Script Shrink

#text #shrink gets mad #bad therapists #bad psychology #gif #netflix #future posts #alcohol #this is not psychological or medical advice #this is writing advice

So I watched the first two episodes of that Netflix series named a slur that’s purportedly about a ‘therapist’.

[[Gif: A long sequence as Eddie Murphy opens a door and becomes increasingly horrified and disgusted as he looks into an unseen room. He eventually shakes his head and closes the door unable to put up with this shit.]]

I’ll be making a big rant-y post about it, but there’s so much fucking wrong with this show that it’s going to take me a while.

For fuck’s sake.

[[Gif: woman: “I swear I need a cocktail and a lobotomy.”]]

Mixed Episode - Demystifying the DSM-5

CW: suicide

Basically, in a mixed episode, the character experiences the symptoms of a major depressive episode AND a manic / hypomanic episode at the same time.

While "mixed episode” is a common term, the DSM-5 actually doesn’t have a single diagnosis for it; instead, it has been split into “major depressive episode with mixed features” and “manic/hypomanic episode with mixed features.”

Here’s a visual guide type thing.

[[Image description: 4 lines of white text with different colored backgrounds. From top to bottom, “Major depressive episode” is dark blue, “major depressive episode with mixed features” is bluish purple, “manic/hypomanic episode with mixed features” is reddish purple, and “manic/hypomanic episode” is red]]

Essentially, people call anything purple a mixed episode, but nowadays psychologists like to be a little more specific about what kind of purple it is.

Note - if a character meets all the criteria for both a manic and a depressive episode, they should be diagnosed with a manic episode with mixed features. Mania always wins the tiebreaker.

Major depressive episode with mixed features

The depressive episode (see criteria here) has some symptoms of a manic (see here) or hypomanic episode (see criteria here), but not enough for a full diagnosis.

Your character doesn’t have to have bipolar I or II to have this diagnosis; however, they’re at extremely high risk to develop a bipolar disorder in the future, and as such may be diagnosed with “other specified bipolar or related disorder” instead of “major depressive disorder.”

This requires 3 or more of the following symptoms nearly every day, more days than not, during a depressive episode:

Elevated, expansive mood (defined here)
Inflated self esteem or grandiosity
The character is more talkative than usual, and feels a pressure to keep talking.
Flight of ideas or racing thoughts (Will be the topic of a future post).
The character has an increase in goal directed activity in their social life, at work or school, or sexually.
The character becomes excessively involved in things that have a high risk of painful consequences (such as reckless driving, maxing out credit cards on shopping sprees, foolish business investments).
The character has much less of a need for sleep.

These symptoms need to be observable by other people and are a significant change in behavior from how the character usually acts.

These symptoms cannot be the result of a drug (such as meth).

Manic/hypomanic episode with mixed features

The full criteria for a manic episode (see here) or a hypomanic episode (see here) need to be met, and the character has to have 3 or more of the following symptoms, which have to be present in the majority of the days of the manic/hypomanic episode:

The character generally feels bad / sad / depressed. This can be reported by the character themself, or observed by others.
The character loses interest or take less pleasure in almost every activity they formerly enjoyed.
The character has psychomotor agitation or retardation (see here) nearly every day. This has to be observed by other people, not just reported by the character themselves.
The character feels fatigued / drained of energy.
The character feels worthless or excessively guilty.
The character has any of the following:
Repeated thoughts of death
Suicidal ideation (without a plan for committing suicide)
Suicide attempt
Specific plan for committing suicide

These symptoms are observable by other people and are a change from the character’s usual behavior.

These symptoms cannot be the result of a drug.

But these dry criteria don’t truly convey just how awful a mixed mood episode is. Stay tuned, Shrinky-dinks, for some posts about what a character having a mixed episode might actually experience.

Anonymous asked:

I've got a character with really spotty foresight, who mostly has a vague overview of the future. She attempts to explain/warn her friends and family, but it comes out as variations of 'Some sort of disaster is going to happen eventually and we need to be prepared'. She gets taken to a psychiatrist over this when she's around 11, what would it get diagnosed as? She can't give details about the disaster until she's in her late teens, so all she knows is that it will happen while she's diagnosed.

That depends on a lot of factors - and most notably, what other symptoms that could be read into her behavior.

The key factor here is that a psychiatrist would think she’s delusional, which is one of the ways psychosis can be expressed (see here). As such, the differential diagnosis would be looking specifically at the psychotic disorders (delusional disorder, brief psychotic disorder, schizophreniform, schizophrenia, schizoaffective), or disorders that can have psychotic or delusional features (bipolar I; major depression, OCD).

That’s a long list of options, and a lot of posts to read through! So I’ll make it really simple:

If your character has no other symptoms and her life is not negatively affected by her beliefs, she’d be diagnosed with delusional disorder.

Some of the psychotic disorders have very similar criteria, and differ mostly in the amount of time your character has been symptomatic.

Brief psychotic disorder - less than 1 month
Schizophreniform - more than 1 month, but less than 6 months.
Schizophrenia - more than 6 months.

If your character also has signs of depression that existed for at least two weeks without any delusions, your character could be diagnosed with major depression with psychotic features.

If your character has had a previous manic episode and the delusions only happen while the character has been in a mood episode, your character could be diagnosed with bipolar I with psychotic features.

If your character has had a depressive or manic episode with psychotic features but has had psychotic symptoms for at least two weeks without having a mood episode, they could be diagnosed with schizoaffective disorder.

If your character is driven to perform compulsive actions because of the things she foresees, she could be diagnosed with OCD with delusional beliefs (see here).

Note - if your character has most, but not quite enough symptoms to merit a diagnosis, she could be diagnosed with “Other Specified [category of disorder]”.

That’s a hell of a lot of diagnoses! I hope this helps!

#Anonymous #asks #future posts #schizophrenia #delusions #delusional disorder #schizophreniform #brief psychotic disorder #hypothetical #this is not psychological or medical advice #this is writing advice #differential diagnosis

Hypomanic Episode - Demystifying the DSM-5

There needs to be a distinct period of time where the character experiences at least one of the following moods most of the day, nearly every day, for at least four days in a row:

Elevated - the character feels euphoric or excessively happy
Expansive - there’s a lot of definitions for this. It can be shown through the character overly expresses their feelings, to the point that they disregard the reactions of others. The character may feel that they’re more important or significant than they actually are, seeming grandiose or superior to others.
Irritable - the character is easily angered

The character also needs to be consistently more energetic or active for at least those four days.

While the character is in this state, they have to show at least three of the following symptoms (4 if their mood is irritable), which have to be a significant change in behavior from how the character usually acts:

Inflated self esteem or grandiosity (see expansive mood above).
The character has much less of a need for sleep.
The character is more talkative than usual, and feels a pressure to keep talking.
Flight of ideas or racing thoughts (Will be the topic of a future post).
The character is easily distracted.
The character either has an increase in goal directed activity OR psychomotor agitation (see link here) .
Goal-directed activity typically means that the character frequently takes on ambitious new projects without necessarily thinking it through or completing previous projects first.
The character becomes excessively involved in things that have a high risk of painful consequences (such as reckless driving, maxing out credit cards on shopping sprees, foolish business investments).

These symptoms have to be a complete change from how the character normally acts.

The symptoms have to be noticeable by other people.

The symptoms cannot be severe enough to cause the character great difficulty in their occupation or in interacting with others.

The character cannot be psychotic - if they are, it’s a manic episode. The character also cannot need hospitalization - again, that’d be a manic episode.

These symptoms cannot be the result of a drug (such as meth) or a medical condition.

#text #bipolar #bipolar II #demystifying #demystifying the DSM #hypomanic episode #future posts #mania #this is not psychological or medical advice #this is writing advice

Manic Episode - Demystifying the DSM-5

Man, it’s been a while since I made one of these posts! I’ve changed the structure of these criteria a bit from the DSM-5, but it’s all there.

Manic episode:

There needs to be a distinct period of time where the character experiences at least one of the following moods most of the day, nearly every day, for at least a week:

Elevated - the character feels euphoric or excessively happy
Expansive - there’s a lot of definitions for this. It can be shown through the character overly expresses their feelings, to the point that they disregard the reactions of others. The character may feel that they’re more important or significant than they actually are, seeming grandiose or superior to others.
Irritable - the character is easily angered

The character also needs to be consistently energetic OR increase their level of goal-directed activity most of the day, nearly every day, for at least a week. Goal-directed activity means that the character frequently takes on ambitious new projects without necessarily thinking it through or completing previous projects first.

Inflated self esteem or grandiosity (see expansive mood above).
The character has much less of a need for sleep.
The character is more talkative than usual, and feels a pressure to keep talking.
Flight of ideas or racing thoughts (Will be the topic of a future post).
The character is easily distracted.
The character either has an increase in goal directed activity (see above) OR psychomotor agitation (see link here) .
The character becomes excessively involved in things that have a high risk of painful consequences (such as reckless driving, maxing out credit cards on shopping sprees, foolish business investments).

These symptoms have to be one or more of the following:

Be severe enough to cause the character great difficulty in their occupation or in interacting with others.
Require the character to be hospitalized to prevent them harming themselves or others.
Note - if a character has to be hospitalized, you can ignore the requirement for the symptoms to last at least a week.
Cause the character to become psychotic (ie lose touch with reality)

These symptoms cannot be the result of a drug (such as meth) or a medical condition.

#text #demystifying #demystifying the dsm 5 #mania #manic episode #bipolar #psychosis #future posts #psychomotor agitation #drugs #this is not psychological or medical advice #this is writing advice #bipolar I #mood disorders

scix-in-the-back-row asked:

This is the very loosest beginning of an idea. Say a person undergoes trauma and as a result has triggers for panic attacks, etc. Is it possible for the triggers to be something inappropriate? I mean, something like being triggered by the sight of a black person, or a person in a wheelchair, or a gay couple. Would that person's worldview pre-trauma predict, in part, what sets them off after the trauma? How would such a system of triggers be treated?

A trigger is something that is intrinsically linked to a traumatic event. It’s involuntary - the character has no control over what triggers they develop. Sometimes, that trigger is going to be problematic.

PTSD can mess with a character’s perception of the world around them. It can create exaggerated and excessive fears about any group linked with the character’s trauma.

Conversely, if a character already had negative views about a group that they are now triggered by, they may see it as confirming and strengthening their previous views.

These problematic triggers would be treated the same way that any other triggers would be treated. I’ll be writing some posts about how they’d be treated soon-ish.

#scix in the back row #asks #future posts #PTSD #trigger #flashbacks #problematic #this is not psychological or medical advice #this is writing advice #cognitive distortions

Anonymous asked:

Hello, I really love this blog!!! I'm writing a story about a zombie apocalypse but setting at a time where there's already a vaccine. However, the vaccine causes schizophrenia as a side effect. I wanted to know how would a person act of they didn't know they had schizophrenia. Also, what are the symptoms of severe schizophrenia? Lastly, what are some of the medications for schizophrenia, I want to have a scene where the MC has to remake some of the meds to help another immune character.

There are a lot of questions here, so I’m going to go one by one.

I wanted to know how would a person act of they didn’t know they had schizophrenia.

There’s something called “anosognosia” that affects about 50% of people diagnosed with schizophrenia. While it’s a medical term, when used in a psychology context, it basically means that the character lacks awareness of their mental illness or is incapable of understanding that they have one.

So not knowing they had schizophrenia would not make their behavior significantly different from those who naturally have schizophrenia.

As for the symptoms of schizophrenia, check out my post here for the criteria.

I’m not 100% comfortable answering the meds question, but I am going to take Psychopharm in the fall - I’ll do posts on it then!

But there is one other thing I’d like to address:

I want to have a scene where the MC has to remake some of the meds to help another immune character.

This is going to be very, very hard for your MC to do. Antipsychotics are very complicated.

I asked Z and J from @scriptchemist to help explain some of the things you have to consider here:

Z:

1) Precursors. What are they starting with? If you have the appropriate precursors and just need to put a few pieces together and/or tweak a few bonds, that is a very different story than if all they have is a can of burning gasoline and some vinegar (also, sometimes even “just a few bonds” is ridiculously difficult with several sub-steps but I digress). For example, I’m assuming they don’t have halogenated nitro arene just lying around in their kitchen?

2) Equipment and other reagents. A “standard” organic/med chem lab has a whole host of specialized equipment and reagents, the latter of which isn’t specific to this synthesis but so broadly used in so many procedures they have them on hand, such as solvents, hot plates/cold baths, reducing agents, etc. I’m sure there must be some way of jerry-rigging a reflux condenser but I’m having a hard time thinking of it right now.

3) Yield/purity. Really important for drugs. That importance increases exponentially the further you are from your finished final product as you have to purify your intermediates before proceeding to the next step. My very first search for clozapine synthesis involves four steps from a particular arene, though there are other variations. That’s four steps of equipment, reagents, and purification.

4) Dosage. Medicine is very precise in dosage and how that dosage is delivered for very, very good reasons. 5 mg of actual drug can be wrapped up in a 50 mg package with excipients to control the delivery; you don’t want to take it neat. And even if the character can somehow get a batch of 100% pure clozapine and appropriately store it, can they accurately parcel out the dosage? If one is supposed to take 10 mg of drug and accidentally takes 100mg…well.

J:

While I am certain that some existing person could actually do this, the experience, equipment, and precursors are going to be impossible hurdles for almost everyone. Those are rather complicated syntheses, and a huge amount can go wrong very quickly. Even with the correct precursors and a full laboratory, I wouldn’t trust myself to get the right product in sufficient purity to actually use as a medicine.

TL;DR: It’s really not feasible to synthesize antipsychotics in your kitchen.

Since you describe the situation as a zombie apocalypse, I’d honestly recommend that your character raid an abandoned pharmacy or hospital to get the medications (though I imagine they’d be in high demand).

#Anonymous #asks #schizophrenia #medical #scriptchemist #anosognosia #vaccine #future posts #zombies #hypothetical #antipsychotics #medication #this is not psychological or medical advice #this is writing advice #post apocalyptic #atypical antipsychotics #pills

Anonymous asked:

In my story my mc accidentally kills her bff's mom right in front of her. Can seeing MC be considered a trigger for BFF? (They're like 16 and share two classes together in school.) I haven't seen much about people being triggers themselves; usually they're doing something to cause the trigger. How long do you think I can keep them at arm's length before they can maybe take steps towards reconciliation?

Yes, people can absolutely be triggers in and of themselves. It doesn’t have to matter what they’re doing; just seeing them can be enough to trigger your character.

As for how long it would last; that depends on your character and how severe of a trigger it is. Unfortunately, severe triggers tend to reinforce themselves - check out my post on why this is here.

I’d suggest putting your character in therapy so they can start the process of identifying and addressing triggers; otherwise, the trigger may not go away.

I’ll go into what kind of therapy your character would need in a future post.

#Anonymous #asks #trigger #PTSD #flashbacks #character critique #characterization #this is not psychological or medical advice #this is writing advice #future posts #violence #death #murder #short answers

Anonymous asked:

Hey there. I'm planning on a novel in which a man who has a mental illness is temporary placed in a psychiatric hospital. I intend for the character to have had the condition all his life and be able to manage it, but occasionally he has to be hospitalised. My question is what kind of condition could the character have and what would cause him to be put in hospital because of it?

There are so many answers to this that I don’t even know where to begin.

The criteria for hospitalization varies depending on where you are. Typically, in America, the things that merit inpatient (rather than outpatient) treatment are:

The character is actively suicidal
The character is actively homicidal
The character is psychotic (has completely lost touch with reality)
The character is unable to take care of themselves
The character has severely impaired judgment

Here’s an incomplete list of what could cause those:

Any of the depressive disorders
Any of the Bipolar disorders (if the character is in a depressive episode; if the character is in the hospital because of a manic episode, it would have to be Bipolar I, NOT Bipolar II or Cyclothymia)
Many of the personality disorders (especially borderline personality disorder)
Schizophrenia or any of the schizophrenia-related disorders
Any of the trauma related disorders
Most of the eating disorders (you’re probably not going to get put into inpatient if you’ve got pica)
Any of the disruptive, impulsive control, and conduct disorders
OCD or some of the OCD-related disorders

This list is not exhaustive.

As for something that your character has had “all his life,“ while many of the disorders mentioned above tend to have an onset in adolescence / young adulthood, it’s not unheard of for children to develop them.

One really important thing you have to realize, Anon - any kind of mental illness severe enough to merit hospitalization is going to be something that has an incredible and often pervasive effect on your character’s personality, psyche, and how they experience life. It’s not something you can add as a footnote.

Even if your character is managing their illness, that comes with its own set of hassles. Your character would probably have to be in intensive therapy and/or on a medication regimen. Maintaining that shit is not always easy. Therapy can be difficult. Medications have side effects, require refills, and can be ridiculously expensive.

Speaking of expensive, so is inpatient treatment. If your story takes place in America, one thing thatwould add a lot of realism to your story is bringing in the frustratingshitstorm that is trying to get your insurance to pay for hospitalization. Ican do a post on this specifically if there’s interest.

#Anonymous #asks #vague asks #shrink can't answer #lists #hospitalization #hospitals #inpatient #how do I describe #this is not psychological or medical advice #this is writing advice #fuck insurance companies #future posts #medication

#adonisisdying #asks #how do I therapy #upcoming #future posts

masonhawth0rne asked:

hey there, i see you've done posts about writing good therapy sessions, do you have any tips for a character encountering a bad therapist?

You’re in luck - one of my classes this semester is about counseling skills, so I’ve got a lot of references for what NOT to do.

Stay tuned - there will be some upcoming posts on this topic!

Anonymous asked:

Would a person be diagnosed with an eating disorder if their mindset is less "I'm too fat I have to get thin" and more "I'm a horrible person I don't deserve to eat," or would that be something else? (Also, what if they're a carnivorous species? Would it be considered bad at all then, or would it be "you can stand a little bit of pain in order to not kill things?" They can't really *buy* meat because of reasons.)

Diagnostically, it doesn’t always matter why someone isn’t eating - what matters in this case is what the character is doing.

Applying the diagnostic criteria for anorexia (see here), your carnivorous character could be diagnosed with an eating disorder if:

She refuses to hunt and will not accept food from others
She doesn’t realize (or is in denial about) how dangerous it is for her to not eat

It’s actually a common misconception that the only ‘reason’ someone has an eating disorder is because they don’t want to ‘get fat.’ I’ll go into more depth about this in a future post.

#Anonymous #asks #eating disorders #anorexia #hypothetical #violence #criteria #symptom checklist #character critique #characterization #this is not psychological or medical advice #this is writing advice #food #fat shaming #future posts

Writing Traumatized Children - Emotional Effects

CW: abuse, suicide mention

Being victimized or traumatized as a child can have myriad consequences on a character. Today, I’ll be focusing on how to portray some of the emotional aftereffects.

Anorexia Nervosa - Demystifying the DSM-5

The character needs to have restricted how much they eat or drink to the point that it leads to a noticeably and abnormally low weight in comparison to other people who are the same age, gender, etc., as the character.

The character needs to have at least one of the following:

Have an intense fear of gaining weight or becoming fat
Consistently do things that prevent themselves from gaining weight

The character also needs at least one of the following:

The character’s experience of their own weight or shape is distorted
The character’s self-esteem pretty much depends on their weight or shape
The character doesn’t recognize how serious and dangerous their low body weight is

There are two subtypes:

Restricting type: For the last 3 months, the character has only lost weight through dieting, fasting, and / or excessive exercising.

Binge-eating / purging type: For the last 3 months, the character has had multiple binges or purging behaviors (which will be covered in a future post).

You also need to specify the severity.

Mild: BMI ≥ 17 Moderate: BMI 16-16.99 Severe: BMI 15-15.99 Extreme: BMI < 15

#scriptshrink #text #eating disorders #anorexia #weight mention #weight loss #vomit #future posts #bmi #dieting #this is not psychological or medical advice #this is writing advice #demystifying #demystifying the dsm 5 #dsm #demystifying the DSM 5

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Psych Terminology: Nervous / Mental Breakdown

“Nervous breakdown” and “mental breakdown” are phrases that are in widespread use by the public, but are not terms used by professional psychologists. It can refer to many VASTLY different diagnoses.

I’ve been getting a few asks that use these terms, and I can’t help you until I know what exactly you mean when you’re using this phrase.

These are oversimplifications of the disorders to keep things short.

CW: Suicide mention

The character is freaking out very badly for a short amount of time (less than an hour) either in response to something stressful, or at random.
Panic attack (see my post here).
The character has a severe emotional reaction to a stressful situation that lasts months, but goes back to normal when the stressful situation ends.
Adjustment disorder (see my post here).
The character becomes too sad / tired / etc. to do everyday activities and is generally very unhappy.
Depression or a depressive episode (see my post here).
The character wants to or tries to kill themselves.
Suicidal ideation or a suicide attempt.
For a period of time (from a few days to a few weeks or months), the character becomes super excitable, energetic, impulsive, and has severely impaired judgement.
Manic episode or hypomanic episode
The character starts hallucinating, believing things that aren’t true, and / or becomes incoherent and difficult to understand.
Psychosis (see here).
The character experiences flashbacks or other symptoms in the wake of experiencing a traumatic event.
PTSD (see here) or acute stress disorder (see here).
The character entirely forgets who they are and either travels purposefully or seems to wander in a state of confusion.
Dissociative fugue (see here).
The character cannot remember something important.
Amnesia (see here)
At times, the character acts like a completely different person and has difficulty remembering what happened when that ‘alternate personality’ is in control.
Dissociative identity disorder (see here)
The character becomes almost completely unresponsive and unmoving or does strange, repetitive movements.
Catatonia (will be covered in a future post)
The character feels like they or the world around them isn’t real.
Depersonalization / derealization (See here)
Because of a medical condition or drug use, the character is less aware of their surroundings and has changes in their ability to function and behave normally.
Delirium (see here)
The character’s ability to think and function declines due to aging or a medical condition.
Neurocognitive disorder (see here)

#Anonymous #asks #behind the couch #scriptshrink admin #future posts #binge watch suggestion anon

Anonymous asked:

Thanks for your post about abelist language and OCD! Since you asked for suggestions of similar/related topics, one that bothers me is the word "binging" as in "binge watching" a show, etc. I thought the term "binging" was mostly associated with bulimia--does it have a separate connotation, or is this another instance where it would be less abelist for people to choose another word?

Oooh, this is a good one! I didn’t even think about that! Thank you so much, I’ve added it to the list!