#i'll never know i guess

[postmodernmulticoloredcloak]

This has evoked so many emotions in me and the prevailing one is a sense of... hauntingness.

We have just started understanding so many things. Not many years ago the only thing we knew about the human brain was that we knew pretty much nothing about the human brain.

We sneer at psychiatric practices and theories from the past but people in the future - possibly a near future, not even a far away one - will look back to our progressive times and be freaked out by what we are doing now, the mental institutions we have, the medication we fill our sick people with.

It's not a bad thing, of course. It means hope. But I also grieve for the lives, the happinesses, the joys and serenities that have been lost and are being lost because discoveries that will be taken from granted later have arrived too late for many.

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

[egophiliac]

WAIT when did he get FANGS

[barghest-land]

drawings from paleo expedition to dagestan, done right on the trip. sometimes messy when it was cold and rainy, but i won't correct it. i think it's cool to leave it just the way it was done, and not retouch it after. there will be more drawings later, but those will be done from home

[caliartcat]

klavier you're gonna have to be more direct than that

[fedoraspooky]

dusting off the ol' running Mabel meme after all these years because i am Tired

[whatlurksbean]

Hypothetical reigns

an exploration of where I think they'd be if they had been chosen by The Tide instead of Trouty.

Hake would fail, and sturgeon would rule with an iron fist.

[secretagentspydetectiveninja]

more v3 doodles (it's all just maki)

[nouverx]

WHY SO SERIOUS?? 🎉 Nika is here to party!!

A little unfinished project I started on flipaclip last year while the Luffy and Kaido fight was still happening in the anime :D

[wildsaltair]

Nightmare

Pairing: Maximus Decimus Meridius x reader

Rating: T (hurt/comfort, angst, fluff)

Word Count: 2.3k

Tag List: @enjisbf, @nasatshirts, @empressenchanted

Author’s Note: Up until now I've never posted any Maximus fanfiction because it's always just sort of been something I did for my own enjoyment, but this is one that I don't mind sharing :) @streets-in-paradise inspired me by sharing some Maximus love with me, so this is dedicated to her (and all you other wonderful people who have made Tumblr a place where I can share my passion for this wonderful man)! There's a lot of love poured into this fic, so I hope y'all enjoy it :)

*~*~*~*~*~*~*~*~*~*~ 

You are not surprised to learn that Maximus has nightmares. The details of his past are something you can only guess at, though he has alluded to the terrible battles and bloody escapades that haunt his memories. You also know that his refuge in your home is the first peace he has known since he was a child.

But you are not prepared for the sheer forcefulness of his first nightmare. He’s asleep next to you in bed, pale blue moonlight filtering through the window of your room, but you are awakened by his movements in the middle of the night. He’s jerking back and forth, his face twisted in a look of concentration, agony, and terror. You can’t help the fear that rises in your throat at the sight.

He makes a quiet sound in the back of his throat, one hand gripping the sheets tightly enough that his knuckles turn white. Blinking yourself into consciousness, your heart tightens at the sight. Even all these miles and months away from battle, still his past pursues him in dreams.

His next convulsion shakes the bed, and you instinctively reach out to him, hoping to wake him from the nightmare. It proves to be a mistake the second your hand presses onto his shoulder to shake him awake.

His eyes fly open at your touch, but it’s abundantly obvious that he is not awake, still seeing visions of whatever memory he was in a few moments ago. The look in his eyes is one of pure survival instinct, of a desperation that breaks your heart.

A split second later, you’re flat on your back, and the full weight of his body is pinning you down against the bed. You barely have time to register the shock of his swift movement before you realize that you did not wake him up. Blinded by memory, all he can see is his opponent, and the thought drives you to panic and try to wriggle out from under him.

Grinding his teeth, he grips both your wrists in his left hand and restrains them above your head effortlessly, despite your struggling. You call out his name softly, then more loudly, but still he is lost in the nightmare.

You thought you had tasted his strength before, when he’s made love to you and demonstrated how easily he can hold you in whatever position he chooses, but this situation gives you an entirely new perspective of his strength. A second after flipping you over, his right hand is around your throat, his thumb pressing into your jugular with enough force to crush it.

You’ve never been afraid of him once, but in this moment, without a single hint of recognition in his eyes and all his power focused on choking you, you are so terrified you can barely react. You can’t even use your hands to try to push him away.

Knowing that you may only have a few seconds to react, you gasp out his name as loudly as you can, the word immediately drowned out by the pressure on your throat. Your vision is fading to black a moment later, all the feeling in your hands gone from his vise-like grip.

But your strangled cry reaches past the fog of his nightmare somehow. The pressure on your throat releases, and his eyes widen suddenly, letting you know that he’s finally awake and realizing what he has been doing.

You can never forget the look in his eyes at that moment. All the terrifying forcefulness, the single-minded fierceness, the brute strength that made him such a force of nature on the battlefield — it all vanishes in a split second, dissolving into a gaze of such horror and regret that it shatters your heart instantly. You know that from this moment forward, he may never truly trust himself with you again, a thought that devastates you for him.

You can’t move for a moment, still struggling to catch your breath, and the look of horror in his eyes only increases as he pushes himself off you. He seems torn between the need to gather you in his arms and the fear of hurting you as he just did. His lips move, but no sound comes out.

You draw a ragged breath, reaching out one hand toward him desperately. “I’m all right,” is all you can manage. “I’m all right.”

You try to push yourself to a sitting position, but you find that you simply cannot, still so shaken from thinking you were about to be choked to death by the man you love, who you know would rather die than cause you any harm. His hands are trembling wildly when he reaches out to steady you.

“I didn’t know it was you,” he says, his own breathing so erratic that you wonder if he can feel your pain. “I couldn’t see you. I didn’t know it was you.”

He’s repeating himself in absolute shock, his eyes scanning every inch of your face, your neck, your arms to see what damage he’s done to you. His shaking only worsens, but he doesn’t lay a hand on you during his frantic checking over you for injuries, just lets them hover as if he’s afraid to touch you again.

You manage to sit up this time, steadying yourself with a calming breath and trying to give him a relaxed smile. “I know, I know,” you murmur, reaching out to brush your hand over his ruffled hair. He almost recoils at your touch.

“I could have killed you,” he whispers, involuntarily shifting himself to the edge of the bed away from you.

You keep running your hand lightly through his hair, determined to reassure him. “Of course not,” you promise. “You were only dreaming. It was just a dream.”

“It was just a dream,” he echoes, but not in agreement. “A dream of a battle in which I almost died. In which I killed so many men I could never count them.”

You don’t betray a single hint of fear, just scooting forward to close the distance between you. You use both hands now, framing the sides of his face as his eyes search your face desperately.

“I’m perfectly all right,” you assure him with a smile. “See? No harm done at all.”

“You don’t understand,” he insists vehemently, his voice breaking. “I could have killed you. I didn’t know it was you. I only saw my enemy and thought of killing him.”

Seeing how shaken he is, you push forward and clasp your arms around his neck to steady him. He still doesn’t touch you, doesn’t return your embrace. You can feel his whole body quaking in your arms.

“You don’t understand,” he repeats. “You don’t know what I’m capable of.”

“I don’t need to know,” you whisper in his ear, stroking his hair rhythmically in the way he always responds to.

He actually pushes you away this time, his hands gentle on your forearms as he puts space between you again. His eyes are blazing, his face as white as your sheets. “You don’t know,” he murmurs again, dropping his hands. “I could snap your neck with one twitch of my wrist. I could break your wrists, your ribs, your spine as easily as I can hold you down.” He holds his hands up in front of you, eyes wide and haunted. “You have no idea what these hands have done.”

“I don’t care what they’ve done,” you argue, seizing his hands with yours before he can pull them away. This time, though, he doesn’t make a move to pull away, freezing in place while he watches you carefully. Slowly, intentionally, you kiss the backs of both his hands, his knuckles, his fingers, to demonstrate your words. “I know you, and I love you, no matter what you’ve done.”

He shakes his head, though his eyes drift closed at the touch of your lips on the base of his palms. “No,” he half-whispers, “no, no.” Your heart tightens seeing him so tortured, knowing that all this anguish lurks beneath his stoic exterior every day, hiding so you can’t see it. “I should never have risked you like this.”

“You’ve never risked me,” you insist. “You’ve never done anything but protect me.”

“Until tonight,” he counters sharply, his eyes flashing open and fixing on yours with his typical intensity magnified. “It only takes one time. I should never have taken the risk.”

You can read the meaning behind his words — that he thinks he can’t trust himself to sleep next to you. The thought of giving him up, especially for this reason, is utterly unacceptable to you.

“I am not afraid of you,” you tell him firmly. Your words seem to affect him, because the tension in his shoulders lessens fractionally. You kiss his hands again and again, then rest your cheek against the roughened skin that you love so much.

“You should be,” he replies softly, the severity in his voice already decreasing. You can see the waves of exhaustion and sorrow washing over him, and you reach out your arms to enfold him again. This time, he accepts your embrace, folding his arms around your waist gently and resting his forehead in the crook of your neck. His skin is burning hot against yours, his arms still trembling.

“I could never be afraid of you,” you whisper. “I could never be afraid of the man who has protected me and cherished me. You have treated me so gently, so tenderly all these months. Never once has it crossed my mind to be frightened of your strength.” You press a kiss to his shoulder, then the side of his neck. “I take pride in having the heart of a man so strong, so capable. I know you would never hurt me.”

He shifts you in his arms, lifting you slightly to align more easily against his body. You can feel the deep, shuddering breath he draws while he thinks about your words. “I would never mean to hurt you,” he replies, “but in a dream, I cannot tell the difference between memory and reality.”

“I believe you would be able to keep yourself from truly hurting me,” you reassure him, threading your fingers into his hair at the base of his neck. He reacts to your touch with a hand sliding up your back to cradle you closer to his chest.

“And if I could not?” he whispers in response, his lips pressing against the sensitive skin of your neck. “If I should wake and find you dead by my hand?”

You shake your head, feeling tears spring to your eyes. Any fear you felt in the moment while he was holding you down is completely gone, lost in the tender embrace he holds you in now. “I do not believe the gods would allow such a thing to happen. Not to you. Not to us.”

He releases a shaky breath, one that glides across the exposed skin of your neck. He ducks his head to press a kiss to your collarbone, letting his lips linger there in a way that makes you shiver in his arms. “I am honored by your trust.”

You smile in response, dragging your fingertips lightly down his sides, over the deep scar that slices down his ribs. “I could never trust another man on earth as I do you,” you reply. “My only fear is that I may drown in the love I see in your eyes every day.”

He kisses your collarbone again in response, then moves upward slowly, pressing his lips to the soft hollow of your throat, then the underside of your jaw at your pulse point. Lifting you up effortlessly with his hands hooked under your arms, he repositions you so that you’re straddling him.

He then rests his fingertips, feather-light this time, against the sides of your neck. He strokes his fingers over each mark they left, then presses the softest of kisses against each one. Goosebumps break over your skin at the intimacy of his actions, of the wordless apology in every touch.

He lowers his forehead against yours, eyes closed as he breathes you in. “I do not know what blind fortune allowed me to find you,” he murmurs, touching his lips softly against the corner of your mouth, “but I thank them every moment for the gift of holding you like this.”

At your affectionate smile, he finally gives you the ghost of one in return, though his eyes are still haunted. You suspect that he will retain that haunted look for some time, no matter how many reassurances you offer.

As the intensity of the last while calms, he shifts you in his arms again, cradling you gently and laying you back against the pillows. He leans up on one arm, facing you, and you reach up a hand to stroke the side of his face. His expression softens again, giving you a look of utter fondness and devotion that makes your heart melt.

He leans forward slowly, as if asking your permission, and you gladly grant it. His lips touch yours with a gentle brush, then a bit more pressure. His tongue slides across yours in the way that always sends shivers up your spine, and one of his hands reaches up to stroke your hair, the other resting lightly on your waist. He kisses you once, twice, three times, each one more tender than the last, then lets his lips linger against yours for a moment more.

“I love you,” he says softly that you barely hear it, but rather feel it against your mouth.

“I love you,” you return, “more than I can say.”

One last kiss, and he finally lays down beside you, his face mere inches from yours and his arm folded across your waist. He takes his time in going back to sleep, choosing instead to gaze at your profile in the soft moonlight, but sleep finally takes him. And when you finally close your eyes, content to sleep peacefully beside him again, it’s to the sound of his even breathing and the warmth of his protective embrace.

*~*~*~*~*~*~*~*~*~*~*~

More of my fanfiction if you're so inclined :)

[gayofthefae]

Girl, I'm so sorry, but if you he really was gonna tell her he loved her before Argyle interrupted them, I would not want somebody to say to me

"I guess, I just, I don't know, I guess I just wanted to say that I love you."

You guess you love me? What, you don't know? Be sure then come back to me.

[thesmokinpossum]

If My Body Could Speak, Blythe Baird | The Godfather, Mario Puzo | My Father's House, Sylvia Fraser | To The Daughter Who Secretly Longs For Her Mother’s Affection, Lynne Shako | Storms from Jupiter, Wanda Deglane | DO NOT REPLY, @filmnoirsbian

[mobius-m-mobius]

You wanna hear a good story? Listen to this one.

Mobius + comfort

[egophiliac]

"IT WAS SUPPOSED TO BE A JOKE" As someone who's been playing TWST since march and stopped going out of my way to be spoilerfree after I got stuck at Overblott!Jamil? That's honestly been one of my favorite things about it - seeing something in fanart or a comment you think is just fans joking, only for it to be canon. "The economy!", "May I also throw a tantrum?", Malleus' gargoyle thing, and... everything about Rook being my top examples.

there's a whole bit in Trey's platinum birthday card where he goes on about how he became increasingly obsessed with mustard for like a week straight until the other students held an intervention. how are you supposed to talk about this. how can you bring up something like Trey's descent into mustard obsession to the point that the other characters are worried for him without it sounding like the most obvious lolrandom "he mentioned it once and now fandom acts like he puts mustard in everything" joke. also, how can I slip this into every Twst post from now on, because I need everyone in the world to know that this is a real canon fact about Trey "I'm just an average normal guy (who sticks my hands into people's mouths and owns 20 toothbrushes and used to eat flowers off the side of the road)" Clover.

for bonus points, 1) the punchline is that he still doesn't even like mustard that much, 2) he's saying all of this to Leona, and 3) Leona is actually kind of invested in Trey's mustard story for some reason, which is the most unbelievable part of all of this to be honest. (then Trey gets distracted by a painting of the Cheshire Cat and Leona takes the opportunity to powerwalk away to freedom before they can start talking about dijon versus spicy brown or whatever and extend this bit even longer)

[barghest-land]

ata tu corazón, mi amor, y arrástralo por la tierra

[beatcroc]

what, didn't you know most amphibians shed and eat their skin? what did you think was going on there, peppino? this is normal frog stuff. come on now.

many more sketches bc i had way too many thoughts about this to try and illustrate all in a comic. horrid beast fp agenda ❤

[shalom-iamcominghome]

My jewish community, friends, rabbi, and educators: We are very invested in helping you be jewish. Do you want to help read the haftarah? Here's a chanukiah! You can have it!! Borrow these books! Here's some books! You need more books... Come to pesach! Come to the chanukah party! When are your classes done? We need a minyan for once!

Me and my 50000 IQ: What if I am Secretly Appropriating judaism? What if I am doing a Cultural Appropriation........