#medical treatise

[upennmanuscripts]

Today's #MedicalMonday is LJS 398, an Arabic medical treatise in 50 chapters, 35 concerning reproduction and the final 15 addressing the soul and intellect from a neoplatonic perspective. It was written in Syria or Iraq, A.H. 689 (1290)

Online:

[maverick-werewolf]

Werewolf Fact #70 - Werewolves in medical history + "clinical lycanthropy"

The results of the werewolf fact poll over on my Patreon are in, and now we have this month's werewolf fact: all about werewolves in historical medical treatises of the Renaissance/Early Modern period and the term "clinical lycanthropy," as well as what all that means and how it still impacts werewolf studies and werewolf pop culture today.

This post will make use of a lot of primary sources, which I always find fun, so buckle up!

I've done several posts touching upon subjects similar to this before, you might be familiar with them, such as how werewolves in folklore are the result of a curse instead of a disease, and my two-parter on when werewolves became associated with insanity (Part 1 and Part 2 are here). You can also read a whole lot more about that topic and my arguments regarding it in my thesis, which was on werewolves, and can be found here on Amazon.com (hardback coming soon!).

However, I have never really delved in detail into a few of the actual medical treatises written during the Renaissance/Early Modern Period - in other words, primary sources - of which we have several. In this post, I will cover a few, but not all. I'm also going to make mention of a few more modern ones in regard to clinical lycanthropy, but let's start with older first...

First of all, there was a lot of discussion of "melancholy" in the 1500s in regard to werewolves. This was even referenced in the play The Duchess of Malfi (and I actually have an academic article dedicated to the discussion of the lines involving werewolves in said play). This is, of course, related to the ancient Greek theory of humors, in which the composition of the human body and health required the balance of four humors: black bile (earth), blood (air), choler (fire), and phlegm (water), each related to one of the classic elements.

Throughout the Renaissance, "wolf-madness" was attributed to a case of melancholy, or an excess of black bile. There are many examples of this. And, of course, there are also many attributions to Satan... which was not a thing at all before this time period, as before this, werewolves were even sometimes associated with Christianity (see: werewolves of Ossory, among others).

An oft-referenced source in both werewolf studies at large as well as my own works is "Admirable and Memorable Histories" by I. Goulart, from around 1607 and translated from French by Ed Grimeston; I use this source from my book A Lycanthropy Reader by Charlotte F. Otten. Please note that the language of the piece is dated, so it will read funny to modern audiences.

Goulart discusses "Licanthropes and mad-men, the which wee will consider of two sorts," not necessarily equating those suffering from "lycanthropy" as mad-men, but as those "in whom the melancholike humor doth so rule, as they imagine themselves to be transformed into Wolves." He refers to them as "counterfet Wolves" and discusses how they "runne into Church-yardes, and about graves," something not uncommonly seen in the newfangled werewolf sources of the 1600s onward but not commonplace in werewolf legends of previous time periods.

Goulart also discusses men "tormented with an evill spirit, that at a certaine season of the yeare, hee imagined himselfe to bee a ravening Wolfe," and references other elements seen only in the later werewolf trials as opposed to previous werewolf legends. I also can't help but wonder if the "certain season" element is something Curt Siodmak saw and carried over into the original werewolf in The Wolf Man turning during a particular season (when wolfsbane blooms in autumn)...

Anyway, another of Goulart's sources is Job Fincel in 1541, who describes werewolves in ways we see around a lot when googling and finding garbage on the internet but not so much in legends previously, such as how those afflicted with the "disease" of believing themselves to become a wolf (but not actually turning into one) "are pale, their eyes are hollow, and they see ill, their tongue is drye, they are much altered, and are without much spittle in the mouth." This is consistent with particular illnesses rather than anything seen in werewolf legends, as these are not the people who truly become wolves, only those who believe that they do - and Goulart was still drawing lines between those with hallucinations, those who actually change shape, and those who are werewolves by other means. For example, Goulart also discusses the idea of people whose souls fly from their own bodies and enter into the forms of wolves instead.

There are other examples that discuss these same topics, of course, including but not at all limited to "Diseases of the Mind" by Robert Burton and "A Treatise" by Robert Bayfield, both of which are also featured in A Lycanthropy Reader, and there are plenty of others in assorted other werewolf studies publications.

Now, in addition to these older examples, we also have much more recent medical studies regarding what is known in modernity as "clinical lycanthropy."

Here's a fun fact: the term "lycanthropy" wasn't ever used in antiquity to refer to werewolf legends. It was created by the medical profession in the 1500s to refer specifically to a form of madness, not shapeshifting. It referred to what was recognized as a mental illness that they called lycanthropy: someone believing that they turned into a wolf, not to someone actually turning into a wolf (as in, not referring to the legends in which this happened).

Today, we call this "clinical lycanthropy," because the term "lycanthropy" was basically taken by werewolf media and werewolf studies and retroactively applied to werewolf legends. But the term "lycanthropy" was never actually used in said legends.

The term "lycanthropy" to refer to a "werewolf disease" is just another way in which medical studies and Renaissance writings turned werewolf legends into a "werewolf disease" instead of a magical curse, as it always used to be.

Now, of course, the medical world doesn't really recognize "clinical lycanthropy" anymore. It's considered to be a part of other mental conditions, the result of drug-induced hallucinations, or something entirely different. Several cases were attributed to schizophrenia instead, for example. So the term "clinical lycanthropy" in itself is all but outdated.

I won't be including or directly quoting from the case reports from the 1970s in this discussion, as this post is already enormous and, frankly, the case reports are not things that could be easily discussed in today's environment, as the language in the reports would certainly be considered offensive today, and that's not something I want to navigate. So I won't get into all that. They're out there if you want to read them, but I won't bother breaking them down here.

There are also certainly other examples of medical history relating to werewolves and werewolf legends, but I'll save all that for the werewolf facts book or another publication of mine!

Medical treatises are just another example from the Renaissance (and for quite a while after, into at least the 1800s and even early 1900s) of trying to rationalize and find "scientific explanations" for all manner of folklore and mythology. This also resulted in a considerable amount of condemnation for those who still believed in this sort of thing, as well as those who believed themselves to be experiencing it. As mentioned in some of my other werewolf facts, this didn't always include punishment (many victims of clinical lycanthropy at the time were actually well taken care of), but it did include things like being locked away from society for being declared insane. And, of course, if the victim in question was not a victim but a perpetrator, then it would result in a trial and punishment - and often execution. However, this was much more likely to happen to witches rather than werewolves. Just another way in which the trial of Peter Stubbe were very obviously witch/sorcerer trials and had nothing to do with werewolves at all.

Now, of course, you'll also recognize that a lot of the things you see in the treatises I used as examples don't follow up with many or even any werewolf legends you're very familiar with. Things were getting a bit weird at this point in history in regard to folklore and the like, and the reaching for rationalizing something like a person turning into a wolf or wolf-monster of any sort certainly resulted in some wild connections.

While this is far from the werewolf legends that personally fascinate me most, they are an important part of werewolf studies - hugely so. In fact, they're often discussed more than almost anything else, because unfortunately werewolf scholars are overly obsessed with later time periods that I personally find less fun and interesting than the Middle Ages and ancient times. But, hey, I love all of it.

Until next time!

And remember, if you want to vote on the next werewolf or vampire or other folklore fact, be sure to check out my Patreon. Thanks for reading!

( If you like my werewolf blog, be sure to follow me here and check out my other stuff!

Patreon — Personal Website (new and improved! Great starting point!)  — Wulfgard — Werewolf Fact Masterlist — Twitter — Vampire Fact Masterlist )

[heartsbreaking]

locked in on writing until midnight that being said i am a lil 😐 cause my piercings are fucking infected again and i'm allergic to most antibiotics so i can't do anything about it

[transmutationisms]

doctors complain about doctor google the same way they complained about medical treatises written for a popular audience ever since printed material became more widely accessible. which is to say, it has very little to do with the specificities of the internet and a great deal to do with their fear of losing prestige and practitioner privilege. if it was actually about providing accurate information they should be campaigning for things like rigorous medical education accessible to all, but they won't, bc that would threaten their bottom line and epistemological authority. don't let them play coy about this

[novafire-is-thinking]

Medic, Maverick, Maniac, Murderer: Understanding Pharma

First thing’s first: I love Pharma, dearly.

In all the time I’ve spent evaluating his character, I’ve mainly focused on what can be worked out about who he is as an individual: his core sense of self, psychological drives, subjective worldview, etc.

When all else is stripped away, who is Pharma?

This treatise is the product of obsessing over Pharma, analyzing canon (and extras), and reading as many different perspectives on his character from fans across the fandom as I could find. The post is long, so for those of you who balk at the thought of reading a shortfic’s worth of Pharma thoughts, feel free to read the TL;DR (Conclusion) at the end and then decide if the full read is worth your time. Also, a premium reading experience is available in the form of the original Google Doc version.

As you read, keep in mind that this is primarily a mix of psychoanalysis, evidence-based examination, and speculation—not moral, ethical, or sociological commentary. The goal is to examine Pharma’s psychological drives and core values, and each of his appearances in the context of those. All other types of evaluation are up to readers.

Now, take your victim blaming-allergy meds (just in case); remove your black-and-white thinking caps; and leave your personal morality lenses at the door.

Psychological Drives & Core Values

Why does Pharma act the way he does? What gives him a reason to keep living? What are his personal priorities?

At the beginning of the Delphi arc, First Aid establishes Pharma as a “control freak” and someone who “thinks he’s an expert on everything.”

Now, First Aid has a habit of complaining about his bosses, but on both points, there’s canon evidence to back them both.

Expertise and Intellect

Throughout the Delphi and Luna 1 arcs, it’s established that Pharma is a skilled and brilliant doctor.

He once performed a 4-way fuel pump transplant, donating his own fuel pump in the process. (see above panel)

Later, he invented a soundbomb that left an echo laced with a virus and invented an antidote to that virus:

And on Luna 1, he was on the edge of finding a cure for Cybercrosis, based on the fact that Swerve was able to formulate a cure from his notes.

More than being a doctor, Pharma lives for intellectual and scientific achievement as a physician scientist. He feels most alive when he’s able to solve complex medical problems, and when his achievements are recognized by those whose opinion he considers important.

This is Pharma’s 'why.'

And even though he’s arrogant and enjoys praise, it’s not his primary motivation. He doesn’t need it in order to set his mind to whatever he’s interested in, although he’ll seek it from those he values most (i.e. Ratchet).

Pharma sees himself as less of a doctor, and more as a scientific innovator or medical maverick. The practice of medicine is primarily a catalyst for his creativity and intellect; it’s not an end in and of itself like it is for someone like Ratchet or First Aid.

First Aid’s observation of Pharma can be better phrased as, “[Pharma] thinks he’s an expert on everything medical”—because he’s not so driven by achievement and admiration that he’ll grovel at the feet of strangers and get good at something he doesn’t personally find interesting. The only time we see him express a desire for praise is when he’s around Ratchet—someone he holds in high regard for both personal and professional reasons. This makes sense since Ratchet is one of the only people who can give Pharma any kind of competition within what he considers to be his area of expertise.

“Each day we go to our work in the hope of discovering—in the hope that some one, no matter who, may find a solution of one of the pending great problems—and each succeeding day we return to our task with renewed ardor; and even if we are unsuccessful, our work has not been in vain, for in these strivings, in these efforts, we have found hours of untold pleasure, and we have directed our energies to the benefit of mankind.” —Nikola Tesla

Ego

Without question, Pharma has an inflated ego, but having an inflated sense of self doesn’t automatically mean a person is a full-blown narcissist or that they are totally uncaring.

Every personality trait exists on a spectrum. Yes, Pharma is arrogant, but the presence of arrogance doesn’t automatically and completely cancel out all “positive” traits. (For fun, check out studies on Dark Tetrad and Light Triad personality traits.)

People are complex. Arrogance can coexist with genuine kindness, ruthlessness can coexist with deep compassion, etc.

Whether Pharma exhibits genuine kindness is up to each reader’s interpretation of what little canon material exists, but the point is: Pharma’s arrogance doesn’t automatically rule out the possibility of authentic “positive” traits.

Controlling Tendencies

Pharma is comfortable pulling the power card and using it to dump what he sees as uninteresting parts of medical practice on those below him:

“So Fisitron’s writing about the Wreckers’ elbows now, is he?” said Delphi’s Chief Medical Officer. “Come on, First Aid - get to it. You’ve got a Fader in Row 2 downstairs.” He squeezed the air with his finger and thumb. “He’s about this far from shutdown.” —from Bullets by James Roberts

However, there’s nothing in canon indicating he’s power-hungry in a megalomaniacal sense. He’s not Starscream or Megatron; he doesn’t seek political or social power. In fact, he seems perfectly happy hiding away in a lab or medibay by himself so he can direct all his energy toward solving issues and achieving the so-called ‘impossible’ within the field of medicine:

The ways in which Pharma exercises power and control are through his expertise, and his administrative/management skills. That’s it.

Self-confidence

Pharma’s arrogance and controlling tendencies don’t seem to be a mask—like he’s trying to compensate for some sense of lack (in those areas). Yes, he fears failure, and yes, he displays some insecurity when Ratchet questions his competence. But at every other point and in every other way, Pharma is unapologetically self-confident. He’s fully self-assured of his intellectual prowess and problem-solving capabilities; he knows what he knows, and he also knows what he doesn’t know.

Pharma’s arrogance and desire for control don’t stem from a hidden lack of confidence or a hunger for power on its own. They stem from the fact that he genuinely sees himself as the best person for the work he does. He trusts himself above anyone else to solve problems that come his way—medical or otherwise (within limits).

Elitism vs. Superiority

I’ve always read Pharma as having an elitist attitude, but not in the social stratification sense:

elitist (adj.) relating to or supporting the view that a society or system should be led by an elite.

There’s no evidence that Pharma believes an elite class of people should hold the most power. Instead, Pharma’s “elitism” is actually an individualistic sense of superiority. It’s centered on him alone, and is tied to his capabilities as a physician scientist and surgeon.

Pharma sees himself as the best of the best and makes sure everyone knows it—sometimes through his words, but mostly by his conduct in the field of medicine. This, paired with Pharma’s natural temperament, doesn’t exactly make him socially popular—inside or outside of medicine:

One could argue that the “personality” Lockdown is referring to was a result of all Pharma had suffered at Delphi and Luna 1, but just as easily, one could argue he was always a bit difficult to get along with, and that his traumatic experiences merely magnified his already-present psychological patterns. Personally, I like the latter interpretation because it’s a flaw that makes Pharma a more interesting character no matter his mental state.

Everyone reacts differently to real and perceived social rejection. Some are so concerned about it that they’ll try anything to belong; others genuinely don’t care, and they continue as usual; and still others cope by shifting their mindset and developing a sense of pride in being an outsider.

There’s no evidence for this in canon, but I believe it’s within reasonable characterization boundaries to headcanon Pharma as being in the second or third category.

With either of those two mindsets, a sense of superiority can develop, or even be an inciting factor. Either someone sees themselves as genuinely superior to the majority and doesn’t mind when this alienates them from people, or they convince themselves they’re superior because the pain of accepting they were rejected for who they are is too much to handle.

Whatever the case, the point is, having an “elitist” attitude isn’t necessarily rooted in a sociological or ideological belief. Sometimes, individuals just see something in themselves that—to them—justifies a sense of personal superiority. A quick glance at Pharma’s canon appearances makes it clear he holds such a view of himself, at least to some degree.

Morality and Compassion

When Pharma first shows up in canon, he’s working at the New Institute. A lot of questionable things took place there on a regular basis—things Pharma would have been aware of, to some degree. However, his presence at the Institute doesn’t automatically mean he agreed with everything happening. Depending on how strongly someone feels about something, some people are content to disagree in silence. Not everyone who seeks employment considers it a priority that the establishment they work for aligns perfectly with their moral values. After all, there are other reasons to take a job: financial benefits, exclusive educational and career opportunities, pure convenience, etc.

I’m not here to say either way whether Pharma’s willingness to turn a blind eye to the events at the New Institute was wrong or right; that’s up to each reader to decide for themselves. However, Pharma’s choice to remain employed at the Institute for some time can say something about him as a character: his priority as a doctor and person is not to take care of everyone he encounters, or to act as some kind of moral or ethical authority.

This isn’t to say Pharma won’t ever stand up for something he regards as right or push back against something he sees as wrong, “off screen.” It’s just that everything in canon points more to a tendency to choose his battles instead of acting immediately on any moral sense the way someone like Optimus or Ratchet might.

This also isn’t to say Pharma doesn’t care about saving lives, but from what little is shown of him before Delphi, it’s hard to say how much he cared. Ratchet confirms later that Pharma was an excellent doctor for most of his life, but all that tells us is he was an excellent doctor; it says nothing about his internal attitude toward his work or patients.

However, inferences can be made based on doctors in our own world:

Being a doctor—especially one in trauma care—is far from easy. It takes a lot out of a person, and there are very few people who last in the profession for a long time. Most medical professionals fall into one of the following categories:

People possessing a strong will that’s coupled with an unwavering passion for taking care of others (the public’s favorite)

People who naturally have, or develop, an ability to switch their empathy off and on at will, or build walls around it—also possessing a strong will (the ideal)

People who naturally have a limited capacity for empathy (the one the public hates to acknowledge)

People with a strong social and professional support system (the necessary, but underutilized and underappreciated factor)

Of course, even if a person has one or more of the above, burnout can and does still happen, but individuals who have at least one have the best chances of surviving and thriving amidst the demands of the majority of medical professions.

As far as is shown in canon, Pharma never had a strong support system—either circumstantially or by choice—so something else was keeping him in medicine.

Pharma shows concern for both Tumbler (Chromedome) and Hubcap:

But even though he obviously cared enough to step in, neither instance makes a strong case for a capacity for empathy beyond the “average” or “norm.” Performing a job well is a lot different from being personally invested in the work.

Based on everything up to this point, and this later comment from Pharma, about Ratchet…

…Pharma has probably never shared the same I-care-about-everything-and-everyone view of the world. Instead, it’s more likely that Pharma holds a more rational view of his work and patients.

One of the first things learned in medicine, especially in trauma medicine, is that you can’t help or save everyone, and to hold yourself to that standard can destroy you quickly if you have a certain temperament or lack healthy boundaries for your empathy.

“There are times when it may seem as though I view sick or injured people not as living, breathing humans with feelings and emotions and people who love them, but simply as cases, as problems to be solved. And that is absolutely true. It's not that I don't have empathy, but the hard fact is that as a doctor, and especially as a trauma surgeon, too much empathy can get in the way of your job and cause you to make decisions based not on sound medical judgment but on your own emotions. Sure, I've seen things that even years later can still make me choke up when I think of them: a little girl shot and killed, a shattered young Marine who shouldn't have died but did. But you can't choke up in the ER or the operating room. To be effective as a trauma surgeon, you have to put a layer of Kevlar around your heart.” —Dr. Peter Rhee, Trauma Red: The Making of a Surgeon in War and in America’s Cities*

Pharma may have learned this difficult truth earlier than Ratchet and developed a practical way of managing his empathy that comes across as “cold.” He may have always had an ability to put up walls around his spark. Or, he may have always had little to no capacity for empathy.

The fact that the morality lock on Tyrest’s portal prevented Pharma from passing through proves he felt guilty for what he’d done, and JRO confirmed this. Therefore, it’s safe to assume Pharma had some level of empathy for his former patients, suffering moral injury when he felt he had no other option but to start killing them.

Still, looking at Pharma’s psychological drives and his behavior throughout canon, it’s clear compassionate care and morality are subordinate to his other values and interests.

*I highly recommend this book, and learning about Dr. Rhee in general. He’s a huge inspiration of mine, and one of my main sources of inspiration when writing Pharma. Level-headed and capable, strong-willed, selectively empathetic, an excellent scientist, etc. He lives for the thrill of practicing medicine both on the floor and as an expert in his field who pushes trauma medicine to new heights through his research. He also takes great pride in his hands. Seriously—the man spent an entire paragraph and a half talking about his “good hands” and how they were one of two reasons he decided to go into trauma surgery. The other reason was that he “liked action and excitement, liked the feeling of being able to walk into a tough situation and take control.” (Sounds familiar…)

Delphi

First thing’s first: we don’t know how much Pharma did or didn’t know about the DJD before agreeing to take the Delphi assignment.

That far into the war, he would have known something about the DJD and their ways of terrorizing traitors and Autobots, but for whatever reason, he took the assignment anyway. Perhaps Prowl assured him the situation on Messatine would be monitored and that the security team would be enough. Perhaps he underestimated the DJD’s capabilities, or scale of territory, and thought he would be able to handle things on his own. Perhaps Prowl gave him no choice. Maybe it was all of these and more.

Whatever the case, according to JRO, Pharma didn’t hate Delphi before the incident with the DJD.

Word of god remains a touchy subject in fandom, but in this case, it’s important because it says two things:

The DJD left the Delphi medical team alone for some time.

Being on the edges of DJD territory didn’t automatically mean isolation and harassment by their hand.

On the second point, First Aid was free to come and go from Messatine as he pleased, seeing as he attended a medical conference at Kimia five years into his assignment at Delphi:

Five years ago [mid-Delphi assignment], the leader of the Wreckers had cornered him at a medical conference at Kimia, the space station that doubled as a weapons research facility. —from Bullets

And five years after that, he was able to not only contact Springer without delay about one of Agent 113’s bullets he’d discovered in an Autobot badge…

He raced upstairs to his computer terminal and typed in a certain frequency code for the second time in his life. A face appeared on the screen and grinned. “It’s me,” said First Aid. “And you're never gonna guess what I’ve got for you..!”

…but he was also able to meet up with Springer to hand off the bullet:

“Your friend has a funny way of making contact,” First Aid had said when he’d got in touch three days earlier, and he was right.

It’s not known if this handoff happened on or off world, but either way, the DJD didn’t interfere.

At some point, Tarn set his sights on Pharma and the Delphi team. Knowing the DJD, one can only imagine what Tarn used to show off his team’s capabilities and convince Pharma the best option was to cooperate.

In striking a deal with Tarn to keep the DJD away from Delphi, Pharma established his territory and ensured his continued security and the safety of his staff. As long as Tarn got his T-cogs, Pharma could continue on in relative peace. He could work his magic on bots that ended up at Delphi, carry out his management duties, and work on whatever projects or research he may have been conducting in his free time.

For whatever reason, after he first came into contact with Tarn, Pharma didn’t call for help. Communications were still operational, as Pharma wouldn’t have suggested contacting High Command about the Duobots if the team was aware of any comm malfunctions:

Also, First Aid later confirms that communications were fine until the Big Bang (soundbomb detonation):

It’s always possible the DJD was monitoring the radio waves, but secure subspace frequencies exist, such as the Datalog Network First Aid used to send the datalog containing the death statistics:

Speaking of which, assuming First Aid sent the datalog with the statistics right when things started to get ‘weird,’ and before the Big Bang shut down comms, it only took—at most—a few days for them to reach Ratchet and Swerve on the Lost Light:

But back to Pharma not calling for help: for all of Prowl’s intel, contingency planning, and fretting over the security of Autobot territories, I find it hard to believe he would have stuck an Autobot medical team on the fringes of DJD territory without giving them some means of securely contacting the outside in case of issues.

But even if Prowl didn’t give Pharma a secure way to contact him or anyone else, and even if Pharma was convinced the DJD was monitoring regular communications, there were other ways he could have reached out for help. After all, the team wasn’t alone on Messatine. Like Pharma said, Prowl continued to send bots to defend the nucleon mines:

The Autobots had been mining nucleon for millions of years at this point, so I doubt the mined nucleon was just sitting in storage on Messatine; shipments of the stuff would have been sent off-world to wherever the Autobots needed it. Why not send a message for Prowl with someone leaving with one of those shipments? A message meant only to be sent over a call when absolutely certain they were out of range of the DJD’s potential monitoring.

Or, why not order in off-world medical supplies and send a message back with the delivery bot(s)?

There are two possible answers to this. One takes into account JRO’s word on the subject; the other is more intricate and speculative on my part, but it leads to the same place. So whatever your stance is on the validity of word of god, there’s an answer for you.

Answer one (word of god)

Simple as that. Pharma was aware of the scope of the DJD’s capabilities and relentlessness, and determined he was trapped prey.

Answer two (no word of god)

There are a few possible reasons Pharma didn’t call for help right away:

He was convinced all his other options would take too long and/or would still lead to him being put under suspicion. After all, being found to have harvested even a single T-cog from an already-dead patient for the DJD could have raised concerns that would lead to Pharma being investigated and/or having a mark put on his record.

He underestimated the severity of Tarn’s addiction, and was certain he could keep up with the T-cog demand without resorting to other means of harvesting, not realizing Tarn’s quota would increase later on.

He was already paranoid as a result of whatever mind games Tarn had set in motion at their first meeting, making Pharma think escape was futile.

Word of god or no word of god, there are clear reasons as to why Pharma ended up trapped. Most likely, it was a mix of all of the above.

Whatever was going on in Pharma’s mind before, he ended up in deeper trouble. Tarn increased his demand for T-cogs, and Pharma couldn’t keep up. By the time this happened, even if he had wanted to call for help, it was too late to do so without implicating himself. He reasoned his only option was to start killing patients to harvest their T-cogs.

Soon, Pharma was so consumed with fretting over whether he’d be able to meet Tarn’s next demand that he didn’t have time or freedom to do anything else except worry and feel guilty. His whole life revolved around Tarn’s addiction; he was no longer in control, and could no longer enjoy whatever it was about Delphi he’d previously enjoyed. Perhaps the facility itself enabled Pharma to research cures and perform scientific miracles of medicine.

Being at the mercy of Tarn—convinced the DJD would find him no matter what—would have been pure psychological torture on its own, but also knowing that any small chance he did have of getting help would end in him losing everything would have added to his suffering. Pharma became desperate to reclaim control over his life and began planning an escape.

Now, JRO has said that Pharma didn’t originally plan to use the rust plague on the DJD…but canon says otherwise:

Of course, Pharma could have been lying to make himself look better in Ratchet’s view, but based on everything he’d been through up to this point with Tarn, it’s more likely he was telling the truth and had tried to eliminate the source of his suffering first. After all, wiping out the DJD would have been the simpler, cleaner option.

When the Duobots refused to detonate the soundbomb near the DJD, Pharma’s objectives shifted. He had to get Delphi shut down in a way that would:

Convince the DJD the shutdown was legitimate.

Pharma knew chances of escaping the DJD at all were slim to none, but he was desperate. Getting Delphi shut down would cut off Tarn’s supply of T-cogs and allow Pharma to escape Tarn’s immediate control, but the shutdown had to be “legitimate” to prevent Tarn from retaliating and hunting him down later. Leaving Tarn even the slightest chance of regaining control was too risky, so Pharma had to make sure his plan was as airtight as possible. 

Cover up the patient murders.

If the truth got out about Pharma killing patients, he’d lose his medical license and most likely be put away for life. Being cut off from the practice of medicine and his intellectually stimulating work as a doctor would mean losing more than a job and a reputation. It would mean losing everything in which he’d anchored his sense of identity and life’s meaning. His refusal to consider any other options wasn’t just about ego and preserving his image as an excellent doctor; it was about preserving any kind of meaningful future he saw for himself.

Pharma needed a plan that would fulfill all of the above. Turning the engineered virus on the medical facility was the most effective and efficient solution. Anything else would have made him suspicious in the view of either Autobot High Command or the DJD, and neither of those would have ended well for him.

Because of his goal to preserve his reputation and future in medicine, he couldn’t even risk revealing anything to First Aid or Ambulon, who would have seen to his ruin. They became nothing more than loose ends that had to be tied up, and based on the fact that Pharma only prepared one vial of the vaccine, his original plan involved him being the only survivor:

He probably would have had no problem making more of the vaccine for anyone else who survived, but he wasn’t counting on it. He wanted a totally clean slate; in letting his staff die with most of his patients, he would be getting rid of any and all evidence and reminders of his failures. He may have cared about First Aid and Ambulon before things got bad, but somewhere along the way, he decided either it wasn’t worth it to go through the trouble of finding a way to save them without raising suspicion, or he didn’t want to risk them putting together the pieces later on.

Of course, when Ratchet showed up, plans changed.

Ratchet

Ratchet is not the kind of person who seeks first to understand or be understanding. He’s inclined to trust what’s in front of him over anything abstract, and tends to look at the results of someone’s actions over trying to find any kind of ‘why’ behind them. Also, unlike Pharma, he operates from a strong moral sense, and reacts quickly and strongly when something or someone goes against that internal moral sense.

Ratchet’s reaction to finding out what Pharma did may seem hasty and harsh, but it makes perfect sense on a human level. There is no such thing as unconditional love; everyone has personal and moral lines (boundaries), and they’re different for each individual. When the most rigid of lines is crossed, that’s it; walls go up and the offender is cut off, no matter how strong the relationship may have been.

Ratchet obviously knew Pharma well enough to think he could try talking some sense into him, but then Pharma revealed that he’d crossed one of Ratchet’s lines: murdering patients. Any willingness Ratchet may have had to try to understand vanished. By the time Pharma started trying to provide a ‘why’ for his actions, Ratchet’s moral judgment had already shut down any chance of understanding what could have possibly led Pharma to kill patients. It didn’t help that Pharma seemed totally unapologetic and outright proud of his plan. For Ratchet, the ‘why’ didn’t matter anymore. What he saw was what he trusted, and what he saw was a friend who’d become his idea of a monster.

Now, Ratchet and Pharma’s relationship is one of the most confusing IDW relationships I’ve had the pleasure and pain of dissecting.

It is notoriously difficult to determine the depth and strength of a relationship from the outside. However, I’ve decided to go ahead and address it anyway because it has the potential to provide insight into Pharma as an individual.

If I were to sum up Pharma and Ratchet’s relationship in a single word, I would use “ambivalent.” The first time I read MTMTE, the thing that stood out to me most about their relationship was the drastic differences between how they each perceived the relationship.

In one sense, there’s the idea of Pharma basically being Ratchet’s crazy stalker ex, which is tossed around in fandom a lot. While I personally dislike seeing it regardless of context (yes, even as a joke), I do see how JRO’s writing choices set things up in a way that makes it easy to superimpose that trope.

In another sense, there’s the idea that Pharma and Ratchet were always close friends, and that what happened at the end of the Delphi story was a betrayal of both sides that came out of nowhere and whose consequences were taken too far.

I disagree with both. Personally, what I see at the end of the Delphi story isn’t an obsessed ex gone mad, a sudden betrayal, or a badly executed backstabbing. What I see is a breakdown of an already-complicated and poorly-maintained relationship: true feelings being revealed, long-repressed bitterness being forced to the surface, carefully-hidden cracks being split wide open.

Most people don’t have an accurate understanding of how much or how little they truly know the people in their lives, often overestimating how well they know a person until something surfaces and blindsides them.

According to JRO, Ratchet was oblivious to Pharma’s romantic interest, and throughout canon, it’s easy to see Pharma was more invested in the relationship than Ratchet ever was.

The question is, did Ratchet ever care about Pharma at all? And if so, to what degree?

Yes, Ratchet calls Pharma “buddy” and “friend,” but the former was sarcastic, and the latter means something different to each person. Also, in light of the circumstances, Ratchet could have just been saying “friend” in response to Pharma saying it—an emotional appeal more than anything.

However, Pharma must have been aware of Ratchet’s lack of relational investment because during the confrontation at Delphi, Pharma’s first reaction wasn’t to appeal to their friendship (ex: “But you know me!”). Instead, he appealed to their shared profession:

Then there’s the exchange of insults: 

This is what I meant earlier by “true feelings being revealed.” Ratchet may have just been trying to match Pharma’s insult, but it’s unlikely it was merely reciprocal because while Ratchet is snarky at times, he’s sincere in that snark. There’s almost always some truth in his verbal jabs no matter how unserious they seem, and he’s never cruel for cruelty’s sake.

So, if Pharma saw Ratchet as an inferior doctor, and Ratchet saw Pharma as an inferior Autobot…it’s reasonable to assume there was always some deep-rooted competition and conflict preventing them from being super close.

Possible suspicion surrounding Pharma’s conduct as an Autobot paired with a tendency to misjudge the nuances of relationships could explain why Ratchet was so quick to decide Pharma was a lost cause. Maybe Pharma’s actions at Delphi confirmed something from the past that Ratchet had brushed off for whatever reason.

In any case, Ratchet seems to have been largely unaffected by the Pharma he found at Delphi. While leaving Messatine, he emphasizes that he’ll miss Pharma’s talent.

Not “who he used to be.”

Not “what we used to have.”

Just…“his talent.”

Later, on Luna 1, Pharma mentions that he and Ratchet were inseparable, but that could mean a few different things:

Best case scenario: Pharma and Ratchet sought each other out on equal terms.

Worst case scenario: Pharma followed Ratchet around.

Somewhere in the middle: the job forced Pharma and Ratchet to work in close proximity most of the time, and while Pharma intentionally ran into Ratchet more often than necessary, Ratchet also sought out Pharma every now and then.

Whatever the case, working with someone every day doesn’t tell you anything about who they are as a person, and the amount of time spent with someone doesn’t automatically correlate to how deep the relationship is or how well the people know each other. It’s not like either Pharma or Ratchet are shown to be good at expressing their personal feelings outside of extreme circumstances. 

Ratchet does bring up late-night conversations of the past:

But while this indicates there was something deeper between him and Pharma, because neither of them were ever shown to be super open with their true feelings, it’s unlikely the conversations were full of touchy-feely talk. In all likelihood, the conversations were mostly medicine and war-related, with the rare spark-to-spark talk sprinkled in. Also, considering everything up to this point, one has to wonder if those talks ever meant anything to Ratchet, or if he was just digging for something that might stall Pharma’s torture.

Maybe those late-night conversations did mean something to Ratchet, but whatever the case, Pharma didn’t take the bait. He knew Ratchet was trying to stall by making an emotional appeal, and perhaps he was convinced the conversations hadn’t meant that much to Ratchet.

Looking at all of this, it��s hard to believe Ratchet ever cared about Pharma as more than an interesting work friend. But even if he had cared more than he let on, it wasn’t enough to overcome the doubts he had about Pharma’s character.

As for whether Pharma truly cared about Ratchet, I’m convinced he did, but in a mostly unhealthy way, and with a strong undercurrent of one-sided rivalry. At some point, Ratchet had been an equal and a source of challenge, and he probably listened to Pharma pretty often. It’s reasonable to assume Ratchet was one of the only people—if not the only person—able to handle Pharma’s intense temperament and challenge him in a meaningful way, providing some semblance of friendship for Pharma.

However, one last thing that stands out is that, when telling Ratchet why he’s torturing him, Pharma didn’t say anything like, “Because you hurt me” or “Because you turned against me—your friend.” Instead, he said it was for “ruining things at Delphi” and because “you declared war on my body.”

Either Pharma wasn’t being entirely honest, or Ratchet’s friendship didn’t mean as much in the first place as he’d previously implied. It’s possible the ‘Because you hurt me’ was implied in “for ruining things back at Delphi,” but why not say it outright? Perhaps it was a fear of vulnerability and admitting there was ever a relational need at all.

At the end of the day, it’s difficult to say for certain how close Pharma and Ratchet were, but it’s clear they were never on the same page and there were always barriers between them.

Luna 1

Revisiting the matter of Pharma’s morality taking a backseat to other priorities, his time on Luna 1 further underscores this. Again, Pharma chooses his battles and is unwilling to put himself at great risk for the sake of others, but a closer look at the situation with Tyrest reveals there wasn’t really anything he could have done for the Cold Construct population even if he had wanted to. It would have been him against Tyrest, an army of Legislators, and a bunch of Decepticons. Pharma knew his limits, and seeing as his goal was self-preservation, it was perfectly rational for him to go along with Tyrest’s grand scheme.

Besides, it doesn’t look like he was given much of a choice:

Although, knowing Pharma, he still would have demanded to know beforehand what he would get in return for the pain, and evidently, Tyrest held up his end of the deal since Pharma had access to the Luna 1 tech collection.

As for Tyrest’s plan to wipe out the Cold Construct population, there’s nothing indicating Pharma’s decision to turn a blind eye to it was rooted in malevolence or bigotry—just rational apathy: ‘I can’t stop Tyrest, so why concern myself with the outcome?’

Again, you can’t save everyone; Pharma had all he could do to save himself.

But it wasn’t all horrible. I would even go so far as to say Pharma found some happiness on Luna 1. Tyrest didn’t care about him, but he didn’t need Tyrest to care. Everyone else there hated him, but he didn’t need to feel like he belonged or was admired. At this point, Pharma’s only interest was Tyrest’s Luna 1 tech collection, and that meant playing nice so he could keep his reward. Back at Delphi, he probably assumed he’d never again practice medicine the way he’d loved; being brought to Luna 1 was an unexpected, yet welcome, second chance.

Even so, Pharma had his moments of cruelty. Back at Delphi, he had easily-identifiable reasons to kill patients—both the ones whose T-cogs he harvested and the 20 more he tried to kill when he shot the life support machine. But on Luna 1, he had no reason to be cruel, yet he chose to be. By this point, he’d mastered the ability to almost completely ignore or subdue his conscience.

In the case of Ratchet’s torment, one could argue Pharma only drew it out for retaliation purposes; it was personal for him.

As for cutting Ambulon in half, it was obviously meant to be as gruesome as possible, yet also quick. But personally, I don’t think it was about Ambulon; it was more about hurting Ratchet. Due to the fact that Ratchet’s identity is wrapped up in his compassion and his ability to be helpful as a doctor, one of the most effective acts of revenge would be to do something that makes him feel utterly helpless.

Also I wonder if, subconsciously or consciously, Pharma was attempting to recreate the sense of helplessness he felt back at Delphi under Tarn’s watch: “Do you see, Ratchet? Do you now understand how it feels to have control ripped out of your hands? To be totally helpless?”

Next, for some reason, Pharma was invested in the promised execution of Getaway and Skids:

He had no personal connection to either of them that would give him a reason to be interested, so maybe Tyrest told him he could perform the execution and/or have the corpses for medical experimentation. Either way, Pharma would have had a chance to use some of the tech in Tyrest’s tech collection, possibly explaining his excitement.

Of course, any chance of an execution disappeared when the final showdown went wrong.

When Pharma tried to escape to Cyberutopia and discovered he couldn’t pass through the spacebridge forcefield, he gave up. He’d been caught; he would no longer have access to Tyrest’s tech collection; Ratchet and every other self-righteous Autobot would never forgive him; and the morality lock prevented him from escaping. By all appearances, he would never again be able to engage in that which gave him a sense of meaning. He had shrunken his world down to his obsessive interest in a specialized field and one significant, yet unrequited relationship. With both of these lost, his world collapsed. 

Yes, guilt played a part in Pharma’s despondency, but because he seems to have been in denial of said guilt, it’s more likely his despair was primarily due to the fact that he saw no future for himself. He had nothing left to live for.

In light of this, Pharma’s flippant comments to First Aid make sense. He wasn’t being insensitive as much as he was goading First Aid. Pharma’s not stupid. First Aid had a massive rotary cannon on him, and Pharma knew exactly which emotional buttons to push to get him to pull the trigger.

Pharma wanted to die.

Adaptus

First, let me emphasize that Adaptus did not take possession of Pharma’s body. Instead, Pharma was the unwelcome guest:

How Pharma ended up in Adaptus’ new body is a mystery, but whatever the case, Pharma didn’t pass on to the Allspark. Whether or not he had a choice can only be speculated.

First Aid had blasted Pharma’s head clean off, so whatever happened must have been related to the spark. Perhaps some residual spark energy was trapped in a body part that Adaptus repurposed, leaving Pharma tethered to the new body unwillingly.

Still, Pharma managed to assert his will and override Adaptus for a brief moment. Considering Adaptus was basically a god, this is impressive.

Based on Adaptus’ surprise at being interrupted, it seems he didn’t know Pharma was there. Why Pharma hadn’t tried to assert himself sooner is a mystery. Maybe Adaptus’ scheme was entertaining; maybe Pharma actually liked the company; or maybe he’d been waiting for an opportunity to get revenge on Tyrest for everything done to him back at Luna 1.

Sure enough, just like with Ratchet back on Luna 1, Pharma’s vengeful streak came out as soon as there was an opportunity.

Unfortunately for him, this left him vulnerable, and Tyrest took advantage of the confusion:

Conclusion

When someone reduces their world to narrow personal interests and one or a few very special people, their grip tightens around what little they have. They often become obsessive and possessive of the few things that make them feel alive, and their view of the world becomes increasingly more subjective and detached from the outside world. Pharma seems to have fallen into this trap.

Even so, in the context of the circumstances, several of the decisions he made were rational—even if coldly so. Oftentimes, “extreme” rationality and self-preservation are villainized in fiction, and characters like Pharma who don’t automatically put themselves at great risk for anyone and everyone are villainized, or at least looked down on. Their choices are often regarded as less human, but rationality and self-preservation are just as human as compassion and self-sacrifice.

Ultimately, Pharma was trapped and pushed over the edge into “insanity” by Tarn’s cruelty, but his own choices made from a place of pride determined how he fell, and how far he fell. It was a perfect storm of Tarn’s mind games and Pharma’s intellectual arrogance, excessive self-confidence, obsessive nature, and stubborn grip on the kind of future he wanted for himself.

Pharma is yet another Icarus who flew too close to the sun and paid dearly for it, and while JRO/the narrative could have given this Icarus better wings, that doesn’t change the fact that he chose to fly so high.

***

Many thanks to anyone who made it to the end of this monster of a post.

-tosses a Rodimus Star at you-

[crowsintheforest]

you can look at the vorkosigan saga books and assume (correctly!) that it's a lot of space opera/space war stories, with daring rescues and laser gun pew pew and clones wandering around. but they're also full of other things, like

probably most famously, jane austen via space russia (a civil campaign my beloved)

look I swear we're going to finish our honeymoon but my boss's ships got impounded and whoops I seem to have found a murder mystery

oh no we lost a dead body before we could do future medicine to bring it back oh no we lost the protagonist

fake wedding turns out to be a real wedding and your cousin won't stop laughing at you

great news shareholders, we've genetically engineered humans to live in null G by giving them arms instead of legs! what do you mean humanity invented artificial gravity

culture and medical exchange's influence on gendered politics, or how does nobility's patrilineal inheritance work when you can trans your gender

navigating polyamory when one of you is dead

basically a decades-long multibook treatise on the impacts of providing and utilizing alternatives to in vitro fertilization and live births

[sleeplesssmoll]

Reverse 1999 Connections to History: Wandering Womb & Hysteria

Isolde, Evangeline, and many other women were diagnosed with these "afflictions". This is a SFW run-down of Wandering Womb & Hysteria. I won't go into graphic details about anything, but its still one of the darker aspects of history. If this makes you uncomfortable, please skip over this post or stop reading!

For those who read on, we have a special historical figure with a last name you should all be familiar with! I'm excited to share my findings with you! All sources will be listed below. If I was a good Smol I'd include in text citations but I forgot to do it as I went. But who doesn't enjoy a scavenger hunt? Channel your Sonetto energy and read on!

Please feel free to add on or correct anything I got wrong. I left out A LOT for the sake of brevity and sensitivity but there is a lot to chew on in this topic.

Wandering Womb Concept:

Definition: Belief that a displaced uterus caused various medical issues in women.

Description: Aretaeus (2nd century AD) described the uterus as moving freely within the body, reacting to smells, akin to "an animal within an animal."

Scent therapy: Like an animated creature, the uterus was believed to be attracted to sweet and pleasant perfumes and repulsed by foul smells.

However, future generations would move away from blaming the womb and pin the blame on women's "weaker" minds and bodies. It's one of the "illnesses" used to demonize or claim superiority over women. The way this illness was weaponized is extremely sinister but I'll leave it to the reader to look further into that if they want to. A Victorian woman going through menopause was often considered to be emotionally unstable. During this 'climacteric period', she may well have been prescribed leeching or bloodletting from the ankle. Her doctor would have advised against reading novels, going to parties and dancing. For a 45 – 50 year old Victorian woman, an onslaught of instability and madness was considered inevitable. Interesting how the "curse" on the women in Isolde's family killed them before they passed the age of 40.

The bullshitters (There's more well-known men with opinions but I'll keep this short and relevant to Reverse 1999):

Aretaeus: Advocated the mobile uterus theory. The origin of bullshit.

Edward Jorden: Popularized the concept in the 17th century through his treatise "The Suffocation of the Mother" (1603), linking it to hysteria and witchcraft. The spreader of bullshit. The Suffocation of the Mother connected the phenomenon of hysteria with actions like singing, laughing, crying, and choking.

Hysteria:

The idea of hysteria linked to the wandering womb, evolved from ancient Greek "hysterical suffocation." It was described as exhibiting a wide array of symptoms, including anxiety, shortness of breath, fainting, nervousness, sexual desire, insomnia, fluid retention, heaviness in the abdomen, irritability, loss of appetite for food or sex, even sexually forward behavior, and a "tendency to cause trouble for others". It is no longer recognized by medical authorities as a medical disorder. Its diagnosis and treatment were routine for hundreds of years in Western Europe. Even though it was categorized as a disease, hysteria's symptoms were synonymous with normal functioning female sexuality. In the context of hysteria, every symptom and negative thought was linked to sex (also it was problem if you didn't want sex either). Essentially, you were "sick" because you were a woman. Woman disease. How dare females exist 😰

Hysteria was thought to affect only women until the early 1600s. Thomas Willis' concluded Hysteria originated in the brain, not the uterus, implying it could affect men. Despite Willis' findings, hysteria remained a common diagnosis for women, particularly in Victorian times.

Franz Anton Mesmer advanced the theory of hysteria, influencing John Elliotson and James Braid. Elliotson believed mesmerism was particularly effective for hysteria, noting it was not exclusive to women and also affected boys and men. Mesmerism is hypnotic induction held to involve animal magnetism, but we usually use the word "hypnotism". This man appeared in an old journal I was skimming and jump scared me!

Freud's Influence:

Freud shifted focus from physiological to psychological causes. He moved away from Charcot’s hereditary theories, emphasizing psychological rather than genetic or physiological triggers (mind rather than body). Repression is the basis for hysteria. Traumatic memories must be repressed to cause hysterical symptoms. Freud’s therapy aims to bring repressed memories to consciousness to alleviate symptoms. We can see Kakania using this method on Isolde.

Seduction Theory: Freud initially believed that actual childhood sexual abuse caused hysteria but later revised this to include fantasies. This shift was influenced by public resistance and scientific criticism.

Freud's Contributions to Hysteria Theory

Etiology based on nurture, not heredity.

Pubescent experiences as triggers, not causes.

Hysteria redefined as a psychological, not physiological (this one is a very big deal. He was quack, but this shift in perspective is why we've progressed so far in caring for people with PTSD, depression, and so on).

Emphasis on sexual infantile experiences and repression.

Gender distinctions in hysteria based on psychological attitudes towards abuse.

Modern Diagnoses and Connections: Symptoms previously labeled as hysteria are now diagnosed as:

Somatic Symptom Disorder: Characterized by physical symptoms that cannot be explained by medical conditions.

Dissociative Disorder: Involves a disconnection from reality, often linked to trauma.

Conversion Disorder: Involves neurological symptoms without a neurological basis, often linked to psychological factors.

However, there are many other potential diagnosis since hysteria is so broad and vague.

Sources

[whencyclopedia]

Galen

Galen (129-216 CE) was a Greek physician, author, and philosopher, working in Rome, who influenced both medical theory and practice until the middle of the 17th century CE. Owning a large, personal library, he wrote hundreds of medical treatises including anatomical, physiological, pharmaceutical, and therapeutic works. With principles based on his anatomical dissections, he spoke and wrote extensively on the anatomy of the body emphasizing the role of the heart, brain, and blood. While he criticized many of his contemporaries, he embraced the ideas put forth by the Greek physician and theorist Hippocrates (460-370 BCE), primarily his concept of the four humours that controlled the human condition: blood, phlegm, black bile, and yellow bile.

Much of our knowledge of early medicine comes from Galen's writings. Like Hippocrates and other theorists Galen believed that illness was caused by an imbalance, so how does one restore the balance: bleeding, enemas, and vomiting. Aside from his writings on medicine, he wrote extensively on language, logic, psychology, ethics, and even moral philosophy. Regrettably, most of his works no longer exist or survive only in fragments. He lost many of his writings, instruments, and medicines in a storeroom fire in 192 CE.

Early Life & Education

Born in 129 CE in the Asia Minor city of Pergamon, Galen was the son of the wealthy architect Nikon and was initially educated in both rhetoric and philosophy. The Pergamon of his youth was home to a sanctuary dedicated to the god of medicine Asclepius. His father, a member of the Roman elite, had assisted in the renovation of Pergamon's temple complex dedicated to Zeus. At the age of 16, Galen changed educational directions, possibly at the suggestion of his father, and decided to study medicine, eventually completing his schooling at both Smyrna, located on the Aegean coast, and Alexandria where he studied both anatomical science and physiological theory. At the time Alexandria was the premier center for the study of medicine in the ancient world. After the death of his father in 149/50 CE, he continued his studies as he traveled throughout the Mediterranean. In 157 CE he returned to his home town of Pergamon to be the physician to a group of gladiators; a position that provided him with an opportunity to study anatomy.

Continue reading...

[probablyasocialecologist]

According to Brisbane GP Dr Fiona Bisshop, immediate past president of the Australian Professional Association for Trans Health, the Cass Review largely ignored doctors who were providing gender-affirming care.   “There have been multiple expert academic treatises written on what was wrong with the Cass Review … they intentionally sidelined people who worked in the field,” she told The Medical Republic.   “Practitioners who worked with trans patients and trans people themselves were excluded from that whole review, and that didn’t happen [in Queensland].   “They talked to the right people who were using the service and they also included some people in the review panel who were experts.”  Dr Bisshop rejected criticism that framed the involvement of doctors who practised gender-affirming care as biased.   “If you were reviewing a neurosurgical service, you’d need to have some neurosurgeons on the review panel,” she said.   “You don’t put faith healers on it.   “You have to have people who understand how it works.”  Victorian GP Dr Michelle Dutton, who also works with young people experiencing gender dysphoria, independently echoed Dr Bisshop’s words.   “The Cass Review reflects the political climate of the UK as much as it does any kind of objective review of the evidence,” she told TMR.   “The British Medical Council is now doing a review of the Cass Review because of concerns about the way that evidence was selected and analysed.   “It really highlights the fact that the Cass Review was about care in the UK and the way their health system was structured, whereas our health system is set up very differently.”  

20 August 2024

[jacksprostate]

Treatise on why No, the doctor just giving the narrator of Fight Club (full name) his requested sleep medication or sending him to therapy would not have Fixed Him

Firstly, saying giving him the insomnia meds would’ve fixed him ignores the reason he has insomnia in the first place. He is so deeply upset by his place in society that he literally cannot sleep. Drugging him to sleep would not change that. That, of course, is the easy, quick response.

But with regard to therapy? The biggest flaw is that it ignores a central tenet of the book. Part of what tortures the narrator and drives him to invent Tyler is that his feelings about this collective, systemic issue are constantly reduced to a Just Him thing. His seatmates ask what his company is. He’s the only one upset at the office. He gets weird looks if he says the truth of what he does. People will do anything in their power to pretend he is the issue, as an individual, because it is far scarier to consider the full implications of the systemic issues implied by what he is saying. Everyone treats it as if the issue is him, so he goes insane. He does anything to get someone to say, holy shit, that’s fucked up, what you’re a part of is wrong. In an attempt to feel any sort of vague sympathy and catharsis, he goes to support groups to pretend to be dying, because then at least people don’t habitually blame him for his anguish. 

Saying therapy would fix him ignores that his problems are not individual. They are collective. It’s the reason the entire story resonates with people! Something deeply, unignorably wrong with society, where people would rather blame you for bringing it up than try and address it, because it feels impossible. I don’t blame people for this, really, because it IS scary. It’s terrifying to sit and feel like you’ve realized there’s something deeply, deeply wrong, but if you say something, people will get mad at you since it’s so baked into everything around you. Or, even if they agree, it’s easier to deal with the dissonance by pretending it’s individual.

And it’s not like that’s not the purpose therapy and medications largely serve, anyway. Getting into dangerous territory for this website, but ultimately, the reason the narrator was seeking medication was because it’s a bandaid. A very numbing bandaid. For these very large, dissonance causing problems, therapy does very little. Medications do what they always have, and distract you with numbness or side effects. It’s a false solution. He is seeking an individualized false solution because he has been browbeaten with the idea that this is an issue with him alone, when it's plainly clear it's not. 

Don't get me wrong. Obviously he has something wrong with him. But it's a product of his situation. It is a fictional exaggeration of a very real occurrence of mental illness provoked by deep unconscionable dissonance and anguish.  There is a clear correlation between what happens and his mental state and his job and how isolated he is. 

The thing is, even if he were chemically numbed, I do think he would’ve lost it regardless. Many people on meds find they don’t fix things. For reasons I’ll get into, but in this case because even if numbed or distracted, once you’ve learned about deep, far reaching corruption in society, it’s very hard to forget. Especially if, in his case, you literally serve as the acting hand of this particular variety. He’s crawling up the walls. 

So why do people say this?  Well, it's funny I guess. Maybe the first time or whatever. But also, often, they believe it, to a degree. Maybe they've just been told how effective therapy and meds are for mental illness, they believe wholeheartedly in The Disease Model of Mental Illness, maybe they themselves have engaged with either and have considered it successful. Maybe they or someone they know has been 'saved' by such treatments. 

But in all honesty.... What therapy can help with is mentality, it's how you approach problems. For issues on a smaller scale, not meaning they are easier to deal with my any degree, but ones that are not raw and direct from deep awareness of corruption; these are things that can be worked through if you get lucky and get an actually good therapist who helps build up your resiliency. But when your issue is concrete, something large and inescapable? It's useless. At best it can help you develop coping mechanisms, but there is a limit for that. There is a point where that fails. To develop the ability to handle something like this requires intense development of a comfort with ambiguity and dissonance and being isolated and a firm positioning of your purpose and values and and belief in wonder and all the other shit I ramble about. The things that the narrator lacks, which lead him to taking an ineffectual death knell anarchist self-destruction path. Therapy, where the narrator is, full of the knowledge of braces melted to seats and all the people that have to allow this to happen? It fails. 

And meds — meds are a fucking scam. We know the working mechanism of basically none of them, the serotonin receptor model was made up and paid its way into prominence. We have very little evidence they're any better than placebo, and they come with genuinely horrific side effects. Maybe you got lucky. I did, on some meds. On others? I don't remember 2018. The pharmaceutical industry is also known for rampant medical ghostwriting, and for creating 'off-label' uses for drugs that have gained too many protests in their original use, then creating a cult of use to then have 'grassroots' campaigns for it to be made a label use (ie, legitimize their ghostwritten articles with guided anecdotes). 

The DSM itself is basically a marketing segregation plot. It's an attempt to legitimize the disease model by isolating subgroups of symptoms to propose individualized treatments for subgroups that are not necessarily all that separate. But if the groups exist, you can prescribe more and different medications, no? Not to mention, if you use the disease model, you can propose that these diseases are permanent, or permanent until treated, considered more and more severe to offset and justify the horrific side effects of the medications. Do you know why male birth control doesn't really exist? Same reason. They can justify all the horrible side effects for women, because the other option is pregnancy. For men, it's nothing. 

And they're not bothering to invent new drugs without side effects. When they invent new drugs it's just because the last one got too bad of a name, or they can enter a new market. Modern drugs don't work any better than gen1 drugs. They still have horrific side effects. At best, the industry will shit out studies saying the old one was flawed (truth) so they can say this new gen will be better (lie). They're doing it with ssris right now. 

Fundamentally, the single proposed benefit of any of these drugs is that they numb you. To whatever is torturing you. It's harder to be depressed if you can't feel it, or if you just can't muster the same outrage. Of course, there is people who find that numbness to be helpful, or worth it. But often, it's stasis. For the people who have problems that can be worked on, it serves as a stopgap to not actually work on said problems. The natural outcome of the disease model is stagnation for those whose need is to develop skills and resiliency. It keeps them medicalized and dependent on the idea that they're diseased and incapable. Profitable. Stuck in the womb. 

I’ve been there. It’s easier, to wallow, and resist growth because it’s difficult and painful and unfair and cruel and you can think of five billion reasons to justify your languishing. But don’t listen to anyone who tells you you’re just permanently damaged, no matter how nicely they word it, no identity or novel pathologization, no matter how many benefits they promise, especially if they swear up and down some lovely expensive medications with little solid backing and plentiful off-label usage and side effects that’ll kill you. Some days it feels like they want us all stuck in pods, agoraphobic and addicted to the ads they feed us to isolate the markets for the drugs they’ve trained us to beg them to pump us with. Polarization making it as easy as flashing blue light for go, red like for stop, or vice versa. I worry about the kids, for fucks sake. That’s a bit dark and intense, and I apologize. But I want you (generic) to understand, there is a profit motive. Behind everything. And they do not mean well. They do not care about your mental health or your rights or your personhood or your growth. They care about how they can profit off of you.

For those struggling with immovable, society problems, like the narrator grappling with how his job fits into and is accepted by society while his rejection and horror in the face of it does not, it can work about as well as any other drug addiction. Your mileage may vary. From what I've seen, recovering from being on prozac for a long time can be worse than alcohol. They put kids on this shit. They keep campaigning for more. Off label, again. A pharmaceutical company’s favorite thing to do has to be to spread rumors of someone who knows someone who said an off label use of this drug helps with this little understood condition. Or, in the case of mental illness, questionably defined condition. And like, damn, I know I'm posting on the 'medicalization is my identity' website so no one will like all this and has probably stopped reading by now, but yall should be exposed to at least one person who doubts this stuff. Doesn't just trust it. Because I mean, that's the thing right?

It's so big. What would it mean, for this all to be true? Yeah, everyone says pharmaceutical companies are evil and predatory and ghostwriting, but to think about what that really entails. Coming back to the book, everyone knows the car lobby is huge and puts dangerous vehicles through that kill people. What does it mean if the car companies all hire people to calculate the cost of a recall and the cost of lawsuits? No one wants to think about the scale that means for people allowing it or the systems that have to be geared towards money, not safety like they say. Hell, even Chuck misses the beat and has the narrator threaten his boss with the Department of Transportation. And shit, man, if every company is doing this, you think Transportation doesn't know? That they give a fuck? You're better off mailing all the evidence to the news outlets and hoping they only character assassinate you a little bit as they release the news in a way that says it's all the fault of little workers like you, not the whole system. Something something, David McBride, any whistleblower you feel like, etc. 

So I don't blame you, if your reaction is "but but but, that can't be right, people wouldn't do it, they wouldn't allow it" or just an overwhelming feeling of dread that pushes you to deny all of this and avoid thinking about it. Just know, that's in the book. That's all the seatmates on the flights. That's all his fellow officemates. It's easier to pretend, I know.

But think about, how the response fits in with the themes of the book. The story, as a movie too. What drives the narrator’s mental breakdown? How would you handle being in his position? How would you handle being his seatmate? It’s easy to say you’d listen. But have you? Have you had any soul wrenching betrayals of how you thought society worked? How about a betrayal by the thing that promised to be the fix of the first? Can you honestly say you wouldn’t follow that gut instinct, saying follow what everyone says, that person must just be crazy, evil, rude, cruel, whatever it is that means you can set what they said aside?

For a lot of people, they can do that, I guess. Set it aside. Reaching that aforementioned state of managing to cope with the dissonance and ambiguity and despair is very hard. The narrator made the Big Realization, but he couldn’t cope. He self-destructed. Even when people don’t make the big realization consciously, they’re already self-destructing. It’s hard to escape it when it feels easier than continuing anyway. When it feels like the only option,

Would therapy fix the narrator of Fight Club? Would meds fix the narrator of Fight Club? No. He knows too much. All meds will do, by the time he’s in the psych ward, is spiritually neuter him. A silly phrase, but really. Take the wind out of his sails. 

Is he fixed if he doesn’t try to blow up town? If he just shuts up and settles in and stops costing money? If he still can’t cope with the things he’s unearthed? Do you see how this is a commentary in a commentary in a commentary?

Fight Club is an absolutely fascinating story because of this. The fact that it addresses the fallout of knowing. The isolation. The hopelessness. The spiral that results from a lack of hope. This is, I think, what resonates most with people, even if not consciously. Going insane because you’ve discovered something you wish you could unknow. It’s a classic horror story. Should our society be lovecraftian evil? I don’t think so. 

Do I think changing it will be easy? No. Lord knows a lot exists to push people who make these sorts of Realizations towards feelings of individuality and individualized solutions and denial and other distractions and coping methods. And to prevent people who make One realization from expanding on it and considering further ramifications. Fight Club itself gets into this; the isolation of men being a strict part of the role society shapes for their sex leaves them very vulnerable to death fetishes, in a sense, and generally towards self destructive violence. It helps funnel them away from substantial change and towards ineffectual change. Many things, misogyny, racism, serve to keep people isolated from one another, individualized, angry, and impossible to work with. Market segregation; god knows even appealing on those fronts has become such a classic ploy that companies do it now, the US military frames its plundering that way, etc. 

I’ve wandered a bit but ultimately, my point is this: Fight Club is a love letter to the horrors of critical thinking, and the importance of not falling into the trap of self destruction and hopelessness in the face of it. The latter is why Tyler was an anarchoterrorist instead of anything useful. The latter is why it was a death cult. It’s important to work through the horrors of critical thinking so you can do it, and stand on the other side ready to believe in each other. It’s worth it.

[upennmanuscripts]

Ms. Codex 69 is a collection of scientific, alchemical, and medical works. Some are by famous individuals such as Geber, Albertus Magnus, and Johannes de Rupescissa, but most are unattributed. The manuscript includes many marginal notes, symbols, corrections and comments in various later cursive hands. Keep your eye open for the page of alchemical devices!

🔗:

[myemuisemo]

In approaching the first chapter of The Hound of the Baskervilles in this week's Letters from Watson, I initially felt that I was sort of cheating as I know I've read this more recently than middle childhood. Then I read the first chapter and realized my memory of the story consists of a vague impression that it has a moor and a dog. Oh well.

Mortimer's staff being referred to as a "Penang lawyer" reminds us that when you live in a colonialist society, the mindset is everywhere. The staff is presumably made from Licuala acutifida, a sort of cane native to China, southeast Asia, and Pacific Islands. By 1889, when the novel is set (five years after the date on the walking stick), British Malaya had been under direct crown rule for a couple decades. The Brits had owned Penang since at least the secret Burney Treaty of 1826.

Dr. Watson's initial wrong guesses provide a window into his world and preconceptions. My first reaction was "how did he think hunt rather than hospital when he himself has medical training?"

Growing up in the genteel countryside would explain "hunt." But Charing Cross Hospital, then located just off the Strand, would have been only about two miles from Baker Street. How do you miss a large hospital?

There might be a titch of snobbery in play, as Watson did his residency at much, much older Barts (St. Bartholomew's). Barts dates from the 12th century, while Charing Cross Hospital was an early 19th century upstart. Watson also went for additional training at the military hospital at Netley.

Watson really puts up with a lot, though.

James Mortimers' publications focus on the idea that illness stems from throwbacks to a more primitive state, an idea also applied to criminology of the day. Through 2024 eyes, this is unlikely to be a good thing, but let's see where Doyle goes with it. I have faith in Holmes due to his love of that book that attributes much of human civilization to non-white world cultures. (Coveting Holmes' skull reeks of phrenology, but I can't believe this was meant as an appealing trait.)

After being informed that Sholto was based on Oscar Wilde, I'm wondering which of Doyle's acquaintances was the pattern for James Mortimer (who is not addressed as "doctor" because he's a surgeon; it's a British thing).

While Holmes describes Mortimer as "amiable" before meeting him, he does not find being described as "the second highest expert in Europe" all that simpatico. There's some impatience in Holmes' chapter-ending request that Mortimer explain why he's there.

At this early stage, I dislike James Mortimer. It's partly the nature of his publications, but also the false humility of calling himself a "dabbler in science" when he in fact has publications, an award, and a degree. It's dabbling to collect bones or bugs or whatever and be perpetually working on a treatise that never gets finished or published. It's not dabbling when you have official recognition within your chosen career for your research.

So what is Mortimer here about?

[soundchet-archive]

Masterpost!

Hello!! Welcome to the Storage Bin ❤️ all curated by yours truly, @redsea8me for your Soundchet needs (even tho I’m literally doing this all for myself lol) feel free to submit anything about these two!! Everything is welcome here, and feel free to tag me in soundchet stuff so it can make its way here!! Also, if you have any requests or questions for me, I’d be happy to answer them!

‼️Important Note!! NSFW content will be shown on this blog!!‼️

Everything here will be tagged accordingly, depending on what continuity, what type of post it is and such (a lot of it is going to be my own stuff lol)

Underneath the cut is a big masterlist of fics I have dug up, excluding what’s on Ao3, feel free to inform me of any others that might be out there

This will be updated whenever I find something, and when I’m able I’ll add new links to pdf versions just in case something happens and the old links no longer work

FFN

Adjustment of Plans - G1, Partly NSFW, posted 2010 (I got so scared I lost this one bc it’s no longer available on FFN but I have it saved!!)

Split - TFP, NSFW, posted 2013 (Zenophrenic, mentioned on the page used to be on Tumblr but I can no longer find their account, they may still be on DeviantArt, I’m hoping to find their art) (saved)

Do What You Have To - G1 (I believe, though it might be the movies) PG, posted 2011 (saved)

Revenge - TFP, PG, posted 2013 (saved)

Run For A Fall - TFP, PG, posted 2013 (saved)

The Bad Touch - G1, NSFW Humanformers edition, posted 2007 (saved)

Medic Fever - TFP, NSFW featuring multiple ships, posted 2012 (multi ship Ratchet fic, Soundchet is the section titled Sparkling Treatise)

LiveJournal

Echos - G1, NSFW, posted 2009

A Good Yarn - G1, PG, posted 2012

No Need to Say Goodbye - G1, PG, posted 2011

(Currently looking for an unfinished TFP fic, will be updated when I find it)

Wordpress

Training Session - TFP, Fade to Black NSFW, posted 2016 (this author also has two other Soundchet fics on Wordpress, but they’re up on Ao3 as well so I didn’t feel inclined to link them)

DeviantArt

Betrayed - TFP, Some NSFW, posted 2014 (this is a part of a longstanding series, and under Betta132 account you can find all of it under the Soundwave Series segment, the first chap of Betrayed is linked here bc it’s when the Soundchet shipping actually becomes apparent in the series)

[richmond-rex]

Medical treatise owned by Henry VII and Elizabeth of York. On the left side, Elizabeth of York's coat of arms is supported by Henry VII's badges of the red dragon and the white greyhound (x)

[transmutationisms]

like every third medical treatise i read has like at least one lengthy section dedicated solely to hemorrhoids. like philosophical treatises too where hemorrhoids are just being used as an example bc the presumption is everyone has experience having/treating them so you can just do medical discourse thru them... it always makes me wonder like, did people used to get way more of them in the 18th and 19th centuries? or were they just less deterred from letting a doctor poke around their buttholes. or are doctors now the squeamish ones who fear that discoursing about buttholes would make them be perceived as unserious... but nowadays people talk about the hardness of their poops and stuff in legacy newspaper columns so it can't all be buttshame. but like there is a definite difference in discussion of hemorrhoids specifically like when was the last time a french doctor trying to be a public figure was just like here's my entire three straight chapters on bleeding piles. i feel like the equivalently in-vogue medical problems now are like, hypertension, nafld, dehydration, whatever wellness bullshit about digestion, and then like all that quasi physiognomy stuff about posture and alignment etc. you never hear someone be like yeah i've got these hemorrhoids in a state of bleeding flux. and i do think europe has gotten broadly more squeamish about assholes in the last several centuries because once i found this letter by erasmus the reformation one that was like musing about the social situations in which it was and was not acceptable to fart. can you imagine. if like one of those celebrity splinter church ministers was writing letters to the racecar driver heir of the habsburgs, about farts

[thaisibir]

Phantom Thieves react to getting anesthesia: headcanons from a real anesthetist

Ren: wakes up unusually chatty, thinks the recovery room nurse is Sae in the interrogation room, talks about all the stuff he has to do to increase his social stats

Ryuji: won't shut up about being a Phantom Thief and rats out his friends as Phantom Thieves (fortunately none of the OR staff believe him because they chalk it up to post-op delirium)

Ann: confesses her undying love to the recovery room nurse taking care of her (which destroys Morgana)

Yusuke: wakes up reciting a very long list of all the hospital food he wants to eat, ends up not eating for a while due to having the terrible luck of previously undiagnosed post-op nausea and vomiting (PONV sucks, and known history of it in a patient definitely affects the anesthetic plan. A lot of drugs in our disposal have anti-nausea properties: propofol, decadron, zofran being the most common. But a bunch of others can do the exact opposite and cause nausea: opioids, anesthetic gas, etomidate (which I call vomidate) etc. It's a careful balance of what meds to use and which to avoid, and it depends on the patient.)

Makoto: wakes up alternating between yakuza movie quotes and swearing every other word from surgery pain (a bad habit she got from Sae, who swears like a sailor out of work stress when she thinks Makoto can't hear)

Futaba: takes fore-fuckin'-ever to get to sleep, gets slugged with enough medication to knock out a 100 kg 6 foot tall man (redheads are known for needing higher than average anesthetic to go past the threshold of consciousness and awareness. This is actual book knowledge plus my own clinical experience. Futaba would be a real chore to anesthetize.)

Haru: wakes up throwing hands, swinging fists and feet into OR staff, keeps asking for her axe, has to be restrained to the bed until enough sedatives kick in to calm her down (little kids, teenage girls and big healthy guys tend to wake up violently as the anesthetic wears off. The solution and wonder drug for this: precedex.)

Morgana: makes a weepy proposal to Ann, launches into verbal treatises and theories on the psychology of the Metaverse (which just sounds like incoherent meowing and yowling to the vets)

And for the honorary PTs:

Sojiro: the amount of gunk and spit suctioned out of his mouth before removing the airway device is through the roof (suctioning the mouth and throat is super important during emergence of anesthesia, so that stuff doesn't make the vocal cords spaz out and slam shut, which is laryngospasm, an airway emergency. Smokers tend to produce excessive oral secretions, and if they smoke enough, it can even look gray and brown. Lovely huh?)

Sae: has a low heart rate in the 40s that kind of unnerves OR staff, but that's only because she's very athletic (very fit people can have pretty low baseline heart rate, because exercise remodels the heart to optimize blood output for less work/heart rate. Normal heart rate range is 60-100 bpm, but I've seen Ironman type athletes have 30-40 bpm.)