Sunday, August 21, 2011

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 door-nob. 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.


  1. I totally agree with the last part. Why cant athiests come together and reach out to other people for no other reason but to help them? Or would athiesm become another sort of religion in trying to convince people that god doesnt exist?

  2. We totally can; it's just taking some time to catch up with religious groups.

    If someday we were to find scientific evidence for the existence of god and atheists were to go on being atheists, then they would just be subscribing to another sort of religion. However, those who adjust their views based on new evidence have a world view that is completely different from religion.