Needing to Take Care of Myself

I feel exhausted this morning. I have this overwhelming sense that I somehow haven't been taking good care of myself, but I somehow cannot put my finger on exactly how. I've been eating okay--not perfectly, of course--but for the most part pretty well. I've been sleeping enough--perhaps too much? I've consumed some substances/medications that may have been best avoided, but certainly not in alarming quantities.

It's more this feeling that I haven't been taking care of myself emotionally, but I'm not sure exactly how. There are a few things I can point to: I've been emotionally investing myself in others to an extent that it's been harmful to me. I've brought up issues with others in ways that have turned out to be unproductive and potentially hurtful, and this has been stressful. To top it all off, I've been entertaining rather than resisting my obsessive thoughts, and have engaged in compulsions I thought I was done with for good.

My dreams have been intense the last couple of nights. I had one extremely vivid dream that I ate magic mushrooms that were fresh and moist and tasted like shiitakes. I started to trip. Everything was sparkly and beautiful and I woke up wanting to trip, but then remembered that mushrooms distort my emotional perception an order of magnitude more than they distort visual perception. A sparkly trippy world would never feel so light to me. My dream was so happy, but I felt sad.

I had another dream that I spoke to a friend I had a falling out with 6 months ago. He invited me into his apartment and was nice to me but then told me he felt like he was better off in his life without me. I told him I agreed and left. I didn't feel sad, I just felt closure: It felt good that we had agreed to go our separate ways. I went next door and then reconnected with a friend that I haven't spoken with in a while. Then tension between us was gone. I woke up and of course it wasn't real. My dreams are grasping at closure I'm not getting in real life.

It's not all bad. In the past few weeks, I've had some moments of intense focus on my work. I've had uncharacteristic moments of compassion for myself and others. That said, I feel like I have work to do in terms of taking care of myself. I just don't quite know what that means.

Irving Kirsch

Interesting video on antidepressants and the placebo effect.

Coping

I am going back to therapy tomorrow. The last 6 weeks have been too much. I am in the library and feel like I'm about to cry. I've done just about everything on my to do list, so I'm giving myself permission to feel shitty.

Everything feels like a compulsion right now. Writing, sex, exercise. A run would help me so much right now, but my legs hurt from how much I've been running. About a mile in, my thoughts start to disappear.

I don't feel hungry right now, but I should. Maybe Thai food would be tasty.

I don't even know if I like my therapist. He just understands OCD/skin picking/etc. and he's not involved in the mess my life currently is in. Or perhaps I should say feels like it's in. Everything is okay in some cosmic sense.

I don't want to spend money on therapy. I'm trying to spend less money. But my mood has been sour, so I haven't been cooking much. I'm spending too much money and now I'm going to spend even more too much money on therapy again. I suppose if not cooking and therapy are what I need to get my shit together, they're what I need to get my shit together.

Maybe I'll take klonopin tonight. I'm craving it right now. I know, accept that I'm craving it and think about what that means. It means I want to feel less anxious, I suppose. Therapy! SSRIs?!

Everyone around me right now talks about how sex is a coping mechanism for various things. Sex is never (or perhaps rarely) just sex. I use sex for intimacy, rather than just accepting that intimacy is a fleeting and inconsistent feeling.

God. I want to have sex right now. Too bad I have a raging yeast infection.

I don't skin pick as much when I cry or let myself show sadness, anger, or frustration. The urge disappears when I express intense emotions. I skin pick to keep myself together. I was trying not to cry in the shower the other night. I made my fingers bleed and then broke down and cried anyhow.

The Cycle of Meaning

I was feeling down today. More than just down, bad about myself. I've been unusually irritable lately, which has caused me to feel guilt. I took a nap, read some OCD forums, pet my cats--tried to do the things that tend to make me feel better. Finally, I got tired of going it alone and called a friend. I burst into tears and told her all the things that were going wrong in my life. Basically she told me that yes, there was a lot going on for me and I had every right to feel the way I felt and that I was being asked to tend to others needs which wasn't leaving me much room to tend to my own. I immediately felt better. Sigh of relief. Now, how had I gotten myself into this situation of talking care of others better than myself? I started to try to figure it out. If I can just set my life up as to take better care of myself, I won't feel bad again.

But wait! Doesn't this seem familiar? Wasn't this just the cycle of obsession, relief seeking, obsession? The obsession: I'm feeling bad. Why do I feel bad? Will I feel this way forever? Relief seeking: I called a friend for whom I supplied ample evidence for the theory she put forth that my emotional reaction was indeed a reasonable response to my circumstances and that I needed to be careful that others did not request too much of me. OCD sets up these perfect little problems for me. If I just do x, all my problems will be solved. If I just check the doors one more time, I'll stop worrying about them. If I can just figure out what's wrong in my life and then fix it, I'll be happy.

So, back to square one. Why do I feel bad? Is there a reason? Have people's requests of me really been the source of my dis-ease? Has there really been a lot going on? I want to avoid answering these questions, at least for the time being.

This goes back to a question in a previous blog post--Is anxiety meaningful? I've been reading Peter Kramer's Listening to Prozac. Despite the fact that we disagree on the evidence, I find Kramer's anecdotes compelling. He told a story of a woman held back by perfectionism, that is until she took Prozac. Once on the drug, her family relationships improved, she got a better job, and she felt more fulfilled. The social worker who the woman had been seeing called Kramer and was confused. She had spent hours analyzing this woman--breaking down the meanings in her conflicts and helping her become more self-aware. None of this helped, but drugs did. Clearly, this anecdote doesn't say anything about what Prozac does or whether it works, but it does speak to the fact that our anxiety isn't always meaningful. At the very least, doing the "hard work" in therapy doesn't always pay off. Understanding the origins and meanings in our conflicts and trying to become more self aware can certainly go a long way, but it isn't a guarantee of fixing things.

I see a lot of this woman in myself. I can get hung up on things and upset over little things. I can be very aware of what I'm doing and what I should do, but it doesn't always help. For example, I know I'm being hard on myself for being irritable. I'm trying to let it go, but I can't always let it go. If there existed a magic pill that would allow me to let go of my perfectionism and my hang ups, I would take it.

So, to go back to that list of questions:
Why do I feel bad?
The trivial answer is some combination of my surroundings and my reactions to them.

Do my life circumstances really warrant my reactions to them?
I don't think there's an easy answer to this question. What does it mean for my reactions to be warranted? Moreover, even if my reactions are warranted, do I want them? Are they useful to me? Much of the time I don't want my reactions and I doubt their usefulness to me, I just have trouble dismissing them.

Hard Day

Things have been going swimmingly for the most part. My anxiety levels have been pretty low since quitting my job. That is, until a couple days ago.

I've had a friend that I've been wondering for a long time whether or he's a positive influence in my life. Sometimes I've had a good time with him and sometimes I've left my interactions with him feeling bad about myself. I've tried to point out the behaviors he has that rub me the wrong way on a few occasions and he inevitably responds that I've too sensitive.

In any case, on Friday he invited me to hang out with him in a group. I said no a couple of times and he kept pushing. I was kind of like fuck it, I might as well be honest with him. I told him it was hard for me to spend long periods of time hanging out with him. He didn't take it well.

Then he wrote me a long email saying that he believes I am selfish, ungenerous, mean, and overly sensitive. I wrote an email back. I am feeling intense guilt for this email. I got 5 or 6 emails back about how mean my email was. My partner asked why I felt so much guilt and not more anger? I don't know. I don't know if I'm capable of anger anymore.

I feel like a horrible person in all this to be honest. Maybe I really have done all these horrible things to this person. Maybe I am overly sensitive. Maybe I am deserving of his harsh reactions. It's horrifying that I've hurt someone so badly without even trying.

I've forgotten what it means to be nice to myself. I've forgotten why I even brought this up in the first place--because choosing to hang out with him wasn't being nice to myself.

I feel so lost. Horribly guilty. Uncertain what to feel, what to think. I so strongly want to make things right, but I don't know that I can (at least without sacrificing myself an my values), or if I can if it would be good for me to.

I'm worried I'm falling back into a hole of anxiety. I can't be unselfish when I'm anxious. It's too much of effort to even take care of myself. I'm worried I'm not capable of being a good person.

The Meaning of Anxiety and Depression

It seems bizarre to me that a number of people seem to very strongly believe that anxiety and depression are always meaningful. My first therapist told me that anxiety was like a sign post directing me towards my needs. This was a terrible thing to say to me. I've also come across a number of books that say more or less the same thing. 

I'm not saying that there aren't external factors that contribute to anxiety and depression, but whatever one is feeling anxious or depressed about isn't necessarily related to those factors. Stress is a trigger for OCD, for example, but when I find myself obsessing, it's not like I obsess about what I'm stressed out about. Trying to find meaning in my obsessions is generally disastrous.

I understand where this idea that anxiety and depression are meaningful comes from. We live in a society where antidepressants are frequently prescribed and we are told that antidepressants are necessary to fix chemical imbalances in our brains. More are more people are taking drugs.

The people who believe that anxiety and depression are meaningful are responding to some of these disturbing trends in the over-medicalization of mental illness. They see finding meaning in anxiety and depression as an alternative to blindly popping pills.

But there's a third alternative I think. We can recognize that anxiety and depression arise from a number of complex factors, which include, but are not limited to:
1. Some sort of life situation or problem--that is, the anxiety and depression is meaningful
2. A structural or chemical issues with the brain
3. A lack of exercise or good food or sleep
4. An excess of caffeine or other substances that exacerbate anxiety
5. A health condition--thyroid hormone imbalances are linked to anxiety and depression, for example. 

Just because we recognize that anxiety and depression sometimes are not meaningful doesn't mean that popping pills is the only answer, either.

Various Things I've Taken for Anxiety

Taking drugs or supplements for anxiety is a tricky thing. I've come to believe that taking anything regularly to treat anxiety probably not a good idea. I'm always concerned about becoming reliant on any substance since I seem to suffer from anxiety so regularly. Chemical addiction is another issue. For example, benzodiazapenes work really well, but they affect your brain's synthesis of GABA if you take them long-term. This causes anxiety to only get worse. This may be an issue with other substances, but the consequences of long-term use may not be as well understood.

I haven't taken anything for my anxiety in a bit. But for those who are struggling and looking for something to help with anxiety, here's what I've taken and my thoughts:

Clonazepan 
Clonazepan is a benzodiazapene. I got it from my doctor for sleep issues I was having a few months ago. I was told I could take 1-2 pills at bedtime for sleep. I found that half of a pill more than did the trick. The first time I took it, I felt a bit drugged and groggy in the morning. Then again, I hadn't slept well in three or so weeks when I took it, so it could be I was just exhausted. I took it every night for a week, and then stopped without any adverse effects. I've taken a half pill from time to time when I've been feeling particularly anxious and unsure if I'd be able to sleep well. It makes me feel calm and a bit dizzy. It's not like the things that I'm anxious about magically disappear, but I'm too dumb to really think about them. If I've been having a lot of anxiety, it's nice to feel dumb for a while and then pass out. Clonazepan is super addictive though, so when my bottle runs out, I don't plan on asking for more.

SAMe 
SAMe is a supplement that is supposedly a fast acting antidepressant. It's regularly prescribed in Italy instead of SSRIs for mild to moderate depression. Like SSRIs, it's thought to increase levels of serotonin in the brain. I took it when I was feeling both anxious and depressed and having insomnia. I took it for just over two weeks and I did not have a good experience with it. I felt emotionally numb, had zero sex drive, and my insomnia got worse. It was only when I was thinking of going off of it that I did more online research and found that a lot of people find it negatively affects their sleep, which was exactly what I didn't need. SAMe may work just fine for depression, but I don't think it works for OCD.

Inositol
Inositol is a substance found in food and also sold as a supplement. Normally you get 1-2 grams a day in your diet, but therapeutic doses are in the range of 10-18 grams per day. A number of small studies indicate that it helps with panic attacks and OCD. It doesn't have an side effects, other than temporarily causing diarrhea in some. If you start taking it as a supplement it supposedly takes 3-6 weeks to work. I initially took inositol nearly two years ago when I started getting panic attacks. I worked my way up to taking about 10 grams a day, and found my panic attacks when away. I then weaned myself off of it. I took it sporadically a few times until this last spring when I started taking around 12 grams a day to help with anxiety and OCD symptoms. I weaned myself off of it again this fall. I don't really know what I think of inositol. I feel like it helps, but it's effects are subtle. Since the only studies of it are small, it's unclear whether it really works and what its long-term effects are. This is why I stopped taking it. I find that I get a lot more anxiety while going off it, which is why weaning is so important. This last time I went off it, I felt like I was getting facial twitching. This was likely just a sensory obsession though, and it passed after a week. I think I feel a little bit more like myself, and a bit more motivated since going off of it. Then again, I'd been doing a lot of work in therapy and thinking better about my life, so who knows. Since it really doesn't have side-effects and isn't addictive, I certainly wouldn't recommend against it.

Valerian, Passionflower, and Catnip
I took a mixture of these three herbs for insomnia. I think they helped me fall asleep, but I'd wake up in the middle of the night feeling anxious and physically weird. My skin felt funny while taking these herbs. I know people who have had success with these herbs, but I'm not a fan.

Other things
Pot sometimes helps with anxiety and insomnia, sometimes doesn't help at all. Unclear why it sometimes works and doesn't. It certainly helps me stay asleep, but not necessarily fall asleep. I feel very calm and happy while drunk, but I wake up feeling horrible the next morning, so I generally avoid alcohol nowadays. Caffeine seems to contribute to my anxiety and insomnia, so I avoid it all together. I even avoid tea, including green tea. Occasionally, I'll drink twig tea (about 5 mg per cup) and eat chocolate, but I avoid these things if I've had any sleeping issues.

Update

For anyone out there, who reads this and doesn't already know what's going on with me, here's an update:

A few weeks ago, I decided to quit my job. I went into therapy and told my therapist about it. He was ubber supportive and said I seemed happy about this decision. I then asked if I should keep seeing him and he said we was going to ask me the same question. I said I felt okay going it alone for a while. We chatted a bit about a few other things--skin picking, perfectionism, etc. And that was that. I left feeling certain of my decision to quit my job, so I went and quit that afternoon.

I know I've whined a lot about how my therapist suggested I take SSRIs. After our last conversation about them, though, he let the topic go. I think he realized it flustered me. It's odd now that I'm not seeing my therapist how much I notice his absence. There are so few men in my life who are consistently nice to me, my partner being the one notable exception. Also, my therapist and I had quite a few conversations about being nice to myself. At first, I think, I believed he was telling me this out of some sort of utilitarian belief that being nice to myself would serve me better. On some level I believed that he was just nice to me because I was paying him to be. I think, though, after talking to him more I kind of came to believe that he was nice to me and wanted me to be nice to me because that's actually how he fundamentally approaches people. I found this deeply encouraging.

Since quitting, I've had a rough few weeks and wondered many times if my decision to quit therapy was hasty. Having to go to work has been really difficult. I have a lot of mixed feelings and I feel like I'm ditching  my coworkers with a lot of work to do. I find myself getting angry about things I tend to get angry about it work, and then reminding myself that I need to let go. I'll be saddest not to see my coworker every day, but we live near each other and can continue to be friends if we choose to.

I've had a really good past few days. I think not being at work has helped considerably. My anxiety levels are pretty low.

I'm concerned about January when I won't be working. I need to have structure in my life and I need to be working on things that I care about and seeing people every day. This will be hard without a job, but not impossible.

Letter to Robert Whitaker

I wrote the following letter to Robert Whitaker, author of Anatomy of an Epidemic. 

Dear Mr. Whitaker,

I wanted to first of all thank you for your book. I read it when I was having a difficult time with my OCD symptoms and was considering taking antidepressants. Your book, along with a few others, convinced me otherwise. Given that these drugs appear to have dramatic side-effects, both short- and long-term, and aren't particularly effective, I am grateful that I did not go down that path. I am now doing significantly better.

Your book, as well as other books, advocate for a shift away from treating mental illness with drugs towards a therapy-based paradigm of care. While I wholeheartedly agree that drugs are not the answer, I also see many potential problems with a therapy-based paradigm. It seems to me that therapy is frequently advocated for, like drug-based care has been advocated for, without thorough analysis of it's dangers and benefits, as well as an thorough understanding of its philosophy towards treating mental illness.

If I may share my personal experience, my first foray into therapy was about 8 months ago. I didn't know I "had" OCD, all I knew at the time was that I was finding myself extremely anxious about strange things. My first therapist failed to accurately "diagnose" me and failed to offer any sort of effective treatment. I found myself getting worse over the few months that I saw her. My second therapist has been extremely helpful both in accurately assessing my "condition" and offering effective, science-based treatment. The caveat, however, is that he has repeatedly suggested medication for me to supplement his treatment, which I have refused.

My sense, from my limited experience, is that two problems can readily occur in therapy: First, therapists can fail to offer effective treatment as a result of not drawing upon the scientific data and tools that psychology research provides us. This can result in harm to the patient. And second, therapists can offer effective, science-based treatment. However, those most likely to offer science-based cognitive-behavioral treatment are also most likely to see drugs as playing an essential role in an effective treatment plan. I don't believe that the science-based psychology is functionally distinct from psychiatry--the two work together oftentimes to offer treatment in tandem. It is sometimes difficult to get good psychological treatment while refusing drug treatment, as it's easy for the therapist too see the patient as uncooperative or to see the refusal to take drugs as symptomatic of the underlying mental illness.

I was wondering if you had considered the difficultly of getting effective, science-based therapy while attempting to avoid psychiatric "care." I would be very curious to know anything that you've come across in your research or if you have seen anyone else explore this topic.

Thanks for a wonderful book,

Thinking of Myself as Well

I've been starting to think of myself as more and more well again. It's hard to say what causes what, but thinking of yourself as well and actually doing well seem to go hand in hand.

This is part of the reason, I think, why my therapist's suggestion that I take antidepressants bothered me. Admittedly, I tell him all the ways in which I am not doing well--all the ways in which I am failing to appropriately manage my anxiety. But it's somewhat discouraging to overall feel better than I have in months and be told that I'm still not well enough.

But I am in charge of whether or not I think that I am well, not my therapist.

Frustrated

I'm frustrated with my therapist. He brought up medications again. I didn't really want to engage and I kind of made that clear. He kind of pressed me. I didn't want to fully engage him the sense that I didn't think it would be a good use of my time. So, I made the worst possible choice and half engaged him. At the end of the appointment I think I seemed flustered. I failed to answer a question because I was only half paying attention. He then asked me how I was feeling and I said I was fine. I wish I hadn't lied, but I didn't know what to say.

I don't know why I'm so frustrated. I guess he's well-intentioned, but I think he's wrong and I think all the arguments he presented me with were stupid. I guess I wish I had been more direct, so I'm frustrated with myself a bit too. Sigh. My next appointment isn't for two weeks. I have an urge to bring this up at my next appointment, but it's a waste of time and I will probably be over it by then.

I think I just want my therapist to be ideologically aligned with me. The thing is, he's a good therapist and I shouldn't expect to find someone who is fully aligned with me.

Crazy

There have been a number of people over the years for whom I have thought, "things would just be better for you if you took antidepressants" or "you're just doing such and such because you're a little crazy." I no longer these things for the most part. My own struggles have really changed how I think about being so-called crazy. These sorts of comments are dismissive and too simplistic.

But since my thinking on these matters has changed, I frequently find myself frustrated with people who don't understand what it means to struggle--either with a poor mental state or with some physical ailment. Struggle creates an ability to empathize even with people who have vastly different experiences, I believe. This ability to empathize is clearly lacking in some.

For example, a few weeks ago, I encountered someone who said that this other person she knew just needed to take his anti-psychotics again. There didn't seem to be any exploration of why this person stopped taking them or what the effects were of taking them long-term. Even if they worked wonders for this guy, there may have been a number of reasons to not continue.

More recently, I was talking a friend about a mutual friend who is a bit eccentric. This acquaintance seemed to think that this friend was a combination of naive, crazy, and lonely. The eccentric behaviors were seen as a means of attention getting.

Since I used to make such comments, I understand where they're coming from. I assumed that modern pyschiatric medications worked long-term with relatively few side-effects and that a decision to stop taking or not take them was symptomatic of the underlying psychiatric condition. I also saw no reason previously not to behave "normally," so behaving outside of the norms was obviously the result of illogical thinking. So many assumptions with so little data!

It's very easy to be dismissive of people thought to be mentally ill, regardless of whether they are ill, because any behavior that is considered abnormal is attributed to the mental illness. This has been shown to be the case on a clinical level: A lot of the emotional side effects of antidepressants and discontinuing them were initially attributed to the underlying illness. It was only when these medications were given to "normal" people that they realized the side effects were real.

But it's also certainly true on a social level. Most people don't really want to get inside the heads of those who are thought to be mentally ill, because of course their thinking is pathological! Understanding their thought process won't accomplish anything. Best to just tell them what to do since you're thinking is clear and theirs isn't.

The reality is, I think, that many formerly or currently mentally "ill" people have a lot of insight. Obviously, this depends on the "illness" and severity. But in my experience, people who have struggled with their emotional state have more compassion and empathy for others who are struggling. They understand what it means to struggle and that there aren't simple answers. And of course, having struggled with your mental state, doesn't mean that you're not self-aware. You're capable of knowing what helps you and what doesn't and what to do when you're having a rough time. Just because your thinking isn't productive or clear 100% of the time, doesn't mean that you're not qualified to help yourself. In fact, you are the most qualified to help yourself because you're the best acquainted with your issues.

I wonder about these people who are dismissive of "crazy" people. I find it hard to believe that they have never legitimately struggled with their mental state in their lives. I'm sure that they have at one point or another. I don't want to make the same mistake of over simplifying them and their position. But I wonder, do they just conceptualize their struggles as simply situational? Or perhaps the severity or the length of the struggle wasn't great enough or long enough to revise their thinking. Or perhaps calling other people crazy is a defense mechanism. Who knows? Regardless, I don't think they've thought particularly clearly about what it means or what it's like to be mentally "ill." They're certainly not approaching mental "illness" with a lot of compassion.

Therapy Jealousy

I sometimes get jealous of my friends who actually talk to their therapists about things. Like they have some problem in their life and they go talk to their therapists about it. And their therapists listen and give them advice and they feel better. Or maybe their therapists just give them some things to think over that will help point them in the right direction.

My therapy sessions are nothing like this. My therapist does not know anything about my day-to-day problems. He knows nothing about my relationship or the dynamics at my job. I don't talk to him about sex. He doesn't know what I value in life and what I don't give a shit about.

The thing is, this is okay. I think my therapist is very good, in part because he is so direct and to the point. We work on a specific issue I'm having and don't dabble into anything else.

I have no problem with talk therapy--it's been shown to work just fine for a number of things. However, I don't think it would be good for me unless perhaps I had a talk therapist who could tell me when my talking starting sounding like obsessing.

Nonetheless, part of the reason I went into therapy was that I needed more support in my life. I get support in the sense that my OCD and skin-picking symptoms are lessened, but not really any emotional support outside of these limited topics. I'm kind of jealous that I don't have an impartial person to talk to about my problems. 

More than that, a few of my friends can casually mention, "my therapist said such and such" or "I'm going to talk to my therapist about that." I never say these things, not because I'm a closed person, but because there never is a good way to drop into a conversation what my therapist says or what I'm planning to talk to my therapist about. I suppose I worry that I come off as more closed than I really am.

An Over the Weekend Obsession

I had an obsession over the weekend. It was bad and it reminded me of what it feels like to be fully immersed in one: really shitty.

The situation was that something shitty happened at work Friday. I was able to let it go for the day, but when my partner got home from work, I launched into the whole story. I found myself getting angry and I couldn't let it go. I exercised and still couldn't let it go. I tried to sleep and still couldn't let it go. I eventually fell asleep, but Saturday morning I woke up early and it was there. I cried about it Saturday afternoon while trying to enjoy myself on a hike. Saturday night I told my friend about it and she recommended I take action. Sunday morning it was still there and I decided to write an email about the situation to my boss. It took me forever, I wrote it, and after some deliberation I sent it. I was anxious after sending it, but I definitely experienced significant relief. I was able to move on to other things.

The thing is, I didn't regret sending the email. I didn't see it as a pointless compulsion, like driving home to find that the door is already locked. At the same time, I know I was having an obsession. I wanted to write the email because I knew it would provide relief.

So, the question I have for myself is can I make difficult decisions without obsessing? I ultimately think it was a really good decision. But I just don't know how to come to those sorts of decisions without obsessing. Ack. I don't know how to live my life.

More on BFRBs

I just took a bath and thought about my last post.

My therapist says that perfectionism is what ties OCD and BFRBs together--a sort of perfectionism. I had never thought of my behaviors in this context. My desire to pick and pull stems from a desire to make things smooth, look better, and be more perfect. I would have said relief-seeking was what tied them together, but perhaps relief-seeking is considered to be symptomatic of perfectionism.

In any case, I was thinking about the whole ramblely paragraph in my last post regarding my unwillingness to think things that I don't believe to be true. I just realized that this is symptomatic of a sort of perfectionism: "my thoughts must be logically consistent at all times." Now what do I do with that?

I guess I want to know more about behavioral therapy at this point. Maybe perfectionism isn't something I can easily address directly. Maybe I can only address the problematic behaviors that stem from it--i.e. BFRBs and OCD.

Body-Focused Repetitive Behaviors

Therapy was hard yesterday. I suppose I was already having a hard day, but there's something particularly hard about talking about my body-focused repetitive behaviors--skin picking, hair pulling, etc. I'm just so ashamed or embarrassed I guess.

It's weird, because talking about my OCD is also embarrassing. You have to say that you're incredibly anxious about something that doesn't make sense to be anxious about. Or something that doesn't even make sense at all. But there's something worse about BFRBs. I don't know if anyone uses that acronym. I just made it up, I guess.

Last session, I said that I thought my BFRBs were weird and gross. My therapist said I needed to have more compassion for myself and stop being ashamed. He said he could think of at least ten things that people did that were weirder and grosser than my BFRBs. He said that he wished people were more ashamed of some of these things. I suppose he's right. I have exceptionally little compassion for myself, which paradoxically enough exacerbates the behaviors I'm trying to stop.

So, I guess the question is how do I cultivate compassion for myself? My therapist was particularly interested in me reevaluating idea that my BFRBs are weird and gross. He told me he thought I was smart and asked me why I think that if I knew it wasn't serving me. I didn't get an opportunity at the time, but for me thinking things is about whether or not I believe them to be true, not whether or not they serve me. It seems intellectually dishonest to change what I believe to be true based on what will serve me best. I can understand not dwelling on things that I believe to be true if it serves me not to dwell on them, but I can't understand not believing them. The thing is, I do think my BFRBs are weird and gross. I can agree that there are weirder and grosser things that people do, and I suppose that helps me cultivate at least some compassion for myself.

Emma Pillsbury on Glee

The sort of odd thing about OCD is that everyone is familiar with it, but no one seems to have any idea what it actually is. It's entered the vernacular as a description of someone who is overly meticulous and perfectionistic, which doesn't match the clinical definition at all. I think there are a lot of potential reasons for this. For one, it's relatively uncommon affecting only 2-3% of the population. That said, diabetes affects around the same percentage of the population, though, and everyone knows what it is.

I think the bigger reason is that it's never portrayed particularly clearly or accurately in the media. To be sure, this is a difficult task, because so much, if not all, of OCD, happens in the sufferer's head. A couple of common mistakes are made. The first is to confuse OCPD (obsessive-compulsive personality disorder) with OCD. Outwardly OCPD and OCD can appear similar, but the main difference is that OCPD sufferers don't realize that their behaviors are odd and don't make sense. It's much easier to portray OCPD since it isn't something the sufferer is ashamed of and tries to hide. The second mistake--or perhaps omission--is is to focus solely on overt compulsions, usually cleaning and washing compulsions. In reality, OCDers actually perform from a much wider variety of compulsions: praying, tapping, checking, hoarding, counting, as well as a host of mental compulsions.

I've been watching Emma Pillsbury on Glee with some interest for a while. She has OCD, which has for the most part been disappointing. She obsessively cleans to get rid of germs and doesn't seem to understand it's weird until late in second season. In second season she goes to a psychiatrist who tells her if she takes a low dose of an SSRI her symptoms will get better. Two weeks later, she tells Will that she's better and that her SSRI worked. At this point, I was pretty disappointed. First of all, it wasn't really clear she had OCD in the first place. Second of all SSRIs are not magic, particularly not at low doses when treating OCD.

The most recent episode, "Asian F," however was a little bit more accurate. Emma experiences a relapse after a stressful dinner with her parents. Also, Emma tells Will that one of her compulsions is praying in her head all the time and when that doesn't work, she prays out loud. Indeed, stress triggers OCD and mental compulsions, including praying, are a very real and common symptom of OCD. The only disappointing bit was Will offered to pray with Emma. I suppose this makes sense, but hopefully at least of of their characters will figure out that performing compulsions (or assisting in the performance of compulsions) only makes OCD worse.

Therapy Yesterday

I shared with my therapist the thought that I was having that my anxiety levels were meaningful and indicative that something in my life wasn't working. He seemed to think this was an OCD situation and then I felt embarrassed. I think I even started to blush. God.

I don't know what to think now. I think that my anxiety is meaningful, but I'm starting to doubt my doubts that my life isn't working. I don't think my obsessions point me towards what isn't working, but I think there existence is an indication of something. And I think I know what that something is: work is a bit of a mess right now for various reasons and I don't handle work stress well.  

Then we ran out of OCD things to talk about, so we talked about skin picking. Ug. I know I brought it up two weeks ago and I know I want to stop doing it, but it's probably the most embarrassing thing to talk about in any detail. It doesn't feel so bad to say I skin pick, but if you actually want me to get into the details of it, I will get embarrassed and have trouble telling my therapist all the details. I don't even know that my partner knows all the details. I mean, he knows that I do it, finds it gross, and for God knows what reason accepts me despite this, but I don't know if he understands the urges and perverted and bizarre thought processes that lead me to do it.

From what I've read about skin picking, like OCD, it comes down to sitting with discomfort. With OCD, that discomfort tends to be anxiety (but it can be guilt or other unpleasant emotions). With skin picking, the discomfort comes from an urge unsatisfied. It's sort of depressing for me to feel that all my issues stem from an unwillingness or inability to sit with discomfort. So, I obsess more, perform compulsions, and skin pick. It makes me feel like a bit of a wimp. I wonder, am I a wimp? Or do other people not experience discomfort at the same levels I do? I suppose I can never really know the answers to these questions.

Stress and OCD

I think OCD is my perverted way of dealing with stress and burnout. It's sort of irritating that this is how I deal with these things. It'd be much better if my mind said, "Hey! I think you're getting a bit stressed. Maybe you need to address the stress in your life, do less, and take better care of yourself." Instead, my mind says bizarre perverted things like, "you must ruminate NOW on the nature of death and time" or, more mundanely, "maybe you left the stove on."

The thing is, I think my mind does tell me I'm stressed and on the path to burnout but I don't listen. So, I just keep on going. Eventually, my mind makes me listen by either causing a stress related injury or OCD. Both of these things make me slow down, but have the unfortunate side effect of fucking up my life making me wish I had listened and slowed down sooner.

I had a long conversation with a kind-of coworker today. He told me about how a number of my predecessors had epically and suddenly burned out. I knew that two of my predecessors had, but there apparently were a few before that that did too. I had an odd emotional reaction to this. On the one hand, it felt relieving to know that my bizarre and perverted obsessive-compulsive reaction to work stress wasn't unusual or unexpected. Not that my predecessors were OCD, but one of them apparently was a big drinker who was stealing alcohol from work. It apparently was a bit of a mystery where the red wine was going. We all express our issues in uniquely self-destructive ways, I suppose.

On the other hand, I had already been wondering about whether or how to continue at my job. My predecessors, I suppose, uncomfortably reminded me that I need to continue exploring this issue.  A number of books I have on anxiety say that a lot of anxiety disorders don't go into remission until you are doing something that makes you feel passionate and excited. It's clear to me that my job causes me undue stress and that a change is needed. I don't know whether all I need an attitude change. Given my predecessors, is such a change possible? Or do I need to do something more drastic... like quit?

Relief and Then...

I feel like I have experienced some relief from my OCD in the past few days, ever since getting lost in the woods the other afternoon/early evening.

The funny thing about getting out of my head and back into the world is that I've realized there are all these things I've neglected--cleaning my house, cleaning my kitchen, my relationship, my job (not so much), and my friendships. It suddenly feels like these things matter again and I feel angry at myself for not giving them sufficient attention--particularly my relationship.

And it's all feeling a little stressful now. It's like I've been suffering so much, what I really need is some peace. But life isn't giving that to me. Now I have to deal with the mess I left when I wasn't feeling so good. The thing is stress triggers OCD for me, so I need to manage this feeling that I'm having as best I can so that I'm able to actually pay attention to the important things.