Tag Archives: Lee Baer

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.

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Tuesday Q&A: Lee Baer

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IMG_3972 top pickIf you follow my blog or know anything about me at all — at least as far as my OCD story goes — you know how much I respect and admire Dr. Lee Baer, author of The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad ThoughtsWhen I finally made an appointment with an OCD specialist and croaked out a few words like “bad thoughts” and “no one will love me if they know,” the psychiatrist recommended The Imp of the Mind. “It could fit in my front pocket,” he said, patting his shirtfront, “but it’s packed with good information.” (By the way, that’s only true if you have unusually large pockets, because the book isn’t that small.)

That “little” book saved me. After having silently suffered with taboo obsessions for years and years, I learned that I wasn’t actually alone — I wasn’t the only person who’d had thoughts like I’d had, and they were nice, relatively normal people, too.

Nine years later, Lee and I are collaborating on a peer-to-peer support program (stay tuned!), and we presented together at the OCD Conference in Boston in August. What a rush! As I tearfully told everyone in the audience, I was up there with my hero.

Now you have the benefit of hearing directly from him — sorry, these are all my questions, but I tried to ask what you’d want to yourself if you had the chance. Thanks, Lee!

When I was struggling the most with my taboo obsessions I was actually worried that getting better would be a negative thing. I thought, “What kind of person would I be if these terrible thoughts didn’t bother me?” and I thought the distress is what kept me from acting on them. What would you tell someone with similar fears?

This is very common: OCD is very tricky so it puts sufferers of taboo thoughts in a “damned if you do, damned if you don’t” dilemma. It is very important to recognize that the OCD is trying to make you think like this and not be fooled. CBT and/or medications will not make you any less empathetic to terrible things that happen in the real world–instead, they will keep you from over-reacting to “what-if” scenarios that OCD conjures up in your mind.

What made you decide to treat OCD?

I have specialized in treating patients with OCD and related problems since about 1985, when Drs. Jenike, Minichiello, and I established one of the first OCD treatment and research programs in the country at Massachusetts General Hospital, because we were fascinated by this disorder, in which otherwise highly intelligent people experienced thoughts and rituals that they were unable to control. Also, at that time, OCD was considered to be resistant to existing treatments so we saw solving this problem as both a challenge and an opportunity to make a real difference in people’s lives.

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I recommend The Imp of the Mind all the time. As you know, it was one of the first things my psychiatrist prescribed the day he diagnosed me with OCD, and just knowing I wasn’t the only person with taboo obsessions like mine helped tremendously. Why did you focus on this type of OCD?

The idea for this book developed soon after we founded the OCD Institute residential treatment program at McLean Hospital in 1997. In the course of running several groups in this program, I noticed that patients with taboo obsessions felt ashamed to discuss their problems in group settings with other OCD sufferers with problems like excessive hand-washing or checking doors or electric plugs. When I asked why, these sufferers of taboo obsessions told me they felt that the other patients’ problems–although very troubling–did not have a moral component and did cause one to question if he or she was truly evil. They worried that these other patients — although they also had OCD — would not understand their taboo obsessions and think they, in fact, wanted to do the terrible things they imagined. To address this problem, I began a separate evening group for individuals with taboo obsessions, and found that the participants experienced great relief in being able to share their experiences with others who had similar problems. It was through running this group that I recognized the need for a book on this topic to reach others who were suffering in private. And it was through my experience with these groups over several years that I learned much of what I know about these taboo obsessions.

In The Imp of the Mind you share an example from White Bears and Other Unwanted Thoughts by Dr. Daniel Wegner. The basic idea is that if you tell someone they’re forbidden from having a certain thought — in this case, picturing a white bear — they’ll be even more likely to have the thought. In fact, the thought becomes stronger the more they try to rid it from their mind. How can someone with taboo intrusive thoughts overcome the urge to push the obsessions out of their minds as quickly as possible? The thought of murdering a loved one is so painful it’s a natural response to recoil at it.

Dr. Wegner’s book explains one key reason for the “stickiness” of taboo obsessions in a very easy-to-understand way. Dr. Wegner and I often discussed this topic, both before and after he joined the Harvard College faculty, and I was saddened by his untimely passing two years ago. We agreed that the first step for sufferers of taboo obsessions was for them to understand that thoughts passing through our minds are not as important as we often believe them to be. Everyone has thoughts they don’t like having at times, but the very universal nature of these thoughts proves that they are not dangerous — if this were not the case, violent and sexual attacks would be occurring daily in every home and office! Taking this leap of faith is often the first step in successful treatment. Secondly, sufferers have to understand that OCD is “tricky” and it will try to get you to fight the obsessions, giving them strength, through the mechanism of “thought suppression” that Dr. Wegner researched so thoroughly. Truly understanding these two concepts often reduces the OCD sufferers’ suffering instantly.

People with taboo obsessions are terrified they’ll act on their thoughts. They think the thoughts must mean something; otherwise they wouldn’t have them. Without giving in to our compulsion to be reassured, what can you tell us about the likelihood of people with OCD acting on their obsessions?

Although I tell my patients (only once, mind you!) that based on my experience, and the experience of my colleagues who treat OCD, they will not act on their violent or sexual obsessions. However, I also know that this will not really work to reassure them, because OCD preys on doubt and tries to get them to find absolute, 100 percent certainty. Yet there is no absolute certainty about anything in the future — even about the sun rising tomorrow — so the solution is to learn to live with the feelings of uncertainty, even of things that are extremely unlikely.

Why do you recommend ERP to patients with OCD?

I tell my patients that we all have a “rational brain” and an “emotional brain.” Their rational brain can understand that their taboo obsessions are not meaningful, and they need to learn to let these obsessions pass without fighting them, while their emotional mind can continue to react with strong, uncomfortable feelings to these thoughts. The most effective, non-drug treatment we have for reducing or eliminating this reaction of their emotional mind is through exposure and response prevention. I describe this process in detail in my book Getting Control.

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Many people with “pure O,” that is, mostly obsessions coupled with mental compulsions, wonder how ERP will work for them. You can’t have advise them to touch a toilet seat and then resist the compulsion to wash their hands, for example. Let’s say someone with pedophilia OCD comes to you. How might you go about exposures?

I’d first help them to identify situations that they are avoiding due to their obsessions. Next I would have them gradually go into these situations while learning to tolerate the discomfort and obsessions that come while doing it. This is called in-vivo, or real-life, exposure and response prevention, and I always try to begin with this if possible. We’d also probably prepare a worst-case scenario of their worst fear coming true for them to record and listen to at home until their discomfort goes down without ritualizing. This is called imaginal exposure and response prevention.

What advice do you have for folks who live in rural areas or far from quality care?

I would definitely suggest they start by joining the International OCD Foundation (IOCDF) and, if there is one, their local chapter. This will provide them a wealth of support and information about support groups and providers in their area, as well as the annual meetings for sufferers and their families to learn about treatment for OCD.

You and I have been working on a peer support program — our goal is to match folks who have taboo obsessions with people who have had similar obsessions and have been some progress toward recovery. What are the benefits of such support?

My experience has always been that it benefits both individuals greatly: I have yet to have a patient get better from their taboo obsessions who is not excited about the idea of having the chance to give back to another sufferer at an earlier stage of dealing with this disorder (probably because they remember how hard it was at the beginning for them). And for my new patients, hearing from someone with similar symptoms who has gotten better gives them hope, and also lets them feel comfortable sharing some of their most private fears, often for the first time.

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

Try and find someone you trust to talk with about your obsessive thoughts. This can be a family member, a doctor, a clergy person, or someone affiliated with the IOCDF. But no one should have to deal with OCD alone.

Tuesday Q&A: Melanie Lefebvre

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If you’ve been keeping up with my blog posts you probably know how much I admire Dr. Lee Baer, author of The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts, and how I owe so much of my recovery to this book. Well, at the OCD Conference in Los Angeles in July 2014, I went to his session on intrusive taboo thoughts. Beforehand he said, “I’m glad you’re here—I plan to ask for volunteers to share their obsessions and compulsions in front of the group, but if no one wants to I hope you’ll role play with me.”

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Showing off her OCD Conference badge

Knowing how scary it is to utter obsessions and compulsions, I honestly thought Dr. Baer would have to call on me to sit at the front of the room with him. Instead, several audience members volunteered, eager to learn from his expertise. Melanie Lefebvre, our guest this week, ended up sharing her struggle with hit-and-run OCD with Dr. Baer and, of course, the whole group.

Melanie was so terrified she might hit someone while driving, and possibly kill the person without even realizing it, that she’d stopped driving altogether—even though her job occasionally required her to travel throughout the day. She’d resorted to taking the bus and having her husband give her rides. She thought she’d never drive again.

Enter Dr. Baer.

You were so brave to volunteer! Tell us why you did.

I almost didn’t! I joined the people who were gathered around Dr. Baer during the break to soak up as much knowledge as I could. I had connected with Dr. Baer prior to the workshop to verify whether it would be a good fit for me. When he saw me at break, he asked if I’d like to volunteer and I shyly declined. Dr. Baer surveyed the group to see who had done treatment—everyone had. I shared that I had dabbled in it and suddenly I had a cheer squad rooting for me to volunteer. How could I resist a cheer squad?

You mentioned you dabbled in therapy before the conference. How was that working for you?

I would do the reading; I’d make the hierarchies; I’d do the cognitive work. But the thought of driving around my neighborhood for 20 minutes as an exposure was terrifying. I kept chickening out once it got to the gold standard of what works.

It was pretty cool to watch Dr. Baer talk you through your fears and help you come up with a plan to confront them. It was like inspirational OCD improv. How did you feel as he gave you advice?

Hearing you describe it as inspirational OCD improv is a confidence booster! I was worried I was boring everyone—that someone else should have volunteered. Good ole OCD doing its thing. Despite that, I was incredibly grateful that I was getting personalized advice. It was a surreal experience that left me floating on air.

Did you feel empowered to implement his advice right away, or did you still have your doubts about whether you’d be driving by the end of the summer?

I definitely had doubts but I had committed to Dr. Baer, to a room full of people. My OCD trumped any feelings of empowerment but accountability was something I could embrace. Accountability was the motivator that gave me the push I needed. Thank you, Dr. Baer and the room full of people!

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On the red carpet at the OCD Conference

You’re doing well now, and you’re driving again. I think that’s such a powerful testament to how well ERP works. Were there moments or days when you struggled through the ERP, and if so, how did you work through it?

It was hard listening to the Stephen King–inspired loop tape over and over. [Editor’s note: Dr. Baer challenged Melanie to think of her worst “Stephen King scenario” related to her hit-and-run obsession and record herself describing it.] But I’d been given a prescription and I was going to keep taking the course of antibiotics. Eventually, I became bored with the script and knew it was time to get behind the wheel. I got through it by remembering what a psychologist from Texas told me after the workshop: “Just drive an inch.” Anytime the fear of getting behind the wheel surfaced, I reminded myself all I needed to do was drive an inch. But once you drive an inch, the inches keep building. It also helped to have my husband as the passenger until eventually I felt brave enough to drive solo. I’d poke fun of the OCD and sing “All I do is kill kill kill no matter what!” to the tune of “All I Do Is Win.” Or my husband and I would see pedestrians and say, “Another opportunity for a kill!” It sounds awful but OCD is what’s awful. Taking it to an absurd level helps take its power away. On the days where those strategies didn’t work, I’d get home and sit with the anxiety until it went away—repeating over and over that I had killed someone—an impromptu loop tape. It’s still hard. I still avoid driving at times. But I haven’t stopped driving altogether like I had before the conference.

Not only are you doing better, you’ve also started sharing your story on the OCD and Families blog. Has writing about your experience with OCD helped you get through it?

Writing about my OCD allows me take something nasty and mold it into something else. Being featured on the OCD and Families blog has been empowering (finally empowerment is trumping OCD!) and helped me embrace my inner advocate.

Tell us more about your OCD awareness videos on YouTube. Where did you get the idea to model it after a cooking show? It’s so clever!

The OCD Awareness Video Contest through the IOCDF threw me for a loop initially. I wasn’t a videographer. I’m a writer! Where was the writing contest?! But I knew that if I was going to make a video, I wanted it to be creative, to intrigue the audience. So my husband and I got to brainstorming. The plan wasn’t for me to be the chef. We were going to focus on the mixing bowl and feature text explaining the ingredients of OCD. I wanted to explain less commonly known types of OCD—give them a deserved place in social media. And by disclosing about having OCD, I hoped to combat stigma—not only from the public but to also challenge the self-stigma that was still lurking within me. This naturally progressed to the idea of a cooking show—why not be the chef? When else do you get to wear a chef’s hat?

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

Learn as much about it as you can! Once you have context, you can better navigate what’s happening. I keep an OCD file on my phone where I store tips, quotes—anything that I can quickly access and remind myself of when I feel like I’m going under. One of my favorites is from Jon Hershfield, “If OCD thoughts are loud, the options are to accept their loudness or try to turn them up and blow out the speakers.”

But I can’t stop at one! Tip two: connect with others who have OCD at your own pace, whether it’s an anonymous online group or a support group in your hometown. Peer support is special and dear to my heart.

I loved the conference and being surrounded by people who understood OCD—so much so that I felt pretty let down once I was back in the real world! Tell us about your experience at the conference last summer. Was it the first time you’d attended? Other than meeting with Dr. Baer, what was your most memorable experience? 

I can relate to the sharp contrast of the real world to the world of the International OCD Foundation’s annual conference. Attending the conference for the first time was the biggest accomplishment of my life. It was a huge ERP on multiple levels. My second most memorable experience is Ethan Smith’s speech which was heartwarming and hilarious all wrapped together. But I’ve got to add another: meeting my friend from an online support group. Meeting in person solidified our friendship. We were partners in crime as we experienced our first conference side by side.

Do you plan to attend this year?

I am grateful to have won the OCD Awareness Video contest through the IOCDF that comes with a prize of a trip to the conference. The win gives me a push to keep challenging myself. I still have travel-related OCD but the conference is calling!

It’s Not You, It’s Your OCD

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Have you ever tried to spare someone’s feelings during a breakup by saying, “It’s not you, it’s me”? Well, when you dump OCD for good, go ahead and tell the truth: It’s you, OCD, not me.

Dr. Lee Baer, OCD specialist, Harvard professor, and author, titled his book about intrusive thoughts The Imp of the Mind. That’s what OCD is–an unwelcome little devil that needs to be cast out with no pity. You don’t need to be polite to this rude guest. While I’m not one for making excuses, I definitely blame OCD for every terrible obsession that’s plagued me.

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But I haven’t always had this clarity: Before I was diagnosed with OCD I blamed myself, even though I didn’t understand what, if anything, I had done to deserve the intrusion. I felt helpless and scared. Then I met a psychiatrist who looked at me with compassion and told me I would be all right. Since I had taboo obsessions (Baer uses the categories of violent, sexual, and blasphemous, but I suffered  from the latter two), my doctor recommended that I read The Imp of the Mind. It was the best prescription ever. For the first time in my harrowing journey with OCD, I felt less alone. Here was a man who had heard everything from his patients with OCD and didn’t seem to bat an eye. Worried you might want to have sex with your dog? We can work on that. You’re a priest who can’t stop staring at women’s breasts? Don’t feel bad.

Dr. Baer knew how tortured his patients felt, and he helped ease their pain. He did the same for me when he documented many of their stories in The Imp of the Mind, and I don’t think I’ll ever be able to thank him enough. So when he contacted me and asked me to share my story on his new website, I jumped at the chance. His contributions to the OCD community helped save me and made my life feel worth living again. Now I had the opportunity to help him.

OCD doesn’t define me, and it shouldn’t define you, either. You can take it down to size.