Hugaddicted

Hi! Two things: 1) I appreciate your nuance, and your willingness to talk the argument through, re the asks you’ve been getting on Israel/Palestine. Genuinely kind of refreshing, particularly around here. 2) I noted a post earlier that mentioned oppositional defiant disorder (ODD) and I was wondering if you’d be willing to talk more about that kind of issue? One of the things I do when I’m quiet at work (as you might’ve guessed, hi, I’m also a lawyer) is read English & Welsh family court judgments on BAILII (I don’t do family law, thank God) and there seems a bit of a trend for labelling kids with things like ODD. But also Intermittent Explosive Disorder, and labelling usually mothers with things like Emotionally Unstable Personality Disorder, and other things like that. I worry that these are labels we’re using for people whose main problem is ongoing trauma, and often also abuse and poverty. Obviously you can’t clinically speak to whether these are legitimate, and I don’t have any real question here, but it troubles me.

You do not know what kind of rant demon you are summoning by opening this subject, but I love you for it.

I think your instinct is right on.

A lot of us are now familiar with the potential psychiatric diagnosis of "complex PTSD." Where current definitions of post-traumatic stress disorder focus on a single event taking place to cause the symptoms, with complex PTSD the diagnosis would encompass multiple events, long-term situations, and cumulative stress.

There was a time when I found the DSM's resistance to a diagnosis of "complex PTSD" to be fairly puzzling. It seems pretty readily apparent that long-term exposure to trauma creates a different thing than PTSD. I think the book The Body Keeps the Score is also pretty troubled about this, because what the author uncovered in a whole lot of pathologized people was a whole fucking lot of child abuse.

(Literally this seems to even have been a problem with Sigmund Freud; a current prominent theory says that his whole Oedipal Complex thing was a way to deliberately disregard the evidence of his female patients' sexual abuse.) (Link is to Wikipedia article.)

I also see kids with these absolute parades of diagnoses. IED, ODD, BPD, ADHD, depression, anxiety. Label after label after label. Dig even slightly under the surface, and you find: that child is... being raised by their grandparents! Adopted and abused in the first two years of life! Father in prison! Mom in prison! A morsel of meat being shredded between two vengeful parents in a horrible divorce! Problems suddenly started after a series of suspicious happenings with an older cousin! Constantly on marijuana! Subject to constant verbal abuse by stepmom! Witnessed one parent beating another on the reg! Take your pick.

A truly astonishing amount of the time, I end up feeling very strongly that the child should be diagnosed with "having a completely understandable reaction to genuinely horrible shit." It's hard not to start thinking "wow this all seems fake" when you get a kid with yet another arm-length dissertation of alphabet diagnoses and ONCE AGAIN you find the heinously obvious reasons behind them.

(Same with my adult clients, who have essentially fossilized versions of the same disorders. More likely to see bipolar and borderline, more likely to see schizophrenic.)

Ah, you say, Ryann, but what about the whole neurotransmitter thing? Depression is caused by low neurotransmitters, we've got that kind of cracked.

Actually, there are "huge bodies of evidence" showing that low serotonin in particular has no causal link to depression and that the affect on serotonin might not be (probably isn't?) why antidepressants even fucking work! (Best evidence: SSRIs and SNRIs work on neurotransmitters immediately, but take weeks or months to kick in to be effective against depression. Why?)

For a long time, I hung my hat on schizophrenia, actually. It's like, genetic, right? Surely we know things about schizophrenia. Surely that is real science. Surely that isn't just a response to trauma!

Well, um. You can have genetic and environmental things that predispose you to schizophrenia, but actually, as my therapist informed me, it tends to actually show up when there's a history of trauma.

This has led to me feeling pretty strongly that the DSM's method of diagnosis is wrong from jump.

Metaphor with me for a moment about the DSM and its diagnostic methods.

Now we all know of the diagnosis of Stuffynose, correct? It's when your nose is stuffy. It's an ailment that's pretty common. Most adults experience Stuffynose several times in their lifetime. There are two main treatments for Stuffynose. The first is antihistamines; the second is decongestants. Doctors are very divided as to the uses of these two medications. Studies show that both of them are more effective than placebo in the treatment of Stuffynose. If antihistamines work, you might have to be on them for the rest of your life. If decongestants work, you're out of luck after a week or two, because they can be dangerous if taken too long. Hopefully that fixes the problem! What? What's a "cold"? What is "flu"? I've never heard of these things. Yes, Stuffynose can sometimes cause a sore throat or coughing. Stuffynose is related to fevers sometimes, but we think that's just an overactive bodily response... Yes, Stuffynose can sometimes be fatal. Listen, the insurance company doesn't cover "surgery" for a "deviated septum" or for "cancer." Likewise, "environmental allergens" aren't something we check for. Thank god we live in the modern world and we've taken care of a lot of the stigma surrounding Stuffynose!

Me. That's me, w/r/t diagnoses of depression and anxiety and frankly most everything else. It's like personality quizzes. If you divide people by any quality and then make that quality a Category, you've created an Identity, not (not just?) a diagnosis. If everyone who likes candy and reads a lot of books is a Sweetreader, you'll now have a whole lot of people identifying as a Sweetreader and being like "omg trying to pass by the Nerds gummy clusters without buying any... #SweetreaderLife" while the Meatjocks are out there having a cookout, typical #meatjock behavior! Obviously DSM diagnoses are much more specific than my Sweetreader/Meatjock dichotomy but I think the tendency is very much there. So here's the thing. I don't think the reluctance of the DSM to acknowledge complex PTSD is puzzling anymore. I think there might be some people there who, overtly or subconsciously, recognize that they are playing Barbies with fake words and fake diagnoses and fake concepts, and that if they add complex PTSD, the whole party is over.

The minute you add complex PTSD, you are acknowledging that it isn't the individual person that's sick. It's their circumstances. It's society.

It's not a defiant child, it's not an explosive child, it's not a child with baby bipolar disorder but we can't call it yet so we call it something else: it's a child with developmental challenges and unlearned skills (THANK you Ross Greene PhD and your book The Explosive Child), or it's child abuse.

And currently the whole goddamn burden of identifying and dealing with developmental challenges, unlearned skills, and child abuse is on our schools, which are equipped for like 30% of that list. I think there is an absolute epidemic of unnamed child abuse in this country, some of it based on the absolutely predictable results of the war on drugs constantly depriving children of their parents (either through being high, drug-seeking, going to ineffective rehabs, being jailed, or doing fucking terrible things because of the shit they're in up to their neck or how much brain damage they've inflicted on themselves). The rest is screens and devices being heinously bad for neurological development (children must be SPOKEN TO in order to turn into people in a developmentally appropriate way!!) and constant parental supervision taking away all opportunities to learn self-sufficiency, self-regulation, and problem-solving.

So of course we pay teachers handsomely to help us raise the next generation of good citizens with so many disadvahahahAHAHAHA AGHHHHHH

So I dream of a day that we have a different paradigm for diagnosing mental illness entirely. In the novel I work on occasionally, when I have time and brainspace, Martian culture in particular diagnoses by picking out areas of the brain that are under- and over-active and using direct stimulus (like a far more advanced version of Transcranial Magnetic Stimulation, a process I have actually undergone myself to unbelievably cool results) they will help the brain strengthen itself.

There is also some good news about antidepressants: the way they work might be in enhancing neuroplasticity, giving the brain more flexibility to heal itself. That's really cool and interesting to me, because it's like -- humans found ways to unlock our own powers of building ourselves and our identities and it fucking?? works???

ok obligatory disclaimer: I am a lawyer not a psychologist and in this post I have done an absolutely abysmal job of staying in my lane. This is not based on any science of which I am an expert and is rife with speculation and frustration at our current paradigms, which are clearly just flat-out inadequate. Thank you so much for opening the doors for me to goosh out my thoughts and feelings.

rose-in-a-fisted-glove

Oh hey! Someone else knows that book!

The Explosive Child by Ross Greene saved my childhood, no joke.

I was in late elementary school when my social worker recommended it to my parents and the difference it fucking made!

All of a sudden, instead of punishing me, my parents were working with me? And we were coming up with plans and solutions together? And I wasn't being punished. And we retired the idea that being told "use my words" was productive or useful. It was amazing to feel like my parents were actually listening to me instead of insisting on the impossible.

Just, the difference that book made in my life was huge. I can not state it enough.

That is one of my small handful of absolute paradigm-shifting books. Children want to be good and they are good if they can be. It unlocked so many new ways of thinking about the things my clients were going through! I actually have a book my him in my small to-read stack right now about how kids fall through the cracks in the educational system, and I am looking very forward to it. I have also literally given it out to the parents of clients before.

I'm so glad that it worked for your family!! I love hearing about that kind of experience because it helps me tailor when I recommend it and how I talk about it to others.

amaraqwolf

Good news: if you’re currently laying around and not producing anything, you are a credit to your species.

willow-wanderings

It’s recently been found that even hive insects rest. Bees will play with colorful toys. Ants sleep for about 1 minute but they do it so frequently it amounts to a few hours per day. Even trees take breaks.

The only things that work without rest are machines; literally everything that lives requires rest.

EVERYTHING THAT LIVES REQUIRES REST. STOP JUDGING YOURSELF FOR NOT BEING A ROBOT.

roach-works

robots require very frequent breaks! welding machines generally have it programmed in that they can’t run so long they melt themselves. ive overseen two different manufacturing robots now and each of them were fragile, finicky idiots that require constant maintenance and repair. they pause in between moves, in between jobs. you’re always keeping an eye on programming errors, on coolant levels, on heat. you’re always pulling bits of scrap out of joints, sweeping up debris, washing off nozzles and untangling hoses. and even then it snaps a chain and takes a whole morning’s vacation.

even robots need downtime.

One of the best letters I’ve ever seen just popped up on my Facebook memories. Still makes me laugh.

As today is the 50th anniversary of the moon landing, it’s a great time to revisit Dinah from Devon’s memory of this historic event. And yes, still makes me laugh.

Today is the 54th anniversary of the moon landing, but Dinah’s diary entry is still absolutely magnificent.

57th anniversary of the moon landing and the best diary entry in the history of diary entries. Sit down Samuel Pepys, it’s over. UGH.

heycallmered

people will really come into kink spaces and say you can't forcefem women like there wasn't a feature length movie about an elderly gay man forcefemming a woman as part of scheme to thwart an elaborate assassination attempt before the killer even determined their target

llama2237

What... What movie is this.

heycallmered

ain't no way in hell this post even breaks 500

marmoset-marmoset

i was trying so hard to remember the nonexistent assassination subplot in My Fair Lady

pyrrhiccomedy

can I talk about my new vampire the masquerade pc I think I really went off with this concept. never seen this as a pc in a vtm game before tbh. he's a responsible adult with a job

wizzard890

I'm running this campaign and it's so fun to give him challenges like "the local newspaper is reviewing your business", or "your high strung show pony employee has gotten into trouble with the mafia". he will deal with these obstacles by going to talk to the offending party like they're both in their thirties.

pyrrhiccomedy

his name is Sam. he's managing payroll. he's appeasing investors. he's requesting a receipt from the police precinct when he reclaims an inappropriately confiscated object from evidence lockup. his favorite Discipline is Summon because he can use it to make people show up to places on time (cell phones don't exist yet). obviously yes he is a Ventrue.

one of his employees who turns out to have a Dark and Mysterious past offered to kill somebody (anybody) for him and instead of thinking that was sexy or cool Sam was just like "that's a weird way to approach solving your problems. have you tried using your words"

pyrrhiccomedy

Sam is a guy who just wants to run a successful night club but unfortunately necromancers are trying to take over the city, and he might be the only person in a position to stop them. And he's a responsible adult so he's taking that on, but please understand that he will not let that effort come at the expense of opening his night club's private gambling room on schedule.

pinche-aquarius

Keep up the great work, lads

mayax81

snakebites-and-ink

I love how this addition would be absolutely incomprehensible almost anywhere else but we know exactly what it means

having the Aviation Accident Investigations Autism™️ has actually done wonders for the way I process and respond to my own fuck-ups

And I don't just mean "oh, my little work mistake is actually nothing compared to a fiery crash that kills people," either. The reason commercial flight is so many orders of magnitude safer than any other form of transportation is because after every accident and incident, an independent regulatory body investigated it with the express goal of figuring out exactly what happened, why, and how to prevent the same thing from ever happening again—not to root out which person deserved the blame or the liability.

It's a simple, shockingly effective idea. It's also worlds away from how most people approach their own mistakes and the mistakes of others.

Because it’s never just one person’s fault. And even when it is, it still isn’t.

The sharpest, best-trained pilots make worse decisions when they're tired or sick or stressed out, so there's two of them. The most dedicated and experienced air traffic controllers garble an instruction over the radio sometimes, so pilots are trained to always repeat clearances back to catch misunderstandings quickly. The best and brightest maintenance mechanic still overlooks a screw or misconnects a wire once or twice in her career, so aircraft systems are built with two or three or four layers of redundancy, and pilots are exhaustively trained to deal with failures safely.

Everyone eventually has a bad day. Every component breaks down. Every computer gets a bad a Windows update and spirals into a reboot doom loop. If it’s possible for one person’s mistake to domino into a mushroom cloud of a fuckup, then that task is too critical to be one person's sole responsibility. The accident sequence starts with the design of the system—so how do you improve the system to keep it from happening again?

oh yeah. The “modern commercial aviation is the safest form of transport” thing only applies to planes, btw. A helicopter is a beautiful metal horse that wants to break its legs and die so so so badly

This is such a good example of systemic solutions to problems!! Putting it in my pocket for explaining problem-solving vs. blame and punishment in the future.

When I was 12, I was diagnosed with Oppositional Defiance Disorder (because I was angry at my physically/emotionally abusive mother). One time my mom was tickling me, and I told her to stop three times but she didn't stop. I pushed my mom off of me. My mom went to my therapist and told her that I hit her without any context (and I was too embarrassed to tell my therapist anything).

My therapist almost sent me to a juvenile detention center. The only reason that she didn't was because having six months of therapy was a requirement before I could go to the center, and my mom and I moved away before the six months could be completed. What do you think could've happened to me if I went to a juvenile detention center? Would I have ever had access to a lawyer at any point in the process?

And this is why Oppositional Defiant Disorder is fake fake fake!! It depends on reports from adults, and adults are eager to portray themselves as entirely reasonable and teenagers as just crazy idiots.

When the ODD label gets slapped on a child, parents have no responsibility apparently for when a child habitually responds badly to authoritarian control. Nor do teachers, or systems; disabilities are suddenly irrelevant or their very existence is doubted.

ODD: fuck that child, in particular, but like clinically.

Okay, if you were in America, your therapist could not have just sent you to a juvenile detention center. There are a couple things that could have been happening here that you misunderstood or that were not explained to you. (People also tend to stop explaining things to kids diagnosed with ODD.)

Your therapist could have been referring to a youth mental health facility. Some of these are locked and do look and feel a lot like juvenile detention centers, and the locked facilities also do a lot of work with kids that are involved with the juvenile justice system.

Your therapist could have been threatening/offering to file something in court that could have ended up with you in detention. This could either be criminal charges (how dare you assault your mother);

Or it could have been an alternative civil type of case that's very common but called many different things in many different states. The civil charge is basically "hello I would like a judge to help me parent my child" and historically involved determinations of "incorrigibility." Now it's usually something involving determining if the child is at risk or in need of services or something.

Youth Mental Health Facility: this would have been undoubtedly the potential worst and also the potential best of the three options, depending utterly on how garbage your mom was going to be and what facility you ended up in. Those mental health facilities are rife with horror and abuse, as you might expect from anywhere containing a whole population of people who are habitually not believed and who have extremely limited legal rights.

Depending entirely on who is staffing the place and how vigilant and focused they are, their leadership, their ability to set goals and keep the kids first, some of those facilities... actually... are pretty good. I actually think architecture might have an influence on this too: if it looks more like a prison, it's going to end up with the staff acting more like it's a prison. I toured one of our higher-security locked youth facilities before, and they were super eager to show me their classrooms, their counseling rooms, and then... a blank hallway painted friendly colors, with a room coming off of it that had padded walls. I was like "wtf is this" and they were like, this is actually the pacing hallway! If kids are having a meltdown, they can come here any time with a staff member and yell and punch the wall and have a talk about it!

Court Filing: If you got a criminal charge, you would have gotten someone like me (ideally; the access to decent lawyers for youth is. spotty at best) and (ideally) a guardian ad litem, an attorney to look out for your best interests. This would be because your parent was the "victim" of the charge and so might not be looking out for your best interests. I actually ask for a GAL to be appointed on any case where I suspect the parents might be doing some Fuckery.

If the case was criminal, you also possibly would have gone to detention very briefly on arrest but whether you stayed there would have depended on the jurisdiction, the judge, and the lawyers. My experience overwhelmingly would say: probably you would not be staying in detention for a push unless your mom refused to have you back at home.

If you got a civil case, you would have gotten an attorney who's not quite like me. As a public defender, I specialize in criminal defense and I have the backing of my office and lots of training. Attorneys for civil cases for kids (which can still end up with them in detention) vary wildly in experience, commitment, general intelligence, and whether I have ever low-key wanted to throttle them.

Either way, you probably would have gotten stuck going back to court pretty regularly for a while to prove that you could shape up and be better (TM). During this process, you would have to behave orders of magnitude better than, just for a random example, the President of the United States, under constant provocation, with no right to privacy or autonomy, and the penalty of detention if you failed.

For more general information, I actually super recommend John Oliver's Last Week Tonight about Juvenile Justice, which is on Youtube. He is correct about basically everything and it's so satisfying to see it laid out like that. In fact, for most of what he describes I've personally known cases where it's happened.