#psychotherapy in media

[emotionallychargedtowel]

The Eighth Sense e5 & e6: portraying trauma with nuance

Episodes 5 and 6 of The Eighth Sense have really blown up a discourse bomb in tumblr’s BL scene. I had been putting off watching these episodes because I had gathered that episode 6 ended with something pretty distressing, and stuff like that sometimes hits me pretty hard, especially when it’s left as a cliffhanger. But I was already tempted to rip off the band-aid and watch it anyway, and then everyone has been debating aspects of these episodes. So I just had to see what all the discussion was about and figure out my own take on it.

In case it’s not obvious, the following will have spoilers for the series up to and including episode 6. I have a lot to say about this, because it touches on subjects that have been a major focus for me in my personal life, in my previous work as a trainee therapist, and in my research and writing. But I want this to be a manageable read, so I’m going to put things in bullet form when I can to keep them brief and organized and I’m going to make some section headings to help with skimming or skipping around. But before I launch into the rest, there’s one thing I should get out of the way: I don’t think any part of episodes 5 or 6 are a hallucination, a dream, or otherwise did not occur. I do think that there are aspects of the way the show portrays certain things that indicate dissociation and/or an acute trauma response. I’ll talk more about that below. (Hey, @waitmyturtles, this is the epic TES post I’ve been writing off and on for two days! I hope it’s of interest.)

Here are the section headings I’ll use below, to give a sense of what I’m going to talk about:

Conceptualizing Jae Won: Or, what I think is happening with him

Jae Won’s therapist - comments and interpretations

Jae Won’s therapist - medication management

Human beings’ amazing capacity for self-blame

Interpreting show production choices psychologically

Are the creators of The Eighth Sense going to pull a “who shot JR?” move?

Conceptualizing Jae Won: Or, what I think is happening with him

We don’t know how his younger brother died, but we know that he died in front of Jae Won when they were together, and it’s clear that he blames himself. I would be shocked if he was actually at fault even a little bit. But it does appear to have happened “on his watch” in a sense that lends itself to blaming himself. This is a huge issue, one that I’ll discuss in more detail later on.

Even before his brother’s death, Jae Won was clearly under a ton of pressure from his parents. And his father appears to be emotionally and, almost certainly, physically abusive. This is also far more likely to have pre-dated his brother’s death than to have only developed afterward.

In addition to pressure and abuse, I think it’s pretty clear that Jae Won was a parentified child. This means that he was put in a position of having to take care of his parents’ emotional needs as a child. This kind of role reversal has profound effects throughout the parentified person’s life. 

Jae Won’s self-blame about his brother’s death means he was always going to be predisposed to stay stuck in the chronic version of the acute trauma response instead of moving through the natural healing process. In other words, he was almost certain to develop PTSD.

This is less clearly shown in the show, but my impression is that Jae Won has a deep-seated depressive tendency that existed before the loss of his brother. This would make sense for someone who faced the family-of-origin difficulties that he did. 

When he did develop PTSD, as I have no doubt he did, Jae Won’s existing challenges were going to make him even more likely to develop the depressive symptoms of PTSD than others. We’ve seen some of these in the show already:

feeling alienated from others, unable to form meaningful connections with them,

anhedonia (an inability to feel positive emotions), and

negative beliefs about himself, other people, and the world.

All of this is happening at once. He’s dealing with PTSD, but he also still has all the same habits and beliefs he had before due to the parentification and training in people-pleasing, so he’s supposed to bottle up all of this pain. And if it’s his fault (in his mind) that his brother died, how much more does he owe his parents than he ever did before? This is a distorted, unhealthy way of thinking about all of it, but these kinds of maladaptive thoughts and expectations happen all the time with trauma survivors.

Jae Won’s therapist really sums all of this up very well when she says, “All your worries, not doing what you want to do because you do not want to let your parents down, and trying hard to be a good person to everyone because you do not want to disappoint others. Don’t you think it might be all because of your younger brother? Your younger brother, who got into an accident while with you. Your younger brother, who you couldn’t protect. And you are struggling to live your life for him as well.” 

Jae Won’s therapist - comments and interpretations

I went into this series feeling nervous about its portrayal of therapy. I was very excited that therapy was being portrayed at all, mind you! It’s horrifying how seldom we see therapy mentioned as an option, much less shown, either in BLs or kdramas, and I’ve hoped for this to change for a long time now. But therapy  is shown in an inaccurate way so often in media. And often, we see therapists and other mental health professionals breaking ethical rules. So I was on my guard, big time.

There’s one thing I really take issue with about Jae Won’s therapist, and it’s somewhat of a small thing: her office is way, way too dark! I just don’t think that kind of low lighting, with a lot of the illumination coming from her aquarium and other tinted light sources, is professional or conducive to therapy work. Of course, it’s obvious that her office is lit in this way because it looks cool and sets a certain mood for the show. And that’s fine. It’s a very stylized show in a lot of ways. But it makes me a little tweaky to watch it. 

Some of the things she does in the therapy space with Jae Won are a bit open to interpretation, and could be debated. But I view her in a fairly charitable light, and I found that a favorable interpretation wasn’t difficult to justify at all. I ended up viewing her (so far, at least) as a very skillful and effective therapist.

I loved it when she joked, in the first scene after the credits for episode 1, “For God’s sake! Just tell me what your worries are!” Jae Won isn’t great at sharing. He’s been trained from early childhood not to show his messy, vulnerable emotions around authority figures. Jae Won is not an easy client by any stretch, so she may have been showing a mild version of some real frustration with him when she began that comment with mock-hostility. But he seems really sensitive to criticism, real or perceived. Coming at him directly about this could be risky. Using humor is a good way to get around this sensitivity pretty effectively. It’s worth noting, though, that I wouldn’t endorse this kind of move by a therapist unless they knew a client very well and had built a solid rapport with them.

The comment I quoted above (”Don’t you think it might be all because of your younger brother?”) connects so many of Jae Won’s interpersonal difficulties to the loss of his brother in a skillful way. It was very astute and well-put. But there are some things I would quibble with about it.

First, I’m kind of surprised that she is only saying this explicitly this far into therapy with Jae Won. It seems rather late to make such an observation considering this constellation of issues has, without a doubt, been in place the entire time they’ve been working together. This could definitely have been done sooner.

At the same time, paradoxically, it’s delivered abruptly, as if she blurted it out too soon. Actually, the abruptness comes from the fact that there’s not sufficient lead-up to the comment in their discussion beforehand.

Though the show’s treatment of mental health is strong overall, I think this part of this scene suffered from flawed writing. If I had written this scene, I would have made a change that I think would have resolved both of these issues. Instead of introducing this insight as if the therapist has just voiced it for the first time, I would have presented it as something she and Jae Won have touched on together more than once during their work together. Anyone who’s been to therapy knows that the same ideas, which appear as shocking revelations at first, often have to be returned to many times and worked through before we can benefit from them. She could have said something like, “This is that issue we’ve talked about before, right? It seems like another case of your beliefs about your brother’s death causing trouble in other areas of your life.”

Even better, she could have been shown quoting some kind of metaphor or shorthand Jae Won came up with himself when they’d spoken about this previously. For example, I had a client once who used to talk about metaphorically carrying around a giant, heavy book where he wrote down all of his failures. He described it in a similar way to “the catalog of mistakes” (I’m not going to share his actual wording, of course). Whenever I would use his wording, saying “the catalog of mistakes” or even “the catalog,” all of our prior discussion of that issue came into both our minds immediately. It also served as a reminder of our rapport and the importance I placed on his perspective.

Jae Won’s therapist - medication management

There’s one other area of Jae Won’s interactions with his therapist that is a bit hard to interpret. The exchange he has with his therapist about the amount of medication she’ll prescribe to him certainly seems important, but it’s hard to tell what exactly it means.

One thing that complicates this is the fact that he is receiving therapy and medication management services from the same provider. In other words, she seems to be a psychiatrist who provides therapy services. In most parts of the United States, this is rare (though that wasn’t always the case). I haven’t been able to tell whether this is more commonplace in South Korea.

Because she’s a prescriber and a therapist, asking for three weeks’ worth of medication instead of two also means waiting longer before having another therapy session. Maybe Jae Won really is just busy and trying to cut down on demands on his time, but this doesn’t seem too likely. It’s also possible that he’s seeking a greater quantity of his medication for some purpose, such as abusing it or using it for self-harm or to end his life. But he also could just be trying to put off his next therapy session to a later date because of his difficulty talking about vulnerable topics, something he demonstrates at multiple points in his therapy session. Similarly, when his therapist says she can extend his prescription to three weeks but not a month, because, as she puts it, “I need to do my job,” this could be in reference to the medication or her therapy work. Part of her job is keeping him from having access to too large an amount of medication at once, while another part is having therapy sessions with him (that are frequent enough to be useful). It’s hard to tell which of the two she was referring to, or whether it could be something else entirely. So I don’t think there’s one clearly correct interpretation here. But I do think we should be attentive to the possibility that he might be medication-seeking, possibly with the aim of using the medication for self-harm.

Human beings’ amazing capacity for self-blame

Even if you have experienced trauma or have been close to someone who has, unless you’ve spent time with a sizable sample of trauma survivors, it’s hard to understand just how readily people blame themselves for traumatic experiences. I had had personal experience with this as a survivor of intimate partner violence before I ever did any training in trauma therapy, but I was still totally floored when I observed firsthand just how often this happens and how unjustifiable every single instance of self-blame I encountered in clients turned out to be.

This is actually a big area for me as a researcher so I’m going to try not to go off on a massive tangent, but I think this is important. When we experience trauma, one of the most frequent responses people have is to blame themselves. I used to describe this to clients as a “deal with the devil.” Blaming ourselves allows us to feel like we have control over whether such things will happen to us (and/or those we care about) in the future. If we tell ourselves, “the trauma only happened to me because I did something bad, or something wrong,” then we can also tell ourselves, “but I’ll never do the bad or wrong thing again so from now on I’ll be safe.”

It’s very tempting to make this bargain, but it is an extremely bad deal. Self-blame is one of the biggest reasons some people get stuck in their acute trauma response instead of completing the healing process, resulting in PTSD. That feeling of control isn’t worth that. But human beings are so tempted to make this trade. When I was doing trauma therapy as a trainee, I saw example after example of folks who did seriously remarkable amounts of mental gymnastics in order to justify blaming themselves for their trauma.  I’m going to talk briefly now about a client I had many years ago, without giving any details that could be remotely identifying. This person had witnessed the death of a close friend when they were in combat together. I did prolonged exposure therapy with this person, meaning he had to tell me the story of his friend’s death again and again and again. When we do this type of work, it usually seems at first like the client is telling the exact same story again and again without any real change. But little changes crop up gradually and accumulate and after a while, you find the story has made big shifts. And occasionally, a big change happens.

This client started out telling his story in a way that looked for every possible reason his friend’s death could have been his fault. And wow, was he ever grasping at straws. It was almost as if he had said something as nonsensical as “I had oatmeal for breakfast that day and maybe that’s why my friend died.” Every miniscule decision he had made that day could, in his eyes, potentially have caused his friend’s death in some mysterious and imperceptible way. It would have been absurd had it not been so sad. But thankfully, as we continued the exposure work, his story gradually changed and these justifications for self-blame started to fall away a little at a time.

Then, one day, a crucial detail was added to the story that blew me away. After weeks of telling the story in the usual way, my client mentioned for the first time that just before his friend was hit, he had called out a warning to him, which the friend had ignored. He’d mentioned countless ways he might be to blame--none of them remotely justified--but had never told me about the one very clear way in which he had tried to prevent his friend’s death. When I pointed this out, my client was shocked that he had never mentioned that detail before. We spent a lot of time unpacking what all of this meant. It was the single biggest turning point in his therapy. So, yeah. People have an amazing capacity for figuring out even the slimmest of pretexts for self-blame, and it’s abundantly clear that Jae Won is exercising that capacity big time. I’m pretty certain we’ll find out that he has been blaming himself a lot for what happened while having no real justification for doing so.

(Side note: I have tons more thoughts about trauma, self-blame, victim-blaming more generally, and other related psychological constructs--these are all longstanding research interests of mine--but I’m going to stop here because this thing is already ridiculously long. But if anyone reading this ever wants to discuss any of this further, please feel free to hit me up! I love talking about these things.)

Interpreting show production choices psychologically

Let’s review where we find Jae Won toward the beginning of the show. I’ve talked about how Jae Won had a lot of psychological difficulties before the story started. His family of origin situation was damaging even before he lost his brother, and then he had to contend with trauma and complicated grief. After that, he went through a breakup (possibly due to his partner cheating on him), completed his military service, and then had to make the transition back to civilian life, which isn’t easy under the best of circumstances.

And then he meets Ji Hyun, and his feelings for him unsettle the precarious set of strategies that he’s been using to get by. Ji Hyun makes Jae Won feel tempted to let his guard down and be himself. He places a degree of trust in Jae Won that challenges his cynicism and makes him feel tempted to trust Ji Hyun in return--to trust him to an extent that would normally be out of the question for him. Ji Hyun shakes things up, and while this is mostly a very positive thing--there are a lot of things in Jae Won’s life that urgently need to change--it’s also rather destabilizing in the short term. 

Then the shit starts to hit the fan when Jae Won wakes up after staying out late drinking to hear his father pounding on his door. And the makers of the show start to play around with cinematography, editing, sound design, and other aspects of the show’s production to evoke Jae Won’s inner experience. After his dad pounds on his door, the way the show is shot and edited changes.

This disjointed editing and other distortions of typical filmmaking at this point in episode 5 have reminded some folks on here of a dissociative state, and I can see why. I would agree that it has a dissociative flavor. There are two prominent types of dissociation (which can happen simultaneously):

derealization, a feeling that the world around us isn’t real--it may feel empty, strange, or just plain wrong; and

depersonalization, in which we feel like we’re seeing ourselves from the outside, as if the person we’re observing isn’t us.

It’s tricky to talk about either of these in the context of tv/film because as viewers watching a fictional story unfold in a TV show, we are by definition:

perceiving that the world the characters inhabit doesn’t seem real, because it isn’t

looking at the characters from the outside, because they aren’t us (and they aren’t real)

But there are conventions of film and tv production that give us a sense of realism and of seeing things from characters’ points of view, and when Jae Won is dissociating we see those conventions get suspended or distorted. For example:

Conventional editing creates a flow of time that feels realistic (partly because we learn the “language” of film from a young age and interpret it that way). At important moments in The Eighth Sense, the editing breaks the rules of conventional editing, often messing with the viewers’ sense of time. Contexts change abruptly, as when Jae Won suddenly goes from being at home to being in his car. At other points, dialogue also goes out of sync.

Shot-reverse shot techniques help to approximate seeing things from the characters’ perspectives, situating us in the story so that we don’t feel like we’re observing from a distance. The most notable moment when this rule is broken happens when Jae Won is upset about his camera being damaged. We see him telling someone between sobs that the camera was a gift from his younger brother, but that person (assumably his dad) isn’t shown at all--not even a shoulder or the back of a head.

There’s also a lot of use of shallow depth of field (something the show uses in other ways as well), putting Jae Won in focus while his surroundings become a blur, making the world around him look hazy and unreal.

The sequence where Ji Hyun and Jae Won kiss in the ocean puts their dialogue way out of sync. On my first viewing, this just seemed like an interesting choice, one that gave the scene a sort of dreamlike quality. I’ve seen this strategy used before, as well, without any reference to mental illness, usually in art films. The first example that came to mind for me was from a Godard movie. It would be a valid option regardless of mental health-related content in a show. But after what immediately follows, I think that scene is portraying a trauma memory. Sometimes benign events that happened just before something traumatic become encoded with trauma memories rather than our usual type. (To put it briefly, trauma memories are encoded and stored in a different part of the brain from our everyday memories, and this is why they “behave” differently and have a different sensory quality from typical memories. Trauma recovery often involves some degree of re-encoding these memories in a more normal manner.)

Basically, the show sometimes puts the viewer into an approximation of a derealized and depersonalized state, particularly relative to what we’re used to as TV watchers. At other points, it shows characters’ experiences as if they were traumatic memories.

Are the creators of The Eighth Sense going to pull a “who shot JR?” move?

All this being said, I think that Jae Won’s dissociative moments, while very concerning and doubtless extremely distressing for him, do not point toward any sort of severe dissociative disorder like Dissociative Identity Disorder, nor do they make me concerned that his reality-testing (his ability to effectively distinguish what is and isn’t real) is impaired. I also don’t see any signs of cognitive impairment that would create a similar degree of confusion about reality. As a result, I don’t think the show’s use of signs of dissociation suggests that entire sections of the story will later be shown not to have happened.

Here’s the thing about dissociation. On paper, it sounds like an extreme symptom that approaches the kind of severe mental illness that includes symptoms like hallucinations and delusions. But the vast majority of the time, it’s very different from psychosis. And it’s also, in my opinion, more of a spectrum than we care to acknowledge most of the time. When we look at it that way, we can see that in a sense, Jae Won is at least a tiny bit dissociated a whole lot of the time. But frankly, so am I. It’s not uncommon for trauma survivors. It’s very different from something that would result in impaired reality-testing.

It’s possible that the show will end up revealing that Jae Won’s mental illness has resulted in him imagining entire segments of the show. These types of symptoms are often portrayed in media, for a couple of reasons: 1) people just find psychosis fascinating, and 2) these types of symptoms are very handy for creating plot twists and other interesting narrative devices. It’s not hard to think of examples of this. Fight Club, Black Swan, Shutter Island...the list goes on and on. But these portrayals are almost always inaccurate and exploitative. So far, the folks who make The Eighth Sense have shown a great deal of nuanced awareness of and sensitivity toward mental health matters, so I don’t think they would use this kind of cheap plot device. But they might. If so, I’ll find that pretty disappointing.

There is one thing the showrunners are doing that is somewhat sneaky in a way that could look analogous to that. Others have pointed out that Jae Won and his therapist are wearing the same clothes in every therapy scene, suggesting that we’re seeing the same therapy session interspersed with the other events of the series. In other words, the therapy session operates on a very different timeline from the rest of the story. We don’t know where to situate it relative to the rest of the plot. But I don’t see that as tied to the show’s portrayal of Jae Won’s mental health, nor does it seem exploitative or out of left field.

To sum up:

So far, The Eighth Sense has been remarkably accurate regarding psychological matters and has portrayed therapy and the use of psychotropic medication in a mostly positive and realistic light. I get the feeling the writers/directors/etc. have had some experience receiving mental health treatment. I really hope they maintain this level of quality throughout the remainder of the series.

I don’t think Jae Won’s PTSD (or his depression/anxiety) are sufficient for him to experience psychosis. I don’t expect entire segments of the show will be revealed to be an elaborate lie or hallucination, and if they are, I would consider that to be an example of poor writing and an unrealistic and potentially harmful representation of mental illness.

[therapy-bites]

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[gregor-samsung]

Celle que vous Croyez [Who You Think I Am] (Safy Nebbou - 2019)

[t-jfh]

(Illustration by Jun Cen)

Dissociation is the ability to disconnect from our thoughts, feelings, environment or actions.

Dissociation can even help athletes do their jobs, for instance, because it allows people to focus on the most salient or life-preserving aspects of a situation without mental interference.

But sometimes people experience a major form of dissociation, often in the aftermath of overwhelming trauma. In this case, the dissociative symptoms become more extreme and frequent.

What Does It Really Mean to Dissociate?

People are turning to social media to define dissociative disorders, but those portrayals aren't always accurate. Here is a primer.

By Christina Caron

The New York Times- Oct. 5, 2023

[hellyeahscarleteen]

"Last month, the UK’s four-year-long review of medical interventions for transgender youth was published. The Cass Review, named after Hilary Cass, a retired pediatrician appointed by the National Health Service to lead the effort, found that “there is not a reliable evidence base” for gender-affirming medicine. As a result, the report concludes, trans minors should generally not be able to access hormone blockers or hormone replacement therapy (HRT) and instead should seek psychotherapy. While the review does not ban trans medical care, it comes concurrently with the NHS heavily restricting puberty blockers for trans youth.

The conclusions of the Cass Review differ from mainstream standards of care in the United States, which recommend medical interventions like blockers and HRT under certain circumstances and are informed by dozens of studies and backed by leading medical associations. The Cass Review won’t have an immediate impact on how gender medicine is practiced in the United States, but both Europe’s “gender critical” movement and the anti-trans movement here in the US cited the report as a win, claiming it is the proof they need to limit medical care for trans youth globally. Notable anti-trans group the Society for Evidence Based Gender Medicine called the report “a historic document the significance of which cannot be overstated,” and argued that “it now appears indisputable that the arc of history has bent in the direction of reversal of gender-affirming care worldwide.”

Most media coverage of the report has been positive. But by and large that coverage has failed to examine extensive critiques from experts in the US and elsewhere. Research and clinical experts I interviewed explained that the Cass Review has several shortcomings that call into question many of its findings, especially around the quality of research on gender medicine. They also question the credibility and bias underpinning the review. I spoke with four clinical and research experts in pediatric medicine for gender-diverse youth to dive into the criticisms.

“I urge readers of the Cass Review to exercise caution,” said Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco and author of the forthcoming book Free to Be: Understanding Kids & Gender Identity."

[andi-o-geyser]

Continuing my Dr Jacob rants, I wanted to mention how... off I've been feeling with how the rest of the characters have been treating the whole situation regarding him dating Michelle. It's so far been exclusively framed as a marital issue that Ted has to work through, and it's being massively downplayed by the people around him and the narrative itself? I feel as if it's being equated to simply struggling with watching an ex move on, which is SO not what is happening here. This is a deeply unethical and damaging relationship to everybody else being pulled into Michelle and Dr. Jacob's absolute fucking nonsense, and I know I've brought this up before, but this is the type of shit you get your license taken away for. Having a relationship with a patient, former or not, is such a full stop unethical crossing of every boundary meant to exist between a patient and therapist that I couldn't explain just how much of a no it is if I had 15 hours uninterrupted and a megaphone.

At least where I live, the college of registered psychotherapy has a half a decade minimum legal time frame that must be elapsed to have a relationship with a patient, but honestly that's just technicalities. Therapists should, under NO CIRCUMSTANCE, have any kind of duel relationship with a current or former patient. Therapy is meant to make a connection to help you work through your problems, but it's not for making a friend and it's certainly not for meeting a partner. And for a therapist to abuse that power and, in this situation, maybe even coerce a patient out of their marriage so they can date them (because come on, that's exactly what fucking happened given the facts), is beyond deplorable. I don't give a fuck if Dr. Jacob gives nice guy energy, he's a professional (unprofessional as he may be) who knows exactly what he did, and he's a piece of shit for it.

I know this is TV, and the way therapists act in media is so sensationalized and dramatized, but considering Ted Lasso is "the show about having good mental health" and understanding and unpacking trauma and issues, the lacklustre reaction from characters regarding the relationship between Ted's ex wife and her (and Ted's!!) therapist are just bizzare. I need at least somebody in-universe to acknowledge how baffling the behaviour is, and I really can't deal with the idea of Ted being left out to dry in this situation. This isn't some simple "my ex is moving on and that's tough for me but I need to accept it" situation, this is a borderline traumatic betrayal of trust Ted is going through, and the thought of it being left unaddressed while Ted has to make nice with Dr. Jacob because "Well, I really need to not make a fuss because he makes Michelle happy and he's Henry's new father figure now!" is soooo fucking awful I honestly can't even think about it. Anyways don't date your therapist this has been my PSA

[gothhabiba]

Although the chemical imbalance model remains the dominant cultural story of depression in the United States (France, Lysaker, & Robinson, 2007), its validity has been publicly questioned with increasing frequency in recent years (e.g., Angell, 2011a, 2011b; Begley, 2010; Spiegel, 2012; Stahl, 2012). Scientists have long understood the “low serotonin” explanation of depression to be unsubstantiated (Kendler & Schaffner, 2011; Kirsch, 2010; Lacasse & Leo, 2005), and psychiatry is currently attempting to distance itself from this pseudoscientific notion. Prominent biomedical model proponents now use adjectives like “antiquated” (Insel, 2011) and “outmoded” (Coyle, cited in Spiegel, 2012) to describe the chemical imbalance story, thereby creating the misleading impression that this notion has only recently been exposed as mistaken. Pies (2011) proclaimed that the chemical imbalance theory is an “urban legend” that was never taken seriously by thoughtful psychiatrists. “In the past 30 years,” he asserts, “I don't believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it.” This declaration might come as a surprise to former APA president Steven Sharfstein who explicitly defended the validity of the chemical imbalance theory on NBC's Today Show (Bell, 2005b) in the wake of actor Tom Cruise's infamous remarks criticizing psychiatry (Bell, 2005a). Patients with mental disorders might also be surprised to learn that some doctors use the chemical imbalance story simply as a convenient metaphor for facilitating drug treatment and/or attempting to reduce stigma. Until recently, the American public had little reason to doubt the veracity of chemical imbalance claims promoted by the popular media, health websites, patient advocacy groups, governmental agencies, and other reputable medical authorities. Given recent high-profile revelations about the limitations of the chemical imbalance story, biomedical model advocates may face increasing pressure to disseminate accurate information about mental disorder rather than persist in the promotion of an unfounded but politically and economically useful scientific caricature.

–Brett J. Deacon, “The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research.” Clinical Psychology Review 33 (2013), 846–861. http://dx.doi.org/10.1016/j.cpr.2012.09.007

[pikapeppa]

15 questions for 15 friends

Tagged by @elveny and @johaerys-writes -- thank you, my loves!

ARE YOU NAMED AFTER ANYONE? My mom. Apparently my dad really wanted to name me after my mom and she was like "ugh really fine" LOL. My dad is also named after his dad, who was named after his dad... REAL ORIGINAL. This is going to sound like a total humblebrag, but my mom and I are both published academic authors, so we have to use our middle initials to distinguish who published what 🙃

WHEN WAS THE LAST TIME YOU CRIED? Probably in therapy last Thursday LOL. Though I got a little prickly-eyed earlier this week watching the episode of ATLA where Zuko and Aang go on their lifechanging field trip to the Sun Warriors' secret village 😂❤

DO YOU HAVE KIDS? Nope! Childless by choice.

WHAT SPORTS DO YOU PLAY/HAVE YOU PLAYED? I played T-ball when I was 5 or 6 (hated it, cried so much that my parents pulled me out LMAO) and I was on the volleyball team in Grade 6. I'm left-handed and I had a habit of serving into the wall, unfortunately, and the habit got worse when I was nervous. During one game, they took pity on me so much that they paused the game until I got the ball over the net. I was fucking humiliated and have never played a team sport since then. 🤣💀 Re: other physical activities, I like dancing! I've taken a ton of different kinds of dance classes including swing, salsa, bellydancing, and Bollywood dancing, and loved all of them!

DO YOU USE SARCASM? No. Me? Never. 🙃🤣 Forreal though yes. All the time.

WHAT IS THE FIRST THING YOU NOTICE ABOUT PEOPLE? Uh...! I don't know if there's any one specific thing? I usually take in an "overall impression" of appearance. Vague, but that's all I've got. If the question was "what's the first thing you notice in people you're attracted to", that might be a different story 🤣

WHAT'S YOUR EYE COLOUR? Brown.

SCARY MOVIES OR HAPPY ENDINGS? I am going to copy Johaerys's answer and say it doesn't matter to me, as long as the story was good. But also, who says scary movies/horror media can't have happy endings?? 🤣Haunting of Hill House, anyone? (Bittersweet, maybe, but it counts as happy to me!)

ANY TALENTS? Would it be wretched if I said I feel like writing might be a talent? Whatever, I'm saying it. 🤣😅

WHERE WERE YOU BORN? In a hospital in the same city where I currently live! Which I will chose not to reveal openly! 🤣

WHAT ARE YOUR HOBBIES? Writing! It takes up a solid 75-90% of my free time. Also gaming (which I might count into the writing time since it often becomes Research™ for the writing 🤣). I also enjoy baking and cooking, though I don't know that I'd count those as hobbies since they're necessary ADLs?

DO YOU HAVE ANY PETS? A cat named Meeko. She is my daemon. We can never be apart when I am home. Case in point, a photo taken in real-time while completing this quiz:

HOW TALL ARE YOU? 5'3".

FAVOURITE SUBJECT IN SCHOOL? Uhhh... what level of school are we talking here? In undergrad, I took an incredible linguistics/history course about writing systems, and that was probably my favourite class ever. I took a course during undergrad about different schools of psychotherapy that was pretty damned influential too.

DREAM JOB? I also loved Johaerys's answer here: "I don't think there's any sort of job anyone could do in this capitalist hellscape we're all currently living in that would be enjoyable enough to make up for, well... living in a capitalist hellscape." I'm lucky enough to work in the public healthcare system so I'm pretty safe from the worst of capitalism, I guess, though my job (speech-language pathologist) is one I chose more for practicality (certainty of employment) than because I was really passionate about it. If I could do something else and not have to worry about money, I would either want to be a fiction editor, or a sex therapist.

Tagging forward to @ranaspkillnarieth @iamcayc @heroofshield @fantasy-girl974 @hellas-himself @midnightacrobat @alyssalenko @vorchagirl @elinorbard @stuffforthestash @mwasaw @lordofthenerds97 @y0ureviltwin @ladyofthelake91 @perhapsrampancy @cha-mij and genuinely, anyone else who wants to share!!! Tag me so I can spy on your life! 🤣❤

[writingsofwesteros]

Social media au:

Realest gift Otto ever gave to stev? He took and paid to get her to psychotherapy to go over her youth

Only the targ siblings and Otto know she goes, it's sensitive to her. But then she admits to Stannis that she is going and his approval seems to mean everything to her.

That's also when Otto realized maybe he should offer the same gift to Aegon

BLESS HIM! Oh it takes Otto months to even try and gift Aegon this until he just sends it in an email..oopsie

[therapy-bites]

HAS YOUR THINKING SPRUNG A LEAK?

Reading Time Ahead: 45-60 seconds

Hey, TBALr's, Sarah here! Adventure-seeker, book-worm, & associate to Doc Heath, your friendly Neighborhood NeuroMechanic!

Imagine this: You're scrolling through social media and you see it: A social media post claiming to be a PSYCHOLOGY FACT.

But, there is a problem! The post says something to the effect of: "If it doesn't bring you joy, cut it out of your life!"

Seems like a good idea, but think again! If we cut everything out of our lives that didn't bring us joy, we would eventually cut ourselves out of the bulk of our own lives! This kind of thinking encourages us to catastrophize difficult events, situations, circumstances, thoughts, and emotions. If we aren't happy, there must be something wrong, right? Nope! Humans are engineered to have emotions; even difficult emotions. None are bad for us and none are even good for us! We have emotions because we are meant to have emotions.

The next time you see some social media pseudo-psychological clap trap, use Phil Swift's approach in this meme:

Don't let it cause "a lot of damage," slap some accurate, realistic thoughts on it!

Join the REVOLUTION!

Live the A.R.T. Life!

[religion-is-a-mental-illness]

By: Paul Garcia-Ryan

Published: Apr 18, 2024

Paul Garcia-Ryan is the board president of Therapy First.

A comprehensive review commissioned by England’s National Health Service, released last week, found that gender transition medical treatment for children and young people has been built on “shaky foundations,” with “remarkably weak” evidence. The independent study — led by physician Hilary Cass, the former president of the Royal College of Paediatrics and Child Health — incorporates multiple systematic reviews “to provide the best available collation of published evidence,” as well as interviews with clinicians, parents and young people, in reaching its conclusions.

Referring to young people who have already been treated under these dubious circumstances, such as those at the Tavistock Centre’s now-closed Gender Identity Development Service, Cass wrote, “They deserve very much better.”

In the wake of the Cass Review’s release — which has rocked the British medical and media establishment, and might soon reverberate in the United States — many are asking how we got here. How did clinicians come to recommend the use of puberty blockers and cross-sex hormones to thousands of children and adolescents when there was insufficient evidence that these treatments were safe and effective?

Part of the reason is that “the toxicity of the debate is exceptional,” as Cass notes in her foreword: “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”

I know all too well how the absence of good-faith, healthy debate on this subject can affect clinicians and patients. When I was 15, a therapist affirmed my conviction that I was born in the wrong body. After more than a decade of hormonal and surgical interventions, I detransitioned at age 30. I had come to realize that my transition was motivated by my difficulty reconciling with being gay. Today, I am a licensed clinical social worker and board president of Therapy First, formerly the Gender Exploratory Therapy Association, a nonprofit organization that advocates psychotherapy as a first-line treatment for youth gender dysphoria.

Usually in psychotherapy, treatment approaches are refined and improved by vigorous discussion, research and dissemination of new information. When it comes to youth gender treatments, though, professionals who raise concerns have been censored and subjected to reputational damage, threats to their license and doxing. As a result, countless gender nonconforming young people have been badly served.

Therapy First has been the target of silencing and intimidation efforts. Now with a professional membership of more than 300 clinicians based in 36 states and 14 countries, we are joined in our concern regarding the quality of mental health care provided to gender dysphoric youth. Even though the organization is apolitical and non-religious, with many of our members being LGBT, we have been falsely linked to the religious right. Despite being strongly opposed to conversion therapy, or trying to change someone’s sexual orientation or gender identity, we have been accused of practicing it.

What I’ve learned is that therapists who cite the poor quality of evidence in support of medical interventions for youth gender dysphoria, or who advocate traditional principles of psychotherapy in this area, are likely to be vilified — sometimes by fellow clinicians. Last week alone, eight complaints were filed against one of our members’ licenses by other therapists for simply posting, on a professional Listserv, the link to one of our organization’s webinars, on trauma-informed mind-body practices.

An activist website has labeled our therapists as part of the “global anti-transgender movement” and listed details from their personal lives, including the names of their children and other family members. Last month in London, the Telegraph reported, a medical conference that explored evidence and heard from seasoned therapists and doctors regarding the treatment of gender dysphoria was interrupted by masked protesters who set off a smoke bomb and attempted to force their way into the building.

In addition to worrying about activists outside the consulting room, therapists apparently must now also be concerned about whether their patients are wielding hidden cameras. This month, an undercover video recording of a therapy session was posted online, presenting the clinician as a practitioner of conversion therapy, yet the would-be video sting merely revealed a clinician engaged in normal therapeutic exploration. In the current climate, any therapeutic response other than immediate affirmation is considered transphobic.

It isn’t right that professionals must risk their livelihood and reputation to help young people struggling with gender dysphoria. If the culture of bullying persists, I fear that fewer clinicians with a developmental approach will be inclined to keep working with this population. These young people will be left with clinicians who aren’t following the science, many with good intentions, but others who might behave more like activists than mental health professionals.

The Cass Review made clear that the evidence supporting medical interventions in youth gender dysphoria is utterly insufficient, and that alternative approaches, such as psychotherapy, need to be encouraged. Only then will gender-questioning youth be able to get the help they need to navigate their distress.

[ Via: https://archive.today/83ZJa ]

[incarnateirony]

Hi. Is there a book or resource someone can look up to start learning the basics of the concepts you talk about? I find it very interesting but a lot of times it’s hard to keep up with.

Depends which concepts and where you want to start from.

If you mean the things generally considered spoopy, that kinda depends on your mindset.

Technical brains: Carl Jung, like, all of it, giddyup, start understandin deep psychotherapy, archetypes included

Storyloving brains/media lovers: Joseph Campbell, all of it but start at Hero With 1000 Faces instead of general Hero's Journey. The back end of the book will start walking you through the way archetypes interact with alchemical storytelling pretty much everywhere, but what they are and how blatant they are is something you can learn from that angle.

Romantic/magical/mystic minds: The Kybalion is like, The Poetic Shorthand Of The Concept For Beginners, and from there, you'd want to break out into other gnostic books depending on which particular sect appeals to you. Personally I appreciate Thelema's take, it lessens the direct impact of christianization while still being compatible as Brothers In Christ, very nice. There's a Thelemapedia to start with if the Kybalion entry point makes you curious.

The Super Scientific Brains More Than Psychotherapy Stuff: Check out what is going on in LLM AI models and the drive behind that, check into princeton's global consciousness project and the noosphere, and the associated data there. Also other good princeton or CIA projects ranging from EGG and Big Noise Experiment to the good old Stargate files to put a highlighter under it. If you grok the general presentation of As Above So Below in other texts LIKE Kybalion, you can check into quantum physics on things like superpositions, dimensions, vibrations, all kinds of fun stuff and go "oh, it was some old dude a million years ago trying to explain quantum physics and we're just now catching up to him"

When it comes to my ... strapped together tweet chains, there's messages in that quite specific and personal, and even references to arcane things have meaning to those it should, like Saturn's son, but it's someone who refuses any form of message. The tweet chains themselves are not the mystery, they are result of the application of the mysteries as I am attaining towards a goal. They are my mark, and my signature, and my path to keep expanding another thing.

Like no FR guys this is the plot idk what to tell you beyond that the day that you grok, you too will do amazing things you will look like a madhat for until everyone else around you starts questioning their sanity.

[psychologeek]

Liminality (by any other name)

skill is the learned ability to act with determined results with good execution often within a given amount of time, energy, or both.

Life skills are abilities for adaptive and positive behavior that enable humans to deal effectively with the demands and challenges of life. The subject varies greatly depending on social norms and community expectations but skills that function for well-being and aid individuals to develop into active and productive members of their communities are considered as life skills.

..........

Liminal is an English adjective meaning "on the threshold", from Latin līmen, plural limina.

May refer to:

In anthropology, liminality is the quality of ambiguity or disorientation that occurs in the middle stage of a rite of passage, when participants no longer hold their pre-ritual status but have not yet begun the transition to the status they will hold when the rite is complete. During a rite's liminal stage, participants "stand at the threshold" between their previous way of structuring their identity, time, or community, and a new way (which completing the rite establishes). More recently, usage of the term has broadened to describe political and cultural change as well as rites. During liminal periods of all kinds, social hierarchies may be reversed or temporarily dissolved, continuity of tradition may become uncertain, and future outcomes once taken for granted may be thrown into doubt. The dissolution of order during liminality creates a fluid, malleable situation that enables new institutions and customs to become established. The term has also passed into popular usage and has been expanded to include liminoid experiences that are more relevant to post-industrial society.

Liminal beings are those that cannot easily be placed into a single category of existence.

liminal deity is a god or goddess in mythology who presides over thresholds, gates, or doorways; "a crosser of boundaries". These gods are believed to oversee a state of transition of some kind; such as, the old to the new, the unconscious to the conscious state, the familiar to the unknown.

Liminal spaces are the subject of an Internet aesthetic portraying empty or abandoned places that appear eerie, forlorn, and often surreal. Liminal spaces are commonly places of transition (pertaining to the concept of liminality) or of nostalgic appeal. Research from the Journal of Environmental Psychology has indicated that liminal spaces may appear eerie or strange because they fall into an uncanny valley of architecture and physical places.

Psychology:

Liminal experiences, feelings of abandonment (existentialism) associated with death, illness, disaster, etc. Existential thought bases itself fundamentally in the idea that one's identity is constituted neither by nature nor by culture, since to "exist" is precisely to constitute such an identity.

In Depth Psychology:

Jungians have often seen the individuation process of self-realization as taking place within a liminal space. "

Individuation can be seen as a "movement through liminal space and time, from disorientation to integration [...] What takes place in the dark phase of liminality is a process of breaking down [...] in the interest of 'making whole' one's meaning, purpose and sense of relatedness once more".

As an archetypal figure, "the trickster is a symbol of the liminal state itself, and of its permanent accessibility as a source of recreative power".

Jungian-based analytical psychology is also deeply rooted in the ideas of liminality. The idea of a 'container' or 'vessel' as a key player in the ritual process of psychotherapy has been noted by many and Carl Jung's objective was to provide a space he called "a temenos, a magic circle, a vessel, in which the transformation inherent in the patient's condition would be allowed to take place."

Jungians however have perhaps been most explicit about the "need to accord space, time and place for liminal feeling"—as well about the associated dangers, "two mistakes: we provide no ritual space at all in our lives [...] or we stay in it too long". Indeed, Jung's psychology has itself been described as "a form of 'permanent liminality' in which there is no need to return to social structure".

Please vote for a name! :)

[magdeline1]

What I Love About The Catcher in The Rye

What I love about The Catcher in The Rye is that while there is so much representation in the media of the gifted burn-out kid, TCITR presents a narrative where the kid is burned out before he can even try. He develops an all-or-nothing mentality toward education, giving up the minute he decides he dislikes something because perhaps the turbulence of his parent's ways, boarding school trauma, and his brother's death haven't allowed him to pursue or earn any victories in his life. He calls other people "phonies" (so iconic) and seems to judge others as a coping mechanism while still displaying sympathy towards them. He's still a young boy; he's not a sociopath. However, by judging people and roaming around NYC, he doesn't look internally. He explains how he might've felt, what he said, and what he did through his inner dialogue, but it's up to the reader to understand that the prose almost seems shallow because Holden suppresses deep-rooted trauma and a lot of context to his life. He has a mental breakdown and wants to get away somehow and preserve every child's innocence because his own is lost. But what can he do? Not sure. Maybe try again at a new boarding school, maybe attend psychotherapy.

[edmundodiazz]

psychiatrist vs psychologist vs therapist

A question for Americans (and others if someone else wants to chime in).

So recently I became very curious about the distinction of these professions in the US (and around the world, as well, but the media I've been consuming has been, for the most part, American).

I keep hearing these words used interchangeably, and I began to wonder if maybe it wasn't always necessarily as much as lack of knowledge as, perhaps, differences in culture and education.

(Tbh I wasn't aware of all the nuances myself, so to explain the differences in a most comprehensive way I've searched for online acrticles that could explain it better, so the definitions below are translated (and sometimes also edited) paragraphs of online articles and not my own words.)

A psychiatrist is a medical doctor. To become a psychiatrist, you must gain a medical degree (after six years of study at the university) and then undergo an additional five years of internship in the field of psychiatry (similarily to any other medical doctor such as surgeon, endocrinologist, gynecologist etc.)

The specialization lasts about five years and includes theoretical classes and an internship in a designated medical facility. Only after finishing those additional five years of study can a medical graduate obtain the right to practice as a psychiatrist.

A psychiatrist is, therefore, primarily a physician who can work in medical facilities - treating patients with mental disorders and diseases. He also has, unlike a psychologist, the ability to prescribe medication to patients for the disorders they suffer from, as well as order a blood test or some other additional medical examinations.

A psychologist, on the other hand, is a person with a master's degree in psychology (the education lasts for five years). A psychologist, however, doesn't deal only with diseases and mental disorders but can also provide psychological support in difficult moments of life, career counseling and similar areas.

Not every psychologist works at their own office or provides consultations. There are psychologists who recruit employees or conduct training. There are psychologists who deal with psychometrics (development of psychological tests), scientific work, consumer research, etc.

Unfortunately, the profession of a psychologist in Poland has not yet been properly regulated or controlled (as is the case with doctors). Therefore, there are abuses by people who have completed postgraduate studies or courses in psychology in the title and call themselves psychologists despite the lack of five-year master's studies.

There is also somone called a clinical psychologist who has attained the master's degree in psychology and then completed an additional four-year specialization in psychology. They have more practical experience in the diagnosis and treatment of mental disorders. Clinical psychology is a discipline applied to healthcare. A clinical psychologist is a master of psychology with competencies in the field of specialization in the clinical psychology of adults, children and adolescents.

A psychotherapist is a person who has completed higher education and, in addition, a minimum of four years of psychotherapy training. Psychotherapists are most often psychologists, but they can also be doctors, midwives, nurses, sociologists or educators. To some extent, their competences overlap with those of a clinical psychologist. There are several leading schools of psychotherapy, which means that the training of a psychotherapist may emphasize various elements of the functioning of the psyche. Training in psychotherapy is long and very expensive.

(It should be noted that a psychiatrist, like a psychologist, is not licensed to conduct psychotherapy, unless they have completed postgraduate training in psychotherapy. A psychiatrist deals primarily with the diagnosis, prevention and treatment of mental illness.)

A therapist is an oft confused and overused word. Many may call themselves a therapist because they have completed one-year postgraduate studies in, for example, behavioral therapy for children with autism. Still others have master's degrees in pedagogical therapy with children with dyslexia. For others, completing a weekend-long therapy course is enough to call themselves a therapist. There are also occupational therapists working, for example, with children with disabilities. A therapist does not have to be a psychotherapist or even a psychologist.

Again, I wasn't aware of everything that has been said here, though I think it is safe to say that most people in my country (or at least the people I've come into contact with) do distinguish the major diferrences between a psychiatrist and a psychologist.

I wrote this post because, like I said before, I was often confused by the their perception in (mostly, I'd imagine) American media (tv shows, movies, books, online videos and articles, blogs and fanfics.) I'm curious, does the education look similiar in other countries? How easy/hard is it to study in those fields?

(I know I could search for the answers on the Internet but I guess I'd like to try a more social approach of asking actual people first).

(Sources for the articles can be found here, here, and here.)

[calmboyl]

I had a what if idea, where pitch just is a hikikomori (a recluse) and it does partially fit in with his character (at least in my eyes) yes im throwing out like, almost all the canon here but this is my idea and i can bend it to my will! ( ^ω^ ) also i thought changing the word hikikomori to pikikomori would be funny, yk switching a letter. i think its cute! and thats also what i decided to name this au, i also think there are like not many altercations with other spirits and myths with Pitch. he might’ve been out there and moving in the past but now he just stays hidden completely from sight, once in a while you’ll get to see or year about him being out but i think its mainly just the bare minimum for his existential. i think that some spirits (probably North) would be worried for him, maybe once in a while a spirit might hang out but not much, maybe drop of food or smth?

anyways heres some info on hikikomories

Hikikomori (Japanese: ひきこもり or 引きこもり, lit. "pulling inward, being confined"), also known as severe social withdrawal, is total withdrawal from society and seeking extreme degrees of social isolation and confinement. Hikikomori refers to both the phenomenon in general and the recluses themselves. The concept is primarily recognized only in Japan, although similar concepts exist in other languages and cultures. Hikikomori have been described as loners or "modern-day hermits". Estimates suggest that half a million Japanese youths have become social recluses, as well as more than half a million middle-aged individuals.

While many people feel the pressures of the outside world, hikikomori react by complete social withdrawal. In some more severe cases, they isolate themselves in their bedrooms for months or years at a time. They usually have few or no friends. In interviews with current or recovering hikikomori, media reports and documentaries have captured the strong levels of psychological distress and angst felt by these individuals.

While hikikomori favor indoor activities, some venture outdoors occasionally. The withdrawal from society usually starts gradually. Affected people may appear unhappy, lose their friends, become insecure and shy, and talk less.

When it comes to psychosocial support, it is hard for therapists to attain direct access to hikikomori. research to find different and effective treatment plans to aid hikikomori has been ongoing. One such treatment plan is focused on the families of hikikomori. Such focus primarily includes educational intervention programs (e.g. lectures, role-play, etc.) that are geared towards reducing any averse stigma that family members have towards psychiatric disorders like hikikomori. These educational programs are derived from other established family support programs, specifically Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). CRAFT specifically trains family members to express positive and functional communication, whereas MHFA provides skills to support hikikomori with depression/suicidal like behaviour. Studies so far that have modified the family unit's behavioral response to a hikikomori has yielded positive results, indicating that family behavior is essential for recovery, however further research is still needed.

Although there has been a primary emphasis on educating family members, there are also therapy programs for the hikikomori themselves to participate in, like exercise therapy. The individual psychotherapy methods that are being stressed in current research are primarily directed towards cultivating self-confidence within the hikikomori. However, studies have delineated that efficacious treatment of hikikomori requires a multifaceted approach rather than the utilization of one individual approach, such as individual psychotherapy or family therapy.