my wife brought up a brilliant point this morning: a huge problem with the way we view psychology (a problem which is frequently exploited + used to justify a lot of just. shitty work) is that it lives in a no-man's land between "social sciences" + "natural sciences" in the collective imagination.
consider: one of the first works which spurned my interest in psychiatric abolition was durkheim's work on suicide. as a sociologist ("social scientist"), he uses pretty rigorous quantitative methods to show that suicide is much less correlated with levels of depression than it is with cultural factors (like religion, country of origin, marriage rates). however, people do not respond to the medicalization of suicide by saying "well, durkheim proved that suicide isn't a mental illness symptom, so this is unscientific"- this is obviously a drastic oversimplification of his work + it's commonly understood that sociology does not "prove" immutable social truths.
similarly, i would not comment on a study which identifies changes in t-cells over time among hiv+ patients by arguing that it didn't deeply explore the social environments or past traumas they had experienced, (even though those could have an impact on t-cell count), because i understand that is not the purpose of the research + ultimately they had to choose to control for these factors without centering them in order to obtain important medical information. "this information is meaningless because it doesn't include each patient's trauma history" would be an absurd critique.
among the general population + many self-assured researchers, psychology gets both the privilege of being a "social science" (so we can't expect it to be TOO exact; it's complicated; it's not really saying that's ALWAYS true; if it proves inaccurate that's because culture/social factors must have muddied it up; we can't really expect PROOF for most of it) as well as a "natural science" (you can't question its basic presumptions or you're a science denier; the dsm describes real things which existed even before it was written; it obviously is rooted in biology even if we haven't discovered how yet; reducing its measures to quantitative evaluation is fine + unproblematic).
my point here isn't to argue that psychology is a "social" or "natural" science, but rather that we need to rethink what work those categories actually do + whether the distinction between them is as strict or meaningful as we believe it to be. our strict dichotomies between "objectively proven truths" + "social observations which are ultimately just informed opinions" are exposed when we look at a field which seems to be uncomfortably situated within both. what kind of work might become possible if we abandoned this dichotomy, rather than bickering over whose work belongs in which club?
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WIBTA if I broke up with my girlfriend for not taking her meds?
My (24M) girlfriend (28F) has bipolar and BPD. We've been together coming up on 3 years now. For the last half a year we were together it was pretty rough and turbulent, she was unmedicated and was having suicidal breakdowns almost every day, ended up in hospital several times, threatened and got into physical altercations with other girls who spoke to me or she thought were flirting with me, and I was spending almost every single day of my life having to take hours to talk her down from suicide or self-harm. It was emotionally exhausting and as someone who's also had suicide attempts in the past it was also incredibly triggering and damaging to my own mental health.
For additional context as to why I feel the way I do, my last girlfriend also had diagnosed BPD and NPD and when she stopped taking her medication she became fully abusive both physically and verbally and it took me a year of being absolutely beaten down to finally snap and leave her.
(Obvious note: I'm not saying everyone with bipolar, BPD, or NPD is abusive or that these illnesses inherently make you abusive. They were an abuser who just happened to have those things, and that played into how they acted and thought/felt.)
Current girlfriend eventually got medication and has been doing much better for most of the time since then. When she's on her meds she's a wonderful and generally pretty healthy partner - she's supportive, understanding of my boundaries, checks in with me, she's a year clean from self-harm, hasn't displayed any kind of self-destructive behaviour. She's gotten a job and managed to hold it down (got fired from several jobs in the past because of her daily meltdowns meaning she wasn't attending work), she's started exercising and going to the gym, she's picked up new hobbies, made new friends, she's just been doing great in general.
For about the past month though, she started going days without taking her medication and when I reminded her she would say she didn't want to, that she hated taking it, that she doesn't like the way it makes her feel etc. This is something my last girlfriend said too, and I know it's really common for people with BPD (and maybe bipolar too?) to stop taking their medication because they feel emotionally flat in comparison to how they feel off of the meds. I pretty much said that I couldn't handle going back to how she acts when she's off of the medication again and that if she was going to stop taking them then I didn't think our relationship would last through that kind of period again because last time it completely destroyed my mental health, my sleep, my life and several of my relationships due to how much energy and time I was having to put into her vs. myself and everything else. I suggested asking her doctor/psychiatrist/etc. for another dosage change or meds switch again to see if that would work better (though up until recently they have seemed to be working great so I'm not sure how good of an idea switching it up again would be).
She agreed at the time but I was kind of concerned about whether she'd been keeping up with it or not because over the last few weeks I've already noticed things devolving again - her screaming at me out of nowhere and having mood swings, intense jealousy and possessiveness, impulsive behaviour, even a couple of breakdowns again and having to talk her out of self-harm for the first time in over a year. True enough, today I found out she's been pretending to take her medication and throwing them out. When I confronted her about it she admitted she hasn't taken her medication for weeks.
I pretty much withdrew after that and didn't say anything at that moment but after a while she asked me why I was being so quiet and I basically repeated what I'd said to her in the last conversation, that I was honestly rethinking whether or not the relationship would work because I can't handle that kind of emotional exhaustion and constant sacrifice all over again. I don't mind some emotional support and some labour of love in a relationship because of course I'm going to need to look out for her mental health and reassure and comfort sometimes, that's the reality of loving someone who struggles, but I can't do it 24/7 again. I can't once again put talking her down for hours every day and weathering screaming and violent lashing out all the time at the expense of even my own basic needs and my own mental health struggles (for example my c-PTSD from my last relationship).
When I said that she got very very upset and basically said I was forcing her to choose between me and freedom or being able to live a normal/unmedicated life (which I mean, I guess I can't argue with because in a way I am making her choose between me and stopping her meds), and that I couldn't control her like that. I told her I wasn't doing it to control her and that if she's really determined to go off of them she could, but that I would have to make my own personal choice to walk away as a result of it for my own sake.
She said she'd think about it but ever since that conversation I've been going back and forth in my head on how much of a dick move it would be to flat out just do a black-and-white "Either you stay on your meds and regulate your behaviour or I leave"
TL;DR Girlfriend wants to go off of her medication, but when she's off her meds she has almost daily suicidal breakdowns and lashes out at me physically and verbally. WIBTA if I broke up with her if she goes ahead with stopping?
What are these acronyms?
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Hearing Voices & Unusual Experiences & Psychosis & Schizophrenia & Etc
Hearing Voices and Co 101
Community overview of hearing voices by BC hearing voices network and Hearing Voices Network of South Australia
A rare community and medical overview of hearing voices by Understanding Voices
Medical and Mental Illness style overviews of hearing voices (separate from pages on psychosis and schizophrenia, which is kinda nice) by Mind UK and Rethink Mental Illness
Explanation of psychosis by Likemind UK
Explanation of schizophrenia by Project LETS
Lived Experiences
“LUNAR: a psychosis zine” by feyxuan, interviewing 6 folks with lived experiences
"A Bipolar, A Schizophrenic, And A Podcast” hosted by Gabe Howard and Michelle Hammer aka Schizophrenic.NYC
“MadHaus” podcast by Maddie Jericho, who also is part of Students With Psychosis
“Living Well with Schizophrenia” Youtube channel by Lauren
“The Collected Schizophrenias” by Esmé Weijun Wang, book review with quotes here
Dealing with Life
Lists of coping strategies by Hearing Voices Network Aotearoa New Zealand, Hearing Voices Network Australia, and Manchester Hearing Voices Group
Advice from young people hearing voices by Manchester Metropolitan University
“Dealing with Psychosis” toolkit by Early Psychosis Intervention program in Canada
List of Hearing Voices Networks around the world on Intervoice website
Peer support groups for folks with “schizophrenia or a schizophrenia-related illness”, family and caregivers, and a helpline by Schizophrenia and Psychosis Action Alliance
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some comparisons between disorders and symptoms
we've been meaning to write this for a while now, because we often receive asks that are like "how do I know if I have a schizospec disorder or (another disorder)?"
so, here are breakdowns of symptoms that affect thoughts, some things we'll take from the EASE for more officiality and clarity
intrusive and impulsive thoughts
intrusive thoughts are by nature aggressive, horrid, macabre, and/or sexual.
they're different from impulsive thoughts. impulsive thoughts are silly, usually fun, are things that wouldn't bring too much harm on yourself or others if acted upon. things you would realistically do in the spur of the moment. they are purely caused by impulsivity.
examples of impulsive thoughts:
thoughts/imagery of breaking some object
thoughts/imagery of sneaking up on a person to give them a scare
thoughts/imagery of impulsive buying, spending, etc
examples of intrusive thoughts:
thoughts/imagery of blood, catastrophes, death, etc
thoughts/imagery of harming yourself/others
thoughts/imagery of sexual harassment, violence, etc
intrusive thoughts are unwanted, cause distress, are met with resistance, and often with attempts to push them away
impulsive thoughts aren't necessarily unwanted, cause minor distress or no distress at all, aren't met with much resistance
intrusive thoughts are a symptom of many, many, many mental health issues and illnesses. though, they also happen in healthy people, occasionally.
the keyword is: occasionally.
when intrusive thoughts become frequent and constant, they become obsessions.
obsessions
obsessions are, simply put, ongoing intrusive thoughts.
they are repetitive, they won't stop showing up no matter how much resistance or attempts to ignore them is shown, and are cause of great distress.
they are often met with attempts to push them away, which can too become frequent and become compulsions.
compulsions are often present with obsessions, but not always, and the reverse is also true. obsessions are often present with compulsions, but not always.
obsessions are the defining feature of OCspec disorders such as obsessive-compulsive disorder (both obsessive and obsessive-compulsive types, but not compulsive type) and body dysmorphic disorder.
ruminations
thoughts/imagery of any past event.
ruminations are frequent and ongoing as obsessions, but they're a bit different depending on the subtype of ruminations.
subtype 1:
the person is unable to find any reason for their tendency to obsessive-like states; they simply rethink and relive what happened during the day/past days – not motivated by perplexity, paranoid attitude, or sense of vulnerability or inferiority.
subtype 2
the obsessive-like states appear as a consequence of a loss of natural evidence, disturbed basic sense of the self, or hyperreflectivity, or they appear to be caused by more primary paranoid phenomena (suspiciousness, self-reference, etc) or a depressive state.
subtype 3
ego-dystonic, as in obsessive-compulsive disorders, with ongoing internal resistance, but a content that is not aggressive, horrid, macabre, or sexual. they're also categorised as true obsessions, but can have a different content.
subtype 4
obsession-like phenomena, which appear more as ego-syntonic (not met with resistance, or only occasionally), and with a content that is directly aggressive, sexually perverse, or otherwise bizarre. they often feature an imaginative character doing the actions, instead of the person who's experiencing the ruminations.
to make it clearer:
intrusive thoughts are unwanted, cause distress, are met with resistance, and often with attempts to push them away. they do not happen regularly, and often aren't a cause of concern, though they are distressing. everyone can experience intrusive thoughts, regardless of if they have a disorder or not.
obsessions are unwanted, cause distress, are met with resistance, and often with attempts to push them away. they happen regularly, often on a daily basis, and often are cause of concern. since they cause distress regularly, they're often basis for a diagnosis of obsessive-compulsive disorders. again, if they don't cause distress, they're not obsessions, they might be ruminations or impulsive thoughts, or something else entirely. they are often, but not always, met with compulsions, rituals, or attempts to ignore them to neutralise the obsession.
ruminations are varied. they all have in common that they happen regularly, often on a daily basis, and they're thoughts/imagery of past events. they can just be (subtype 1); they can be in response to depression, hyperreflectivity such as anxiety, paranoia, suspiciousness, etc (subtype 2); they can be bizarre, met with resistance and distressing as obsessions, but of a different content (subtype 3); they can be of the same content as obsessions, but without the same resistance and without being distressing (subtype 4). though, they can also be met with compulsions, rituals, or attempts to ignore them. they can happen in any disorder, but especially subtype 1 can... just happen, even in healthy people. subtypes 2-4 are frequent in schizospec disorders. subtype 2 is also frequent in other non-schizospec disorders such as anxiety, depression, etc.
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