I’m going to try and write this as coherently as possible. We still have one more week left of Mental Health Month, and this Thursday, Friday, and Saturday (given my brain doesn’t melt from out of my ears) we will be covering the last stretch of diagnoses we could fit in this month: Somatic disorders, eating disorders, and depressive disorders. If you have a story you’d like to share about any of the labels we’ve covered this month, contact me here or on my social media handles (below).
This evening we’ll be covering Substance-related and addictive disorders, with “substance related” excluding any of the typically prescribed psychotropic medications. That seems like a given, but it shouldn’t be; a lot of psychotropic meds can induce mania, depression, panic, and psychosis. This often gets labeled as proof of a disorder, but in the future when we dive more deeply into what kind of industry this is (and how helpful it can be in many circumstances), we’ll talk about how that’s bullshit.
To be frank.
But for now, we’ll talk about what they want to talk about, and that is the illegal substances no agency can make money from.
What we’re talking about here is the big ten: Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids, Sedatives, Stimulants, Tobacco, and unknown.
In order to be classified under this section, an individual has to continue using their choice substance even while recognizing (or not) significant substance-related problems. This is like the alcoholic whose doctor says their liver is fatty and swollen (a sign of cirrhosis) and despite the eventual fatal outcome, the alcoholic continues to drink. This could be because of many reasons. It could be the person is psychologically dependent on the mood alteration provided by the alcohol. Drinking may be the only way to feel “normal” by then. Physically, the person may be dependent on the resulting biochemical reactions of heavy drinking; stopping alcohol suddenly is the same death sentence as cirrhosis of the liver, but quicker. The body becomes so dependent on the substance that the removal of the substance puts the body (the brain mostly) in shock. This is called withdrawal.
It’s the same thing you experience if you stop your medication suddenly: your brain, having gotten used to whatever receptors that medication was binding to, suddenly has a stark depletion in that neurotransmitter and this can cause irregular electrical activity, mood changes, physical changes like heat flashes, cold sweats, muscle aches, etc. Your brain is constantly seeking homeostasis and there are two ways this gets disrupted: ingesting a substance and stopping a substances after long-term use. For those of us who stop, say, antipsychotics, the psychosis that presents itself is not necessarily what would happen if you were substance free. It’s not your “illness coming back”, its the disruption in homeostasis exacerbating your experiences.
Alcohol withdrawal is one of the most dangerous withdrawals and, if I’m still up to date on all my medical understanding of this, the only one in which you have a high chance of dying. I believe it surpasses benzo withdrawal risk. Those in severe Alcohol withdrawal will typically experience Grand Mal Seizures alongside all of the other mental and physical experiences.
Benzodiazepines are some of the quickest addictive substances prescribed. Even if you don’t feel psychological dependent on them, you may realize quite suddenly that your body has become very accustomed to them. Some people have stated that even when taking two of their PRN Benzo medication per week for four weeks, their body went through physical withdrawal. The problem with that is benzos also work on GABA receptors, like alcohol. This is why Benzos are often a first choice in easing alcohol withdrawal.
It’s kind of like when they learned Morphine was addictive and synthesized heroin to use as a replacement. That backfired. We just don’t learn.
You can read about that in short-form here. There’s a much more in-depth, dependable review on the history of this on PubMed, I’ve just yet to find it again.
Stimulants, like cocaine, are not addictive as quickly but people still lose their lives to them. They target chemicals like dopamine, serotonin, and norepinephrine, all that handle feelings of pleasure, confidence, and energy.
Opiates target Endorphins, which inhibit both GABA and Dopamine. This stimulates the receptors to increase the amount of dopamine that’s released because there’s not enough in the synapses. This is the same chemical that releases when you exercise.
I’m not up to date on Inhalants, but I’m going to go ahead and say breathing in condensed chemicals probably tears a few cells up in the process.
Hallucinogens, including Acid, are some of the safest drugs, if you want to think of them like that. They still affect the body; some raise blood pressure or cause a racing heart, but their addictive properties are non-existent. These are being studied currently to treat depression, PTSD, and anxiety which means at some point they’ll be monetized, synthesized and eventually ruined. Many have had profound experiences though, and worked through trauma while micro-dosing LSD or being a risktaker and experimenting with one of the most powerful hallucinogens, Ayahuasca. These substances have a rich history in religious ceremony.
Tobacco and Caffeine are very much legal. Tobacco, once used in abundance as a smoking agent, is now full of carcinogens and heavy nicotine doses which trap the user in one of the hardest addiction cycles to break. Caffeine perpetuates anxiety, raises blood pressure, and is also great on cold mornings with a cigarette. So, pick your poison.
The majority of them, yes.
No, that does not make them safe.
Yes, many are not safe in part due to what people put in them.
No, I don’t suggest traveling to South America just to chew on a coca leaf.
Yes, if I didn’t have such bad anxiety, I’d probably be one of those people to travel to South American just to chew on a coca leaf.
Some people can, and do.
This is not a problem of disease. It is, however, a problem of weakened and exhausted self-control. This sounds as if it is blaming the user, but it is not.
There was a study I just learned about in a previous course where they tested individuals self-control and whether it could be exhausted. They set a task in front of a set group of people, one by one, and told them one specific instruction: do not eat the cookies, but feel free to have some of the radishes. They set the same task in front of another set group of people, one by one, and told them one specific instruction: have anything you want on the plate.
Those who had to exercise their self-control (by not eating the cookies) had less patience when it came to do the second task, which were some puzzles on paper. Those who did not have to exercise any self-control maintained their base awareness.
This is one of many tasks that shows it may not be indulgence that starts or continues an addiction, but rather a consistent breakdown of self-control; once someone uses a substance, they have went against the cultural norm to NOT use that substance. The physicality of the drug doesn’t make the second time easier, the reduction in self-control does.
There are many ways to continue to test this and could revolutionize how addiction is treated and looked at. It’s not the fault of the person. It’s not a defect in will-power or a weakness. It’s simply exhausting your bandwidth of self-control, which we could all easily do. That’s why addiction has no preference for creed or color.
Some may be genetically predisposed to a shorter self-control bandwidth, not addiction. This is my hypothesis. It’s not disproven, and it probably won’t be any time soon, not by me at least. But having grown up with generations of severe alcoholics behind me, one of which died at 56 because of it, I know what it’s like to feel like your genes might be defective. The truth is, at least between fathers and sons, sons of alcoholics are no more likely to become alcoholics than the average man.
I’m a woman, so I’m not sure of our statistics.
When I was prescribed Percocet for my back injury, the first pill did nothing. So I took two. And had no idea how hard it would hit me. I remember sitting in my research course and the room feeling light as air. My body felt warm and nice and I felt kind, friendly, approachable. I felt social, something I never feel. Then I spent forty minutes trying to keep my eyes awake and my notes were just scribbles. By the end of the class, I’d written nothing worthwhile, and my back still hurt.
But coming out of that I realized how people could get so attached to the feeling. It’s a level of happiness one couldn’t attain naturally, and evolution probably derived that limit for a reason. We’d have no sense, no awareness, no anxiety, no fear. We wouldn’t survive as a species.
I also noticed my need to take more. I told myself no.
I told myself no for two months.
And then I rewarded my self-control with a lack of self-control and two months later my stomach was tore up, I felt I couldn’t make it through the day without at least a half of pill, and I was becoming increasingly dissatisfied with my own natural state of being–the state without the high.
I went into this experimenting; if I focused on my self-control, designated days to take one pill, two pills, a half a pill, one and a half pills, could I sustain myself without becoming attached? And I did for one month until I exhausted that bandwidth; the more times I told myself “no” and then “okay, just take half”, the more likely I was to say “well, half isn’t going to do it, take one and a half.”
So, another way to evaluate this hypothesis would be to ask: is someone more likely to become addicted if they exercise self-control or no self-control? We couldn’t run those trials ethically, but there may be a way to design an experiment without ruining people’s bodies.
I was not addicted. But I felt the pull.
This can happen to anyone, for any reason, at any time, and it’s not a sign of internal weakness or brokenness or some other negative connotation that gets thrown alongside these experiences. We are creatures who often want to alter our moods. We want our anxiety to stop, our depression to ease up, our happiness to never end. We’re a culture ripe for the course of addiction. Think twice before your blame someone for their experiences.
I’ve never been. They didn’t work for my dad. But they work for many. Some people embrace the programs, like 12 Steps, and swear by it. Others find a different path. Some find no path and succumb to the substance. I’ve only been to an Alanon meeting for myself with a previous therapist and it felt too programed. I’ve went to AA and NA meetings and the cult aspect of it gave me panic attacks. But for those who felt truly touched by the program, there were many success stories and as long as people are living the life of health that they want to be living, I’m not going to knock that.
What about it? I hear many people learn new things from their relapses. Don’t get me wrong, these slips can and do kill people. But to regress and then progress and regress again only provides a new insight to the self and a different perspective on life. Relapse is slowly being seen as a natural progression of addiction rather than an added failure of the person.
If we take away the aspect of death (not to minimize it, but for the purpose of this thought experiment) we can think of it as experiencing another depression episode or psychotic episode. We learn more about how we need to care for ourselves. We may have a new respect for friends and family who come through for us. We can look back and see where we slipped up in self-care or evaluate an incident that lead to our regression.
We all fall back into things we don’t mean to. And when we learn to stop attacking ourselves for mistakes we make, we may just give ourselves a chance to heal.
I will be back with Somatic disorders on Thursday. Although, keep your eye out for a post on something a little more personal. I feel the need to express feelings through words. Thank you for reading.
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If this was a full-time position, I’d be fired by now.
I am struggling cognitively in a way that I haven’t in a few years. Writing is difficult. The post on Substance Use will be tomorrow evening after I get off work, granted my mind does not melt from my ears between right now (10pm) and 7pm tomorrow.
You all have been so patient with me, so kind, and have been thoughtful readers.
A big welcome to the many of you who have followed recently in these last three weeks. We will be on a grand writing adventure together.
Until tomorrow, friends
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Hey everyone. Welcome to this hour of Mental Health Month. Upon checking my notes, I realized I’ve completely skipped the week of the 18th, where we cover Somatic disorders, eating disorders, and depressive disorders, and went straight into the last week which covers Gender Dysphoria, Neurodevelopmental disorders, and personality disorders. So, I’m switching things around a little.
Yesterday we talked about Gender Dysphoria, the meaning of tolerance, and the realities of biological humans–that is, a brain can indeed develop specifically toward a different sex than the sex of the body. Today, we’re going to talk about Personality Disorders. Tomorrow we will cover Substance-Related and addictive Disorders. The following week will be Somatic disorders, eating disorders, and depressive disorders. We will include Neurodevelopmental disorders on the last day of the month so no one feels left out.
If you want to share an experience you’ve had with any of the above conditions, or even ones we’ve already talked about, feel free to contact me here or on my social media (profiles below).
Now, we come to my favorite section of the DSM-5, with one of the only disorders that has been characteristically diagnosed unreliably–that is, psychologists often come to same conclusions on other disorders but can never quite agree who has this one– and with little to no genetic influence detected. I’m, of course, talking about Borderline Personality Disorder. We’ll get to that shortly. 761
Because personality disorders widely controversial, the DSM constructs this section completely differently. First they describe personality disorders, clinically, as a discrepancy between a persons inner experience/behavior and the expectations of their culture. This is stable over time and generates impairment.
Then, they mention because of the “complexity” of the review process (this is a fancy way of saying because research that correlates these labels with “disordered brains” are inconclusive and scarce), they have split the personality disorder section into two. The second section updates what was in the DSM-4-TR, and the third section has a “proposed research model” for diagnosis and conceptualization.
Personality disorders are separated into clusters still. Cluster “A” disorders are:
Paranoid Personality Disorder: this includes someone with a “pervasive distrust” of others. People’s motives are perceived as malevolent and the individual has a preoccupation with doubts about people’s loyalty, and trustworthiness. There is a constant level of perceiving personal attacks where attacks are not intended and believe that others are exploiting them. This cannot occur during schizophrenia or any other psychotic disorder, including Bipolar mania. They may, however, experience brief psychotic episodes that last minutes or hours. I’ve always thought of this disorder as a miniature schizophrenia.
Schizoid Personality Disorder: This one is actually less harmful in terms of relationships because the person does not form close relationships and has no desire to do so. Not quite sure why that’s a problem. But, they have restricted range of expressed emotions and chooses solitary activities. They may be indifferent to praise or criticism and has a flattened affect. I’ve always thought of this disorder as the negative symptoms of schizophrenia, plus one.
Schizotypal Personality Disorder: This includes issues with close relationships as well but includes cognitive distortions, ideas of references but NOT delusions of reference, odd beliefs, bodily illusions and odd thinking. Paranoid ideation and constricted affect are also included. This cannot occur during the course of other psychotic disorders either, and is probably more of a mini schizophrenia than Paranoid Personality. People often seek treatment for the anxiety and depression rather than their thoughts or behaviors and they may experience psychotic episodes that last minutes to hours.
Cluster “B” Personality Disorders are the ones everyone wants to get their hands on.
And by hands on I mean “grasp an understanding of.”
And when I say Cluster B personality disorders, I really mean just the first two. The others no one seems to mention very often.
Antisocial Personality Disorder: This is not sociopathy. Sociopath isn’t even the correct word. Psychopath is. But that’s not who these people really are. We’ll talk about The Dark Triad next month. It’ll be great fun.
Those diagnosed with Antisocial PD do share some things with clinical psychopaths though, and that is their unyielding disregard for other’s natural rights. This includes breaking the law remorselessly, lying, conning, and being otherwise deceitful for fun or personal gain. It also includes impulsivity, aggressiveness, disregard for other’s safety, and irresponsibility. People must be 18 years old before this diagnosis is concluded and must have evidence of a conduct disorder before 15 years of age. None of these criteria can occur during schizophrenia episodes or bipolar episodes.
Borderline Personality DIsorder: This is the controversial one. It’s described as instability of relationships, self-image, and affects, with a sprinkle of impulsivity and efforts to avoid real/imagined abandonment. Individuals may also be impulsive with self-damaging activities, like reckless driving or spending, binge eating, substance abuse. There may be reoccurring self-mutilation and emotional instability around irritability and anxiety that lists a few hours and rarely more than a few days. Feels of emptiness, intense anger, and severe dissociative symptoms may also occur.
The dissociative symptoms should give a clue to what is one of the number one correlations with this disorder.
75% of diagnoses are female. And with every clinician learning that statistic, more females are likely to be diagnosed with it than actually have it. Across cultures as well, according to the DSM, it is often misdiagnosed.
Histrionic Personality Disorder: Not a commonly heard one, but in reading the description you might think you know someone with this personality type.
These individuals are attention seeking excessively, and very emotional. They need to be the center of attention and are often seductive. They have rapidly shifting expressions of emotions and their speech lacks detail. Everything is a theatrical display.
Narcissistic Personality Disorder: The second of the Dark Triad, which we will talk about next month. This is a pattern of serious grandiosity, fantastical or in behavior, and a need for admiration. There is a severe lack of empathy and these individuals generally want to be recognized as superior without reason. They are obsessed with fantasies of unlimited power, love, beauty, and success. An individual may believe they are inherently “special” and are insanely entitled. They are arrogant and envious.
50-75% are male. Again, these numbers also make it more likely they will be diagnosed with this.
Cluster C Personality Disorders are on the softer end of the spectrum. Softer not in intensity, but in personality. These are the people certain Cluster B types would take advantage of easily.
Avoidant Personality Disorder: This is someone who feels inadequate and hypersensitive to criticism, so much so that they avoid anything that may make them feel inadequate. This includes social gatherings, work, and any other interpersonal situations.
Dependent Personality Disorder: These individuals have a pervasive need to be taken care of. This may lead to serious submissiveness and clinging behavior. They fear making others feel bad, and so they will not disagree with people. Initiating projects on their own is hard, and seeks another relationship as comfort when another relationship ends.
Obsessive-Compulsive Personality Disorder: This is kind of like the umbrella diagnosis of OCD, but more inclined toward only orderliness, perfectionism, interpersonal control, and lists. They really like lists, rules, and organization. Money will be hoarded in case of catastrophe and they may be inflexible about morality, ethics, and values.
There are other personality disorders that may be due to medical conditions or are unspecified/otherwise specified.
Well, what isn’t up with Borderline Personality?
It’s been the hot button in clinical psychology because of the intensity of emotions these individuals feel. It often results in some psychologists refusing to treat people diagnosed with these conditions. Two out of my six therapists have told me some version of a “horror story” of an anonymous someone diagnosed with BPD who stormed out of an appointment or blew up in anger and then stormed out of an appointment.
I feel this attaches a very negative connotation to this set of experiences. Everyone expects the outbursts, the sudden changes, the unruly emotions, and so when they happen it’s just more affirmation that the individual is out of control. Self-expectations and other’s expectations can play a huge role in behavior, even in those with this condition.
The problem is, psychologists actually really struggle in diagnosing this. Back in my research course I learned that studies showed psychologists are quite confident when they make the diagnosis, but when other psychologists evaluate the same patient, they often don’t come to the same conclusion. This is in comparison to someone with narcissistic personality disorder, where most psychologists came to the conclusion that that diagnosis was fit for that person. This could be for many reasons: the background of the psychologist, the presentation of the person, the interpretations of the psychologist. It could also be, though, that this condition presents varying experiences and that makes it harder to recognize patterns.
Borderline Personality usually comes with a decent set of childhood trauma. This article from 2017 talks about how childhood trauma can affect biological systems that are then connected to the development of borderline personality. This article from 2014 talks about Complex PTSD (which is not a DSM diagnosis) and Borderline personality. CPTSD overlaps a lot with Borderline, and so these researchers question the scientific integrity of CPTSD and the role of trauma in BPD.
It could be that we’ve had it wrong this whole time, that BPD is not in fact a personality “disorder”, but instead a trauma response condition. This switch would require absolute links between BPD and trauma, the likes of which would match with PTSD, and right now we have no absolute links for any mental health anything. So let’s not hold our breaths.
The point is, the experience of BPD are very real. The label and possible cause mean nothing when someone’s life is turned upside down, when relationships are constantly crumbling, when someone blames themselves constantly for “not being normal.”
Let me re-frame: the possible cause is important in the sense that it could change how treatment is approached. But it is not more important than affirming people’s experiences. Right now treatment for BPD includes therapies in which the individual learns to recognize, label, and acknowledge when their emotions are exaggerated, and medications normally meant for other conditions. There are no medications registered solely for the treatment of BPD.
People often see this as a hopeless diagnosis. Because of this, I encourage people to read personal stories from people diagnosed with this condition so you can see that many of these individuals are creative, vibrant, determined, beautiful people in many ways. There’s one personal story and one more here to get you started.
Well, one’s in the DSM-5 and the other is a checklist, for starters.
Psychopaths often lead pretty normal lives. The likelihood that you will see them in a therapists office or in the cell of a jail getting diagnosed with something is very, very slim. They are charming people, do very well in life, and no, they are NOT only serial killers. That’s romanticized Hollywood bullshit. They will manipulate, remain remorseless, and often create an abundance of wealth for themselves. C.E.O’s can score quite high on the psychopath checklist.
People with Antisocial Personality have trouble leading normal lives and can find themselves in trouble. They may be erratic and rage-prone, which can catch quite a lot of attention.
Criminals, like gang-members, are not necessarily psychopaths or antisocial. The DSM mentions that Antisocial may be misdiagnosed if someone is fighting for what they believe to be is their survival. Often gangs are comprised of people who feel close to the other members and consider them family, people who believe they are fighting for “the principle of the matter”, for honor, for integrity, for power. They know their lifestyle inflicts violence and fear, but believes there is no other way to live. They are willing to die for their street family.
That is the opposite of antisocial. It is criminal, but not abnormal given the circumstance.
Some people with antisocial personality are also psychopaths. Some people who are psychopaths are serial killers. Both overlaps are rare.
You are safe.
If anyone watches SBSK on Youtube with Chris, they did an interesting interview with someone diagnosed as Antisocial. You can watch it here. Again, sociopath is a clinically incorrect term.
Please. Stop using it.
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If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue encouraging critical thinking about psychology.
I’m hoping to write this Mental Health Month post with as much care and thoughtfulness that has been given to the other diagnostic labels we’ve covered this month. I am in severe back pain and terrified of going to Urgent Care in fear they’ll label me a drug addict. I’ve been accused of using meth by doctors in the middle of a panic attack, had my blood taken against my consent, and already had a Percocet prescription filled three or four months ago when I first injured my back. I did well, didn’t need the pills, got into physical therapy, but all of the stress and mental deterioration has set my back aflame. Severely.
I thought about postponing this post tonight because my mind is defeated. But I fear people will assume I’m giving unfair and biased treatment to Gender Dysphoria, as people who struggle with it are often treated unfairly and forgotten. My voices were having a nice time watching my suffering tonight. They told me “look at the fun we’re having!”
I’m defeated and emotionally fragile.
But tonight, we talk about Gender Dysphoria as a label and also as an experience.
There is only one diagnosis of Gender Dysphoria in the DSM (besides the unspecified/ other specified category) and that is called, well, Gender Dysphoria.
In simple terms, Gender Dysphoria occurs when someone (child or otherwise) feels their biological sex is incongruent with the gender they identify with. In children, as well as teens and adults, this must be observed for at least 6 months. Criteria includes a strong dislike of one’s sexual anatomy, a strong desire for one’s body to match one’s experienced gender, cross-dressing and insistence that one is different than what they have been told to present as.
To be honest, I have no idea. Gender is indeed a construction, whether people want to believe that or not. We, as a society, have chosen what is masculine and what is feminine. This influences every facet of our lives, from the clothes we wear, the attitudes we bare, the emotions we stuff down, our careers. It even influences how well we do in math; girls are consistently praised less and encouraged less in elementary math. This is not on purpose, it becomes an unconscious habit.
People think that biological sex is black and white; you are either male or female. Hormones in development tell a different story.
Like the rest of the students who started college the same time I did, I was plunged into the diversity of people on campus. Well–gender diversity at least. There were more people open about their sexual orientation, their preferences, their pronouns. I didn’t care, honestly, if someone who presented as John wanted to be called Caroline and wear dresses. It really doesn’t affect my life. But I didn’t understand. How could someone feel like a different gender? When I was a kid, I preferred playing in the dirt and as a teen I preferred wearing baggy jeans and getting into fights. I made out with a girl in middle school. Did that mean I was supposed to be a man? What the hell was all this transgender stuff?
From someone who has never experienced Gender Dysphoria, let me tell you: it’s impossible to imagine how it feels. At least there’s a simulator for hearing voices, that can give a non-voice-hearer insight to what it feels like and sounds like. There’s no Gender Dysphoria simulator.
The depth of my outside understanding came from my Biological Psychology course my second semester of college. Sex hormones, in fact, have trouble making up their minds sometimes. Testosterone, for example, will get busy forming the physical parts of a man while Estradiol gets charged with forming certain pathways of the brain. Depending on the pathways that get more estradiol than average for what would be a biologically male child, the brain may end up having more feminine instinct.
That’s not exactly how it happens, but you get the drift: one hormone develops more in an area of the body while the opposite develops more in the brain. This has been documented. While I couldn’t find the great sources my professor from 6 years ago had–at least not publicly available ones–I did find this review that might be interesting to you. It talks about hormones, development, and further research specific to brain sex differences.
Gender Dysphoria does indeed appear to have biological and genetic connections. What is there to argue against?
It is, after all, in the DSM-5. In the DSM-3 it was considered “transsexualism” and in the 4th it was called “Gender Identity Disorder”. The name has been through many transformations but the fact is they still want to classify this as a medical condition. I’m not quite sure why.
I don’t see how normally developing hormones is considered a disorder. There are no malformations or diseases that result from your brain developing with more female hormones and your body developing with more male hormones. I see that those who are forced to suck back their truth in fear of condemnation, homelessness, violence, and rejection, suffer from depression, anxiety, and consistently die from suicide. That’s not a result of Gender Dysphoria. That’s a result of societal intolerance and ignorance.
Humans come out in variety. Inter-sex is more common than people think; people are born with two types of sex organs, or half of one, half of another, and you wouldn’t know who they are on the street. The internal fight that carries on with people stuck in a world that sees everything in black and white would kill the average person. People think that the rate of transgender transformations going up means the youth is being corrupted, that too many boys are being told “it’s okay wear a dress” and too many girls are being told “you don’t need to have children”. The reality is spaces are getting safer. People are coming out because they can now. People in their sixties are stepping into a freedom they’ve never had. Children are being raised to embrace their feelings rather than stuff them. Gender Dysphoria and Transgender individuals have been around for as long as your average man and woman.
Gender Dysphoria itself, in my opinion, shouldn’t be in the DSM-5. Instead, I vote for added Gender Dysphoria specifiers on things like depression and anxiety. Hiding inside of yourself can cause a lot of internal turmoil. The cause of the dysphoria, however, is not a disorder. We might as well label being human a disorder at this point.
I think parents get worried when their kid is learning about all these terms, like Non-Binary, Transgender, Cis, Assexual. They worry it will “confuse” them. And I think, as with anything, there are parents who go too far. Some pull their kids out of health class if they discuss gender differences, and there are some parents who force gender neutrality on their kids. None of this seems to help the cause either of them are so passionate about.
No one cannot hammer your kid into experiencing gender dysphoria.
You cannot force your kid into being gender neutral.
You can encourage them to express their feelings.
You can let them know that if they ever feel like they want toy cars instead of barbies, or visa-versa, that it’s okay.
Children will develop into who they are regardless of what you want from them–that is a given. It’s your choice to accept them, and their level of wellness, especially in the beginning, is in some way dependent on your acceptance. As they grow older, it’s then their choice to accept your position. Are you willing to risk losing your child, metaphorically and physically, just because you think stuff like gender dysphoria is some new-age hippie shit? That’s the question I feel parents should ask themselves.
I grew up hating anything girly. I refused to wear pink, yellow, or anything bright. I ripped apart every Barbie or doll I was accidentally gifted (the gifter not knowing my anti-girl tendencies). I had a collection of hot-wheels and other model cars, and all of the toys I played with were animals mostly, who’d i’d give voices and character to. I remember my mom asking me one day whether one of the toys was a boy or a girl and I shrugged and said I didn’t know. It didn’t matter. I wore baggy clothes, got along better with boys than girls (still do) and I greeted all my friends with a fist bump or one of those “masculine” hand shakes.
The point is, NONE of this resulted in me being confused about how I identify. I am comfortable with my biological, female sex. I have a boyfriend of 5 years, and am considering children in the future. I still dress in baggy clothes sometimes, I have a resting bitch-face I’m quite proud of, and honestly I had that problem guys do with women: I used to get friend-zoned constantly with guys. It’s a horrible experience. I don’t hesitate to punch someone in self-defense, but I like to have my nails done and my make-up on point and my club dress “lit af”.
Talks about tolerance and acceptance can’t turn anyone transgender or create true dysphoria. The arguments about whether people with gender dysphoria, and people who transition, are worthy of kindness is what’s going to confuse kids.
There are so many major points to hit with Gender Dysphoria. I can’t fit them all in this post. If you have more knowledge and experience than I do, please feel free to comment below, correct me, or contact me. If you want to share your story with Gender Dysphoria, let me know. I would love to put it on this site. Although it’s talked about often these days, it’s not always talked about in the right way. We need more voices and experiences to drive home that everyone deserves respect regardless of gender identity.
As always, thank you for reading. Please send good thoughts my way. Judging by the amount of mini breakdowns I’ve been having this week, it’s going to take a lot of self-love and self-care to keep me from going back on medication.
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As promised, here is last weekend’s OTHER Mental Health Month post. Tonight we’re talking about Dissociative Disorders.
You all know how this works: we talk about what the manual classifies as disorders, then we talk about the experiences. If you would like your mental health story (substance use and LGBTQ+ also!) shared on this site for Mental Health Month, contact me here, or reach me on my social media (linked below). People have seem to like reaching out through Instagram, and I enjoy talking with people. Feel free to contact me just to chat–that’s what’s been happening most recently.
Let’s dive into it.
Like Bipolar, this section is concise in the DSM-5 and tied deeply to studies in cognitive psychology, especially when it comes to the controversy of repressed memories. You’ll recognize the first diagnosis:
Dissociative Identity Disorder: This is not a light diagnosis to come by, although it has a wild history of it’s introduction into mainstream mental health. Formally known as “Multiple Personality Disorder,” DID is characterized with identity crisis. This means someone’s personality states are split into two or more, and can affect memory, behavior, perception, cognition, and other senses. This can be reported by others, or noticed by the individual themselves. Gaps in memory of trauma or everyday events may be obvious. This, obviously, must cause severe distress. We’ll talk more about this below.
Dissociative Amnesia: This is also related to trauma. The individual will be unable to recall autobiographical information related to a trauma or stressor. This is not the same as being stressed out and forgetting your keys. The forgetting must be above and beyond that of ordinary memory decay. This can be with or without dissociative fugue.
Depersonalization/Derealization Disorder: Depersonalization is feeling detached, or outside of your body observing your thoughts, feeling, and bodily sensations. Things feel unreal, your self is absent, and your sense of time is distorted. Derealization is a detachment with respect to what is around you: objects, people, feel unreal, wrong, or are distorted. You do not leave reality but this does cause distress and impairment in everyday life.
Other Specified Dissociative Disorder: Mixed symptoms of the above types.
Unspecified Dissociative Disorder: People experience characteristics of the above, but none of it meets the full criteria. Again, your normal is disordered.
This is the big question everyone asks.
I don’t refute people’s experiences. If someone tells me they have 25 different personalities, I’m not going to sit there and tell them they don’t; I’m not inside their body or their brain, and I haven’t lived their life. And it seems in the science community that experiences aren’t being question either, but rather the onset of symptoms comes into question. So, let’s talk about what we DO know.
So, in the spirit of respecting those who know this to be their experience, and also respecting cognitive science which shows it may be possible to create these personalities in therapy, I looked up an article that compared the two causes of DID: Trauma Or Fantasy? I can’t link the study because I downloaded it from my school’s database, but if you’re interested in reading it, contact me.
Researchers compared four different groups: Genuine DID diagnosed individuals, DID simulating individuals (people acting), people with PTSD, and a healthy control group (“healthy” meaning unaffected by a condition). Long story short, results showed that those in the Genuine DID group were not more prone to suggestive memories nor were they more likely to generate false memories. There are some limitations with this study, one being that it was a small group of people and that their malingering results came back inconclusive; I didn’t see them list any reasons for this. They used reliable and valid testing measures, but didn’t experiment, which is a big problem if they’re really trying to challenge the fantasy model of DID.
The point of all this scientific arguing? People’s experiences are people’s experiences. I honestly don’t care if a therapist put it in your head or if you actually went through a horrific trauma. The point is you’re distressed, you’re suffering, and no one needs that in their life. As far as experience is concerned, DID is as real as any other condition.
This is a hard question. When it comes to DID, it’s highly unlikely those series experiences are going to come after something like your verbally abusive dad. I’m not saying it can’t, we don’t know everything there is to know about the brain or how it processes things that harm us, but it is unlikely. However, derealization and depersonalization are common in people with anxiety and PTSD.
My second depersonalization episode happened when I was 15. I remember (and there’s a chance I’m remembering incorrectly, remember?) sitting in the passenger seat of my mom’s car as she drove me to school. I usually rode my bike or walked, but it was raining particularly hard that day. I felt myself floating, my spirit, and I was leaving my body. The inside of the car didn’t feel real, my arms didn’t feel real, and the experience of life wasn’t real. I told my mom, I said, “see, there it is again, none of this feels real. The car doesn’t feel real. It’s weird.”
I don’t remember if she said anything. But from that point on, dissociation became synonymous with living for me. I walked across four lanes of traffic and the three miles home with friends shouting at me, shaking me, calling my name, and I was lost in a void. I don’t remember them shouting at me. I don’t remember them touching me or that I’d narrowly escaped death. What I do remember is blackness. Becuase that’s all I saw.
It wasn’t painful.
It felt ethereal almost. I’d shed my physicality. I’d shed my ego, my anxiety, my worry, my fear. I’d shed my anger, and I had a lot of it back then. I’d shed my need for escape. I’d shed my uncomfortable reality. And, as strange as this sounds, it felt damp and warm, the blackness did. I couldn’t feel it how we feel, say, water on our skin, but I felt it in a purely infinite, internal sense. I felt spread across eons and for the first time I felt complete.
In our world, we diagnose this as dissociation, but I have not been convinced. This felt like I experienced raw life, real life, what we are outside of these meat sacks. But that’s a whole other conversation.
I remember walking through the door of my apartment and my dad asking me how school was. That, and the void.
I was never sexually abused or physically beaten to the point of hospitalization. I’ve never been in a car accident or a house fire. By big trauma event standards, I’m pretty low on the scale. I have endured repeated emotional and verbal abuse, some physical violence, homelessness, schooling terrors, and an alcoholic/drug addict parent while growing up. There are painful memories and a lot has stuck with me. So, the answer to the above question is, no. If something hurts you, your body and mind respond in the best protective coping mechanisms it can. Sometimes it needs to yank you out of the physical world and remind you who you are.
By DSM standards, no.
But, if your day-dreaming becomes so distracting that you find yourself struggling day to day, it’s worth talking about.
Thank you all for coming down this road with me. Mental health isn’t just my job or my personal affliction, it’s also my passion to share my experiences and knowledge, and to be apart of this kind of writing community. I am terrified of speaking and haven’t yet climbed over that hurdle, so writing is the next best way for me to be active in mental health advocacy. Thank you for being there with me.
This Thursday, Friday, and Saturday, we will continue with Gender Dysphoria, Neurodevelopmental Disorders, and Personality Disorders. If you have a story you’d like to share with me, here are my social media handles. *Feel free to just chat with me, it’s been great getting to know all of you* My email info is linked above as well.
If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue promoting critical thinking for all.
I have been bouncing back and forth between what is healthy for my future and my present. They are often in conflict. We experience time linearly, but our choices can take us in spontaneous, curved, spiked, and winding direction. All of that contemplation has only landed me here. So, as promised, here is last weekend’s Mental Health Month post. We will continue with Dissociative disorders tomorrow evening. On Thursday, Friday, and Saturday we will talk about Gender Dysphoria, Neurodevelopmental disorders, and Personality disorders.
You know how it goes: we list the different diagnoses, what the manual thinks, and then we dive into the experiences. Today we’re talking about the Bipolar spectrum. If you have experience with Bipolar or any other altered state, including substance use, contact me here, or on my social media (below) to get featured.
Compared to the exhaustive lists of other diagnoses, this section is relatively concise. Most people are familiar with all of the terms listed below:
Bipolar 1, which is characterized by it’s key diagnostic criteria: a manic episode. This includes abnormal levels of euphoria and agitation. It will usually be obvious when someone is not themselves. they may be talking extremely fast, floating enough ideas to make your head spin, and getting a lot of things done–at least until things start not getting done. It’s stated that if you experience this while receiving any type of antidepressant treatment (including ECT) and this state persists, you can be diagnosed Bipolar 1. I’d personally like to see the studies that proved these states weren’t caused by the treatment being received, but of course that will never be possible. Take it with a grain of salt, people. Mania can elevate paranoia and distrust, and present confused, racing thoughts. It takes some time to be able to distinguish this state from an acute psychosis state related to schizophrenia.
After this extreme state, Hypomania (a lesser form characterized by an elevated mood, increased energy, inflated self-esteem and the likes, lasting for most of the day, most days of the week) may or may not occur. Depressive states may occur as well, in which a person cannot function, drowns in hopelessness, and lacks energy. In the same way that people who hear voices can miss their voices if a treatment “takes them away”, those with mania may experience a feeling a loss when stuck in a depressive state, particularly when it’s related to medication treatment.
Bipolar II is the next diagnosis. So, imagine constant, and sometimes severe depression, with a sprinkle of hypomania. You need to meet the criteria for hypomania at least once to be considered Bipolar II. Even if you never experience Hypomania again, or someone misdiagnoses your happiness amid all your darkness, you will have the brand of Bipolar II. Often the Hypomania does not impair the individual.
Cyclothymic Disorder may not be too familiar of a term, unless you’ve been diagnosed with it. This is when your Hypomania doesn’t match the criteria for hypomania, and your depressive symptoms don’t meet the criteria for a major depressive episode, for at least two years. Basically, if you’re more happy than usual, but not too happy, or more sluggish than usually, but not entirely hopeless, you’re also disordered. These symptoms must be present at least half the time, and for that 50% of those two years, if you don’t experience being a little too happy and a little too sluggish for more than two months, you’re just normal I guess.
I do not say with this condescension. I have no idea if Cyclothymic disorder throws people out of their normal routine or how it affects their life; I don’t have this. But if you read the wording in the DSM-5, it’s what I said above, without words like “basically.” It SOUNDS very much like they’re labeling normal states as disordered, particularly when they say “well, if you don’t meet the criteria for any symptoms, you’re still sick.”
While looking up some studies about Cyclothymic, I found that Schizothymia is also a thing–not a diagnosis, but a thing. It essentially embodies the “temperament” required to resemble that of someone with schizophrenia, without actually meeting the diagnostic criteria. So, again, normal but still disordered. Schizothymia has yet to make it in the DSM. It’s only a matter of time.
We can guess what Substance/Medication-induced Bipolar and Related disorder is. What’s highly interesting is that if your “bipolar” is activated by Alcohol, Phencyclidine, other hallucinogens, stimulants, cocaine, or sedatives, then you fall in this category. If it’s caused by an antidepressant or E.C.T., treatment that makes money, you don’t. I don’t suggest taking cocaine in place of your antidepressant, but I also recognize there are overlapping neurochemicals involved when we compare street drugs to legal drugs.
You can also have Bipolar and Related Disorder Due to Another Medical Condition, and Other Specified and Unspecified Bipolar and Related Disorder.
If you feel I’ve been tough on this particular category, I have. Wording matters. Wording is what gets people proper and improper support. Wording is how we start to internalize the views of ourselves. Wording is how others see us. Wording is everything. If you’re a studious kind of person, or already in the world of academia, I’d recommend taking a DSM critique course. They rip this manual apart. If not, give the document a read for yourself; it’s in PDF form across the internet and there are available copies in bookstores. If you are unable to separate your own experiences from the diagnoses though (that is, you can’t read one without going OMG I HAVE THAT), maybe just read some articles on critiques.
To get you started, This article is about how much influence pharmaceutical companies have in the revision and editing process. It’s scary. Again–you have substance-induced Bipolar ONLY if your drug of choice is illegal.
I remember being manic. It’s been categorized as an acute mania, but I remember getting at least a few hours of sleep each night and my functioning wasn’t so impaired, so I’m more inclined to believe I attract the Hypomanic bug. I honestly don’t care, I just know I was managing a 4.0 average across semesters, taking Chemistry, Physics, Calculus, Psychology and Philosophy. I was happy. Very happy. I tackled five classes a semester, spent a lot of time out in the middle of the night, in my car with friends or my boyfriend, and I knew that I was special–beyond special. All of my ideas in science, in philosophy, had never been thought of before and every night I knew the next day brought fame.
My senior year of high school, and my first couple years of college–before I started working at Second Story–I tumbled through a lot of these mood shifts. A lot of my suicidal thoughts and actions, and self-harm, came as a result of these shifts, and so the Mania or Hypomania may not always cause the most damage. Sometimes it’s the aftermath, the picking up the pieces, the coming to a realization that something isn’t going right, that can impede wellness. I did not take care of myself, physically, mentally, every way, nor did I know what that was. I went through medications and doctors and therapy and sometime after one of my more serious depressions, the voices became more prominent and–well, the rest is history.
My experience in many ways pales in comparison to what some people go through. If you haven’t read the book “Mental: Lithium, Love, and Losing My Mind” by Jamie Lowe, I suggest giving it a read. She chronicles her journey fluently, and you get a sense of just how intense and fundamentally altering mania can be.
Many people get a sense of when a manic episode may be near, and this is just one story.
I believe a lot of descriptions of experiences should be thrown away, but Bipolar is not one of them. Mania can slam the breaks on people’s lives. Hospitalizations become traumatizing. People lose their career, their happiness, their stability, their wealth, their trust in themselves, their families, their possessions, their freedom, their understanding of what life is. All of it can be gained back, one way or another, but the act of starting over sometimes feels like an insurmountable obstacle.
Believe it or not, Bipolar 1 and 2 are quite over diagnosed, and ironically the over diagnosis causes stereotypes and expectations in a clinical setting which, in turn, fuels more incorrect diagnoses. For example, the night I was transferred to the psychiatric hospital over the hill, as soon as they learned I hadn’t been sleeping well–I hadn’t been up for days, I just had trouble sleeping more than a few hours, due to anxiety, panic, voices, and the feeling of being hunted–they diagnosed me Bipolar 1.
When I was released to the hands of the county here, I was interrogated with questions I can barely remember answering. I was still kinda gone, pretty sedated, and confused. The social worker acted more like a detective, or a doctor trying to figure out if I was actually in pain or just wanted opiates. Well, what do doctor’s usually assume? That you’re just trying to pop a pill. What did this social worker assume? That my diagnosis has been bogus because “they always throw that diagnosis at people, it’s a throw away diagnosis”.
That’s what he told me. He said I didn’t need any help and through his line of interrogation concluded my state was a result of marijuana. I had told him I’d smoked two weeks prior, but it had been over a year. As I said, I was gone, had no sense of time, and again slipped through the cracks. I also hadn’t been in contact with many people, my parents were still unsure of what was going on, and my boyfriend who came with me wasn’t allowed to say anything. It felt like I had to make a case in front of a judge without a seasoned lawyer, while hoping for my conviction.
In short, Bipolar is not a throw away diagnosis. People’s experiences are real, they are intense, scary, and incapacitating.
Because they present similarly, and the wording to diagnosis either of these states is vague compared to the amount of variety in symptoms. For a proper separation of diagnoses, the key is to wait. Watch how the state presents itself, how it reacts to what medications, what kind of services, and how is the person after they are more lucid. Are the paranoia and hallucinations persistent without the lack of sleep? What level of insight does the person have to their experiences?
Although not much is known about psychiatric medication, I cannot deny the fact that there are people who are helped a great deal by it, including myself at one point. Sometimes we have data on medications that work better with some diagnoses compared to others. Mood stabilizers may not affect someone with persistent psychosis, and that can help rule out Bipolar 1.
This process is similar to when someone is on a substance, like amphetamines. Once the drugs are out of the person’s system, you observe their behavior and see if the temperament and experiences persist.
Two things are very important if you deal with any kind of mood fluctuations, but particularly if you have a bipolar-type condition: sleep and routine.
One thing that made doctors notice I had a mood issue was the fact that I wasn’t consistent in anything that I did, especially taking medication. I’d go on it for a few months, feel well, balanced, and annoyed by the medication side effects, and I’d stop cold turkey. I’d feel okay for a couple days, and then spiral, usually into a depression or severe agitation.
Having a routine includes being consistent with medication: this is true even if you decide to stay off of medication. Forcing your body through the process of adapting to medication, juggling brain chemicals, and then having to re-adapt when you stop isn’t good for your mind or your biological systems. If you choose to stay off medication, what are your limits? It may sound crazy, but mine is hospitalization; if I get hospitalized or feel myself moving toward the idea of voluntarily committing myself, I need to get back on medication. Neither has happened yet. If you choose to stay on medication, what are your limits? Do you believe you will have to stay on them forever or are you open to the idea of working toward getting off of them?
Having a bedtime and morning routine can help develop that stability. Having a set time to sleep and wake up, having rituals even (shower, teeth, pjs, a good book) can aide in that process. It’s important to note that this is not to make you feel “normal”. This is part of self-care. It’s not about being like everyone else, or wanting to feel like a “normal person”, it’s about being healthy and learning what you need to stay well.
And that takes us to sleep.
Get it. It’s important.
Medication is helpful for this in many respects. One thing I miss being on medication is how I got 8 hours of sleep every night, to the second. My body just instinctively took on this role of: wow, my brain has slowed down, I don’t have as many distractions and the sun is going down, you should probably start winding down. Melatonin and chamomile tea can help accentuate this if your normal medication doesn’t quite do the trick. Be wary of sleeping aides like Ambien.
Staying active and nutritious will also help your body get back into the natural sleep-wake cycle. No one will kill you if you have one of those chocolate pies or a doughnut, but if your diet is perpetuated with processed sugars, heavy carbs, and un-nutritious fats, sleep will be hard to come by. Exercise stimulates many different hormones and chemicals in our body, the same ones some psychiatric medications attempt to promote, so adding in a routine if you don’t already have one can dramatically affect how you feel in yourself and about yourself.
These are important for everyone, diagnosis or not, but especially important with a diagnosis. Wellness does not come from one branch on a tree. Wellness is the tree, and its branches are things like exercise, nutrition, attitude, outlook, worldview, medication, physical health, productivity, e.t.c. The more branches, the bigger the tree.
Thank you all for the Instagram messages and for reading this blog. I’ve been so incredibly happy to see that so many viewers are enjoying this content. Tomorrow we will talk about Dissociative Disorders. If you have a story to share with me, or you want to put it on this blog, please reach out to me via my contact page ( linked above) or my social media:
If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.
Although I couldn’t put the man hours into the usual Mental Health Month blog today, I paused in writing a Case Study on Donald Trump (yes, it’s a real assignment) and blogged something fun. Thank you Caz over at mentalhealthfromtheotherside.com for nominating me. She writes about her experience with mental health, like anxiety, depression, and trauma, from a personal and professional lens. She’s a great writer and the depth of her openness on her blog is inspiring.
Now, I haven’t done one of these awards since I wrote on MentalTruths, my old blog I started in July 2015. I notice there’s been followers from that blog who have jumped over to this one, so if you all are reading this, you know my other style of writing is full of sarcasm, blunt humor, and, well, weird stuff. If you can’t quite picture what that means (I’ve been very formal on this blog), I implore you to read this piece on Clinical Arrogance, and any other piece. A laugh might be needed today.
What I do remember about these posts is that there are rules. And the rules for this one are as follows:
Is the Liebster blogging award still going on around WordPress? I’m so out of the loop now. Let’s answer some questions.
This made me giggle because you all know how I feel about this. I don’t believe keeping a constantly positive mindset is one that promotes health. I think it’s helpful to remember that a negative moment does not doom one to a negative life. I think it’s helpful to remember all moments in life are temporary, including ones filled with grief, pain, horror, and sadness. However, I think it’s equally as helpful to embrace the pain we feel as a species (like mortality) and as an individual (like our mental health conditions). Pain cannot exist without pleasure, and pleasure cannot exist without pain. We must give both attention to foster a balanced relationship.
I read my old writing, or I read other’s writing. What I haven’t shared yet on this blog is that I also write fiction stories and have a novel in the works. I haven’t had much time to work on my short stories, but after finals I will be spending out some for (hopeful) publication. It’s a dog eat dog world out in the creative writing sphere. I took to writing on Booksie some time ago, which I guess is kind of like saying “I’m a Wattpad author”, and that’s kind of the writing equivalent to when your friend calls you and says “hey bro, I sent my SoundCloud link, check it out.” I haven’t written on it for a while, but here’s the link. Yes, I’ve taken creative writing classes and workshops, and was published when I was 17. I didn’t get to go to the ceremony because I’d spent the previous night in the E.R from a panic attack and slept two whole days on the max dose of Ativan they shot me with. They told me it was Ativan, at least. But I slept two days.
I also simply let the writer’s block be. Some people like to force themselves to write but I don’t always have the mental energy for that level of discipline sometimes. If I want inspiration, I will go for a run, a walk, or a bike ride. Nature inspires.
No. I will never delete a frank post. I never did my 5 years of writing on Mental Truths, and that blog tore into so many sensitive topics. I don’t believe people should be shielded. I remember one post I was very angry and I discussed my personal level of aggression, how I felt like I manipulated people sometimes, that I was, essentially, “an unfeeling asshole” and one person commented “you just lost a follower, you say you’re violent.” And I let them know they have every right to unfollow my blog, that they actually don’t need to tell me, and that I’m not a violent person, I am just angry in the moment.
The world is offensive. There is no need to censor that, but rather it can become a strength to acknowledge that, and a strength to know your limits. It’s not enyone else’s job to censor everything because of your sensitivies or your traumas. It’s your responsibility to put up boundaries against what you feel you can handle and what you feel you can’t. I do that often. There are some things that are too violent or sickening or scary for me to read about. I couldn’t watch the Aumaud Arbery shooting video. That doesn’t mean it shouldn’t be posted.
That also doesn’t mean go around purposefully disturbing people. That’s just sadistic. It’s a fine line, people.
Some things I plan. If I am going on a trip, I plan the time I’m going to leave and what I’m going to take. My boyfriend insists on planning activities, and I go along, but I prefer to have a couple things planned and a couple things not planned. I need flexibility in my existence.
7-up cake. Enough said. I was looking for the Mountain Dew cookies, though.
In High School we had a substitute teacher in my honors class. He spoke quickly, and was a very boisterous, fun personality, and I hated that. He made me very nervous. When he suddenly called on me to answer a question, my anxiety caused me to speak in tongues. Nothing I said was a word. In fact, it came out like this: bleepsdhajfjpeajdjiepad. He said “oooooooookay” and moved on to someone else.
I own a cat, but I love dogs as well. I want both.
There are listed options, like time-travel, teleportation, telepathy, psychokinesis, and invisibility. I already believe I have telepathy so I won’t touch on that. If I had to choose, I’d choose the ability to time travel. I feel I’d learn so much about the universe.
The basic ways are breathing exercises, reminders, and exercise. I throw most of that out the window. Math helps me tremendously with anxiety. Any focused, intense task activates my executive functioning, the frontal lobe, and removes focus from my amygdala. If you want to get scientific about it. I’ve had anxiety since I was a toddler, so a lot of my coping comes from pushing through or using biofeedback (blood pressure, heart rate, e.t.c) to show my brain that my body isn’t as broken as it thinks.
We are physical beings, made of matter. Matter is made of atoms, and atoms are simply condensed energy (once you get past all the tiny particles that make it up). Matter then, is condensed energy. Energy cannot be created or destroyed. Many people have heard of the double slit experiment, where we learned photons and electrons can behave as both particles and waves. If you haven’t read a physics textbook though, you might not know that we can never know whether it is our measurement of the particles that changes its presentation or not. We can never know because when we take away an important part of our measuring tool: the camera with the light, we can’t see the particle’s behavior. Our physicality limits what we can learn about nature. That’s part of a paradox and part of Heisenberg’s Uncertainty Principle.
And so, evidence points toward the universe being infinite, from our limited understanding of how gravity and other forces push through the universe. Will we ever know? Probably not.
Things exist and do not exist simultaneously. If there is a reason, it’s probably beyond physical measurement and therefore we can only speculate. Poorly.
Eat all the junk food. Reconnect with nature. Mull over mortality and the normalcy of it. Speed-finish my fucking book. That’s such a hard question to answer. I prefer having no clue about when I will die.
Nominees. I will do 8. I need to get working on my homework. But all of you are worth nomination. You can still have fun answering the questions if you’re not listed below. I encourage you to, actually. (There are also listed blogs to check out on my homepage on both my current blog–this one–and my old one. Please check them out, they are all great people!)
No pressure to participate, I remember these things being very fluid and fun. But if you do, here are your questions:
I really tried all I could to finish up my articles for this weekend but it looks like Bipolar and Dissociative Disorders will have to be pushed back to Monday evening and Tuesday evening, assuming I don’t work late on Monday.
If you’re wondering, I am still a student and have a couple finals and a paper to finish. I was at work yesterday too to help hire some people, and I needed some extra self care these last two days.
We will still cover those two diagnoses and continue on the regular schedule next week.
Thank you everyone who has been reading, following, and reaching out to me on social media. If you are interested in sharing your story for any part of Mental Health Month, I welcome all experiences. Please contact me on my social media:
OR reach out to me on here via my contact me page.
Thanks everyone! Enjoy your weekend.
*This is a post dedicated to my Mental Health Month series, where each week we talk about different diagnoses, share stories, and ways toward wellness. Tomorrow we will cover Bipolar Disorder. If you have some experience to share for any of the topics we cover (or have covered), contact me here or on my social media handles and we will get you featured.*
Today we’re talking about schizophrenia and related diagnoses, one of which I have. I’ll share some of the things I’ve experienced and ways that I’ve dealt with certain aspects.
The reason Schizophrenia is now considered a spectrum is the wide ranges of experiences people have, and the level of distress resulting from those experiences. Our last DSM separated Schizophrenia into subtypes like “paranoid, residual, undifferentiated, disorganized, and catatonic.” I think it was a big sigh of relief when these boxes were removed. The DSM 5 now reads with these diagnoses:
The thing that gets misconstrued often about psychosis is the level of danger someone experiencing an episode poses. Of course there are cases of those lost in delusion acting aggressively. There are many more cases of abuse and violence against those in psychosis.
The thing that isn’t understood is that when we are in this fragile state, everything is terrifying. Your smile is terrifying–a sign you’ve been conspiring against us. Your tone of voice, your pitch of voice, your very existence in our world means you are, in one way or another, against us. Every person, television, web camera, corporation, government institution, is a hunter and we are the prey, frightened only because we’ve just realized this whole time people have been plotting to harm us. And suddenly every bad thing that happens, or has happened, every innocent mistake we witness, every abnormal movement becomes apart of that plot.
Not everyone is vocal and so obviously outlandish. I, for example, spent a lot of my time in my room with a blanket over my head playing Minecraft in the dark. I spent five or six days a week doing this. Meanwhile, one of my coworkers controlled mby body, blocked the thoughts she hated, inserted new ones, forced me to eat a bowl of cereal, hounded me until I did it. I couldn’t walk properly and I’d lost awareness of my body because it wasn’t really mine anymore.
I spent weeks playing Grand Theft Auto in a room piled so full of trash and clothes my door couldn’t open properly and I couldn’t touch my carpet. The sheriff managed to shove my door open, though. That was when the voices were keeping me up all night with screams and mocking banter and whispers. I sat rigid and silent, only answered their questions with “yes” or “no” even if they asked an open ended question.
My diagnosis is Schizoaffective, first diagnosed as Bipolar 1 and several other things.
What pains me is when I hear about people deep in their experience who trigger the fear in officers that they’re trained to have to protect their lives. One man, over 8 years ago, came at an officer with a boom. This officer knew of the man’s psychosis and still opened fire with 7 shots.
Another man, silent, mute, like me, but naked, walked along a highway in the middle of the night. A trucker stopped him, called police when the man, also diagnosed schizoaffective, crawled up on the roof of his semi. The cops, assuming he was on drugs, gave him a pair of shorts or something, called the paramedics who took his vitals. The Sargent then drove the man to a closed gas station and dropped him off. That man then wandered back to the same highway and was killed by a car that didn’t see him.
The Sargent’s defense was that he’d dropped the man off in a safe place.
Are psychotic people dangerous? Not usually. What’s dangerous is the situations made volatile by people who don’t understand.
I’ve written on this before (big surprise) and if you’re curious, you can read the post, “Is Schizophrenia a Brain Disease?” You may be surprised by the answer. If you frequently keep up with psychology research, not the pop psychology agenda, you probably won’t be.
For some people that means taking medication or living in a group home where social skills and independence are prioritized. For others, this means getting off of medication or moving out a toxic living environment. For all of us, though, who choose some version of wellness, it usually means keeping a routine, engaging in consistent self-care, and learning to manage our experiences to the best of our abilities.
Not everyone hears voices 24/7. Not everyone’s voices are external. Not everyone’s voices are negative. Not everyone has visual hallucinations. Not everyone is hospitalized constantly, or for insanely long periods of time.
So what happens to those who don’t reach a stable wellness? A lot of people give up on those who don’t seem to present a lot of insight, as if it’s someone else’s responsibility to make them develop insight. I don’t want to say that stability isn’t achievable for some. What I will say is that the level of insight depends on many things: support, past trauma, current trauma (hospitals, police, doctors), self-esteem, general worldview. All of this gets distorted in psychosis, yes, but the foundation is the same. If someone has spent a lifetime in child abuse where intimidation, violent threats/attacks, and coercion dominates their perception, assuming even bizarre things like aliens probing their thoughts is routed in a feeling of lack of privacy, feeling intruded upon, and invaded. If those underlying feelings are never addressed, if only obvious positive symptoms (like hallucinations) are dulled, and that is called the ultimate progress, then that persons self-esteem, drive, and hope will suffer.
Much of the mental health system stifles the cultivation of wellness for those with psychosis in many ways.
Living normally can mean many things. It could mean working. But it could also mean just steady self-care. It could mean being satisfied. It could mean getting on social security disability and getting back into hobbies and cultivating contentment. It doesn’t have to mean what society wants it to mean.
This varies in intensity and frequency across the spectrum of Schizophrenia. Common experiences are auditory and visual hallucinations, olfactory (smell) hallucinations, tactile (touch) hallucinations, thoughts and feelings of being hunted, attacked, hated, and the reasons for these feelings are what become delusions–for example, if someone feels they are being watched, the delusion isn’t just the action of being watched, but why; the government has tracked their IP address, put bugs in their phones, turned their family against them. They hear the agents outside their window, conspiring.
Other experiences may include a severe drop in drive, motivation, and emotional expression. They may have an affect that is inappropriate, that doesn’t match what they say or the atmosphere of the room. This is the reason one of the top Google questions about Schizophrenia is “why do schizophrenics laugh randomly?” They’re hinting at affect, but also possibly voices. Sometimes they say funny things and we laugh. That’s a normal reaction to something hilarious, but on the outside it seems scary, weird, and bizarre. There is no scientific consensus to whether medication is the cause of these “negative symptoms.” If we get some studies that aren’t done by researchers with severe conflicts of interest (e.g grants from pharmaceutical companies) we may get a definite answer.
When I was on medication, I was more focused and aware of my surroundings, but I was tired and had trouble caring about things. Apathy can come after a psychotic break, especially a first psychotic break, and again, there is no scientific consensus on whether this is result of the medication blockading certain synapses, damaging them, or just a result of the brain restructuring itself after the break.
For me, my voices are often but not constant, internal and external, random, mocking, encouraging, and repetitive. I also hear familiar voices, such as friends or coworkers, particularly when I’m around them. When I worked at the local library at the beginning of 2019 (yes, I tackled two jobs) I often heard the boss and the branch manager discussing me. One afternoon in particular, I was shelving some books. I heard them giggle and the boss (my supervisor) said my name, followed by words I can’t remember and the branch manager said “well, what are you going to do about her?” very loudly, and when I whipped my head around, they were talking, smiling, laughing, and I couldn’t hear them at all. They were across the library.
I took my cart to a different part of the library, felt my heart racing, and tried to look at the event objectively. They were far away, I couldn’t hear them, and maybe they weren’t taking about me. But they’d said my name. Maybe it was something good. Or maybe they hadn’t said anything at all. Every day in that place was me psychically defending my honor. I quit abruptly four months into the job.
I also hear unfamiliar voices, strangers walking down the street. One afternoon, before I was hospitalized this last time I think, my boyfriend and I were on the wharf walking back toward the street. We walked past a couple, and the man growled “you better watch your back”.
This was when I knew there were people placed on the street to intimidate and berate me. I knew some were possessed by the same entities that wanted me dead. I spun around and I asked my boyfriend, “didn’t you hear that?” Of course he didn’t, and I stopped in the middle of the walkway, blocked it really, watching the couple, and spoke loudly; “that guy just told me to watch my back. He thinks I don’t know what’s going on, but I fucking do. They don’t know who they’re messing with.”
I don’t know if my boyfriend remembers this, he may not, but I remember the fear, the anger, and the uncertainty.
Some people see creatures, demons, devils, regular people, spiders. Some people feel things crawling under their skin or in their organs, or smell strange scents. I remember smelling a lot of weird, noxious fumes not of earth and fire smoke. I always feel like someones touching me, grabbing me, trying to pull me in a different world. I feel things crawling on me frequently(not in me thankfully) and I misinterpret a lot of my body’s signals.
All of these things together can be incapacitating, terrifying, and unreal in real way. I still think back on some things and don’t believe that any of it happened, that I made it up, and that belief often has my voices calling me a liar, that I’m some kind of malingerer and my therapist knows it, my coworkers know it, and it’s going to cost me my job and my therapist is going to put me in jail.
How ironic, right?
If your friend, child, parent, or any other relative is experiencing an episode or is home, on medication, and still in the midst of psychosis frequently, panic is probably the most incorrect way to respond. The second most incorrect way to respond is feeding or attacking delusional, disorganized, or otherwise different behavior. Do not agree that the government watches your son, but don’t dismiss it either. Sometimes the underlying feelings of being watched are fear, mistrust, or anger. Address those.
Studies show that the involvement of trusted family members during someone’s hospitalization can enhance and support the person’s recovery. Show up, visit, learn what you can. My mom feared driving over the hill to the hospital I was at and so my boyfriend brought me clothes and visited. It would have been nice to have either one or both of my parents though, so they could not only see the extent of my fear and mental frailty, but also so they could get involved and be a source of comfort. It’s so hard to get them to be a source of comfort sometimes.
Most of all, respond with compassion, patience. Step outside of your world and into ours.
This post is so late (it’s 11:46 pm for me on May 14th) because I have loads of classwork and have been working full-time for the first time in my life. Adjusting to that is taking some time. And so tomorrow, later as well probably, we will cover Bipolar. If you have a story on any diagnosis and you’ like to share it here, CONTACT ME or reach me on:
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I’ve been thinking a lot about what it means to be happy. Here are some of my thoughts.
I’ve done what all good, sheep-like psychologist eventually do: create categories for something that is probably far too complex for such an explanation.
But, hear me out.
I’ve reasoned there’s organic happiness and there’s constructed, or synthesized, happiness. An organic happiness would be someone’s baseline: how you are when you wake up in the morning, how you respond to the corresponding events of the day. This is the happiness we often feel we need to correct.
A synthesized happiness, then, comes in peaks and waves from an outside source. It eventually decreases gradually or exponentially. It may be uncertain, untrustworthy, or fleeting.
These thoughts came into my head not only because of our humanly need to correct all feelings we feel don’t line well with other’s feelings, but because there is such a stark difference between the happiness I feel organically, the one that sprouts naturally in my consciousness, a simple product of biological existence, versus the happiness I feel after I’ve accomplished something I had doubts about, after spending a day with the people I love, or after I take a pain pill for my back.
I think I’ve made this distinction because I notice I’m often disappointed in my organic happiness, in my baseline of existence.
There are tons of speculated biological and evolutionary reasons why certain chemicals peak at certain times in our brains–to keep us focused, to associate good feelings with good friends so that we build connections which were at one point most essential for survival, to simply bring us enjoyment. But now, there are so many things in life that can trigger intense rushes of endorphins, like substances and fame, that what we experience in the day to day just can’t compete. I am happier and friendlier when traveling. I am happier and friendlier when on pain medication. I am happier and friendlier to strangers when I am also among people I care for and love.
And so I find now, when I have a moment to rest and reflect, I remind myself that everything is enough.
I’ve had three of my six past therapists tell me I need to tell myself that I am enough, and I’ve tried that, but I think this stretches deeper. I think that realizing that life is enough, that how I feel is enough–negative or positive–is what paves the way for accepting myself. If I can truly believe that every negative feeling exists as a moment ripe with the potential for growth, and that every positive feeling exists as a moment ripe with the potential for contentment (as opposed to: oh no, I’m happy, let’s see how long this lasts), then I think that may be the key to actually existing.
But believing something doesn’t mean I create a mantra and repeat it to myself until I drop dead. That doesn’t foster belief and studies show that reiterating positive mantras to yourself can actually make you feel worse. I measure how much I believe in something by the rate and construction of my reactions. Let me give an example.
Last night while watching television, I felt the same disappointment I discussed earlier: I felt sad that I couldn’t spend every day feeling the fuzzy, determined, focused happiness that pain medication brings. I felt sad that I felt sad about that. I felt sad that my own level of being just didn’t seem to be enough; I enjoy my personality, I admire my intelligence, I accept my flaws, but the feeling of existing, the feeling of being human, limited, temporary, often enrages me. Being just isn’t enough.
And in this moment of realization, my mind reacted with a simple thought: let’s be okay with this.
Now sometimes I have voices responding to my thoughts, or voice-like thoughts responding to my thoughts, but this was all me, it was a reaction that I haven’t programmed. I haven’t spent the last two years off medication waking up every morning spewing “learn to love yourself” and “you are enough” quotes until I repeat them robotic, on demand. I’ve spent my time entrenching myself in the madness, the chaos, the pain. I spent time locked in my room staring at the wall, if that was what my pain was. I spent time walking off waves of panic, if that was what my pain was. I spent time being unhappy, if that was what my pain was. I resisted the urges for bail outs–a psychiatrist would have bailed me out, numbed me to my anxiety, tainted the voices and the paranoia, evened the mood swings and depression. And I would have learned nothing.
This is not to be said in a way where everyone taking medication should be offended. For me, medication was another avoidance technique that I’d perfected through years of trauma. For others, medication is the stability key that allows them the time and focus to come to the same types of realizations I have. We all reach wellness in different ways.
I’ve noticed in depression, I am no longer overwhelmed with sadness because I allow the sadness to spread. I choke sometimes with the paranoia, fight it, try and reason with myself and that often cycles me further. I am still growing. I choke with the anxiety as well, get lost in the sensations of my body, and the doom my mind screams. I am still growing. But the depression, which has been with me since I was eleven years old, has become a close friend. I am 24 years old. It’s taken 13 years to cultivate this friendship.
And so happiness for me does not mean contentment or joy or the absence of sadness. Happiness for me means experiencing being without judgement.
I figured I’d share some of these thoughts with everyone as we plunge through Mental Health Month as well as the Covid Pandemic.
This week we are covering Schizophrenia, Bipolar, and Dissociative disorders, starting tomorrow. The post will be later in the evening (PST) as I have some self-care and some things that need to get done at work. If you have a blog post on those topics that you’ve written and would like to share, or if you’d like to submit your own story, contact me here or on my social media handles below.
If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.