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cairavende · 7 months

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Worm Arc 9 thoughts:

Not enough of my daughter. Where is my baby girl? Though I do enjoy getting different PoVs. It'll work for a little bit.

Weld is neat. Didn't feel great about him at first but he grew on me. His scene with Vista made me love him. He's a good kid. (He should probably have learned Aegis, Gallant, and Browbeat's names before talking to the team the first time though)

On the note of that scene - THEY HAD A THERAPIST THIS ENTIRE TIME? The Wards had a therapist available to them and no one was having them see said therapist after 3 of their teammates died? Piggot is so bad at this.

Me reading Flechette's chapter with the aim of making her gay as I have done with everyone else: "Oh wow this is a really easy one!"

I wanted to see more of Parian sooo badly after I first saw her and I'm so fucking glad this is how I see her! Flechette and Parian are wonderful and I hope they get gay married and retire together.

Me saying that probably highly increases the chance that one of them dies in the future.

I'm very glad Flechette gave up on Shadow Stalker. I like Flechette and she shouldn't have to deal with that asshole.

I feel so bad for Clockblocker. He's just a kid and his dad is dying and that sucks. I wanna bake him some cookies or something.

The professor of that class was so clearly identifiable as "one of those professors". All "up until now you haven't had to think, but in Parahumans 103 you'll need to think and I'm not gonna baby you yada yada". It's still just a 100 level course dude, geeze. Get off your high horse.

Clockblocker and Vista are siblings and I love their dynamic.

Despite me feeling for these kids some, the second the Travelers started clowning on them I was enjoying the shit out of myself.

Fucking Trickster is just so much damn fun. His powers are cool and he really lives up to his name. I love him.

Glory Girl getting rocketed off into the sky by Ballistic had me in tears from laughter.

Kid Win has ADHD. I was sure Kid Win had ADHD before I even started on the Kid Win chapter where he says he has ADHD. Someone get this kid some Adderall. And some therapy for all that self doubt and imposter syndrome.

Kid Win also didn't even hesitate to illegally spy on Chariots personal computer by hacking into the wi-fi, so that doesn't give me great confidence in the Wards following rules. Or any heroes. I'm sure that won't ever come up again though.

These Slaughter House Nine guys I'm sure won't be a big deal. They won't do horrible things to hundreds of people. Gonna be taken care of by heroes off screen during the next arc. No worries at all!

Vista joined the team when she was 10? The superhero team that has to deal with death on a semi-regular basis and terrifying violence all the time. That team. She joined it when she was TEN?! Shitty system you guys have here!

Saved the best for last - SHADOW STALKER GETTING FUCKING MEMED ON BY MY WONDERFUL DAUGHTER! (And my daughters friends)

God I wasn't sure about her chapter at first. She is so mean and I didn't necessarily want to spend a long time in her head watching her be mean. But then my daughter showed up in a swarm of bugs and fucked up a bunch of Nazis and I knew everything was going to be ok.

The instant Shadow Stalker started to follow Skitter I knew she was gonna get fucking wrecked. I don't know why I knew, maybe I just know my daughter well enough. But no matter the reason I was so happy to watch it happen. Wasn't worried for Skitter at any moment cause I knew she was gonna bitch slap this asshole.

Just. Damn I fucking LOVE watching my daughter just be a goddess of bugs and go to town.

I could keep going about Shadow Stalker getting absolutely destroyed for who knows how long, so I'll just have to stop myself.

And we see a new person with the Undersiders, did Aisha get her powers? I'm so happy for her! I can't wait to see what they are.

Imp is a great name and it's kinda fucking bonkers it wasn't taken by somebody else already.

Did I mention Shadow Stalker getting clowned?

Cause she did.

Just completely baited and then my wonderful baby girl even got to tase her. I'm so happy for her. Sometimes a little violence is the answer.

#Worm #Worm Web Serial #Parahumans #Cairavende reads Worm #The Wards #Vista is baby #Flechette and Parian are always going to live a happy gay life in my head no matter what actually happens #Parian is too pure for this world #Shadow Stalker getting taken to FUCKING CLOWN TOWN #I love my wonderful bug daughter so much #Seriously though how bad can a group of villains call The Slaughterhouse Nine actually be?

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multifandumbmeg · 9 days

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Random update per my fics:

Sorry I haven't updated in the last few days. I usually try to write some every day, but I took a day off to plan Golden Glint and then finished the mini fic (Reckoning of Mike Carrera) I started before it because that's what I wanted to write and I wanted to finish it.

On the topic of all my in-progress fics, my writing just isn't consistent right now. I mentioned a while ago that I'm going through AO3 author's curse and would eventually expand on that, so since I'm extremely frustrated and paralyzed from being productive today I'll do that now.

Starting from winter/late fall of 2022 I got sick and basically never got better. I was having illness after illness that meds weren't solving, and my headaches just got more and more frequent until they were every day for at least three months. By the time I came home from Korea, I was having full-blown debilitating migraines every day and attacks where I would almost pass out and couldn't breathe. It took me a couple months but I got on insurance, started a new job, and managed to convince my parents to let me focus on getting my health together this year.

It's been extremely difficult and frustrating because US healthcare, but I found out I do not in fact have ANY allergies despite doctors telling me I do, literally putting me on allergy shots for a year, and telling me that was the cause of migraines, inability to breathe, and constant illness, none of which were true. I had to prove this to them by fighting to see an actual allergist and getting re-tested which costs me hundreds of dollars out of pocket, but at least the allergist was a good dude who wrote a SCATHING letter to my primary care demanding I be sent to the proper specialists for my symptoms. Several blood tests and medications later, we have whammy number two:

The hypoglycemia I was diagnosed with as a teenager was not in fact random. Instead, I have hyperthyroidism caused by Graves Disease. Except I ALSO have Hashimoto's Disease, because I am just so special like that. Basically, rather than allergies like I was always told, I have been getting every single sickness that rolled by for the past several decades and because I was so used to being sick and so criminally gaslit about it, I didn't even know I was ill and just kept going. Thyroid also has tumors on it. I may also have other autoimmune disorders, or thyroid cancer, but I won't know until I finally see an endocrinologist an hour away later this month.

Though my daily migraines stopped last summer, I still get frequent headaches and now extremely bad ones (or migraines) every time it rains. Generally, there seems to be some kind of inflammation issue where my body over-reacts to literally everything by swelling up and causing more problems.

Possibly tied to that, I was in pain every single day at work. Considering my age, there is no normal reason I should be crippled by joint pain but that is yet to be solved. I now only work two days a week, which has helped significantly, but I am still consistently in a ton of pain two days a week, sometimes three as a rebound.

In January, before I had gotten any diagnoses, my parents gave me an ultimatum that they were kicking me out in May. I had to beg them to go part-time because I simply could not keep up with job applications while I was so constantly tired and pain. After sobbing for two straight days about the inevitability of becoming homeless because I can't afford to or logistically live on my own, my mom convinced my dad to let me go part time on the condition that I continue to pay the same rent Ive been paying to live in one of their empty spare rooms.

In February, I went in for the first appointment toward getting an Autism screening. The therapist suggested I get an ADHD test and recommended me for the official autism screening, saying I have a solid case for suspecting. After a little computer game and another talking appointment, slightly to my own surprise (especially because of how easy it was) I was clinically diagnosed with ADHD. I recently started meds for that and it has made basic tasks and job applications infinitely easier to the extent it's insane, plus my final Autism screening is next week and based on my results every step of the process so far diagnosis seems likely.

All that said, the job search process has been soul-destroyingly frustrating. I have a masters degree in a specialized field, backed up by a Bachelor's in a relevant field, years of study abroad and work abroad (which is relevant to my career path) and a track record of excellent academic achievement. I also speak French and Korean near-fluently and am conversational in Romanian and Russian, as well as knowing a fair few phrases in a number of other languages. Every job I've had has stressed me out to the point of quitting by around a year (hello Autism), but also none were related to what I studied at all, highly customer service oriented, and still every one would tell you I was one of the best employees they ever had and begged me to stay. Even with this track record, after literally HUNDREDS AND HUNDREDS of applications (which in my field almost always require a cover letter, often questionnaires and lengthy short answers, or even writing samples in addition) I have had ONE interview in four years. ONE. And I was so heinously underqualified for that hail-Mary I'm 99% certain they only interviewed me to meet a quota. As you can imagine, for someone with highly probable AuDHD, doing the same thing over and over for 4 years with a 100% failure rate is enough to make me want to dive into a lake with a pile of bricks chained to my back.

I'm still months out from seeing a neurologist about my headaches and general constant pain, I don't have a plan of action for my buck-wild medical anomaly thyroid, and I don't know if my parents are kicking me out next month. They haven't brought it up so maybe with my recent headway on the Peace Corps application (was told I stand a very good chance, but that's another contract job overseas, further pushing back my ability to find a stable, long term career job) and slew of diagnoses and medications, my dad is cooling off a bit. I don't know.

All that to say my body is crumbling out from under me, my job is stressful, and despite being extremely qualified and putting in so much effort, I have zero long-term life prospects. Sometimes, that results in me diving whole-hog into writing for fun and as an outlet, other times I'm too tired or need to bury myself in mindless content consumption or days of spending every spare moment staring at my ceiling in silence until I maybe fall asleep. Did I also mention the crippling lifelong insomnia which my ADHD meds (along with rapid weight loss I'm desperately trying to curb because I'm already borderline underweight due to my thyroid) are exacerbating?

Anywyay. Point is I'm very tired and stressed so my writing is going to be much less consistent than in the past. Hope you understand. Also just an update for my online friends. TMI but I needed to rant and put it out there for those wondering to lower expectations.

#Sorry #You can leave now

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adhd-thot-jail · 8 months

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Wow, this is scarier than I thought.

Which is funny, this blog is me talking to myself but others can read it. Kinda the definition of a blog?

I don't expect many people to interact with my posts. But If you do find me around come say hi! If you have any tips for task initiation and organization hit me up. I love learning and trying what works for other adhd homies.

A little about me, since this is my first post on this blog. I was diagnosed August 2022. I graduated with my bachelor's in March 22' and felt so listless, and nervous about looking for work as a Graphic Designer. Being a designer wasn't my first choice tbh. Maybe a story for another time, but all I knew was that I wanted to be in a creative field because art is the only thing I felt that I could stand. And I hated my job (that I unfortunately still have).

So, it's summer 22' I just finished my bout with COVID and, I didn't know it at the time, in the middle of the biggest burnout of my life. I'm on a road trip to see the Killers in Vegas, and I can't stop crying, mind racing, just completely icky in the back seat of a dark car, wishing the whole trip was over already, even though I was excited months before about his trip. So after I composed myself a little, I looked up online therapy options 'cause I don't have insurance, and have to pay everything out of pocket. I choose an app, sign up, and end up getting my money back cause they don't set me up with a therapist for weeks LMAO. So I chose another app and finally got a therapist. After I explained what I had been feeling she told me, "Wow, have you ever thought of being screened for ADHD?". I never, ever, thought about it, or was never diagnosed as a kid. That one sentence kinda turned my world upside down. It made me look back at every single moment of my life and think...There's a name for what I've been doing my whole life? It was depressing that it wasn't caught early, even though I struggled heavily through all my schooling. But it also gave me some relief. My life was put completely into perspective, it was such a bittersweet feeling. I had been masking so hard to get through my college work, like I said earlier, I struggled with my schooling so I was trying to prove to myself and my family that I could do this, get good grades, and graduate. I was running on empty by the end of it all.

So now I'm working on myself. Working with a new therapist who also has ADHD and specializes in ADHD. I'm occasionally on medication (long story). And learning new ways to accommodate my brain. It's a journey for sure. But the main takeaway I got from my life up to this point is that I'm resilient, all neurodivergent people are. This isn't the kind of thing that can be easily understood, so many people, women especially, are diagnosed later in life. And yet here we are powering through, and learning about strategies that work for us it's empowering. I know that sounds cheesy as hell. But it took a lot of soul-searching, and some self-love to come up with this realization.

#adhd #neurodiversity #actually adhd #adhd things #sentenced to thot jail

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cafedanslanuit · 4 years

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RFA with a MC that has dyslexia

This is the last request I had saved! It’s by @gompereatsall, who sent me this:

The other is where MC has dyslexia (and dropped out of high school, so she doesnt even have a high school education) and she struggles to keep it s secret from her S/O

I ended up having no ideas for Jaehee :( Since it was already long, she’s skipping this particular headcanon. I hope you liked it, sending hugs!

Yoosung

He was really, really excited when he learnt you were the same age as his. His excitement decreased a little when he realized you weren’t enrolled at SKY, though.

He asked for your major, but you decided to keep it a secret. Since he didn’t want to share his either, you joked you would tell him about yours when he told you about his.

It was all fun and games until he told you what his major was.

You tried to hide for months, even going to the extent to say you had online classes so that’s why you were almost always home.

Until that night came.

You had decided to spend the quarantine together and Yoosung was having trouble with the whole online classes idea. You had just woken up and were still half-asleep when he came to the bedroom to ask for your help, since his classes started in ten minutes and he couldn’t get the platform to work.

“MC, I really need your help, please, get up,” he asked, shaking your shoulder gently. You groaned and rubbed your eyes.

“Help you how?”

“I don’t know how to use this platform, and maybe it’s the one you’re using too. Please, they will count me as absent if I’m late!”

“Hmm, how would I know how that works?” you mumbled, turning around and trying to get to sleep again.

“Because you… take online classes,” Yoosung reasoned. He pouted, his eyes going around the bedroom. “Right? You told me all your classes were online”.

The realization you had just messed up made you sit up on the bed, startled.

Yoosung was looking at you confused and you realized there was no way to explain what you had just said. You just looked at him, feeling incredibly small in your pajamas, his confused expression hurting you. You bit your lip, and opened your mouth to talk, but Yoosung cut you off.

“Can we… talk about this later? I’ll call Seven for help”

You nodded as he shut the door behind him. You let yourself fall on the bed again. You knew how much he hated secrets and you couldn’t believe you had done well for so long before letting him find out like this.

A couple of hours later, you went to the kitchen and found him there, drinking a can of soda as he looked at his phone. You took a deep breath and asked him to sit down on the couch with you so you could explain.

Once you told him the real reason behind your lie, his anger seemed to go away for a bit. You explained you were so proud of him for going to school, and that you didn’t want to share your experience with the education system, since you felt it had failed you and your dyslexia diagnose. SKY was a tough uni to get into, and knowing he studied there, you didn’t want him to know you were actually stupid.

Yoosung immediately hugged you tightly against his chest.

“You’re not stupid! Never say that again,” he said, pressing a kiss on your forehead. “It’s not like only smart people get into good unis. The exam is design in a way only with good memory pass it, intelligence has nothing to do with it,” he assured you. “I’m not really smart either. But you’re definitely not stupid. You had something that got in the way of your learning! Your school should have helped instead of letting you drop out”.

The next days, Yoosung took his time in getting educated about everything and anything that had to do with your diagnose. He found out all the ways he could help and tried his best to make your life a little bit easier. He always asked you what else did you need and what else he could do to fill that need.

And, honestly? That level of love and support was everything you needed

Zen

You were watching a series with him after a long day of work. The protagonist and their love interest went to a classic American prom and had the mandatory slow dance scene.

“I guess having something like prom would have been fun. The guys at my school went on a trip” Zen commented. You stayed in silence for a moment, not knowing what to say next. You just hummed and nodded, your eyes fixed on the screen. The episode ended and as the credits rolled, he turned to you again. “How was your prom? Who did you go with?” he asked with a teasing smile.

“Oh-- it was nice,” you answered. “Hey, I’m making some coffee for myself, you want anything?” you offered, getting up from the couch and heading to the kitchen.

“Hey! Why don’t you wanna tell me who did you go with?”

“It’s not important!”

“Oh, that means you did go with someone!” Zen reasoned, following you. “Babe, it’s okay, it’s not like you are still dating or seeing that guy anymore,” he said, his expression falling shortly after. “You’re not, right?”

“Of course not!” you huffed.

“Right, sorry, my mind went somewhere really dangerous,” Zen apologized. “So, why won’t you tell me about your prom? C’mon, I wanna know”

You sighed and turned around, finally facing him.

“I didn’t have one,” you muttered. “I didn’t finish high school”

Zen furrowed his eyebrows. “Oh,” he said. “Why… why didn’t you tell me? You know I also dropped out.”

“Yeah, but I didn’t do it for… you know, your reasons. You had to make a choice to further your career and you were also going through issues. I was just stupid”

“You’re not stupid, what are you talking about?”

“I… I had a lot of trouble at school. I have dyslexia and it made school so damn difficult, I was about to fail the year so I… dropped out. My drawings were somewhat good so I became a freelancer but yeah, my stupid brain didn’t let me have a prom”

“Okay, you have to stop calling yourself stupid. You’re an amazing artist! C’mon, don’t be so hard on yourself,” he asked, pulling you to his chest and hugging you.

Two weeks after your conversation, you got home after delivering a project and found Zen’s apartment filled with balloons, a small disco ball on a table, soft music playing one of your favourite songs.

Zen came out of the window wearing a light blue shirt and black pants, a slightly loose tie around his neck. You smiled when you saw him and left your purse near the door. As soon as you were in reaching distance, he twirled you around and then set his hand on the small of you back, his other hand taking yours. He started slow-dancing with you, his soft eyes fixed on you.

“Where did all this come from?” you asked with a grin, swaying your body to the music.

“I guess this way we both get to have a prom dance like the ones we see on TV,” he shrugged. “I even prepared punch, it’s in the kitchen.”

“Is it spiked?”

“You know me too well, babe,” he laughed, pressing a kiss on your forehead.

Jumin

Jumin had noticed you didn’t tell him stories about your school. He would tell you all about his time with V, but you never shared stories of your own. He didn’t mind it at first but was curious.

For a moment, he thought you might feel uncomfortable since he went to a fancy private school and you didn’t, but when time passed and you easily accommodated to his lifestyle he realized that wasn’t the case.

Jumin is a very observant man, so he also noticed how you had trouble reading. He had never mentioned it, figuring you hadn’t put on your contacts lenses.

That night when he left work and came to you, something couldn’t leave his mind. And of course, you noticed the tiny tell-tales he wasn’t as relaxed as he usually was when you two were together. You both were sitting on the sofa in silence when you couldn’t hold it any longer.

“What’s going on, love?”

“You know I hate bringing up work when we’re together, but…” Jumin sighed. “Assistant Kang wrote the speech I’m supposed to give at the gala I told you about and I just can’t see why I don’t really like it. I can’t even tell her to do it again because I don’t know why is it about it that I dislike,” he paused and took out a piece of paper from his briefcase. “Would you take a look at it? Maybe you can help me pin what’s wrong about it”.

You nodded and took the piece of paper from Jumin’s hands. He watched you as you scrunched your eyebrows, but kept your eyes focused on the paper.

“Do you need me to hand you your contacts?” he offered.

“I have them on,” you muttered, trying to concentrate.

“Maybe those aren’t working for you anymore? I could have the best optician see you tomorrow morning”

“No, I just-- I have-- Give me a minute to try and read this,” you tried to explain. Jumin looked at you confused. “I have dyslexia, so I have a little trouble reading long texts. But give me more time and I can finish this”

“I didn’t know,” Jumin said. He stayed in silence for a moment. “Did that make school difficult?”

He noticed the way your hands tensed. “I… I didn’t finish high school. Couldn’t keep up”.

And that was the moment everything clicked for Jumin.

He gave you the time you needed to finish reading and then listened to your comments about it. Knowing it was a delicate subject, he didn’t make further comment on it, but rather tried to be more affectionate than ever that night.

In the following days, he asked you if you wanted to get your high school diploma. He offered the help of a therapist that could help you and a tutor if you needed one. If you didn’t want to get a diploma, he still offered the help, as he knew it could still be beneficial for you.

He would ask a lot of questions about it on how he could make life easier for you. Do you prefer audio messages rather than texts? Because he would ask Saeyoung to change the RFA chat if needed.

He just wanted to know he would try and give you anything that could make you feel as happy as he was with you.

Saeyoung

Working this under the theory that Saeyoung has ADHD.

Neurodivergent team!

SILENCE, NEUROTYPICAL is your favourite catchphrase tbh

You try to help each other as much as you can! You do your best to help with his cluttering and remind him when he should get some rest. You also played a big part in changing his eating habits.

He also makes sure to add a feature for voice messages. Jaehee hates it because she is always working or listening to Zen’s recordings and it’s not practical. But Saeyoung uses it all the time and has upped his prank game sending the most annoying audios to everyone. But you know the only reason why he added it was to make your life a little bit easier.

He offers to pay for a therapist if you want to exercise your reading skills.

One late night, as you both had just finished watching a movie and were cuddling on the couch, you confessed you hadn’t been able to finish high school due to the dyslexia. You told him you hadn’t told him before because you were ashamed of it, and would appreciate if he didn’t tell anyone either. You didn’t want them to know you didn’t have a diploma.

“You know I can hack your school system and get you a diploma, right?” he asked. You chuckled and shook your head.

“Thank you, baby. There’s not need, though”

“If you want to try again, it’s okay,” he said, kissing your cheek. “And if you don’t, that’s okay too. Just whatever you decided to do with it… remember you won’t have to do it alone this time”.

#mystic messenger #mystic messenger headcanons #saeyoung choi #jumin han #yoosung kim #hyun ryu #mysme jumin #mm jumin #mysme saeyoung #mm saeyoung #mysme yoosung #mm yoosung #mm zen #mysme zen

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mentalillnessmouse · 5 years

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(p1) Hi, I'm writing because I feel there is no hope for me. I'm 30, I live at home where I get verbally mistreated (it was physical when I was younger.) I'm morbidly obese, agoraphobic, I literally didn't leave the house for a 2 year period and still rarely do. I have 0 friends and never had any except a few online ones who ditched me years ago. I was bullied constantly. I have self-harm marks all over my arms. I've NEVER had a job, or finished high school. I still almost never leave the house.

(p2) I’ve asked for help to learn to drive, but they tell me I can’t. I guess because they call me autistic and tell me I am not very smart and make jokes about me having ADHD. I took those comments seriously and they told me I was “looking for problems.” WHAT? I made the mistake of speaking with a few psychiatrists about it who shut me down because, in their words, I didn’t “look” like I had those issues. And that my parents had hard jobs so it made sense they would lash out at me.

(p3) I deal with other issues too like menorrhagia. A doctor had me do an ultrasound (this was like my 3rd one since ‘06) and sent me to a specialist because they saw something. The specialist said she didn’t think anything was there and wasn’t going to actually examine me. I gave up. I’m afraid to speak up for myself, I genuinely don’t understand how to live, make friends, talk to people. I feel like I just have TOO MANY issues. And at my age I don’t see why anyone would bother with me anymore.

(p4) I have an appt with a psych at the same place as the others because I have my city’s free insurance and nowhere else to go. I don’t know if I can do it again after this? I just wanted somewhere to reach out at least one more time :( I’ve reached out to others (like extended family) who will talk to me for a bit then ignore? I can’t help but to feel damaged or like I’m doing something wrong I can’t figure out. I feel like a weak loser and I didn’t try good enough.I’m sorry this is so long

Hello Anon,

I’m mod Bee and I’ll do my best to help you out, but I received help myself from the other mods to write you back. So this is a communal effort!

Thank you for reaching out, and I’m sorry you’re going though such a difficult and distressing situation. You sound strong and tenacious, and I’m proud of you for the way you keep trying to improve your life.

We have some suggestions that we hope can be of help. They’ll concerne:

finding online communities/groups to hang out with

finding a professional that suits your needs

looking for courses you can join

thinking about possible job options

Just an head up: this is going to be long, and it will contain tons of links. I’ll highlight one - that I think it’s most useful - for each section, but I suggest you to go through them all.

1. finding online communities/groups to hang out with

Having friends is important for our mental health, but it can get difficult to make new ones, especially when we’ve been burned before.

Online communities, forums, and groups, can be good places to start looking for friends again. You can approach them with as much caution as you need, and find those people you relate with the most.

If you like games, and rpgs in particular, there are online options that allow you to connect with other others all over the world. Activities like Dungeon&Dragons are based around players’ interactions, so you’d get to know people without putting the stress on forging new friendships. The article 10 Best Online Chat Rooms & Games suggests other equally fitting games.

Forums and groups where you can share your experience and fears are another important tool you can use. I’ve looked into active ones and found Panic Disorder and Agoraphobia Forum, r/Agoraphobia/ (on reddit), bus (a self-harm support forum), Mental health support group and discussion community, Online Support Groups by Turn2Me, PsychForums (Psychology and Mental Health Forums), and the ReachOut app.

Trying with pen pals - a one on one exchange - could also be a good idea: InterPals and PenPalWorld are only two of the many websites dedicated to this purpose. Here’s some tips on how it works.

Finally, there are apps with the specific purpose of finding new friends, like Bumble BFF. Try to see if you there’s one of your liking in this list.

2. finding a professional that suits your needs

We usually recommend what it’s colloquially called “psychiatrist/therapist shopping”, the act of choosing a professional after inquiring what we need to know of their line of work, based on our own wishes, and asking this to more than one.

It’s difficult when insurance covers just a little portion of professionals, but not impossible.

Can’t afford therapy? No insurance? Need low cost options? Here is a great list of ways to get help when money or insurance is an issue.

Therapy For Every Budget: How To Access It

9 Ways to Get Free or Cheap Therapy When You Don’t Have Health Insurance

Dial 211 for Essential Community Services: if you call 211, you can ask about free therapy options in your area, or how to work with you insurance to afford other professionals.

If none of these options work out, and you have to stick with the professional your insurance provides, there are measures you can take that might help making the sessions successful. Check out 21 Tips for getting the most out of each therapy session and How to Talk to Your Doctors When They Don’t Listen.

If your new psychiatrist tries to dismiss you without hearing everything that you have to say, insist that they write on your record exactly what they did and why, and that you absolutely want a copy of it before you exit their room. It’s your right to have both your requests accomplished. I know it’s not easy to have them respected: you’ll probably have to stand your ground and that can be difficult, but I think it’s important for you and fundamental for what you can get out of this session. This is a post with links to various module you can complete to help you assert yourself, which I suggest you to start before going to your appointment, if you can. It can be useful to face your family, too.

Does your insurance cover a different specialist for the gynecological problem your doctor wanted you to check out? Is there any free or low-cost clinic near you, like Planned Parenthood or Free Clinic? You can inquire about their services through email.

3. looking for courses you can join

Online courses can be helpful for a number of things, like keeping busy, learning new stuff, feeling accomplished, and possibly getting some qualifications.

There are some free options that end with a proper certificate, but not all are accredited, meaning that they’re not automatically accepted by employers (they can choose to consider them valid or not). Still, there are no downsides in joining such a course, seeing that it doesn’t cost anything but your time.

Not accredited certificates/no certificates:

Alison’s Diploma Courses and Certificate Courses

FutureLearn doesn’t grant you certificates with their free courses, but it still provides learning access

edX’s Courses

Udemi, not free but it offers up to 90% discounts generally once a month

Learn how to code, a masterpost that lists different courses to learn coding

Free Online Language Courses, a masterpost that lists different courses to learn languages

24 Invaluable Skills To Learn For Free

Accredited certificates

coursera offers some free courses, and/or the possibility to apply for financial aid

Online Degree require no tuition, no applications, and no interviews, and has worked so participating Universities around the country will consider the courses for credit, potentially finishing up to an entire freshman year of college

edX’s Professional Certificate Programs are not free, but edX offers up to a 90% discount to those who prove they cannot pay a full price.

University Of The People is tuition-free, which means there is no charge for teaching or instruction, only initial fees (around 160$) for each course. You can also apply for scholarships.

on StudyPortal - Scholarships, you can find a huge number of scholarships available in your country, and here you can find the easiest scholarships to apply to. There are also scholarships for online courses.

There’s also the possibility of completing high school through virtual courses, and if they’re organized by your State’s public school system, they should be free. You can find more info on this here.

4. thinking about possible job options

Working towards finding a job is important for our own self-worth and feeling like a valuable member of society, and of course it can also help with looking for better therapy.

It can be tricky when mental and physical illnesses are at play, though. That’s why I’d like to give you some online options here, too, that don’t ask for any particular prerequisite, and would give you enough free time to focus to get better. Jobs like data entry or app testing are doable from home, and may not pay much, but they’d allow you to start building some savings.

5 Online Jobs That Require Little or No Experience

No Experience? Start One of These Online Jobs

Best Data Entry Jobs From Home

10 (Legit) Data Entry Jobs from Home

Work At Home Data Entry on Indeed.com

FlexJobs

Glassdoor

Whatever you choose, creating a strong resume is always a good step. I’m giving you some resources on how to do that:

How to Create a Professional Resume

How To Make A Resume 101

Help Everyone Find A Job In Their Field

And between checking out all these options we gave you, please try to do some of this Workout For Daily Life, because focusing on a screen for too long can cause so many aches!

You’re not a loser, you’re strong and you keep fighting for yourself, which is admirable. I hope these resources can be of help, and please do send another ask if you need anything else.

Take care,

mod Bee

#ask MIM #seeking help #online jobs #online courses #agoraphobia #self harm #mod Bee #Anonymous

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onigarbage · 4 years

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did

I have Dissociative Identity Disorder. In response to trauma, my core personality separated and eventually I came along. I’m not what people would call the core, I just happen to be the current host. I have 10 alters currently, alters are the different personalities. There are Persephone and Jasper, a married couple. Up until last month, Persephone went by Percy. There are Marc and Lily, brother and sister. There are Jake and Nero, a couple, both dormant, however. There’s Alistair, a fictive from my own writings. There’s also James a member of the vulture culture community who loves bees. Then there’s Mars who’s also dormant, and finally, there’s Salem.

“It’ll take some time, but somewhere down the line, we won’t be alone.”

I watched my fingers type as if it were a film, words popped up on the screen. “I feel like we're dying out here sometimes, it’s like no matter where we go we're dying.” Persephone was right. We were dying up here. Here I was, trapped in my own body once more. Watching someone else take control. I was fine with it, I had become used to it.

“The ocean washed over your grave.”

When I was little, I was very tall. I was 4’7” by the time I was 5. I was also ahead of my time. Adults loved me, my peers, not so much. Up until 3rd grade, I was very talkative, even through the abuse I had suffered. I was fine. I won’t divulge that trauma, at least. But the Summer of ‘08 changed me. It must’ve been the year the stock market crashed because my family moved from a nice home in Romeo to a trailer. A trailer that had a leaky roof, a trailer that had smoke leaking from a socket one night, a trailer that doesn’t have electricity in parts of it. It was home. It was also the year my mother attempted suicide.

“I want a cutscene, I want a cut from your face to my face, I want a cut, I want the next related video.”

After that, I began to have “imaginary friends.” The only thing was weird about them was that they could sometimes “possess” me. That’s not exactly how it works but honestly, that’s how my child-brain worked. This is called dissociative identity disorder, formerly called multiple personality disorder. I had only 4 alters then, now I have 10. I also coped by lying, I tried to make myself more interesting than I was. I grew out of it by the time I hit high school, I had lost and regained friends. My closest being Peter. I loved my friends dearly more than anything, but soon things turned sour.

“I didn’t like you anyways. You always spoke so quiet.”

It was by 10th grade when I started hearing voices again. It was by 10th grade when Peter and I began dating. It was by 10th grade when everything began crumbling. In 10th grade I had started going to therapy, I wanted to figure out what these voices were but I was too embarrassed to tell anyone. So instead I developed a relationship with my therapist and focused on my ADHD. I started taking a plethora of drugs, against my fears of becoming like my parents. They made me very tired, every day after school I began sleeping. During the week I would see myself fighting with Peter. It was all an out of body experience. I found out his name was Marc, he left notes for me. While on a date with Peter I discovered Lily, Peter thought I had age regressed. It was in the shower when I discovered V, he changed me that day. V was a bad person at the time. He’d terrorize Lily, who was only 9. He’d terrorize me in disgusting ways that I dare not tell anyone about. But when he changed we welcomed him. V no longer took the form of a demon but a man with long white hair and big blue beautiful eyes and an even bigger nose. He changed his name to Klaus. My friends soon found out about my alters. Thanks to a then stranger, now good friend Jaden. Jaden found out first, he knew from my Vent profile. Then Peter and Jason found out, but I was most scared to tell my friend Stevie. I felt I had betrayed her in the past and didn’t want to do it again.

“I was up late last night!!” Klaus said talking to Stevie as we walked to our math class.

“Yeah I know,” she replied then paused, realizing her mistake. Klaus smiled to himself, so she knew? He thought.

"I saw you again last night you were hiding in a poor man's body. But I saw your soul slip out of his fingers”

Things turned sour fast. I remember being in my history class when everything started. Stevie had posted on Vent that I was abusive. Panic had flooded my chest, my cheeks burned, and tears welled up in my eyes. To think that I was abusive. She then later posted that she would pretend to be uncomfortable if Peter and I had any public displays of affection. I went to the bathroom and sobbed that hour. Then the rest of the day, I don’t remember. Lily had fronted to save me from having to deal with it all. Peter and Stevie began spending more time, I turned nasty from all the stress. From walking on eggshells out of fear of being called abusive to dealing with constant voices who occasionally “possessed” me. I even had to deal with homework and abuse at home. I was stressed back then, and I took it out on him. I accused him of sleeping with Stevie even. By the time we reached 11th grade Stevie started avoiding me, Jason grew apart and Peter broke up with me. By 12th grade I had finally turned things around with Jaden, we stopped being strangers and became friends. We bonded over memes about our deteriorating mental health and the passion we had for the stories we worked on. This was the year I met Ms. Bourlinghaus, who became a mother to me. At the start of the year, seeing Peter gave me panic attacks and made me want to rip my flesh off.

“Don’t worry! You and me won’t be alone no more.”

I fell in love, twice that year. I don’t remember who I dated first. DID does that to your memory, in fact, I don’t remember anything really before 9th or 10th grade except for my mother’s suicide attempt. But I digress. I fell in love twice that year. I fell in love with a boy named Elliot and a girl named Eve. Both were amazing even though both lasted what I estimate to be a week. Mars even made a pizza with green peppers that were made into a heart for Elliot. We went to see End Game together. Eve and I only talked about kissing, planning to do it where nobody saw us. We joked about kissing by the Chuck E Cheese car ride. We were weird teenagers, well, normal teenagers actually.

Elliot broke up with me because of my age, we’re only a year apart, however, it made him uncomfortable. That’s okay. We still talk to this day. Eve realized that she was a lesbian part way through our relationship, or at least that’s my theory. We also still talk to this day. I consider both of them to be two of my closest friends.

“You never stopped smoking, but I forgive you. My words and my heart were not enough to give you”

I was 17 when I started vaping. My friends Luke and Zack were doing it so why not me too? I started at 50 nic, which is about 3 and a half cigarettes. Or at least I think, I don’t know anything about cigarettes. Or vaping for that matter. When I turned 18 I became more firm in who I was. I came out to my parents as transgender, my mom had always shrugged it off as me pretending to be someone I’m not, my stepdad has always accepted me but didn’t see why I cared about the surgeries.

"I wish I was sober, I can’t get off the ground."

A revelation, I am killing myself. With all the weed and smoking. We aren’t dying up here of loneliness but of ourselves. Night after night I’ve induced manic episodes from getting too high. Each night I think of myself as a god. Mostly I’m a fire god, able to feel fire without burning myself. These manic episodes started a few weeks after I was diagnosed with bipolar. My life goes up and down it seems. Caffeine doesn’t help, sugar doesn’t help. Nothing I ate really helped with the mood swings. I feel broken. I want my story to end with hope, not despair.

“Apologies to future mes and yous.”

I sometimes wonder if I can be better than I am now. If I’m destined to smoke forever. If I’ll always have manic episodes on the weekends. If my life is a constant back and forth between depressed and manic with no balance between both of them. It’s been raining all week, but just now as I type this there’s the sun shining through my window. Everything exists in cycles after the rain comes the sun. Maybe this is just my rain, maybe this storm will last for a few more days or even a few more years. I know now that someday the storm will end and I will see the sun. Then again, I’ve always loved getting caught in a storm.

“This is a version of me and you that can exist outside of everything else, and if it is just a fantasy, then anything can happen from here.”

A final note:

All quotes separating text are lyrics from Car Seat Headrest. I’ll include a playlist of songs that I’ve sampled these quotes from. Thank you for reading. http://bit.ly/2WAlYMW

#writing #writers on tumblr #DID #car seat headrest #dissociative identity disorder #memoir

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moggieblanket-blog · 5 years

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My Autism Evaluation

I wanted to write this for a number of reasons. First, I wanted to provide an explanation of the process I went through in order to help those who are currently seeking a diagnosis, to give them a better idea of what they might reasonably expect to experience. Secondly, I see many posts on this site which dismiss official diagnoses with statements like, “All they do is give you a list of traits to fill out!” or, “Doctors sometimes don’t have enough experience in X disorder to know what they’re talking about!”

I cannot speak for other diagnoses, but I can tell you now that as far as autism is concerned (and also ADHD; I will add a post about my diagnostic experience with that condition once I receive my assessment results), the number of tests which rely on quantitative data (e.g hard numbers that leave no room for interpretation), external family input, and the observations of both a primary and secondary diagnostician, both in the room at the same time, and who later compare notes, mean that a single doctor’s interpretation or idea of what autism does or doesn’t look like is largely irrelevant to the diagnosis.

For the way in which I was assessed, if you met the numeric cutoff for the various tests, you got the diagnosis, if you didn’t, you didn’t. There was really no room for doctor bias or opinion. I was 21 years old at the time of testing.

My diagnostic evaluation took place in increments over a period of five days that spanned a three-month period between February and April. The eval was administered by a graduate student who was being filmed and mentored by a doctor in psychology. The student met with the psychologist after each of my sessions, and the footage and test results were reviewed and discussed.

My initial appointment was two hours long. It consisted of a detailed intake evaluation which included questions about my current and childhood histories; my family and relationships; the symptoms I experienced both past and present; questions about physical illnesses, any substance abuse, trauma, and all other meaningful life events (family deaths, divorce, etc.). I was given basic one-page screenings for symptoms of depression and anxiety (neither of which I had in sufficient quantities at that time to warrant diagnosis; those would come later). I was also given two different multi-page forms for my parents to fill out (my mother completed mine.) They asked detailed open-ended questions about my early childhood and development, any anomolies or missed milestones, my medical history, etc. They also included at least 50 likert-scale questions (questions whose responses are chosen from a multi-point scale; e.g 1-5 with 1 being mildest and 5 being most severe) about traits I exhibited throughout my childhood which would be specific indicators of ASD. My mother filled these out independently with zero input from me.

My second appointment occurred two weeks later. I submitted all of the paperwork I and my parents had been given to complete, and was given an IQ test, specifically the WAIS-IV (Welscher Adult Intelligence Scale edition 4). This test took two hours to complete, and consisted of spatial reasoning and pattern-recognition tasks (creating patterns from blocks, visually constructing complex illustrated shapes by selecting a specific quantity of smaller illustrated components, the trail test, etc.). Following that were tests of short-term memory and memorization; auditory processing; abstract language abilities (e.g similarities between given words, word definitions, etc.); mental arithmetic and number manipulation; and general knowledge assessment (e.g who was X famous dead person? What does this formula mean? etc.)

The second appointment also included a self-test to pinpoint features of psychotic or personality disorders such as Schizophrenia, Antisocial personality disorder, Bipolar disorder, etc. This was not a basic test in which answers could be fabricated to achieve a specific result. It had a built-in failsafe which allowed the examiner to determine if the answers were genuine or being manipulated during scoring.

Appointment number three took another two hours, during which I was given the WIAT-II (Welscher Individual Achievement Test, edition 2). This was a test of academic achievement which screened for academic ability, particularly as it related to the overall intelligence scores attained on the IQ test. It was used to determine the presence of any learning disabilities, and examined everything from oral reading ability to reading and writing comprehension; spelling; basic and advanced mathematics and processing speed.

The final appointment before sitting down to discuss test results took just under an hour. The grad student who had been examining me performed the ADOS-2 (Autism Diagnostic Observation Schedule edition 2, module 4 for fully verbal adults). Sitting to the side to observe our interactions and score the test, was a second grad student.

This test was a semi-structured interaction between the examiner and myself, during which time the examiner presented a multitude of activities which were designed to elicit specific responses, the nature of which could indicate the presence or absence of autism. It “pressed” for responses to social reciprocity; attempts at social overtures; nonverbal body language; idiosyncradic language or behaviours; odd or extremely narrow interests; complex body movements; theory of mind; and the understanding of complex social behaviours such as friendship, marriage, and emotional expression.

The fifth appointment was when I finally received the results of my evaluation. The grad student who had tested me gave me an 18-page document detailing every aspect of the assessment, from the details of our conversations about my childhood and experiences, to breakdowns of the scores on all of my various tests and explanations of their meanings, and a multi-paragraph examination of my ADOS results, along with a quantitative chart denoting my scores relative to each social press.

Page 14 noted that I officially met the necessary criteria for an autism spectrum diagnosis, and that I had no learning disabilities or depression, but that my anxiety, while not severe enough to warrant a diagnosis, was high enough to be in need of monitoring.

The four pages after that contained a number of recommendations for future treatment, including individual therapy, social skills group, medication, and continued self-education.

And there you have it. As you can see, an autism evaluation, when conducted properly, is so much more than just a doctor giving you a checklist of symptoms, or of you describing your symptoms to a psychologist and their saying, “Yep, sounds like autism!” It is very detailed and complex, and takes a lot of time and energy, both on the part of the person being evaluated, and on that of the diagnostician. It is not a simple thing, but, at the end of the day, you can rest assured that the testing was thorough and in earnest, not something that was cobbled together halfheartedly.

This is why I get so frustrated when I read things like, “I know myself better than a doctor does!” or, “Doctors make mistakes too!” Of course doctors make mistakes, they are human too. The difference is, doctors are far, far less likely to make a mistake than a layman reading information on the internet, because they’ve studied their specific field for years, and taken very specific, very difficult licensing exams to be able to conduct testing. Doctors also have the ability to use objective, quantitative evaluations of your strengths and weaknesses to reach conclusions about you that you didn’t know about yourself. For example, I suspected that my atrocious math skills were a result of dyscalculia. They’re not. They’re the result of a severely diminished processing speed (as in 13th percentile severe, meaning that 87% of the adult population has a processing speed that is faster than mine). If I had just rattled off a list of symptoms to my psychologist and said, “I really suck at math,” and she took that at face value, I could easily have been misdiagnosed with dyscalculia and given inappropriate treatment. I don’t need to be taught math differently, I just need to be taught it more slowly. Please remember this post the next time you see someone say, “Professional diagnosis is no more valid than self-diagnosis because professionals just listen to you talk about symptoms and give you a checklist off the internet!” Thank you.

TLDR: My autism eval was very long, very time and energy-intensive, used a variety of different standardized testing measures, and was generally a lot more complex than being given a questionnaire by my therapist or reeling off my symptoms and being told, “Yep, it’s autism!”

#actuallyautistic #evaluation #self-diagnosis #self-dx #ados #iq test #prof dx

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nancygduarteus · 7 years

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Therapy for Everybody

JOHNSON CITY, Tennessee—The first patient of the morning had been working 119 hours a week. Greta (not her real name) had been coming home late at night, skipping dinner, and crashing into bed. One recent night, her college-aged daughter melted down, telling an exhausted Greta that her parents’ marital tensions were putting a strain on her.

“She’s like, ‘Why don’t you just divorce him?’” Greta recounted to her psychotherapist, Thomas Bishop, who was perched on a rolling stool in the bright examination room. “‘Why don’t you just do it and get it over with?’” Greta planned to stay with her husband, but her daughter’s outburst worried her. “Is this going to affect the way she feels about relationships?” she asked Bishop.

Listen to the audio version of this article:

Download the Audm app for your iPhone to listen to more titles.

Though it was just 14 minutes into the therapy session, and Greta had only seen him a few times, Bishop tried his best to interpret the daughter’s feelings. “There’s a period developmentally where we kind of look and go, ‘Gosh, I wish mom and dad were this way,’” he explained. Later, in their 30s, people realize their parents “are what they are,” he added.

“So this is her struggle, not your struggle,” Bishop told Greta, reassuringly. He wrapped up with some practical tips, urging Greta to compartmentalize her work and life issues, perhaps by journaling or taking a different route home from work.

Greta seemed genuinely pleased as Bishop swept out of the exam room. Her therapy session had lasted just 20 minutes.

Two weeks prior, Greta had walked into the clinic, a family-medicine practice situated on the campus of East Tennessee State University, hoping to see a primary-care doctor because she was so stressed she could barely function. When the receptionist initially told her, because of a miscommunication, that it would take a month to be seen, Greta cried, “I’ll be dead by then!” She was seen that day. After a medical resident finished evaluating her physically, he called in Bishop, the psychotherapist.

Bishop is part of a unique new breed of psychologists who plant themselves directly in medical offices. In clinics like ETSU’s, the therapists eschew the familiar couch-and-office setup. Instead, they pop right into in-progress medical appointments and deliver a few minutes of blitz psychotherapy. (ETSU allowed me to visit the clinic and sit in on patient visits as long as I did not disclose their real names or identifying details.)

Exploring one’s demons by the 50-minute hour might be a relatively common practice in large cities, but ETSU’s clinic is situated in the thick of Appalachia, where mental-health care is both less familiar and less accessible. Johnson City has recently witnessed an economic revival, with its brewery scene a modest tourism draw, but the surrounding region is still dotted with discount stores and unpainted shacks. Bishop’s patients bring him stories not only of family and marital strife, but also of financial pressures. If the trope is that psychologists help the “worried well,” this clinic helps the worn-out but hanging-in.

Also stationed in the clinic’s busy atrium that day was Jodi Polaha, a fellow psychologist, ETSU professor, and evangelist for this kind of therapy, which is called “integrated behavioral health care.” Along with providing therapy to patients, the clinic’s psychologists help train the clinic’s medical residents to employ their therapy techniques, which emphasize finding solutions. Some of the most common issues that send people to their primary-care doctors—like bellyaches and backaches—often don’t have clear physical causes. “It’s usually some lifestyle change that’s needed,” Polaha said. “That’s where we come in.”

Integrated psychologists can help patients manage their pain at home so they, for example, don’t run to the emergency room at the slightest twinge. One chronic-pain patient, who saw painkillers as the only way to ease her suffering, recently told Bishop that one of the residents gave her some of his “Buddha stuff”—relaxation exercises to do at home. Savings like these are especially important to the perennial American quest to cut health-care costs. An estimated 5 percent of the U.S. population accounts for 50 percent of all medical costs, and mood disorders are one of the most common conditions these high spenders suffer from. Some types of psychotherapy can make patients more likely to adhere to a doctor’s medical advice or to follow-through on weight-loss plans, saving a medical practice time and money in the long run.

The clinic charges uninsured people on an income-based sliding scale, and patients aren’t charged an extra co-pay if a therapist drops in on their medical visits.

Bishop, a 52-year-old who squints when he smiles, is the earnest one. (He frequently mentions that he has been married 31 years and has moved 20 times.) Polaha, who is 47 and looks like a nerdier Robin Wright, is more irreverent. One day during my visit, a clinic resident, Becca Sacora, approached Polaha to see if she wanted to check in on one of Sacora’s patients. “She’s a pretty sick lady,” Sacora said. “I’ve been putting out fires with her medical state. She’s 39 and has a severe history of anxiety and depression.”

“If you’re not busy,” Polaha responded, “it would be great if you could work with me on an introduction” to the patient. Then she added with a wink, “It’ll take two minutes of your time, and then you can go back to looking at Facebook or whatever you do all day.”

The next morning, I went on a pre-dawn hike in the Appalachian Mountains with Polaha and Bishop—grueling feats of athleticism being the preferred activity of these two middle-aged colleagues. Other days, Polaha does open-water swimming or weightlifting, and Bishop trains for one of his frequent marathons.

In the freezing dark, Polaha pulled on her headlamp and leapt into the air a few times: “Let’s get warmed up!”

“Exercise is stress management,” she assured me, as we trekked straight upward and snot ran down my face.

Polaha, who grew up near Philadelphia, got into rural medicine as a grad student at Auburn University in Alabama, where she treated poor, troubled kids. Some of the kids didn’t have running water, and they gave her head lice, but she loved feeling needed. She went on to practice pediatric psychology in Nebraska, traveling around the state to help kids whose developmental or emotional problems were too severe for their small-town doctors to fix. Once a week, she would work with primary-care doctors in a town called Hastings, staying at a Comfort Inn. When she left that job, the Comfort Inn threw her a going-away party.

Polaha and her husband moved to Johnson City in 2006. At the time, Bishop was already practicing integrated care in a nearby town. He’s a northerner like Polaha, but his blue-collar past helps him relate to his patients, a quarter of whom are on Medicaid. Bishop spent his childhood in Flint, Michigan, helping raise his own younger brothers and sisters after his parents divorced. The experience made him embrace chaotic environments, like that of the juvenile offenders he worked with in Michigan.

Integrated care helps solve a lot of the problems with more traditional forms of psychotherapy—like getting to a therapist, which can be impossible for many Americans. About half of U.S. counties don’t have any mental-health providers, and about a third of psychotherapists don’t accept insurance at all. An hour is a long time to take out of one’s workday, so many patients don’t show up to psychologist appointments, even when they’re referred by their regular doctor. “Physicians used to call us black holes,” Polaha explained.

By offloading mental concerns to an on-site psychologist, the primary-care doctors’ time is freed up. Doctors can see more patients, so the clinic makes more money, which can be used to pay the psychologist.

There aren’t clear numbers on how many primary-care practices in the U.S. are integrated to ETSU’s extent, but one study found 23 percent of rural primary-care practices, and 40 percent of urban ones, have a mental-health provider onsite. In many cases, though, “integrated” just means the two providers have offices in the same building.

When Polaha arrived in Tennessee, she heard about Bishop’s work and persuaded him to join the university’s medical school. Eventually, they opened up the integrated practice together. Today, Polaha splits her time between clinical work, research, and teaching. “Since he’s been here, we’ve been able to do even more,” Polaha explained as we hiked, not even straining to keep up her rapid-fire speech. “Plus [we] have time to go hiking.”

At the clinic, a resident pulled Bishop into another room, this time to speak to a patient who had cycled through several antidepressants, ADHD drugs, and sedatives. Now, she was asking her primary-care doctor about getting on a new stimulant drug to help her focus at her new job.

This is fairly common: Primary-care doctors, for instance, are the ones who prescribe the bulk of the antidepressants that Americans gobble down. In most cases, they do so without diagnosing the patient with any clear psychiatric problem.

Meanwhile, typical primary care often fails to catch mental-health issues in people who don’t know they have them. The U.S. Preventative Services Task Force recommends that all American adults be screened for depression at primary-care doctors’ visits, but only 4 percent of primary-care appointments include this type of screening. Normal primary-care doctors may feel too busy or ill-equipped to provide mental-health care without a psychologist present, or they may not be able to bill insurance for it. “I went to the minute clinic this weekend because I was afraid I had an ear infection,” Charles Ingoglia, a senior vice president at the National Council for Behavioral Health, told me. “In the course of talking to the [nurse practitioner], she indicated that she would not feel comfortable screening for depression, as she has no resources to do anything about it if a screen was positive.” In other words, she needs a Tom or Jodi.

“If I don’t keep it together at work, I’m going to lose my job,” said Bishop’s patient, a 30-something mom and bill collector. “It’s the highest-paying job that I’ve ever had.” Bishop asked her about her childhood, figuring that any signs of ADHD would have emerged when she was young. Growing up was just “eh,” she said. “My mom was very strict, very ... judgmental.”

“Did you do any counseling or anything when you were young?” Bishop asked.

“No. My mom doesn’t believe in it,” she responded, her voice breaking.

In her new job, “there’s no room for error,” Jane said. But she doubts herself constantly. Her manager scolds her, then wonders why she second-guesses herself. “She reminds me of my mom a little bit,” Jane said.

Jane dropped out of college twice. She knew she could do the work, but every time she stepped foot on campus, she had an anxiety attack. By the time she got to class, “my heart would be palpitating so fast that I wouldn’t even be able to hear the teacher.”

“I’m not completely convinced that this is ADHD,” Bishop told her. And given her anxiety levels, he said, he didn’t want her to take more stimulants. Before leaving the room, Bishop suggested she also meet, for no extra charge, with the health coach—one the clinic also employs—to help her lose weight and drink less.

“You’re awesome!” Bishop said. The woman chuckled a bit as she wiped her tears.

The week before I visited, there was a hate crime in Polaha’s neighborhood. Someone threw a dismembered cow carcass in the yard of a woman who had decked out her house in gay-pride flags. They also scattered about 70 nails near her car.

The following Sunday, Polaha and her neighbors rallied around the woman, standing in the park and selling rainbow flags to raise money for LGBT causes. On top of the gay-rights activism, Polaha also sits on a committee of mothers concerned about gun violence and is part of a supper club devoted to discussing topics like philosophy and ethics. Her county, like the rest of Tennessee, overwhelmingly supported Donald Trump last November, but Polaha showed up to the polls in an all-white pantsuit and later helped organize the local Women’s March.

At the park fundraiser, Polaha explained to me an analogy she often uses to get patients to make small, incremental changes in their lives. Think of a target, she said, and think of the bull’s eye as representing your values. “If each thing you do all day long is throwing a dart at this target, where would you say your darts are landing?” Polaha asked. If your darts aren’t landing near your values, “What are some things you could do today? Tomorrow morning? This week?” Patients, she told me, will say things like, “I could take my dog for a walk,” or, “I could offer to drive my husband to work.” Before long, patients start to resemble the good mom or loving wife they envisioned at their target’s center.

I had seen Polaha use this technique at the clinic with an overwhelmed mom of twins. The woman had arrived weeping because her neighbor criticized her parenting skills, which she was already feeling insecure about. “It’s like a never-ending sleepover at my house,” the woman complained.

Polaha told the mom to imagine herself as a captain navigating a ship through a terrible squall. The mom had to choose between forging ahead to the other shore—that is, parenting her rambunctious kids the best she could—or retreating below deck to cognitively hide under some blankets. It might be more comfortable to seek cover from the gales of parenting, Polaha explained, but it would come at the expense of the twins’ health and development.

Watching her sell rainbow flags in a park in rural Tennessee, I asked Polaha whether it ever bothers her that her patients are, statistically, likelier to be Trump voters than not. I wondered how she, a woman who devotes much of her spare time to progressive causes, mentally digests the fact that her patients’ values, which she tries to get them to endorse more fervently, might be radically different from her own.

Polaha minimized the importance of political identity to a person’s overall value system. “Everybody, in their core,” she said, “wants kind of the same sorts of five or 10 things, right?”

Anyone who happened to spot a friend or neighbor walking into the ETSU clinic waiting room would never know whether they’re there to get their minds or bodies checked. That’s important, because stigma surrounds people with mental illnesses—as anyone who has ever had to explain a mid-workday jaunt to their therapist knows.

That stigma might be especially pronounced in areas where therapists are a foreign concept. For some Appalachians who suffer from depression or anxiety, “they’ll attribute it to ‘nerves,’” Miranda Waters, a psychometrist at West Virginia University Hospitals, told me. Waters grew up in Stearns, Kentucky, about three hours from Johnson City. The advice from locals, she told me, would often be: “Go to your doctor and get something for your nerves.”

Religion is a source of comfort and strength to many here. But a deep devotion to Christianity is viewed, by some, as a replacement for professional psychological help. “There’s a lot of ... thinking that, if you go to church, if you pray, if you’re faithful, you can get over a mental illness,” Waters said.

Several locals I met around town echoed this sentiment. One 63-year-old woman named Nancy, who was shopping at a nearby Walmart, swiftly told me, “No, no,” when I asked if people in the area get therapy. “We go to church,” she added. “We pray for the best.”

Compounding the cultural obstacles, there are only enough resources to treat four in 10 Tennesseans who need mental-health care, according to Marie Williams, the commissioner for the Tennessee Department of Mental Health and Substance Abuse Services. Appalachian cities have some social workers and master’s-level practitioners, but unlike in larger cities, there aren’t as many doctorate-level professionals who open up private practices here, Waters said.

To Polaha and Bishop, that’s precisely why their model can help in areas where people can’t or won’t get therapy otherwise. In one large study, elderly people were more likely to accept mental-health care at their primary-care doctors’ offices than at specialty mental-health clinics. In other words, if more primary-care providers embedded therapists into their practices, therapy could shed both its luxury status and its shame factor. It could become as ordinary and widespread as taking high-blood-pressure medications.

Bishop described a patient who came into the ETSU clinic recently and said, “I’m only here for my physicians’ assistant. There’s nothing you can do to help me.”

Bishop said, “You’re right, there’s nothing I can do to help you.”

That patient ended up coming to him for two years.

“Does everybody need psychotherapy? No,” Bishop said. “Could everyone benefit from psychotherapy? Probably.” Even Polaha once got therapy to overcome her public-speaking jitters—long after she’d already received her psychology doctorate.

With therapy so readily available, it might be hard for Bishop and Polaha’s patients to determine just how much therapy is enough—another struggle well-known to therapy-goers everywhere. Not unlike packing, therapy seems to take as much time as you have. Some studies show even one session of some types of therapy can help beat back depression, but the benefits of therapy tend to fizzle out as the number of sessions enters the double-digits. Bishop says a good therapist is a “mirror,” helping patients see their life goals more clearly, and reach them. Once you’ve achieved your goals, there’s little point in continuing.

I thought about my own therapy, which largely consists of me explaining the economic realities of journalism, over and over again, to a petite, middle-aged woman, after which she tells me to do more mindfulness exercises and charges me $170. “I wonder if I’ve been doing my therapy wrong,” I mused to Bishop during one quiet moment in the clinic.

“You’ve said that about four or five times in the last few days,” he said. “I think you should approach your therapist about that. I mean that sincerely.”

With his own patients, Bishop is sometimes the one who suggests it’s time to say goodbye. “I see myself working myself out of a job from day one,” he said.

At one point, it seemed like Bishop was trying to feel out whether one patient should still be coming to see him. She was a woman in her 50s, but she looked about 70, with a raspy voice and a tired expression, though she said she was feeling good. She had been seeing Bishop for years, talking about her struggle to quit smoking and a tessellating array of family issues. The woman spoke slowly and cautiously, in short sentences. At times, she sounded like she was answering a boring questionnaire rather than unburdening herself.

“Is it still helpful to meet?” Bishop asked finally.

“Yes,” she responded, to my surprise. She had been feeling more isolated from her friends than normal recently. “With me not being able to get to church, it’s nice to have a friend I can visit and talk with.”

Over the coming months, the woman did return to see Bishop several more times. But in the end, it was Bishop who announced he was moving on: He had accepted a new role at another university’s family-medicine center, where this coming year he will set up another integrated behavioral health practice. When Bishop offered to transfer her to a new therapist at ETSU, the woman declined. Even briskly efficient therapists, it seems, are too much like friends to be interchangeable.

from Health News And Updates https://www.theatlantic.com/health/archive/2017/06/therapy-for-everybody/531120/?utm_source=feed

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ionecoffman · 7 years