The psychiatrist refused to prescribe them, but he also couldn’t suggest any alternative: my case genuinely stumped him.
Generally, this awareness is brief; it's used for a joke or two and then never mentioned again.
Used this way, it's Lampshade Hanging as applied to Paratext. Compare with other metafictional devices, particularly Painting the Medium, which uses Paratext and artifacts to tell the story, and Reading Ahead in the Script which is exactly what it sounds like.
Because of my fears—my fears of being “outed” as a nerdy heterosexual male, and therefore as a potential creep or sex criminal—I had constant suicidal thoughts.
As Bertrand Russell wrote of his own adolescence: “I was put off from suicide only by the desire to learn more mathematics.” At one point, I actually begged a psychiatrist to prescribe drugs that would chemically castrate me (I had researched which ones), because a life of mathematical asceticism was the only future that I could imagine for myself.
You can call that my personal psychological problem if you want, but it was strongly reinforced by everything I picked up from my environment: to take one example, the sexual-assault prevention workshops we had to attend regularly as undergrads, with their endless lists of all the forms of human interaction that “might be” sexual harassment or assault, and their refusal, ever, to specify anything that definitely wouldn’t be sexual harassment or assault.