Tag Archives: International OCD Foundation

Tuesday Q&A: David Adam

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This Tuesday we’re hearing from David Adam, author of The Man Who Couldn’t Stop, 2015 recipient of the International OCD Foundation’s Illumination Award, and 2016 OCD Conference keynote speaker.

I’ve had several different themes of obsessions, and many people I know who have OCD do, too. David struggled with just one, a fear that he’d contract HIV/AIDS, and maybe you do, too. It’s another reminder that OCD is crafty and takes on many forms, but no matter what forms it does take, it’s treatable.

Your keynote at the OCD Conference was titled “The Accidental Advocate”—you said you never expected your book would lead to speaking at schools and answering emails from others with OCD. What was your purpose behind writing the book?

To tell what I thought was a great story. The more I researched and read about OCD and the science and the history, the more I got the sense that there was something in it that people would want to read. And then the journalist in me kicked in and said that I wanted to write it all down before someone else did!

The Man Who Couldn’t Stop was a little different from other first-person narratives in that it included an in-depth account of the history and science behind OCD. Why did you want to write about OCD in this way?

That was the stuff that I was most interested in. The personal narrative stuff almost came later in the writing, as a way to stitch all the material together and to provide a narrative structure. Books, I have learned, are all about narrative structure!

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Writing and speaking about your OCD helps people with OCD feel less alone, particularly those who relate to your AIDS-related obsessions. Has being open about it helped you as well? 

Yes, it’s helped with the indirect harm that was caused by previously keeping it (or anything that central to someone’s life) secret. But it hasn’t helped with the actual symptoms of the OCD, and why would it? If only it were that simple.

During your keynote address, you mentioned that while many people have told you you’re brave for sharing your story, you think young people taking on advocacy are the truly brave ones. Why did you say that?

Because to an extent I have little to lose. I am in my 40s, have a wife and children and a job. I think it’s brave to confront a situation like OCD head-on when you know that it could follow you around—when one goes for the job, for instance. And because it takes guts to do so rather than try to pretend it wasn’t as serious as it was, which I did as an excuse not to get help.

Although you didn’t mean to become an advocate yourself, do you have any advice for my readers who want to get into advocacy themselves?

One reason I was hesitant is simply because there are plenty of organizations who do it so well, and who would welcome help I am sure—just Google your local OCD charity or help group!

OCD kept its grip on you for many years, but it wasn’t until after you became a father that you became serious about addressing your obsessions and compulsions head-on. Can you tell us more about that?

I simply didn’t want to do anything that would make my daughter (at the time, now a son also) more likely to follow me and to develop OCD. And after I started to involved my daughter in my own OCD thoughts and rituals, then that was the push I needed.

What do you consider the biggest misconception about OCD?

That’s it’s about behavior. It’s a pathology of thought. And that is what makes it so difficult.

If you could share just one piece of advice with others who have OCD, what would it be?

Tell someone, a friend or family member. And then realize it’s a medical problem that probably won’t go away without medical help.

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Tuesday Q&A: Aaron Harvey

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AaronHeadShotOn March 21, I shared a link to IntrusiveThoughts.org on my author Facebook page and said, “I am so excited about this new website!” And I really was. Not only was it all about the intrusive thoughts that plague those of us with OCD, it mentioned all the secret shameful ones like pedophilia and harm, and—and!—it’s gorgeous. Looks shouldn’t matter, but let’s face it: Important, life-saving information served up in an attractive package certainly doesn’t hurt.

Aaron Harvey is the man behind the site, and I’m honored to host him today. We met in person at the OCD Conference in July (haven’t I told you like a million times that you need to go to the conference?), and he was warm, smart, funny, and open. He’s been talking about things many of us are still keeping to ourselves. But Aaron doesn’t want anyone else to hurt the way he hurt for so long, and that’s what keeps him talking and what inspired him to start IntrusiveThoughts.org. Thank you, Aaron, for being here today and for everything you’ve done to help people with OCD.

After suffering in silence and confusion for decades, you finally realized that your disturbing intrusive thoughts were symptoms of OCD, a treatable disorder. Unfortunately, you’re not alone in this—too many people go undiagnosed and untreated for too long. What sets you apart, though, is that you almost immediately undertook an ambitious project to spread awareness so no one else would have to suffer as long as you had. Where did your idea for IntrusiveThoughts.org come from?

I lived silently in fear for two decades unaware that I had a mental disorder. In March 2014, my mental health had really deteriorated. So I finally got the strength to search “violent thoughts” online. Within seconds, I read a list of symptoms for Pure O. My heart was on the floor. I couldn’t believe what I was reading. Every symptom. Check. Check. Check. In that brief moment, I was relieved and terrified at the same time. What did this mean? The symptom list confirmed to me that I was an animal. As I continued my search, I found an article on the Guardian. The author, Rose Bretecher, humanized the suffering of OCD in an absolutely humble, honest, and beautiful way.

For the next six months, I would only share my disorder with a few close friends and family. And I could only do it by sending them the link and saying, this is what I’ve been dealing with since a child. I had to read it verbatim to my parents because I was too emotional to use my own words.

That’s when I knew I needed to build something that helped to humanize the experience. And two years to the day following my Google search, I launched IntrusiveThoughts.org. I wanted to find people who might be suffering from OCD, but are unaware, just like me. I wanted to build a site that brought comfort to people seeking their symptoms, and push them on a path to treatment, offsite.

My goal was simple. Save one life. Prevent one person from self-medicating. Reach a younger audience to help them live a normal life—one that, sadly and admittedly, I did not have.

If you could pinpoint one thing you want IntrusiveThoughts.org visitors to walk away with, what would that be—and does it depend on who the visitor is?

I want sufferers to realize they have a chance at happiness. I want sufferers and their friends and families to be able to relate to the disorder, understand its brevity, and utilize it as a jumping off point for treatment. You are not alone. And you are no more likely than anyone else to act on your thoughts.

You and I both struggled with taboo obsessions, those sticky intrusive thoughts that are really embarrassing and difficult to talk about. But you were candid and brave much sooner after diagnosis than I was. How did you find the courage to tell wide-reaching outlets such as Self, Cosmopolitanand Fast Company about your violent and sexual thoughts? And what kind of response have you gotten from readers, friends, and family?

I remember the night before the site launched, my tell-all article was queued up to launch in FastCompany.com and soon my family, friends, clients and employees would know what’s in my head. That night, I really started to question what I was doing. And if it was worth it or not. But ultimately, I laddered back up to my mission to build awareness and advocacy. With my role in the advertising industry, I have a unique opportunity to use my skills to spread that message. So I basically said, fuck it. And let Fast Co know to run the article.

As I started to receive more inquiries about more taboo topics like sex, it certainly was getting even more personal and invasive. But ultimately, I have to ladder back up to my mission—build awareness and advocacy. Sex is a huge part of life. And sex can be an extreme challenge for people with OCD. It’s an imperative that we discuss these taboo topics to help those suffering know that they are not alone, there are tips and tricks to improve your sexual experiences, and you can have an open dialogue with your partner.

I mentioned that you were diagnosed decades into your struggle with OCD. What’s your first memory of an obsession or a compulsion, and what finally tipped you off to the idea that what you had been going through was OCD?

In hindsight, I see there were so many now! But, the first intrusive thought I really struggled with was when I would pray. I grew up in a Christian household, and at night, at 12 or 13, I would say the Lord’s Prayer as I went to sleep. As I reached the end of the prayer, I would have an intrusive thought of my cumming on Jesus’ face. Shocked and horrified, I would beg for forgiveness and repeat the prayer until I could make it all the way through. I remember each time I would get close to the end of the prayer I would be like “OK, almost there,” and then sure enough, I would cum on Jesus’ face.

From there, the sexually related OCD thoughts really took off. I thought I was a pedophile at 13.

A question I often get is “How did you tell your family about your diagnosis?” So I’ll pose this to you as well. Do you have any tips to share with my readers?

I flew to Florida to see my family. We sat on the back porch—Mom, Dad, and I. I pulled up my phone and said, hey, I’ve been dealing with something for a long time. I could see the mood got serious. I was choking up a bit trying to tell them. So I pulled up Rose’s article in the Guardian, and I started to read it line by line. As I hit a particular tough spot, I started to lose it a bit. It wasn’t until I read the entire article that I could start to tell them about how my experiences are different than Rose’s experiences. I told them not to mention it to me or ask me how I’m doing because it’ll just make it worse. In hindsight, I really needed to be more educated.

The home page of IntrusiveThoughts.org is supposed to do one thing: sum up the most important notes of the disorder in a way that is serious but digestible. I hope people who are nervous to tell their loved ones can say, hey, check out this link, this is what I think I’m going through.

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In your interview with Cosmopolitan, you said, “My experience with OCD is that your intrusive thoughts will try to disrupt the most beautiful moments in your life.” I always say OCD is tricky, and it’s a bastard, too: You had upsetting, graphic sexual and violent thoughts while you had sex with your ex-wife, and this took a toll on your relationship. What advice do you have for someone with similar obsessions who may be avoiding intimacy because of them? 

Transparency. That’s the most important thing. Because of my distance due to fears of intrusive thoughts, my ex thought there was something wrong with her. It led her down a depressive cycle. It’s really important to share these thoughts with your partner. Beyond that, there are tips and tricks that I’ve learned that might help people. Mindfulness. Focus on the breath. When thoughts get disruptive and start to avalanche, pull your partner closer, go slow, engage in foreplay, live in the moment, don’t worry about the end result. Mindfulness is really key to being able to enjoy a sexual experience. To let the thoughts pass and stay in the present.

So many people with OCD unknowingly undergo the wrong treatment for OCD, usually “talk” therapy where they’re asked to delve into their childhood to determine where this mess all came from. You’re currently practicing exposure and response prevention (ERP) with a therapist. How did you find someone qualified to help you tackle your OCD symptoms, and how did you determine that they were indeed qualified? 

The sad part is, you really don’t know. Sure, you can read someone’s credentials on a website where they state “OCD” as part of their specialty, but you really don’t know. You must be educated first. You are the CEO of your recovery. Not some doctor or therapist.

All that said, you do have a few starting points as Dr. Phillipson points out in the OCD3 video series. (1) Work with a behavioral psychologist. (2) Work with someone who specializes in OCD, someone with many cases under their belt, a track record, not a generalist. (3) Interview them to make sure they speak intelligently about OCD, OCD treatment, and ERP. Again, this step requires you to be educated first.

IOCDF has a directory of OCD specialists in the US.

Also, it’s important to note that many people suffering from OCD may also be suffering from depression, generalized anxiety disorder, addiction, body dysmorphia, etc. It’s critical that your behavioral psychologist actually understands these elements and how to build a treatment plan for you.

How are you doing now, a few years after you were diagnosed? I often tell people that the goal of treatment shouldn’t be to never, ever have a bad thought again, because it’s simply not realistic. Do you still experience intrusive thoughts?

I struggle every day. Some days worse than others. No day is easy. I have pretty severe depression as a result of two decades of self-hatred. I have very little self-worth. There are no accomplishments that help to prove me wrong—whether it’s owning an agency, starting a non-profit, etc. So my treatment is very challenging, because when you have harm OCD where you’re plagued with constant thoughts of self-harm, and you also have depression, the combination can be very dangerous.

If you could share just one piece of advice with others with OCD, what would it be?

Let people in on your secret.

Tuesday Q&A: Tim Blue

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TimandWifeTim Blue and I met the way I’ve met so many of my incredible “OCD friends”—at the national conference the International OCD Foundation puts on every summer. (Seriously, you should go!) He’s such a nice guy, and we have a lot in common, which is always refreshing. In fact, that’s kind of the idea behind his blog and Facebook community, To Know We Are Not Alone: There are others out there like us, so let’s help each other! Let’s not suffer in solitude when someone else with OCD is right there on ye olde Internet ready to chat.

You have a great blog—and also a Facebook community—called To Know We Are Not Alone. How did this come about?

Frankly, my blog came about because I battle intense loneliness, especially in regard to my mental illnesses. I’ve found that people who are mentally ill tend to either keep it to themselves or keep to themselves. It’s very hard to find people who truly understand. I originally intended that the blog would become a forum for community. It has, but only to a very small extent. I guess it has served to help me find people who appreciate what I’m doing, but I don’t think it has done much to help others find new friends. I’ve decided to take the next step with it and move toward forming a nonprofit that aims to educate and encourage, but once again, I’m very hopeful that I will figure out a way to help other struggling people find each other.

Tell us more about why you decided to start a nonprofit. Do you have anything in the works?

The truth is that, over the past few years, I have found myself unable to sustain a go-into-the-office-every-day sort of existence. I’ve had to turn my attention to my mental health in ways that mean radically altering my life. But at my core, I love connecting with people, helping people, teaching people, etc. The reason I’d like to take the next step is that I find myself at a crossroads in my professional life, and I can’t think of anything I would rather do than to turn my passion for writing, teaching, and speaking into something that might (fingers crossed) grow into something bigger than just me writing my blog. I’d like to get others involved, and I’d like to expand the resources I offer, and starting something official seems like a good next step.

Why do you think knowing we’re not alone is so therapeutic?

When I taught high school English, I used to periodically ask the question, “If you could live forever, would you want to?” The first question was always, “Would my friends and family live forever too?” When I told them “no,” about 90% said they wouldn’t want to live forever. I suspect the other 10% would eventually regret it, too, because I think that human beings are “herd animals.” I can’t speak for others, but I know that I have battled a fierce loneliness my entire life, and I’ve always looked for ways to find out if others are thinking like I think or feeling like I feel. When I find someone who really understands my idiosyncrasies and oddities, it’s like getting a new lease on life. I don’t know exactly how it all works, but I think quite simply that our hard-wiring is for being in a group, and that requires not just physical presence but emotional, mental and even spiritual connection.

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Your blog fulfills its mission: You do a tremendous job at helping people with mental illness—and their loved ones—feel less alone, and that’s because you’re candid. I know how hard it can be to be so open about something many people consider embarrassing or taboo. Did you make a conscious decision to be so transparent, and did it take a while to get to where you are now?

What a great question! I don’t remember making a conscious decision, but I spent over 30 years hiding my struggles from everyone. Those closest to me knew I had my quirks and anxieties, but we never talked about it, and I never pursued professional help. I guess eventually it sort of just burst out of me—first in the form of a self-published book and then in the form of the blog. It took so much energy to pretend that I just couldn’t (or maybe wouldn’t) do it anymore. I’d call it more an act of desperation than a conscious decision. But I wouldn’t go back to faking it for anything.

One of the things you’ve been candid about is self-harm—you’ve cut yourself at times. What would you tell someone who’s never done this and doesn’t understand why anyone ever would?

I could talk for a long time about this subject because it’s so misunderstood. I remember in the past, seeing students with the obvious scars from cutting themselves on their forearms. I didn’t understand it at all, even after I had been diagnosed with OCD and depression. Then…and I’m going to share something I’ve never shared openly…I had an experience that led me to understand self-harm. A family member and I had had a very rocky relationship for over a decade, and one day I decided to text him to see if we could try to talk things through. What came back was an onslaught of hatred unlike anything I’ve ever experienced. He accused me of faking my mental “issues,” said my wife and kids would be better without me, and told me he’d heard through the grapevine (despite living 1000 miles away) that the employer I had recently left due to depression was glad to finally be rid of me. At the time I had given up drinking, but that night I took it back up in earnest, and later that night, well past midnight, I sat there drunkenly feeling like every fear I had about myself and my worth had come true. It felt like this relative had spoken for everyone, and I wondered if what he had said was in fact true. There was no conscious decision to do this, but I was in so much emotional pain that I took out the pocket knife from my pocket and just started digging the blade into my arm. Rather than hurting, it sent a wave of relief coursing through me, and I kept going. Eventually, over half of my forearm looked like a rabid cat had decided my arm was the enemy. After I had done this once, it started to become a somewhat natural reaction to the emotional pain I felt, and I did it many more times (and I’m not saying I’ve done it for the last time either, if I’m being honest). Eventually, I came to find out that the reason people do this isn’t a cry for help, as so many assume. It’s actually basic chemistry: For some reason, when one is in intense psychic pain, physical pain actually releases chemicals in the brain that bring release. As I understand it, it’s sort of like a drug high in terms of how it relieves one’s brain. I’ve gotten so I can actually test how depressed I am by how appealing self-harm is. As I sit here now, it holds absolutely no appeal. I just think, “Ouch!” But when my brain gets turned upside down, so does the appeal of hurting myself.

As you might know, my blog is primarily about OCD because OCD is my primary diagnosis—so let me ask a few OCD-specific questions. How did you first realize you might have OCD? And once you were diagnosed, how did you go about treating it?

OCD is also my primary diagnosis. I wasn’t diagnosed until I was 25, but I remember symptoms from my earliest years of life. Growing up, I was just aware that I was more anxious that others, so I just thought of myself as anxious, not obsessive. Finally, in my 20’s someone mentioned that I should look into getting medication for my “anxiety,” and I reluctantly went to a psychiatrist. He diagnosed me within about 12 seconds with OCD. It was that obvious to him, and looking back, I can see why it would be so blatant to someone who knew what to look for. Like many, I was a reluctant patient for a while. I went on and off of meds, not to mention starting over and over with various doctors, for years. I resisted the idea of medicine and thought that eventually I would just figure out the magic cure. It took a breakdown that landed me in the hospital before I finally surrendered and starting working on my symptoms in earnest. Thus far, I have found medication quite helpful as well as mindfulness meditation, which, to me at least, seems very, very similar to exposure and response prevention therapy. Both involve accepting one’s situation just as it is, and that, oddly enough, is the key to a healthier view of the world you’re living in.

Can you tell us more about your obsessions and compulsions? Are there any that seemed more stubborn than others?

My obsessions and compulsions have gone through various phases. As a kid, I went through a couple of years of germophobia, washing my hands incessantly and so on. As an adolescent, my hyper-religious upbringing brought on a severe case of scrupulosity: I was convinced that every thought and action was somehow tainted, that I wasn’t really a Christian, so I would say the sinner’s prayer (asking Jesus to save me from my sins) literally countless times a day. I also had magic numbers to ward off the devil. Later in my teen years, my obsessions took on a sexual nature. I had been raised to remain a virgin till marriage, and like any other teenage boy, I put a very high value on sex. But I became convinced that I would be impotent once I could finally have sex. The incessant “checking” involved all sorts of things I won’t detail here, but I was never without the fear that the one thing in life I wanted most—sex—would be stolen from me by impotence. Finally, my obsessions have taken on the form of relationship OCD. Basically, I can’t quit evaluating or questioning my relationship with my wife. We’ve been married 13 years, but I still examine our relationship as if we are dating and thinking of marriage. It’s truly torture because I’m made and remade this decision so many times, and I’m committed to my wife and kids, so I know it’s a useless question. But it won’t stop hammering my brain. There’s never a moment I’m not evaluating and re-evaluating my relationship with my wife. If I’m with her, everything she says, does, wears, implies, etc. becomes part of this pile of evidence in my brain about the state of our relationship: Is it as good as it should be? What is my level of attraction to her at this moment? Am I in the right relationship? Even when we’re apart, I might look at others’ relationships and compare them to my own or look at the way some other woman does something and compare it to how Ann does the same thing. As you know, it’s torture. I’d give anything to make it stop; I know it’s illogical, but I can’t turn it off. Even in the middle of the night.

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Your book, Compelled: A Memoir of OCD, Anxiety, Depression, Bi-Polar Disorder, and Faith…Sometimes, discusses your Christian upbringing and how it affected your mental health. Specifically, instead of your struggles being as symptoms of a mental illness, they were seen as spiritual failings, as a lack of faith. This is far too common in many faith communities. How did you finally break away from that and get the help you actually needed, beyond prayer?

Wow. This one is huge. What would I give to have the hours back that I spent praying or worrying that I was not in God’s will?! When someone gets cancer, we consider them crazy if they refuse treatment in favor of just trusting God. But with mental illness, we are still pretty far behind in this regard. Until people see mental illness as every bit as “real” as a broken leg, we won’t be able to fully solve this problem of people thinking prayer can heal your OCD. Our friend Chrissie Hodges, who works with mentally ill patients all day, said that almost to a person, people’s various mental instabilities have something to do with religion. I also recently heard a statistic that something like 45% of evangelical Christians think that mental illness can be cured through prayer alone. For me, I still live very deeply entrenched in a community/social circle of evangelical Christians. I have people tell me almost every day that they are praying for me. Within the mental health community (counselors, groups, doctors) I think religion should be pretty much off limits. I’m fine with people telling others that if they have a faith tradition that they find helpful, by all means embrace it. But to me, when someone pushes their religious ideas on you, it would be just like me telling you that you need to take the same medications I’m taking. Obviously, that’s ridiculous. But with religion, that’s what people do because they believe they’ve found “the answer.” Religion helps a lot of people, but they need to be extremely careful about how they share that with others, because religion has also probably done as much damage to people as any other entity in history other than maybe the abuse of sex. These days, I am very much of the belief that one should evaluate for him/herself what is helpful and go with that. Meditation helps me a lot. Certain medications have helped me a lot. Meeting with friends who just listen and don’t prescribe helps me a lot. Maybe prayer will help Bill and nature hikes will help Sally and yoga will help Susie. We need to encourage each other to keep taking the next step, but we shouldn’t tell them exactly what that step must be.

If you could share just one piece of advice with others with OCD, what would it be?

I would give them the same advice I give myself: give yourself grace; you are fighting a very hard battle. Don’t berate yourself for something you can’t control. All you can control is whether or not you keep trying new things to see what might help. Don’t expect to get a magic cure. Try to find things that will help you take a small step forward. For me, Mindfulness Meditation has been a helpful step. For you, maybe it will be smoking cigars (that’s another of mine too). But I don’t want to tell you what will help you. There’s a lot out there. Just try something. Determine what a reasonable time frame is and if it’s not working, find the next thing. And find friends! And when you find them, introduce them to me, because I need them too!

Tuesday Q&A: Michael Jenike

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IMG_2367[1]In 2014 I attended my first OCD Conference, and I kept hearing snippets of conversation about this man, Dr. Michael Jenike. It was “Jenike this” and “Jenike that.” I finally asked my hotel roommate who Jenike was. “You haven’t met Jenike?!”

In 2013 Dr. Jenike had granted me permission to use his very helpful checklist for finding an effective therapist in my book, so when I met him at the 2015 conference, I thanked him. After all I had heard about him, I thought he’d have an intimidating, scholarly presence. Nope. Not so much. He said, “Where’s my cut of the royalties?”

Dr. Jenike is brilliant, yes, and he’s helped countless people gain control over OCD. But he’s really goofy, too. Going to this year’s conference in Chicago? See for yourself.

You’re kind of a big deal in the OCD community. You founded the Obsessive-Compulsive Disorder Institute (OCDI) at McLean Hospital, a world-renowned residential treatment program. How did that all come about?

After treating thousands of patients for a number of years, we realized that some patients did not improve despite medications and behavior therapy. I thought that perhaps a residential OCD facility where patients could stay for long periods of time might make a difference. We planned to do the same treatments, just for a longer period of time and more intensely. McLean OCD Institute has now been open around 20 years and the demand for services has not let up.

When you decided to go into psychiatry, did you know you’d end up treating OCD? If not, when and how did you decide to focus on this particular disorder?

I had no idea about OCD. In medical school I had a classmate who would miss many classes because he was in the bathroom washing his hands. I had no idea why he was doing that. I was going to be a surgeon and planned on going to Johns Hopkins for surgery. In medical school I had an inspiring teacher, Dr. Ronald Krug, who thought I would like to take a psychiatry elective with a local psychiatrist. This was an amazing experience and I could see that if you were aggressively working to help people with real expectations that many got better or improved markedly. Prior to that elective, I mostly saw psychiatrists as talkers and not result oriented in medical school. I was always a results oriented sort of person, thus my interest in surgery. However, there were some awesome psychiatry lectures in medical school and I thought it would be great to learn psychiatry, but I had no intention of becoming a psychiatrist. I asked the doctor in charge of the elective and Dr. Krug where the best place to learn psychiatry was, and they said Massachusetts General Hospital (MGH). I applied and was accepted for training and finished up there and stayed on the faculty ever since.

While in residency at MGH I saw a few OCD patients and was fascinated with these patients who would do crazy and seemingly purposeless rituals for hours despite being totally sane. They were really nice people but they were suffering as much as anyone I had ever seen. I was always interested in lessening people’s suffering so this intrigued me. Also, the total lack of knowledge in my supervisors about OCD was astounding. No one thought they could be helped. OCD became my hobby. During these early years of my career, I ran the MGH inpatient psychiatric department and founded and ran the MGH dementia clinic for about 15 years. I mostly published in geriatrics and dementia with occasional OCD papers. We thought OCD was very rare. Out of the blue, the Larry King TV show called me and wanted me to go on the show with an OCD patient. Their request was for me to discuss where you could shoot yourself to improve mental illness. There had been a report of a young man with depression and OCD who shot himself in the front of his head and he recovered and his OCD and depression were gone. After that, we got over a hundred calls a day for a long while. The OCD disorder that we felt was very rare was obviously not uncommon. Soon after a large study came out showing a prevalence of OCD of over 1 percent of the population. With the onslaught of OCD patients I gradually shifted to mostly doing OCD clinical work and research. Over the next few decades we branched into all kinds of clinical trials, genetic studies, neuroimaging studies, and innovative treatments. The staff grew to over a hundred people, and we now have a huge clinic at MGH headed by Dr. Sabine Wilhelm that specializes in OCD and also related disorders like body dysmorphic disorder, trichotillomania, Tourette syndrome, et cetera.

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You contributed to Life in Rewind: The Story of a Young Courageous Man Who Persevered Over OCD and the Harvard Doctor Who Broke All the Rules to Help Him. That’s a long subtitle—did you really break all the rules, and did doing so change the course of OCD treatment for generations to come?

I don’t really worry about the rules if they get in the way of patient care. I was told when I was in training that psychiatrists are not allowed to make house calls but my patients were stuck and could not get out of the house so I saw no other way. I don’t break rules just to break them (I hope). It seemed silly to have a nonsense rule that prevented very ill patients from getting help. We have systematically set up a group of master’s-level clinicians to go into people’s homes to treat severely ill patients. I do think this is a model for the country but funding is a problem. I have gotten around this by very generous donations from a few people that allow me to pay these clinicians well to do this work. I still spend much of my time out of the office seeing people on their turf. I find this fun and exciting, and the results can be fantastic. Ed Zine, the person in the book you mention, is doing great. He has two teenage daughters and a wonderful wife. He has gone back to school to become a therapist and wants to help OCD patients. He will talk to patients on the phone to help motivate them. Could anything be more rewarding?

Jeff Szymanski said he credits you with setting the tone of the annual OCD Conferences because you were always willing to answer questions after your sessions—once for 12 hours. I’ll quote him here from the wrap-up podcast he did after last year’s conference: “If you see Dr. Jenike, shake his hand. He really set that norm of, ‘You’re here, you’re working, you’re going to be generous.'” Did these early experiences surprise you, or did they confirm what you already knew, that people desperately needed help and resources for OCD?

That was always my style. I gave the keynote talk at the Boston annual conference and after there were many questions. I told the audience I would stay till all their questions were answered. After a while they moved us to another room, and I was there over 12 hours, and it was a totally amazing experience. Each question is worth taking seriously as sometimes you answer a question or send a patient to a good clinician and that few minutes changes their or their children’s lives forever. Each year at the annual conference people come up to me and report how well they are doing. Life is short; if I can make such a difference it makes what I do totally worthwhile. This is such rewarding work.

Through my advocacy work I’ve met lots of other people with OCD, and so many of them either refuse to take medication in the first place or decide to go off it because they see it as a crutch. Say you have a patient you think could benefit from medication, but she is either afraid or thinks taking medication is a sign of weakness. What would you tell her?

This is always a hard problem. Sometimes medication helps a lot and people decide to stop it even though they are not having much in terms of side effects. If people get well after long periods of illness, there are demands on them. Work. Family. Dating. Et cetera. It is sometimes easier just to go back to the old and “comfortable” illness. Some people almost see OCD as an old friend. I explain that using meds for OCD is really no different from a diabetic using pills or insulin to control their sugar. The person has an illness and the medication can help them lead a more normal life.

Who can benefit from a residential program like OCDI? Would an individual with OCD enroll only after exhausting medication and outpatient ERP?

Usually outpatient treatment like behavior therapy and medications are tried before the OCDI. Most patients at the OCDI have not done well with these treatments.

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I have what some people call pure O; I mostly struggle with obsessions and don’t perform physical compulsions such as hand-washing. How would my OCD be treated at OCDI? 

Patients with so-called pure O all have compulsions but the compulsions are mental. If you look at it like that, the treatments are similar. They can read Lee Baer’s book The Imp of the Mind for detailed instructions on how to manage the thoughts. Everyone has intrusive thoughts but they pass through the brain quickly if you don’t have OCD. If you have OCD, the thoughts can get stuck and a person will ruminate about the thought; what it means, are they a bad person, et cetera. The pure O patient has to learn to just let the thoughts be there and not analyze or ritualize about the thought. Similar to a person who washes away contaminants; they just contaminate themselves and then not wash.

If you could share just one piece of advice with someone with OCD, what would it be?

Don’t let your OCD go untreated. Thousands of people just accept OCD and don’t take advantage of treatments that may do a world of good. OCD sucks the enjoyment out of life and life is meant to be enjoyed. It is short (I realize this more now that I am older) and there is no cosmic requirement for lifelong suffering.

Tuesday Q&A: Kevin Putman

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Kevin and his wife, Tana

Tuesday, Tuesday, Tuesday! Welcome Kevin Putman, one of last year’s recipients of the IOCDF Hero Award—and with good reason. He’s done a tremendous amount of awareness building in his small community in Michigan and has shared his unique idea for OCD advocacy with the larger community as well: Ping Pong 4 OCD. Maybe you’ve played ping pong at one of the OCD Conferences and met Kevin yourself. He’s funny, approachable, and tireless in his efforts to get people to the right treatment sooner.

Last summer at the International OCD Conference you were presented with the IOCDF Hero Award—and you were very deserving! Tell us what you’d been doing in advocacy to get you on the hero radar.

It was unexpected. I see so many people doing so many big things and I always feel like I’m not big time, or doing big things. It just doesn’t seem like it to me, but I guess it seems like it to someone. There are three main things that I do. One is an OCD support group here in Petoskey, Michigan, where I live, and that’s top on the list for sure. That’s really giving back and helping out. We do that once a month. I really enjoy doing that. The other thing that I have going on — I like to say “we” because it’s the community here — is RUN OCD, which is the nonprofit organization, and the big event is Ping Pong 4 OCD. We do those events here in Michigan and we do them in conjunction with the International OCD Foundation. We’ve kind of branched out and some other people have taken that torch and run with it in their community. I also work with Christian Benway. He’s brought in the disc golf for OCD side of RUN OCD.

You have OCD yourself. Can you share some of your OCD story with us? When were you diagnosed, and how did you realize something was wrong—and that it could be OCD?

My formal diagnosis didn’t come until I was married with kids. Actually, my wife was the one who diagnosed me. I self-diagnosed, but I probably didn’t get an official diagnosis until I was almost 30. Looking back on it, I know that I have had OCD since forever. I can’t think of a time that I didn’t. But in college I was taking a psychology class, Psych 101. We were talking about anxiety disorders, and one day the topic happened to be OCD. I’m just some college kid taking notes, but some things my professor was saying were relating so much to me it was crazy. It was like someone was punching me in the stomach every time he said, “Someone with OCD does this, and they do this.” It was real stuff. At that point I still wasn’t convinced; I thought, “Oh, this is just a coincidence.” But from there I started to pay attention more, and once I got married and started living with my wife she started noticing a lot of stuff—the checking, the rechecking, and a lot of other things I was doing that revolved around OCD.

Once you knew it was OCD how did you go about treating it?

Well, at first, I went to a counselor locally. I went to a handful of counselors here in this town, and the unfortunate part was that there wasn’t really anyone who knew what to do, so I wasn’t treated how I needed to be treated for a long time. I had a handful of counselors where I would go in and they would just accommodate me and reassure me— it was almost like my weekly reassurance session. I’d save up all this stuff I was anxious about and I would say, “Here’s what’s going on” and we’d talk about how things are going to be all right, it’s gonna be okay, the total opposite of what we needed to be doing, which was to build that anxiety up. So it wasn’t really until I got into the Houston OCD program that I started hitting hard and started working on ERP. My wife is a counselor, and she had read Loving Someone With OCD, and that book talks a lot about the family accommodation piece. She had already started doing that before I went to Houston; she was not accommodating at all at home because she’d read that for her to be checking locks and checking the stove for me was not the right thing to do. That was a huge, huge benefit to have her. To have your wife be a counselor is a lucky thing.

So do you live in a relatively small town? Is that why there weren’t that many people who knew about it?

Right, exactly. I live in Petoskey, Michigan, which is a super small resort community, and anyone who really specializes in OCD would be in the Detroit or Lansing area, which is like three hours away from here. Our counselors up here have to be so broad; they can’t just focus on OCD because they wouldn’t have enough clientele. They have to do the full gamut, and that means they may or may not be up on what the correct practices are. Now that I have gone to the conferences and gone to the Houston OCD program and I’m running this OCD support group I’ve made myself available in the community as an OCD resource. So whenever I talk to anybody, whenever anyone calls me, and they tell me that they’re in counseling, I always ask, “Have you ever heard of ERP?” I would say 99.99 percent of the time they say no, and they’ve been treated by a counselor for a while. It’s a little bit scary to me, still, but not everybody knows it. I’ve been trying to bring that in, too, when I talk to people. I just met with someone the other day, and they were sharing with me, and they had never heard of ERP. They’re a big research type of person, so I said, “Google it, and if you’re not doing that with your counselor, you need to find someone else.”

How did you go from that to the Houston program? Did you find out about it on your own, like doing Internet research?

My wife found it. I have “just right” OCD; my OCD revolves around checking, and I do a lot of symmetry and over-responsibility. All of my symptoms crashed down on me all at once. I didn’t want to move one way because it didn’t feel right, or I’d have to move back the other way. I didn’t want to turn anything on because I’d have to turn it off. I was sinking into this deep, deep depression, and I was suicidal. I was not functioning. I was on the couch, burying myself underneath a sleeping bag, and I was making a plan to kill myself. My wife was like, “Okay, we’ve got to do something.” She called Community Mental Health here in town and they said, “O-C-what?” It was like, “Are you kidding me?” At first I was going to go out to McLean in Boston. That was the original plan, but they were full and couldn’t take me. This was on a Thursday or Friday, and my wife said, “No, he’s got to get in now.” She called the Houston program and they said, “All right, we’ll see you Monday morning,” and we went.

Did you have kids at this point?

I did. My kids at the time were three and six.

You started a nonprofit called RUN OCD. First of all, explain the name for some of my younger readers. 

[Laughs.] Isn’t that funny? We were looking for a cool T-shirt to make, so it wasn’t supposed to be what it happened to be. I’m a big hip-hop guy from back in the day, so we looked at the logo for RUN DMC, the rap group from the 1980s, early ’90s. Their logo looks exactly the same except it says RUN DMC and ours is RUN OCD. So at first it was just a play on words and a T-shirt, and then when Ping Pong for OCD started happening and Christian and I were both speaking and we were doing support groups and events, we realized maybe this is bigger than we thought it was going to be. People will always ask, “What does it mean?” I wish there was a straight answer but there’s not. It’s kind of what you want it to be. A lot of the time we say it’s to run your own OCD or to take charge, don’t let OCD run you, run your own OCD. It’s neat to see who gets the RUN DMC reference and who doesn’t. I like that it’s ambiguous because it makes people ask questions. You walk down the street with a RUN OCD T-shirt on and someone’s like, “What do you got going on there?” And it opens the door for conversation and for sharing. It’s inevitable—if you talk with someone they’ll be like, “Oh my gosh, my cousin, my brother, myself” has OCD, and it opens that door. I have met so many people and built so many relationships just because I was walking down the street wearing the shirt or the hat. I’ve considered changing the name, I’ve considered adding a tag line, I’ve considered all these things, but I really like that people have to ask because then the conversation can start.KevinPingPong

Let’s talk about ping pong. I love it, but what I like most about it is seeing how many times my partner and I can go back and forth, so I wouldn’t win any tournaments. What gave you the idea to introduce ping pong to the OCD conference? 

We’d done a couple of ping pong for OCD events in Michigan, and they were fun. And I’d been going to the conferences and it seemed like you’d get into the evenings of the conferences and there was not a ton to do. They had some evening activities, but a lot of times the conferences are in these gigantic towns and you don’t necessarily want to venture out into San Diego or Chicago—of course there’s cool stuff to do, but you’re meeting people and you just end up staying right in the conference hotel and want to spend time with these folks. So I thought, “Man, we have all these big conference rooms that we use during the day but we don’t use in the evenings, so wouldn’t it be neat to just clear them out and put in some ping pong tables?” Then people can come in and they can hang out and it’s a nice networking time, a nice ice-breaking time. The kids really like it too because the conference has a bunch of kids and they can’t go out to the bars or the restaurants, really, and they’re looking for something to do in the evening. It’s something that people of all ages and all skill levels can participate in. We tried it once and people liked it and we kept doing it.

I think most of us with OCD have pet peeves about how misunderstood the disorder is and how the misconceptions are perpetuated. How do you feel about things like someone saying, “I’m so OCD about how I organize my clothes”? 

Some people get all fired up about that kind of stuff. I know there’s a huge side of the OCD community who thinks that’s blasphemy and thinks it’s disrespectful. That bothers me none. What bothers me is people in the OCD community who are bothered by it because I think it’s silly. I think there’s so many more places that we can put time and energy into than chasing down someone who says, “Oh, I’m so OCD about organizing my groceries.” I just think it’s a null point and I don’t care one bit. I really don’t.

What would you say is your biggest OCD awareness accomplishment?

The first ever Ping Pong 4 OCD tournament we did in my hometown in 2011. It just came out of nowhere. The response from the community was super cool. Every person I talked to said yes, everywhere I went somebody donated something, gave me something. It was just really cool and the neat part about it was that the whole idea behind Ping Pong 4 OCD stemmed from starting a support group. When I was in the Houston OCD program I had found huge value in the Houston-area OCD support groups, which weren’t affiliated with the program. It was people coming from the community and all walks of life, different shapes and colors and sizes, and I thought that was so cool. My therapist talked to me at discharge about how I needed to find an OCD support group when I went home, and I said, “We don’t have one.” She said, “Well, you’re going to have to start one.” I was trying to figure out how you start an OCD support group. What, you put a sign in the door and say, “All right, OCD support group tomorrow night!” You’d be sitting in a room all by yourself. We needed an event or a gimmick, basically, to get people together to get this support group started, so we organized a ping pong tournament. We just had this small little table in the corner that had some books and some pamphlets about OCD awareness and a sign-up sheet that said, “I’m interested in attending an OCD support group.” We never announced that we were doing that; it was just ping pong all day long, but the people who needed to find that table, and the people who needed to put their names on that list, did. From that list we got the OCD support group started and we’re still doing it five years later.

If you could give just one piece of advice to someone with OCD, what would it be?

Laugh. Because it’s really funny when you think about it, the things we do. It’s just funny. And if you can use humor as your friend I think that’s a huge piece of recovery.

Tuesday Q&A: Jeff Szymanski

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JeffIsSittingI know what you’re thinking: How do you pronounce that name? As far as I can tell, it’s something like Shhhhhmanski. But here’s the thing: You can probably* just call him Jeff! He certainly deserves the respect and honor of being called Dr. Szymanski, but he’s friendly and open enough that you’ll find yourself on a first-name basis.

*For the record, he hasn’t authorized me to say you can call him Jeff.

Jeff Szymanski has undertaken the incredible responsibility of leading the International OCD Foundation. It’s a job he seemed born to do. He doesn’t have to have OCD himself to go to bat for us — he seems as genuinely frustrated as we do when he hears “I’m soooo OCD” or that OCD is all about a germ phobia. He’s working hard to overcome stigma and spread the awareness OCD — and its sufferers — so desperately need.

Tell us how you came to be the executive director of IOCDF.

In 2001 I was hired as a staff psychologist at the McLean OCD Institute in Belmont, Massachusetts, a suburb of Boston. In 2008, as the Director of Psychological Services there, I became aware of the transition at the Foundation. Namely, that the organization was moving from New Haven, Connecticut, up to Boston. During my tenure at the Institute, while I was able to help many people with OCD and related disorders, what I was continually frustrated by was the lack of access many individuals with OCD had to effective care. I worked with many people, who, if they had gotten the right treatment years before, would not have had to suffer unnecessarily for so many years. When I was offered the position at the Foundation, I realized it would give me the opportunity to work on a much larger scale to help those affected by OCD and related disorders in a more macro way.

During the 2015 conference wrap-up podcast, you mentioned that your motivation to become a psychologist wasn’t primarily about helping people. However, that’s exactly what you’ve been doing. Did you make a conscious decision to make that shift, or did it happen naturally?

When you apply to graduate school you are asked to write a “personal statement.” That is, “Why do you want to be a psychologist?” When I look back at what I wrote then, it was true. I wanted to understand why people did what they did. Why they made the choices they made. This is still the primary driving force in my career. At the Foundation, the question changed to “Why, as a society, can’t people who need access to help get access to that help? How do we, as a group, make decisions in which people who could get better aren’t given that opportunity?” At my core I am a problem solver. I am curious. I like solutions.

I don’t see my role as helping people. I see my role as empowering people, giving people access to resources and tools to help themselves. Maybe it’s semantics, but it is how I think about things.

What do you see as the biggest misconception about OCD?

I wrote a blog a few years back entitled “The ‘D’ in OCD.” I think this captures my thinking about this to this day. If you confuse being “obsessive” or “compulsive” with OCD, then it is easy to dismiss or minimize the experience of actually having OCD. The other common misconception concering any disorder, is that our mental health is 100% determined by our willpower. Our brains, our physiology, the power of habit and a lifetime of habits (that may or may not have ever been “chosen”) are incredibly powerful. When we say to someone, “Don’t be so anxious,” or “You don’t need to worry so much,” we are enacting the fallacy that we can “control” our anxiety or worry.

What advice do you have for someone who may not have ready access to the proper care, whether because they live in a rural area in America or in another country?

The Internet is the great connector! There are amazing online support groups and a “virtual” community that is willing to be there for people all across the globe. I believe accessing a community can be incredibly healing. There are also more and more internet-based services for people who need more structured support: some therapists treat clients via skype, and there are now numerous smartphone apps to help with self-directed ERP. Here are some of those resources.

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Every once in a while someone will email me from another country and say they can’t tell their family or friends about their OCD because their culture doesn’t accept mental illness or has strong stigmas against it. How can someone in that situation get support? And how can we help spread awareness in such countries? 

As noted in my answer above I think that people can connect via the Internet if they have access. This issue is also the main motivation in changing our name to the International OCD Foundation. To widen our focus to those all around the world affected by OCD and related disorders. And to bring together those willing to help. It has been an incredibly rewarding experience to build our Global Partnership program. So much more room for growth there, however. In 2015 we appointed our first international spokesperson, Ro Vitale, specifically to help increase awareness and combat stigma in Latin America. We look forward to continuing to expand Ro’s role in that regard, and continuing to partner with other organizations with similar missions around the globe. With more awareness there will be more acceptance.

The IOCDF recently launched a new initiative, asking people to become OCDvocates. Tell us more about that.

When I took over the Foundation in 2008 there was so much infrastructure and programming we were focused on building. During those first few years we received an increasing number of people saying they wanted to be part of the mission. But, we didn’t have a place to “plug them in.” Last year, our Director of Marketing and Communications, Carly Bourne, along with our amazing Spokespeople, Jeff Bell, Elizabeth McIngvale, Romina Vitale and Ethan Smith all collaborated to come up with the OCDvocate program. The idea is to have grassroots-based activities and “calls to action” that anyone who would like to participate in can join. An example of this is the holiday card initiative this past year. We asked our OCDvocates to write a personal note in a holiday card so that we could mail them out to patients currently receiving treatment at residential and intensive outpatient treatment programs around the country. Patients were able to receive words of encouragement from those who knew what it was like to be where they were at in that moment and to continue to fight to get their lives back. Anyone can become an OCDvocate by filling out the pledge.

What would you tell someone who feels hopeless, who thinks his or her OCD will never get better?

I borrow this from the acceptance and commitment therapy (ACT) community: With or without OCD symptoms, what really matters to you in your life? At the end of it all, what do you want your life to stand for? And OCD symptoms or not, how can you commit to making those values a reality?

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Let’s say I’ve never been to the IOCDF’s Annual OCD Conference before. Why should I go?

This one is your hardest question! This is like learning to play tennis by reading a book about how to play tennis. The sense of generosity and community at the Annual OCD Conference is powerful and you can only truly understand it if you have attended one. I believe one of the most valuable experiences for those affected by OCD and related disorders is to find a community like this, and the Annual OCD Conference exemplifies that in spades!

One of the most common stories I hear from others with OCD is “It took me umpteen years to be diagnosed because I thought people with OCD just wash their hands a lot.” Another is “I did talk therapy at first and that made my OCD worse.” What can we do as a community to dispel myths about OCD and make sure therapists know how to properly treat OCD?

This is a core issue that we focus on every day at the Foundation. Raising awareness about what OCD is and what effective treatment looks like. This is the driving force behind all of our initiatives from the Conference to the Walk to OCD Awareness Week to the OCDvocate program. It is all with the intention of making sure that if you are affected by OCD or a related disorder that you have access to the help you need.

One thing that helps tremendously with this, is people like you being willing to share their stories publicly. Whether through a blog, or book, or simply by talking with family and friends. The more representations we have of what OCD actually looks and feels like, the more people will be able to identify their symptoms and find the right help. Sharing stories also helps to dispel myths and combats stigma by putting a (familiar) face to the disorder. Stigma is so often based out of fear and a lack of understanding. By sharing your story, you are actively helping to eliminate that fear.

If you could offer just one piece of advice to someone with OCD, what would it be?

Get connected. Get involved. On any level.

Tuesday Q&A: Denis Asselin

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Denis on his pilgrimage

Welcome back to Tuesday Q&A! I admit the hiatus wasn’t exactly planned; life and the holidays conspired to throw me off schedule.

I couldn’t be happier to kick off the New Year with this post from Denis Asselin, an amazing advocate who’s been working tirelessly and with compassion to spread awareness about body dysmorphic disorder (BDD) since his son, Nathaniel, committed suicide after struggling with the disorder for years.

We all know how misunderstood OCD is, and it’s possible BDD is even more misunderstood. Denis is working hard to change that. His dedication is inspiring — and, honestly, he is so nice. Incredibly, genuinely nice. You can’t help but want to help him tell Nathaniel’s story and join his cause.

I’m always amazed to see what a parent is capable of after the tremendous pain of losing a child. After your son, Nathaniel, committed suicide you took action. Since 2012 you have participated in your initiative, “Walking With Nathaniel,” walking thousands of miles and raising thousands of dollars to spread awareness of the illness that led to Nathaniel’s death, BDD. Tell us why.

What does a parent do when s/he loses a child? Initially, cry a lot. What an incredibly sad event! Losing a child is the ultimate loss, and definitely not the natural order of things. The event and its repercussions were so significant. We were like ants at the base of Mt. Everest, required to climb to the very summit. I not only lost my personal and spiritual “equilibrium,” but initially I also lost a sense of purpose for living. As a father, I’m instinctually programmed to preserve and protect my children, and through no fault of my own, it felt as if I had failed in that critical mission. So what’s next when the void looms so large before you?

I distinctly remember seeing myself at a junction, the intersection of two possible paths to take for the rest of my life — one was to inevitably fold into myself, live in constant self-pity, be perpetually grumpy, and see myself as the ultimate victim. The energy required in the choice of that particular path would be dark, negative, and all-consuming. My social arena would close and include no one else; I would be a hermit and I would yell and blame everyone for everything, consider the universe totally unfair, and spread an aura of darkness wherever I found myself. The other road led to slow and progressive healing, to an eventual reordering of my life with what is (not what should have been). Bitterness would eventually melt away, and new possibilities would slowly reveal themselves and emerge. I would slowly see beauty and light pierce the huge darkness and recognize once again the gift of possible life and living before me, rather than a death in life. That vision/possibility included a forward movement — first in small steps and then in bigger ones. To me, walking forward reflected that outward expansion and healing.

After my wife, Judy, and my daughter, Carrie, and I returned from Spain where we had walked for three weeks on the Camino de Santiago after Nathaniel’s death, I felt as if I had more walk in me. Every time I took a step forward, I felt much better. At first I started to walk in circles (daily walks around the neighborhood) in wider and wider concentric circles. It was during those circular peregrinations that I hatched the plan to walk in a line rather than in a circle from our hometown (Cheyney, PA) to Boston, MA. I envisioned a new kind of “pilgrimage” à la El Camino, but here in the USA instead — a personal spiritual and physical journey of healing. I asked myself, “What would it look like to walk out my front door and go to Boston (the home of the International OCD Foundation), connecting along the way all the happy and sad chapters/places/events in Nathaniel’s life like dots on a trail map (where he was born, where he went to school, where he got his first job, where he died, where he was first hospitalized, where he stayed in clinics and treatment centers thereafter, where he had appointments with his doctors, psychiatrist, psychologists, and counselors)?” The imagined trajectory spanned 552 miles to Boston where he had spent an entire day in the Emergency Room at Mass General back in 2009 desperately seeking help because he couldn’t do “his life” anymore. I wanted my pilgrimage to end at the Boston harbor, at the water’s edge (just like Finisterre over the cliffs of the Atlantic in Spain at the end of the Camino). I would then face toward the east where the sun rises — again a symbol of an opening rather than a closure. That is how the Camino de Nathaniel was born and executed in 2012.

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Denis walking with Nathaniel

Tell us about Nathaniel. What kind of kid was he? What was he passionate about?

Nathaniel was an amazing human being. His spirit could fill the room, so could his physical presence — he was tall, handsome, fit, intelligent, highly responsible, sensitive, compassionate, loving, magnetic, funny, engaging, strong, athletic, generous, quick of mind, creative, energetic, positive, in brief a very old soul. I’m not saying this because he was my son. I recognized his incredible gifts and talents starting on the day he was born. He stared me in the eyes letting me know he was ready to journey forth. His close friends, Judy, Carrie, and extended family members would also describe him with the same litany of adjectives. Everyone loved Nathaniel. His force field was so strong. Everyone wanted to be his friend. Everyone wanted to be in his presence. Unfortunately, OCD/BDD slowly gnawed away at these incredible positive attributes during the long years of his illness. But even in the depth of his sickness, those deeply rooted qualities still radiated through in some recognizable measure. He was passionate about running, playing, and engaging in creative and imaginative games, staying fit, and doing his very best at all the time.

When was Nathaniel diagnosed with BDD, and how did you realize something might be wrong?

Unfortunately, the BDD diagnosis came much later during his 13-year illness, when he was 17. He was hospitalized at 11 for OCD behavior (but somehow the diagnosis seemed incomplete and not totally accurate). Then we began to see him spend more and more time in the bathroom grooming himself, worrying about flab on his tummy (there was actually none there) and imagined dark circles under his eyes, the placement of his hair, and the quality of his skin (any marks on his face would ruin his day and keep him in the bathroom for hours picking at it). He spent less and less time with his friends and worried more and more about his appearance and looks. He would look away and avoided eye contact. He shaved in the darkness in the bathroom, and returned repeatedly thereafter checking on imagined flaws on his face that he saw in the mirror. He literally got stuck in the mirror and the bathroom for hours on a daily basis. His social circle and connections began to get smaller. His social life slowly diminished. School became an issue. He would always overdo his assignments, not be able to live with anything less than perfection, and even be hard on himself for not knowing in advance what a teacher was going to teach him that day before s/he did. We had to withdraw him from formal schooling by his sophomore year in high school. The initial change in personality and in behavior came quickly at age 11 and then it was the unpredictable roller coaster ride up and down during the subsequent years as therapists, counselors, doctors, and we tried to understand what was going on with our dear boy/young man.

Why do you think so few understand what BDD is? How would you explain it to someone who has never heard of it before?

BDD is poorly understood because it hadn’t been recognized as a disorder until the mid 1980s. Katharine Phillips put the brain disorder on the map with her famous book The Broken Mirror. Everything she described in the text, Nathaniel had and had experienced. Although the disorder label was publicly available, very few therapists recognized its behavioral manifestations in their patients. If you were tall and handsome and beautiful like Nathaniel, would you feel comfortable announcing to others that you were obsessed all day with unrelenting worries about your looks? Folks would think you were vain. So, in general, sufferers tend to say nothing. They simply suffer in silence. Unlike the other OCD-related disorders, BDD self-awareness is rather poor. We now know that a BDD sufferer has perceptional processing problems, which accounts for the distortions described above. Nevertheless, what a sufferer sees, s/he totally and truly believes to be true. It is difficult for that person to achieve any level of objectivity. It affects up to 2% of the population. That’s a high percentage rate, yet mention BDD to anyone on the street, and you get a blank stare in return. Nobody seems to know it. Given the high suicide rate in the rank of BDD sufferers, we have a fatal illness on our hands, in my opinion. Medication dosage administered is usually twice as high in BDD cases than for the other OCD-related illnesses. Effective treatment protocol needs to be slowly and methodically administered if the sufferer is to experience any kind of relief. Of course, there are various levels of BDD illness. In hindsight, I think Nathaniel had the worst case of it. Although we sought the help and advice of the best professionals in the field, Nathaniel’s BDD progressed. There were some moments of hope for healing along the way, but the relapses were cruel and drove him even further down into the pit of despair. He could not imagine growing old with this impossible illness, and adopting a lifestyle that would require regular medication, counseling and, perhaps even occasional in-patient treatment as a tune-up. For Nathaniel, this was not a life to live for!

How is BDD related to OCD? Do they share any treatment methods, such as therapy or medication?

The obsessive behavior of BDD sufferers is similar to what we see in OCD. However, there are many differences. I do know that the SSRIs used in treatment for BDD are almost double in dosage for effective treatment than those used for regular OCD patients. Although there are day clinics and treatment programs specifically for BDD patients, those sufferers who need hospitalization or overnight surveillance are usually grouped with OCD-ers. Good BDD therapists would suggest that the treatment protocol be administered at a slower pace and that CBT treatment be more specifically tailored to this disorder. Of course, addressing the perceptional distortion remains key to healing. This would require visual retraining that works in tandem with the long-term behavioral restructuring required for control of unwanted thoughts.

Nathaniel

Nathaniel

Let’s pretend I’ve said the following to you: “The issue is that people today are just too caught up in material things and their looks. If they would just stop being so vain and focus on their inner beauty this wouldn’t be a problem.”  

A BDD sufferer is anything but vain. H/she is a silent sufferer of his/her illness. The inner turmoil is constant and very unrelenting. Sufferers usually don’t dare to mention what’s on their mind 24/7. Why would they? No one would believe them based on what the observer sees. Reassurance given by others is only a temporary patch of relief. It never lasts long and only fuels the retched beast. Unfortunately, those who are rich and have the financial means have recourse to plastic surgery as a temporary solution to their angst. Unfortunately, those procedures only give temporary relief, if any. Think Michael Jackson — so many surgeries that eventually his whole face totally appeared distorted by those interventions. But he had the money to pay, and no doubt the plastic surgeons involved didn’t dare to question the patient’s motive to assess whether or not BDD was the root of the malaise. I’m so appreciative of Reid Ewing, the actor on ABC’s Modern Family, who recently came out and publicly announced that he suffers from BDD and that all the plastic surgeries he underwent did not help one bit. What is more worrisome, however, is that those same surgeons never dug deeper to discern whether or not he had BDD, a brain disorder. Now that’s really unprofessional behavior.

It seems that people assume mostly women suffer from the disorder. Has anyone expressed surprise that your son had BDD? 

Good question. I think statistically the number is practically 50/50. Women and our cultural focus on women and fashion would suggest that BDD be more evident among females. However, muscle dsymorphia with men is gaining greater recognition these days — men who focus on their bodies, their physical build, their muscles, and their general appearance and body proportions. Our culture of aggressive advertisement that celebrates bodily perfection does not help the BDD cause, for sure. However, it was interesting for me to learn that there are even cases of BDD in remote villages in Africa where such cultural distractions and focus are absence or negligible. Check out Argentina where plastic surgery for woman is now a cultural phenomenon. How an Argentinian woman looks and the public and private discourse about her weight and size are quite disturbing phenomena, in my opinion. The culture is indeed playing a role in nurturing BDD.

What advice do you have for my younger readers who may be suffering in silence? How could a teenager approach his or her parents for support — and what if parents don’t understand and refuse to believe there’s a problem?

Don’t suffer in silence and in isolation! Find someone you can trust and describe what’s going on inside your head, even if it sounds a bit silly in the telling. Be sure you open up to someone who is non-judgmental and a really good listener. Let him/her know how painful your daily journey is. If possible, create a team dedicated and committed to your ultimate healing (parents, siblings, and even a good and close friend, etc.). Check out the new BDD website at IOCDF launched a year ago. There is something there for everyone — sufferer, parent, sibling, educator and professional. Invite your team to consult this rich resource too. Be sure your therapist/counselor/psychiatric/psychologist knows something about BDD and is well read and well trained in the treatment protocol. Strongly suggest that your family read the most recent literature about BDD, starting with Katharine Phillips’ book The Broken Mirror. Let them know that there are now specific treatment protocol manuals available, including one co-authored by Sabine Wilheim. But more importantly, try to understand that your brain is physically broken and that is why you are experiencing what you are experiencing. The bio-chemical process is physically responsible for the perceptional distortion. And don’t forget to add into the mix daily meditation, regular exercise, and good nutrition as ways to help support your efforts to heal. Let your personal mantra be, “I can do this. We can do this. I’m not alone. We are a team working together so I can heal. I deserve to be well and whole and complete in life!”

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Denis and his wife, Judy

How can people get involved in spreading awareness?

Getting the word out is not easy. If BDD affects 2% of the population, there is a good likelihood that someone in your life is impacted by this awful illness and is suffering immensely because of it on a daily basis. And worse still, no one knows! Check out our Walking With Nathaniel website. It is the personal story of one sufferer who did not deserve to suffer so cruelly. Let my awareness efforts inspire others to do something rather than feel victimized. Join the annual IOCDF 1,000,000 steps for OCD Awareness Walks in June. Can’t make it to Boston? Create your own awareness walk. No matter how small the team or the event, when you connect with other walkers physically or virtually, the community of supporters becomes larger and awareness grows incrementally, a step at a time. That is how all journeys begin and move forward. Moving forward beats staying still and stagnant. For me, it is definitely the ultimate balm for body, mind, spirit, and soul.

If you could offer just one piece of advice to someone with OCD or BDD, what would it be?

Please seek help! And remember, you are not alone! There are folks out there who want to help and can!

15 Things People with OCD Want You to Know

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I love talking about OCD, and it’s always interesting to see how my words are used in the final product! It’s an exercise in letting go and giving control to someone else. This time my interview—as well as several others from both people with OCD and those who treat it—was worked into a list of 15 Things People with OCD Want You to Know.

What do you think? Would you have added anything? Removed anything? Expanded on anything?

OCD Conference in Boston

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I blogged for the International OCD Foundation again this year, recapping the conference events from my own perspective.

Enjoy! Although there is so much more to the conference than I wrote about, I hope you see how wonderful the experience can be and make plans to go to Chicago next summer.

OCD Conference: Boston Edition

OCD Conference: Saturday, Saturday, Saturday!

OCD Conference: Going Home

Tuesday Q&A: Ethan S. Smith

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It’s a big week — the week of the 22nd annual OCD Conference! It’s in Boston this year, where the International OCD Foundation (IOCDF) is based, and I’m so excited to be a part of it again. But enough about me.

Last year Ethan Smith, a Los Angeles-based actor, writer, producer, and director, delivered the conference keynote. Ethan described his fight against severe OCD, and even as he was talking about the darkest moments of his life he managed to make the audience laugh. In retrospect, he was able to see — and share — the humor in getting kicked out of residential treatment at the OCD Institute at McLean Hospital in Boston by deliberately hurting himself and pretending to pass out on a snowbank.

Ethan will be at the conference this year as well, so be sure to check out some of his sessions.

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Photo credit: Roberto Farren

Last year, after years of suffering from OCD, you gave the keynote presentation at the 21st Annual OCD Conference. What inspired you to apply for this huge honor — and long speech?

To be honest, I wanted to give the speech the minute I knew it existed. Probably desperate is the right word when describing how badly I wanted my story out there so others wouldn’t have to go through what I went through. I knew through that speech I could impact the most amount of people. 

During your presentation you shared candid videos of yourself engaging in ERP. You said you’d never shown this footage to anyone, and suddenly you were sharing it with a room full of people. How did you find the courage to do this? Why did you think it was important for the audience to see you in your lowest moments?
 
During the intervention portion of my treatment, I was fortunate enough to have one of the therapists at the OCDI playing an almost coach role in my life, in addition to my therapist. Because of this, although I was a victim of stigma many times before getting better, I never felt embarrassed about what I had gone through because I was able to discuss my concerns, doubts, fears, and pretty much everything else as they happened in the real world, in real time. I started to feel a sense of pride and accomplishment for what I had been through. Therefore, those videos represented a completely different person. They represented what I had been and where I had come from, not who I had become. It was a shell of my former self. But a very significant shell. It’s a side of OCD people don’t often see, especially the public. It’s a far cry from quirky hand washing or laughing about germs. Seeing how low OCD can take you is necessary to reach those who haven’t hit that bottom yet. To let them know that bottom exists should they choose not to pursue treatment or take it seriously. It’s the reality of severe OCD.

You’ve said you were born with OCD. How did you realize there was a name for what you were dealing with? When were you diagnosed?

It was only apparent I was born with OCD in retrospect. I went to my first therapist at age 6 but he did not diagnose me with OCD. I just had “issues.” I was a quirky kid with emotional issues. This was 1984. Did they even have an OCD diagnosis then? I didn’t realize there was a name for it. And to be honest, I didn’t really care. I don’t think I realized it was odd behavior until high school. I knew I wasn’t like other kids, and I definitely was unhappy much of the time, but I always thought, “That’s me. That’s who I am.” I don’t think I ever considered it was something else until I was actually diagnosed. I was diagnosed at age 14 after my first panic attack in high school. I refused to go back to school. I would just walk in the school and panic. After anything physical was ruled out, I went to a “top” psychologist in the Atlanta area and he diagnosed me with OCD. 

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Ethan and IOCDF director Jeff Szymanski

As a young adult you had a fear that you’d harm yourself, a fear so powerful you became scared of your own hands. Your life must have been pure torture at the point — you couldn’t escape your own hands, after all — but we know you’ve overcome this fear. How did you do it?
 
Just to clarify, most of my young adult life was spent being afraid of illness. Not germs, but a fever was meningitis, or a headache or a brain tumor. Constant trips to the doctor, I took my temperature upwards of 60 times a day, and carried thermometers with me at all times. The fear of harming myself didn’t come until I was 32 when I that trio of being off my meds, my girlfriend breaking up with me, and my grandfather dying happened. I just spun out of control and my OCD shifted based on a question a psychologist had asked me. He asked if I was impulsive. “Would you ever impulsively hurt yourself?” I thought the question was ridiculous. Of course I wouldn’t. And then I got in the car and thought, “What if I did? What if I just lost control and started hurting myself?” That’s when the OCD shifted. That was also the day I completely stopped taking my temperature for the first time in almost 20 years. 
 
As far as how did I do it, that’s a really big question. So I’m going to give you a very simple answer: I became willing to harm myself. I became OK with the idea that it might happen. I finally embraced the uncertainty and embraced radical faith and what my doctors were telling me.

After years of treatment — you attended the McLean OCD Institute (OCDI) but got kicked out and your mom even lived with you for a semester during college — you ultimately had to help yourself. How did you realize that if you were ever going to improve you had to take responsibility for your own recovery?
 
Ahhh, finally an easy question. When I was living in the crack house and hadn’t left the bed in six days. I hadn’t eaten, showered, barely drank any water. I realized no one was coming for me. Praying hard wasn’t enough. There was no magic that was just going to take it all away. I had to meet people halfway. I had to invest in myself what others were willing to invest in me. Only then, did I stand a chance. So I got out of bed and headed toward the fire. I never looked back.

Your parents were very involved in your treatment plan. Why should family members be a part of the recovery process? Is there such thing as too much family involvement?
 
I definitely think it’s individual in terms of too much involvement. But, what seems to be a very consistent pattern with OCD is that good parenting favors the OCD, not the child. The treatment for OCD is completely counterintuitive to parenting. Therefore, it’s a family disorder. The behaviors of the parents have to be modified in order to achieve long-term success. They must be just as educated about OCD, how it works, how it affects the sufferer, what snuffs the OCD out. I’m very passionate about imparting my position on family involvement. I firmly believe true success is impossible without the family/wife/caretaker component. Otherwise, after, let’s say, residential treatment, it’s just a dry addict going back to all his druggy friends he used to hang out with. Only a matter of time before he uses again. And once that snowball gets rolling, you’re back to square 1…or worse. 

Do you have any advice for someone considering residential treatment? Advice for not getting kicked out?
 
Haha! Yeah, don’t cut open your head and dive into a snowbank pretending to be passed out. Easy…Treatment is scary, and hard, and terrifying, and it most definitely gets worse before it gets better. But like I said in the keynote, the pain you invest now is worth the pleasure you’ll experience the rest of your life. We overcomplicate treatment. Treatment, at least in theory, is easy. Listen and say yes. That’s it! That’s all you have to do. Unfortunately, in order to do that you have to not listen to your own brain, what you believe to be your gut, all that you know. You’re most likely an incredibly intelligent, smart, creative individual and you probably know it. So, being told not to listen to the part of you that you believe makes you incredibly unique and special is a tricky proposition. Slowly but surely, however, you start to hear that the OCD sounds different than “you”; it becomes less tricky. It doesn’t define you or your uniqueness. In fact, in regards to OCD, you’re not special at all. It’s all the same tornado in all of us. Sure, it may suck in different stuff, but it’s the same. 
 
OCD is like math. In math there’s a right or wrong answer, and nothing in between. Treatment is exactly the same way in my opinion. Can you get better kinda sorta trying? Sure, but I think that’s still a wrong answer. Negotiate with OCD, surfing that area between the right and wrong answer, and you’ll never truly achieve the full life you’re looking for. Fully embracing treatment, especially residential, can potentially give you that right answer, that full life. Ever think you could have OCD and serenity at the same time? Yeah, me neither. But I do.ethansmith1

You’re able to joke and laugh about your OCD. How do you feel about others joking about it? How about people who claim to be “soooo OCD” on Twitter?

You have to have it to joke about it. Just like being Jewish and making a Jewish joke. Totally kidding. Listen, I think it’s a fine line. I know a lot of people that get really angry when the term “OCD” is misused or joked about. To be honest, for the most part, it doesn’t bother me, because in most cases it comes from a lack of education. When I hear it, I see it as an opportunity to enlighten and educate so that it doesn’t happen again. Anger or frustration regarding doesn’t yield an effective result. I know what cancer is and how it affects others. For the most part, you don’t hear a lot of cancer jokes. If you do, yeah…that person is a %*$&%*. But OCD, as with many mental illnesses, is still so misunderstood and grossly misrepresented. So can I blame the majority of people for saying they’re  “sooooo OCD?” No, but I can engage those people in a friendly way and redirect into something meaningful.

You recently shared some exciting news: You’re an IOCDF spokesperson! How did this come about?

Much like the keynote, I knew I wanted to be a spokesperson the minute I discovered they existed. It was just another avenue to share my experiences on a larger scale in the hopes to make a difference. As to why it happened or came about, I definitely expressed interest in becoming one to the amazing individuals at the IOCDF. I’m not known for being quiet or introverted, so I was vocal. But, in my heart, it was never about the “title” or becoming a “spokesperson.” It was about the work. It was about those suffering and not getting help. It was about no other child or adult suffering in the way that I did. That was/is my passion and my mission. But you can’t go on a mission from your couch, so I started talking to other people. Being open about my story. Allowing my former therapists to reach out to me as a resource and talk to their patients. And then becoming involved at the conference and speaking, et cetera. This work that I do, if you can call it work, is the most fulfilling part of my life.

If you could give offer just one piece of advice to someone with OCD, what would it be?

Uncertainty is one of the greatest and most exciting aspects of life. Give it a big hug. Oh…and don’t cut your head open and jump in a snowbank.