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 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.

Thursday, June 2, 2011

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?

Saturday, November 20, 2010

Why I started this blog, 4 months later

Oh yeah, I was going to write about OCD/OC spectrum (because I went to the International OCD Foundation's annual conference over the summer and it was really interesting)! So, OCD: persistent, unwanted thoughts plus repeated, undesirable actions in order to reduce the anxiety caused by those thoughts, but the actions have no logical connections to the thoughts or are excessive. OC spectrum: includes everything from eating disorders and Body Dysmorphic Disorder to pathological gambling and trichotillomania (hair pulling) and even autism and Tourette's Syndrome. All characterized by varying degrees of impulsivity and compulsivity. Say what? Basically, an impulsive behavior is one that provides pleasure or gratification, and a compulsive behavior is one performed to reduce anxiety. The two represent opposite ends of a spectrum (impulsivity is associated with decreased frontal lobe and serotonergic activity, while compulsivity is associated with increased frontal lobe and serotonergic activity), but they both refer to an inability to delay or inhibit repetitive (and ultimately unwanted) behaviors.

To illustrate, let's look at the completely random example of skin picking. I have concluded by highly unscientific measures that most people have popped a pimple or picked at a scab at some point in their lives. It's not hard to see why--you have a blemish, you get rid of it, you feel better. And for most people, it stops there. For some, however, there's more work to be done. If you look really closely, you can see tons of little blackheads on your face, and you must get rid of all of them if your face is to be truly clean. If doing so takes an hour and results in severe redness, so be it. At this point, picking is more than a bad habit--it is a compulsion.

The healthy majority who occasionally pick may even admit getting a sense of gratification from the activity--not just the satisfaction of knowing that you eliminated an imperfection from your skin, but the actual sensation of doing so. You may even look forward to the time when a pimple has grown enough so that you may pop it. But do you actively seek these opportunities, searching your skin for any little bump that you may squeeze in order to experience that sensation again? If so, then you may have an impulse control disorder.

Hold up now. Searching for blemishes? That sounds more like compulsivity. Indeed, searching might be a compulsive element that develops from an impulsive activity. And the impulsivity may evolve in the first place from compulsivity--the discovery of a pleasurable activity resulting from an initial desire to reduce anxiety. But now, are we talking about anxiety caused by the imperfection, which may be reduced by eliminating the blemish? Or anxiety from some other source which may be temporarily reduced by engaging in a pleasurable activity such as picking? And which of these corresponds to impulsivity and which to compulsivity? These questions are popping up as I write this, and honestly I'm not sure what the answer is. All I really know is that this stuff is complicated. And really interesting, in my opinion.

If any of this hits close to home for anyone, there's lots of help out there, including these online support groups: http://health.groups.yahoo.com/group/OCDSupportGroups/links
I will also try to answer any questions you may have. You can even comment anonymously!

Also, this is not related to OCD but it's related to mental health: See the movie It's Kind of a Funny Story for an honest, humorous, sensitive look at mental illness. Not that I'm an expert on mental illness, but I hope to be one someday. And I know that a big part of being an expert will be acknowledging that people are individuals, and I can never fully be an "expert" on anyone other than myself. A big part of understanding OCD, OC spectrum, and other mental health problems is putting aside preconceived notions about how people think.

Friday, October 15, 2010

Blog to restore sanity

Language is interesting. In Don't Sleep, There Are Snakes, Daniel Everett recounts his experiences as a missionary living among the Pirahã, a small tribe in Brazil. Everett eventually realizes that it would be impossible to translate the Bible into Pirahã because the language lacks the words to describe anything that was not personally witnessed or told to the speaker by a witness. This is consistent with their culture; the Pirahãs place importance on immediate experience. Claims necessitate evidence. There is no story of the earth's creation, and no sense of sin. As we say in one of my languages, "no day but today." Religion is incompatible with their culture and, consequently, their language.

Let's take a look at some other language that is incompatible with religion. Taken from my own comment on my own blog: I get my values "from progressive thinking rather than ancient, dogmatic works of fiction." I guess you could say I have strong feelings about this. I use these words to get my point across, which is important, but so is productive discourse. So perhaps I can use some more neutral words (as a side note--is "dogmatic" not a neutral word? It's a simple fact that many religions contain dogmas--principles that are not to be disputed--but the word is used disparagingly these days): I don't consider the Bible to be an authoritative source due to its unverifiable claims. I view science as a reliable source of information because it provides evidence and makes its methods known. So, what about morality? Thanks to innate characteristics and personal experience, I have a general desire to be nice and not kill people. Science doesn't tell us how we should act, but it can shed light on why we tend to act certain ways. For an example, see the Veritas Forum's discussion on altruism from last year.

It gets interesting at the end of that discussion when someone asks what happens when science and religion conflict. In my opinion, Sussman's answer--basically, that they don't conflict--is a cop-out. Of course they conflict. Now, is conflict inevitable? I have long been inclined to think so. However, the fact remains that in our society, both science and religion exist. In order for them to coexist peacefully, we have to find a common language. True, there are plenty of scientists who are also religious, and have attempted to bridge the gap, but belief is complicated, and there are always people who remain dissatisfied with some detail. So, are people's various beliefs so fundamentally different that they must conflict? Maybe, but it's still fun to look for that common ground. Philip Clayton does a pretty good job, I think, in this Assembly Series talk from 2008. Sure, I yelled at the computer a few times while listening to it, but it was better than anything I'd heard on the topic before. My main issue was with his use of the word "spirituality." He seems to imply that spirituality is a requirement for being human. But guess what? I don't need to be spiritual in order to enjoy life or appreciate nature. I have emotions. I just don't believe in anything supernatural. Can we expand the definition of spirituality or find another word that is more inclusive in describing the human experience?

Sometimes when I think about it too much, I become convinced that we are all saying the same thing, just in different words.

Sometimes, I think not.

And other times, I wonder how pushy I should be in advancing my cause. And then my dad sends me an article about a conference at which that very question was addressed.

Also, sometimes I have lots to say but can't figure out how to tie it in with everything else, but if you're like me and just can't enough of this stuff, check out this article, then follow the link to the author's blog and read the comments. That should keep you busy for a while.

So, in conclusion, language is interesting, I'm not sure if sanity was restored but I tried, and I like to write about religion.

Thursday, October 7, 2010

What if god were one of us?

I don't even know what that question means, really; I'm just quoting that song, but with proper grammar. Anyway, Grilled Cheesus lived up to my expectations. It was hilarious and touched on a lot of important issues. I just hope the episode's warm and fuzzy ending doesn't overshadow the fact that there are issues.

That's not to say that I don't appreciate the warmth and fuzziness. Like Kurt, I don't believe in god, but I believe in friends and family, and I am grateful that we can put aside our differences and hold hands and sing, literally and figuratively.

But, you know, there are still issues.

Okay, I think that's quite enough for now. But if you ever want to discuss/debate, just holler...

Monday, October 4, 2010

Return of the... METABLOG!

Bad thing: I discovered the page that shows me how many times my blog has been viewed.

So now I know that people are viewing it and choosing not to comment.
Here she goes with the obsessing...
Okay, but the thing is, with my last post I'm not looking for reassurance; I'm looking for other points of view. Mostly. It's true, though; the desire for reassurance is always there. Of course, I could interpret the silence as reassurance that everyone either agrees with me or has failed to come up with a strong rebuttal. But it is also quite possible that people are refusing to engage me in a conversation because they view my claims as radical or ignorant and doubt that I would understand any explanation that draws upon a religious perspective. Or maybe people are still thinking about how they would answer, and maybe they won't tell me, but would still think about it, which would be cool too.

Anyway, my main point is this: Reassurance feeds the OCD monster, but discussion feeds the intellectual monster. And maybe the OCD monster as well, actually.

Thursday, September 30, 2010

What would you do if you made a grilled Cheesus?

I have a question, but that's not it. That was just a trick to get Glee fans to read my blog. But in all seriousness, I really am curious what people think about the issue I'm about to discuss. Of course I have an agenda--don't we all?--but we can still converse and learn from each other. I'll go ahead and give my disclosures for the hypothetical readers who don't know me, or those who have managed to interact with me without learning my stance: I am a humanist. To clarify, as there are many different humanisms, the humanism I speak of is secular and rejects supernatural explanations of the world.

Now, my question concerns the holy text of the three major monotheisms. If I were to read the whole Bible, I'm sure I would generate an enormous list of passages that trouble me, but for now I will focus on Leviticus 20:13. (That's right, Jews. You are not exempt from this question. This shit is in the Torah.) Leviticus 20:13 is the verse that says that sex between two men is an abomination punishable by death. My question is, what does one do with such a statement? It's kind of a big issue, but I haven't been able to find an adequate answer. As I see it, there are four ways to go:

1. Uphold the holy word and sentence gay men to death. Lesbians, too, if you think that was implied. In this case, I would have to respectfully disagree. Scratch that--disrespectfully disagree.

2. Say that this is a misinterpretation; the real meaning of the verse is x. In which case I say, speak up!!! Tell me what it means! Tell everyone what it means! Stop the hate!

3. Reject this verse, but keep the rest. Which, of course, brings me to my preferred solution...

4. Reject the whole book. If you reject one verse because it doesn't fit in with your values, why do you even need the Bible? Clearly you are able to derive your values from other sources. Also consider, for a moment, creation myths. Why trust a source that has so much false information and hatred? If modern science and ethics shape your interpretation of the Bible, I don't see why the Bible is necessary. Some of the teachings of religion might turn out to be true, or good, but given how much we've already disproved or rejected, we know its methods are flawed. Allow science and your instincts to shape your understanding of the world. That's my two cents. But I want to hear yours.