#should go see the dr about upping my duloxetine but

[vielle-art]

our rent is going up by over $200/month at the end of the year and im back to my instinctive reaction to everything happening being 'what if i just... stopped existing'.

anyways happy fall time the regular sad to become advanced sad i guess.

[alyssasmuses-blog]

Josh’s mental health - a novel by me.

(obvs this post is gonna contain some triggery material like mental illness & suicide attempts & things of that nature && also maybe some scenes from the game will be here. so u kno. proceed w/ caution)

GET READY KIDS THIS IS GONNA BE A LONG ONE.

So, first of all, let’s look at Hannah’s Diary. 

On an entry dated October 29th, 2013;

I really think Josh is doing better now that he's out of the hospital. I saw him today and he seemed better. He's pretty upbeat, but he talked like he's been doing therapy for such a long time. I guess I didn't know. Mom and Dad never let on. Funny how you can not even know your own brother. I kinda need a good cry thinking about how lonely he must feel... 

Now we’re gon’ look at josh’s psych report.

Josh’s first psych evaluation took place on 06/11/2006.

So, Josh was seeing doctors for seven years before his sisters found out.

The game makes it incredibly clear that Josh was really close to Hannah&Beth, and if his sisters didn’t even know about all this, then his friends sure as hell didn’t know yet either. Meaning for seven years, his only support system was his parents. Who, as we know, aren’t exactly present in his life. So Josh, for the most part, was dealing with his mental illness completely alone. Which, given his fear of isolation, probably didn’t help his recovery.

Now, for an overview of his medication.

(06/18/2006 - 01/24/2010): Josh was originally put on Fluoxetine one week after his initial appointment. He was on it for ~4 years, stopping when the side effects became too severe for him to handle.

After that, he was put on Duloxetine for three years (02/13/2010 - 11/01/2013), stopping that when it stopped working & he claimed his mood had “badly worsened” 

(Fluoxetine & Duloxetine are both common anti-depressants--they’re generics for Prozac & Cymbalta)

After that, Josh is put on Amitriptyline, which specifically warns people with a personal or family history of psychosis should talk to their doctors before taking it, something Josh shows symptoms of later in-game, but never actually gets diagnosed with. But we’ll get to that later.

Josh’s original prescription for Amitriptyline was given to him on 11/29/2013.

But, let’s look at Dr. North’s portion of the profile;;

01/03/2010 Sarah North, MD, PhD Cranleigh Hospital Referred on 11/29/2013 after patient's response to drugs tapered badly

12/19/2013 is when he starts seeing Dr. Hill, meaning for the first ~20 days he wasn’t seeing a doctor while on new meds.

Later on, Dr. Hill makes note of Josh being suicidal while on this medication, and later takes him off of it due to him self medicating & taking stronger doses. (04/05/2014)

All of this happened within six months of him getting on this medication. Every other medication he was on up until this point worked for several years. But, given that within these six months, his sisters also went missing, it seems more likely that Josh’s mental illness--which up until a few months before the prank had been manageable enough that he was able to hide it so well his sisters had no clue--had worsened significantly, possibly even triggering his schizophrenia. But, again, more on that later.

The next medication Josh is put on is Phenelzine, which he started taking 04/15/2014. According to his psych report, he spent 30 nights in the hospital, being sent home on May 16th, 2014. Meaning that he started taking Phenelzine on his first day in the hospital.

It says that Josh is still currently taking Phenelzine, but the psych report is dated May 21, 2014, and we know Josh stopped taking his meds at some point between then and February 2nd, 2015. We just don’t know when, exactly.

So, first of all, let’s talk about Josh’s depression.

There isn’t much to talk about that isn’t made abundantly clear--despite the fact that his diagnosis of Major Depressive Disorder (Clinical Depression) clearly doesn’t cover all the bases for what he’s experiencing, it’s definitely a piece of it. Understandably so, too. His parents seem relatively absent from his life, later on his sisters go missing & are presumed dead. Anyways, here’s a short list of some of the symptoms of clinical depression && I’m just going to bold the ones Josh is mentioned to experience in his psych report & in-game

Difficulty concentrating, remembering details, and making decisions, fatigue and decreased energy, feelings of guilt, worthlessness, and/or helplessness, feelings of hopelessness and/or pessimism, insomnia, early-morning wakefulness, or excessive sleeping, irritability, restlessness, loss of interest in activities or hobbies once pleasurable, overeating or appetite loss, Persistent sad, anxious, or "empty" feelings, thoughts of suicide, suicide attempts

I’m sure Josh has experienced more of these symptoms, but these are the only ones that I’m going to discuss, given I can point out clear examples in canon.

Feelings of guilt, worthlessness, and/or helplessness//feelings of hopelessness and/or pessimism: Several times, Josh blames himself for his sister’s disappearance, despite the fact that he was completely unaware of the prank, & was passed out during it. He couldn’t do anything if he wanted to. The Dr. Hill he sees in his hallucinations calls him a psychopath. You even have the option to call Josh your least favorite character while you’re playing as him. (Which Dr. Hill will bring up later in-game if you do so.) It’s pretty clear that Josh doesn’t like himself, even if that’s how he let on when his big ~reveal~ happened.

Irritability: If you look at his phone, he yells at Dr. Hill (via text, but still) when he tells Josh he’s worried about him.

Loss of interest in activities or hobbies once pleasurable: According to his biography Josh was “studying psychology at college prior to Hannah and Beth's disappearance, which caused him to drop out.” Of course, we don’t know if he actually found his studies pleasurable, but clearly his sisters disappearing made him so depressed he didn’t even want to put for the effort anymore--also a symptom of depression.

Thoughts of suicide, suicide attempts: His psych report clearly states he was suicidal in March of 2014, a month after his sisters went missing.

Okay, okay, now we discuss the other half of his mental illness.

I’m not saying Josh definitely has schizophrenia w/ psychosis, I’m just saying Josh definitely has schizophrenia w/ psychosis.

So, first, let me explain why his behavior in-game is not caused by withdrawal of his medication, like a lot of people claim.

From his psych report;;

On withdrawal: nausea, insomnia, nightmares, agitation, hallucinations, paranoia, aggressiveness, slurred speech, ataxia, catatonia, shocks

Now, it’s true, he experiences a lot of those symptoms (I bolded the ones he actively experiences in-game) However. On Josh’s Cellphone, we see that the messages from Dr. Hill are from January 13th. That’s over 2 weeks. Not only that, but Dr. Hill’s message makes it sound like Josh is mid-planning for his prank. Drug withdrawals are serious and can last quite sometime, but there’s no way he could have all those symptoms at that intensity for several weeks. 

But !!! Let’s look at just some of the symptoms of psychosis (all of these are also symptoms of schizophrenia, but being that psychosis is a symptom of schizophrenia, I figured it’d be easier to explain it this way);;

hallucinations, delusions, disorganized/repetitive speech, suicidal thoughts or actions, aggression/hostility, depression, disorientation

Now, let’s take these one at a time.

Hallucinations: Josh experiences both audio and visual hallucinations of Dr. Hill and his sisters, along with some audio hallucinations of Chris. Every single “session” spent with Dr. Hill in the game is a hallucination, which is revealed later in the game. Very clear, vivid images, too. It’s not some shadowy figure or something that’s there one moment and gone the next.

When he starts hearing Beth & Hannah’s voices, he starts crying, “Not again.” “You’re dead.” “I don’t take orders from you anymore” He clearly knows that this isn’t real, that this is all in his head, and he even seems to be trying to cope and talk himself through it.

You can watch the scene where he hallucinates Beth & Hannah here.

Delusions: His whole prank is a giant delusion. He puts his friends through absolute hell and he laughs about it because he thinks it’s just a funny joke that’s going to make a great youtube video. He thought it was such a good idea he emailed his psychiatrist about it. Clearly, Josh isn’t a moron, if he set this out to actually hurt his friends, why would he tell anyone about it? But if it’s just a harmless prank, that’s something else entirely. And! Not a single one of Josh’s actions ends up killing anyone. That was never his intention. He genuinely believed this was all a fun joke they’d all laugh off and move on from.

Disorganized/repetitive Speech: The most clear cut example of this is the scene in the shed, but it can also be seen while in the mines, during his hallucinations. He starts rambling to himself in the shed, to the point where Mike & Chris even comment on it.

Suicidal Thoughts or Actions: (See above ^)

Aggression/Hostility: (See irritability above ^)

Depression: Josh has literally been diagnosed with depression and treated for it since he was 11 years old. Plus I already talked about this. Moving on.

Disorientation: Not only does his psych report state that he was disoriented when brought into the hospital, but we see this very clearly in the mines when Mike and Sam find him. (But that might have something to do with Mike having just slapped him while he was in the middle of vividly hallucinating his sisters).

ANYWAYS.

This was my long ass post on Josh’s mental health I hope u liked it 

Also if you need me to clarify anything lemme know !! I have a lot of personal experience w/ these mental illnesses so i’d be more than happy to explain something I might’ve forgotten :*

Anyways catch u l8r kids