#(she told me about as much outright. in our first session she heavily questioned why i wanted therapy bc i didn't seem to need it)

[destroyyourbinder]

two articles on psychiatric medication

I'm planning on writing a bigger psychiatry-critical piece soon about how the overwhelming majority of both leftists and trans people that I know believe themselves to be necessarily reliant on either psychiatric medication or therapy or both, and permit themselves (rather, semi-deliberately evacuate themselves of agency in identification with those harming them, I do not wish to victim blame) to be extensively abused by the psychological-psychiatric medical system in a fruitless search of validation for their malaise in some horrible cycle of iatrogenic dependence.

In particular, I know at least two transgender people personally (one male, one female) who are so heavily medicated that I have few compunctions about calling what is being done to them a kind of chemical lobotomy. They have both been left minimally functional and dramatically changed in personality by their "treatments", but both still seek out psychiatry to endorse their transgender interpretation of themselves, despite the fact their doctors are brutally and with little humanity "re-adjusting" them out of inconvenient behavior through repeated hospitalization, high and probably inappropriate doses of lithium alongside multiple other medications, and of course their whole gender treatment paradigm.

So I am continually startled by not only the distinct lack of modern leftist criticism of psychiatric medical institutions but outright collaboration with these institutions. Many people in the broader community-- whether radical queers or lesbian feminists-- purport to value self-reliance and peer support networks, distrusting well-funded and politically undermining officially-sanctioned institutions, but I am not sure I know a single gay person in my everyday life who is not regularly attending counseling sessions of some variety or another or who is not taking psychiatric medications-- prescribed by a psychiatrist that they see monthly or sooner-- that they believe they cannot live without.

One of the reasons I am so critical is that I was once one of these people: I have been on at least fourteen different psychiatric medications in various combinations throughout my life, and both I and many of my doctors believed that I was so critically ill that I could not live a meaningful or even minimally functional life without them. I, or my depression-- we were coextensive, inseparable, my personhood was inconvenient to assessment, I suppose-- was considered so deeply treatment resistant that I had multiple psychiatrists tell me to my face that it might not be possible to help me (of course, while still holding the prescription pad). I was lucky to never have been on lithium or Lamictal, nor subjected to electroshock, but all were floated as an unfortunate but potentially necessary part of my treatment plan. I was indeed considered such a hopeless case that I was actually approved for disability payments for mental illness, without appeal, an extreme rarity in the United States, especially at such a young age (23). I do not know for sure or not whether I could have set the grounds to get my shit together without the intervention of psychiatry-- I did survive long enough to leave an abusive home, after all-- but I do not consider it a coincidence that I did not get my shit together until I stopped having a therapist whispering in my ear and stopped having these substances in my body.

I don't think you can understand the modern transgender movement-- whether the push to identify various gender-distressed people as having a disorder or just niche lifestyle in need of medicalized affirmation, or the ideology that demands we believe that gender identity is an essential characteristic of human beings-- without understanding the history of psychiatry as a coercive practice attempting to normalize the socially abnormal, often in service to extremely oppressive interests, and the history of therapy as inherently individualizing and anti-political, an authority-laden substitute for discernment and appropriate and healthy social feedback.

In any case, I want to keep it short today, and it's with this context I want to share with you two articles, one from the New Yorker and the other from NPR.

The first article, by the amazing writer Rachel Aviv, who has previously covered dense and thorny ethical issues regarding psychiatric treatment and the construction of mental illness, is a critical article about how many modern psychiatric patients come to take consecutive strings of multiple psychiatric medications, coming to have and then losing faith in their doctors and medications to fix their ills. It follows a woman who decided to withdraw from her medications and the people she meets as she must build her own support network during her process of withdrawal, given her unhealthy dependence on the psychiatric network treating her and the psychiatric industry's public denial that medication discontinuation symptoms even occur, nonetheless can have severe and life-disrupting effects. Aviv gives a contextual history and science of the use of several classes of modern psychiatric medications, including their incredible limitations given psychiatry's practice and value system; in a description that will read eerily familiar to any detransitioned woman, she states that "there are almost no studies on how or when to go off psychiatric medications, a situation that has created what he [Allen Frances, chair of the DSM-4 committee] calls a 'national public-health experiment.'"

An important excerpt relevant to both general psychiatry and the practice of transgender medicine and health care:

A decade after the invention of antidepressants, randomized clinical studies emerged as the most trusted form of medical knowledge, supplanting the authority of individual case studies. By necessity, clinical studies cannot capture fluctuations in mood that may be meaningful to the patient but do not fit into the study’s categories. This methodology has led to a far more reliable body of evidence, but it also subtly changed our conception of mental health, which has become synonymous with the absence of symptoms, rather than with a return to a patient’s baseline of functioning, her mood or personality before and between episodes of illness. “Once you abandon the idea of the personal baseline, it becomes possible to think of emotional suffering as relapse—instead of something to be expected from an individual’s way of being in the world,” Deshauer told me. For adolescents who go on medications when they are still trying to define themselves, they may never know if they have a baseline, or what it is. “It’s not so much a question of Does the technology deliver?” Deshauer said. “It’s a question of What are we asking of it?”

The second article, which also contains a longer-form audio interview with the author, is about a new book by Harvard historian of science Anne Harrington called Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. What I found particularly striking about her interview is Harrington's assertions about the state of psychiatry and psychiatric pharmaceutical research now-- she claims that the psychiatric medication market has stalled because of research finding that many common antidepressant medications work no better than placebo versions, and that pharmaceutical companies therefore are de-investing from psychiatric medication research and development because they can no longer use their previous strategy of slightly tweaking the chemical components of previously monetizeable drugs. She states there have been very few innovations in finding new classes of antidepressant medications in particular (the most easily marketed psychiatric drugs, for whom the target population can easily be expanded).

I think her points here are crucial to understanding exactly why pharmaceutical companies and psychiatry have become increasingly invested in transgender health care and in expanding the market for hormones and transgender-related surgeries through promoting interventions like HRT and "top surgery" as elective procedures suggested as ways to "affirm a patient's identity" rather than "treat a disorder". The gender critical blogger Brie Jontry, a mother of a formerly trans-identified female teen, calls this practice and ideology "identity medicine", a term I find useful to describe the unholy conglomeration that is the individualized medicalization of gender-related distress and the advertising of medical treatments (particularly those provided by cosmetic surgeons) as ways to facilitate self-expression and authenticity. Given increasing attempts by gender doctors to create patients permanently dependent on exogenous hormones (those children left with non-functional gonads after treatment with GnRH agonists like Lupron and cross-sex hormones, or those transgender people who have had theirs removed) or to convince patients that gender dysphoria is a life-long, inescapable condition that they had already failed in not treating/affirming earlier (because you Always Were A Boy), I have to note parallels with psychiatric medicine's anti-recovery, anti-patient-autonomy assertions about other recently marketed drugs such as atypical antipsychotics, on which patients are also purportedly permanently dependent, or antidepressants (as above) where withdrawal symptoms purportedly prove that a patient is doomed to relapse should she cease psychiatric treatment. "Informed consent" and the formation of transgender resources outside a "gatekeeping" paradigm, where patients need not seek insurance approval nor the opinions of several doctors of different specialties for transgender medical interventions, nor wait a set period of time prior to transitioning, is often lauded as progressive and anti-institution by radical transgender activists, who can rightly see issue with a psychiatry put in charge of policing the intimate personal beliefs, coping mechanisms for misogyny or homophobia, and individual gender expression of its patients. However, I can't but see this as part of a new and terrifying medical strategy regarding transgenderism, where a loss of patient agency is replaced with the false sense of consumer choice; we have seen this in other realms of psychiatry, where forms of psychiatric incarceration were rebranded as the choice to take a break or "finally" seek help after self-negatingly denying it for so long, where tranquilizing drugs were rebranded as assistive devices for women struggling to have it all, and where high-risk, heavily sedating antipsychotic medications were rebranded as ways to give other psychiatric medications a "boost" should you still experience unhelpful emotions after complying with psychiatric treatment. "Gender dysphoria" is increasingly nebulous, something you might have had all along if you experienced various forms of generic malaise or failed to have your suffering sufficiently validated and thereby dissipated by psychiatry; funny that we've seen this before with other conditions and their treatments, and psychiatry somehow always comes up with a money-making solution for its own problems.

#medcrit45 #writings

[drunkendetours]

the awkwardness of mock counselling sessions with near strangers

I used to think I wanted to be a therapist or counselor, but I’m becoming cynical about therapy as a whole (along with nearly everything else).

For one class, we were grouped into triads where we had to do mock counselling on each other, rotating through the roles of client, counselor, and observer. As if it wasn’t intimidating enough to spill personal issues to a classmate I barely knew, we had to discuss and replay our (recorded) session while an actual counselor would give line-by-line feedback—and each counselor was handling two groups, so another group of three other people would be listening in on what we were saying.

My strategy was to keep my topic confined to topics like work that were relatively vanilla and unembarrassing. (So yeah, no mentioning my crazy family, head-scratching relationships, my frustrations with the nearly uniform religious slant of my classmates, and questioning whether I should even be studying counseling in the first place.) That was reasonable, but then I stared with horror as the counselor dissected one girl’s work complaint until she was clutching her chest, surprised and struggling with long repressed emotions, because he’d had her regress to her childhood. She told me afterwards that it gave her so much relief and clarity, but no way am I going to have the same theatrical moment and air out my dirty laundry in front of six other people who are practically strangers.

Am I being standoffish? I’ve gone to therapy several times, and I never had issues with confiding. And I asked other people (who, to be fair, probably wouldn’t even open up to a therapist in the first place)—they agreed that they’d find it too vulnerable.

Anyway, when it was my turn to be the client, I was anxious about what I was going to end up blurting out. I talked about feeling creatively frustrated and blocked with my personal writing, and… maybe it was the wrong topic, but my mock counselor classmate and I seemed to be perpetually confusing each other. She thought I was annoyed about my career when I said outright that I’m okay with it and I just want to do creative writing during my free time. Then she asked me what I plan to do with it—I’d already said earlier that I’d tried so many productivity systems and they wouldn’t work, so what more did she want me to come up with? I was reaching for some sort of insight that would remove the psychological block because just plowing ahead and trying to force my way through it wouldn’t work.

Somehow, I mentioned my critical and perfectionist mother, probably because there were awkward silences when she was mouthing to me she didn’t know what she was going to say next and I was trying to give her more material to ask me questions about. She handled that fine during the session, but afterwards, when we were walking out together, she reassured me that I was still an obedient daughter. Internally, I flinched—I don’t give a shit about being “obedient” to my dysfunctional family, and I thought I conveyed that well enough—but I just gave a neutral, polite answer because there was no point arguing it out.

To be fair, she really was trying to help, and she told me repeatedly that she believed in my writing. It was… more of a motivational speech. I’ll also probably be crappy at it when it’s my turn because maybe people are just generally bad at understanding each other until they’re trained enough. It was a bit of a struggle for both of us because we come from different backgrounds and I think she had a hard time imagining my situation. For one, she’s middle-aged and her work doesn’t really involve tech, so she was already getting frazzled when I was explaining my digital marketing work. Another is that she’s a very family-oriented person—which is the cultural default here—and I’m not.

I feel bad that I’m putting it like this—I mean, it was a commendable try on her part, I just probably had high standards because of my experience with therapists who were great. My friend told me that this was why she didn’t trust therapists who hadn’t gone through what she had. That’s not necessarily true—a good therapist should be able to reflect back what you’re feeling and proceed without initial assumptions, regardless of how far removed your experiences may be.

In any case, as helpful as it can be, I’m starting to believe that therapy (and conventional psychology) can be quite limited, or at least it’s not the most efficient or direct (or even affordable) way to help people to stop screwing themselves up, not to mention that there’s a heavy orientation on problems and the past rather than your goals or what you want to move towards. I mean, shouldn’t we also have positive reflections? It’s counterintuitive, but the answers to what I’m looking for are better found in spirituality—for example, I stumbled upon this method for releasing emotions that seems to cut across different sources and traditions, and knowing that earlier could have spared me from so many therapy sessions (and the angst that brought me there in the first place).

So do I want to be a therapist? Not anymore, or at least that’s not the title I’d brand myself with eventually. I’d still recommend the counseling program, though—as long as you can stand being around heavily Catholic people all the time. They’re nice, at least, and the program does a decent job of teaching you about what’s emotionally healthy and letting you internalize that so you live it out rather than only spouting terms from textbooks.  

[mianmimi]

Dude, you have the junior novel? Give us the good stuff! I actually love the novelizations because they're script-based, so you get to see what was an ad lib and what got cut. I get the feeling that most of the beautiful gay shit was purely Chiwetel and that Mordo in script is just a charmless str8 tough guy tbh lmao

This is going to take a while Nonny so buckle up and let’s go! I can’t outright screencap the novel cause of copyright so I’ll just write out brief summaries of things that were omitted from the film.

When Stephen is taking that fateful drive and making a phone call, the movie has him talking to Billy. In the novelization he’s talking with…..Claire. Now it’s not specifically stated that this is Claire Temple but like, come on. They both work at Metro-General, she’s a nurse, and nurses often float from one department to another. Also doesn’t that make you wonder if she and Christine met? :D *eyebrow wiggle*

We’ve all seen the deleted scene of Stephen and the wounded dog (that looks just like him, I see what you did there Scott Derrickson). But what didn’t make it to the screen was the scene before that. Stephen’s asking around for where KT is and Mordo notices him. Stephen comes across a kid begging for money. Stephen gives him the last bit of his money for directions to KT. Kiddo points to a direction. Stephen makes a snide remark. Kiddo speaks in English and tells Stephen that he’s the beggar not him, making Stephen smile. It’s a cute little scene but I understand why it was cut. Makes me wonder if he was part of KT and gets kicks giving different directions to people seeking it out, only giving the correct directions if the person parts with the last of their money. Just another headcanon. Who knows?

And now we get to Mordo’s great appearance. And he’s rather pissed D: Like he doesn’t come off as the calm, gentle Mordo we see on screen. He’s described as being uncomfortable talking with Stephen, and he looks annoyed with Stephen’s comments, even glaring at him. He’s more business minded here and doesn’t really give off that compassionate, soft spoken vibe when we first see him.

When Stephen gets a room he thinks the book on the table is…well, a book. But really it’s just a tablet in a case that looks like a book. KT’s keeping up with the times.

There’s a sweet little paragraph just describing a tree in the courtyard, and Stephen realizing it’s been forever since he noticed how beautiful flowers are. Idk, it was just really sweet and spoke to how Stephen’s now appreciating things he didn’t before.

Wong! Ah! Wong my man, Wong! He’s described as being a large man, a stern teacher who watches his students like a hawk as they train. Very drill sergeant like. Stephen’s one of his students, and Stephen’s trying to copy the other students trying to conjuring runes. He’s scared of Wong hahaha. Intimidated. Thinks that Wong’s powerfully built beneath those robes (Yes for you Worange otp-ers, that’s pretty much directly from the book….Stephen think’s Wong’s BUILT) Also, Stephen knows that Wong’s not someone you mess with. He too, glares at Strange.

Wong judges Stephen. Glaring, staring, eyes narrowing, his motions revealing that he’s annoyed with Stephen saying he’s already read through the books he was given. Pretty much says that Stephen isn’t funny.

This part hurt me nonnies….Mordo looked embarrassed when Stephen couldn’t conjure the portal with a sling ring while The Ancient One was assessing the students. He felt like a bad teacher for Stephen’s inability to make a portal ;___;

Super cute confirmation that the Everest Test is a favorite teaching method of The Ancient One. Mordo doesn’t like it. This part is more in line with the characterization we see on film. He was about to go save Stephen but TAO makes it clear that he won’t lift a finger. When Stephen finally returns he looks at TAO with a ton of anger and wanted to rant but he was too happy that he conjured a portal that he doesn’t.

GUYS. NONNIES. The classic training scene…..occurs with Mordo removing his shirt, leaving his entire torso exposed to Stephen. Our baby baron has a lot of scars on his skins though :( And Stephen noticed bullet wounds. Like the fuck right? And Stephen wonders what Mordo’s backstory is cause…that’s a lot of story written on his skin.

Oh god I wish I could screencap this cause man oh man….Stephen and Karl’s training is laced with a lot of flirting. It’s probably meant to be playful banter but like…I’m reading it with my shipper heart and I’m gonna say it’s flirting. Stephen asks questions about TAO and Mordo makes up these obviously silly answers like she was born from the tree thousands of years ago. Stephen actually believes him and Mordo LAUGHS and tell him he’s just kidding, only to tell Stephen another obvious lie that TAO was a hitchhiker who wandered in and never left. Once again, Stephen falls for it and once again Mordo’s…giddy XD And yes, he’s still shirtless while all this is going on.  Mordo teases him, while smiling, saying “Look at you, Doctor I-Don’t-Believe-in-Fairytales- ready now to believe anything I say!” I haven’t done sources in forever but that’s the direct line from the book, not mine.

While teaching Stephen about relics and simultaneously beating him up, Mordo and him are joking and laughing and just having a very good time ^^ They speculate what TAO’s actual name is. Stephen believes she looks like an Elizabeth. Mordo beats him in the sparring session and ends it by saying that she looks like a Catherine. Of note, fanon’s headcanon that Karl loves romances seems to have made a weird retroactive cameo her. Elizabeth Bennet and Catherine Earnshaw are the heroines of Pride and Prejudice and Wuthering Heights respectively, novels that people have headcanoned are among Karl’s favorites.

The novelization ends right after Stephen messes with the Eye and Kaecilius attacks the London Sanctum, so unfortunately we never get a description of Mordo and Stephen’s argument or Mordo leaving. The novel’s also structured oddly with a lot of flashbacks. One chapter has the time moving forward and the next one talks about what happened to lead Strange in the past. Weird but kinda fitting for the time theme.

I also have another novelization called…*deep breath* Marvel’s Avengers: Infinity War: The Heroes’ Journey (Road to Infinity War). Yes my dear nonnies, that’s the entire title. Whew. It’s a long book and honestly I was only really interested in the DS section. I think they complied a bunch of other novelizations together into this big one. What I like about this book is that it’s told through the pov of side characters. Like Captain America’s section is told through Natasha’s pov. I did read this section and it made me really feel for her :( I think they kinda did her an injustice on screen. Nat’s got a very big heart y’all, and she loves Steve. Not in a romantic sense either. The vibe I get is more that of siblings/really great friends, and she wants his happiness so much.

But anyways, back to DS things…..Wong is the pov character for the DS section. He journals to unwind and de-stress, it’s his major coping skill so to speak. He rips out pages in his journal in a rage when he gets stuck or doesn’t feel like it’s good enough. Relatable as fuck. It’s heavily implied that he and Mordo were really good friends and gossiped about Stephen. So yeah, Wong knows a lot about Mordo and understands how dangerous he can be when hurt. I think Worange fans should check this novel out as it has Stephen constantly trying to make Wong smile and Wong being very -__- about it at first but slowly warming up to him :)

#ask and answer #thank you nonny #strordo #stephen strange/karl mordo #otp feels