look at the skill and spirit

Sign of spring (Detail)   -   Kaii Higashiyama

Japanese, 1908-1999

So, my insurance has been trying to not cover my SNRI because it is new on the market and no generic available yet, so pricey.

I apply for a refill and the request gets locked for review. Again. For the 3rd time.

This time I call and immediately ask to speak to the actual doctor making these clinical decisions. Very politely. Must be a slow day because they allow it.

ME: [Teacher voice] I'm calling in regards to the SNRI you have placed a lock on. Why was this decision made?

DOC: Well, there are dozens of other medications on the market in that tier, and far cheaper for you and [insurer]. We have sent a request to your doctor to consider alternatives.

ME: I am aware of that. So, can you do me a HUGE favor and look up my prescription history really quickly and tell me how many SSRIs and SNRIs were only filled once in 2022 for me, showing they were poorly tolerated?

DOC: It looks like eight.

ME: Great job! Now, can you please look at my genetic test for psychiatric drug tolerance and tell me how many medications are listed in the safe category?

DOC: Two.

ME: Awesome! Now, can you tell me what type that other drug is that I'm not taking?

DOC: Yeah, totally, it's an MAOI.

ME: That's correct, you're really knowledgeable! Should I be taking something as dangerous as an MAOI with my other medications, or even just in general?

DOC: It's contraindicated for sure.

ME: It is! So true! So, last question since you've been incredibly smart and helpful. Is it less expensive for [insurer] to pay out for the medication knowing they already get a huge manufacturer discount anyway, or is it more expensive for them to pay for me to need potentially long-term inpatient psychiatric care?

DOC: I'll clear the code, ma'am and flag it as medically necessary. I'm sorry about this.

ME: I appreciate you SO MUCH. You have a great day now.

The acronym is unfortunately named, but what can you do.

Anyway, this very much IS a cycle in my experience and this describes a lot of the things I have noted over the last few years of trying to figure this stuff out, although as always not everything described herein is something I co-sign. I especially like:

Emphasis on nonjudgmental evaluation of one's own needs & capacities

Importance of connection

Role of curiosity/inquiry in assessing how one is framing one's own identity & how trauma informs that

Focus on increasing awareness of one's own internal processes

The way these are all framed as goals that build on one another rather than Mandatory Steps

That last one can trip people up sometimes I think, bc it's easy to get stuck in. Its important to install brakes/gears on that one so that you can shift out of self analysis mode and reconnect with being present in your own body (also emphasized in this model!)

The resurrection of the Teacup Demon pup pattern is complete! I remember how to make them after a day of messing around. Now you can customize your own little tiny hellion.

For now, I'm just offering pups, but I will probably move on to the full-size demons and the full-size but munchkin-legged ones too :)

All the details are available in the listing, let me know if you have any questions!

by Rainer Maria Rilke tr. Joanna Macy

Quiet friend who has come so far,

feel how your breathing makes more space around you. Let this darkness be a bell tower and you the bell. As you ring,

what batters you becomes your strength. Move back and forth into the change. What is it like, such intensity of pain? If the drink is bitter, turn yourself to wine.

In this uncontainable night, be the mystery at the crossroads of your senses, the meaning discovered there.

Bodily autonomy (like abortion, anti draft, etc) -> “The government shouldn’t be able to force anything on my body I don’t want.”

Anti surveillance -> “I don’t trust big government/big tech (big brother if you’re feeling frisky) with the ability to spy on me and my family.”

Immigration -> “Next to all of us immigrated at some point, I don’t see why the elites get to decide who’s allowed to be where. What’s to stop them coming for me?”

Climate Change -> “Big oil shouldn’t get to determine whether or not I get to go places. I don’t want to be dependent on some big business to survive.”

State Violence -> “I don’t want the goddamn secret police breathing down my neck! I trust my community a whole hell of a lot more to help me than I do the state!”