Untitled: Taboo

I had a conversation in which I was discussing what I understood about the background of the Jewish people and Imperialism from the book 'The Origins of Totalitarianism', and the conversation moved towards how younger generations of the Western world don't quite understand the concept of Colonialism. More so that it doesn't get spoken about, that it's 'taboo'.

They went on to say 'How can you address a problem if you're not allowed to talk about it?' and I thought this to be rather apt as it had made clear an issue I've had in regards to Australian society.

A Quick Update After Deleting An Unfinished Post

    The end of last year I started writing a post, however, twice, I was unhappy with the content and intent of what I'd written. I'd hoped to have returned to finish the post yet found my thoughts changing away from the original expression. I considered publishing it regardless but the thought of stating my dissatisfaction with the subsequent garble of unfinished thoughts irritated me. As such I've removed that draft and am moving on.

    Though I'm now uncertain as to what I would like to write about. A common problem. 
So, I think I'll just write what comes to mind.

    Thinking back over the last couple months, I've been feeling a lot better. I'm not sure of which more concise words to use to describe these feelings. I've definitely been feeling calmer, more confident, happier, and more content. My mind has been a lot less jumbled, with less 'fog', and overall feels cleaner and works better. I still go through ups and downs, generally related to motivation, but they aren't as deep or long lasting - it's easier to manage them as well. 
I haven't felt as strong a need to be constantly playing video games for the sake of playing them which also means I've been doing a larger variety of alternate activities, especially socialising. I haven't been relying on lists to remember what needs to be done or when, and have found it easier, enjoyable even, to go shopping for longer periods of time. 

    Just last week I took the canvas painting to get framed. Only taken just over 5 years to do. 

    There was a period of time where I started settling back into old habits. After I became concerned about this I found what was happening after to be strange. 
Those habits began to shift away into newer habits and attitudes in a way that has required much less effort from me overall. This used to be something that I'd have to put in a lot energy to start changing, and even then maintaining that change was even harder. I do still have some trouble getting to bed earlier and more consistently, so that's something I still need to work on. I plan to speak to my psychiatrist about getting melatonin combined with the dex to help with that. 

 
    I'm back to uni next week, in 3 days, and I'm a bit nervous. A lot of that feeling has to do with not feeling like I've done enough of the aims I'd set out at the start of the uni break. It's likely that those aims involved the completion of those aims, but even then there are a few that I didn't even start on, let alone get halfway through. So, I dunno.

    Well, that's all I feel like writing.

Started/Trialling ADHD medication

Just some quick notes on what's been happening with the meds. Brain is falling apart so hopefully I remember my points tomorrow.

Started 3rd Nov 22. First two to three days were the most intense. New chemical in the system. Unwanted effects were the headache, dry mouth, slight dehydration, going to the toilet more, and disrupted sleep, e.g., waking up multiple times through the night, and/or poor sleep quality.
I also was becoming incredibly tired between 2-4pm, often needing to lie down for a tad then I'd be good till about 8-9pm. I thought this to be a result of the dose timing, and I think that is remains true.
Oddly I've found myself shifting from a 'night owl' to a 'morning lark'. I used to have trouble getting to sleep before 12am and waking up before 8am, but now I find myself waking up around 7am and ready to sleep by 11pm. I've decided to just run with it and shift everything to match it.
I haven't been running out of motivation as quickly. Best analogy I could think of at this time of night. Basically doing things has become so much easier to do. I don't feel like I'm fighting myself every step of the way. Getting out of bed is easy, starting almost any task is so much easier, staying focused, paying attention, remembering,,,, so much easier. Something I struggled with constantly is showering after the gym. I'd get home and just need several hours to recover before being able to get myself to the shower. Now I get back home from the gym and go shower almost immediately. It's a huge relief to just be able to do something like that without having to fight myself every step of the way. After the shower I do something else, like reading, organising my room, planning, ect. Some mornings I've managed to get 2-3 tasks done between showering after the gym and lunch time ... 2-3 different tasks used to be the limit of what I often could do a day. Being able to read through more complex texts without constantly forgetting or being zoning off is no longer a chore. 

One analogy I've been somewhat using is that of driving a car. Driving a car that runs out of fuel quickly, with the handbrake partially on, several music stations playing, several news stations discussing something important, someone in the passenger seat trying to have a deep conversation with you, someone in the back trying to get your attention with a bunch of interrupting methods, no idea what is going on with the third person in the car but they're really upset with you for something, and you need to get to the fuel station, workplace, the museum, and possibly somewhere else but you're not sure where.
When taking the meds, suddenly the music and news stations get quieter or go away, the passengers are quieter, more patient and not trying to talk over each other, or constantly trying to grab your attention, the third person isn't upset with you for something, the handbrake is down, the fuel leakage has slowed down a lot, and you realise that your GPS now shows the route you need to take to drop the third passenger off at the museum, fill up fuel and get to work on time.

20 Days later: The last 20 days taking the meds has been enlightening; definitely provided a contrast to how I've been living/functioning to that of 'normal' people. Most side effects are no longer present. I've still been having some issues with sleep quality, but my overall circadian rhythm remains consistent. I find myself waking up around 7am with a positive mood and although I try to sleep for a bit longer due to the general low quality of sleep, when I do decide to actually 'wake up' and get going then it's a lot easier to do so. It becomes a case of making the decision to get up then enacting it, rather than making the decision and finding myself struggling against myself to do just that. I used to force myself downstairs to make a coffee and breakfast then return to my room to slowly wake up. If I came across anyone during the day then I'd often have short conversations with them before running out of steam. With the meds it's a little different and I have a differing perspective. For a start I don't need to put in extra effort just to pay attention to what's being said and forming thought out sentences, but also I can track what's been said, what my thoughts and feelings are, what thoughts and emotions they have and are expressing, to a degree I can pull up relevant info at will, and not forget about all the things I was going to do just then or for the whole day (something that bothered me; was disruptive.).
    So, getting going in the morning is easier. It's easier to have conversations with people as I can pay attention easier, pay attention to more things, and keep track of plans and actions. Another thing, although I do try practice it as well, is mentally putting aside the things I want to talk about to let the other person speak so that my own thoughts aren't, I guess, 'louder' than the other person.
    In general, being able to plan and enact has been significantly improved. Nor does doing this require a huge effort that sucks up most of my energy for the day. Starting and finishing tasks, even if I don't particularly feel like doing them, has become effortless in most instances. 
    An example would be mornings where I go to the gym: getting ready (mentally and emotionally) is barely an issue, I'm consistently arriving at the time I've set to arrive at instead of being inconsistent, being able to remember what stretches I need or want to do and change them as needed without needing a list or other reminders, remembering subsequent exercises, remembering rep and set counts, remembering conversation topics, are more things that have become substantially easier to do (to the point where I can do them all simultaneously), I'm finding myself a lot more emotionally stable and no longer finding myself getting easily flustered/frustrated over mistakes or having other easy mood swings, and when I get home I'm not so drained in all aspects that I spend a couple hours on the computer or phone before getting myself into the shower and instead I'm able to get home, play with Minnie, talk with housemates, shower, and start cooking lunch before 1130 (not to mention that the gym session ends a little later than with Tys, ~1005, and I'm getting home around 1025). Before 1130 I have the freedom to do something else although often I catch up on the idle mobile game I've running. 
    Something else I've noticed is how consistent my mood and emotions have been, compared to what they used to be. At first I thought that it was the euphoria from the meds that fuelled my good mood, and they probably do to a degree, but I'm finding that even when I feel them wearing off or when I wake up before taking them that I'm still in that consistent good mood. I haven't been as easily swayed by negative emotions or thoughts, things that bother me. I still do get bothered by stuff, however they don't become as extreme or consuming, and it's easier to return myself to that good mood. 
    A couple more observations that I remember. Not feeling as strong a desire to (binge) eat junk or sugary foods, and not feeling like I constantly need to be playing games (more specifically, LoL). Like I still enjoy playing LoL but no longer feel a constant need to be playing it, or to be sitting at the computer getting lost in video's or games.

That's all I can think of currently.

I suspect that I'd benefit from a higher dose but I'm more than happy to sit at this current dose for a while, iron out some kinks, and practice improving executive function skills. Another thing is that the dose is low enough that it reminds me, in a sense, of what it was like before I started taking them, but I feel those memories are starting to become distant.
    I don't wish to become addicted on them. I may have to accepted dependence, I'm dependent on glasses already, but to become addicted is something I'd very much hope to avoid. I feel a part of me would slip into addiction if it got the chance, but in saying that, as long as I don't decide to start taking more for the high then I should be fine. There is the possibility that worrying about it too much will keep it on my mind and increase the likelihood of a spontaneous decision to take an extra one or two.

A Case Regarding An ADHD Diagnosis

 Since writing the title I've been distracted by something shiny out the corner of the title, taken a bite of food, moved my phone from in front of me to the right of me, wanted to put some music on, been bothered by where I've moved my phone, forgotten how I was going to write this all out, and am trying to- wait gotta move the keyboard over slightly, and am trying to remember the- now my back and neck is tight and sore so it needs stretching, and am trying to remember how I was going to organise my thoughts to- fuck, maybe more coffee will help me focus. Uhm, ADHD, potential diagnosis, reasons for and against, trying hard to focus. Fuck. Thankfully sitting here recapping everything I've read has just amounted to me daydreaming or spacing out. This isn't exactly an uncommon part of my day. 

So basically my plan now is just to wing it, stream of consciousness style, write a list of things I wanted to focus on, and type as much out as quickly as possible cause I got other things that need to be done asap; as for why I'm not doing the more important things right now, the things that I need to do now or else I won't get them done .... shhhh, don't think about it, just do.

1) Reasons for and again (though at this point I'm having a hard time arguing against)
    a) Possible examples through my history, vaguely up till the army.
    b) Examples in the army.
    c) Examples outside, during study

2) Cliffnotes on what ADHD is, ect

3) Something something, definitely didn't forget.
    a) Conclusion? 

Lets see:

• Zimbabwe, primary school years 1-3: 
• Daydreaming a lot (like even I'm aware that it's a lot)
• During breaks I'd roam around the school and temporarily hang out with other people before moving on
• Did lots of sports.
• New Zealand: 
• Not sure what to say here
• The Riverland, Renmark & Waikerie: 
• Same here. Felt distanced from others, assumed it was from moving so much.
• Reading a lot of books to pass time.
• In Waikerie it's here I first noticed that once I was doing something it was often difficult for me to stop doing it and do something else, e.g., going from reading to swim training.
• Adelaide:
• Still feeling really distanced (assumption that none of it mattered and there was no point to paying attention to any of it).
• Still reading a lot of books to pass time.
• Staying up late reading, unwilling to stop to go to sleep.
• Start really getting into the internet and gaming, late 2000's
• Feeling distant from almost everything in my life.
• Doing hockey, cricket, swimming, and briefly tennis.
• Introduced to cannabis and alcohol
• Big drinks, big smokes.
• Worked at the video production company, constantly late to work and had no idea what I was supposed to be doing. 
• Playing a lot of video games.
• Staying up late till I couldn't keep my eyes open anymore, normal behaviour.
• Townsville: 
• Still smoking and drinking, feeling disconnected from life.
• Interactions with other people helped me start feeling happier and more connected. 
• No longer Christian, looking for Truth & the meaning of life through other avenues.
• Frequently late to work. I remember never really being sure of what I was supposed to be doing or how to do it, much as if there was just an empty gap between knowing I have to do something and the something itself. 
• Working as a kitchen hand kinda worked for me at the time; I knew the process of wash dishes, take food out, buzz the number, prepare salads, make and bake pizza's, and it all needed to be done immediately. It was a mix between simplicity, minor variations, and urgency that worked for me.
• I remember that when I'd take rubbish out to the skip bins, I'd be captured by everything else, the atmosphere, the lights and reflections, the quiet, to the point where I'd almost forget what I was doing and needed to be doing.
• It's about here where I notice, or am making an attempt to take in all information at once and experience it. If that's an ADHD thing or not, I'm not sure, I assumed it was due to the influence of Taoism and Zen.
• Sleep schedule is non-existent.
• Adelaide:
• Wanting to be a pro-gamer but finding I just can't make things work. I remember not understanding how other people were able to both plan so far into the game, I couldn't see past 15s of gameplay, let alone 5mins.
• University. Being stimulated by all the new information, and trying to work it all out. 
• Struggled to care. Not sure how to explain this further, I do know that I didn't like how uni is kinda pre-job training, though I don't think that's the most accurate reason.
• Finding myself unable to find motivation or enough meaning to do anything, or chase something.
• Contemplating and almost attempted suicide.
• Bluewater, Waikerie & and Asad:
• Not sure what to say here.
• When things are urgent or highly stimulating then brain go brrrr
• The Army:
• There was so much to do and learn immediately that I really enjoyed this. Super stimulating.
• Start noticing a few issues here:
• Really struggling to do drills, or things that require planning-  Especially when I'm being assessed.
• Emotions tended to be more extreme, more prone to fluctuation.
• A lot of difficulty winding down after doing something. 
• Smoking and drinking more heavily to try relax.
• Most of free time spent playing games to try relax.
• Forgetting simple and important things like: patches, hats, thermal sights, ect
• Becoming lost in the moment or the task (or hyperfocusing)
• Inability to let go of negative thoughts and feelings. Ruminating
• Singleton specific?: 
• Loss of urgency
• Loss of goals
• Loss of constant learning
• Frequent punishments
• Next to nothing to do off base
• Living on base
• Having no way to escape from army life
• Arm/shoulder/neck issues
• Studying:
• Similar to the above
• Difficulty maintaining focus during self-regulated learning.
• Difficulty in regulating emotions, or at least being more stable.
• Constantly being distracted by everything else
• Passive procrastination, constantly.
• Alternating between a high urgency, highly stimulated and obsessed state, or an uninterested, unable to focus on or be motivated about state.
• Difficulty in having a regular sleep pattern.
• Planning assignments is a challenge.
• 
  
•  

3) Something something, definitely didn't forget. Against? Conclusion? Questions, Queries, Concerns?

• Perhaps I didn't properly learn executive function while growing up. Parents, teachers, or other carers basically told me where to be and what to do, and my day-to-day was pretty structured.
• Perhaps I just had a very different view on life and living as a result of growing up in Zimbabwe then NZ and around Auz, being a Christian and seeing the world through those lenses, adopting Tao/Buddhist/Zen views, thinking about the world through the use of drugs, seeing the world not from a mainstream perspective, through the different experiences and places I've been, and through the array of differing viewpoints and attitudes I've come across along the way.
• Ruminating on negatives. May posit an argument for what is a negative but in this case it'd be topics that the general social considers negative.
• High cannabis use for several years straight. I don't think this could have had lasting effects as deep as what ADHD/I'm experiencing now.
• Generally accepting or considering that day-to-day tasks are challenging. Surely most people don't struggle with day-to-day stuff in the manner I do? Though it seems that people with ADHD struggle with day-to-day stuff the way that I do.
• Difference with/from ADHD and Big5 personality. I think this is negligible; the personality tests give an indication of where those aspects of your personality sit in relation with the other people being tested. Having ADHD or not would still mean that your personality would be in relation with other people.
• What is ADHD? (apart from having a terrible name). Neurochemical and physiological differences, generally deficits.
• Is there correlation between ADHD and attitudes, belief systems, culture, ect? Not in the way I was originally approaching this. 
• What about the framework and theories humans use to explain/understand the world or how they operate within it? Again, not in the way I was originally approaching this. 
• ADHD and head injuries (e.g., ACP)
• What about testing for neurochemical imbalances? Without actually taking tissue samples, possibly the next best thing would be taking dopamine/noradrenaline reuptake inhibitors (stimulants) and seeing how they influence the distractibility and focus.
• What about the consideration that my current situation is, in a sense, new and different for me. This may be the first time I'm consciously trying to dedicate myself to achieving a long term outcome. Up till ending high school I had little input on my life and what I was doing. Moving to Townsville was me leaving my current situation and trying to make sense of something. Having figured out that I need a goal, or direction, to orientate myself towards I tried to become a professional LoL player and the way that differs from now is that I was still playing competitive sports/games and they basically play themselves - very different to learning how to have relationships with people or helping others overcome their own problems. I went to uni out of curiosity, and with no further plan went fruit picking to get away from things and think for myself. I joined the army, and all its structures, with the desire to enter combat situations. Now I'm trying to structure the rest of my life, both my internal and external life, so that I'll be competent in helping other people make their lives better - is that not different enough that some aspects of the ADHD symptoms don't make sense? (not really). I've been in my current situation for almost 1.5 years and it's pretty stable, the fact that I'm still having difficulties with routine, planning, emotions, distractions, ect, ect, which are the things that people with ADHD have trouble with. I think at this point, considering how stable my situation has been, ADHD seems most likely.

4) The conclusion after a hiatus. Will the questions from 3) ever be answered?

Given my limited knowledge, essentially ADHD is the name given when the brain doesn't have enough of certain chemicals, most notably Dopamine. Other chemical/s include noradrenaline.

It seems that some of the strongest evidence in favor of ADHD is that I've been taking Modafinil, a dopamine reuptake inhibitor, for help me get motivated and stay focused on getting day-to-day tasks and study done.

Another strong indicator for me is alternating between these two generalised states: 1) difficulties focusing on any thing, low motivation to do anything, easily distracted, or 2) obsessed/hyperfocused on one thing, and highly stimulated when it comes to that one thing.

DSM-V: Somatic Symptom Disorder (Most of it anyways)

Somatic Symptom Disorder

Diagnostic Criteria(F45.1)
One or more somatic symptoms that are distressing or result in significant disruption of daily life.
~ Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
~ Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
~ Persistently high level of anxiety about health or symptoms.
~ Excessive time and energy devoted to these symptoms or health concerns.
~ Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Specify if:
With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.
Specify if:
Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
Specify current severity:
Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

Diagnostic Features

Individuals with somatic symptom disorder typically have multiple, current, somatic symptoms that are distressing or result in significant disruption of daily life (Criterion A), although sometimes only one severe symptom, most commonly pain, is present. Symptoms may be specific (e.g., localized pain) or relatively nonspecific (e.g., fatigue). The symptoms sometimes represent normal bodily sensations or discomfort that does not generally signify serious disease. Somatic symptoms without an evident medical explanation are not sufficient to make this diagnosis. The individual’s suffering is authentic, whether or not it is medically explained.

The symptoms may or may not be associated with another medical condition. The diagnoses of somatic symptom disorder and a concurrent medical illness are not mutually exclusive, and these frequently occur together. For example, an individual may become seriously disabled by symptoms of somatic symptom disorder after an uncomplicated myocardial infarction even if the myocardial infarction itself did not result in any disability. If another medical condition or high risk for developing one is present (e.g., strong family history), the thoughts, feelings, and behaviors associated with this condition are excessive (Criterion B).

Individuals with somatic symptom disorder tend to have very high levels of worry about illness (Criterion B). They appraise their bodily symptoms as unduly threatening, harmful, or troublesome and often think the worst about their health. Even when there is evidence to the contrary, some individuals still fear the medical seriousness of their symptoms. In severe somatic symptom disorder, health concerns may assume a central role in the individual’s life, becoming a feature of his or her identity and dominating interpersonal relationships.

Individuals typically experience distress that is principally focused on somatic symptoms and their significance. When asked directly about their distress, some individuals describe it in relation to other aspects of their lives, while others deny any source of distress other than the somatic symptoms. Health-related quality of life is often impaired, both physically and mentally. The diagnosis can further be specified by stating whether complaints predominantly involve pain and/or if complaints are marked by a persistent course(Katz et al. 2015).

Additionally, severity of somatic symptom disorder can be specified by the number of fulfilled B criteria. Mild forms of somatic symptom disorder (one symptom as specified in Criterion B is fulfilled) are more prevalent(Rief and Martin 2014; Voigt et al. 2012), while moderate (two or more B criteria are present) and severe cases (two or more symptoms as specified in Criterion B are fulfilled in combination with multiple somatic complaints or one very severe somatic symptom) are marked by higher levels of impairment(Claassen-van Dessel et al. 2016; Hüsing et al. 2018; Limburg et al. 2016). In severe somatic symptom disorder, the impairment is marked, and when persistent, the disorder can lead to invalidism.

There is often a high level of medical care utilization, which rarely alleviates the individual’s concerns. Consequently, the individual may seek care from multiple doctors for the same symptoms. These individuals often seem unresponsive to medical interventions, and new interventions may only exacerbate the presenting symptoms. Some individuals with the disorder seem unusually sensitive to medication side effects. Some feel that their medical assessment and treatment have been inadequate.

Associated Features

Cognitive features include attention focused on somatic symptoms, attribution of normal bodily sensations to physical illness (possibly with catastrophic interpretations), worry about illness, a self-concept of bodily weakness, and intolerance of bodily complaints(Voigt et al. 2012; Voigt et al. 2013). Besides health anxiety, emotional features may include negative affectivity, desperation, and demoralization related to somatic symptoms(Rief and Martin 2014). The relevant associated behavioral features may include repeated bodily checking for abnormalities, repeated seeking of medical help and reassurance, and avoidance of physical activity(Voigt et al. 2010). These behavioral features are most pronounced in severe, persistent somatic symptom disorder. These features are usually associated with frequent requests for medical help for different somatic symptoms. This may lead to medical consultations in which individuals are so focused on their concerns about somatic symptom(s) that they cannot be redirected to other matters. Any reassurance by the doctor that the symptoms are not indicative of serious physical illness tends to be short-lived and/or is experienced by the individuals as the doctor not taking their symptoms with due seriousness. As the focus on somatic symptoms is a primary feature of the disorder, individuals with somatic symptom disorder typically present to general medical health services rather than mental health services. The suggestion of referral to a mental health specialist may be met with surprise or even frank refusal by individuals with somatic symptom disorder.

Development and Course

The course of somatic symptom disorder is likely to be chronic and fluctuating and influenced by the number of symptoms, individual’s age, level of impairment, and any comorbidity(Creed and Barsky 2004; olde Hartman et al. 2009; van Geelen et al. 2015). The course is also influenced by personality traits, with less harm avoidance and greater cooperativeness associated with a shorter time to remission(Greeven et al. 2014).

In older individuals, pain localized in several body regions appears to be the most common symptom(Hiller et al. 2006). Somatic symptoms and concurrent medical illnesses are common as multimorbidity increases with age. Prevalence rates of somatic symptom disorder seem to be stable until age 65 years and might decrease thereafter(Hilderink et al. 2013). For making the diagnosis in older individuals, a focus on the requirement for excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns (Criterion B) is crucial. Somatic symptom disorder may be underdiagnosed in older adults either because certain somatic symptoms (e.g., pain, fatigue) are considered part of normal aging or because illness worry is considered “understandable” in older adults who have more general medical illnesses and medications than do younger people.

Risk and Prognostic Factors

Temperamental

The personality trait of negative affectivity (neuroticism) has been identified as an independent correlate/risk factor of a high number of somatic symptoms(Creed et al. 2012). Comorbid anxiety or depression is common and may exacerbate symptoms and impairment(Lee et al. 2015; Limburg et al. 2017).

Environmental

Somatic symptom disorder is more frequent in individuals with few years of education and low socioeconomic status, and in those who have recently experienced stressful or health-related life events(Creed and Barsky 2004; Creed et al. 2012; Deary et al. 2007; Reddy et al. 2019). Early lifetime adversity such as childhood sexual abuse is also likely a risk factor for somatic symptom disorder in adults(Eberhard-Gran et al. 2007; Rief and Martin 2014).

Course modifiers

Persistent somatic symptoms are associated with demographic features (women, older age, fewer years of education, lower socioeconomic status, unemployment), a reported history of sexual abuse or other childhood adversity, concurrent chronic physical illness or mental disorder (depression, anxiety, persistent depressive disorder, panic), social stress, and reinforcing social factors such as illness benefits(Deary et al. 2007). Total somatic symptom severity is probably associated with female gender, anxiety, depression and general medical illness(Tomenson et al. 2013). Cognitive factors that affect clinical course include sensitization to pain, heightened attention to bodily sensations, and attribution of bodily symptoms to a possible medical illness rather than recognizing them as a normal phenomenon or psychological stress(Deary et al. 2007; Rief and Broadbent 2007; Rief et al. 2004).

Culture-Related Diagnostic Issues

High numbers of somatic symptoms are found in population-based and primary care studies around the world, with a similar pattern of the most commonly reported somatic symptoms, impairment, and treatment seeking(Gierk et al. 2014; Lee et al. 2015; Rask et al. 2016). The relationship between number of somatic symptoms and illness worry is similar in different cultural contexts, and marked illness worry is associated with impairment and greater treatment seeking cross-culturally(Lee et al. 2011; Lee et al. 2015). In many cultural contexts, individuals with depression commonly present with somatic symptoms(Bagayogo et al. 2013; Dreher et al. 2017).

Despite these similarities, there are differences in somatic symptoms across cultural contexts and ethnoracial groups(Rohlof et al. 2014). Sociocultural factors, particularly stigma related to mental disorders, may explain differences in somatic symptom reporting across cultural contexts(Bagayogo et al. 2013; Löwe and Gerloff 2018; Wilkins et al. 2018). The description of somatic symptoms varies with linguistic and other local cultural factors.

Association With Suicidal Thoughts or Behavior

Somatic symptom disorder is associated with suicidal thoughts(Wiborg et al. 2013a; Wiborg et al. 2013b) and suicide attempts(Asselmann et al. 2018). It is likely that suicidal thoughts and behaviors are partly explained by the diagnostic overlap and frequent comorbidity of somatic symptom disorder and depressive disorders(Wiborg et al. 2013a). In addition, dysfunctional illness perceptions and the severity of somatic symptoms appear to be independently associated with an increased risk of suicidal ideation(Jeong et al. 2014; Wiborg et al. 2013a; Wiborg et al. 2013b).

Functional Consequences of Somatic Symptom Disorder

The disorder is associated with marked impairment of health status and high psychological distress(Voigt et al. 2012). Many individuals with severe somatic symptom disorder are likely to have impaired health status scores more than 2 standard deviations below population norms(Lee et al. 2015; Tomenson et al. 2013). Health status is particularly impaired in the presence of multiple or severe symptoms(Creed et al. 2013).

Differential Diagnosis

If the somatic symptoms are consistent with another mental disorder (e.g., panic disorder), and the diagnostic criteria for that disorder are fulfilled, then that mental disorder should be considered as an alternative or additional diagnosis. If, as commonly occurs, the criteria for both somatic symptom disorder and another mental disorder diagnosis are fulfilled, then both should be diagnosed, as both may require treatment.

Other medical conditions

The presence of somatic symptoms of unclear etiology is not in itself sufficient to make the diagnosis of somatic symptom disorder. The symptoms of many individuals with disorders like irritable bowel syndrome or fibromyalgia would not satisfy the criterion necessary to diagnose somatic symptom disorder (Criterion B). Conversely, the presence of somatic symptoms of an established medical condition (e.g., diabetes or heart disease) does not exclude the diagnosis of somatic symptom disorder if the criteria are otherwise met. Factors that distinguish individuals with somatic symptom disorder from individuals with general medical conditions alone include the ineffectiveness of analgesics, a history of mental disorders, unclear provocative or palliative factors, persistence without cessation, and stress(Suzuki et al. 2017).

Psychological factors affecting other medical conditions

The diagnosis of somatic symptom disorder requires distressing or impairing somatic symptoms that may or may not be associated with another medical condition but must be accompanied by excessive or disproportionate thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns. In contrast, the diagnosis of psychological factors affecting other medical conditions requires the presence of a medical condition, as well as psychological factors that adversely affect its course or interfere with its treatment.

Panic disorder

In panic disorder, somatic symptoms and anxiety about health tend to occur in acute episodes, whereas in somatic symptom disorder, anxiety and somatic symptoms are more persistent.

Generalized anxiety disorder

Individuals with generalized anxiety disorder worry about multiple events, situations, or activities, only one of which may involve their health. The main focus is not usually somatic symptoms or fear of illness as it is in somatic symptom disorder.

Depressive disorders

Depressive disorders are commonly accompanied by somatic symptoms such as fatigue, headaches, or joint, abdominal, or other pains. However, depressive disorders are differentiated from somatic symptom disorder by the requirement of the presence of depressed mood or, in the case of major depressive disorder, either depressed mood or decreased interest or pleasure in activities. In some cultural contexts, these core symptoms of depression may be initially denied or deemphasized by individuals whose presentations would otherwise meet criteria for a depressive disorder(Lanzara et al. 2019; Ryder and Chentsova-Dutton 2012; Ryder et al. 2008). Such individuals might instead emphasize somatic symptoms that may be idiomatic (e.g., heavy heart) and unfamiliar to clinicians(Ahmad et al. 2018; Bragazzi et al. 2014; Haroz et al. 2017; Seifsafari et al. 2013).

Functional neurological symptom disorder (conversion disorder)

In functional neurological symptom disorder, the presenting symptom is loss of function (e.g., of a limb), whereas in somatic symptom disorder, the focus is on the distress that particular symptoms cause. The features listed under Criterion B of somatic symptom disorder may be helpful in differentiating the two disorders.

Comorbidity

Somatic symptom disorder is associated with high rates of comorbidity with other mental disorders as well as general medical conditions. The most relevant co-occurring mental disorders are anxiety and depressive disorders, each of which occurs in up to 50% of cases of somatic symptom disorders(Bailer et al. 2016; Newby et al. 2017) and significantly contributes to overall functional impairment and poorer quality of life(Liao et al. 2019; Löwe et al. 2008). Other mental disorders that have been found to co-occur with somatic symptom disorder are posttraumatic stress disorder and obsessive-compulsive disorder(Bailer et al. 2016; Liao et al. 2019). Other evidence indicates an association with sexual dysfunction in men(Fanni et al. 2016).

Elevated levels of the psychological features (Criterion B) of somatic symptom disorder have been found in several general medical conditions(Kop et al. 2019). When a concurrent general medical condition is present, the degree of impairment is more marked than would be expected from the physical illness alone. Moreover, somatization in medical illness has been shown to worsen disease and treatment outcomes, adherence, and quality of life and to increase health care utilization(Grassi et al. 2013).

Post-Session Reflection on Topics

Things discussed at todays session

- Being late
- Competency
- Emotional reaction, stress, frustrated, flustered
- Self-Doubt
- Army: Tex's section and being singled out. Ingroup and Outgroup.
- ID, Ego, SuperEgo in comparison to my idea of existential self and social self, and managing the two.

I was supposed to attend a DBT session at 3pm. However around 2pm the idea that it was 3:30pm not 3pm stuck in my mind, so I didn't plan to leave until around 3pm.
As it would happen, I looked at the time at 3pm and realised that this was the correct time to attend so I rushed to get ready and leave. I called and let them know I'd be late.
I began feeling self-conscious and frustrated with myself. I was thinking of walking in late and of everyone knowing that I was late, and of feeling incompetent because I managed to relax too much and didn't achieve a simple task. I felt somewhat flustered; I guess I was also frustrated that I was flustered, that this emotional reaction happened over something I didn't consider as something that 'should' set off those reactions.

I was still able to accept those emotions, the frustration, the fluster, the self-consciousness; I was still able to accept that I was late, that little could be done about it apart from remaining calm and focusing on arriving safely.
In reflection, I think another aspect may also be the shock of how quickly I switched from everything going well, emotionally steady (mood fluctuation included) for weeks without issues to being late, frazzled, uncomfortably self-conscious, and emotionally raw.
To be clearer, this wasn't a massive reaction to the situation in the sense of catastrophising or being overwhelmed by emotions but closer to the analogy of having stubbed your toe, it was sudden and it hurt but also it wasn't damaged or going to be painful for the whole day.

This bothered me through to the following day where I arrive to the wrong location, despite having known about the change for about a month in advance. I knew, I checked the night before, I jumped in the car and drove to the previous location out of habit. Just to top it off I arrived at the previous location just after 10am. 
Not only did I arrive slightly late but also to the wrong location.
I remember having a lack of urgency that morning .. until I was late. I do wonder if I'd relaxed too much and if that's the case, which I suspect it is, then I can take this all on board and fine tune things a bit so it's no longer the reason for my being late somewhere.
 
I spoke over the phone while driving, using headphones. It was just going over what I was experiencing and why those thoughts and feelings may be coming up. I was asked if I'd considered if other people made mistakes even when they're otherwise competent and I gotta admit it wasn't something that I had considered recently, or for a long while.

Despite knowing that competent people make mistakes, I think that I'd been self-obsessed over my own errors and faults whilst simultaneously disregarding others errors as once off and not a reflection of their character or competence.
Having just reached the aforementioned conclusion it has just occurred to me as peculiar that I've been attributing certain groups/types of mistakes as proof my own incompetence. I can only think that this occurred directly as a result of being part of Tex's section on RCB 117. I don't recall having such an issue with confidence at 2coy 4pl, or IET's, or Basic, or ... heck, I don't think Asad bothered me as much as Tex. Yea, Asad dragged me down and made me question myself but I still left feeling intact.  
I still felt confident that I could do things. I nailed the cognitive tests, the physical, medical, psych, fucking everything. I didn't doubt or feel incompetent; I know at times I felt nervous, frustrated and sometimes confused but I don't recall doubting my capability to perform or letting mistakes bother me much. I just did it - I looked forward and did it. In a way it was one of the easiest things I've done. It was tough physically, emotionally/socially draining, and simultaneously both stimulating and brainless but it was just 'do this' and I'd do it and it would be done. Like following a path - just go forward.
I do miss that aspect of that time.
Was I a top soldier? Nope but I wasn't bad either. People liked me and wanted me to spend time with them. I know they tested me various times and they seemed happy with how I performed (or at least that's how I remember it), if I made mistakes they were willing to help me improve or if it wasn't a big issue then it may be remarked on then forgotten. I was part of the group. I never felt like my competence was doubted, actually I think almost the opposite where people saw potential with me. Even after I left a thermal sight in my pack for over a week and got ROP's, people didn't treat me as if there was something wrong with me. I think I was a bit frazzled by it, I think I was a bit frustrated that I'd made that mistake but I don't think it was overbearing. 

I remember when we were packing our bags for RCB, I know my memory of the words used is a bit vague and I remember it as "Don't take your battalion PT shirts as you'll get given RCB PT shirts when you arrive. Those will be the PT shirts you wear when you do PT". 
I know that he said it several times. I know that the intended message was as previously mentioned even if I don't remember it 100%.
I remember when we got there, within the first couple hours of arriving on the base, Tex and section wanted to go to the gym. Oh who didn't bring a PT shirt? Must be the shit cunt.
What's this? Stafford didn't bring his gunner's rig? MJ has a spare? Hahaha we'll just forget this even happened because the person who didn't bring the PT shirts they were told not to bring is clearly the shit cunt.
It might not have been huge to start with but they also picked up on that I wasn't the fittest and strongest infanteer in the group. Like I wasn't unfit or slacking, just not the best at those weighted exercises. I wasn't trailing far behind everyone anyways. I could run and swim better than them but no lets just stick to doing Hundred 100's and similar exercises. I got looked down on for that.
When was the last time I've done volley ball? Once or twice 10+ years ago? Can't let MJ play cause he's bad.
What about the amount of times Tex shared orders when I left to go to the toilet? And then get berated for not being ready for that task. Holy fuck. The first time I put down to chance and them thinking someone else had filled me in. After the third time it was clear that it was deliberate so I began speaking to other sections and secco's to find out what was coming up. I remember when we were with the Malay Rangers I got grilled for hanging back at the mess to talk with other people. The reasoning was incase they received orders ... mother fuckers, call me, we've all got phones, and there's almost no place to go apart from maybe 3 spots. With that incident the icing on the cake was that they knew I stayed behind, they knew were I was. 
I'm pretty sure I ended up on armory piquet a few time times more than others.
I remember there was an incident, I can't place when it happened, where we patrolled into rows of these tall straight trees at night and we were supposed to sit down in rows. It's nearly pitch black under these tree's and Tex is obsessing over where I'm sitting. It was constant "Move forwards a bit. Move back a bit. Move back a bit more. Move forward a bit. Move back. Move forward." Like, holy fuck, I'm moving around in 10-20cm increments; he complains to sarge then drags me back like 20cm. It was bizarre and enraging - did it really matter that much for me to be in that exact fucking spot during an admin stop under near pitch black vision.
Imagine standing with your feet together and someone saying 'take a step back' so you do, 'take a step forward' so you take a smaller step forward, 'take a step back' so you take a smaller step back, and this process just continues. 
And the range. I'm on the mog pulling everyone's packs onboard. 'OK all the packs are on the mog, lets go', 'Oh wait guys I don't see my pack on the mog', 'Nope it's definitely on here, we put them all on, none left behind, stop worrying and overthinking shit -- WTF MJ why didn't you make sure your pack was on the mog? Gonna have to reprimand you for this'
I swear to fucking god, fucking ridiculous. 'trust us we definitely put your pack on the mog, woops it's not on the mog and it's all your fault'.
Then to add to that, during a pistol test, apparently I didn't look down the sight (didn't look down the sight correctly?) and I'm thinking 'uhm, yea I did' but can I say that to rank?? Can I prove I didn't??
Re-training!!
Just another thing to make me look and feel incompetent. Hey look, the shit cunt is so bad that he needs re-training on the pistol!
Cool. I've handled a pistol just long enough to get qualified. Did I do my drill wrong? I don't believe I did. Was I rigorously re-trained to the point I doubted myself? Yes.
The live fire shoot. 'Hey MJ, immediately after this shoot you're going out on piquet to replace so-and-so'.
'No problem lemme just oil the gun quickly before I jump on the vehicle'
'Nope, no time gotta go right now'
'Cheezy can you oil the gun please' 'MJ get on the vehicle now'
'Sure I'll make sure it gets oiled' 'MJ get on the fucking vehicle now!'
3 days later: 'MJ I just pulled out your gun and it was completely rusted, we spent half the afternoon cleaning it, I was so embarrassed'
No fucking shit, you made such an issue about me fucking getting on that fucking vehicle that I thought I was going to get a formal warning. You were so desperate to get me on that vehicle that you wouldn't let me oil the weapon and then you berate me for not oiling it.
The time we went to an island and they tried to get me to sleep with a trans lady. When I say 'tried' I mean it was closer to 'forcing'. I didn't want to, they didn't me but they tried to make it happen. I told that lady what was going on, they said they were happy for me to stay the night if needed, I didn't need to but I really appreciated it. I bullshitted out my arse to everyone about what happened.
There was a night were Rhode was making so many passive-aggressive remarks to me. I don't really know what or why, I vaguely remember him insinuating that they were trying to help me and I was being disrespectful. I remember everyone else was acting a quiet and cautious. So I had a punch on with Rhode. I end up on the ground and everyone decides it's over, and I'm confused - I'm fighting and I'm able to continue fighting and I want to keep fighting but they decided when it's over. It was stupid, it annoyed me. I got a lot of respect from Rhode after that. I still look back and don't understand why it happened nor why it was allowed to happen.
They left behind to piquet on Ex. Harangaroo. 
Ohh. That patrol where I get heat exhaustion, can barely stand and am about to pass out but first Tex has to grill me because the minimi stock pin has come out. I remember he ripped into me pretty hard but I was so fucked I don't remember much.
Later on only my weapon got the white glove inspection, every weapons inspection was white glove. Not literally as he didn't have any white gloves but if there a spec of carbon anywhere on the weapon I got a warning and went back to cleaning. Not for anyone else, just me. It got to the point where I wouldn't fire unless I couldn't get away with that and I'd clean the gun thoroughly every chance I got.
Also there was the bellend guy. Just a fucking random who's like "you look like a bellend, what would you do in this situation", fuck you champ.
What angers me about all these incidents is how Tex would act as if he's looking out for us and trying to be a good secco.
Don't forget Singapore! We wouldn't want to forget about all that bullshit. Oh yea, lets run MJ through urban drills and grill him for the minutest detail. Lets just fabricate some story about MJ pointing a rifle at someone elses head. At this point I know he has it out for me. I know. There was no way I was even close to pointing a rifle at someone's head, we were about a meter apart and I'm pointing 30cm above the second floor. Nobody steps in and points out that I wasn't. It was just me trying to convince Tex that I was didn't do the thing he fabricated, and he's like 'oh well from where I was standing it looked like you pointed it at his head'. Aha, is that right Tex? Are you really spending your time and energy to imagine faults with what I'm doing? Are you not able to disconcert angles or how how objects operate in 3D space? No? You're trying to find any and all fault with me. You'll imagine them if you have to. Nobody else has flaws in their urban clearance, nothing to improve on, only MJ.

So what does all that have to do with me today, with the over-reactions and hyper-vigilance reactions of me post army? 
Well I think that I'd internalised some of this somehow.
I think I grew into a person who didn't like interpersonal conflicts, as in, I greatly valued getting along with others and fitting in with the group to the point that I would devalue myself to conform to the groups values. I think that moving around as much as I did also had a side effect of not understanding how to fit into close groups appropriately. I think that statement is lacking, it's not quite correct, moving around a lot is part of it but ...
I think by wanting to be part of the group, being ostracized by the group, unable to leave the group, being lead into situations by the group where I'd be in the wrong or make a mistake then having those mistakes tallied against me as proof of my incompetence as a person has lead to me having the issues that I have now. Having strong emotional reactions over simple or perceived mistakes, lacking confidence in myself, feeling inadequate and incompetent as a human after making any mistake, becoming hyper-vigilant and self-conscious when doing tasks where I could perceive the people around me as judging my competence doing the task.

Where do I go from here?
(what does the literature say?)

During the session I'd tried to explain the things I can't disprove, that I'm consciously aware of phenomena and its consistent change, and I'm consciously aware of the use of language to explain what's happening. They asked if I was aware that I was describing Freud's ID and Ego, I wasn't and I thought that was interesting but also how was this related to proving and disproving reality and truths.
Anyways.

A Different Perspective On My Life: It Can Be Broken Down To Three Stages

About 30 minutes ago I was driving home from the gym and I was thinking about how I was basically trying to re-structure my life, more specifically how I was re-structuring my life after discharging. This lead me to think about the reason for trying to re-structure my life. I'm re-structing my life because everything before now was not working or working poorly. Interestingly this wasn't the only this has happened to me. I went through a massive change in perception and belief when I stopped believing in Christianity.

It's a little difficult to contrast this new way of thinking with the old, though I suppose I was thinking of the current moment as building upon the previous such that my motivation for going to uni and studying was still part of the previous way of living. 

To explain in a more linear fashion would be to point out what lead to the dissolution of my belief in Christianity. While there are many factors involved I think it ultimately came down to:
    My belief in Christianity was not working and many more things could be explained through the absence of a God, and through science and technology. It's possible to argue about tests of faith and temptation, about how I was tempted off the path of Christ through the temptation of Satan and how I needed to continue my faith in God or the Holy Trinity. In response I find myself drawn to the Parable of the Lost Sheep (Luke 15:1-7) where Jesus talks about the shepherd who goes out to find a lost sheep whereupon finding it the shepherd celebrates. Were I to be the lost sheep and Jesus as the Shepherd then I ask/ed "How difficult is it to bring me home? I'm looking for truth, for what's there, and what's real. Where are you if you are The Way, The Truth, and The Light that you proclaim to be?"

I've had no response to that for the last 11 years. 

I now see this as a transition stage. At this point onwards I'm re-structuring my life.

It lead me to try seek out what's "really out there" and "what's really going on?". Those questions, that line of thinking, and where I was emotionally and situationally lead me to move to Townsville. I think I was driven by two, maybe three, aspects here: "What drives me as a person?" and "What is this existence and my beliefs about it?". 

Tarot, spiritualism, drugs, introspection, psychology, metaphysics, sensory experiences, philosophy, Buddhism/Taoism, history, anthropology, dreams and trances, serial killers, sonder and solipsism, ect.

I found my desire to win at League of Legends rather intoxicating. It was a goal I'd set and parameters to determine how well I was moving towards that goal. It was a huge contrast to the difficult and confusing attempt at understanding everything in existence, one that was feeling overwhelming and pointless. I wish I did well at LoL but I can't say I was that good and living circumstances didn't help. Ironically I performed best when my father cut me out of the internet and I was going to an internet café to play. 

Perhaps the next question would be "why uni?"

I know I didn't have anything else going for me at the time. I'd just quit the door-to-door sales job, and my mother suggested I take a look. There was a few things that interested me so I did the Bach. Health Science to cover them all. Really titillating. To start with. I remember being frustrated because it was just pre-job training and I was feeling unfulfilled. I think unfulfilled in the sense that I didn't know who I was or how I saw the world, how I operated within it or with other people. What was my purpose? My life had no meaning.

I had an argument with my father that lead to me staying with Nick, his partner and his mother. Later I moved to stay with Andrew and met Trish. Trish introduced me to muntrie picking at the neighbours which turned to grape picking with a local Italian family. I enjoyed doing something, having my mind free to process things, and the outdoors. I decided to do some orange picking for a living up in Waikerie at a backpackers hostel. That lead to the work on the vineyard, Asad and the Army.

I think the orange picking was a bit of a confidence booster. Thoughts come and go but oranges get picked, processed, packaged and consumed. Similar with the vineyard work. I noticed that I could work fairly hard for most of the day, I liked being outside and moving, I liked being part of a process that benefited people. I also began to notice that I really needed to think deeply about things as I'd frequently find a quiet spot and just process things. I remember this girl saying "Because I know who I am" and it really struck me hard because of the conviction in which she said it, it made me question myself. I still don't think I can say the same thing with the same conviction she had.

Kristina occurred around here, and the pain of no longer being a part of her life or how it ended.

Asad and his lies. Promised to build up my confidence. Teach me Krav. 

So all these experiences, all this stuff is my reality, my beliefs, perceptions and motivations drives my decision into the army.

This idea of being physical, being outdoors, a not-for-profit organisation, being able to fight and kill, of being the shield in front of others, of being useful and having purpose.

Well army didn't work out that well for me.

I guess I did learn that I don't want to be that physically fit all the time, that I'm a lot more gentle than I thought, I'm definitely quite introverted, that I'm more prone to conceptual thought and that I want something along the lines of helping people.

Physical injury and adjustment disorder diagnosis.

So a lot of stuff had occurred up to that point and I go to study psychology, which is kind of a big change from before. I begin trying to change my whole world, to develop a new and hopefully better reality, and to put that into practice; trying to process all these experiences into something useful and understandable, using what I learnt about myself and changing. I've developed habits and thoughts that aren't helpful, I'm having disproportionate emotional responses, I'm feeling insecure and all over the place, my view of the world is complicated and my sense of self is obscure.

This leads back to the thoughts I was having during the car drive home. I'm re-structuring my life.

What I was doing before was not working well and helped create the problems I'm struggling with, which is why I'm working on changing and rebuilding myself and my worldview. 
This process is the change before the next stage in my life.

The first stage was as a Christian up to 18yo, the next was what lead to the army, and the current stage is now.

At the very least this is a different perspective for me.