All useful things turn to shit when you privatize them.

Even though April had all the clinical signs of schizophrenia, the team believed that the underlying cause was lupus, a complex autoimmune disorder where the immune system turns on its own body, producing many antibodies that attack the skin, joints, kidneys or other organs. But April’s symptoms weren’t typical, and there were no obvious external signs of the disease; the lupus appeared to only be affecting her brain.

The autoimmune disease, it seemed, was a specific biological cause — and potential treatment target — for the neuropsychiatric problems April faced. (Whether her earlier trauma had triggered the disease or was unrelated to her condition wasn’t clear.)

The diagnosis made Markx wonder how many other patients like April had been missed and written off as untreatable.

“We don’t know how many of these people are out there,” Markx said. “But we have one person sitting in front of us, and we have to help her.”

The medical team set to work counteracting April’s rampaging immune system and started April on an intensive immunotherapy treatment for neuropsychiatric lupus. Every month for six months, April would receive short, but powerful “pulses” of intravenous steroids for five days, plus a single dose of cyclophosphamide, a heavy-duty immunosuppressive drug typically used in chemotherapy and borrowed from the field of oncology. She was also treated with rituximab, a drug initially developed for lymphoma.

The regimen is grueling, requiring a month-long break between each of the six rounds to allow the immune system to recover. But April started showing signs of improvementalmost immediately.

As part of a standard cognitive test known as the Montreal Cognitive Assessment (MoCA), she was asked to draw a clock — a common way to assess cognitive impairment. Before the treatment, she tested at the level of a dementia patient, drawing indecipherable scribbles.

But within the first two rounds of treatment, she was able to draw half a clock — as if one half of her brain was coming back online, Markx said.

Following the third round of treatment a month later, the clock looked almost perfect.

Drawing a clock is a common way to assess cognitive impairment. These clocks, drawn by April, show how significantly the treatment regimen was helping her. (Courtesy of Sander Markx)

Despite this improvement, her psychosis remained. As a result, some members of the team wanted to transfer April back to Pilgrim Psychiatric Center, Markx said. At the time, Markx had to travel home to the Netherlands, and feared that in his absence, April would be returned to Pilgrim.

On the day Markx was scheduled to fly out, he entered the hospital one last time to check on his patient, who he typically found sitting in the dining room in her catatonic state.

But when Markx walked in, April didn’t seem to be there. Instead, he saw another woman sitting in the room.

“It didn’t look like the person I had known for 20 years and had seen so impaired,” Markx said. “And then I look a little closer, and I’m like, ‘Holy s---. It’s her.’”

It was as if April had awakened after more than 20 years.

A catatonic woman awakened after 20 years. Her story may change psychiatry.

It's been 84 years and still the debate rages.

The biggest male privilege I have so far encountered is going to the doctor.

I lived as a woman for 35 years. I have a lifetime of chronic health issues including chronic pain, chronic fatigue, respiratory issues, and neurodivergence (autistic + ADHD). There's so much wrong with my body and brain that I have never dared to make a single list of it to show a doctor because I was so sure I would be sent directly to a psychologist specializing in hypochondria (sorry, "anxiety") without getting a single test done.

And I was right. Anytime I ever tried to bring up even one of my health issues, every doctor's initial reaction was, at best, to look at me with doubt. A raised eyebrow. A seemingly casual, offhand question about whether I'd ever been diagnosed with an anxiety disorder. Even female doctors!

We're not talking about super rare symptoms here either. Joint pain. Chronic joint pain since I was about 19 years old. Back pain. Trouble breathing. Allergy-like reactions to things that aren't typically allergens. Headaches. Brain fog. Severe insomnia. Sensitivity to cold and heat.

There's a lot more going on than that, but those were the things I thought I might be able to at least get some acknowledgement of. Some tests, at least. But 90% of the time I was told to go home, rest, take a few days off work, take some benzos (which they'd throw at me without hesitation), just chill out a bit, you'll be fine. Anxiety can cause all kinds of odd symptoms.

Anyone female-presenting reading this is surely nodding along. Yup, that's just how doctors are.

Except...

I started transitioning about 2.5 years ago. At this point I have a beard, male pattern baldness, a deep voice, and a flat chest. All of my doctors know that I'm trans because I still haven't managed to get all the paperwork legally changed, but when they look at me, even if they knew me as female at first, they see a man.

I knew men didn't face the same hurdles when it came to health care, but I had no idea it was this different.

The last time I saw my GP (a man, fairly young, 30s or so), I mentioned chronic pain, and he was concerned to see that it wasn't represented in my file. Previous doctors hadn't even bothered to write it down. He pushed his next appointment back to spend nearly an hour with me going through my entire body while I described every type of chronic pain I had, how long I'd had it, what causes I was aware of. He asked me if I had any theories as to why I had so much pain and looked at me with concerned expectation, hoping I might have a starting point for him. He immediately drew up referrals for pain specialists (a profession I didn't even know existed till that moment) and physical therapy. He said depending on how it goes, he may need to help me get on some degree of disability assistance from the government, since I obviously shouldn't be trying to work full-time under these circumstances.

Never a glimmer of doubt in his eye. Never did he so much as mention the word "anxiety".

There's also my psychiatrist. He diagnosed me with ADHD last year (meeting me as a man from the start, though he knew I was trans). He never doubted my symptoms or medical history. He also took my pain and sleep issues seriously from the start and has been trying to help me find medications to help both those things while I go through the long process of seeing other specialists. I've had bad reactions to almost everything I've tried, because that's what always happens. Sometimes it seems like I'm allergic to the whole world.

And then, just a few days ago, the most shocking thing happened. I'd been wondering for a while if I might have a mast cell condition like MCAS, having read a lot of informative posts by @thebibliosphere which sounded a little too relatable. Another friend suggested it might explain some of my problems, so I decided to mention it to the psychiatrist, fully prepared to laugh it off. Yeah, a friend thinks I might have it, I'm not convinced though.

His response? That's an interesting theory. It would be difficult to test for especially in this country, but that's no reason not to try treatments and see if they are helpful. He adjusted his medication recommendations immediately based on this suggestion. He's researching an elimination diet to diagnose my food sensitivities.

I casually mentioned MCAS, something routinely dismissed by doctors with female patients, and he instantly took the possibility seriously.

That's it. I've reached peak male privilege. There is nothing else that could happen that could be more insane than that.

I literally keep having to hold myself back from apologizing or hedging or trying to frame my theories as someone else's idea lest I be dismissed as a hypochondriac. I told the doctor I'd like to make a big list of every health issue I have, diagnosed and undiagnosed, every theory I've been given or come up with myself, and every medication I've tried and my reactions to it - something I've never done because I knew for a fact no doctor would take me seriously if they saw such a list all at once. He said it was a good idea and could be very helpful.

Female-presenting people are of course not going to be surprised by any of this, but in my experience, male-presenting people often are. When you've never had a doctor scoff at you, laugh at you, literally say "I won't consider that possibility until you've been cleared by a psychologist" for the most mundane of health problems, it might be hard to imagine just how demoralizing it is. How scary it becomes going to the doctor. How you can internalize the idea that you're just imagining things, making a big deal out of nothing.

Now that I'm visibly a man, all of my doctors are suddenly very concerned about the fact that I've been simply living like this for nearly four decades with no help. And I know how many women will have to go their whole lives never getting that help simply because of sexism in the medical field.

If you know a doctor, show them this story. Even if they are female. Even if they consider themselves leftists and feminists and allies. Ask them to really, truly, deep down, consider whether they really treat their male and female patients the same. Suggest that the next time they hear a valid complaint from a male patient, imagine they were a woman and consider whether you'd take it seriously. The next time they hear a frivolous-sounding complaint from a female patient, imagine they were a man and consider whether it would sound more credible.

It's hard to unlearn these biases. But it simply has to be done. I've lived both sides of this issue. And every doctor insists they treat their male and female patients the same. But some of the doctors astonished that I didn't get better care in the past are the same doctors who dismissed me before.

I'm glad I'm getting the care I need, even if it is several decades late. And I'm angry that it took so long. And I'm furious that most female-presenting people will never have this chance.

ai covers make me so uncomfortable dude. like i know hearing characters or creators sing songs is cool cause its like wow youve never heard them do that that sound cool but like man if that was my voice and people did that id be fucking ill. that would make me so anxious that people were using my voice to make whatever they wanted to hear even if it was nothing malicious. ‘wow that sounded so good, x has so much potential if they did this!’ well they didnt. because they didnt want to. and it wouldnt sound like that anyway cause its fucking ai. but you made them do it anyway i guess

this gif is actually literally so cute. her little eye roll when she usually puts effort in being so little expressive. making the conscious effort to do that gesture just to come off as annoyed. adorable

SLEEP I want to try

Pillow is my favorite guy

REST I need some more

into bed where I go snore

PHEW I go honk and shoo

have a blanky feel the snooze

Tired system overload

Everybody SLEEEEEEPINGGGG

Hello welcome my ADHD themed gameshow, "So you were holding it literally moments ago but now it's gone" the where YOU look for whatever you were just holding while going increasingly mad