While arcade games are stimulating, both opiates and alcohol are depressant drugs and well known for causing depression. Depression isn’t sadness, it’s slowness, emptiness, and an inability to get things done. Opiates and alcohol obviously do that in the moment, but repeated use eventually results in a prolonged depression that persists long after the substance is eliminated from the body.

I’ve been making obsidian vaults/notebooks actually! Earlier this year I made one about tarot cartomancy and what I guess you could call Christian Esotericism (connecting myself to many of the cultural traditions while eschewing most of the traditional bodies of authority) and right now I’m working on a basic/informal intro to DBT for people struggling to access talk therapies due to poverty and/or rural living.

I dream of one day being a famous copypasta author.

Ok I’ll bite…?

This is just proof of the peak performance of CHONK. Prioritizing energy storage is a great strategy utilized by many different organisms even as distantly related as animals and plants. You can afford to send out more shoots than a seraphim has eyes when you were born from the ground gently swaddled in a metric fuckton of starch you generational wealth inheriting bastard. But like it or not, this is peak evolutionary performance.

I was in the mood, lol. lmk if it helps.

I’m genuinely not sure if this is in jest or not. The way I know this is common is that it’s a common thread across human interest pieces about sex work. I grew up with those rare fundie parents that were big on education so anything they got weird about I just read about and they were more or less fine with that, so I just started reading about sex and have since gone on numerous multimonth ADHD hyperfixation learning binges about various aspects including both anatomy and physiology and the psychological and cultural ones. A good couple of them have either centered on or referenced sex work in some way. I don’t think I’m brave enough personally but it’s definitely fascinating.

So the Dialectal Behavior Therapy (DBT) skill above is called sensory-self-soothe, but it sounds like you might need something more like opposite action. I do recommend you take a breather first, so try to take a little bit of time away from those things entirely. This is to let some of your overall emotional inflammation die back before actually getting to work on this. You’re not gonna get this done right if your emotions haven’t even had a chance to stop getting their ass beat. How much time is gonna depend a lot on how you specifically relate to or need any of those things, but even 15 minutes can make a huge difference, especially if adrenaline/panic juice is involved.

So opposite action means intentionally acting differently than the emotion you are feeling calls you to, with the eventual goal of changing the emotion you are feeling. The worst part is that that’s a legit measurable phenomenon in behavioral psychology; you actually can fake an emotion until you feel it. Your brain will literally be like,"well. I’m smiling. So I guess I’m happy???

-hang on my phone is dying and I really need a keyboard anyway.

Trained pavlovian responses to sensory triggers. If you meditate to the smell of lavender enough times eventually it starts inducing a trance you can use to combat panic attacks. You can also use other smells, sounds, colored lights, textures, etc. It actually works best if you use multiple different senses at a time. The catch is you have to continue meditating to whatever sensory trigger(s) you’ve decided on, and you have to do it more often than you use it to stop anxiety/panic. If you use it a bunch of times when you’re anxious / panicking and don’t keep using those triggers when you’re already calm, eventually the behavioral pathway will flip and the calming trigger will start causing anxiety instead because that’s when you’re doing it most. Ever set your morning alarm to your favorite song (if you haven’t, don’t). Even your favorite song in the world will eventually sour if it’s heard more often interrupting a blissful sleep than being vibed to.

Also I don’t think people realize how much time a (skilled / knowledgeable) sex worker spends vetting their clients. They’re one of the easiest and therefore most common demographics targeted by people who literally just wanna rape-torture-murder someone for varying to absolutely no reason. As a result a lot of sex workers have shared blacklists, some ask for references, some do background checks, some don’t work alone, etc. Only having to do that once or even not at all once the john is well-known is a huge time-and-effort saver, even if you ignore the fact that it’s just literally safer to take a chance on one man murdering you instead of five.

I just wanted you to know that not only did your joke amuse me, but I have also forwarded it to several friends who I am almost certain will also enjoy it. Your joy is spreading throughout the world.

I keep trying to explain to people that “efficiency” is actually really bad for the most part. It’s a glass cannon; it can pump out a huge number of both necessary and unnecessary goods and services at record rates, but if someone calls in sick or something in the supply line is more than a day late, the whole thing just fucking collapses. I would be much happier living in a society that strongly values reliability over efficiency. For fucks sake, the first thing I think about when I hear the word “efficiency” is a cheap tiny apartment with paint all over the door hinges.

People also get really mad when I tell them that their grandma dying of a brain bleed from a fall in-hospital is the “efficient” Healthcare system working as intended. Your grandma’s life or peaceful death mean next to nothing to an efficient system. They’re here to squeeze 98% of the necessary care out of half the people it takes to do it well, and sorry but keeping your grandma alive was just in the 2% of care that we didn’t have time for today. But we got 10 other people sorted out in record time so focus on that for us, champ.

Yuuuup. We try to give them by mouth first to check for those kinds of things, but sometimes

1. they’re just missed. I came in one week and got my same patient back and they’d had EPS for the almost entire time I’d been gone and nobody noticed because (aside from the drug being the lowest risk antipsychotic for EPS) the patient was complaining their teeth hurt and nobody made the connection it was because the EPS had been making them grind them! I only checked because I’ve had EPS before so cogwheeling is like the first thing I check for (after the big stuff like heart attacks and strokes obvs) for any complaint involving the head neck or arms. (I’ve heard everything from “my tongue feels too big” to “I’m blinking too much” to “the aliens implanted a chip in my neck” and “my arms have gone numb” that all presented with cogwheeling and were cured by benadryl or benztropine!) If I hadn’t by chance had that one weird professional quirk and also been assigned to that specific patient no one would have known.

2. Sometimes the horrible side effect drug is the only thing that stops them from throwing literal fucking haymakers multiple times a day, so you just pile on more meds to try to control the side effects and… pray. No joke, farm kids on meth are hell. All that strength and not a lick of sense or reason left.

Well to me that can go a couple different ways. I realize I forgot to clarify above that my knowledge of meds outside of psych drugs fades pretty quickly beyond the easy ones like metoprolol and pantoprazole, so I can’t really speak to the specifics from the back end of drug testing and approval of long acting medications from other drug families without a lot more reading that I am not doing on my day off (it was my least favorite class the better part of a decade ago).

On the other hand I could absolutely see an IM med being approved at a higher relative dosage and/or with a slightly harsher side effect profile in veterinary medicine even if just to reduce occupational dog bites by increasing the time interval. That could also just be empathy for someone who has had to stab an actively struggling patient (and been the reluctant stab-ee myself believe it or not).

q6months? Current long acting injectable birth control lasts like 3 months and antipsychotics are sometimes lucky to last 1! (After researching the existing PrEP LAI, it looks like it usually lasts 1-2 months) 6 months is some hella staying power. I shudder to think what having an antiviral in you for 6 months at a time does to your liver long-term, but I suppose it can’t be worse than full compliance with the pill. Wonder if I’ll be giving this in a few years (LAIs are usually a dayshift problem though). There’s good odds psych has the most sex workers in the hospital, it turns out people who can’t reliably name an abuser are really easy to traffic to all kinds of ends.

Truth.

I was waiting for someone else to comment because I was hoping they would know and I just wanted to say that you really let me down, man.

Situational awareness. I’ve had people look me up and down and ask how I handle the patient population I do considering I’m kinda skinny-fat and like

a) I’m a lot stronger than I look, especially with adrenaline in me one time I picked up one of the weighted dayroom chairs because I needed to get to a patient and it was in my way

b) 99% of it isn’t even fighting people anyway it’s mostly just having an ear for bullshit. One time we had a patient set off one of the safety alarms in their room and waited in the dark behind the door for someone to come answer it. I got there, saw the darkened room with the weird alarm going off and just noped the fuck out and called security.

If you have the common sense of every guy in the horror film that says,“Absofuckinglutely not” (and you don’t mind being paid pennies) psychiatric nursing calls to you.

I mean I’ve done this like 5 times over the past decade all with the same results, so it’s been working for me!

One of my favorites too. I’ve never understood people who say it’s hard to follow.