Therapist Red Flags

whats the ice cream bar approach ?

So, @bipolarings has a post talking about this a little already, but I'm always happy to be given an excuse to blather about brains :D

The ice cream bar/sundae bar metaphor was originally created to describe the autism spectrum, but it works really well for other things too, including bipolar disorder. I'mma adapt it a lil bit here, in fact, to make it work even better. Yay me.

The principle is this: instead of trying to divide up bipolar disorder into I/II/NOS/etc, or classify it as 'severe' or 'mild', picture it as a sundae bar.

Now, every day, you make yourself a sundae. You can take as many toppings as you 'want' and as much of each topping as you 'want'.

There are some toppings that go well together, so, for instance, if you take a lot of euphoria there's a good chance you'll also get some hypersexuality, some delusions of grandiosity, some creative drive, some ambition, some psychomotor agitation. And that would be called a 'manic episode'. You could get somewhat less of each, maybe leave off the delusions of grandiosity, and people might call it a 'hypomanic episode'. Even less and people might call it 'euthymia'.

But the thing is, you don't have to get it that way, and you can take any amount of each! So you might get low mood but a lot of psychomotor agitation, irritability, and disregard of consequences. Or you could get a huge amount of emotional numbness but combine it with the stuff other people like to put with euphoria. Or you could get just a bit of low mood but spice it up with hallucinations and delusions (other). Or you could get a lot of delusions of grandiosity but only a tiny amount of euphoria.

And what you get one day doesn't determine what you get the next. You could spend years getting nothing but the 'hypomania combo' and the 'depression family-size' and then one day decide to dump the entire bowl of euphoria in your cup and top it with so many delusions it starts to spill over the sides. Or maybe you've only ever gotten small, carefully curated sundaes with a healthy amount of two or three toppings but today you just tell the server 'fuck me up' and get some of absolutely everything.

Without all the metaphor:

While certain sets of symptoms commonly appear together, and are then labeled 'mania', 'hypomania', 'depression', or 'euthymia', symptoms don't have to appear in those particular combinations. (Also the DSM isn't necessarily even right about what combinations are common.)

You could also have different proportions of symptoms than someone else does. (And that doesn't necessarily make your disorder or theirs automatically more 'severe'.)

Even if you do only get common combinations of symptoms, that says nothing about how 'severe' it is. If you get an enormous amount of emotional numbness, lack of motivation, executive dysfunction, suicidality, paranoid delusions, and disregard of consequences, continuously for 98% of your adult life; and someone else gets one (1) single 3 day long episode with a medium-sized serving of delusions of grandiosity, hallucinations, and disregard of consequences; they'll probably be diagnosed with Bipolar I and you with Bipolar II, but your life is probably being affected a lot more.

What symptoms you get can also change, which can include changing from what a psychiatrist might call 'Bipolar I' to 'Bipolar II', or 'BP-II' to 'BP-NOS', or whatever. You haven't magically gotten a new disorder. You just got a different sundae today. You're still eating at the same sundae bar.

I-d

Why do we love to pathologise normal behaviour online?

By reducing nuances of mental health to sweeping statements, social media might actually be leading to over-diagnosis.

Did you enjoy reading as a child? I'm sorry to be the one to tell you this, but the cherished hours you spent reading Harry Potter books were actually just your body’s way of dissociating in an uncomfortable environment (also RIP to your idea of JK Rowling as a decent person). Do you sometimes forget to text your friends back? It’s probably, definitely, because of a past trauma, and certainly not the natural result of a culture in which we are expected to be socially available at all times. Better get a therapist on the line! Do you struggle to concentrate at your office job, where you spend eight hours a day performing boring tasks in front of a screen? I hate to be the one to tell you this, but there’s probably something immutably wrong with the chemicals in your brain. 

As far as the internet is concerned, just about everything you do might be evidence of a troubling pathology. Social media can undeniably be a great resource for people experiencing mental illness, alongside people who have ADHD, and people who fall somewhere along the autism spectrum. A condition like ADHD, for example, is still said to be underdiagnosed (particularly among women) and raising awareness about this might bring people to a diagnosis they sorely need. But as with many things online, there is a downside to a free, entirely unregulated flow of information. 

This is good. It talks about capitalism too.

[Image description: four slides with black text on a light blue background that read as follows: 

Victim blaming by abusive parents looks like… “You’re disrespecting me by having boundaries that are inconvenient to me. Therefore, I’m entitled to hurt you.” “You know I get mad when you do this and you did it anyway, so it’s your fault I hit you/yelled at you/belittled you.” “You’re hurting my feelings by accusing me of being a bad parent.” “What have I done to deserve this?” (Usually as a reaction to you establishing boundaries). “You’re tearing this family apart (by fighting back against the abuse).” “You’re a bad child. Look at all the bad things YOU’VE done to ME.” (often, those things are trauma reactions, like avoiding their presence or acting behind their backs). (When you try to hold them accountable) “Oh, I forgot, you’re always right and I’m always wrong. Nobody cares about me or my feelings. I do everything for you and this is what I get in exchange.”

In reality… Every person is responsible for their actions. You didn’t make them abuse you—they CHOSE to abuse you. You have the right to be able to establish boundaries without fear of punishment. You have the right to have your needs met. Your trauma reactions are not something you’re doing to disrespect them—they’re something your body is doing to protect you from harm. End image description] 

These are just some examples of things abusers say to frame their abusive actions as the victim’s fault (taken from personal experience and the stories of people who have messaged me). Feel free to add your own examples if they’re not listed here and if you want to help spread awareness about what victim-blaming looks like!

And remember: abuse is never the victim’s fault.

What does guilt-tripping by abusive parents look like?

What does gaslighting by abusive parents look like?

your bare minimum isn’t actually that bare or minimum. my dad once told me that there’s nothing in this world that’s easy and that’s true tbh. everything we do takes energy, time, and effort. even the little things. if you feel like you’re not doing enough please try to think about your circumstances and what’s currently available to you: chances are, there’s something that’s diverting or otherwise draining you. and to pull away from that and get something done regardless? well, i think that’s really admirable! please try to take pride in the things you do accomplish in a day, no matter how small or trifling you perceive them to be. you can’t be proud of your growth if you don’t notice where you already are!

I find myself explaining to people a lot recently why using "bipolar" "narcissistic" "psychopath" etc is an issue, because it can be hard to articulate in the moment, so here it is all together:

The terminology that is related to certain conditions, disorders, and neurotypes being appropriated by others to be used in commonplace situations necessarily creates problems for those whose conditions these terms are supposed to belong to and help. It stigmatises certain behaviours, makes them the butt of the joke, or underplays how debilitating they can be.

For someone who has to live with bipolar disorder, people using "bipolar" or "mania" loosely suggests that the actual bipolar people are overreacting, or else that their condition is a joke when in fact this condition not only hinders them in an ableist world, but also brings violence and discrimination against them because of the condition.

Such also is the case for personality disorders and complex disorders like schizophrenia. Using "psychotic" as an insult or a modifier erases the fact that it's a condition which most aversely affects the psychotic person, it stigmatises them as dangerous when in fact psychotic people are the ones more likely to receive violence than inflict it statistically and historically.

Saying psychopath when you mean a serial killer and sociopath when you mean someone who is cruel is also wrong in that same vein because these are ((now redundant)) subtypes of anti social personality disorder, which does not make people more likely to cause harm or to be "evil" or abusive, but rather causes issues in their own lives due to a lack of empathy, which must also not be confused with a lack of compassion.

Narcissistic personality disorder similarly is a cluster of self esteem issues, identity crisis, and a fragmented sense of self that shows itself in certain behaviours. Borderline personality disorder also is similarly stigmatised, when in fact people with this disorder are far more likely to be victims of abuse. Terms like "narcissistic abuse" or "borderline abuse" suggest that these people abused you because of their disorder, which is not at all true, and any idea of abuse can already be encompassed simply by calling it "abuse" plain and simple rather than stigmatizing a bunch of people in the process of this.

All of these disorders, though not curable, still are treatable in that people are trying to get help and adjust to life despite their symptoms. This only becomes possible as long as these symptoms and terminologies are not stigmatized any further by an ableist society. The terms used to describe these disorders are meant to HELP the people with those disorders. Not to become an excuse to treat these people worse and make them feel unwelcome.

Leia Organa - Bipolar Pride

“I’m not crazy- That bitch is!” - Carrie Fisher

(bipolar pride flag by @bipolarings !)

Another thing people don’t talk a lot about in hypo/mania is that it can cause your emotions to be very intense and switch very quickly. doctors call that emotional lability

so while the bi in bipolar represents mania and depression which last an extended period of time, switching emotions quickly and intensely can still be a bipolar experience in hypo/mania

There’s a big problem in the autistic community we need to address

I am a semi speaking autistic with high support needs, when strangers see me, they know I’m autistic.

I’ve often seen fully speaking autistics refer to me and other autistics like me as “just stereotypes”

But I’m not just a stereotype, and neither are other autistics like me.

We deserve to be seen too, we deserve to be seen as people with our own personalities.

Please don’t forget us

(Absolutely ok to rb, please spread this around)

if you’re a mentally ill adult, especially if you’re psychotic or have bipolar, i highly recommend you look into getting a psychiatric advance directive. basically they’re a form you can fill out where you can specify what kind of treatment you want and don’t want in the case that you ever get legally declared incompetent. normally, getting declared incompetent means that psychiatrists take away your right to make decisions about your mental health care. for example, they can force you to take medications you don’t want or institutionalize you longterm without your consent. also the state appoints someone they choose to legally “consent” in your place.

what a psychiatric advance directive does is put limits on what the psychiatrists assigned to you can do. you can appoint your own person to be your legal representative, someone you trust who knows you and cares about you. you can also specify what hospitals you don’t want to be sent to or what doctors you don’t want to see or medications you don’t want to take or whether or not you consent to electroconvulsive treatment. you can also say what you do want, like i put down that they decided to institutionalize me, i wanted it to be at a specific psych ward i’d already been to and had a not terrible time at. and now, if i ever get declared incompetent, psychiatrists are legally not allowed to put me back on the meds that gave me a seizure. 

nobody wants to be legally declared incompetent. it’s really scary to think about, but it does happen, especially to people with psychosis or bipolar disorder. it’s better to have legal safeguards in place ahead of time and not need them than to get declared incompetent and not have an advance directive

"I support people with POCD as long as they seek help and don't act on their urges" people with POCD don't HAVE "urges" they have intrusive thoughts that they are disgusted and horrified by and would never act on, please learn the difference