raise hand

I've also danced with OCD, psychosis, insomnia and catatonia

There are a lot of crossover diagnosis that largely make little difference in treatment or medication.

Do you think that means that we are dividing diagnoses too much and need more umbrella terms, or not giving each one enough specific attention and need more varieties of treatment?

Or neither and having the same treatment for similar but different diagnoses works as is?

When I was 5150'd, I would have been unable to engage with, much less benefit from any other treament method until I was stabilized on an effective combination of meds. At least effective enough to get me lucid and coherent. (Hashing out cost, availability, side-effects and overall effecacy are topics worthy of 100 PhD dissertations.)

I'll also spare a thought for novel (and controversial) psych treatments like ECT (still the "nuclear" option reserved for when everything else fails), spravato (esketamine, an enantiomer of what some might know by the street name special-k), TMS, psilocybin, LSD, even Ayahuasca. Of that list I've tried psilocybin, but only recreationally. (Good times, would repeat.)

My favorite example of how f'ed up the pharmaceutical industry is is pointing to diphenhydramine. It's commonly known as Benadryl and used otc as an antihystamine with the prominently listed side effect of drowsiness. The same dose of the same chemical is sold separately as Nytol, a sleep aid which curiously lacks any mention of the side effect (treats allergy symptoms). They don't know what a substance will or won't do when they engineer it--they frankenstein molecules until they come up with something patentable and then put it through trials to see if it kills people and, if not, how best to market it based on its outwardly observable effects. Better than nothing, but emblematic of how much pharmacology relies on brute force and blind luck to achieve its desired aims. Even then it continues to be profit driven--an inherent conflict of interest in any field--and governed by the same "good enough, shove it on the market" approach employed by the software (particularly videogame) industry.

"Is it fun yet? Yeah? Forget the rest of the bugs, we've got a release date to meet. We can issue a critical patch later if necessary."

Besides, there's no larger pool of defacto QA interns happy to work for free than the pool of customers using whatever half-baked product gets cooked up and served to them.

I failed to specify that I was referring to my own diagnosis--embarrassing since I tend to appreciate greater specificity.

For medical diagnosis, separately cataloguing each discrete condition is extremely important because it informs both prognosis and treatment modalities. I feel that, the hairy topic of labels notwithstanding, having a name for ones condition makes it easier to accept, address and cope with, not to mention find and lend support for. A certain amount of cossover diagnosis is inevitable due to overlapping pathology in a given individual's constellation of symptoms.

The bigger problem is how rudementary our collective understanding of mental health continues to be. This, combined with a similarly rudementary approach to developing and prescribing psych meds, results in what would at best be described as the "throwing spaghetti at the wall and seeing what sticks" approach to treating mental illness. At least as far as the chemical supplement end goes. Counseling, therapy (individual and group), CBT, DBT, and overall lifestyle (diet, exercise, sleep, socialization) are crucial factors as well.

I used to think of meds as the prime treatment for my own mental health issues as I believed them to be rooted in chemical imbalance. Becasue I had no "issues"--no trauma to unpack--I regard talk therapy as irrelevant. This was absolutely wrong--the myriad forms of talk therapy play at least as big a role in mental health treatment and management. However I continue to believe that medication is the FIRST treatment.

Interesting approach. Most people look at medication as a last resort, but sometimes you can't talk about your problems until you get the medication to start feeling better in the first place.

I think the biggest problem with mental health is the separation from psychological and neurology. Neuropsychology is finally becoming a developing field, but it needs more support to become mainstream enough to make a difference.

I f'ing love meds. I've been uttery reliant on them for 25 years and made peace with the fact that I'll always be chemically dependant. My only questions are what are the side effects and will I have steady, reliable access to them. Frankly it's that or killing myself, and there are too many people who care about me. I'm an asshole, but I'm not that selfish. Not until ever other possible avenue has been exhausted.

Same. I ended up on the other end of the equation when my brother killed himself a few months ago and I had to handle everything because my parents were too distraught about it. Very motivating seeing what other people have to go through when someone dies.

And yes, the pharmacology industry is beyond f**ked. It's like trying to fight a swarm of bees with a shot gun.

Holy shxt that's rough. Was he older or younger? My sympathies are meaningless because even if I could relate, they change nothing. I offer them anyway. 🙏

The closest thing to guidance I can offer is to advise you to embrace grieving. Don't force it but for your own sake for the love of god don't shy away from it.

The other thing is that after a catastrophic loss, everyone adjusts to their new situation differently, and in their own time. Not everyone goes through every "state of grief" and not always in the same order. The important point is that it's not about getting back to how you used to be. It's about adjusting to the reality of your situation now. I'm sorry I'll get off my soapbox now. I hope that even if none of that was helpful, it at least didn't come across as patronizing.

I wish I could give you a hug. 😢

It's okay actually. He was 12 years older than me. We lost him as a family 3 years before when he had his last drug problem. He never forgave us for choosing to protect his kids over enabling him. Part of my autism makes it so that I can't really grieve death, which is also funny to me because normally I'm very emotional. I'm usually just happy for people when they die though, but the whole planning a funeral thing definitely made me anxious. That's good advice for people who haven't heard it though. Some of it mirrors my eulogy pretty well actually.

I'm relieved to hear the experience wasn't traumatizing for you. I too tend to envy people their death. It's the suffering part I can't stand. As much as I loved my grandparents, their suffering made their eventual passing an absolute relief. (Interestingly the eulogy I wrote for my late aunt echoed this sentiment. She struggled with bipolar disorder and substance use issues for most of her life.)

The adversarial attitude the west takes towards death--viewing it monolithically as an enemy to be feared or a problem to be solved--is a colossal disservice to all involved. Which is to say, everyone.