Wear A Mask

Abert's Towhee Melozone aberti

You do not know what kind of rant demon you are summoning by opening this subject, but I love you for it.

I think your instinct is right on.

A lot of us are now familiar with the potential psychiatric diagnosis of "complex PTSD." Where current definitions of post-traumatic stress disorder focus on a single event taking place to cause the symptoms, with complex PTSD the diagnosis would encompass multiple events, long-term situations, and cumulative stress.

There was a time when I found the DSM's resistance to a diagnosis of "complex PTSD" to be fairly puzzling. It seems pretty readily apparent that long-term exposure to trauma creates a different thing than PTSD. I think the book The Body Keeps the Score is also pretty troubled about this, because what the author uncovered in a whole lot of pathologized people was a whole fucking lot of child abuse.

(Literally this seems to even have been a problem with Sigmund Freud; a current prominent theory says that his whole Oedipal Complex thing was a way to deliberately disregard the evidence of his female patients' sexual abuse.) (Link is to Wikipedia article.)

I also see kids with these absolute parades of diagnoses. IED, ODD, BPD, ADHD, depression, anxiety. Label after label after label. Dig even slightly under the surface, and you find: that child is... being raised by their grandparents! Adopted and abused in the first two years of life! Father in prison! Mom in prison! A morsel of meat being shredded between two vengeful parents in a horrible divorce! Problems suddenly started after a series of suspicious happenings with an older cousin! Constantly on marijuana! Subject to constant verbal abuse by stepmom! Witnessed one parent beating another on the reg! Take your pick.

A truly astonishing amount of the time, I end up feeling very strongly that the child should be diagnosed with "having a completely understandable reaction to genuinely horrible shit." It's hard not to start thinking "wow this all seems fake" when you get a kid with yet another arm-length dissertation of alphabet diagnoses and ONCE AGAIN you find the heinously obvious reasons behind them.

(Same with my adult clients, who have essentially fossilized versions of the same disorders. More likely to see bipolar and borderline, more likely to see schizophrenic.)

Ah, you say, Ryann, but what about the whole neurotransmitter thing? Depression is caused by low neurotransmitters, we've got that kind of cracked.

Actually, there are "huge bodies of evidence" showing that low serotonin in particular has no causal link to depression and that the affect on serotonin might not be (probably isn't?) why antidepressants even fucking work! (Best evidence: SSRIs and SNRIs work on neurotransmitters immediately, but take weeks or months to kick in to be effective against depression. Why?)

For a long time, I hung my hat on schizophrenia, actually. It's like, genetic, right? Surely we know things about schizophrenia. Surely that is real science. Surely that isn't just a response to trauma!

Well, um. You can have genetic and environmental things that predispose you to schizophrenia, but actually, as my therapist informed me, it tends to actually show up when there's a history of trauma.

This has led to me feeling pretty strongly that the DSM's method of diagnosis is wrong from jump.

Metaphor with me for a moment about the DSM and its diagnostic methods.

Now we all know of the diagnosis of Stuffynose, correct? It's when your nose is stuffy. It's an ailment that's pretty common. Most adults experience Stuffynose several times in their lifetime. There are two main treatments for Stuffynose. The first is antihistamines; the second is decongestants. Doctors are very divided as to the uses of these two medications. Studies show that both of them are more effective than placebo in the treatment of Stuffynose. If antihistamines work, you might have to be on them for the rest of your life. If decongestants work, you're out of luck after a week or two, because they can be dangerous if taken too long. Hopefully that fixes the problem! What? What's a "cold"? What is "flu"? I've never heard of these things. Yes, Stuffynose can sometimes cause a sore throat or coughing. Stuffynose is related to fevers sometimes, but we think that's just an overactive bodily response... Yes, Stuffynose can sometimes be fatal. Listen, the insurance company doesn't cover "surgery" for a "deviated septum" or for "cancer." Likewise, "environmental allergens" aren't something we check for. Thank god we live in the modern world and we've taken care of a lot of the stigma surrounding Stuffynose!

Me. That's me, w/r/t diagnoses of depression and anxiety and frankly most everything else. It's like personality quizzes. If you divide people by any quality and then make that quality a Category, you've created an Identity, not (not just?) a diagnosis. If everyone who likes candy and reads a lot of books is a Sweetreader, you'll now have a whole lot of people identifying as a Sweetreader and being like "omg trying to pass by the Nerds gummy clusters without buying any... #SweetreaderLife" while the Meatjocks are out there having a cookout, typical #meatjock behavior! Obviously DSM diagnoses are much more specific than my Sweetreader/Meatjock dichotomy but I think the tendency is very much there. So here's the thing. I don't think the reluctance of the DSM to acknowledge complex PTSD is puzzling anymore. I think there might be some people there who, overtly or subconsciously, recognize that they are playing Barbies with fake words and fake diagnoses and fake concepts, and that if they add complex PTSD, the whole party is over.

The minute you add complex PTSD, you are acknowledging that it isn't the individual person that's sick. It's their circumstances. It's society.

It's not a defiant child, it's not an explosive child, it's not a child with baby bipolar disorder but we can't call it yet so we call it something else: it's a child with developmental challenges and unlearned skills (THANK you Ross Greene PhD and your book The Explosive Child), or it's child abuse.

And currently the whole goddamn burden of identifying and dealing with developmental challenges, unlearned skills, and child abuse is on our schools, which are equipped for like 30% of that list. I think there is an absolute epidemic of unnamed child abuse in this country, some of it based on the absolutely predictable results of the war on drugs constantly depriving children of their parents (either through being high, drug-seeking, going to ineffective rehabs, being jailed, or doing fucking terrible things because of the shit they're in up to their neck or how much brain damage they've inflicted on themselves). The rest is screens and devices being heinously bad for neurological development (children must be SPOKEN TO in order to turn into people in a developmentally appropriate way!!) and constant parental supervision taking away all opportunities to learn self-sufficiency, self-regulation, and problem-solving.

So of course we pay teachers handsomely to help us raise the next generation of good citizens with so many disadvahahahAHAHAHA AGHHHHHH

So I dream of a day that we have a different paradigm for diagnosing mental illness entirely. In the novel I work on occasionally, when I have time and brainspace, Martian culture in particular diagnoses by picking out areas of the brain that are under- and over-active and using direct stimulus (like a far more advanced version of Transcranial Magnetic Stimulation, a process I have actually undergone myself to unbelievably cool results) they will help the brain strengthen itself.

There is also some good news about antidepressants: the way they work might be in enhancing neuroplasticity, giving the brain more flexibility to heal itself. That's really cool and interesting to me, because it's like -- humans found ways to unlock our own powers of building ourselves and our identities and it fucking?? works???

The Explosive Child by Ross Greene saved my childhood, no joke.

I was in late elementary school when my social worker recommended it to my parents and the difference it fucking made!

All of a sudden, instead of punishing me, my parents were working with me? And we were coming up with plans and solutions together? And I wasn't being punished. And we retired the idea that being told "use my words" was productive or useful. It was amazing to feel like my parents were actually listening to me instead of insisting on the impossible.

we got an hour long infodunp about dungeon crawler carl, the author, the story, all of the adaptations and which are the best, the voice actor who reads the audiobooks, how much the kickstarters raised, I mean EVERYTHING

gentle attempts to widen the scope of the conversation into things like "the phenomenon of lit rpg in general" were very strongly resisted so after a while we just stopped trying and just nodded and Reacted to what he told/showed us. and then after he left we absolutely lost our shit about the Unskippable Dungeon Crawler Carl Nurse Cut Scene

i feel like when I talk about social skills I have learned I often focus on, like, things that are perceived as autistic deficits and how I compensate for them. that's true, I have worked a lot on those things. but also VERY IMPORTANTLY, along with the skill "remember to take turns in a conversation and ask the other person questions back," there is a parallel skill of "understand that incidents of failing to do this in a conversation are not malicious"

I try to think of being patient and friendly during an hour long infodump about something I'm not particularly interested in as a gift that I can give someone. it's annoying but it isn't hurting me. sometimes people have weird communication days just like they have weird hair days.

I understand that it is important to try to have reciprocal conversations where I show interest in other people and actively listen and ask questions about them. I also have a few friends who don't have that skill. they'll just talk about themselves. so a skill that *I* have learned is to pretend they have asked me about myself and respond as though they have. they'll say some things about them and their lives, and then I will take the initiative to share stuff about my life. this was difficult for me for a while because I felt like if I wasn't explicitly invited to say something or asked about myself that indicated a lack of interest. it usually doesn't. my friends who don't have that particular conversational skill respond to my spontaneously listing all the stuff that's going on in my life/stuff about my interests/etc very positively. they like that I do this so they don't have to feel self conscious about having trouble remembering to ask me about myself.

i think that understanding different communication methods that may not be the extremely basic rote "take turns in a conversation and invite people to talk about themselves!" type stuff is a VERY important social skill. and tbh? goes along with trying to give people grace and the benefit of the doubt/good faith/whatever.

i think that outlining what "usual" conversational expectations are is helpful bc people may not understand why they get the reactions that they often get from others during or after social interactions.

i also think it's not great to frame it like "if you don't do this you're Rude and Bad and it is correct that people do not like you"

something can be broadly understood and experienced as inconsiderate and ALSO be something someone can't help. we can learn to compensate for some things to the degree that we are able and I think it is important to try and learn as much as we can about social interactions and expectations. and also, like... sometimes that doesn't look like "I simply know now that interrupting people is rude and elect not to do it"

Interrupting people is the conversational issue I still struggle with the most. i know ! its bad! to interrupt! and also sometimes i just do. so part of "compensating" for me is knowing when I do it (something it sometimes takes effort to spot in the moment) and making dure to say "I'm so sorry, I interrupted you, what were you saying?" when I do

if "knowing most people find it more Socially Correct to ask questions -> get asked questions in return" is information that someone can possess about socialization, then "some people's brains don't really work in a way that makes doing that intuitive. they may not do this in conversations and it is not malicious" IS ALSO information you can know and SHOULD APPLY to your interactions

i have been seeing an increasing number of like "y'all don't know how to act/manners are important actually" posts and like... i agree... they are. and also it's important to not end up just sounding like we are ABA practitioners because I will be so real, some of these posts are pretty much an ABA hand out 😬

In many draconic cultures, the Hroom marks a dragon’s coming of age, a time to recognize that a dragon is now of a proper age to hold a weapon and defend itself. Some dragons believe that it is only by bonding with an elemental spirit that a dragon has a soul, and that a dragon is only a whole dragon when it has both the mortal shell and the inner spark.

Metaphorically, yes. One dragon had married the witch she brought back to her clutch, and she said that meant their two souls had become one, which was basically the same thing.

This means:

If you draw a hard line between "drug" and "medicine" based on current legality where you live (or any other criteria) you've gone wrong somewhere,

If you think legality and/or prescription status tells you all you need about a substance's capacity to do massive harm to someone's body, mind or well-being you've gone wrong somewhere,

If you think legality and/or prescription status tells you all you need about a substance's capacity to contribute meaningfully to someone's healing, function or happiness you've gone wrong somewhere,

You should be able to add anyone you want on your health insurance plan.

You should be able to sponsor the visa of anyone you choose to move to your home country.

You should be able to name anyone you choose as the legal-from-birth legal coparent of any child you give birth to.

You should be able to apply for student aid on your own at any age.