mental health

On trauma aftermaths that don’t advance the plot

The way TV shows trauma can lead people to expect every reference to trauma to be a plot point. This can be isolating to people coping with the aftermaths of trauma. Sometimes people treat us as stories rather than as people. Sometimes, instead of listening to us, they put a lot of pressure on us to advance the plot they’re expecting. 

On TV, triggers tend to be full audiovisual flashbacks that add something to the story. You see a vivid window into the character’s past, and something changes. On TV, trauma aftermaths are usually fascinating. Real life trauma aftermaths are sometimes interesting, but also tend to be very boring to live with. 

On TV, triggers tend to create insight. In real life, they’re often boring intrusions interfering with the things you’d rather be thinking about. Sometimes knowing darn well where they come from doesn’t make them go away. Sometimes it’s more like: Seriously? This again? 

On TV, when trauma is mentioned, it’s usually a dramatic plot point that happens in a moment. In real life, trauma aftermaths are a mundane day-to-day reality that people live with. They’re a fact of life — and not necessarily the most important one at all times. People who have experienced trauma do other things too. They’re important, but not the one and only defining characteristic of who someone is. And things that happened stay important even when you’re ok. Recovery is not a reset. Mentioning the past doesn’t necessarily mean you’re in crisis.

On TV, when a character mentions trauma, or gets triggered in front of someone, it’s usually a dramatic moment. It changes their life, or their relationship with another character, or explains their backstory, or something. In real life, being triggered isn’t always a story, and telling isn’t always a turning point. Sometimes it’s just mentioning something that happened to be relevant. Sometimes it’s just a mundane instance of something that happens from time to time.

Most people can’t have a dramatic transformative experience every time it turns out that their trauma matters. Transformative experiences and moments of revelation exist, but they’re not the end all and be all of trauma aftermaths. Life goes on, and other things matter too. And understanding what a reaction means and where it came from doesn’t always make it go away. Sometimes, it takes longer and has more to do with skill-building than introspection. Sometimes it doesn’t go away.

On a day to day level, it’s often better to be matter-of-fact about aftermaths. It can be exhausting when people see you as a story and expect you to advance the plot whenever they notice some effect of trauma. Pressure to perform narratives about healing doesn’t often help people to make their lives better. Effect support involves respecting someone as a complex human, including the boring parts.

The aftermath of trauma is a day-to-day reality. It affects a lot of things, large and small. It can be things like being too tired to focus well in class because nightmares kept waking you up every night this week. TV wants that to be a dramatic moment where the character faces their past and gets better. In real life, it’s often a day where you just do your best to try and learn algebra anyway. Because survivors do things besides be traumatized and think about trauma. Sometimes it’s not a story. Sometimes it’s just getting through another day as well as possible.

A lot of triggers are things like being unable to concentrate on anything interesting because some kinds of background noises make you feel too unsafe to pay attention to anything else. For the zillionth time.  Even though you know rationally that they’re not dangerous. Even though you know where they come from, and have processed it over and over. Even if you’ve made a lot of progress in dealing with them, even if they’re no longer bothersome all the time. For most people, recovery involves a lot more than insight. The backstory might be interesting, but being tired and unable to concentrate is boring.

Triggers can also mean having to leave an event and walk home by yourself while other people are having fun, because it turns out that it hurts too much to be around pies and cakes. Or having trouble finding anything interesting to read that isn’t intolerably triggering. Or having trouble interacting with new people because you’re too scared or there are too many minefields. Or being so hypervigilant that it’s hard to focus on anything. No matter how interesting the backstory is, feeling disconnected and missing out on things you wanted to enjoy is usually boring. 

When others want to see your trauma as a story, their expectations sometimes expand to fill all available space. Sometimes they seem to want everything to be therapy, or want everything to be about trauma and recovery. 

When others want every reference to trauma to be the opening to a transformative experience, it can be really hard to talk about accommodations. For instance, it gets hard to say things like:

  • “I’m really tired because of nightmares” or 
  • “I would love to go to that event, but I might need to leave because of the ways in which that kind of thing can be triggering” or 
  • “I’m glad I came, but I can’t handle this right now” or
  • “I’m freaking out now, but I’ll be ok in a few minutes” or 
  • “I need to step out — can you text me when they stop playing this movie?”

It can also be hard to mention relevant experiences. There are a lot of reasons to mention experiences other than wanting to process, eg:

  • “Actually, I have experience dealing with that agency”
  • “That’s not what happens when people go to the police, in my experience, what happens when you need to make a police report is…”
  • “Please keep in mind that this isn’t hypothetical for me, and may not be for others in the room as well.”

Or any number of other things.

When people are expecting a certain kind of story, they sometimes look past the actual person. And when everyone is looking past you in search of a story, it can be very hard to make connections. 

It helps to realize that no matter what others think, your story belongs to you. You don’t have to play out other people’s narrative expectations. It’s ok if your story isn’t what others want it to be. It’s ok not to be interesting. It’s ok to have trauma reactions that don’t advance the plot. And there are people who understand that, and even more people who can learn to understand that. 

It’s possible to live a good life in the aftermath of trauma. It’s possible to relearn how to be interested in things. It’s possible to build space you can function in, and to build up your ability to function in more spaces. It’s often possible to get over triggers. All of this can take a lot of time and work, and can be a slow process. It doesn’t always make for a good story, and it doesn’t always play out the way others would like it to. And, it’s your own personal private business. Other people’s concern or curiosity does not obligate you to share details.

Survivors and victims have the right to be boring. We have the right to deal with trauma aftermaths in a matter-of-fact way, without indulging other people’s desires for plot twists. We have the right to own our own stories, and to keep things private. We have the right to have things in our lives that are not therapy; we have the right to needed accommodations without detailing what happened and what recovery looks like. Neither traumatic experiences nor trauma aftermaths erase our humanity.

We are not stories, and we have no obligation to advance an expected plot. We are people, and we have the right to be treated as people. Our lives, and our stories, are our own.

Taking pills when it’s difficult to do so

arrowhearts said to realsocialskills:
I was wondering if you knew of any tips or resources for taking (pill-based) medications daily when for a variety of reasons (anxiety, forgetfulness, bad taste, fear, etc) it is difficult to do so? Also thank you so much for the time and thought you have put into this blog! It has been very useful and informative to me!

realsocialskills said:

There are some potentially useful reminder/tracking apps for iOS, Android, and Apple Watch:

  • Mango Health, which is gamification-based and offers rewards/badges for taking your pills every day. (It’s not very flexible.) It also has notifications and reminders.
  • (If you like gamification, HabitRPG may also be helpful).
  • Medisafe, which is in no way gamified and isn’t trying to make you have fun or like anything. It’s just an app that tracks medications, gives reminders, and has a few other features. 

Getting help remembering from someone else:

  • Some people find it helpful to have someone remind them to take pills.
  • Or ask them whether they’ve taken a pill.
  • Or to bring them the pills.
  • (Both medication apps allow you to link another person to your pill-taking records, if you want to.)
  • This can also backfire, and isn’t the right option for everyone.
  • (One way it can backfire is that if you ask people for help remembering, they may think that it’s their job to *make* you take it, whether you want to or not.)
  • (Needing help with the logistics of pill-taking doesn’t mean that you need someone else to take over your medical decisions, but a lot of people think it does).
  • Some people also find that their anxiety skyrockets when others pay attention to their pill-taking.
  • Sometimes this is less of a problem if it’s mutual (where you remind someone about their pills, and they remind you about yours.)

Help can also be more occasional:

  • Some people need occasional help figuring out the logistics, or overcoming anxiety or other barriers. It can help to have people you can ask for occasional help, along the lines of:
  • “I need to take my pill, but I need to eat before I can take it, and I have no food. Can you help me figure out how to eat?”
  • “I can’t make myself take my pill, can you tell me to go do it?”
  • “Can you remind me that it’s ok to take pills and that I’m not being lazy or something?”
  • “I’m having trouble with the pharmacy’s online refill system, do you know how it works?” 
  • tl;dr: Needing help doesn’t mean needing others to take over, and it doesn’t necessarily mean needing supervision or ongoing daily assistance. 

If the problem is that the pills taste disgusting or are hard to swallow:

  • Sometimes this is a problem that goes away over time.
  • Sometimes if you keep tasting a particular taste regularly, it become less disgusting.
  • Similarly, many people who initially find swallowing pills difficult find it much easier as they get more practice.
  • You can also put the pill in a spoon of something like applesauce, yogurt, or pudding. That can mean that you taste and feel the pudding and not the pill, which can make swallowing easier for some people.
  • Some people find it helpful to chase pills with a liquid they like.
  • (A caveat about that:
  • If  the taste/sensation makes you feel sick to your stomach or like you’re going to throw up, it may not be a good idea to drink/eat something you really like right after. 
  • Because you can end up associating that feeling with the thing you like, and then develop an aversion to that too.
  • But if the nasty-tasty pills *don’t* make you feel sick, washing the taste away with something you do like can work really well.)

If the problem is irrational or mostly-irrational anxiety:

  • Reminding yourself that the anxiety is irrational can help.
  • Reminding yourself what the pill does and why you want to take it can also help.
  • And once you get used to taking the pills regularly, the anxiety may go away.
  • Some people find it helpful to think things like “This is scary, but I can do it, and it won’t always be this scary.”
  • One reason that taking pills can be scary is that it can be an unpleasant reminder that you need the pills. 
  • If that’s a barrier, it might help to remind yourself that you need the pills whether you take them or not. 
  • Or you might know that it causes side effects you hate.
  • It also might help to complain about this to yourself, along the lines of “I really !#$!$# hate having to take this pill”.
  • (Having to take pills can suck, and it’s ok to have feelings about it.)

If the issue is reluctance or reservations about the pills:

  • I’m somewhat uneasy about mentioning this, because logistical difficulty is often dismissed as unwillingness to take pills.
  • That said — sometimes the problem really is that someone is trying to force themself to take pills that they don’t really want to take.
  • Everything is harder when you don’t want to do it.
  • There are all kinds of reasons that people might not want to take medication. (Some good reasons, some bad reasons).
  • Eg: Some people feel ashamed of needing medication, or feel like they should be able to somehow will themselves to not need it.
  • Eg: Sometimes the side effects really suck. Sometimes side effects mean that a given treatment needs to be reconsidered.
  • Eg: Sometimes people take pills that don’t seem to be working, and that can be demoralizing.
  • Eg: Sometimes people are misdiagnosed, and prescribed medication that isn’t appropriate, (or suspect that they were misdiagnosed).
  • Eg: Sometimes things that seem like a good idea in the doctor’s office don’t seem like a good idea in day-to-day life.
  • Eg: Sometimes when people have been taking a pill for a while, they forget what it was like without the pill — but keep noticing the side effects. This can make it hard to feel that the pill is still worthwhile.
  • Eg: Sometimes people come under intense pressure from others to believe that a particular pill will fix things. This can get complicated if the pill isn’t actually the right solution.
  • (And there are any number of other reasons).
  • Sometimes the solution to this is changing your attitude towards your medication, and sometimes the solution to this is changing your treatment plan. (And sometimes it’s a combination of both). 
  • So it might be worth asking yourself: How do you feel about taking this medication, Is this a pill you want to take?
  • Why are you taking it? Why was it prescribed? Do you agree with the reasons?
  • Are you having side effects that suck? Are you questioning whether the side effects are worth it? 
  • Is there another option you want to consider, or does this seem like the best choice for now?
  • If you really are reluctant, err on the side of taking that seriously. You may have a good reason, and it may lead to needed changes.
  • If you think about it and decide that your reluctance is irrational, that can also be very helpful.
  • Either way, if the problem is reluctance, thinking through things and getting to a point where you feel confident that you’re making the right choice can help a lot.
  • *All that said*, it’s important to remember that taking pills can be hard for all kinds of different reasons.
  • Some reasons it can be hard to take pills have absolutely nothing to do with how you feel about them. 
  • Wanting to take pills doesn’t always make it possible to take pills.

Sometimes pills are easier to take if you associate them with an action you do every day rather than with a time. Eg:

  • If “take nighttime pill at 11pm” doesn’t work, “take nighttime pill when I brush my teeth” might.
  • If “take morning pill at 8am” doesn’t work, “take morning pill after I eat breakfast” or “take morning pill when I get into my car/bus to go to work/school” might work.
  • Or “I’ll take my pills when my kids come home from school and I’ve given them theirs”.

Sometimes changing where/how your pills are stored can make a big difference, for instance:

  • Keeping pills in the medicine cabinet can make it easier to take them when you brush your teeth
  • Keeping pills next to your bed can make it easier to take them when you get up and/or when you go to bed
  • If you frequently forget to take your medication, keeping some in your purse/ backpack/etc can make it easier to take it once you realize you forgot.
  • If you need to take medication when you eat, keeping the pills near your food might help.
  • Some people find pill sorters really helpful. They’re clear box-things with a box for each day, and at the beginning of each week you put a week’s worth of pills in them. This can also be a way to tell whether you’ve taken a given dose or not.
  • Sometimes you can get pills packed in blister packs, with a compartment for each day. 
  • (Birth controls are usually packed this way, and some pharmacies can pack any kind of pill this way).

If part of the issue is privacy:

  • Sometimes not wanting other people to know can complicate taking medication.
  • This is a common issue for birth control pills — and there are cases you can get for birth control packs that look like little makeup cases. (So you could keep it in your purse and it would just look like you have makeup).
  • (If you’re in a situation in which it’s unsafe for others to know that you’re using contraception, birth control pills may not be the best option. An IUD or Depo-Provera shots might be better. Planned Parenthood can help you consider options.). 
  • Similarly, it might help to keep pill bottles inside little containers that don’t look like pill things (eg: Claire’s has coin purses that are a good size for this).
  • Or to get a lockable toolbox and keep the key on your keychain.
  • Or to keep pills in your gym back if you have one — most people are going to assume there are gross sweaty clothes in there and be reluctant to look.
  • If you’re in college and don’t want your roommate to know about your pills, it might work to keep your pills with your shower stuff, and take them when you shower.
  • Or to keep pills in your backpack, go to the bathroom after class, and then take the pills there

If part of the issue is that they’re hard to afford:

  • If you’re taking a name-brand drug, look online for a coupon. A lot of companies offer them.
  • If you’re taking something insurance isn’t covering, GoodRx can often save you a LOT of money. (It tells you about coupons, and shows you which pharmacy near you has the lowest price.)

Anyone else want to weigh in? What are some strategies you know of for dealing with pills?

An example of both types of mental health stigma

Content note: This post contains both criticism of and respect for the mental health system. If you find either upsetting, it’s likely that this post will bother you.

I wrote recently about two distinct kinds of mental illness stigma. There’s dismissiveness, where people aggressively deny that someone’s mental illness is real. There’s dehumanization, where people believe that someone’s mental illness is real, and treat them as though their condition makes them less than fully human. Both are common, and people who have experienced one more than the other tend to have very different perceptions of the mental health system.

One example of difference in perception: Mental health advocates often say things like “Medication for mental illness is just like insulin for a diabetic”. People who have mostly faced dismissiveness often see this as validation; people who have mostly faced dehumanization often see it as a threat.

From the perspective of someone who has mostly experienced dismissiveness, it might sound like this:

  • I’m really glad that someone understands how serious my medical condition is
  • People have told me over and over that I don’t have a real problem
  • Or that medication is just a crutch I’m using to avoid dealing with things
  • Or that it’s whiny to want medication
  • Or they might say things like “You’re not sick. People with cancer are sick.”
  • My medication is really, really necessary
  • Or even: my medication saved my life, and I think I’d die if I stopped taking it.
  • I’ve had to fight my doctor, my family, or my insurance company to get access to the medication I need.
  • It messes up my life when people don’t take my need for medication seriously.
  • I’m glad someone gets it about how real my medical condition is, and how important it is for me to have access to medication.

For someone who has mostly faced dehumanization, a statement like that might sound more like this:

  • People have treated me like I’m not a person, and use analogies to physical conditions to justify it.
  • People have made me take medication I didn’t want to take, that did things to my brain and body that I didn’t like.
  • They’ve done this to me in order to change how I felt, thought, or behaved.
  • They’ve told me that what they were doing to me was just like giving insulin to a diabetic.
  • And that this meant I could not possibly have any valid reason to object to the treatment they wanted me to have.
  • But diabetes and mental illness aren’t actually all that similar.
  • Insulin-dependent diabetics who refuse treatment die. When I refused treatment, I didn’t die. It’s not the same. I’m not sick in that way.
  • The way I am is not the same as having a life-threatening physical condition with an obvious straightforward life-sustaining treatment.
  • It’s important that people understand the difference.
  • When they don’t understand the difference, they treat me as though I’m not a real person unless I am on the medication they want me to be on.
  • People say “unmedicated” like it means violent, dangerous, or incapable of understanding something. It doesn’t. It just means that someone isn’t taking medication. That doesn’t tell you anything in itself.
  • I need people to respect me as a person, and respect my right to make treatment decisions. When they don’t, things can get really bad really fast.

There are numerous other examples of things like this. Most things people say about mental health look very different to people who have primarily experienced dismissiveness than they do to people who have primarily experienced dehumanization. Neither perspective is right or wrong exactly; both are important and incomplete.

Access to psychiatric medication is important; respect for the humanity and human rights of people who have been diagnosed with mental health conditions is also important. Things aren’t great for anyone, and they could be a lot better for everyone.

tl;dr Mental health discourse often looks very different depending on perspective. People who have mostly faced dismissiveness tend to see things one way; people who have mostly faced dehumanization tend to see things a different way. Scroll up for a concrete example.

Drugs, crutches, and other tools

Psychiatric medication is highly stigmatized, and so is physical disability. One way that this comes out is that people say pejoratively, “medication is a crutch.”

Why is “crutch” an insult? What do people think is so terrible about using crutches?

I think that it’s a kind of ableism where people don’t understand that disability actually exists. They believe that anyone can do anything, if they put their mind to it and work hard. When people with disabilities can’t do something others can, they assume that we are just being lazy. They assume that about moving, they assume that about moving, and they assume that about thinking.

They believe that if they push us to try harder, then we will learn to stop being disabled. They think that if we stay disabled; it’s because someone’s giving us permission to be lazy. They’re constantly on guard against the possibility of a disabled person getting away with something.

They are aggressively hostile towards any visible adaptive strategy. When they see crutches or medications or whatever, they are terrified that we are getting permission to be lazy.

Sometimes, they think it’s ok for us to use these things, but only if we fall into a very narrow category of people think think have real disabilities. For instance, they might think wheelchairs are ok for paralyzed people, but have no respect for wheelchair users who can walk. Or they might think it’s ok to use medication if you’re trying to stop, but have contempt for people who need medication long-term and have no plans to stop taking it. Or whatever other combination of things. People have a lot of really weird ideas about disability, and just about any prejudice you can imagine exists.

Crutches are a tool. There are other mobility tools. Medications are several different tools. There are other mental health tools. They all have advantages and disadvantages, and everyone has to figure out what works best for them. Every strategy is stigmatized, because ableists expect us to think our way out of being disabled. But crutches aren’t actually bad things, whether they’re literal or figurative. We all find the ones we need.

tl;dr People with disabilities need adaptive strategies to work around disability-related limitations. Ableists think that we’re just being lazy when we use adaptations such as mobility aids or psychiatric medication. They often pejoratively say “you’re just using that as a crutch,” as though using adaptive equipment is the worst thing you could possibly do. But actually, there’s nothing wrong with crutches. We all find the ones we need, and that’s a good thing.

you don't have to earn support with a diagnosis

If you were hurt and you’re struggling to cope with the aftermath, that matters. It’s ok to be struggling. It’s ok to need support.

You don’t have to earn support with a diagnosis of something trauma related. You don’t even have to fit diagnostic criteria for a mental health condition to be worthy of support.

Getting hurt matters whether or not it results in PTSD or other diagnosable mental health conditions. There are a lot of different ways that people respond to trauma. In particular, not everyone who experiences abuse or other trauma develops PTSD. It’s ok to want support and to talk to other people whose struggles are similar to yours, whether or not your experience involves PTSD.

It’s also ok if the thing that hurt you wasn’t abuse, or if you aren’t sure whether you think it was abuse or not. It’s ok to need help and support even if it *wasn’t* abuse, or even if things are ambiguous, or even if what happened to you wasn’t anyone’s fault. Not all trauma is the result of abuse. Not all trauma is anyone’s fault. You don’t have to earn support by fitting a particular narrative. You don’t have to earn support by being ideologically or politically useful, either. You matter, it matters that you got hurt, and it’s ok to want help sorting things out.

It’s also ok to relate to and benefit from things that match your experiences partly, but not entirely. (Eg: it’s ok if something written about homophobic bullying helps you to deal with the medical care you experienced in the aftermath of a car crash; it’s ok if something written for people with intellectual disabilities helps you to cope with being the target of transphobic bullying. It’s also ok to use a type of therapy that was initially developed or is usually used to address a different problem than the one you have.)

All of this stuff can be hard to sort out. It’s ok to be struggling. It’s ok to seek help and support where you can find it. You matter, and your experiences matter.

therapy is better without true believers

lizardywizard:

realsocialskills:

Anonymous said to realsocialskills:

I was wondering if you/ any of your followers have thoughts on mindfulness as a treatment for anxiety? It seems to be recommended by a lot of doctors where I live as something that always works and has no side effects.

realsocialskills said:

It sounds like you’re encountering a lot of true believers.

“Always works and has no side effects” is not true of anything. That’s true believer talk; someone who is giving you medical advice ought to be giving you a more nuanced view of your options and the potential risks and benefits involved. If you can, it’s worth putting in effort to get a doctor who is willing to proactively take a frank and nuanced approach to treatment decisions. (Some doctors start acting that way if you ask them enough good questions. Some don’t. Finding good doctors who take your insurance can sometimes be hard.).

Mindfulness is one legitimate approach to managing anxiety that works very well for some people. It doesn’t work for everyone, and it’s not the only legitimate approach. I don’t have any way of knowing whether it’s something that you should try. (Both because I don’t know you and because I’m not an expert on helping people make that kind of decision.)

There are approaches other than mindfulness that some people find helpful. Eg: CBT, various types of medication, general psychodynamic therapy, art therapy, or working to accommodate sensory issues better so that you have less background stress. No approach is universally effective; no approach is universally safe. They all work to a significant extent for a significant percentage of people. They all also have risks and drawbacks.

Nothing is 100% effective, ever. No treatment or approach works consistently for everyone. People are complicated, and many things about the brain and body are still not well-understood. For many issues, there are wide ranges of legitimate and possibility-legitimate approaches. Trustworthy doctors and therapists are honest about this.

Further, everything that is powerful enough to have good effects is powerful enough to have side effects. Some people have this weird misconception that if something doesn’t involve medication or surgery, then there are somehow no risks. In reality, there is no risk-free approach to improving the way your mind and body are functioning. Anything that’s powerful enough to cause good changes runs the risk of causing bad changes. (The risk is not always high, and even high risks are often worth taking.)

Does anyone want to weigh in with experiences with mindfulness? What are some things you wish you’d known, or that you think it would be helpful for the person who asked about this to know?

tl;dr Mental (and often physical) healthcare decisions are complicated. Some approaches work amazingly well for some people. No approach is effective for everyone. Every approach has risks and drawbacks. If you are seeking professional help, it’s worth looking for someone who is realistic and honest about likely outcomes, potential risks, and the range of treatment options.

lizardywizard said:

I’ve definitely heard people talk about mindfulness as having negative side effects, sometimes intense ones. This article, and the things it links to, might be a good place to start.

That’s not to say that mindfulness is bad or that we should avoid practising it - just that, as realsocialskills says, anything that’s powerful enough to cause good changes runs the risk of causing bad changes. This definitely seems to be true of mindfulness.

"You're just looking for a quick fix"

squidids:

realsocialskills:

confide—nemini:

realsocialskills:

bluebirdofgrumpiness:

realsocialskills:

If you use medication to make your life easier or better in any way, some people might object, and say “you’re just looking for a quick fix!”.

This is a mean and unhelpful thing to say.

Medication isn’t the right answer for everyone who has cognitive or mental health problems or pain or other reasons people take medication, but it can be game changing for some people. If you try medication and find that it makes your life easier, that’s a good thing, and it’s ok to be happy about it.

It’s ok to want your life to be easier. It’s ok if it turns out that there’s something that works quickly that makes things better. Using an effective strategy to make your life better isn’t being lazy; it’s being efficient.

bluebirdofgrumpiness said:

Setting aside the fact that working out the correct medication and dosage is often anything but quick, it irks me when people condemn the desire for mental illness to be treated as quickly and painlessly as possible as some kind of moral failing. 

If you have pneumonia or a broken leg, do you request the slowest, most character building treatment available? No? I didn’t fucking think so.

realsocialskills said:

Actually, this happens to people with chronic illnesses a lot too, particularly if they are also fat and in pain.

People often pressure them into treating everything with diet and exercise, even if that’s not an effective treatment. And people who want actually effective treatments for physical conditions are often told that they’re just looking for quick fixes.

It doesn’t happen so much when people without disabilities or chronic conditions need treatment for an acute issue, because those people are socially valued and not blamed for their conditions.

confide—nemini said:

I don’t shame anyone for taking medication and I do believe that it is right in many circumstances. But, as someone who suffered from massive health problems from taking medication and as someone who knows about all the corruption between doctors and the pharmaceutical industry, I have some massive reservations. Just watch John Oliver’s “Last Week Tonight” episode on drug reps. One of the medications I was on is featured during the segment.

One medication made me lose 50 lbs and I was NOT overweight to begin with. I was skin and bones until I stopped taking it. Other medications made me sleep at least 12 hours everyday, making classwork and attendance almost impossible. I did not have this problem after I stopped.

I know fuckyeahlimerence suffered from similar problems though our views on the subject aren’t exactly the same. 

Message me if you want to know more.

realsocialskills said:

I am not familiar with that episode, so I can’t comment on that specifically.

I agree with you that there is a massive issue with lack of regard for the physical risks of psychiatric medications, particularly neuroleptics. (Especially when they are prescribed to control aggression or psychosis.)

Doctors often do not inform people of physical risks in any meaningful way, and often are dismissive of people who want help deciding whether or not the risks are worth the benefits. Further, when people who take psychiatric medications express concerns about side effects they’re experiencing, this is often treated as a symptom of mental illness to be addressed through counseling or a higher dose, rather than a physical symptom needing physical attention.

And it’s not at all uncommon for people to be prescribed medication that is flat-out inappropriate for their actual circumstances. (Eg: It’s fairly common for women to be misdiagnosed as depressed and prescribed SSRIs; it’s fairly common for autistic people who are aggressive during puberty to be prescribed neuroleptics to control their behavior.)

All of that is a huge problem. Medication is important for a lot of people, and so is avoiding inappropriate or harmful medication. Generally speaking, access to respectful, consensual and medically responsible mental health care needs to be far, far more widespread than it is. Far too many people only have access to needlessly dangerous care, often against their will. That’s as much of a problem for people who should take medication as it is for people who shouldn’t take medication.

I don’t want to be dismissive of any of that. Stigma is by no means the only important problem facing people who take psychiatric medications. 

squidids said:

The thing is, every single thing that has effects, has side effects. Literally every kind of thing, not just medication but also herbal stuff, and yes, even diet and exercise changes. Even meditation. If it is capable of doing a real thing to your body, then it is highly likely that it will also do other things to your body. I’d also even argue that lifestyle effects - such as cost, loss of time to do other things, or whatever - can also be just as side-effect-y as other physical effects like dry mouth or weight gain/loss.

It’s good to be aware of the side effects and to know one’s alternative options. And yes, when doctors have perverse incentives, then sometimes that can be hard. 

realsocialskills said:

Yes, exactly. Everything that has effects also has side effects. Those side effects matter. Sometimes they’re dealbreaking; sometimes they’re not, but they always matter.

It can be particularly hard to make good decisions when you’re surrounded by people who have some rigid ideology or other about medication. It’s hard when you’re surrounded by people who try to convince you that medication is bad and that no side effects are worth it at all, ever. It’s also bad when you’re surrounded by people who try to convince you that any medication a psychiatrist might want to prescribe is just like insulin for a diabetic and that there can be no valid question about whether it’s a good idea to take it. 

Decisions about psychiatric medication are complicated and personal. (That’s generally true for physical health treatments as well.) It’s important to acknowledge that reality in both directions.

thoughts on good therapy

anonymous said:

Since you talk about abusive therapy so much (for which, thank you so much) - do you or anyone know anything about distinguishing between good and abusive therapy for OCD? Given that the main idea of the condition is irrationality and the method of the therapy is triggering on purpose, it both seems that it would be really easy for it to get abusive, and that I don’t know how to tell if that happened.

realsocialskills said:

I don’t know that much that’s specific to OCD, and I hope that some people who do will weigh in.

This is what I do know about therapy in general:

Therapists are fallible. Sometimes, you will be right and your therapist will be wrong. (Even if your primary issue is OCD-related irrationality). If a therapist expects you to accept their perspective uncritically, that’s a problem.  

Good therapy involves thinking for yourself, with the assistance of a therapist who respects you and has a lot of experience and tools to help you figure things out.

If a therapist is a good match for you, they will be right more often than they are wrong. They will be right sometimes when you initially thought that they were wrong. But you still have to think for yourself and decide what you think of their advice. You can’t just turn off your mind and replace your thinking with theirs. If a therapist seems to expect that, it’s a major red flag.

The specific ways in which a good therapist helps a client develop their perspective differ depending on methodology. For instance, CBT places considerably less emphasis on the effects of past relationships than psychodynamic therapy does. There are a lot of differences in methods, and that’s ok.

What every legitimate method has in common when it’s done well is that it’s respectful and consensual. A good therapist will respect you and your ability to think for yourself, even though you need help figuring things out. A good therapist will not try to coerce you into adopting their perspective. A good therapist will recognize that they are fallible, and that sometimes you will see things that they don’t. 

If you develop trust with a therapist over time, there will likely be times when you agree to try what they are suggesting despite your reservations. That’s part of how therapy works for most people. When you do this, it means that you’re deciding that they might be right, and that it’s worth trying your suggestion to find out. (Part of what trust means is that you trust them to respond appropriately and help you find another strategy if what they suggested does not work or has side effects you find unacceptable.)

And this is true even if you have OCD or another condition that interferes with your ability to be rational. Being irrational doesn’t mean that you should turn off your mind. It means that you need to get better at thinking effectively. And you can only get better at thinking if you practice. A good therapist will understand that.

Followers with OCD: Are there things that you would advise someone who wants to find a good therapist to look for? Are there red flags you would advise them to watch out for? How do you tell the difference between abuse and legitimate uses of invalidation?

Hey, you mentioned wanting to figure out how to find a good therapist in your last post. I recently tackled that problem, and I’m pretty satisfied with the results I got - I think my method can be improved on, but it’s at least a starting point.

What I did was make a questionnaire in google docs and email it to a bunch of local therapists - anyone who looked like they might work out at all. It included a bunch of different types of questions, everything from basic information about where the therapist’s office is to questions about their ethics and personality.

The first test was whether they filled out the form at all, and a lot of them didn’t. That’s fine - anybody who isn’t willing to put up with being asked to do something a little out of the ordinary is probably not going to be a good match for me anyway.

For the actual questions, here’s a breakdown of what I asked:

- Basic biographical information - name, office location, whether they were taking new clients

- Familiarity with various things that are relevant to me - ADD and autism, PTSD, disability rights, that sort of thing. I also asked how they’d learned about autism. For these, I wasn’t necessarily looking for a high level of familiarity, especially for autism - someone who thought they knew a lot but had never spoken to an autistic adult would have been disqualified, for example - but these questions would have made a good tiebreaker if I’d had more than one good candidate.

- Physical and social accessibility stuff:
    - Is their office physically accessible? Are there stairs to get to it? Are they comfortable with the idea of working with a disabled person?
    - Are they comfortable communicating via text? Is there wifi I can use to IM with them?
    - Are they comfortable working with someone who’s nonbinary? very smart? follows a weird religion? distrusts authority?

- How do they rate themselves on the parts of the Big 5 Agreeableness trait? (Trust, straightforwardness, altruism, compliance, modesty, tender-mindedness - wikipedia can explain more about this)
    - In particular I was looking for high trust and straightforwardness and low compliance - the low compliance is particularly important, since it suggests that they’ll actually listen to me rather than just sticking to what they’ve been taught about the right way to do therapy.

- Treatment approach
    - How familiar are they with the issue I’d be seeing them for? How often do they work with people on that issue? How confident are they that they can help me with it?
    - What treatment method or methods do they use? How firm are they about sticking to their preferred method if it doesn’t seem to be working or if I don’t like it?
    - How long would they expect it to take for me to see results?

- Ethics questions - honestly I’m pretty sure you can do better than I did, on these, but I started by defining ethics as “Ethics is about doing things safely, particularly without risking harm to others. What do you believe about ethics?”, and here’s what I asked - the possible answers were ‘strongly agree, agree, neutral, disagree, strongly disagree’.
    - It is easy to make ethical mistakes.
    - Ethical mistakes can be made unintentionally.
    - Everyone makes ethical mistakes sometimes.
    - It is important to be honest with others about my ethics and ethical beliefs. (This one was not really a question - the idea was to prompt the therapist to answer the next few questions honestly.)
    - Committing to following a code of ethics written by an expert is a reliable way to avoid ethical mistakes.
    - Keeping my behavior the same across different contexts helps me avoid ethical mistakes.
    - It is important to understand others’ ideas of harm so that I can treat them ethically.
    - Cognitive disability, youth, and inexperience can be good reasons to discount claims of harm.

Also for each section I included a fill-in box for the therapist to write in anything else they thought I should know about their answers to that section, but nobody actually used them for anything interesting.

And, to give you an idea of responses - I sent this form to somewhere between 15 and 20 therapists. I heard back from 10, of which 5 weren’t accepting clients, 2 didn’t do IM, 1 didn’t work with people with PTSD, 1 emailed back with a suggestion that I work with a group of therapists in something that sounded like an outpatient institutional setting (*alarmed flailing*) … but the last one seems to be a really good fit, and it didn’t take a whole lot of work or risk to find her out of the original bunch I sent the form to, so I’m pretty happy.

realsocialskills said:

Has this worked (or not worked) for any of y'all? Has anything else?

When outreach programs don't get it or don't help you

So, when I read abuse prevention and recovery things, something that’s almost always recommended is “call a hotline”.

That’s good advice, as far as it goes. Hotlines help a lot of people, a lot. I don’t want to downplay that.

But I also know this: a year ago, I was afraid that someone in my life would become physically violent towards me, and a trained mental health professional close to the situation told me that I really needed to take that fear seriously. I called a domestic violence hotline looking for help figuring out how to assess risk and make a safety plan. They didn’t help me. The general attitude I got was “well, what do you want us to do about it?”

I had friends in my life who understood the situation. I had a certain amount of mental health support. I had access to validation and perspective and support from other sources. I was ok. But it hurt. And if I had been alone, if I hadn’t had other support, I think it would have been devastating.

I know that many other people don’t have the kind of support I did, particularly if the abuse they’re facing doesn’t fit stereotypical patterns. Some people are isolated and have no one in their life who gets it. And sometimes they call hotlines for help and the hotlines help them. But sometimes the hotlines don’t help either. Sometimes the hotlines are just another person who doesn’t understand. And that’s a horrible thing to go through, particularly if you fought through fear and feeling unworthy to find the courage to make the call.

So, if that’s happened to you, I want to tell you that you’re not alone. Hotlines don’t always understand abuse, they don’t always understand other problems, and they don’t always help. If they didn’t help you, you’re still worthy of help. It’s a reflection on them, not you or the problems you’re facing. If they didn’t understand, it doesn’t mean that you are wrong, and it doesn’t mean that no one will ever understand or help you.

If a hotline didn’t help you, all it means is that they didn’t help you.

You can't appropriate your own mind

i briefly self dxed as autistic, but i met with my psychiatrist yesterday and she told me since i noticed social deficits and tried to compensate, and managed just like an allistic person, it was just social anxiety bc if i were autistic, i wouldnt have noticed or been able to learn so well. she didnt mention the cognitive things i brought up so im guessing they were normal /insignificant. how do apologize on my tumblr for fucking this up and appropriating?
realsocialskills said:
You don’t owe anyone an apology. Anyone in our community who has suggested that sincere but mistaken self-diagnosis is appropriation owes *you* an apology. 
Thinking you’re autistic and being wrong is not appropriation. We all make guesses about ourselves; some turn out to be right and some turn out to be wrong. Thinking you’re autistic and being wrong is not appropriative and it is not fucking up.
That said, from what you described, it’s not even clear to me that you are wrong about being autistic. I’m not a diagnostician and I don’t know you, so I can’t say one way or another. But it sounds to me that your psychiatrist is basing their response to you on stereotypes rather than professional knowledge of autism.
Not all psychiatrists are competent to evaluate autism, particularly in adults. Psychiatrists are primarily trained in mental health; autism is a developmental disability. Mental health training does not imply expertise in developmental disability. It’s entirely possible that your psychiatrist is disregarding your cognitive issues not because they are normal, but because your cognitive issues are outside their area of professional competence. 

Most autistic people notice social deficits and try to compensate. Most autistic people generate effecting coping strategies for a lot of things, including social situations. All autistic people can do some things that neurotypical people can do. Being able to notice and compensate for problems does not mean you’re neurotypical.
It’s fairly common for people who think they’re autistic to be told by mental health professionals that if they’re self-aware enough to ask, they can’t possibly be autistic. Or that if they can do anything at all, it must mean they’re not autistic. Those are perceptions based on stereotypes, not accurate understandings of autism. People with advanced mental health training are just as prone to a stereotypical view of developmental disability as anyone else.
If your doctor is responding to your concerns in a way that might be based on stereotypes and misinformation, it’s probably a good idea to find someone else (perhaps a neuropsychologist) who has a better understanding of autism and is familiar with adult diagnosis. 
You may or may not be autistic, but it sounds like you could benefit from investigating further. And ultimately, the opinion that matters most is your own. You know your own mind better than anyone else does. 
And whatever conclusion you or any professional ends up reaching, you have done nothing wrong or appropriative. It’s ok, and important, to try to understand yourself and figure out what you need to make your life work.