PhD/PsyD Just a thread to post the weirdest/whackiest/dumbest mental health-related stuff you come across in the (social) media...

[Therapist4Chnge]

Differential diagnosis in NP programs, especially for psychiatric conditions, is traditionally lacking, a lot. I’ve reviewed a bunch of curriculums over the years and they don’t emphasize it. Kinda crazy.

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[WisNeuro]

The last psych NP I had to work with argued with me and tried to demand I addend my report to say that the patient had ADHD so she could prescribe stimulants. Her argument was that the patient's PTSD made the ADHD undetectable, but it was there and needed to be diagnosed.

By and large my experience with them has been that they are unserious people, and I will not see them as my provider. It's been nearly unanimous poor experiences.

 

[EnPsychlopedia]

Maybe, but remember that the research training here, in general, is pretty surface level.

I know…doesn’t make me feel better about it, though.

 

[cara susanna]

At our VA, the independently prescribing APRN's who essentially function as psychiatrists in this setting routinely farm out the responsibility of differential diagnosis to psychologists, particularly (a) ADHD (I mean, of course), (b) PTSD (this is becoming increasingly common), and (most recently), (c) bipolar disorder (which kind of blows my mind). Having recently been assigned a consult to rule in/out bipolar disorder in a patient who was already established with the APRN, my initial thought was, "umm...YOU'RE their prescribing provider...do YOU think they have bipolar disorder?"

Oh yeah, psychiatry loves deferring diagnoses to psychologists here and it drives me bananas. You really think an hour interview and PAI is going to tell you more than your years or months of clinical observations?

 

[aim-agm]

At our VA, the independently prescribing APRN's who essentially function as psychiatrists in this setting routinely farm out the responsibility of differential diagnosis to psychologists, particularly (a) ADHD (I mean, of course), (b) PTSD (this is becoming increasingly common), and (most recently), (c) bipolar disorder (which kind of blows my mind). Having recently been assigned a consult to rule in/out bipolar disorder in a patient who was already established with the APRN, my initial thought was, "umm...YOU'RE their prescribing provider...do YOU think they have bipolar disorder?"

Maybe they just believe you are far superior to them in acquiring a history, performing an MSE and reaching a diagnosis. So it seems insight is at least partially intact 😉

I could see the referral to assess for bipolar disorder being reasonable if their differential was hyperthymia vs. ADHD, as differentiating the milder psychomotor agitation from hyperactivity or inattention from distractibility (or loss of determining factor) when symptoms will be present at baseline (rather than episodic) may be beyond what a competent (rather than skilled) examiner can do.

The last psych NP I had to work with argued with me and tried to demand I addend my report to say that the patient had ADHD so she could prescribe stimulants. Her argument was that the patient's PTSD made the ADHD undetectable, but it was there and needed to be diagnosed.

By and large my experience with them has been that they are unserious people, and I will not see them as my provider. It's been nearly unanimous poor experiences.

"Please render a diagnosis of ADHD because I believe it is undiagnosable."

You can certainly have cases where one condition confounds the diagnosis of another, but one of the things lacking in their training are the clinical decision-making skills necessary in these situations. In this situation, if inattention is manageable then just focus on the PTSD and after it is controlled reevaluate for ADHD. If inattention is causing significant difficulties you could use clinical knowledge and expertise to make treatment choices that are likely work for both e.g. NRIs and DRIs are effective for PTSD and attention, but are off label with limited literature for former. If inattention is causing overt dysfunction and course of treatment for PTSD will be prolonged, after evaluating risks and benefits you might even empirically treat for ADHD (or symptom of inattention) temporarily and reevaluate after treatment for PTSD later. Importantly, none of this requires falsifying the medical record by entering a diagnosis you cannot support.

 

[Sanman]

I often run into and work with psychiatric nurse practitioners (they're quite common on skilled nursing/rehab/nursing homes) and the amount of times they either just completely write off psychologists, practice beyond their scope, or seemingly misidentify themselves to patients is stunning.

Had one that told me they do "therapy" with patients despite having zero background, training, or experience because they said "they teach courses at a local college and have been doing this for a long time so know what to do" then asked me why I was billing the same codes as them and told me I shouldn't see most patients unless she determined it was appropriate lol.

Now have another at another location, who apparently sees patients before I do and now I have to take time with each patient ti provide psychoeducation about the difference between psychologists, psychiatrists, and psychiatric nurse practitioners. Not as bad as the first one, but still. Almost every one who meets this one then tells me they don't need to be evaluated because "the psychiatrist was here already."

Most of them are well intentioned, but then those end of referring patients to me because "they're sad" or they "are angry" and then I see the patient and it's just frustration and anger at how poorly run some of these rehabs are.

Anyways psychologist prescribing rights are on the table where I'm licensed, a lot of psychiatric nurse practitioners about to be out of work. The first one i mentioned retired shortly after this news broke. Well i also reported the first one for practicing outside their scope as well.

But soapboxing aside, I agree, this is something many of us are thinking about.

In my experience, most of the NPs that do this kind of work are either just out of school or have professional issues that keep them from better jobs. There were a few amazing ones that did this work for non-monetary reasons, but I ran into sketchy ones far more often.

 

[borne_before]

In my experience, psychiatric nurse practitioners tend to be far more collaborative, communicative, and effective than many of the psychiatrists I’ve worked with. I think there are a few reasons for this. First, NPs often represent the top tier of the nursing field: highly skilled and empathetic providers who’ve come up through the ranks of hands-on patient care. In contrast, some psychiatrists, frankly, don’t always represent the “cream of the crop” among physicians...

I also think the nursing background makes a real difference. Nurse practitioners have typically spent time directly caring for undermedicated or complex patients, so they often bring more practical insight and a greater sense of urgency to their prescribing decisions.

That said, I’ve definitely encountered psychiatrists with chips on their shoulders. One recently got pretty pissy with me just for referencing a medication explanation (I said nothing that wasn't in a Barkley book during a conversation with a patient).

But, I do usually refer to a NP post evaluation, so that precludes a lot of their challenges with differential diagnosis.

 

[WisNeuro]

In my experience, psychiatric nurse practitioners tend to be far more collaborative, communicative, and effective than many of the psychiatrists I’ve worked with. I think there are a few reasons for this. First, NPs often represent the top tier of the nursing field: highly skilled and empathetic providers who’ve come up through the ranks of hands-on patient care. In contrast, some psychiatrists, frankly, don’t always represent the “cream of the crop” among physicians...

I also think the nursing background makes a real difference. Nurse practitioners have typically spent time directly caring for undermedicated or complex patients, so they often bring more practical insight and a greater sense of urgency to their prescribing decisions.

That said, I’ve definitely encountered psychiatrists with chips on their shoulders. One recently got pretty pissy with me just for referencing a medication explanation from a Barkley book during a conversation with a patient.

But, I do usually refer to a NP post evaluation.

Where is this? Most of the ones I have worked with had minimal patient care experience prior to getting the NP.

 

[borne_before]

Where is this? Most of the ones I have worked with had minimal patient care experience prior to getting the NP.

Out West, we were one of the earlier states to allow independent practice for nurse practitioners, and I think that’s made a real difference. Most of the ones I work with have their DNP, which might help explain the quality I’ve seen.

As an aside, I used to work with a nurse practitioner who told me, half-jokingly, that “there’s no such thing as a good medical assistant because the good ones become nurses.” Her take was to beware of the career MA. I don’t know if the best nurses always become NPs, but maybe I’ve just been lucky enough to work with some of the really great ones.

Personally, I see NPs for ADHD med management, and I’m pretty low-maintenance. That said, I once had one suggest I might be on the spectrum. I told her, “I actually know a lot about this. I’m highly social, spoke on time, and I’m basically the human version of a golden retriever interpersonally.” She got flustered and replied, “Well, autistic people can be social,” as if I’d made some uncouth generalization. I switched providers after that. But alas, she was an adult NP and it was covid and we had only met thru the screen.

 

[Therapist4Chnge]

Where is this? Most of the ones I have worked with had minimal patient care experience prior to getting the NP.

Direct-entry NP is very much a problem, as the NP was originally designed and pitched for experienced nurses. The direct to NP programs are just a money grab. Day-to-day, it is often very obvious which NP is new w little to no experience and which ones spent years as an RN and went back; the former are much more likely the problem.

 

[cara susanna]

Question for the LGBT/sexual identity experts here... is demisexuality actually a thing? I mean, as a sexual orientation

 

[Shiori]

Question for the LGBT/sexual identity experts here... is demisexuality actually a thing? I mean, as a sexual orientation

I can dive more into the literature, but I imagine it's going to be sparse. When I see people discuss it, it seems to come up most frequently in the asexuality world to push back on expectations of how early relationships look.

If I rely on anecdotes, I most often see this term show up with people not generally interested in sex, but they can become more interested over time to better connect with their partner, especially if that partner is not asexual or demisexual too. There can be lots of reasons the person isn't interested in sexual like the ick factor, feeling over-stimulated, etc. With a familiar person, they can feel more at ease.

Honestly, I think it might make sense as a modifier to other orientations rather than a distinct sexual orientation. I think it has solidified as a "thing" because of the tendency to pathologize a lack of interest in sex. Maybe it'll get its own scale one day with the Genderbread Person. Super interesting question!

The Genderbread Person 3.0

The Genderbread Person deconstructs gender and sexuality to clarify five dimensions of human identity and behavior.

publichealthpost.org

 

[borne_before]

I can dive more into the literature, but I imagine it's going to be sparse. When I see people discuss it, it seems to come up most frequently in the asexuality world to push back on expectations of how early relationships look.

If I rely on anecdotes, I most often see this term show up with people not generally interested in sex, but they can become more interested over time to better connect with their partner, especially if that partner is not asexual or demisexual too. There can be lots of reasons the person isn't interested in sexual like the ick factor, feeling over-stimulated, etc. With a familiar person, they can feel more at ease.

Honestly, I think it might make sense as a modifier to other orientations rather than a distinct sexual orientation. I think it has solidified as a "thing" because of the tendency to pathologize a lack of interest in sex. Maybe it'll get its own scale one day with the Genderbread Person. Super interesting question!

The Genderbread Person 3.0

The Genderbread Person deconstructs gender and sexuality to clarify five dimensions of human identity and behavior.

publichealthpost.org

I’ve been reflecting on how we talk about identities like asexuality, demisexuality, and related experiences, and I wonder how much of this might intersect with the effects of SSRIs. Persistent SSRI-induced sexual dysfunction is well-documented, and given how common antidepressant use is, I wouldn’t be surprised if some people who adopt these labels have also experienced shifts in sexual desire related to medication. That’s not to pathologize the identities themselves - just an angle I think is worth considering.

That said, I find the behavioral and social aspects of sexuality just as, if not more, intriguing.

Take bisexuality, for instance. I have several friends who identify as bisexual but are in long-term relationships with men and have never dated women. For them, the label often feels less tied to specific behavior and more about signaling openness, safety, and alignment with inclusive values - essentially communicating that “I’m a safe person.” No judgment at all - just an observation about how identity can serve as a kind of social shorthand for deeper values or perspectives.

In fact, all of my bisexual friends are incredibly kind, empathetic, and socially attuned people. It makes me curious whether certain personality traits - like empathy, openness, or even cognitive style - might correlate with how people experience or describe their sexuality. I also wonder if those who identify as asexual, demisexual, or similar might lean more toward the “systemizing” end of the spectrum (as in the empathizing–systemizing theory), potentially overlapping with traits we associate with autism spectrum profiles. That’s purely speculative and would need solid data - but interesting to consider.

This all makes me think that, for many people today, sexuality can be as much about identity and meaning-making as it is about desire or behavior. That doesn’t make it less real, but it does shift the frame - from “Who do I want?” to “What does this say about who I am?” to others and myself.

Especially in the context of how media, porn, and evolving social norms influence our perceptions, it raises interesting questions about how fluid or innate sexuality really is.

I heavily edited my original post, If anything I said came across as dismissive or offensive, that wasn’t my intention at all.

SSRIs: Much More Than You Wanted To Know

The claim that “SSRIs don’t work” or “SSRIs are mostly just placebo” is most commonly associated with Irving Kirsch, a man with the awesome job title of “Associa…

slatestarcodex.com

 

[futureapppsy2]

I can dive more into the literature, but I imagine it's going to be sparse. When I see people discuss it, it seems to come up most frequently in the asexuality world to push back on expectations of how early relationships look.

If I rely on anecdotes, I most often see this term show up with people not generally interested in sex, but they can become more interested over time to better connect with their partner, especially if that partner is not asexual or demisexual too. There can be lots of reasons the person isn't interested in sexual like the ick factor, feeling over-stimulated, etc. With a familiar person, they can feel more at ease.

Honestly, I think it might make sense as a modifier to other orientations rather than a distinct sexual orientation. I think it has solidified as a "thing" because of the tendency to pathologize a lack of interest in sex. Maybe it'll get its own scale one day with the Genderbread Person. Super interesting question!

The Genderbread Person 3.0

The Genderbread Person deconstructs gender and sexuality to clarify five dimensions of human identity and behavior.

publichealthpost.org

Agree with this—I think demisexuality is more of an attraction style than a sexual orientation, whereas asexuality is a sexual orientation (different than, say, medically-induced loss of libido).

 

[psych.meout]

I’ve been reflecting on how we talk about identities like asexuality, demisexuality, and related experiences, and I wonder how much of this might intersect with the effects of SSRIs. Persistent SSRI-induced sexual dysfunction is well-documented, and given how common antidepressant use is, I wouldn’t be surprised if some people who adopt these labels have also experienced shifts in sexual desire related to medication. That’s not to pathologize the identities themselves - just an angle I think is worth considering.

That said, I find the behavioral and social aspects of sexuality just as, if not more, intriguing.

Take bisexuality, for instance. I have several friends who identify as bisexual but are in long-term relationships with men and have never dated women. For them, the label often feels less tied to specific behavior and more about signaling openness, safety, and alignment with inclusive values - essentially communicating that “I’m a safe person.” No judgment at all - just an observation about how identity can serve as a kind of social shorthand for deeper values or perspectives.

In fact, all of my bisexual friends are incredibly kind, empathetic, and socially attuned people. It makes me curious whether certain personality traits - like empathy, openness, or even cognitive style - might correlate with how people experience or describe their sexuality. I also wonder if those who identify as asexual, demisexual, or similar might lean more toward the “systemizing” end of the spectrum (as in the empathizing–systemizing theory), potentially overlapping with traits we associate with autism spectrum profiles. That’s purely speculative and would need solid data - but interesting to consider.

This all makes me think that, for many people today, sexuality can be as much about identity and meaning-making as it is about desire or behavior. That doesn’t make it less real, but it does shift the frame - from “Who do I want?” to “What does this say about who I am?” to others and myself.

Especially in the context of how media, porn, and evolving social norms influence our perceptions, it raises interesting questions about how fluid or innate sexuality really is.

I heavily edited my original post, If anything I said came across as dismissive or offensive, that wasn’t my intention at all.

SSRIs: Much More Than You Wanted To Know

The claim that “SSRIs don’t work” or “SSRIs are mostly just placebo” is most commonly associated with Irving Kirsch, a man with the awesome job title of “Associa…

slatestarcodex.com

This is after you edited it to not make it dismissive or offensive?

 

[Shiori]

I’ve been reflecting on how we talk about identities like asexuality, demisexuality, and related experiences, and I wonder how much of this might intersect with the effects of SSRIs. Persistent SSRI-induced sexual dysfunction is well-documented, and given how common antidepressant use is, I wouldn’t be surprised if some people who adopt these labels have also experienced shifts in sexual desire related to medication. That’s not to pathologize the identities themselves - just an angle I think is worth considering.

That said, I find the behavioral and social aspects of sexuality just as, if not more, intriguing.

Take bisexuality, for instance. I have several friends who identify as bisexual but are in long-term relationships with men and have never dated women. For them, the label often feels less tied to specific behavior and more about signaling openness, safety, and alignment with inclusive values - essentially communicating that “I’m a safe person.” No judgment at all - just an observation about how identity can serve as a kind of social shorthand for deeper values or perspectives.

In fact, all of my bisexual friends are incredibly kind, empathetic, and socially attuned people. It makes me curious whether certain personality traits - like empathy, openness, or even cognitive style - might correlate with how people experience or describe their sexuality. I also wonder if those who identify as asexual, demisexual, or similar might lean more toward the “systemizing” end of the spectrum (as in the empathizing–systemizing theory), potentially overlapping with traits we associate with autism spectrum profiles. That’s purely speculative and would need solid data - but interesting to consider.

This all makes me think that, for many people today, sexuality can be as much about identity and meaning-making as it is about desire or behavior. That doesn’t make it less real, but it does shift the frame - from “Who do I want?” to “What does this say about who I am?” to others and myself.

Especially in the context of how media, porn, and evolving social norms influence our perceptions, it raises interesting questions about how fluid or innate sexuality really is.

I heavily edited my original post, If anything I said came across as dismissive or offensive, that wasn’t my intention at all.

SSRIs: Much More Than You Wanted To Know

The claim that “SSRIs don’t work” or “SSRIs are mostly just placebo” is most commonly associated with Irving Kirsch, a man with the awesome job title of “Associa…

slatestarcodex.com

I know you're arguing in good faith. Let's see if we can find some common ground since this is an area of interest of mine.

With anti-depressants and other psychotropics, their use can often lead to discussions of personal clarity rather than an actual shift in orientation. If someone is feeling less anxious, depressed, compulsive, or traumatized, they may have more cognitive space and distress tolerance to consider their sexuality more deeply. Because there can be many negative outcomes associated with coming out as being part of the LGBTQ+ community, this can slow things down. Particularly with bisexuality, it is often easier to perform heterosexuality and not experience those negative outcomes. As people feel more confident and have more psychological tools, they may find more courage to own more parts of their identity.

The literature points to the innate nature of sexuality. Instead of looking at what is making people more "fluid," I would encourage you to think about what would make people, particularly in the last several years, more comfortable being themselves. I work with a lot of older adults and they talk about how they had to live in secret and under the threat of violence and loss. That is still very much a thing now, but there has been more overall acceptance. There are also more safety signals that suggest specific places are welcoming. When we drive things underground because we deem them socially unacceptable, people perform different norms to protect themselves. If we stop demanding that each person be deeply interested in sex and straight, we'll probably find that people align move closely to how they actually feel. As we see more hostility toward LGBTQ+ folks resurface, we'll likely see a shift in how open people are with their sexuality. Their sexuality didn't change, but the risk to their jobs, families, and lives make it less worth disclosure.

Another point is the orientation is about one's internal experience rather than overt demonstrations of sexuality or relationships. Just like single people don't lose their orientation when they're alone and not performing particular aspects of coupling, married folks are still very aware of who they are attracted to and in what ways.

And bi folks are viewed with skepticism across the spectrum. As a tool to signal safety, there are much better ones.

 

[borne_before]

This is after you edited it to not make it dismissive or offensive?

Oof, fair question. Yes, this was my “edited to be more respectful” version (which should give you a pretty good sense of where I started.) 😬

I know you're arguing in good faith. Let's see if we can find some common ground since this is an area of interest of mine.

With anti-depressants and other psychotropics, their use can often lead to discussions of personal clarity rather than an actual shift in orientation. If someone is feeling less anxious, depressed, compulsive, or traumatized, they may have more cognitive space and distress tolerance to consider their sexuality more deeply. Because there can be many negative outcomes associated with coming out as being part of the LGBTQ+ community, this can slow things down. Particularly with bisexuality, it is often easier to perform heterosexuality and not experience those negative outcomes. As people feel more confident and have more psychological tools, they may find more courage to own more parts of their identity.

The literature points to the innate nature of sexuality. Instead of looking at what is making people more "fluid," I would encourage you to think about what would make people, particularly in the last several years, more comfortable being themselves. I work with a lot of older adults and they talk about how they had to live in secret and under the threat of violence and loss. That is still very much a thing now, but there has been more overall acceptance. There are also more safety signals that suggest specific places are welcoming. When we drive things underground because we deem them socially unacceptable, people perform different norms to protect themselves. If we stop demanding that each person be deeply interested in sex and straight, we'll probably find that people align move closely to how they actually feel. As we see more hostility toward LGBTQ+ folks resurface, we'll likely see a shift in how open people are with their sexuality. Their sexuality didn't change, but the risk to their jobs, families, and lives make it less worth disclosure.

Another point is the orientation is about one's internal experience rather than overt demonstrations of sexuality or relationships. Just like single people don't lose their orientation when they're alone and not performing particular aspects of coupling, married folks are still very aware of who they are attracted to and in what ways.

And bi folks are viewed with skepticism across the spectrum. As a tool to signal safety, there are much better ones.

Thanks for this thoughtful response. I really appreciate how you described the role of safety and social consequences in shaping how people express and identify.

I work with someone from an Afghan family, and when I gently brought up the topic of sexuality, they hinted that even entertaining the fantasy could result in stoning. That kind of threat is still very real in many parts of the world, and sometimes even in certain communities here. Your point made me reflect on how what we call “fluidity” might sometimes just reflect changing levels of safety. When it's dangerous, people hide. When it's safer, people feel more free to live as they are.

At the same time, I do think something is happening with younger generations, where identifying with a marginalized group can carry a kind of social value that wasn’t present before. Not in a fake or insincere way, but identity today often communicates values, community, and safety. It can be a way of saying, “I am a kind and open-minded person.” That doesn’t cancel out authenticity, but it does shape how identity is expressed and understood.

You mentioned that orientation is about internal experience, not just behavior. I agree with that to a point. But the behaviorist in me still struggles with things we can’t easily observe. What counts as data when a third of college freshmen identify and LGTBQ+?

I also think about the Kinsey scale and how many people fall somewhere in the middle. If someone is a one or a five, does that count as bi? Or are we basing the label on behavior? That’s where the measurement psychologist in me gets curious. Are we measuring attraction, fantasy, relationships, identity, or something else entirely? These things don’t always line up, and that gap is where the confusion often lives. How do we operationalize these things - which is why the behaviorists still kind of win (that was my point).

On top of that, I wonder about how much our internal experience might be influenced by things we’re only starting to understand, like hormone-disrupting chemicals, stress exposure, or environmental factors. I’m not saying these determine identity, but they add complexity to the idea of what feels “natural.” In some online spaces, people identify as "pornosexual" or "gooners"...

And with rising hostility toward LGBTQ+ people, especially trans folks, I’ve already noticed people being more cautious about what they share. Their identities haven’t changed, but the risks have. That matters.

Lastly, I want to say I wasn’t trying to take a shot at bisexual people earlier. If anything, they get unfair skepticism from both straight and gay communities. If signaling were the goal, I’m sure people would pick a label that doesn’t get questioned so much. That was a miss on my part.

I know I can come off more curious than careful sometimes. I really appreciate the dialogue and the chance to think through this more clearly.

 

[Shiori]

Oof, fair question. Yes, this was my “edited to be more respectful” version (which should give you a pretty good sense of where I started.) 😬


Thanks for this thoughtful response. I really appreciate how you described the role of safety and social consequences in shaping how people express and identify.

I work with someone from an Afghan family, and when I gently brought up the topic of sexuality, they hinted that even entertaining the fantasy could result in stoning. That kind of threat is still very real in many parts of the world, and sometimes even in certain communities here. Your point made me reflect on how what we call “fluidity” might sometimes just reflect changing levels of safety. When it's dangerous, people hide. When it's safer, people feel more free to live as they are.

At the same time, I do think something is happening with younger generations, where identifying with a marginalized group can carry a kind of social value that wasn’t present before. Not in a fake or insincere way, but identity today often communicates values, community, and safety. It can be a way of saying, “I am a kind and open-minded person.” That doesn’t cancel out authenticity, but it does shape how identity is expressed and understood.

You mentioned that orientation is about internal experience, not just behavior. I agree with that to a point. But the behaviorist in me still struggles with things we can’t easily observe. What counts as data when a third of college freshmen identify and LGTBQ+?

I also think about the Kinsey scale and how many people fall somewhere in the middle. If someone is a one or a five, does that count as bi? Or are we basing the label on behavior? That’s where the measurement psychologist in me gets curious. Are we measuring attraction, fantasy, relationships, identity, or something else entirely? These things don’t always line up, and that gap is where the confusion often lives. How do we operationalize these things - which is why the behaviorists still kind of win (that was my point).

On top of that, I wonder about how much our internal experience might be influenced by things we’re only starting to understand, like hormone-disrupting chemicals, stress exposure, or environmental factors. I’m not saying these determine identity, but they add complexity to the idea of what feels “natural.” In some online spaces, people identify as "pornosexual" or "gooners"...

And with rising hostility toward LGBTQ+ people, especially trans folks, I’ve already noticed people being more cautious about what they share. Their identities haven’t changed, but the risks have. That matters.

Lastly, I want to say I wasn’t trying to take a shot at bisexual people earlier. If anything, they get unfair skepticism from both straight and gay communities. If signaling were the goal, I’m sure people would pick a label that doesn’t get questioned so much. That was a miss on my part.

I know I can come off more curious than careful sometimes. I really appreciate the dialogue and the chance to think through this more clearly.

You bring up interesting ideas and I think it can be helpful to pull apart a few pieces. Before we start introducing new variables like environmental factors and stress exposure, let's think through some other key parts.

What we're seeing in the younger generations is probably a less fearful exploration of identity earlier in life than we've seen recently. The United States has very specific cultural practices around sex, sexuality, and gender. These cultural practices aren't universal. We're not just watching young people explore gender and sexuality more openly, we're watching them do it in the context of United States norms which tends to be very binary. There is also a push for more rigidity to return to these interpretation.

Other cultures don't always have that very rigid binary. For example, our definition of "heterosexual" is pretty narrow and the rules that govern what it means to be heterosexual are pretty inflexible. If a man regularly participated in relationships with what would be considered more feminine presenting men, he likely would not be considered straight in the US by the vast majority of people. In other cultures, as long as the man in not in the "receiving" position, he is considered heterosexual. I'm also placing our language on their culture which gets muddy, but you can see what I'm getting at. There are lots of similar examples. Because monotheistic religions were enthusiastic about setting specific guidelines and expectations for culture, you'll see this rigidity in many of the places that were conquered and colonized. Outside of these places, you're more likely to see very different frameworks for understanding attraction, sex, and sexuality. Looking into "third genders" in different cultures can give insight. Sometimes we see something as universal when it's very culture-bound.

I am also very behavioral. When I think about sexual orientation and gender identity, there are a lot of ways to demonstrate these without it being overt to casual observers. But before even going down that path, I will say that I have never asked anyone to demonstrate their sexuality using a scientific framework. I have many veterans who have never been married and occasionally some who have never been in a relationship. When I ask about their sexuality, they still never hesitate to give me an answer. It's very often heterosexual. We can think through what we might use to objectively measure these constructs, but I wonder if it'll ultimately be an exercise in people having to prove they're not heterosexual because heterosexuality is considered the default.

Regarding pornosexual" or "gooners," digital subcultures are tricky. This feels like red and black pill content migrating into more mainstream circles with some of the intentionally subversive and trolling elements stripped away. It's almost taken seriously, especially with outsiders. I think the majority of folks still understand the joke. It's trolling that's got some believability because it's poking fun at something very real. I think this is a different phenomenon. This is not an actual orientation. Even the people claiming are usually claiming it in jest. It's also for mocking other people. The theme is often less sexuality and more nihilism. In the more benign forms, it's probably closer to a fetish. People can form identities around these fetishes (like furries), but it wouldn't be an orientation.

It's all interesting stuff though! If you want a dystopian deep dive, this has been an interesting read: Black Pill: How I Witnessed the Darkest Corners of the Internet Come to Life, Poison Society, and Capture American Politics by Elle Reeve.

ETA: I should clarify not all furries engage in the fetish part of the culture.