People Don't Understand OCD

I've had a number of OCD situations come up that are easily mistakable for real issues.

A few months ago, I was talking to a friend about my ROCD (relationship-themed OCD). Then, I didn't know what OCD was, muchless what ROCD was. I told her I was having a lot of anxiety about my relationship. She told me that anxiety means something and that I needed to take my feelings seriously and explore them. My therapist at the time would say the same things. This only fueled my OCD issues.

A month or so later, I was talking to my mom about my fears of being a lesbian. A few days after that, I discovered what HOCD (homosexuality-themed OCD) was and then told her that I thought I had OCD. She flipped out and told me that questions of sexuality were a real issues, ones worth taking seriously. Always. Needless to say, I haven't been talking to my mom much about my issues.

Again today, I was talking with a friend about an issue I was having. She at one point said, "That's a totally reasonable thing to worry about! That's not like worrying about leaving the stove on or the door unlocked."  Well, yes and no. Yes, it's a different worry. One that in some situations is reasonable to worry about it. The thing is, I wasn't really worrying, I was obsessing. Or maybe it was some combination or worrying and obsessing. Regardless, it was taking up my energy in an unproductive way and was beneficial for me to treat as an obsession. My friend just didn't get it, so I stopped talking to her about it.

I think largely because of my experiences with my new therapist I am much more confident about what is and isn't an OCD issue. At the same time, I'm feeling a bit isolated. One of my good friends is having a lot of problems and has shared the concern that she is occupying too much of my time voicing her issues. The truth is, I'd love to tell her about some of my issues, but I think she might just think I was really weird and not be helpful to me.

Maybe this is all a good thing. I think sometimes I tell people my problems as a means of reassurance seeking, which I need to stop doing. Nonetheless, there are only a few people who really know the meat of what I've been struggling with the last few months.

Unhinged by David Carlat

I recently finished reading Unhinged by David Carlat. All in all, it was a thought provoking book that is worth reading for anyone who is trying to navigate their own mental health.

One of Carlat's main points is that we have thrown therapy out the window and replaced it almost entirely with psychopharmacology. This isn't a good thing, Carlat argues, because psychiatrists miss what's really going on, why a patient is coming in for treatment then, and how the patients thoughts and behaviors are causing or exacerbating their current difficulties. Psychiatrists medicate and move on.

This is an argument I encounter a lot both in my reading and in my personal interactions. When I told a friend of my I was going to see a therapist she said, "That's good. Medications don't treat the underlying cause. They're just a bandaid. Therapy gets at the underlying causes of what's going on."

I do agree that medications don't treat the underlying cause. Whatever they do is complicated and contentious. However, in all this therapy hoopla, no one really seems to get at what therapy does. There's a good deal of evidence that therapy does help at least some people and research shows that it is often times more effective than psychiatric drugs. But therapy can also harm some people. And so much depends on what type of therapy we are talking about, what the patients issues are, how good the therapist is, whether patient and therapist are a good match, etc. It just strikes me as irresponsible for Carlat to advocate so strongly for more therapy without really exploring what its limitations might be. Admittedly, the book would be deeply discouraging if it just said psychopharmacology is a limited approach and didn't present an alternative. 

I say all this for deeply personal reasons. I went to a therapist (a psychologist who practiced CBT, came highly recommended) a few months ago who just didn't seem to get OCD. It was really frustrating and a suffered more than I would've otherwise under her misguided advice. I'm happy to have not gone the medication route, but the therapy route hasn't been an easy one either.