntarily or be Baker Acted (she went voluntarily).”

“Casey does not admit to ongoing AVH.”

“Comments: more guarded today and more reluctant to openly share symptoms”

“She is still reluctant to start another antipsychotic medication”

“Casey’s guarded nature. I would like to move forward with initiation of another antipsychotic (risperidone v olanzipine), but Casey would prefer to defer that today. Will allow time to process fears/concerns related to medication in therapy and revisit starting antipsychotic at next appointment.”

“Discussed risks and benefits of retrying antipsychotic medication, acknowledging her fear of inducing another seizure. Casey would prefer to defer initiation of another antipsychotic today and was encouraged to discuss and process her fears related to this in therapy, which she continues to attend and finds helpful.”

“Today: Mood and anxiety okay on mirtazapine and duloxetine but still having psychotic symptoms, the severity of which is difficult to assess given Casey’s guarded nature. I would like to move forward with initiation of another antipsychotic (risperidone v olanzipine), but Casey would prefer to defer that today. Provided information on both meds, including comparison of side effect profile and laid expectation for starting one of these meds in the future.”

“Strongly recommend Casey start an antipsychotic.”

“Unchanged from last visit.”

This excerpt is a rating scale, with the question “On a scale of 0-10, how likely would you be to recommend this facility to a friend or family member?”. Below the question are the numbers 0 through 10 in sequence, with a box to check next to each number. The box next to 0 is checked with an x, next to the words “not at all likely”.

“Discharge Medications. Patient discharged on 1 Antipsychotic(s):”

This excerpt is a bulleted list, immediately below the colon as if to imply that they are the antipsychotics in question, which has the following bullet points: “Improve eye contact in conversations with unfamiliar people”, “Improve social awareness and boundaries in relationships (learn to “read a room”)”, “Improve patience in relationships”, “Improve reciprocity in (in-person) conversations”, and “Improve tolerance for other people’s perspectives/differences.”

“Comment: somewhat avoidant.”

“Treatment: Continue therapy.”

This excerpt is a box to check, which is checked with an X, next to the words “Against Medical Advice (AMA) Discharge”.



(thanks to @aro-ace-ave-maria for helping with the image description)!