Posted in psychology, science, Supporting Friends/Family

Mental Health Month: Gender Dysphoria

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.

Why Do People Argue About This?

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?

Is Gender Dysphoria a Mental Disorder?

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.

What About The Children?

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.

If you want to chat elsewhere, or share your story, catch me on my social media below:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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 for all.

Posted in psychology, science

Mental Health Month: Dissociation

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.

Is Dissociative Identity Disorder Real?

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.

  1. People are distressed by these experiences. Some lose control of their lives, bounce between hospitals, treatment centers, group homes. People are reliving traumas in their body and their mind. This is not a joke.
  2. Repressed memories, since their conceptual birth within Freudian times and psychodynamics, have never had any real conclusive studies. Behaviors can be studied of course; biological responses can be studied, of course, but whether or not someone’s memory is correct cannot be studied. If you ever take a cognitive neuroscience or psychology class, you will learn that memories are reconstructive. That is, our brains put memories together as we remember them. They are not snapshots of the past. We retain central ideas and key themes, but we will not remember incidents or scenes as they are. Flashbulb memories, those that are caused by sudden trauma, have been shown just as unreliable as our regular memories. Researchers have actually seen this process; new neurons branch and stimulate growth as we remember something–they are not pulling from neurons that are already there. Memory is not as simple as it seems and research on repressed memories is inconclusive.
  3. DID has a bad wrap. It got a bad wrap from people across the country back in the day opening treatment centers, holding people who are struggled with some sort of mental distress in their lives, tying them down, and telling them they have different people living inside of them. These centers were eventually disbanded for fraudulent billing (they got a lot of money for this breakthrough treatment) and got ousted as a cult. They kept people from their families, told them their families were the ones who had abused them, and ruined a lot of lives. It took years for those people to get real trauma therapy and realize their identity was intact. There’s a documentary on one of these centers that I watched in my Research course least year. If I find it, Ill post the link. The concert today, though, is whether this kind of literal brain washing is still happening.
  4. Planted memories are a little more solid than repressed memories. Again, our memories are reconstructed upon remembering, so it’s been shown that people are inclined to fill-in-the-blanks sometimes, remember something that was there that wasn’t.

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.

Does Your Trauma Need To Be Severe?

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.

Does Excessive Day-Dreaming Count?

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.

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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.

Posted in psychology, science

Mental Health Month: Bipolar

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.

What Does Mania/Hypomania Feel Like?

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.

Is Bipolar a Throw-Away Diagnosis?

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.

Why Are Manic Episodes confused with Psychosis?

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.

What is Helpful?

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:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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.

Posted in psychology, science, Voices

Mental Health Month: Schizophrenia

*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:

  1. Delusional Disorder: This basically means someone is consumed with different types of delusions (like grandiose or jealous type) for at least one month or longer. If people do experience hallucinations, they are related to the delusions. Usually functioning isn’t as impaired at the same level of someone in an acute psychotic episode.
  2. Brief Psychotic Disorder: This is more like what someone would picture an acute episode: hallucinations, delusions, and some version of disorganization.
  3. Schizophreniform Disorder: I honestly thought they’d removed this a long time ago, but this is like a short-term schizophrenia; episodes are usually between one and six months long. This includes hallucinations, delusions, disorganization, and negative symptoms (apathy, lack of response, e.t.c).
  4. Schizophrenia.
  5. Schizoaffective Disorder: this includes elements of schizophrenia, like hallucinations, delusions, and disorganized speech and combines it with elements of a mood disorder, like depression or mania. The mood symptoms must be present concurrently with the top criteria of schizophrenia.
  6. Substance/medication induced psychotic disorder
  7. Psychotic disorder due to another medical condition.
  8. Cataonic conditions.
  9. Other specified Schizophrenia spectrum and other psychotic disorder.
  10. And of course unspecified.

Are Psychotic People Dangerous?

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.

What does Research Say?

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.

Can People Live Normally With Psychosis?

Yes.

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.

What Are The Experiences Like?

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?

How Should I Respond?

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:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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.

Posted in Community, psychology, science

mental health month: trauma

Welcome back! Let’s talk about Truama and Stressor related disorders. Read more for a great book recommendation for emotional trauma and CPTSD.

What is Trauma?

This can be any event or events which leave lasting psychological distress. This ranges from emotional abuse influencing your world view to the vicious physical flashbacks veterans face after war. A car crash can be a trauma that makes you anxious or avoidant about cars. Divorce is a trauma. Children of alcoholics, such as yours truly, have a specific set of common trauma responses. Sexual abuse, the death of a loved one, a gun to your head are all specific traumas that can cause specific perspectives and responses from people.

Sometimes trauma can cause a person to lash out suddenly, aggressively, or present the opposite characteristics; some will shut down, avoid, and become stagnant or submissive. There’s research supporting the hypothesis that traumatic events can heavily influence the wiring in our brain. This has a lot of implications in all mental health conditions, not just Post Traumatic Stress Disorder. But for the sake of honoring Trauma today, we will talk about that only in the context of trauma.

What Are Trauma Disorders?

I had a similar question. The DSM-5 has somewhat of an answer. Here are the diagnoses they list:

  1. Reactive attachment disorder: This is in early childhood or infancy where the child does not look toward their caregiver for “comfort, support, protection, and nurturance.” If you’re anything like me, psychopathy might pop into your head. There isn’t a lot of research supporting Reactive attachment disorder as a precursor to psychopathy. But if you’re interested, here’s a random presentation I found on the subject.
  2. Disinhibited Social Engagement Disorder: This is basically the opposite of the above disorder. These children will approach strangers and act overly familiar with them, also breaking cultural boundaries. Often they have experienced some kind of pattern of severe neglect from their caregivers. They must be at least 9 months of age to receive this diagnosis. Don’t ask me how that works.
  3. Posttraumatic Stress Disorder: This has some of the longest criteria to meet and is often diagnosed very quickly. Major symptoms can be obvious. However, for those of us who have struggled with emotional abuse, it takes a keen eye to recognize the signs. PTSD is an emotional response to one or more traumatic events. This includes “fear-based re-experiencing, emotional and behavioral symptoms. Experiences range from explosive “reactive-externalizing”, to dissociation.
  4. Acute Stress Disorder: This would be caused by a gun to your head, or anything else that threatens death, serious injury, or sexual violation. This also applies if you witness one of these events, such as someone being shot in the head, threatened to be shot in the head, someone being raped or beaten. If you had a conscience and were the person filming Ahmaud Arbery‘s death, you may develop this disorder. Evidently that person has not. This can happen to police officers or detectives, or any emergency responders who are repeatedly exposed to violent/disturbing/fatal cases. Keep our COVID front-line medical staff in mind.
  5. Adjustment disorders: This is marked by emotional or behavioral symptoms that appear within three months of a stressor. For example, the changes a person may experience after the death of a loved one or sudden death of a close friend.
  6. Other-specified Trauma and Stressor-Related Disorder and Unspecified Trauma and Stressor Related Disorder: These both carry criteria of a person exhibiting trauma like responses that cause significant distress but don’t fit in the categories of the other disorders.

How do People Manage?

Writing this hasn’t been easy. My chest is tight, my hands are shaking, and I keep having to remind myself to breath. My senses are become more sensitive by the minute and I’ve had to change my music to something softer and easy to ignore. My stomach is in knots. I’m not thinking about any incident in particular, but the body has an amazing memory. It encodes emotions, sensations, feelings. That’s why dissociation is such a common respond to trauma: escape your body and the feelings are void. It’s a mistake to think only the mind holds the capacity for feeling.

Therapy is a common go-to for trauma. EMDR has stormed popular psychology but according to my research professor last year, it’s unclear whether the lights/wands used in EMDR are causing an effect or if it’s the CBT you’re doing during the session. After all, CBT is the leading therapeutic treatment for trauma. There are no studies with participants using CBT, EMDR (that includes CBT), EMDR without CBT (which would basically be flickering lights or waving wands with you sitting there awkwardly staring at them) and no treatment which would put you on a “waiting list”, you unknowingly part of the control group.

Much of my own trauma is rooted in emotional events. Being threatened, bad mouthed (an eleven year old being called a bold little motherfucker for expressing distress about something is kind of how that went constantly), and intimated taught me to be suspicious, distrusting, and defensively aggressive. Being homeless created a lot of insecurity, confusion, and depression; the first day I wanted to kill myself I was eleven, sitting outside of the house we stayed in where the owner drank a bottle of Jack Daniels each night followed by a plate of Xanax. Her daughter had sex orgies loud enough to permeate the street and the other went to work and school. I have many more stories about many wild people I’ve encountered. Maybe I’ll tell it sometime.

But the alcoholism and drugs in my own house, coupled with our 3 year homelessness, and my terror of school I’d experienced since I was five in day care, made me closed, submissive, and withdrawn. When I hear certain words today–for example, in a team meeting at work, if I hear the word “activity”, my body flashes cold, my heart races more than it already was, my hands shake, my muscles twitch. This is an example of an encoded emotion from my days in school. There are studies going into this.

I didn’t ever talk. I fainted if I was asked in front of the class, and was so nervous to raise my hand that I often peed on myself in elementary; I couldn’t ask to use the bathroom. By middle school I’d developed a ritualistic routine to avoid asking for anything in class: use the bathroom before school, five minutes before the bell ended break, five minutes before the bell ended lunch. That’s continued through college; I’ve never got up and walked out of a class before the class ended. By high school, my dissociation got so severe I experienced fugue states (only lasting at most a day), one that caused me to walk into four lanes of traffic against the light, with my friends apparently screaming. They eventually caught up to me but I only remember walking through my door at home. I don’t remember the rest of the day or what made me so terribly distressed that I left my body.

There are some medications offered, usually SSRIs but sometimes heavier medications like Seroquel for a knock-out sleep. Sleeping can be hard with trauma. Your body is constantly in high alert.

Meditation helps some. This can be any activity that helps you focus on your breath and rooting your thoughts in your body. We get so used to ignoring, avoiding, or giving in completely to the distress our body and mind feels that we lose sight of reconnecting our system, which is so essential to wellness.

Support groups and other outlets to express the physical and emotional experiences are key. Just typing my physical experiences above helped relieve a lot of the tension; it’s important to acknowledge what your body feels, and get specific about it–write it down, call a friend or support force, schedule a therapy appointment. Resort to emergency medication if the experience doesn’t abate after trying everything, including sitting with yourself. I’ve had panic attacks related to body-trauma flashbacks push through Seroquel, Ativan, Klonopin, Valium.

Drugs aren’t always what you need. Sometimes it’s just your body screaming for you to offer understanding, consolation, and acknowledgment of its distress; it’s been through the same things you have, on a cellular level.

Complex PTSD: From Surviving to Thriving has been on my read list for a while. It covers “Complex-PTSD” which is not a DSM diagnosis no matter how many psychologists push for it, but references the emotional markers left over from childhood trauma.

Today, we are greatful to hear from Caz again, over at mentalhealthfromtheotherside.com. Read about her experiences with childhood sexual abuse here.

Thank you to everyone who has been messaging me on Instagram. Sharing your story is difficult and I appreciate those of you just reaching out with words of encouragement, thankfulness, and those of you asking about my own experience with psychosis. We will continue with Mental Health Month NEXT WEEK.

Thursday May 14th: Schizophrenia

Friday May 15h: Bipolar

Saturday May 16th: Dissociative disorders.

These posts may be a little later than usual as I am on a hiring panel at my job on Thursday and Friday. Finals are also coming up. I will keep everyone updated. If you would like to submit a paragraph, quote, or personal story with any of those listed experiences, please reach out through my CONTACT PAGE, or message me on:

Instagram: @written_in_the_photo

Twitter: @philopsychotic.

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.

Posted in advocacy, psychology, science

Mental Health Month: OCD and Related conditions

We’re in day two of our Mental Health Month series where we discuss different DSM-5 diagnoses and the research behind them. Today we’re talking about Obsessive Compulsive and Related Disorders, including Body Dsymorphic Disorder.

What is Obsession?

Let’s distinguish the difference between being obsessed with something and obsession ruling your life.

If you have an obsession with Michael Kors, you probably don’t have a condition.

If you have an obsession with, like, that one show that, like, you stream on Netflix, you probably don’t have a condition.

If you had to touch all of the buttons, one by one, on the television, the remotes, the kitchen appliances, the computer, before you leave the house to prevent a house fire, and this becomes so disruptive you leave the house only twice a week for essentials (even when NOT in a pandemic), then you might think about searching for some support.

But OCD (obsessive-compulsive disorder) is not the only condition that exists under this category. There is also:

1.Body Dysmorphic Disorder

2.Hoarding Disorders

3.Trichotillomania (hair pulling)

4. Excoriation (skin-picking)

5. Substance/medication-induced obsessive compulsive and related

6.Obsessive-compulsive and related disorder due to another medical condition.

7. unspecified obsessive-compulsive and related disorder (like obsessional jealousy).

Is Hoarding Like That T.V Show?

Hoarding gained a lot of popularity after A&E came out with their show HOARDERS, which follows the lives of extreme hoarders, often living in squalor beneath their belongings. The people featured are often reluctant to get rid of their material items because of an obsessive emotional attachment to them. This doesn’t just extend into beautiful or valuable items, like a porcelain doll or an antique speaker; most people will be hard-pressed to give away something that has some semblance of importance or function. For the people on hoarders, even garbage or blankets covered in rat droppings and urine are part of their livelihood, either because of memories or because of the simple fact that that item, along with all the other items in the house, fills a void.

Indeed, those with Hoarding Disorder have “persistent difficulty discarding or parting with possessions, regardless of their actual value”, per the criteria of the diagnosis. That difficulty leads to an “accumulation of possessions that congest and clutter active living areas”, much like what you see on Hoarders. This causes “distress or impairment” in all areas of functioning.

We also see a variety of personalities on Hoarders. Some people have what the DSM calls “good or fair insight”. They recognize their hoarding has been causing problems, but feel both trapped and safe among their things. Some people have “poor insight”, in that the clutter isn’t viewed as problematic. As we see in the television show, some people with this level of insight will accept help but fight against losing too much stuff. Some revert back into their old ways after the trauma of losing things all over again. Those with “absent insight/delusional beliefs”, are absolutely convinced nothing is wrong–yes, to the extent of delusion. These are the people you see who halt the process in the show, and the house or yard is cleaned only in a hundred square feet or so.

These behaviors may be related to the temperament of the person, indecisiveness being a leading trait, and also related to some traumatic or stressful event that exacerbates the behavior. Let me give a personal example.

When I was 11, we lived in a two story, two bedroom apartment next to a registered sex offender and across from a drunken, drug-addled manager. My dad, a musician, also spent most of his free time drinking or working on cars, and it was only a matter of time before him and the manager got into an irreparable fight. The problem is, she was the manager and we were the tenants; her words against ours to property management meant nothing. We were evicted.

My parents’ credit was in the tank, and we were not rich, so no other apartments in town would take us and we bounced around from hotels, to a tent, to rooms in houses of family friends—that doesn’t sound terrible, but three years of much more drugs, alcohol, and uncertainty (in every place we stayed) isn’t all that fun.

A two-story, two bedroom apartment can hold a lot of stuff. Everything in my room except important papers and one hand-me-down banana republic plastic shelf went in the dump–bed included. We didn’t have enough space for all my stuff and my parent’s stuff in the small storage locker we rented, so we sacrificed most of our belongings.

I noticed I started clinging to things later when we finally got another apartment. I picked up stuff from the street I didn’t need–like broken street signs, discarded car review mirrors, desks, and even a bent reflector. I kept that bent reflector for ten years. In fact, I kept all of it for ten years. My closet is still full of junk I picked up from the street or things I thought were valuable from the dump. My room itself is cluttered, disorganized, and it took three years of picking through invaluable things with perceived value to keep at least two feet of walk space from my bed to the door. I still haven’t learned how to organize.

This example doesn’t mean I have Hoarding Disorder. I only share this to show that obsessions with material items don’t make people vain or stupid or rude. Loss and grief of any kind can make us cling to whatever solid, certain, undying thing we can find.

I don’t know how much of A&E’s Hoarders is dramatized for television. Sometimes it seems the film is edited to make the people look disgusting and defeated, and then a sob story told to make us feel pity. At the end we’re supposed to feel amazed the house is clean or disappointed in the person if it’s not, without recognizing the uniqueness of each individual’s process. All in all, the people are real. I don’t know about the show, though.

Is Body Dysmorphic Disorder Real?

Yes.

In fact, it’s the first disorder listed in the category. People struggling with this perceive a defect or flaw in their appearance that seems slight to every one else but causes severe preoccupation for the sufferer. This could cause people to go to drastic measures to fix this flaw–which may include several cosmetic plastic surgery interventions, or cause them to remain indoors, trapped behind the fear that everyone will see, ridicule, and be disgusted by their flaw. This is not the same as being preoccupied with ones weight, and it cannot be Body Dysmorphia if the symptoms of an eating disorder are present.

This is linked to people who have relatives with OCD, and has been seen correlated with high rates of childhood neglect and abuse. Females are more likely to have a co-morbid (occuring at the same time) eating disorder and males are more likely to be preoccupied with their genital region. What does all of this mean?

It means life is a living hell. Being in the view of others causes such distress there are people who hide behind their curtains, in their house, for years. And this is, again, not a vain “omg nobody look at me”. This is such a level of heightened anxiety that an entire life is disrupted. I feel that many obsessive conditions get looked at as people being selfish: the person living with OCD can’t take care of their child because the compulsions take up most of the day–that means they don’t care about their kid enough. Or the people with Trichotillomania has pulled a bald spot on their head, but then complains about being nervous of others seeing the bald spot–they need to just stop pulling their hair. And things just aren’t that simple. None of this is vanity or selfishness, it’s anxiety, it’s stress, it’s trauma response.

Here is a great Ted Talk by Meredith Leston that highlights how body image is spread in the world and how troublesome views can lead to great distress and disruptive conditions for some people. Let’s remember: our environment plays a huge role in dictating which genes turn on and off. Everyone has the potential to develop a mental condition at some pointing their life. Why it happens to some and doesn’t to others not only depends on environment, but social factors and genetic make up too. Not so much brain chemistry.

If anyone watched Barcroft on Youtube, you might like this clip on Body Dysmorphia and OCD. I tend not to watch them too often, but sometimes they have okay material. Let me know how real or not real this is.

What Kind of Treatment is Available?

For some of these conditions, like Trichotillomania, there are no drugs that reduce symptoms. Even in cases of severe OCD, psychotropic medications fail miserable. This is a testament to how much we still don’t know and why some researchers are putting more weight on alternative treatments and Cognitive Behavioral Therapy, the only psychotherapy which has been tested (with high reliability AND validity) and proven to change the course of people’s thoughts.

This Double-blind, placebo controlled, Cross-over study examined the possibility for Milk Thistle as a treatment for Trichotillomania. They concluded their sample size too small to yield any confident results, and that their evidence only weakly supported the use for Milk Thistle.

This placebo study with Trichotillomania only further showed that 1) change is possible depending on expectations of the participant and 2) easy access, simple treatments for this condition remain elusive and the condition reminds misunderstood on a clinical level.

I will say that OCD itself gets a lot of research while these other disorders fall short of people interested in finding treatments. For OCD there is a long list of possible SSRI treatment, ECT treatment (if you don’t mind losing your memory), different therapies, stimulants, and even EMDR. This is why I speak on the disorders we don’t hear much about. Because for the rest of these unknown, quiet, hidden disorders, sloppy therapy and hopeful medication are thrown at patients. Many suffer in silence.

For a condition like Body Dysmorphic Disorder, other alternatives are being studied too. This experiment examines whether an intranasal dose of Oxytocin could cue a helpful response for BDD. This too failed. It increased self-blame and “other-directed blame”, and the researchers “advise against the use of Oxytocin in BDD patients”. Glad science kept us from THAT mistake.

But, for those diagnosed with BDD and Social Anxiety disorder, this study found that Cognitive Behavioral Therapy and attention retaining significantly improved the Body Dysmorphic aspect of the participants life.

There is some progress.

What can we do?

If someone comes to you and tells you they have been struggling with one of these conditions, withhold whatever your initial reaction is. Remind yourself that many who struggle with these types of conditions blame themselves enough. Even those who don’t blame themselves may still feel guilty for the disruption it causes their lives. I feel guilty sometimes for the disruptions my anxiety and Schizoaffective-ness has caused in my life and others lives.

Remember that they are not disgusting or vain or weird. Remember that there may be a whole list of trauma you’ve never learned about. Remember that even clinicians don’t understand this, probably because they’re trying to understand it on a biological level too much–some things need a different perspective in life.

So, this Mental Health Month, let’s keep in mind that there is a lot of suffering going on right now. Let’s not compare our pain to others, but instead use that energy to remind each other we’re not as alone as we feel. If you are suffering in silence, may this space give you the extreme–almost inhumane it feels sometimes– courage it takes to send a text, or call to someone you can trust. You can comment on this blog even, or contact me on my home page; eventually the burden of silence will hurt your back. It’s damn near broke mine before.

I write these posts in this format because I’m tired of articles listing symptoms, bland, over-used, understudied treatments, and urging people to talk to their doctor. It’s a good idea sometimes to seek professional help, but to do so uneducated and so desperate for relief that you’re unable to look at things critically will only trap you in the quantum loop that is the mental health system, especially if you’re in America. Mental Health Month is about education and reducing stigma. We can’t do that if we don’t preach from the side of lived experience AND scientific research.

Tomorrow we cover: Trauma and Stressor related DIsorders.

Next week, we cover: Schizophrenia, Bipolar, and Dissociative disorders. If you’d like to submit your story for any of these, please contact me HERE, or on my social media handles below:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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.

Posted in advocacy, Community, psychology, science

Mental Health Month: Anxiety Disorders

Today we start our Mental Health Month series. As a short recap: every Thursday, Friday, and Saturday this month we will be covering different DSM-5 diagnoses, recent research, and featuring personal stories from YOU. This week we’re covering Anxiety disorders, OCD and Related Disorders, and Trauma and Stressor Related Disorders. If you want the FULL LINE UP, click HERE. If you want to submit your story, CONTACT ME, or find my social media handles below.

Now that that’s over, let’s get into today’s topic: ANXIETY DISORDERS.

What Is Anxiety?

We all know feeling anxious isn’t uncommon. It’s simply our body’s natural response to stress. If you look at the state of the world right now, it’s not surprising pharmacies were running out of anxiety medications.

So far, we believe this stress response prompts waves of catecholamines (neurotransmitters like dopamine and epinephrine) which give rise to our flight-or-fight response. From an evolutionary standpoint, this may come in handy if you’re scrounging for food in tiger territory. From a modern standpoint, our sympathetic nervous system is constantly bombarded with new information and new things to worry about. From an epigenetic standpoint, your resulting anxiety from this overstimulation influences the on-off switch in the genes of your child, creating a world of ever-more-anxious, alert, frightened children.

There’s no definitive proof for any of these hypotheses. There is evidence suggesting all sides, and more, but studying humans is hard and concluding one idea over the other might not be practical. Please do not take this ambiguity lightly. Most people want to agree with one of the three hypotheses listed above because it just makes sense to them. This is a trap of confirmation bias.

I find that anxiety becomes a fear of the future, a fear that the present could not possibly (or will exactly) lead to the future, and a fear that the past has ruined the future; anxiety, today, is a summation of fears.

Let’s talk about what happens when this becomes debilitating.

What Is An Anxiety Disorder?

Let’s first consult the DSM-5:

It states, “Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances.”

Not vague at all, right? You’ll learn much of the DSM is vague and simple in a convoluted way that makes diagnosis tricky: much of it is based on the subjective interpretation of the clinician.

There are 11 total anxiety diagnoses in the DSM-5:

1. Separation Anxiety Disorder

2. Selective Mutism

3. Specific Phobia

4. Social Anxiety Disorder

5. Panic Disorder (with panic attack specifier)

6. Agoraphobia

7. Generalized Anxiety Disorder

8. Substance/medication-induced anxiety disorder

9. Anxiety disorder due to another medical condition.

10. Other specified anxiety disorder

11. Unspecified Anxiety disorder

For the sake of the attention span of the average person (including me), we’re going to list the criteria of two of these diagnoses in depth so that you may see how they are broken down.

Let’s run through criteria, and then we’ll talk “causes” and treatment.

Selective Mutism

For this diagnosis, you must have the following (criteria summarized for all of our sake):

A) Consistent failure to speak in situations where there is expectation to do so, like at school.

B) Interferes with education, occupational, social achievement and communication

C) Lasts at least one month.

D) Not attributed to a lack of knowledge or comfort with the spoken language.

E) Not better explained by a communication disorder and does not occur during the course of autism, Schizophrenia, or another psychotic disorder.

These kids will speak in their homes with their immediate family but not with close friends or second-degree relatives—like grandparents. They “refuse” to speak at school, so says the DSM, although I’d argue it’s much more like an anxious reflex, this coming from someone who had this diagnosis; the anxiety is so severe the only option is for the child to shut down.

This also can include “excessive shyness, fear of social embarrassment, social isolation, and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behavior.” It is a “relatively rare disorder”, usually appears before 5 years old, but it may not be obvious until the child enters school. The long-term of this disorder is unknown, and “clinical reports suggest that individuals may ‘outgrow’ selective mutism.”

This next line is what happened to me: “In some cases, particularly in individuals with social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety disorder remain.”

Temperamental factors are not well identified. Environmental factors, such as parents modeling social reticence, can contribute to the development of selective mutism. This may include controlling parents or overprotective parents.

Genetic factors: nothing identified.

Social Anxiety Disorder

For this diagnosis, it’s exactly what you think and some of what you may not have thought of. These criteria have a longer list, so I will summarize in a paragraph:

There must be obvious anxiety about social situations when the person is exposed to possible scrutiny of others, like meeting with unfamiliar people. In children this must be observed with peers and not just adults. The person fears showing anxiety symptoms which could be judged negatively. Social situations always provoke fear. In children, this maybe seen as crying, freezing, tantrums. These situations are avoided or endured terribly—very terribly.

Of course the fear must be deemed out of proportion to the actual threat of the social situation. This lasts for six months or more (like my entire life) and influences impairment in social, occupational, and other areas of life. It’s not attributed to substance use or other medical conditions, and can’t be explained with another disorder.

Apparently, “the duration of the disturbance is typically 6 months” and so I would like a refund please—24 years and counting.

It’s seen that individuals with this disorder might be poorly assertive or excessively submissive or even highly controlling of the conversation. They might not use a lot of eye contact—so parents, don’t worry, your anxious child probably does NOT have autism. They may be withdrawn, and disclose very little about themselves, or speak with an overly soft voice.

They may live at home longer.

Self-medication is common.

The median age of onset is 13 years old. If that average were taken with kids also diagnosed with Selective Mutism, the median age, I’m speculating, would be much lower.

Temperament: The trait of behavioral inhibition (shrinking away from unfamiliar situations) has been linked to the development of this disorder.

Environmental: No increased rates of childhood maltreatment in the development of this disorder, BUT maltreatment is a risk factor.

Genetic: Traits, like behavioral inhibition, are genetically influenced. Social anxiety is heritable (NOT inherited). No specific genetic factors have been identified.

So What Causes Anxiety Disorders?

What’s the first thing that comes to your mind? Trauma? For those of us who have been ingrained in the mental health system for a while, you might think “chemical imbalance”. Not even the DSM endorses that as absolute. You will find that genetic factors are no where near being identified, much less a chemical imbalance.

When tackling this, we must remember that your genes, your body, your cells, your thoughts, are incredibly malleable. When we talk about “predisposition” in relation to genes, we’re talking about the propensity for them to switch on and off. For example, it seems that some genes are more likely to, in response to a traumatic event, turn on.

Every cell in your body is influenced by your environment. This makes it extremely difficult to confirm what is solid at birth—were you doomed to live with anxiety?—and what is developed after birth. In fact, we may never know.

If you Google “what causes anxiety”, you will be lead to proper links citing similar things as the DSM: personality traits with an unknown genetic basis has a large influence.

If you Google “what causes anxiety disorders”, you will be fed a mix of “chemical imbalance like diabetes” and “stress”.

If Anxiety, or any mental health condition, was a chemical imbalance like diabetes, we’d have a psychotropic equivalent to insulin.

If you search for a similar phrase in psychology databases, you won’t find what you’re looking for.

I managed to find an article entitled “Biological markers for anxiety disorders, OCD, and PTSD: a consensus statement. Part 2: Neurochemistry, Neurophysiolgy,, and neurocognition”. If you are interested in it, I only have access through a database, so I can email you the full text.

This paper from the World Journal of Biological Psychiatry summarizes all the current biomarkers (as of 2017) for anxiety disorders, OCD, and PTSD. They state “none of the putative biomarkers is sufficient and specific as a diagnostic tool, [but] an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD, and PTSD.” It cites Serotonin precursors, GABA, Dopamine, Neuropeptides, and even Oxytocin the love neurotransmitter.

My criticism for this starts with their PTSD makers. It states: “Compared with control subjects, PTSD patients showed significantly elevated platelet-poor plasma NE (norepinephrine) levels and significantly higher mean 24 hour urinary excretion of all three catecholamines (NE, Dopamine, HVA).” It cites another study as the source for this, which I can’t find yet. What could other factors be for this rise in stress neurotransmitters? My point: you couldn’t possibly pinpoint this particular rise in catecholamines to PTSD alone because we can’t isolate the PTSD from the rest of the body/brain. Take everything with a grain of salt.

Biomarkers are real. We ARE biological beings, and to ignore that would be, well, ignorant. However, the lack of understanding for how our biology transforms through life means attributing brain states to only chemical differences without connecting the body’s experience of physical life is just as ignorant.

So, we ask, are anxiety disorders a chemical imbalance? The answers is: we don’t know. And we may never know.

Anxiety Disorder Treatments

Medication has been a go-to for years. Benzodiazepines, dangerously addictive and physiologically dependent in a short amount of time (2-4 weeks) do well at cutting panic attacks down for size. Valium, Ativan, and Klonopin have saved me more than once. SSRI’s and SNRI’s, researched for depression and sold for everything else without care, can sometimes help calm anxiety. Lexapro, Effexor, Zoloft, and Trintellix—honestly I couldn’t tell if they did anything at all to my anxiety. But for some people, they work.

Some antipsychotics like Abilify (some, again, sold against the label) are added on to antidepressants with the purpose of easing depression, but can also inadvertently help anxiety and there’s no rhyme or reason for it. It can probably be dedicated to the sedating effect.

Certain therapies, however, have been proven time and time again to be more potent than medication for SOME disorders, and many experiments show a combination of therapy and medication is better than mediation alone or therapy alone. These studies must be scrutinized with care however: some of them have no control group or comparison treatment.

For example, Cognitive Behavioral Therapy has been shown to significantly reduce distress in Panic Disorder and PTSD when compared to medication and no treatment. What will work depends on your willingness to throw yourself into the process. I’ve done much CBT and found that it only started working after I stopped putting off the homework. There are also personalities and onset of the condition that affect this, which you can read about here.

Other treatments are being studied too. We talked about Freespira here, the medication free treatment that is entirely invalid.

There is study going into Chamomile treatment for Generalized Anxiety Disorder. This study concludes there was non-significant reduction in GAD relapse but significantly better GAD symptoms and improved psychological well-being. Part of their funding came from the Nations institutes of health and a cancer center, and the authors have no conflicts of interest. It was a randomized clinical trial. Read it here.

Naturopathic care, including certain vitamins, need more research, but has some success in this article. My criticism is that if the participants were aware that anxiety was being studied, the placebo effect could be huge. I didn’t read through the entire study, admittedly, but if YOU find whether participants were aware or if they were deceived as they should have been, let us know.

Where Can I Get Help?

If you feel you are struggling with anxiety, please reach out. If you don’t have close friends or family, message me.

If you want to speak with someone anonymously, I recommend Peer Support warmlines. These are not hotlines for crisis, but for meaningful conversation with someone who has been there. There is a list at this link. Those are for California, but anyone can call from anywhere. I’ve spoken to people from England before. You can search for some in your own state or region as well.

If you don’t trust any of those, give us a call at 831-688-0967. We are also a peer warm line service where I work, and have gotten calls from people throughout the country. We are open right now, 24/7. We try and keep conversations to twenty minutes, but I’ve been known to stay on longer if nothing else is going on in the house and the person is really needing support. *I will say I won’t necessarily be the person to pick up. We have other staff members.* If something comes up in the house, our current guests are a priority and we may need to get off the phone.

If you choose Therapy, online or otherwise, is another option. I recommend Psychology Today to find a therapist near you, or your health insurance website.

Your general practitioner may also have suggestions. If you choose the medication route, I suggest researching a good psychiatrist, reading your OWN research, and not allowing your general practitioner to run your psychotropic medication case. They are not trained for that.

Our Mental Health Month Featured story is at THIS LINK: Read about Caz and her journey through anxiety and into a mental health nurse career.

For updates, support, or to submit your story, follow me:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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.

Posted in science

A Medication-Free Anxiety Treatment

Briefly last week, I considered getting back on medication. My panic attacks have been relentless, my voices have been annoying, my thoughts have been in and out of this world. I went as far as going online to a pain center my previous psychiatrist worked at. She is long gone, but there are other great doctors there, and I have nothing bad to say about this particular institution of health professionals. They were informative, kind, and their offices are quiet, clean, bright, and overlook trees even though they’re one hundred feet from a freeway entrance.

While browsing their website to see if they conducted Telehealth appointments, I found a tab specified for panic disorder and within that tab they listed a new, medication-free treatment for anxiety. Curious, I investigated.

What is the treatment?

This treatment is the FDA approved “Freespira” developed by Palo Alto Health Sciences. For this section, I’ll be getting my information from the Freespira website and this patient brochure.

Firstly, Freespira is a breathing trainer. You receive a special Freespira tablet and medical censor that tracks your breathing rate and your Carbon Dioxide output. The hypothesis here is that those of us who panic have irregular breathing patterns even when we aren’t panicking. When we do get anxious, our breathing rate becomes even more so arrhythmic and we aren’t outputting as much carbon dioxide as is healthy. This physiological response cannot be addressed by therapy or drugs, and this is the response Freespira targets. The device teaches you how to regulate your breathing so that you exhale the proper amount of carbon dioxide. Their website says “by training panic suffers to permanently change their breathing patterns, panic attacks are dramatically reduced and, in many instances, completely eliminated.”

This takes a set amount of sessions over the course of a few weeks.

Why This Was Exciting

As a desperate panic sufferer, I know all too well of the tingling in the limbs, the racing heart, the feeling that death is imminent. I lost count how many times I’ve went into the ER because my hyperventilation threatened my consciousness. I won’t spend breathless paragraphs reiterating the doctors who accused me of drug use, who almost refused me treatment, who took my blood without consent to test for meth. The idea of an anxiety treatment that doesn’t including putting poorly tested chemicals in my body daily, or risking “as needed” medication becoming “need” medication and eventually, if not severe physiological dependence, than addiction, almost made me cry.

The statistics are promising. Their website states clinical results are as followed:

Protocol Adherence (meaning participants followed instructions correctly): 83%

Panic-Free immediately post treatment: 85%

Panic-Free 12 months post treatment: 81%

Reduction in panic symptoms 12 months post treatment: 94%

A Stanford trial in 2008 showed “positive changes in respiratory physiology, and strong evidence for safety and tolerability”. 68% of participants were panic free, 93% had a reduction in symptoms after 12 months.

Another trial showed similar results, with protocol adherence and freedom from panic ranging from 71% to 88%.

The last study they cite has no verifiable link on google.

These results are pale in comparison to those reflected by drug therapies and every other talk therapy except Cognitive Behavioral Therapy for panic disorders. It is easy, quick, self-administered, and finally puts to use all those breathing techniques you learned that felt useless. Suddenly, they’re not so useless because you have a tablet and sensor telling you they’re not.

So what’s the truth?

I hope you don’t feel as let down as I did.

In my excitement, I didn’t fall blind to the fraudulent world of psychology research. And so, I researched. My first hint that something was off came from the website healthnewsreview.org, a website dedicated to “improving your critical thinking about health care”.

Some of the noteworthy things they mentioned, briefly summarized because I love you guys, are:

1: The cost treatment is not discussed. In 2015, a news story reported the monthly cost as $500.*

2: No absolute numbers are released, just overall percentages states on the website.

3: No mention of what the harms could be, if any, and there were no links to the studies mentioned on the website. We’ll come back to this.

4: one of the most IMPORTANT: Freespira website DOES NOT discuss or post who funded these studies. We’ll come back to this too.

5: No alternatives discussed. I mentioned CBT earlier in this article, as it is one of the leading and most proven methods for treating panic disorder. A comparison is no where mentioned.

*link to the ‘news story’ on healthreview.org

By this point, I’d lost hope.

And so, I’ve done the nice, hard work of finding the studies Freespira reports as their evidence. They did indeed provide citations eventually of their sources, but I could only find them when I switched from desktop view to mobile view. I have linked them above.

The Results?

The “Stanford Study”

Let’s remember How to Read a Research Paper before continuing. I don’t know if this was actually conducted at Stanford, but Freespira lists this citation as the Stanford study they mentioned.

Not Freespira specific, but tested for the effectiveness of capnometry-assisted breathing therapy, the type of device freespira is purporting to be.

Methods and participants: 37 participants, 31 with panic disorder and agoraphobia, 6 with panic disorder and NO agoraphobia. 20 were randomly assigned to the treatment, 17 were wait-listed as a control group. Recruiting happened with community advertisements. You can read the study for more in depth description of the participants.

Treatment: educating patients on breathing, showing them problematic respiratory patterns, having them perform breathing maneuvers with feedback, teaching ways to control carbon dioxide levels, and having them practice breathing exercises daily. Twice daily, 17 minutes, at home. Read for more in depth description.

Results: Low attrition (drop out rate). 40% experienced no more panic attacks during the four weeks. 2 month follow up, 62% had experienced no further attacks, and 68% were panic free at 12 months. This shows brief capnometry breathing therapy can be therapeutic. Improvements were seen in the treated but not untreated participants and success improved as time passed. Non-respiratory mechanisms, such as treatment rationale (meaning they told the participants the point of the study) let the patients develop cognitive components needed to avoid catagstrophic thinking and gave patients a sense of control–one thing we lose in panic attacks. The breathing exercises triggered sensations similar to those we experience in panic attacks, and desensitization may have occurred to the bodily clues rather than respiratory changes being the sole drive. Need future studies testing viability (success of the treatment).

Limitations: The first thing you learn in an introductory research course is that when you are studying treatments for mental health disorders, you can’t simply pair the treatment with an untreated population. In order to test for something like viability, you need to compare your treatment to other treatments. This study did not do that, and lists it in their limitations section.

This study was supported by the NIMH.

The Multi-Center Trial

Freespira specific.

Methods and Participants: Primary diagnosis of Panic Disorder, 18-65, moderately ill or greater based on the Clinician Global Impression Scale, and were off medication or had been stable on medication for 3 months. Conducted at multiple non-academic clinical sites with different clinicians at different levels of expertise.

Procedure/Treatment: 4 weeks. Breathing sessions 17 minutes long with baseline stage (sitting quietly with eyes closed for 2 minutes), a pacing stage (monitoring of Carbon dioxide levels with breathing at a specific rate for ten minutes), and a transition stage (patient maintains breathing pattern with feedback for 5 minutes).

Results/discussion: 20% dropped out. Significant decrease in panic disorder severity over four weeks, early identical results to the previous study. Patient compliance was high as well as patient satisfaction. This treatment can be made largely available at a low cost. Side effects were rare, like mild dizziness or lightheadedness in the beginning training sessions.

Limitations: Again, no control group, not even a wait list. The study itself says “these results cannot be considered a definitive documentation of efficacy”, but instead “extends [the previous studies’] findings to document feasibility and utility in more naturalistic treatment settings.” It discusses no alternative reasons for why they may have seen significant results and a decrease in panic symptoms.

This study was funded by Palo Alto Health Sciences, the developers of Freespira.

Several of the doctors on this so-called study have received research grants and/or consulting fees from PAHS and Merck. This is listed as the Conflicts of interest. For obvious reasons.

Should You Try Freespira?

Results show the need for many, many more studies, but no real evidence of efficacy.

Try at your own risk. Especially if it means you’re paying out of pocket.

If you go in thinking it will work, it will probably work. if you go in remembering this evidence, it probably won’t.

If you have tried Freespira and it worked for you, leave your experience below or message me and let’s write about it! The same applies for if you have tried Freespira and it hasn’t worked for you.

Also, notice the degree of ethical practice reduces when the study is funded by the developer of the treatment. Keep that in mind for when we discuss the studies of psychotropic medications.

For conversation, support, and updates on research and posts, follow me:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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 bad science.

Posted in Community, science

Our Scientific Crisis

In the wake of this lighting striking all over the world, there’s been a level of social (media) distancing I can appreciate. I haven’t written since my break because I don’t just want to talk about COVID. It’s just that everything else seems so irrelevant now. So, I have something very simple to say.

We are in a SCIENTIFIC CRISIS.

What does this mean?

It means we’re not focused on the task at hand: containing a rapidly spread, generally mild but sometimes very severe illness. Instead, we’re focused on our infrastructure, media reporting, fear mongering, and blame-gaming.

How many people have actually went to the CDC website and read up on what a Coronavirus is versus how many people went out and hoarded N95 masks to the point healthcare workers are falling short of the protection they need? I’m not saying self-preservation is bad. I’m saying stupidity is bad.

I’m sick of the fear mongering, in particular. I follow The Mighty, although I’ve never been published by them, probably because for my previous blog Mental Truths I email-interviewed the C.E.O pertaining to questions about the outrageous amount of funding they suck down from pharmaceutical companies in exchange for all the pro-medication ads on their website. If you want to know my stance on biological treatment, give this and this a read (i’m not against it). In my email this evening, a new article came in from one of The Mighty’s editors, summarizing this idea that doctors across the states are considering DNR’s for all COVID patients.

CHRIST! A title like that would scare me too. If I didn’t know any better. The comments were full of immuno-compromised and chronically ill people TERRIFIED. Utterly TERRIFIED. And for GOOD REASON! A breakdown of ethics of THAT magnitude would mean all hope is lost.

Doctors have indeed been discussing DNR’s in relation to those having severe respiratory reactions to COVID. These matters are discussed on a case-by-case basis with the family as they have always been since the dawn of DNR in western medicine. There are no current guidelines for COVID treatment, one of the reasons this has become such a scary time. What makes it scarier is when a website dedicated to chronically ill and vulnerable people can’t cite their sources or present an argument objectively, not even when the argument pertains to peoples’ livelihood, health, and well-being.

I’m seething behind my keyboard.

As other doctor’s have stated (you can find the quotes in that linked CNN article above), the DNR discussions have not been blanket DNR’s–essentially the statement “every COVID patient who’s respiratory system has failed will be left to die for the sake of health care workers and other patients” is the message The Mighty and other media giants like The Washington Post have been spreading. While it IS a concern for a healthcare worker to climb on a failing patient and give mouth-to-mouth when they’ve tested positive for COVID, killing all respiratory distressed COVID patients not only isn’t practical, it’s reprehensible. Two good reasons why it would never happen.

Okay, there is ONE CASE in which this would become a reality in the United States: hospitals in all states are overrun with the infectious disease, there aren’t enough doctors to care for patients because ALL the doctors are sick too, and bodies are piling up in the street. Then it’s safe to say ethics are out the window and the survival of those well enough to survive become precedent because it would be happening in all other countries as well. Luckily, COVID is not going to be the virus to drive us to extinction. Imagine more of a virus that causes the symptoms of Ebola but spreads like the Bubonic Plague. That will be our demise, surely.

What’s going on in Italy and Spain are examples of this: overrun hospitals, bodies having to be stored in people’s quarantined homes (Italy) and on ice rinks (Spain) because there is just no safe way to handle them, or any businesses open to do so. Will this be a reality for the entire world? I strongly doubt it. Is this reality for those countries horrible? I couldn’t even put into WORDS how absolutely sorrowful their experiences are right now.

We are in a SCIENTIFIC CRISIS because funding has been cut to the CDC, the WHO has made countless mistakes, researchers are ignored in favor of big business, and NOW, in the quarantine, people are forced online and what’s online? Secondary, third, fourth, fifth sources that are easy to read but entirely misinformed and not very analytical. People aren’t paying attention to the exponential growth curve of the spread of COVID, nor have they reasoned that the lack of tests (one of the reasons we in the U.S have now become the leader in contracting COVID cases) means many more people have the disease and many more people have recovered at home.

I suggest staying off of Apple News and instead read updated information on the CDC website. I suggest reading your own county information in your own state (if you’re in the U.S). I suggest straying from Instagram, Facebook, or Twitter for reliable pandemic information. I also HIGHLY SUGGEST JAMA Network, a website of specialty journals that are consistently uploading studies and scientific information about SARS-CoV-2, aka COVID-19. If you struggle reading this kind of technical information, read this about how you don’t need to be medicine-inclined to get something reliable and important out of these studies. The reason why the media is so misinformed is because the people who report on experiments do so incorrectly, misunderstand conclusions, and often know nothing about the scientific process. That article will give you just enough basics to read a scientific paper, think critically, and extract the important information. It’s a lot easier than it sounds. And this time, the life of your mother, father, aunt, uncle, and cousin with or without underlying health conditions may be on the line. That’s some good encouragement to READ.

Want some information NOW? Read this article published by Louisiana State University that, with further research, may help us understand why “underlying conditions” can post a threat for coronavirus patients. Hint: it has more to do with the medications they are taking than the actual conditions.

Many people are unaware of what the tiniest bit of misinformation can do in this pandemic: it WILL make or break us. If we are not informed, if we are not reasonable, panic will consume us and all the N95 masks. Please, for the sake of your neighbors, for your coworkers, for your kids, your family, yourself, for my dad who struggles with high blood pressure, seizures, COPD, and congestive heart failure, keep yourself informed, stay indoors, limit or eliminate your contact with non-essential people, and wash your hands. If you’ve ever needed a purpose, this is a time for you to contribute to the health of the globe. You make the difference.

If something in this article hit home for you, if you want others to inform themselves about this pandemic and stay on top of relevent information, please share on your Facebook, Instagram, Twitter and any other social media. The people who look to those sites for information could use this more than you, perhaps.

Stay healthy everyone, please. Someone in the world dearly misses their loved ones because action was not swift enough, because people thought this was the flu, because people didn’t take this seriously. Let’s not make the same mistake twice.

I’m not putting my normal blurb at the end of this article. The only thing I ask is that you share this and think scientifically.

If you have a surplus of PPE or N95 masks, gloves, or disinfectant wipes, please donate some to your local medical facility. Check your county website to see if they have set up protocol for donations. Mine has.

Be safe, stay home, and stay informed.

Posted in Community, psychology, science, travel

The Do’s and Don’ts of COVID-19

My social media break has officially broken, and I am back amid panic, turmoil, and pandemic simply because being quarantined means there is nothing better to do than browse social media, panic more, and then realize that fear is more constrictive than any virus outbreak could be.

If this pandemic has been affecting your Mental Health, you’re not alone. Even if you understand the numbers are not as bad as the media portrays, even if you understand that over 90% of the people who may come in infectious contact with the virus recovery well, with mild to moderate symptoms, the tension in the air, the way people drive, the mad scramble for food, toiletries, and essentials can twist a lot of stress in your body.

So, what should we do and what shouldn’t we do during this time?

DO:

Maintain as regular as a routine as you can. Enjoy healthy meals, and try to avoid stress eating sweets and other things that not only compromise your mental health but your immune health. Exercise in nature if applicable to you: there are forests, state parks, beaches, where you can get a healthy bout of endorphins running and kick your immune system up. The gym isn’t the only place in the world to get exercise.

DONT:

Eat a pot full of garlic and think that will protect you. Chances are, you may come in contact with this virus. This chance, depending on where you live, is either very low or very high. Don’t pretend like staying in your house and sleeping all day is healthy; in fact, it could compromise you more. Fit in exercise and health where you can and however you can.

DO:

Listen to science. For the sake of your neighbors, your friends, your family, LISTEN TO SCIENCE. The facts are there. Yes, COVID-19 is indeed SARS-cov-2, according to the CDC. Yes, there are many cases. But the numbers show a different story than the media. It’s important to help curb the spread, just as it would be for any new infectious virus no matter how severe, but the fact is there are so many people in the United States who haven’t been tested, who have probably come in contact with the virus, been sick, stayed home, recovered, and are now not being counted as a COVID-19 case. This means the survival rate and infection rate is higher than being reported. This means, most likely, you’ll be okay.

Dont:

Act only in SELF-PRESERVATION. Stores are sold out of all cold, flu, and cough medicine, toilet paper, meat, and cleaning essentials. This is NOT the end of the world. By hoarding items, you are SELFISH. By hoarding masks, you are CARELESS. Most likely, especially if you are in the U.S right now, you will NOT get sick. Buying three bottles of Tylenol ISN’T NECESSARY. Masks are for the MEDICAL PROFESSIONALS taking care of the SEVERELY ILL. If you are standing in Safeway with a cart full of items right now reading this, chances are you AREN’T SEVERELY ILL. Chances are, you won’t ever be.

It was advised people get enough items for 2 weeks of self-quarantine, IF NECESSARY.

Six bottles of bleach? That’s going to last you two months, if not more.

Seven boxes of Tylenol? You’ll kill yourself. Even if you did get sick, you couldn’t continuously use it at the rate you would need to to finish seven boxes in fourteen days.

This selfishness is why people are panicking. It’s how the virus will continue to spread. It’s why young people aren’t taking anything seriously, it’s why many people aren’t social-distancing–the hysteria is off-putting, it makes it seem unimportant. So, by hoarding food, house items, and cough medicine, you’re single-handedly increasing the chances of this infection spreading quicker and harder. Those of us who are young are the ones MOST LIKELY to SPREAD this infection without knowing it. Instead of facing this scientifically, intelligently, which would make most of us young folks pay better attention, everyone is facing this hysterically, with misinformation.

Thank you, apocalypse shoppers, for ruining our chances of a speedy, national recovery.

DO:

Wash your hands for at least 20-30 seconds. If you weren’t doing that before, I’m worried. Disinfect surfaces frequently, and personal items like keys, your phone, and the inside of your car, if you want to be extra cautious.

DONT:

Touch your face or put strange objects in your mouth. If you’re anything like me, and a writer, this can be tough if you are, well, writing with a pen. I used to bite on my pens in mid-thought. Can’t be doing that right now.

DO:

Understand that if you get sick, you have a very high chance of being okay. People are dying, and that can’t be overlooked. There are some young people who lose the battle, and many older folks, most of which (from both categories) have some type of underlying cardiac or other health condition. If you smoke, your lungs will have a harder time to push back against this illness. And even still, there are some people in their 80’s and 90’s who are surviving, and some people with underlying conditions who are surviving. This is not endgame.

DONT:

Pretend like you can’t get sick just because you’re young. You can, and if it doesn’t become severe, that’s wonderful. Problem is, you will spread your germs and get the vulnerable population sick. Again, stop acting in SELF-PRESERVATION. Everything isn’t always about YOU. Sorry if that hurts your feelings. Start acting like a community. Start showing some compassion and intelligence. Keep yourself healthy, keep your neighbors healthy. It doesn’t take six bottles of bleach and all the food in Trader Joe’s to keep you healthy. Stop being stupid.

DO:

If you have mental health issues, don’t forget about self-care. Focus on activities you like. Read, write. Play video games, watch television, have a laugh. Engage in news and stories and conversation that isn’t just about COVID-19. Stay updated on current local information, but do not become consumed by it. Unlike COVID-19, panic can spread through the internet and radio.

DON’T:

Spend all your time listening to White House addresses if you’re in the U.S. For the love of God.

DO:

Recognize that people are hurting. The stories coming out of Italy are heartbreaking. Take this seriously without losing yourself.

DON’T:

Become a doomsdayer or conspiracy theoriest. Wait until the global emergency is over for all that.

The world is in so much pain right now, and is so confused. China has made great efforts and cases of COVID-19 have been drastically reduced. Recovery surpassed 80% there, days ago. This will pass.

Every once in a while, humans need to be reminded that we aren’t impenetrable. We aren’t immortal. We aren’t invincible. We’ve gotten so cocky on Earth, we think we know everything, think we can have a sustainable life with the way we purge natural resources. This pain on a global scale isn’t necessarily what we deserve, but it is a reminder that we are only organisms. There is so much more to life than money, jobs, school, Apple T.V, Trump, drugs, sex. And when our life gets disrupted, look how we crumble. Look how fast we are to only save ourselves. Life always, always has a way of curbing arrogance. Always.

We’re not curbing this virus. It’s curbing us.

For updates on posts, research, and conversation, follow me:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue this joyous hobby.