I can has white jacket

Language! It is powerful. I don't understand why cursing is so fucking liberating. If you have an explanation or a compelling reason for me to stop cursing, let me know. Meanwhile, I'll give my reasons for being careful with other sorts of words.

First up: more OCD. Yay! So, you know how people always say "I'm so OCD about this and that?" Well, most of the time THEY DON'T ACTUALLY HAVE OCD. More likely, THEY ACTUALLY HAVE OCPD. That's obsessive-compulsive personality disorder. If you are perfectionistic or anal, then you might have OCPD tendencies. If it doesn't cause major functional impairment, then don't worry; it's just a way of describing a certain personality. But let's take a look at the differences between OCD and OCPD. They are completely different disorders, but I've sometimes had trouble understanding the distinction. The topic came up at this year's IOCDF conference during a session about anticipated changes for the DSM-5. One change is the addition of an insight indicator to the OCD diagnosis. Previously, one of the distinguishing factors in my mind was the presence of insight in OCD vs. absence of insight in OCPD, but it turns out that people can have OCD with little or no insight. So someone asked the presenters, how do we differentiate? Duh, said the experts, OCD is characterized by obsessions and compulsions. kthx, experts. Then they elaborated and it made more sense, but it's still confusing. Consider someone with contamination fears (aka a germaphobe). The OCD thought pattern would be something like this: I just touched a doorknob. What if I picked up a horrible infection? I probably didn't, but what if I did? What if I spread the infection to everyone at school? I'd better wash just to be safe. But the washing will be excessive, and may have a specific pattern. If the individual washed her fingers in a certain order the first time she had these thoughts, and didn't end up spreading any infection, then she may have to wash in the same order each time. If she messes up, she may have to start over. She may have to scrub so hard that her hands bleed. She does not want to be engaging in this ritual, but it is the only thing she can do to get rid of her fear, even if she knows on some level that her fear is irrational. In contrast, a person with OCPD might have to wash her hands immediately before touching food, no exceptions, because she wants to! She'll be pissed if you don't let her wash, but there's no fear involved, and the washing isn't excessive except in frequency... I don't know if I made that any clearer. Post questions if you have them.

Next up: stigma. At my school's orientation, a presenter was telling us about student mental health services offered through the department of psychiatry. She encouraged us to seek help if we needed it, stating that mental health problems were not uncommon. "I'm not talking about schizophrenia or major depression" she said in an effort to dispel thoughts of the most stigmatized mental disorders. Maybe it was a necessary baby step, but at the same time that she was trying to increase the acceptability of mental health care, she was reinforcing the stigma surrounding serious mental illness. "And if the word 'psychiatry' scares you," she added, "here's another service you can use..." As a doctor I want to make some lasting contribution to health care, but I can't bring myself to try to understand the big things like law and policy. What I do hope to accomplish, at least on a small scale, is to change the way we talk about psychiatry and mental illness.

...and the way we talk about atheism. Yes, I snuck that one in there. I want to state briefly what my agenda is with all this talk of religion. Do I agree with any aspect of religion? No. Do I want to try to get rid of all religion? No. I have great friends who are religious. Some of our differences really just look like different ways of approaching the same task. I just want to establish non-theism as an option. Theism is so ingrained in our culture and language. It took me a while to stop saying "bless you" when someone sneezes, but I did it. Now I use various foreign language equivalents, which directly translate to "health." Ta-da! No god implicated. And when people say "thank god," I like to say "thank WHO?" Why? Because these people don't necessarily even believe in god. Some people who go to church or synagogue don't necessarily believe in god, but they do it because it's the norm. People celebrate religious holidays because it's tradition. But if Abraham had cared about tradition, we'd all be pagans. My point is not that Abraham existed or was good or that paganism is bad, but that every new tradition starts by breaking an old tradition. And that's what I'm trying to do, because my current knowledge is incompatible with traditions that started thousands of years ago. Religious organizations provide great social support for many people, no doubt about it. I'd like to see non-religious organizations reach that same level of outreach, so that people can give and receive support that is not contingent on religious affiliation, and can engage in communities that embrace scientific exploration and secular values. In order for this to happen, non-religious people with great ideas need to be willing to go against the norm. This is what I'm trying to encourage.

IDGRA what this post is called

Ever read something that made you cringe? That happened to me with my blog. Sorry. When did I become such an inefficient communicator? I hardly ever post and when I do post it's annoying. How about I try to post more and then just delete the shitty ones? Give up being so perfectionistic. I've always been that way. Didn't try to walk until I knew I could do it perfectly. But people like this about me--I don't talk unless I have something awesome to say. Okay, but sometimes it's maladaptive. e.g., procrastination. Maybe I'll not take it to an extreme.

EDIT: That first paragraph doesn't even make sense, but it therefore fits in nicely with the not-being-a-perfectionist theme. k that's all

Moving on. I've had the privilege of attending weekly case discussions with the anxiety disorders crew at SLBMI for a little while now. Awesome. Finally getting some exposure to OCD (no pun intended! lolz). Okay that was actually my boss's joke. Slash 10,000 other people's joke at some point I'm sure. Huh? Oh, sorry. Exposure and response prevention is a type of therapy for OCD. Have I written about that on here yet? Don't know. Anyway, it's all about facing things that cause you anxiety and saying So what? Yeah, this doorknob might be contaminated with all sorts of germs. Yeah, maybe I left the stove on and my house is gonna burn down. Probably not, but who knows? My carefulness is interfering with my life, so I'm gonna go to the extreme and see that the only real consequence is extreme anxiety, which subsides after a while and isn't going to kill me anyway or something. It's way more complicated than that but this is a blog, not an encyclopedia. Duh. I'll save the more extensive writing for the future when I have some more legit credentials and experience. (Did I mention that I'm gonna be a doctor? Yeah, it's happening.) Anyway, maybe an ERP-like technique can be applied to pathological skin picking after all. The patient can create a hierarchy of triggers. So suppose she tends to pick at her skin when she's in the bathroom, but simply going to the bathroom doesn't cause much anxiety. It's a few steps removed from the main trigger of looking in the mirror or touching her skin. But the behavior is so ingrained that sometimes simply entering the bathroom is enough to trigger the picking, even without any obvious anxiety and intention to relieve that anxiety. So that will be at the bottom of the ladder. She will need a response prevention tool, such as a stress ball. If the patient can make sure the stress ball is available, then she can prevent the semi-automatic picking behavior. Then we can move up the ladder to things like boredom and general anxiety about life, which often trigger picking. Response prevention: stress ball, maybe some mindfulness or relaxation exercises. Then at the top we have touching and looking at her skin. These, unlike the other triggers mentioned, are things that can be avoided somewhat. Previous treatment approaches have aimed for avoidance. The current approach uses that strategy to some extent; i.e., playing with a stress ball in order to avoid touching one's skin. The problem, though, is that sometimes the intention to pick is so strong and, from the patient's perspective, completely justified. And in some cases, the general population might see it as justified too. I mean who wants to look at a big old whitehead on the tip of someone's nose? Gross. But this is where the patient has to take her so what? to the extreme. No matter how gross it is, the response is so what? This will cause me anxiety, but so what? It will allow me to live in a way that I value. (The values thing comes from Acceptance and Commitment Therapy, btw.) Of course, this is at the very top of the hierarchy. There are other exposures to tackle first, such as more minor imperfections. Gradually, the patient will be able to sit with more and more anxiety and refrain from using picking as a way to rid herself of that anxiety.

(Okay, let's be real. The "patient" is myself, but I use third person because I'm playing therapist here, trying to present the case from an objective viewpoint but with a great deal of empathy for the patient... because she is me... so yeah. No, this is not a sign of Dissociative Identity Disorder.)

Next up (or maybe not): Which group is more hated, atheists or psychiatrists?