Id Like To Write An Open Letter To The Whump Community About POTS.

I’d like to write an open letter to the whump community about POTS. 

I have noticed a recent uptick in people giving their whumpees POTS. I can see the appeal: it’s a seemingly innocuous, invisible chronic illness that is perfect, as your whumpee is delicate and prone to fainting. Great for whump, right?

Maybe. I suppose it checks the whumpy boxes, though the appeal really pales for me since I have to live through this hell every day of my life. But I would like to put this out there before you decide your blorbo needs to struggle with POTS. 

First off, for those who aren’t familiar, what’s POTS? 

Postural Orthostatic Tachycardia Syndrome is a chronic illness that tends to manifest later in life, often as a result of trauma, extreme stress, genetics or viral infection (cough cough covid). POTS is typically characterized by heart palpitations, chest pains, trouble breathing, brain fog, dizziness, and yes, fainting, though that happens rarely. It is typically caused by a dysregulation of the autonomic nervous system that causes blood to pool in the lower body, though can be caused by other things as well. Upon sitting up, standing up, standing for long periods, exercising/exerting, bending over or simply being tired or hungry or upset (among other things), your body will go into overdrive trying to get proper blood flow, resulting in a drop in blood pressure and massive increase in heart rate. Blood will pool in the feet and legs, your hands may get tingly, you get extremely sensitive to changes in temperature, you get migraines or headaches, light sensitivity, cottony ears, etc etc etc. POTS is a lot more than just being dizzy or weak. 

I personally am lucky enough (/sarc) to have hyperPOTS, a new type of POTS, caused directly by covid infection. I was perfectly healthy before getting covid. Hyperadrenergic Postural Orthostatic Tachycardia Syndrome causes an increase in blood pressure and heart rate upon sitting or standing, meaning my cluster of symptoms differs from regular POTS, though many overlap. To put it simply, WebMD does not really begin to cover the intricacies that are experienced with POTS.

POTS is an incredibly complex neurological and physiological issue that spans nearly every system in the body, including but not limited to the brain stem and central nervous system, the autonomic nervous system, the immune system, the cardiovascular system and the gastrointestinal system. POTS is an extremely hard illness to get diagnosed with let alone managed (because there is no cure), it is wholly debilitating (I am just finally clawing my way out of a year spent bed-bound; I am not exaggerating when I say it completely and utterly ruined my life), it has a shit ton of co-morbidities, it has various manifestations with different symptom clusters and it is very fucking hard to write respectfully. I would really consider, as an able-bodied or non-POTS individual, if you are capable of taking the time and energy to treat POTS with the respect we deserve and not create a voyeuristic caricature of our struggles for the sake of having an easy “fainting disease” cop out. 

I understand the appeal of it, really, I do. Personally I would never want to read POTS whumpees, especially considering how my experiences with fainting are some of the most traumatizing things to ever happen to me (and that’s saying something), but if you are going to write a character with POTS I really hope you will take the time to listen to personal statements, do your research, understand the complications related to it, and consider how individuals with POTS might feel about your use of POTS as an aid in whump. Do not use POTS as a tokenistic invisible disability. 

That said, if you are still wanting to write a POTS character, I will say this. Do you research, more than WebMD or whatever. What I am listing below is scarcely scratching the surface of what you need to keep in mind: 

Individuals with POTS do not have full mobility. Though it is invisible, everyone I know with POTS (and I know upwards of 5-6 people) has to use a form of as-needed mobility aid. Your POTS character would be really unrealistic and lowkey ableist if you don’t give them an as-needed mobility aid, such as a cane, walker or wheelchair. 

Individuals with POTS wear compression socks. This is one of the main things prescribed for POTS treatment. Do not exclude those just because it doesn’t fit your character’s aesthetic… again, I would hazard to say it borders on ableism to exclude the aids needed for functionality with POTS for the sake of your character’s aesthetic. (I cannot emphasize how much compression helps. If you want delicate fainting disease for your whumpee, then give them their fucking socks.)

Individuals with POTS have a lot of comorbidities, a lot of meds (I take my blood pressure 3x a day and meds 6x a day), a lot of experimental treatment, a lot of cardiac symptoms and a LOT of fucking doctor’s visits. I saw 9 doctors and went to the ER twice before my diagnosis. I currently have a specialist, a PCP, a dermatologist (blood related skin issues probably from POTS), a neurologist and a physical therapist. Others may have less, though some may have more depending on their symptom cluster. 

Fundamentally POTS symptoms are debilitating to the point where when I got my diagnosis, my doctor said, as I was laying down on the exam table because I couldn’t sit upright in a chair for duration of the visit, “You will need to work from home for the rest of your life, if you can even ever work again”. POTS is not an easy solution to wanting to whump your whumpee, and when you diminish it to fainting or dizziness, you’re doing the disabled community a massive disservice. 

Lots of individuals with POTS are fat from not being able to be mobile. At my worst, I couldn’t make it down a hallway without feeling like my heart was going to pop. People with POTS also have issues with developing muscle mass as they are unable to do cardio without having cardiac symptoms and flare ups, and also tend to skip basic grooming things such as shaving, because we only have so many spoons. 

That said, this doesn’t even really begin to cover everything related to POTS, tbh. 

I understand that people are not obligated to research the things they give their characters in fiction, and that whump writing is by and large a hobbyist thing, and therefore you can’t really fault a hobbyist for maybe not covering all their bases with realness. But I also would like to gently suggest that as a person, to keep in mind that you are portraying something that is an incredibly sensitive subject for the people who live it, and furthermore, you are closer to having this debilitating disability than you think.

As a final note, I have previously had people add “prompt lists” to past posts about things I struggle with & are poorly represented, so I would kindly ask for anyone missing the point of my post and getting “inspiration” or “whumperflies” to go ahead and not add your thoughts in that regard to my post. I am a real person. This is something that fundamentally has ruined my life, terrifies me and has caused me more pain than I thought possible. I am stuck with this condition for life. It is disrespectful to reduce my earnest frustrations about ableism in the community to inspo.

Best ways to restrain your Whumpees (a subjective scale)

Tied to a chair: 7/10. Classic, gets the job done. Rub their skin raw while you're at it.

Cuffed to the chair: 9/10. The more cuffs the better. Sure, cuff each wrist to an arm chair. But what if you also cuffed their wrists together with just enough slack so their circulation doesn't cut off? ... what if you didn't give them enough slack? What about their legs?

Chained to the chair: 4/10. Oppressive weight is nice and all, but unless you know what you're doing, these are easy to slide off and best used alongside other methods.

Strapped to the chair: 6/10. Better suited for impersonal settings.

Duct taped to the chair: 7/10. Potential 9/10 if you rip the tape off every time you move them. Do you do it hard and fast, listen to their sudden scream? Or do you do it slowly, savor each pitiful little whimper?

(Surgery required) Put magnets in their wrists: 9/10. Make them try to lift their arms, only to feel like their skin is ripping from the inside. Make sure they know you put the magnets in there. Nothing that will make them sick, you reassure. Just making sure they can't go anywhere without you un-magnetizing the arm rests.

Chained to the wall: 7/10. How much room do they have? Is it only one wrist, both on the same chain? Each one on opposite sides of the room? What about ankles? Do their steps rattle? Can they toss and turn in bed without making any noise?

Chained/cuffed to the floor: 10/10. Absolute humiliation. Forced to kneel, bow their head, cower like a dog before you. Their restraints holding them down every time they try to rise against you, reminding them of their place.

Ankles chained to a pole: 6/10. Oh sure, you can run. You just can't go very far. An interesting idea, but overall mediocre.

Leash wrapped around a pole: 8/10. Leave your pet unable to wander too far, perhaps keep their food bowl just out of reach. Make them dependent on you for bathroom breaks, food, and water.

Tied to a beam/pole: 8/10. How big is the pole? Are they tied so tight that all they can do is squeeze their shoulder blades together, and every time they try to relax the ropes tug them back? Is it large enough that their entire arms can wrap around it? A little too big for that? Did you tie up their feet as well?

Tied horizontally to a beam/pole: 9/10. So many ways this could go! Arms and legs above them like they're a pig on a spit, or one of those rotisserie chickens in the grocery store. Arms below, facing up, like they're laying in bed. Forced to look down at how high up they are, unable to do anything to get down.

Dangling by their wrists: 8/10. Once again, a classic choice. Rope or cuffs work here.

Dangling by their hair: 2/10. Not a long-term solution, hair will be pulled out. Only works with certain Whumpees. Only suited for short-term punishments.

Dangling by their neck: 7/10 if done right. Once again, a temporary solution best used to scare and threaten your Whumpee. I cannot overstate that you must be careful with this method if you like to reuse Whumpees. Remember to let your Whumpee down once they pass out!!

Dangling by their leash and collar: 6/10. Same concerns as above.

Dangling by their waist: 4/10. Has some potential, but have not seen it used much if at all.

Dangling by their ankles/feet: 5/10. A good way to disorient and weaken your Whumpee, but must be used in moderation. Excessive blood rush to the head can cause permanent damage and makes your Whumpee less fun to play with.

Standing in water: 4/10. A good short-term punishment, but can cause loss of toes and even feet of water gets too cold. Proceed with caution.

Gags: 9/10! Good for defiant Whumpees, Whumpees in transport, ones who can't learn the lesson not to speak. Just remember to take it off when you want to hear their screams.

Small rooms, holes in the ground, boxes: 8/10. Less about restraint, more containment, but still gets the point across. They cannot escape you, no matter how much they wish to.

I reiterate, leashes: 10/10. Hold their leash at all times, and you'll know when they try to run away.

things people do after having a nightmare that isn’t crying

struggle to catch their breath

grab onto whatever’s close enough to ground themselves in reality

become nauseous / vomit

shake uncontrollably

sweat buckets

get a headache

things people do to combat having nightmares if they occur commonly

sleep near other people so they can hear the idle sounds of them completing tasks

move to a different sleeping spot than where they had the nightmare

leave tvs / radios / phones on with noise

just not sleep (if you want to go the insomnia route)

sleep during the day in bright rooms

things people with insomnia do

first, obviously, their ability to remember things and their coordination will go out the window

its likely they’ll become irritable or overly emotional

their body will start to ache, shake, and weaken

hallucinate if it’s been long enough

it becomes incredibly easy for them to get sick (and they probably will)

add your own in reblogs/comments!

whumpers who are impossible to bait. whumpers who never get angry. whumpers who dont entertain pointless arguments and screaming matches. whumpers who are so confident in themselves and the fact that they hold all the power that they know they dont need to engage in any of that. whumpers who can smile in the face of a raging snarling feral whumpee because theyre untouchable and theyve already won

power signalling

Kneeling.

Ordered to kneel as punishment or as a show of deference.

Shoved physically to the ground by hands on their shoulders, maybe a kick to the back of the knee.

Picking themself up off the ground but only getting as far as hands and knees.

Crawling because they haven't got the strength to stand anymore.

Dropping to their knees from exhaustion or despair.

Personal space.

Casually invading it.

Uninvited touch - from the deeply creepy to something as simple as a firm hand on the shoulder.

Standing too close - especially if taller or otherwise physically stronger.

Conversely, hurrying to get out of someone's way.

Eye contact.

Staring someone down. Who is the first to look away?

Averting eyes for one's social superiors. Trying to de-escalate by avoiding eye contact.

Too frightened or ashamed to look someone in the eye.

Insisting that someone maintain eye contact while you're talking to them. Insisting that someone never look you in the eye.

Singling someone out just by looking at them.

More generally, Attention.

The room falls quiet when they walk in.

Who cuts in, and who gets talked over. Ignoring those who are beneath your attention.

The excited attention given to the object of respect and idolization.

The careful, wary focus given to a potential threat.

Deliberately attending to something else to appear less threatening. Deliberately burying oneself in something else to avoid attracting unwanted attention.

Codified status behaviours.

Bowing to one's superiors. Bonus points if there are differentiated kinds of bowing for different status differentials.

Soldiers coming to attention when a superior officer comes.

Saluting. Who greets whom first?

Serving food in a particular order.

Standing up when a respected person enters the room.

Non-verbal threats.

Just resting a hand on a weapon, or perhaps even just near a weapon.

Cracking knuckles or rolling shoulders. Clenched fists. The little come-get-some-then life of the chin.

Stepping from a conversational stance into one that's balance for fight or flight.

Pointing a weapon at someone. Casually brushing aside a weapon.

Conversely, de-escalation and surrender.

Open hands, spread in front of them. Hands above head.

(Raised slowly, transitioning from the simple whoa-calm-down gesture to full on surrender as the situation gets tenser.)

Going still. Slow, careful movements being sure to keep hands where they can be seen. Laying down weapons.

Hands on head. Getting down on the floor. Deliberately making oneself vulnerable to prove non-hostile (or non-resisting) intent.

Alternately, deliberately showing "vulnerability" to demonstrate how little of a threat you consider the other person.

The slouch of villainy. Open posture, casual, relaxed in the face of apparent danger.

Casually putting weapons away or turning one's back, confident that they won't do anything.

Signs of fear.

Flinching. Trembling. Closed defensive posture. Tension. Backing away. Fidgeting. Lip-biting.

Arms hugged close to chest. Or refusing to lower defences. Checking for escape routes. Trying to insist that they don't come any closer.

Offer of or requests for help.

Extending a hand to help someone up off the ground. Reaching out a hand in silent plea.

Do they have to ask for help? Are they willing to accept it? Do they get a choice? Who has plenty and who has to rely on the other's goodwill?

Picking someone up off the ground. Carrying them. (Dropping them?)

Adjusting someone's clothes. Withholding aid.

credit:@just-horrible-things // @whetstonefires suggests:

A character can vastly expand their area of influence by laying a hand on a table, for example. If you're standing on opposite sides of a large table, and one of you puts your hand down, that can symbolically take you up into the other party's personal space in a much subtler and more deniable way than actually getting up in their face.

This can be used equally well to convey affection or threat.

Notes on passing out from pain

-it's a dramatic concept, but it's not dramatic for the person it happens to. There's no warning or noticable buildup, you just fade out

-by the time you're at the point of passing out, the crescendo of pain that causes it has been there for some time, there's not really a sudden spike that sets it off

-essentially your brain decides "this has been going on a really long time and it doesn't look like we can stop it so I'm just going to shut off and hope it goes away"

-it doesn't last long, just 5-15 minutes at a time, followed by you being awake and in pain for about the same time before your brain goes "whoops, guess it's not over" and shuts off again

-this on again off again bullshit can go on for HOURS, basically as long as you are in that level of pain (i.e. I woke up at 8am and it's now 1pm; I have passed out more than a dozen times)

-the worst part is that you don't notice it happening

-it's incredibly aggravating especially when you dream about being productive/somewhere else/wherever you planned to go before this bullshit wrecked your day while you're out, and then have to wake up to another round of passing out without having accomplished a goddamn thing

-it's also aggravating because you can't control it; you can't see it coming so you can't fight it, your brain just decides it knows better than you and shuts off

-so imagine a whumpee who keeps passing out and dreaming of rescue, or completing their mission, or escaping the whumper, or fighting back (and winning)

-imagine this happening over and over, not just aggravating but horribly traumatic and essentially a kind of torture in itself, their own body and brain betraying them

-passing out from pain is a pain in the ass, feel free to explore every aspect of it