NB: This is likely going to be a longish post. It is also not aimed at anyone particular, but if the Mythos continues to grow, it is likely we will run into more and more issues with people taking the Hollywood approach to anything Mental Health related.
Being one person (with an official dx of anxiety, and a unofficial-official dx of an autism spectrum disorder (Asperger’s), my view is limited to what I’ve got as research and from what I’ve heard from other neurodivergent folks.
First- basic definitions, why you need to take care, and language you should use
So, the most basic stuff you need to be aware of. Language. Language. LANGUAGE!
First: neurotypical, allistic, neurodiverse, and crazy.
Neurotypical is defined as mental ‘normalcy,’ eg. the lack of any disorder as defined by the DSM or ICD. It is a very culturally bound term, but gets lobbed around to mean ‘normal’ in a more specific way.
Neurodiverse is define as any form of deviation from the assumptive mental norm. Thus, I can say, with my official dx of anxiety, that I am neurodiverse.
Allistic is anyone who is not autistic, but may or may not be otherwise neurodiverse. So my friend with bipolar/manic-depressive disorder is allistic, because she is neurodiverse, but not autistic.
Crazy is ableist slur, but can be used in character to define mental state divergent from character norm.
There’s other language, outside of defining mental state, so let’s go with what the hell the DSM and ICD are.
The DSM is the major diagnostic tool used in the US- DSM stands for Diagnostic and Statistics Manual of Mental Disorders.
It uses Axises to define the larger course of the disorder. The one that is of most note for the Fear Blogging community is Axis 1 (‘clinical disorders’- includes mood disorders (depression/mania/manic-depression), Autism Spectrum Disorders (ASD), and substance abuse)
It is currently in its 4th edition (revised, seen often as DSM-IV-TR), and is up for change next May.
The rest of the world uses the WHO’s ICD (International Statistical Classification of Diseases and Related Health Problems).
It is currently in its 10th edition (read, you’ll see ICD-10 as the shorthand) and is up for change sometime next year.
Why does this matter? Well, simply, it provides for how a disorder is defined, how it is diagnosed, and what therapy is suggested by the psychologist (or psychiatrist).
Please note that neither manual is a perfect tool. They have issues- see the DSM-I through DSM-III defining homosexuality as a mental disorder, see the current issues with gender dysphoria being part of the DSM-IV-TR, see how autism’s definition has changed through time- but they are the BEST tool you can have for defining a characters disorder/dysfunction.
Also note: A psychologist is trained to observe and offer a diagnosis, but they cannot sign on any prescriptions or offer any psychoactive drugs. A psychiatrist can observe, offer diagnosis, AND can write prescriptions/sign off on suggested psychoactive drugs.
For the rest of the talk about diagnosis, etc, assume I’m using the DSM-IV-TR. It’s the manual I’m most familiar with and it has some of the clearest language of any manual I’ve ever browsed.
Now onto the more ‘fun stuff.’
Disorders such as schizophrenia, autism/Asperger’s, any mood disorder, etc are exactly that, they are disorders and/or dysfunctions. They are NOT diseases. PLEASE make sure you’re aware of this. The language here is important, as disease indicates, often times, that it can be cured.
As you’re likely aware, there’s not solid cure for any big mental disorder, only pharmacological stop gaps (which aren’t magic bullets, more on that later), therapies, and a whole lot of shitty fake treatments/cures.
The language that people used to talk about disorders also is a BIG thing in a lot of discourse, both fictional and via news.
Insanity is NOT a diagnosis. It is a LEGAL term defined by the courts, which decides (in the US at least) whether or not a person can stand trial. A person who is ruled to be insane (or mentally incompetent to stand trial) cannot be tried, legally under US law, as the court psychologist has prove that the defendant is not fit.
Contrary to popular belief, it is a bitch to get a legal ruling of insanity, as the process is a complicated one, and includes a set of questions that essentially boil down to ‘can you, more often than not, tell what you did wrong, why it was wrong, and given same situation would you repeat your error?’
Sanity, like insanity, is a legal term.
Never call a character insane or sane, unless they have a history with the law.
Now onto another fun discourse topic: Person first language.
Essentially, putting the ‘proper person’ before their disorder. There’s a lot of talk about it in communities (especially ASD) about how it actually devalues a person by separating them from something that may be an integral part of who they are. This is, though, highly variant on the person, and your best bet is to, as a writer, decide who your character is going to be before slapping labels upon them.
If you want more stuff on it, may I suggest Neurodivergent K’s blog. She’s an amazing disability rights/autistic blogger and she’s covered a lot of what I’m talking about in a LOT better way than I can/could.
[examples of person first language]
autistic – ‘person with autism’ ‘they have autism’
epileptic – ‘person with epilepsy’
Second- more in depth stuff on the four major disorders/dysfunctions I’ve seen used across the Slender and Fear Mythos (Any dissociative disorders (including dissociative identity disorder), schizophrenia, depression (or more correctly, non-specific mood disorders), and autism spectrum disorders)
Note, that any of these disorders have to cause ‘marked distress or disorder to normative function within society’ before diagnosis is considered proper and complete.
This is going to be a bit more dense, so hang with me.
Axis 1 disorder.
Is the large umbrella that collects dissociative identity disorder, depersonalization disorder, and dissociative fugues (all of which have been used in many a Fear and Slender blog).
All disorders under this umbrella are marked by a period in time (be it continuous, periodic, or cyclical) where perception of reality is markably different, often with affects on memory and sensory.
Or, in more lay terms, ever had that feeling that you’re ‘out of your skin’ or reality has slid a little to the left? That’s depersonalization, and mild moments of it are very common. Severe and/or recurrent ones aren’t.
It is VERY different to a psychotic break.
It also is NOT schizophrenia.
The main treatment for any dissociative disorder is therapy, usually talk. In the case of DID, one of the aims of therapy is to ‘mainline’ or integrate all of the personalities back into one whole.
A very, very, VERY large umbrella term that catches mania, manic depression/bipolar disorder, depression, and a few other disorders
Mania is defined as a extremely elevated (up) and/or irritable mood.
Note that it is a big UP! It isn’t 2 cans of Red Bull, pack of candy, late at night up. It’s flying high, feeling incredibly invincible, NOBODY CAN STOP ME!, I can do no wrong, mildly psychotic UP!
Talking to the same allistic friend I mentioned earlier, said it’s a ‘happy mood’ when you’re in it, because often times you’re not self aware enough of the mania to go ‘hang a sec, I should probably think about the consequences of my actions.’
(There is also hypomania, which is a mood similar to mania, but a little more lower in ‘volume. (If full blown mania is the volume up to 11, hypomania is about a 9, and normal mood is about a 6)
Depression is defined as an extremely depressed (down) mood
Like mania, depression isn’t the ‘oh I’ve missed an episode of my favorite show’ down. It’s deep sinking, all encompassing feeling of doom, dread, nononono down.
Often times, severe depression comes hand in hand with ahedonia (lack of pleasure/drive) and suicide.
Mild depression exists, and it’s likely that you have (or eventually will) experienced it at least once in your life.
Using the volume analogy again, if ‘normal’ mood is around a 6, mild depression sits at around 3-4 (depending on the person), and severe depression sits at a 1.
Manic depression, or bipolar disorder, is a disorder defined by a course of 6 or more months marked by 2 or more major manic or depressive episodes.
Contrary to popular belief, manic depression is NOT commonly rapid cycling. There is a form of it which does rapid cycle- which adds the complication of mixed moods into the equation.
Mood disorders are often times treated with a mix of psychoactive drugs (which there are a lot of) and talk therapy.
A note on the psychoactive drugs for manic depression. You can treat mania with anti-psychotics. You can treat depression with antidepressants. You cannot treat both of the poles with one drug.
(Also, lithium is a last resort drug. It causes severe damage to the human body, at the cost of regulating mood, so it’s one of those ones that does not get used straight out. Used to tho’)
This is something, that if you want your character to have the disorder, you WILL NEED TO DO YOUR RESEARCH!
Schizophrenia is a group of disorders that are marked by psychotic episodes, a break down in thought process, and poor/misplaced emotional responses
It is NOT dissociative identity disorder.
Schizophrenia has two classes of symptoms. Positive and negative.
Positive symptoms add stuff that ‘isn’t there.’ So, hallucinations (hearing voices, seeing things that aren’t there, tasting stuff that isn’t there, etc), delusions, and disorganized speech/behaviour patterns.
A sudden onset of mostly positive symptoms is something that can be called a psychotic break or ‘a break in reality.’
Negative symptoms remove stuff from ‘normal function.’ So, poverty of speech, flat affect/facial expressions, lack of motivation, ahedonia, lack of wish/drive to be social, etc.
Negative symptoms actually can do more harm than positive symptoms, as they have a tendency to be low level and continual, as opposed to ‘moments of.’
Any drugs that are given to alleviate the symptoms of schizophrenia only effect the positive ones. Negative symptoms are unable to be ‘treated’ and can, actually (depending on the drug), be made worse with psychopharmacy.
There are a LOT of drugs out there, mostly anti-psychotics which are used to ‘treat’ schizophrenia. Note, there is often times poor compliance with drug courses, as typical anti-psychotics have a whole slew of nasty side effects. (And most of the side effects for atypical anti-psychotics are just heavy drowsiness)
As a side note, if anyone fancies playing with comorbidities- an autistic adult is less likely to be caught as schizophrenic until the disorder has progressed out of it’s prodermal (early) stages, as a lot of the most noticed negative symptoms are part/parcel of ‘classical’ autism.
Autism Spectrum Disorders (including Asperger’s Syndrome, Rhett’s Syndrome, Persuasive Developmental Delay, etc) are a set of disorders which are characterized by sensory processing dysfunction, social deficit, normal IQ, communication issues, and special interests.
It is not a savant syndrome.
It is not caused by vaccines.
There is no cure. It is not a disease.
It does not ‘look’ a certain way.
And all the stereotypes you have are wrong.
Once again, I suggest you read Neurodivergent K’s blog for any autistic issues. She is, once again, a lot more eloquent than I am on this topic.
Reciprocal language development usually is delayed until 3rd-5th year in classical autism, where as it develops ‘normally’ in someone with Asperger’s.
The biggest thing for this is realizing that often times, you cannot tell a person is autistic in text. There’s a flourishing autistic community on Tumblr and everyone is amazingly eloquent.
When writing an autistic character, realize that the largest issues that are faced day to day are sensory. Read, hyperacute hearing is common, meaning shopping malls/markets are a headache because of overhead lighting + music + tannoy + everyone else talking…
Most of the ‘treatment’ for ASD is therapy, with some drugs being used to treat comorbid conditions such as depression, anxiety, and ADD/ADHD.
Part 3- Resources and all the fun shit
~ Avoid #autism. It’s a load of icky nasty shit, mostly supporting Autism $peaks and bullshit cure stuff. Also, anti-vaxxers.
~ If you want first person voicing, I’d go with #actuallyautistic or #actually autistic – note, unless you are actually autistic, don’t fucking post there. It’s a collection of personal ranting, political comments, life tales, etc all from autistic folks.
~ If you want to ask questions about life experiences (no sex questions, no slur questions, and no asking inane questions) to folks on the spectrum, go with #askanautistic (I believe)
~ I’ve a friend who’s pushing for the #actuallybipolar and so far, it’s a good tag. More first person than anything, but a good tag.
~ Thinking Person’s Guide to Autism – They published recently, but from what I’ve heard, it’s an AMAZING resources.
~ Wikipedia. Make sure you use the links at the bottom of the page, but it’s very good for brief, clear English definitions of disorders and treatments.
~ Neurodivergent K I’m going to push her blog again, but seriously, it’s an AMAZING resource for how to avoid writing under the influence of ableism. (So, you know that first post I made? She’s got a breakdown of why the language isn’t so hot from an insider’s perspective.
~ Google ‘online DSM-IV-TR’ brings up a good selection of scanned versions of the DSM-IV-TR. Use it. It defines EVERYTHING in clear language.
~”The Center Will Not Hold” – It was recommended to me by a friend who heard I was writing a blog with a schizophrenic character. …And it’s a really good resource for voicing of psychosis, voicing of the fears that go through people’s heads, and how schizophrenia is a very interesting disorder both socially and individually
(I have more, and they’ll be posted as I remember them)
Part IV- Things I forgot to put in originally, and don’t want to stretch the posts I’ve made any further
More fun language
You’ll note I’ve being using a comment of ‘abelist’ or ‘abelism’ when talking about derogatory language and actions.
It’s a term with pretty much the same weight as racism, but unlike racism, which is the act/actions/language referring to discrimination of skin tone and culture…abelism is act/actions/language referring to discrimination of mental health status, physical ability, and often times any deviation from stated physical-mental norm.
Retard is abelist language. It is a slur which still carries a lot of heavy nasty weight to it. Don’t use it in casual language when you think something is mind-numbingly stupid. There are LOTS of other words you can use.
(It’s also a good marker on age and education level of the character who is speaking/narrating)
Crazy is abelist language.
Psycho/psychopath is abelist language (see below as to why)
Use of insanity/sanity outside of the situation of the courts can be considered abelist language.
On that note, I think it’s best we discuss:
Psychosis/psychotic, psychopathy, sociopathy, and anti-social personality disorder.
Know the difference.
Anti social personality disorder is defined by the DSM-IV-TR as “…a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”
It’s is an Axis Two disorder (personality disorder).
It is not a lack of emotion, more a lack of a realization that ‘others’ are valid humans in their own right.
It is colloquially (and incorrectly) referred to as sociopathy (not a valid condition, but a personality type) or psychopathy (old, out of date language, also considered abelist).
Not all people with anti social personality disorder are crime committing mass murderers, but there is enough correlation that the public view of the disorder is incredibly negative.
Psychosis is defined, rather unhelpfully, as a ‘lack of connect with reality.’
A person experiencing psychosis can said to be psychotic.
Any other use of psychotic is not good.
A psychotic break can include hallucinations, delusions, catatonia (a more motor related movement/lack of movement/bizarre movement), and thought disorder (word-salad being a good example of this).
It is part and parcel of schizophrenia, but can occur just by itself, or in conjunction with manic-depression/bipolar disorder.
Not going to go into it too much here, as it’s hellishly complicated.
Mental health is ‘fun.’ Rarely do you see one disorder come along by itself, as often times you get a knock on effect of one thing leading to another.
Any coexisting conditions that rest alongside any bigger diagnoses are called comorbid.
Very common comorbid mental health conditions include:
~ Any ASD with anxiety and depression
~ Epilepsy with anxiety
~ Schizophrenia with depersonalization disorder, anxiety, and depression
~ Antisocial personality disorder with depersonalization disorder
Essentially, if ability to function ‘normally’ within society is changed/limited/damaged, you will commonly see anxiety and depression hop along for a ride.
Part V- PTSD and your character
(Note, I’m lumping PTSD (which is severe) alongside it’s less severe cousin post-traumatic stress)
First things first, what is PTSD?
PTSD, also known as shell shock, stands for Post-Traumatic Stress Disorder. It’s an anxiety based condition, meaning it sits upon Axis 2.
DSM-IV-TR defines the criteria for PTSD as such:
~One has to have been exposed to a traumatic event. Note here that the definition of trauma has to fulfil the following: It has to have caused risk of serious injury/death to yourself/others (which you observed or were participant in).
I would like to make the comment here that there are those who would make the comment that bullying and emotional abuse can invoke the stress response that leads to PTSD…but on a whole, that is classed as post traumatic stress, rather than full blown PTSD by shrinks.
~ “Persistent re-experiencing,” or in our lay terms “flashbacks.” Note flashbacks can take the guise of what Hollywood presents them as, re experiencing ‘in dreams,’ or any moment which evokes a negative reaction.
~ Avoidance and numbing. You don’t talk about it, because it leads to you being triggered, suppression of memories, bizarre affect, etc. This aspect is what can bring a dependency to alcohol or drugs into the overall picture. (Because alcohol is a depressant and, for most people, a damned good soporific)
~ Persistent arousal not present before occurrence of PTSD. No, not that sort of arousal, but mood. Hyper vigilance, paranoia, etc.
~ Symptoms above HAVE to have been present for a period longer than 30 days. If not, no luck, you’ve got another mental health issue…which can migrate into PTSD territory if it continues.
(And like always, it must form a serious malfunction with a person’s ability to interact with society.)
As for treatment: talk therapy to combat the interpersonal aspects and antidepressants/SSRIs to combat the somatic symptoms.
At this point, I will make comment.
Triggers and flashbacks.
Triggers are items/instances/phrases which can induce a flashback.
So, let’s take an example of a fairly nasty car crash. In that situation you’ve got several potential triggers: cars (and this can just be general, or down to a specific model), specific seating in car, fire, smell of petrol, sound of breaking glass, enclosed spaces, blood, etc.
Not all flashbacks are like Hollywood portrays them as.
For every person with PTSD out there who will re-experience and re-enact the scene of most stress, there are just as many who will ‘shut down’ (a bit like a silent meltdown to those of you familiar with ASD topics), there are just as many people who will just “BLOW UP,” or will sit and have a panic attack.
(For those of you who have never had a panic attack. Gods. The most terrifying thing in the world is to be there, thinking the world is going to end, with no due recompense…and the world is too bright, too loud, your skin feels wrong, you can’t breathe, your heart is hammering, you feel nauseous, etc)
So, car crash, with a trigger of the smell of petrol. Hypothetical person is filling their car up, and a bit of gas leaks. They are triggered by that and experience a flashback.
PTSD/Acute Stress Disorder/Post Traumatic Stress are all comorbid with:
Depression, ocassionally mania, and alcohol/drug dependency.
Okay, sorry if this post goes off into ramble territory. I have a hard time writing about panic attacks, because I’ve discovered discussing them can occasionally cause me to induce one. Which is a right bitch and a half…and thankfully this was a discovery I made by myself, in solitude, not in public.
A panic attack is a response to stress. They can come with something triggering them (read, linked in with PTSD) or can occur ‘out of the blue.’ (Which, from personal experience, is even scarier than knowing that something you’ve bumped into will tick you from ‘oh stressed’ to ‘FUCKSTRESSEDPANIC!!!!!’)
Sometimes, like migranes, panic attacks can come with ‘pre-symptoms’ before the proper panic attack (I’ll explain this in a bit)
What do they look/feel like?
Short response, depends on the person.
Long response, because a panic attack is a somatic reaction to a mental state/condition (read, it’s a psychosomatic response) it has a varied expression.
The general response is that they’re fucking terrifying and because they can vary from time to time there’s no real ‘getting used to them.’
Undoubtedly, you’re familiar with the Dream Theatre song “Panic Attack”?
|Why do I feel so numb
Is it something to do with where I come from
Should this be fight or flight
I don’t know why I’m constantly so uptightRapid heartbeat pounding through my chest
Agitated body in distress
I feel like I’m in danger
Daily life is strangled by my stressA stifling surge
Shooting through all my veins
Suddenly I’m insane
It’s based off of the experiences of one of the band members.
On the other hand, my heartmate just gets very quiet and starts hyperventilating/breathing heavily.
On the other, other hand, a former room-mate of mine got very yelly and shouty when in panic attack mode.
As far as I know, they both don’t have pre-symptoms before they click into panic mode…and they usually have cause, such as a build up of stress or bad situations, before their panic attacks occur.
Well, I’ve had about a handful of them…some without any cause, others with cause.
I can tell, sort of, if I need to take care…as I get this feeling of derealization or nausea beforehand or my face/extremities will get numb and tingly. (Sometimes)
Sometimes, someone can say the most innocuous thing and I’ll start laughing. And laughing. And laughing. And at some point amusement switches over to panic, because I can’t breathe, but I’m still laughing. There’s nothing funny, especially, it gets to the point where I’m hyperventilating, but still laughing.
All the time, there’s that sinking feeling that the world is going to end, and somehow, it’s your fault.
At the point I reach full blown panic attack mode, I essentially ‘shut down’ regardless of where I am. I get incredibly hypersensitive to light, sound, and touch. I’ll hyperventilate, my heart is hammering away. Usually tuck myself up into a tiny little ball and rock back and forth….providing I have enough air to do so.
I hate having people around me at this point. People always want to know ‘what is wrong,’ ‘can we get help,’ and loud.
Eventually, I’ll start breathing normally again, uncurl, and still feel generally miserable…mostly because I’ll still be incredibly tactile defensive.
But that’s just me.
(And this is when I say, with typical gallows humour, all my panic attacks have ever done is inspire me never to have another one…when it caused a song in another person.)
Panic attack versus Meltdown versus shut down
Okay. Realized that I’ve used some terms that I haven’t defined.
A panic attack, see above. Prevelent in NT, allistic, and autistic folks.
Meltdown…autism spectrum related.
Essentially it’s the point at which most instilled coping methods (read stimming, avoidance, reduction of stimulus) fail and you just can’t cope!
They will continue until stimuli are removed, ‘normalcy’ has been obtained, and the body-brain realizes it is ‘safe’
They are, very nastily, often referred to as temper tantrums. They aren’t.
Temper tantrums invariably originate from a behaviour pattern or things ‘just not going the right way’ and are fairly short (2-5 mins) in duration.
Meltdowns much more resemble panic attack, both in origin and length.
Shutdown…sensory sensitivity related, more often observed in older ‘passing’ autistic folks
Exactly as it says on the tin. The brain has had enough, it’s going to hard reboot…a person experiencing a shutdown will often get very quiet, very still, and ‘zone out ish.’
It is distinct from a specific form of seizure, in levels of awareness.
Often times a person who’s shutdown will be present, but in the sort of ‘long lecture after lunch’ sort of way.
Best bet is to, for both meltdowns and shutdowns, remove/minimize offending stimuli and offer the person ‘an out’ (access to a sensory safe/safer zone)
The following post discusses self harm/self injury/dermatillomania and related topics. If this triggers you, I advise you skip the next post or so. I really don’t want to hear that anyone’s gone diving into the behaviors…’kay?
This, again, is heavily biased by my experiences and what I am aware/familiar with. It may be different for other people.
Yes, I do self harm. And yes, I will fucking chew you out if you call me emo. We clear?
Self harm/self injury/Dermatillomania
Self Harm/Self Injury (abbreviated as SI): Also known as “cutting.” The act of injuring oneself with some intention behind it. Can be related to depression, derealization, ‘plea for attention,’ or as a destructive stim. (Reference post on Autism Spectrum Disorders)
Dermatillomania: “The repeated urge to pick at one’s own skin, often to the extent that damage is caused”
(I am putting dermatillomania in here as the behaviours are often classed as self harm by a lot of psychologists)
SI, what it is
FIRST! SI is NOT ALL CUTTING!
I’ve known of people to burn, deliberately bruise (in a case that made me cringe, with a hammer, with intent to break a bone), push their body to exhaustion break. Usually, aftercare, such as cleaning out cuts/making sure that things aren’t going to get infected is minimal.
(Which can increase risk of infection…and let’s just say, having to clean out infected cuts is more painful than the initial cut)
At it’s core, an extended pattern of non-suicidal patterned SI is an addiction. (no, this isn’t just me speaking with this comment, I follow blogs with SI recovery as part of their ‘life blogging,’ and they made this comment recently…and it makes a helluva lot of sense)
For me, it’s the ability to control and command my body to the way I want it. It’s the ability to go “I’m going to
burn/cut /smash/bruise this piece of shit body of mine to MY degree of control.”
It’s also a whisper of endorphins-adrenaline that comes with it. (Go natural biological highs!)
BUT, not all people who engage in self harm are in it for the addiction pattern of it. Some people do it because of depression.
Others (part of the reason I started) do it to snap from ‘derealized moment’ to ‘realized moment’
Others do it because it gets them off. (Which in that case, the psychological community moves it from self harm to a different axis)
There’s also the attitude of ‘maybe I can make the outside reflect what I am inside’ that can come along.
Side note about what people can use
SI can be something that gains ritual around it.
I’ll use myself as a reference here, as I know my own patterns the best.
I never cut when I’m in a low mood, even if I want it. I know myself too well to do that, because it’s too easy to take the route of suicidal intent at that point.
Usually, it’s derealization or crying (because lack of control is indicated by crying, and I need to be in control. People don’t take a women who shows negative emotions to be worth of anything) that ticks it off…but I have to be alone and it HAS to be my small craft knife to do it. …and it’s, in an attempt never to be caught as someone who engages in SI, in places I can cover easily with business casual shirts.
And it HAS to be the craft knife. …Everything else is either too dull or ‘not right’
OH! And on a completely unwanted point: Dull things used for ‘cutting’ (tweezers, dull kitchen knives, scissors) actually tear the skin, rather than cut it.
Attitudes, and why joking about SI/calling a person with SI scars emo/suicidal/attention whore is really the worst thing you can do
On a whole, you say you self harm to anyone, the first thing they will tell-ask you is “Have you talked to a shrink about this and are you okay?” (Usually quickly followed by: “Are you suicidal?”)
OR, if they notice that you’ve got scars/current healing scabs, they ask you ‘what is wrong/what happened?’ …Usually, on my side of things, I lie. I mean, I don’t want the following to happen:
Person: *in head* SI equals depression or suicidal tendencies. They have cuts. They must be suicidal. I must stage an intervention and get them help.
For some people who engage in SI, this may be the best thing that you can do. For others, it may induce the behaviors.
…OR, if people see SI scars, you get branded a ‘nut job’ and treated as such. SI scars can lose you jobs and gain you alienation points (see point about calling someone an emo, etc)
TL; DR: If you think someone is engaging in self harm, ask them if they want to talk about it. If they say no, just state that you are willing to listen if they want to talk and LEAVE IT at that.
If someone states they engage in SI, and want to talk to you about it, LISTEN to them. THEN, after hearing them out, discuss, do NOT judge.
If you know a friend self harms, and the scars are in places which are ‘kill points’ (inside of wrist, alongside inner arm in a vertical manner, horizontally across the crook of the elbow, upper inside thigh, and back of the knee), ask if they want to talk and if they don’t, ask if they’re willing to talk about what’s going on in their life.
Oh, and as a person who also engages in a contact sport that occasionally leaves cuts/nasty bruises along ‘kill points,’ ALWAYS ASK if you think something is up. I’ve had flatmates freak the fuck out when they’ve seen my fencing bruises/archery bruises because they are alongside points traditionally associated with SI.
Addendum: Written by “Foolamancer”
Right. Since I have a bit of time, and I feel as though this could be a useful resource:
For those who don’t know, I have been formally diagnosed with Asperger’s Syndrome and dysthymia.
This is a bit of a look at what it’s like to be me, and to deal with these on a regular basis. Notice that I do not say “struggle” or “try to cope with”. These are not diseases or horrible, crippling handicaps. They are part of who I am.
Dysthymia and Depression
For those who aren’t aware, dysthymia is essentially chronic, low-level depression. In essence, my “baseline” level of Happy is lower than the ordinary person’s. What you feel like when you’re slightly tired, or worn out, or a little bit stressed, I feel like all the time. Slightly bored, unwilling to engage with others, et cetera.
It’s caused by an imbalance of hormones in the brain, and there’s basically no way to treat it; prescribing traditional depression medication tends to end in severe mood swings or other side-effects unless the dysthymic condition becomes full-blown depression. It can do that, by the way, though it’s usually not permanent. When it does happen, though, take it from me – it gets bad.
Depression, you see, is a lot worse than dysthymia. Depression is not something that can be summed up as “sad”. It is an all-pervading, crushing, absolute dread of everything. Your brain will tell you that everything in your life is going as absolutely horribly as it possibly can, that there is nothing that you can do about it, and there is no light at the end of the tunnel.
You want out. You want things to change, desperately. You want anything else to be happening. But you can’t act to make something else happen, because you’re so goddamn crushed and absolutely convinced that nothing you can do can possibly make things any better, and all you can do is wait for things to explode. It is utter, absolute hopelessness and helplessness, with all of the self-loathing and loss of ability to interact positively with others that that entails.
And I do very much mean that it’s your brain telling you this. It’s a chemical imbalance, like dysthymia. It’s just much, much more pronounced.
This is the critical point about depression and dysthymia. They are not things that you can just ignore, or that can be cured by taking some time off and going to the beach. They are legitimate chemical issues in the brain. Medication is not an “option” for those suffering from depression. Much of the time, it is the only possibility that they’re ever going to stop being depressed.
My worst bout of depression was in 2011, throughout October, November, and December. For those who don’t know, I am a college student. At the time, I was majoring in Computer Science at my university. This particular program is highly competitive; since starting college, I had been taking 17 and 18 hours per semester (18 is considered to be a horrific workload, as courses in this particular college have an estimated ratio of one hour of class time per four hours of out-of-class work).
I also commuted to campus, as I couldn’t afford a dorm room. That meant that I had no time to socialize with anyone else in my classes, as I had to leave exactly when classes ended in order to be able to get home that night. Several times, I missed my transport window and had to sit at the nearby McDonald’s until near midnight waiting for someone to be able to come and pick me up.
Beyond that, I was discovering that I hated my chosen major. Between the impossibly hard calculus classes (the calculus you took in your AP courses in high school is nothing compared to what was in this program; we were literally doing rocket science along with other work on that level) and the mind-numbing studies into log(n) efficiencies in sort functions, I couldn’t stand any of my coursework.
So my grades were tanking, because I couldn’t work up the energy to focus in class or do any of the homework. My parents didn’t know, because I didn’t have the courage to tell them, particularly as they had been the ones to pressure me into staying in the program for as long as I had. The end of the semester was coming up fast, and I was failing everything. It felt like there was a shotgun pointed at my head that was going to go off at Christmastime, when the grades became available for the whole world to see.
The only saving grace I had was an online role-playing game called The Reach. It was a Changeling: The Lostrole-playing game that I poured my heart and soul into. I had friends there, and people who loved to see me because of my writing and role-playing skills. The closest of these friends were a small group of players who commissioned artwork of my character as an early Christmas present. That’s my avatar here. We were friends both in and out of character, and talked about our lives and our families and what we wanted to do with our lives in the future and things like that.
I won’t go into details about what happened between me and them, because it’s a long story and it makes me uncomfortable to talk about. Beyond that, I don’t hate any of the people involved, despite how badly mistreated I feel, and I don’t want to bad-mouth them. The short version is that there was an explosive meltdown in our circle of friends that took place over those months, and I caught the worst of it. I am no longer on speaking terms with the players involved.
That was the last straw. I attempted to commit suicide just before Christmas break that year. I would have done it if I hadn’t remembered that one of that group of players, a woman named Nadine, and the only member of the group that I still talk to, had made me promise to call her if I ever thought about doing something like that to myself. I did. She talked me down.
But the point of that story is that, when you’re depressed, everything falls apart, and there’s nothing you feel like you can do about it. At all. As far as you’re concerned, there’s no hope for you, at all, and you might as well end it. I felt as though I had lost my chances at a college degree, any connection I had with my family, all contact with my real-life friends, and the only enjoyable pastime I still had, all at the same time. If I hadn’t been so horribly depressed, I might have been able to do something to change it, but as it was, I very literally couldn’t. When suffering from depression that severe (I was put on medication for it just after my suicide attempt), there is nothing you can do. Your brain very literally stops you from making any real attempts to fix it, because it makes you feel like there’s no point, no chance, and that things are going to go wrong no matter what you do to try and stop it.
Depression isn’t just sadness. It’s fear and despair and self-loathing and utter helplessness all rolled up into one fun little package. When writing any character who is suffering from depression, remember this.
Depressed characters can smile, or laugh, or have fun for a minute or two. I did, with TR. But that won’t fix it. They’ll still be depressed, and after the fun’s over, they’re going to be right back where they started. It isn’t something that you can just “shake off” if you man up, or something that can be cured by a trip to the fair and some cotton candy. Depression is a very real medical condition, and requires medication, along with intensive therapy, to treat.
That’s something to remember about all mental conditions, really. They are medical problems, and they aren’t just going to go away. They need treatment, not miracles.
Asperger’s, as has been mentioned previously, is on the autism spectrum of disorders. According to some sources, it essentially is autism, albeit high-functioning autism.
The thing to remember when writing about Asperger’s and the like is that they aren’t really “disorders” in the colloquial sense of the word. It isn’t something that people will have “attacks” of. It’s more of a way that people who have it view the world, and the way their minds work.
Let’s get over some of the more obvious, overt symptoms that people with Asperger’s commonly display are.
- Repetitive Motions. People with Asperger’s syndrome commonly display certain repetitive motion habits while not doing anything in particular. I, for example, have a habit of walking in circles counter-clockwise, usually around the nearest person that I identify as a friend or family member. I don’t really notice that I’m doing it, most times. It’s automatic.
- “Fiddling” With Things. When at rest and engaged in some activity, whether reading or talking or watching television or anything of the sort, any free hand that someone with Asperger’s has will usually be involved in fiddling idly with something small nearby, usually something that they can move in some way that they find “interesting”. Zippers, buttons, pencils, paper clips, watch clasps, rubber bands and the like are all likely candidates. They may also engage in some repetitive motion involving their hand itself; I tend to rub my right forefinger against the outer edge of my thumb repeatedly. I actually have a callous there from it. Like the first thing, this is automatic, and isn’t really consciously done on the part of the person with Asperger’s.
- Speech Issues. Many people with Asperger’s have odd patterns of speaking or inflection. These range from my own excessively loud voice (my whisper is most other peoples’ pleasant conversation), which gets louder and faster as I get more involved in the discussion, to the point where people cover their ears and lean away, to speaking excessively formally or using odd metaphors or words. People with Asperger’s may also put the accent on the wrong syllable, or remain entirely monotone at all times. There really isn’t any set pattern.
- Avoiding Eye Contact. As with other autistic spectrum disorders, people with Asperger’s tend to avoid eye contact. Holding eye contact with someone for more than half a second or so is very uncomfortable and embarrassing, almost to the point of physical pain. The eye wants to move away from the other person’s gaze. Holding eye contact with someone is either a sign of extreme willpower or that the other person is someone very close and trusted.
- Talking To Yourself. People with Asperger’s sometimes talk to themselves under their breath without realizing it. It isn’t always so much a conversation with one’s self as it is just repeating certain interesting things that you’ve heard (at least, it isn’t for me). This can range from bits of prose or poetry to song lyrics or interesting lines taken from famous speeches, or factoids from physics textbooks, or anything of the sort. It’s usually muttered under your breath, without any real idea that it’s happening; it’s like reading along with something in your head so intensely that you don’t realize you’re actually saying it aloud at first. It’s also far from constant, and doesn’t last long when it does happen.
- Stimming. This is the final and possibly weirdest of the common external tics that those with Asperger’s display. “Stimming” is the point where we start to get into signs of real mental differences from people without the condition. People with Asperger’s, you see, are often hypersensitive in one or more areas – they feel, hear, taste, see, or whatever else much more intensely than normal people. Or, at least, they aren’t quite as well able to trim down the amount of stimulus coming in. Normally, your brain “dampens” signals coming from your nerves, filtering out white noise and the like so that you can ignore the unimportant stuff. In those with autism-spectrum disorders, this doesn’t work correctly in one or more areas. Their brains are quite literally flooded with stimuli, and can’t process everything. This causes the person’s stress level to skyrocket, which results in stimming. Stimming is a simple, repetitive behavior that gives the person something to focus on outside of the swamp of signals coming in. It’s essentially an attempt to create a reference point, something to center their attention on so that they can deal with everything. It’s almost impossible to describe the feeling using words, but I’ll try anyway; you’re at a rock concert, and in the center of a mosh pit, and the speakers are up so high that all you hear is static. It doesn’t hurt, but you do feel as though there’s some sort of pressure there. But you can’t leave, so instead you start snapping your fingers to what you think is the beat, and just focus on the motion of your hand and try to tune everything else out. That’s essentially what stimming is. The motions involved can range from tapping your foot to snapping your fingers to bobbing your head in time to some music in your head to clicking your teeth (the latter three are the ones that I usually use; the last one usually gets people asking me why the muscle in my jaw is jumping like that).
So those are the most common physical aspects of Asperger’s. The mental ones are more difficult to describe, but I’ll try anyway.
- Social Issues. These are often the most obvious issues with sufferers of Asperger’s Syndrome, and the issue is manifold. In short, however, it’s this: people with Asperger’s lack that little processor in their brain that lets them read body language automatically. Most people have a built-in list of things that certain postures, gestures, or actions mean. People with Asperger’s don’t. They can make one for themselves, but it’s a long, painstaking process that essentially forces them to learn all of human body language from scratch, by memorizing how people act when they’re holding themselves a certain way. Between this and the aforementioned aversion to eye contact, people with Asperger’s lack many of the things that most people use to determine how others are feeling. Their grasp on how to read others’ emotions is limited, not because they don’t care, but because they don’t know how to tell. They also lack many of the subconscious bodily cues that signal certain emotions themselves, which can give them the appearance of always being disinterested, unattached, and emotionless, when that couldn’t be further from the truth. People with Asperger’s have emotions just like everyone else, but they often lack the knowledge of how to express them short of outright stating “I’m angry” or “I’m happy”. Between the two problems, people with Asperger’s find it difficult to bond with others. The people they’re talking to think they’re weird, uncaring robots, while the people with Asperger’s are feeling incredibly embarrassed and fumbling desperately to try and make a connection while lacking the instruction manual for how to do so. This usually ends up with the Asperger’s sufferer becoming shy and withdrawn in an effort to avoid further embarrassment or forcing themselves on other people, because they can usually tell enough to know that they’re making the other person feel very awkward and embarrassed, and they don’t want to do that. So, they think, it’s better if they just sit in the back and don’t talk much. The lack of social interaction, though, only serves to make the problem worse.
- Narrow, Intense Interests. People with Asperger’s, like other autism-spectrum disorders, often get very invested in one or two topics, and can devote huge amounts of time and energy towards getting involved in those areas without ever getting bored. This can range from abstract mathematics to logic to herpetology to literature to history to anything in between. What this doesn’t mean is that people with Asperger’s are suddenly geniuses in these fields. What it does mean is that they’re very interested in those fields, and will devote much of their time towards researching and learning them. As such, they can appear to be savants to those who haven’t done the research themselves, but it’s just a product of being so interested in the topic.
- Mild Compulsive Tendencies. People with Asperger’s often establish a rigid, unyielding routine and stick to it no matter what. They’re drawn to the familiar and well-known, as these things are safe and unlikely to overstimulate them. While being overstimulated is not crippling or especially difficult for someone with Asperger’s to deal with, it isn’t pleasant, and most people try to avoid it. The routines and habits they establish can often be strange and arcane; so long as they are familiar, what they are or why they were initially established doesn’t really matter to the person doing them. They also tend to have a slight, uncontrollable urge to share their aforementioned narrow interests with others. This isn’t anything more than a friendly desire to talk about something you enjoy in the hopes that the other person will also get some pleasure out of it, but it is difficult to deal with and can often make conversations awkward. It feels like something “catching” in your brain; be it a phrase, topic of discussion, song, or single word, it’s there and it won’t go away until you say it, and if you say it, you’re going to want to explain it, and if you start to explain it you’re going to go off on a tangent and completely monopolize the conversation. It isn’t something they do on purpose. It’s just something that their brain tells them they have to say.
- Emotional Issues. This isn’t so much a part of Asperger’s itself as it is a natural consequence of all the rest. Because of the social repression and isolation that Asperger’s can often result in, people with Asperger’s often lack social outlets for their emotions, and so can’t express them except in extremely clumsy, often explosive ways. In short, most of the time, an Aspie’s emotions are hidden. When they’re coming out, at all, whether in a positive or negative way, it’s often a sign that they’re feeling something very intense, and can’t possibly contain it. The more regular social interaction the person with the condition gets, the less irregular and explosive these bouts of emotion will be, as they’ll learn to express them more regularly. It isn’t a sign of emotional immaturity; it’s a guy who feels that his emotions are ignored by everyone (and they very likely are) trying to make them plain in the only way he can think of. Imagine if people around you never realized how angry and hurt you were feeling, no matter how strongly you felt it or tried to show it, up until the point when you just scream at one of them because it’s the only way you can think of to get them to realize it. Note that this isn’t an excuse for dickish behavior. It is entirely possible for the person with Asperger’s to learn and employ better, healthier methods for expressing their emotions, and just saying “I have Asperger’s so I don’t have to try” is bullshit. People who try to use Asperger’s as an excuse to be an asshole are heavily frowned upon by other people with the disorder.
People with Asperger’s aren’t some sort of weird alien. They’re ordinary people who lack the toolbox necessary to encode and decode the emotional subtext that others display during conversation.
So there you go. A brief overview of depression and Asperger’s, by somebody who experiences both. Hope it helps if you ever decide to write about either.
Addendum: Written by “erratic”
I’ve been diagnosed with psychotic depression, so I thought I’d share some of my knowledge of how psychosis is at times diagnosed, experienced, and treated (if I can get to all that).
First thing is first. Before a doctor diagnoses any of the psychotic disorders, they -should- rule out any other factors that might induce psychosis. This can include but is not limited to: EEGs, blood tests, MRIs, and sleep studies. Sleep disorders can cause psychotic symptoms. Brain tumors can cause psychotic symptoms. Temporal lobe epilepsy can resemble schizophrenia. It can take months to get a diagnosis. Or it can take days, depending on the doctor.
What can psychosis include? Here’s some of what I’ve experienced:
Extreme, irrational fear: During my most recent psychotic break, I experienced more fear than I ever thought possible, despite being safe in bed, with my mother looking after me. It was as if someone had poked the ‘fear’ part of my brain, and the -intensity- of what I experienced was worse than any of my previous anxiety (or panic, haven’t been diagnosed for that, so I can’t say) attacks. In the days after, my fear had lessened, but was still extremely irrational and delusional.
Auditory hallucinations (during the day, or right before and after sleeping): I’ve heard what sounded like my mother calling for me when she was actually asleep. I’ve heard what sounded like people having a conversation I couldn’t quite make out. I’ve heard voices insult me (sometimes ineffectually). I’ve heard voices threaten me. I’ve had voices call me random names (such as Robert) as opposed to ANY of the names I’m known by. Usually I’m aware that I’m hallucinating when it happens.
Visual Hallucinations (usually in dim or no light, but also in broad daylight): I’ve seen my mother’s face appear to be rotting off. I’ve seen cartoons floating through the air. I’ve seen shadows flit across the air at night. I’ve seen disturbing figures in my peripheral vision too often to count. I’ve seen things in my room move by themselves at night.
Tactile Hallucinations: Crawling, creeping sensations. The sensation of bug bites.
Delusions: I’ve thought I was from another universe and that one day the world would end and I’d ‘find my true form’. I’ve thought that I was being ‘driven insane’ by a ‘god of madness’ (but not Cthulhu because he was sleeping). I’ve thought I was really in a coma, and that I had to interpret the lyrics of Queen to find the secret to ‘waking up’. I’ve thought my ex was attacking me in my dreams. I’ve thought my mother was going to kill me. I’ve thought I had special powers. I’ve sometimes been delusional and -known- it, but it didn’t change the behavior my delusions caused.
Negative and Cognitive Symptoms: I’ve had to be reminded to do simple things like bathe. I’ve gone weeks without brushing my teeth. I’ve lost the ability to speak for short periods. I’ve felt as if I was mentally handicapped, despite normally having a high IQ. I’ve spoken and made little sense. I’ve had trouble understanding other people and what they were saying. I’ve been unable to comprehend the lyrics in songs unless I already knew the lyrics before my ‘break’.
Insight: I know I have psychosis, but I’ve also been in complete denial. Someone who has psychosis -can- be aware of it. They can hallucinate and be completely calm because they know it’s not real.
That’s just a short, incomplete list of things I’ve experienced, and I can talk more in depth about any of them.
I’ll talk about antipsychotics later. For now, I think I’m all wrote out.
Un-addendum: Back to the article by “Squeek”
Part VI – Exclusionary conditions and mental health
What does this mean?
Well, it’s a fancy way of saying that some somatic (body, not including brain) conditions are highly influential upon what we see going on in headspace.
This, before I forget, can go the other way- depression, ADD/ADHD, and anxiety all can effect the somatic side of things.
BUT, as Erratic stated above, often times ‘proper medical’ tests will be ran before a mental health approach is taken. This is to eliminate the possibility that it has a cause that can be ‘fixed’ by the wonder of modern medicine. /sarcasm.
Why is this important?
Well, simply put, psychoactive meds do jackshit for diseases/disorders which are caused by something that’s physically wrong/off centre with the body. And ditto for treating a mental health condition as a physical condition.
There is overlap at times, again, as Erratic stated. You will often times be asked about previous health conditions when you go to a psychologists, as they can recommend (but not force) you to go to a GP/general doctor.
(And in some places of the world, such as the UK, to even access a psychologist, one has to be recommended by a GP to even access psychiatric care (unless you’re posing a danger to yourself). Which, on one hand, helps prevent situations where you’ve got somatic conditions being treated as mental health conditions….BUT on the other hand, it prevents access to later diagnoses of items such as ADHD/ADD and Autism.
Because, remember, the general attitude towards ADHD/ADD and Autism is that they are largely mental health conditions faced by white, middle upper class, male children. Which is fucking bullshit, but that’s a different conversation topic)
Make note that because of how the body works, there are somethings that are able to be minorly managed by tweaking physical stuff… I’m looking at the whole idea of exercise and ‘proper sleep schedules’ in helping manage low level anxiety. BUT, it DOES NOT WORK FOR EVERYTHING. And for some mental health issues (looking at eating disorders as the big ones here), it can actually exacerbate the pre-standing issue.)
I’m going to used the example of the thyroid and it’s basic physical medical conditions as an example. (It’s the one I can talk about on the personal side of things)
So, the thyroid is a gland, located just on top of your Adam’s Apple, that produces the hormones that regulate appetite, metabolism, and some mood.
Too much of either of the thyroid hormones (collectively referred to as thyroxine) or thyroid stimulating hormone, will cause your body to experience such wonderful symptoms, including but not limited to: Generalized anxiety/worry, irritability, racing/erratic heartbeat, hyperactivity, insomnia, low tolerance to stressful situations, and uncontrollable weight loss.
What do those symptoms sound like if we’re looking at only the headspace side of things? Well, generalized anxiety disorder usually looks a lot like hyperthyroidism on four counts (anxiety/worry, insomnia, low stress tolerance, irritability) if you’re not paying too much attention/have low awareness of ‘non-normalacy’ in terms of body to the other somatic symptoms.
Too little of thyroxine or thyroid stimulating hormone and your body will swing the other way. Low mood, low energy levels, weight gain, low cold tolerance, and the general feeling of brain sludge (which is about the best way I can describe that terrible feeling of your brain both feeling like it’s been replaced with cotton wool and is lagging worse than a 10K modem).
Which lines up fairly neatly (low tolerance to cold aside) with low level depression.
So while, yes I do have a dX of anxiety, it is completely exacerbated if my thyroid levels swing to the high end of things….but, on the other hand, if I swing too low I’ve got the issue of low moods (and the nagging feeling that I should have done something, but not quite certain what, and would it be my fault if I skipped out on the event)
(And so on/so forth. Fucking with exogenous hormones is soooo much fun…/sarcasm)
(Article to be continued)