John Green, a Doctor and a CEO Get Real About Mental Health

Summary

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Podcast Summary: “John Green, a Doctor and a CEO Get Real About Mental Health”

Podcast: Get to Know OCD
Host: Dr. Patrick McGrath (Chief Clinical Officer, NOCD)
Guests: John Green (author), Stephen Smith (CEO, NOCD)
Date: February 23, 2026

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Episode Overview

This episode brings together John Green (bestselling author), Stephen Smith (CEO of NOCD), and host Dr. Patrick McGrath for a deep exploration of OCD, misdiagnosis, stigma, the transformative power of evidence-based treatment, and hope for people and families dealing with OCD. Both Green and Smith share vulnerable, personal stories of struggle and recovery, highlighting the impact of properly tailored treatment, specifically Exposure and Response Prevention therapy (ERP), and offer insights into living meaningful lives with OCD.

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Key Discussion Points & Insights

1. Personal Experiences with OCD & Misdiagnosis

• John Green and Stephen Smith both describe long periods of misdiagnosis—typically as generalized anxiety or simply a personality quirk—before finally identifying their symptoms as OCD.
• Both recount extensive suffering, impaired daily functioning, and the feeling of being “lost in fear.”
  • John Green: “I wasn’t able to write. I wasn’t able to, you know, read a menu, wasn’t able to read a book... My kids would be right in front of me, and it would be like they weren’t there because I would be so lost in my own fear.” ([00:00])
  • Stephen Smith: “Was misdiagnosed for generalized anxiety disorder six different times. Eventually developed severe depression... became housebound.” ([00:17])

2. Why OCD Is So Misunderstood

• Misconceptions: Both guests believed OCD was only about observable, cleanliness-related rituals—fostered by media and casual language.

  • John Green: “I thought that OCD was a disorder of like, cleanliness and hygiene.” ([01:54])
  • Stephen Smith: “I thought that OCD was just a personality quirk or an adjective used to describe somebody who’s type A.” ([02:39])

• Invisible Symptoms: Much of their OCD was “mental”: rumination, mental checking, and internal reassurance that outsiders wouldn’t see.

  • Stephen Smith: “Most of my compulsive behaviors were actually in my head... People didn’t even realize I was not focused there.” ([02:39])

3. The Prevalence and Real Burden of OCD

• Stigma & Misclassification: Underdiagnosis leads to insufficient resources and training, perpetuating misunderstanding and reducing access to care.

  • Stephen Smith: “[OCD] gets misdiagnosed... When they’re misdiagnosed, they get miscoded... And then the folks responsible for managing mental health care... say, ‘Well, I don’t see OCD as being a big issue.’” ([05:25])

• Systemic Impact: Proper diagnosis can improve overall health outcomes, not just mental health.

  • John Green: “Getting better from OCD has not just made... it so I don’t have as much difficulty with OCD. It’s also meant that I don’t have as much difficulty with the rest of my health... Not being miserable is good for your health.” ([07:30])

4. Message of Hope

• Recovery Is Possible: Both Green and Smith emphasize the possibility of living well with OCD after effective treatment.
  • John Green: “It just doesn’t have to be that way... recovery is possible.” ([08:37])
  • Stephen Smith: “That’s one of the silver linings... if you go through this terrible experience, but you actually can do treatment, you can come out on the other side in a really positive place.” ([10:42])

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Memorable Quotes & Moments (with Timestamps)

• “There is another side to this. There is a way through.”
  — John Green ([00:29])

• “Most of my compulsive behaviors were actually in my head...”
  — Stephen Smith ([02:39])

• “This is a really, really debilitating illness. This can be a very serious psychiatric condition.”
  — John Green ([07:30])

• “You can actually get people better. And... it’s one of the reasons why you should have hope.”
  — Stephen Smith ([09:29])

• “How do you live with doubt? ...You have to find a way to live with the doubt and to get comfortable with a measure of discomfort. And that’s what ERP has been for me.”
  — John Green ([12:08])

• “OCD is always going to be in the car with you, but maybe instead of being in the passenger seat, it’ll be in the trunk and it might bang on the trunk once in awhile.”
  — Dr. Patrick McGrath & John Green ([15:14–15:28])

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Important Segments & Timestamps

| Timestamp | Segment Title | Content Highlights | |-----------|------------------------------------------------|----------------------------------------------------------------| | 00:00 | Living with Undiagnosed OCD | John Green describes his darkest struggles | | 01:54 | Misconceptions & Misdiagnosis | Both guests challenge myths about OCD | | 04:23 | Internal vs. External Symptoms | Discussion of invisible compulsions | | 07:30 | OCD & General Well-being | How correct treatment improves all aspects of health | | 08:21 | Message of Hope | Guests reflect on improvement and regained joy | | 10:42 | Journey to the Right Treatment | Comparing pre-ERP and ERP experiences | | 11:03 | Difference Between General Therapy and ERP | Detailed descriptions and contrasts | | 13:41 | Living with OCD Long-Term | Coping strategies and realistic expectations | | 15:14 | The "OCD in the Car" Metaphor | Memorable visual analogy for ongoing OCD presence | | 17:24 | Parenting and OCD | How OCD affects family and fears about children | | 20:25 | OCD Attacking Core Values | Why OCD targets what matters most to individuals | | 21:00 | Addressing "Superpower" Myths | Rejecting the romanticization of OCD as a source of success | | 24:18 | OCPD vs OCD | Clarifying crucial differences in common language | | 27:28 | Role of Media & Awareness Efforts | "Turtles All the Way Down" and the impact of accurate portrayal| | 29:49 | Returning to Family Life Post-Treatment | Guests describe returning to loved ones after severe episodes | | 33:07 | What Really Helps: Response Prevention | Applying ERP in daily life, including mental compulsions | | 37:27 | Operationalizing OCD Care | Stephen Smith on tech solutions and NOCD’s mission | | 40:39 | What Treatment Has Changed | John Green and Stephen Smith reflect on life after ERP |

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Treatment Insights: Exposure and Response Prevention (ERP)

• Contrast with Prior “General” Therapy:

  • Pre-ERP, both guests were told to challenge, stop, or “snap away” thoughts—strategies that ultimately reinforced compulsions and distress.
    • Stephen Smith: “It was almost the opposite of what I should have been doing.” ([11:03])

• ERP’s Distinct Power:

  • Focuses on accepting uncertainty and living with doubt instead of seeking certainty.
    • John Green: “You’re never going to be able to close the loop of an OCD worry... so you have to find a way to live with the doubt.” ([12:08])
  • Learning response prevention for both visible and mental compulsions:
    • Stephen Smith: “I had to consciously then accept uncertainty in that moment with really specific statements like, maybe that could happen, I’ll accept the uncertainty, move on...” ([33:58])

• Progress as Subtle, Cumulative Change:

  • Recovery happens in small, often unnoticed increments that add up over time.
    • John Green: “It’s such little steps that you can only see it looking back... then eventually you look back and you’re like, oh, wow, I’ve come a long way.” ([15:34])

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Living with OCD: Realism and Responsibility

• Long-Term Management:

  • OCD may never fully disappear, but with the right tools—including ERP and, for some, medication—it becomes manageable and far less debilitating.
    • John Green: “It just doesn’t take over to the same degree... I have much better tools for dealing with that.” ([13:41])

• Family Dynamics:

  • Both guests discussed how OCD can center on those they love most—spouses and children.
  • The illness affects the whole family; partners and children can bear emotional burdens, often not understanding or seeing the invisible struggle.
    • Stephen Smith: “For me, OCD today focuses mostly on my relationships with my family, my kids... For me, it’s like... my kids’ safety.” ([18:47])
    • John Green: “It’s really hard. I mean, I have a lot of sympathy for my wife... Seeing someone you love in that amount of pain is really difficult.” ([32:28])

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Addressing Myths and Encouraging Understanding

• On “OCD as Superpower”:

  • Both categorically reject the idea that OCD caused their achievements, cautioning against romanticizing mental illness.
    • John Green: “People really want there to be a superpower associated with my mental health conditions. And I wish there were, believe me, but there isn’t...” ([21:00])

• On Media Representations and Language:

  • The conflation of OCD with OCPD leads to dangerous myths.
    • Stephen Smith: “It’s the only word in the English language... that almost everyone recognizes and almost everyone misunderstands.” ([23:16])

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The Path Forward: Advocacy and Access

• Increasing Awareness and Reducing Barriers:

  • Both guests highlight the need for greater awareness, more specialized therapists, targeted outreach, and cultural change in how OCD is understood and treated.
    • Stephen Smith: “Is it a clinical issue or is it an OPS issue?... It’s actually an operational issue because the clinical treatment is there... but we just don’t have enough people getting identified and then enough providers who are specialized in disseminating it.” ([37:27])

• NOCD’s Mission:

  • Kombat stigma, make ERP accessible through digital platforms, and provide supportive community and resources for all affected.

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Final Words of Hope

• Dr. Patrick McGrath:
  • “You can be partners, you can be fathers, you can be entrepreneurs—and you can have OCD.” ([41:21])
  • “If you’re looking for help, you can go to nocd.com... to develop those very specific treatments for you so that you will have personalized care...” ([42:01])

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This episode is a hopeful, practical, and myth-busting conversation offering both deep validation for those struggling with OCD and proof that life after proper treatment is not only possible—it can be rich and fulfilling.

Transcript

[John Green]

I wasn't able to write. I wasn't able to, you know, I wasn't able to read a menu, wasn't able to read a book. I wasn't able to, you know, do any of the things that bring me joy in my life. My kids would be right in front of me and it would be like they weren't there because I would be so lost in my own fear.

[Stephen Smith]

Was misdiagnosed for generalized anxiety disorder six different times. Eventually developed severe depression because I was getting worse through harmful treatment, and then became housebound. And that's what prompted me to start a search for other forms of help.

[John Green]

That's why it's so important, not just to get treatment, but to get the right treatment, to get the right kind of therapy, because this is treatable. I felt so helpless and hopeless at the worst of it, and I wish that I had been able to hear those words, that this is treatable. There is another side to this. There is a way through.

[Dr. Patrick McGrath]

Welcome once again to another episode of the get to Know OCD podcast. I'm Dr. Patrick McGrath, the Chief Clinical Officer for NOCD. I'm joined today by John Green and Stephen Smith. John Green, author, Stephen Smith, the CEO of nocd. Happy to have you both here today.

[John Green]

No, it's great to be with you.

[Stephen Smith]

Thanks, Patrick.

[Dr. Patrick McGrath]

I wanted to start off with the two of you because you've had interesting lives with ocd and both of you really getting to a later diagnosis of OCD in your lives too. And I'm wondering if we could talk about kind of the development of what was going on in your lives, maybe your own kind of understanding or lack of understanding of what OCD was, figuring out how OCD plays a part in it. And then how do you go to finding actual evidence based treatment? Because both of you have some interesting background in that area.

[John Green]

Yeah. So for me, I wasn't inspired to start OCD or anything, but I was diagnosed with anxiety long before I was diagnosed with ocd. And it was only when my checking repetitive behaviors got to a point where it was taking up like eight hours of my day that eventually I was diagnosed with OCD and, and finally was able to access appropriate treatment. And that was an absolute game changer for me. And so that was a long, long journey. And most of the time I didn't even know that I was missing something because I thought that OCD was a disorder of like, cleanliness and hygiene.

[Stephen Smith]

You know, I thought the same thing. I thought that OCD was just a personality quirk or an adjective Used to describe somebody who's type A. I had no idea it was such a disabling, chronic condition that affected one in 40 people globally. And I also didn't realize that the symptoms manifested both, I would say, observable and mental. Oops, sorry. You know, when I think about a lot of the symptoms that I personally experience, I experience a lot of the mental rumination and a lot of the mental checking and the mental reassurance, reviewing past events. So most of my compulsive behaviors were actually in my head. Although some of them were behaviors that you could see, such as Google searching, such as asking loved ones for reassurance. A lot of it was spent in my head. So when I would go through my own episodes, I would basically be in the room existing with everyone else. And most people didn't even realize that I was just not focused there. I was focusing on the dialogue, going back and forth in my own head. So was misdiagnosed for generalized anxiety disorder six different times. Eventually developed severe depression because I was getting worse through harmful treatment, and then became housebound. And that's what prompted me to start a search for other forms of help. And I was doing that in somewhat of a compulsive way too. I was google searching and trying to try to understand why I was having these specific thoughts, thinking that if I could understand them, then I could potentially actually answer, like these questions that were in my head. And that led me to a forum of people who are talking about their OCD symptoms. And so that was when I kind of realized that OCD was much more than just a personality quirk or an adjective used to describe somebody's type aids. It's in fact a condition that manifests in recurring unwanted intrusive thoughts, images and urges, complemented by actions that try to make them stop.

[John Green]

But to your point, a lot of those actions can be invisible. They can be internal actions. And so my understanding of ocd, which was painted by the movies that I'd seen and the stories that I'd heard, was that this was a very compulsion oriented, visible disease. Whereas really it begins with the intrusive thoughts. It begins with the unwanted thoughts and impulses. It doesn't begin with compulsive behaviors. That's in fact what I use to try to make the obsessive thoughts and the obsessive fears more manageable.

[Dr. Patrick McGrath]

There's a skepticism out there about the prevalence of ocd, you know, that. Or that it is just this idea of just washing your hands or something like that. And I know Stephen we found that at first with no cd when we were starting off together, growing this. And your work was just instrumental in helping people to recognize the prevalence of OCD that was out there in the world.

[Stephen Smith]

Well, I think it's, it's because it's so misunderstood, right? It's often then misdiagnosed. So when people don't know about ocd, they don't ask the questions that truly understand what someone's going through. And people who are experiencing symptoms, they don't disclose their symptoms in an open, honest way because they feel embarrassed. They don't realize that they're going to be understood, right? So then what happens is they get misdiagnosed and when they're misdiagnosed, they get miscoded. So when they're seen by a provider, the provider then says, hey, they don't have ocd. They have maybe symptoms of the problem, anxiety or depression or maybe another issue, not necessarily the root challenge, right? And so then what happens is their data gets logged into different claims data sets or even EMR data sets as being symptoms of the problem, not the root issue. And then the folks that are responsible for managing mental health care at the system level, they're looking at their data and they say, well, I don't see OCD as being a big issue, right. And then it kind of unfortunately causes the problem to worsen because then we don't have enough resources for ocd, we don't have the right specialty trainings for providers. All of that comes into play. And then people naturally, then they don't get asked the right questions, there's less awareness. People don't necessarily surface with their own symptoms. So what we've tried to really do is we've tried to kind of step in right at that point of awareness and training to try to hopefully surface people who actually are suffering from OCD and then getting them connected to the right evidence based therapy sooner so that they can then live their life. And that scale, if we do that enough, the system will kind of correct itself because then you'll have the right diagnosis that will lead to the right claims data being connected and then everything else will kind of hopefully fall in line.

[Dr. Patrick McGrath]

In looking at this from, from that claims data and taking a look at where we've kind of grown in the last, well at this point, six, seven years now, we are seeing results from this doesn't exist in claims to when people get treated for ocd, not only does it improve their ocd, but it improves their general health well being as well.

[John Green]

That's certainly been my experience. I mean, getting better from OCD has not just made, made it so that I don't have as much unwanted, you know, as much difficulty with ocd. It's also meant that I don't have as much difficulty with the rest of my health, which means that I don't engage with the health care system quite as much. Yeah, I mean, I have health related ocd, so I was engaging with the healthcare system quite a lot. But even for somebody with other kinds of ocd, look, not being miserable is good for your health. It's just good news and it's a really, I think one thing that, you know, you've done a great job of highlighting, but I feel like sometimes the culture in general has not highlighted is that this is a really, really debilitating illness. This is a very, this can be a very serious psychiatric condition and one that's really hard to live with.

[Dr. Patrick McGrath]

There's a message of hope. To me though, that goes with that. We have a CEO of the largest specialty behavioral health company in the world. We have an award winning author here who both have OCD that at some points in their lives has really tried to strike you both down.

[John Green]

Yeah, I mean, you got to a point where you were, you know, living in your house all the time. And I got to a point where I wasn't able to write. I wasn't able to, you know, I wasn't able to read a menu, wasn't able to read a book. I wasn't able to, you know, do any of the things that bring me joy in my life. My kids would be right in front of me and it would be like they weren't there because I would be so lost in my own fear. And it just doesn't have to be that way. And I do think that's a reminder of hope. I do think that's a stark reminder that, you know, recovery is possible.

[Stephen Smith]

Yeah, I just echo that. I mean, when I realized I was getting better is when I could actually engage with my family. I could actually have a conversation. I would go along on a car ride instead of being in the passenger seat, just in my own head. While everyone else was talking, I was actually able to engage in the conversation.

[John Green]

Right.

[Stephen Smith]

That's so like similar kind of a moment happened with me when I would noticed I was getting better. And I think that's one of the nicest parts about treating OCD is you can actually get people better. And if you're getting treatment, it's one of the reasons why you should have hope, because you can actually get better. It's a manageable condition. And when you get better, it's not just demonstrated by, okay, your scores are lowering. It's demonstrated by what you can actually do in your life again. Because when you're like, for me, at least, the reason to actually seek treatment was I wanted to go back to school. I wanted to start playing football again. I wanted to be able to have a social life, right? Wanted to, you know, get back into working out more. I want to do all these things that I once loved to do that I couldn't do because of ocd. And that was the reason for actually wanting to get treatment. And so when I was able to do those things again, that's when I realized, okay, even though there are certain times where I'm not feeling great, I can do these things again that I actually want to do. And that was really, really profound. So. So that's. That's. That's one of the silver linings about this whole experience. Like, if you go through this terrible experience, but you actually can do treatment, you can come out on the other side in a really positive place, and that can empower you to do much more in your life because you know how you can navigate really challenging times.

[Dr. Patrick McGrath]

You both describe getting the work being done on, maybe anxiety, the misdiagnoses, and doing more of a general therapy, and then eventually coming into erp. I wonder if you could describe what was the difference between the therapies you were doing before ERP and then once you did erp, not only in the treatment itself, but. But the impact that it had on you, too.

[Stephen Smith]

Yeah, I think you have to talk about both, though, too. I think, like, the therapies that I was doing prior to erp, they were just at the fundamental level, teaching me to challenge my thoughts, like, to. To try to stop them, to try to, you know, reassure myself, even. Like, it was almost the opposite of what I should have been doing right there. So it was like thoughts stopping more than anything else. Like, I remember I had a therapist once telling me, hey, for every time you have a thought, I want you to pretend that a train's running through your head. And I want you to take the thought and place it in one of the train cars and just watch it go on by. Like, I was like, wow, that's kind of strange, right? Or I want you to take a rubber band and snap it across your wrist. Or I want you to challenge a thought. So that was what treatment, you know, unfortunately, before I got ERP looked Like, for me, when I got to erp, though, I learned to. Instead of stopping the thought, to accept the uncertainty behind the thought, to just. To really, like, consciously acknowledge that there's uncertainty in the situation, and I'm gonna have to carry on without actually finding an answer. And that's when everything started to change. And why I'm grateful for doing erp.

[John Green]

Yeah, I mean, it's. How do you live with doubt? Because you're never going to be able to close the loop of the worry of an OCD worry, or at least I'll never be able to. It always will find a way to say, yeah, but what if. It'll always find a way to say, well, but wait. And so you have to find a way to live with the doubt and to get comfortable with the doubt, comfortable with a measure of discomfort. And that's what ERP has been for me, is a way to, you know, be uncomfortable. Definitely. To not feel, you know, totally. To feel safe and to feel cared for, but not feel comfortable.

[Dr. Patrick McGrath]

Right.

[John Green]

And then over time, to feel like, oh, I can live in that space permanently.

[Dr. Patrick McGrath]

And I'm glad you bring that up, because I think that is the important piece. Living in that space of doubt is difficult. Right. I mean, it's. Who wouldn't want to know an answer to something?

[John Green]

Yeah, of course, I would love to be reassured that all of my existential worries will not come to pass, but in fact, many of them will come to pass.

[Dr. Patrick McGrath]

Yeah. Yeah. So as you navigate now, a world where you're writing, you're doing podcasts, you and your brother do so much great work, charitable work, even. And, Steven, as we grow NOCD into this NoDo experience that we're doing, OCD will still want to grab at you, I bet. Right? Is it still nipping at the heels, hoping to trip you up and things?

[John Green]

Yeah, it's definitely still part of my life. I mean, I can't speak for you, but for me, it's part of my life, and I think, I suspect it always will be. And there are always going to be times when I sense an intrusive thought beginning to take hold, beginning to have some power over me. But I'm much more equipped now. I have much better tools for dealing with that. Some of that for me is medication. Some of that for me is the experiences of erp. And I have much better tools for being able to live with that thought or live with that fear than I did 10 years ago.

[Stephen Smith]

Yeah, and I'd agree. I think that fact that once you learn how to do response prevention, especially like you have sudden exposures that come out all different points of time throughout your life. Right. How do you then respond to them? And once you learn the tools of learning how to accept uncertainty, you can actually then respond in a really productive way, no matter the type of fear. And so for me, you know, you know, OCD has always existed. It's existed over the last, really the last 11 years since I had my severest onset. And when I think about, though, the most recent decade.

[John Green]

Right.

[Stephen Smith]

I think about how I've been able to, despite ocd, still function in a really happy way. In fact, happier than I was when I even had my most severe onset in college. And that, to me, I think, is a tribute to the tools from erp. And so I, look, I don't worry. Even though I experience ocd, it doesn't bother me like it used to for that reason.

[John Green]

Yeah. It just doesn't take over to the same degree. Right. Like, it doesn't. I think you told me once that OCD is always going to be in the car with you, but maybe instead of being in the passenger seat, it'll

[Dr. Patrick McGrath]

be in the trunk and it might bang on the trunk once in a

[John Green]

while,

[Dr. Patrick McGrath]

but it does.

[John Green]

Yeah. I mean, for me, it's almost like it's such little steps that you can kind of only see it looking back. You know, if you're living it day to day, you're just getting a little bit better a piece at a time. And. Yeah. But then eventually you look back and you're like, oh, wow, I've come a long way.

[Dr. Patrick McGrath]

Well, that's the beauty, I think, of treatment is we're not here to throw somebody in the deep end of the pool. Right. We want steps. We want to gradually put a toe in the water, see how it feels, builds from there. And that's what I always try to give the message out about. Good treatment isn't going to frighten you. I mean, it won't be all that comfortable.

[John Green]

Right.

[Dr. Patrick McGrath]

Because you are facing a fear and you're not doing your typical safety behaviors. But it isn't designed to make you run away.

[Stephen Smith]

Just to add one of the things that I used to do sometimes, still do, I would go back through all of my Instagram pictures and I'd identify the pictures where I remember taking the picture, but feeling the severity of OCD in that moment. And over time, I've realized, like, there, there are much less pictures now when I, when that actually happened. Like you, you make, you know, from 20, call it 2014 through 2018, there were dozens of pictures. Right. From the last five years. They're less than a dozen. Right. And just shows you that's like a great sign of, of quantifiable progress.

[John Green]

Can you tell when you look at a picture if you were feeling it?

[Stephen Smith]

I can't tell from looking at the picture per se, but I remember the moment and I remember how disabling OCD was in that moment. And no one could ever tell.

[John Green]

Yeah. Yeah. I feel that same way with, with looking at old videos when I was really sick, I. I often feel like I can tell and no one else can. It's not visible, but there's like almost something in my eyes or something. Or maybe I'm just remembering what that. What that day was like. And I can tell.

[Stephen Smith]

Yeah.

[Dr. Patrick McGrath]

Now both of you are dads, and so there's the experience of family life with ocd and I don't hear a lot talked about that. So I'd be interested in just how you navigate that experience. And are there existential fears about your kids and OCD or things like that too?

[John Green]

I think there's probably a genetic component to this. I mean, we don't know that much about what causes ocd, but that's my suspicion. And so I do worry a lot about my kids and I want them to be well and happy. But, you know, since I've had access to better treatment, I've understood that they, even if they do live with mental health problems, that. That doesn't have to be final. That doesn't have to be, you know, the all encompassing end all. Be all of their lives in the same way that it's not for me. Like I live with a serious mental health problem and I have a really good life. Both those things are true at the same time. And I actually think that's the norm for people who are able to access treatment for their mental health problems. I actually think that's much more common than we think. So I don't feel as paralyzed by it. Parenting as I did when I was at my worst. But I also know that I'm not always going to feel as good as I feel now. So that's subject to change. Of course. Yes.

[Stephen Smith]

It's like. It ebbs and flows.

[John Green]

Yeah, it ebbs and flows.

[Stephen Smith]

Yeah. We, you know, for me, OCD today focuses mostly on my relationships with my family, my kids. So I. So, you know, subtypes morph over time.

[John Green]

Right.

[Stephen Smith]

For me, it's like when I notice it kind of using your. Your metaphor. Banging on the trunk.

[Dr. Patrick McGrath]

Yeah.

[Stephen Smith]

When I notice the bang on the trunk, you know, I, I oftentimes notice it in connection with either A, how I parent or B, my kids safety. So there were times where, you know, I would ask myself, look, am I doing enough for certain? Like for my, for instance, my one year old, am I doing enough for him? Right. There's fears around choking. Like is, is my son choking right now? Do I have to check to make sure he's not choking? Like, very specific things. I clean the house 15 different times and people are like, why are you doing that? Right. But you know, our housekeepers love, they come over now, like more, more times, you know, I'm just kidding. But it's, it's. No, in all seriousness though, like, it's, it's, it's. I've noticed it come out more.

[Dr. Patrick McGrath]

Yeah.

[Stephen Smith]

When it comes to just being a parent to my children.

[John Green]

Well, that makes sense though, because OCD is always attacking what we love the most.

[Dr. Patrick McGrath]

Exactly.

[John Green]

And what we care about the most. It's always attacking what's really essential to us. And whether that's, you know, your health or your family relationships or whatever identities are most important to you, it's gonna, it's gonna come for those. And I've experienced that over and over again. And to your point, it morphs, but for me, I think it morphs because it's trying to find a new way in. You know, it's trying to find a new way to, to get at those really core relationships.

[Stephen Smith]

That's why it's also such a complex and just crippling conditions that it truly attacks what you love most. And for each person that's slightly different, even though there's similar themes. Right. But that's the one component that I wish people generally understood is like, this is a condition that comes for you at your core and you can manage it if you get the right treatment. But when identifying it, it's important to understand what people really value, because that's oftentimes where you'll see OCD come out.

[Dr. Patrick McGrath]

Do people ever come up to the two of you and say, well, you're obviously successful because of your ocd. It's the thing that drove you to.

[John Green]

Yes. Yeah, all the time. People are. People really want there to be a superpower associated with my mental health conditions. And I wish there were, believe me, but there isn't all the time. People will be like, well, don't you think one of the reasons you're a fiction writer is because you obsessively go through things that might happen and then you write stories. But I don't, I just don't think that I don't. I don't believe that that hasn't been my experience of writing fiction at all. And in fact, I think that, that writing fiction for me is only possible when I'm well, because when I'm really sick, I can't write anything. I get that sort of scrupulosity or whatever where every sentence is insufficient to my needs and what I want to do. And so I can't make my way through a story because I'm too self conscious, because I'm too focused on my own fear. It's just not possible to write. And so I really reject the notion that part of my success is my ocd. At the same time, I do believe that suffering, in whatever form does help you understand and glimpse the suffering of others. It does, it can be. It can break down the empathy gap. And so I'm aware of that. But I don't think there's a superpower power associated with it.

[Stephen Smith]

I'd agree with you. I think that the experience going through OCD I've had has led me to conquer probably the hardest problem I've ever faced in my life. Going through OCD and navigating it is so challenging that most people just don't understand a challenge like it until they go through it. Right. You have to truly go through it to understand it. And what I would say though, is like the question initially that you asked, which was, do people think it's a superpower? I think that actually more reflects the status of society's understanding of OCD than anything else. And it's the only word in the English language. And maybe you may have others, but this is something that I've identified. He's the language, he's the expert here. But for me, it's like the only word that I know that almost everyone recognizes and almost everyone misunderstands.

[John Green]

Yes.

[Stephen Smith]

But then they don't realize they actually misunderstand it. That's the part that is. It's like it's an unintentional misunderstanding that so, so it's like it's not. People aren't, you know, joking about OCD because they're, they think it's funny, but they joke about it because they just, they don't realize what it actually is.

[John Green]

Yeah, they're not trying to be cruel.

[Stephen Smith]

Right.

[John Green]

When they tell those jokes, they're, they, they genuinely, and I was in this boat too, don't understand what OCD is and how it impacts the lives of those who live with it and those who love people who live.

[Dr. Patrick McGrath]

I remember watching during COVID a news, they were out in someone's backyard so they could be appropriately distanced from each other, and they were talking about, you know, washing your hands and masks and. And someone said, if we could all just have a little ocd, that would really help us get through this.

[John Green]

Right.

[Dr. Patrick McGrath]

And I think that goes to your point, Stephen, of. Of there's that lack of understanding. Like, this could somehow just be great forever.

[Stephen Smith]

I almost think there needs to. Like, we talk about ocpd, Obsessive Compulsive Personality Disorder.

[John Green]

That's.

[Stephen Smith]

That's more closely related to the kind of widely accepted connotation for OCD today. The. This. You know, the connotation that's factually inaccurate. I think there almost has to be a campaign that just puts a line between the two and says, here's what people believe OCD is actually like. It's. It's ocpd. What OC is actually like, though, is, you know, the hallmark symptoms that we just talked about here today. Like, there is. There almost has to be some way to. To showcase what OCD is and isn't. We try to do that with our no OCD campaign. But I think there are other mediums that have to take shape here for people to truly understand what this is like.

[John Green]

Yeah. Because I think it's really important to emphasize that it makes it hard for people to get help because they don't know what's wrong with them, because the way that OCD is portrayed in the media is not their experience. That was certainly the case for me. It wasn't until I read a book about OCD called the man who Couldn't Stop that I saw my experience reflected back to me.

[Dr. Patrick McGrath]

Yeah. And for those who aren't as familiar, that concept of Obsessive Compulsive Personality Disorder, first of all, terrible name because it doesn't even involve obsessions or compulsions. And they just thought of it as. That's what OCD was like. It goes back to, you know, over 100 years ago, when we were first kind of starting to think about classifying mental health conditions. OCPD is probably best described as, you can't do it right. I will do it. Go sit in the corner and color. You know, that. That's just one way to kind of think of it. But many people then will take that into this notion of I'm the only one who could do it the right way, and I have to do it. That way. And if it's not done that right, it's going to be awful or terrible, horrible. And there's all these rules that must be followed exactly that way. Now there starts to be a little crossover on the rule kind of thing that you could see with ocd, but. But it's a very different experience because people with OCPD aren't doing these compulsive things over and over, trying to get something just right. They just believe that they're right, everyone else is wrong. And that's just the way that it is.

[Stephen Smith]

It's helpful context. I mean, you know, it's almost like there just needs to be, in my opinion, at least, just like a big wave of here is what OCD is actually like, or a big way of campaigns, I should say, of defining what OCD is actually like.

[John Green]

I have seen, I will say, more awareness among young people than I saw, you know, when I first got diagnosed. I do think that people are more aware. I mean, I think therapists are more aware. I think mental health professionals are maybe more aware. And so you're seeing an increase in diagnosis. But we obviously have a long way to go because we know the prevalence of this is really quite high.

[Stephen Smith]

Yeah, that's what saying. That's why I like what you're doing with all the education, because I think there's. There are specific audiences that need that education more for us to really solve this problem. An example is different provider communities. If providers truly understand what questions to ask and they deeply understand ocd, it's. It's like a percentage of the overall population in the U.S. it's like if we have targeted awareness education to specific groups, that could lead to many people, you know, getting surfaced much sooner on their journey.

[John Green]

Right.

[Dr. Patrick McGrath]

How much was turtles all the way down part of you versus part a way to get a voice out about what OCD really is so that people will understand it.

[John Green]

Well, I very intentionally gave Aza a different set of obsessions and compulsions than my own because I didn't want her to be conflated with me too much. And also in my mind, I didn't want to conflate the two. But, you know, as we've been talking about, the underlying experience is very similar. The. The same shame, the same fear, the same dread. All those emotions are really intense with ocd. And so I was able to bring a lot of my own experiences to her experience while still kind of keeping a safe amount of distance, if that makes sense.

[Dr. Patrick McGrath]

And you were a great volleyball coach, though, the movie.

[John Green]

Oh, thank you. I was very grateful to be in the movie. I was actually in the movie for the fault in our stars as well, but they had to cut me out because my acting was so bad. And so it was nice to be in. Actually make the cut in Turtles all the way down.

[Dr. Patrick McGrath]

Yeah. And, Stephen, I wonder if you could talk about, you know, our partnership with John and. And what we've done with the movie and just why someone like John and us really meld together.

[Stephen Smith]

Well, there was a question that was asked. Someone asked me a question about months ago, and I said, is there any good movie that displays what OCD is really like? And I was. I referenced your movie with Turtle all the way down because I felt like just from watching it, the premiere, it was. It was so accurate in terms of all the nuances with not only how OCD manifests for people, but how it. How it. How that person's experience connects to the people that they love. And I felt like that's such an important part of the journey because it's not just a condition that affects one person. It affects the person and their loved ones. Right. And so when we saw that, we're like, oh, we have to do whatever it takes to get word out about this movie and about your work. Just because it is so important for people to understand that this is a condition that doesn't just affect the person, it also affects their family and their loved ones.

[Dr. Patrick McGrath]

As you navigate your lives and the lives with your loved ones, Stephen, you've talked about being away from your family. I wonder, what was it like to come back to your family and kind of reintroduce you to them after OCD said they were no go?

[Stephen Smith]

You know, I'd be interested to hear my wife's perspective on that question, because I personally would. You know, for me, it kind of was a gradual process, because this is a condition that doesn't just. You don't just snap your fingers overnight and you're better. Right. You kind of work at it over time. You work at response prevention. You slowly but surely get better. But I think going back to the whole point of outcomes are best defined by what you can now do in your life again, like how you've been able to regain your life. There were things that we could do that we weren't able to do. When I was suffering with OCD at my worst, for instance, we could go on a quick weekend trip right before. If I was to go out on a trip, I would spend the entire trip in a complete. I'd be in Shambles for most of the trip just because I was in my head and under so much distress. You know, I remember, like, I would avoid going to, for instance, like, an amusement park, because every time I'd walk down, you know, the. The sidewalk at amusement park, I'd see a bunch of people, and that would trigger me.

[John Green]

Right.

[Stephen Smith]

I'd avoid going to concerts. So we started to be able to. We. When I was getting better and OCD was, you know, when I was using your terms, like when I was reemerging into my family's life, I was able to do the certain things that I used to love to do with them that I. And that was, I think, a really special moment because we, you know, we had all this time. I really couldn't do many things.

[Dr. Patrick McGrath]

And did you feel that too, John?

[John Green]

Yeah, I mean, I feel like, you know, unfortunately, my kids were really little when. When I was sick, my kids were really little. And I say unfortunately because, like, they don't remember that, but. But I know it had to have affected them, you know, and I think that coming back into the world or coming back into their lives happened before they were old enough to know what. What that meant. There have been periods since then when I haven't been well where I've really struggled and where I feel like I'm not the parent that I want to be, but none where I felt like I wasn't present at all. I also would be interested to hear my wife's perspective on that question, because I think for her it was more profound. It's really hard. It's really hard to love someone who's in obvious distress.

[Dr. Patrick McGrath]

Next show, Mrs. Green. Mrs. Smith. That's right. Sitting on the couch here to describe it, but it is important. And you've both mentioned this how, yes, there's a person with ocd, but there's really a family with ocd. There's a community, there's an entity, There's a system with living with ocd, even if they aren't all the ones who have ocd.

[John Green]

Yeah. And it's really hard for family members. Like, it's really. It's really. I mean, I. I have a lot of sympathy for my wife, especially because she had, you know, she loves me. And, you know, seeing someone you love in that amount of pain is really difficult. And not knowing how to help and not knowing what to do is extremely difficult. And so I just. Yeah, I have a lot of. I feel. I feel really bad for her, and I'm glad that I'm. I'm better now, and I'm glad that I've taken steps to get better so that, you know, partly because that those relationships are so central to who I am.

[Dr. Patrick McGrath]

We know that ERP is the evidence based treatment for obsessive compulsive Disorder. And sometimes there's a term thrown out, exposure therapy. And I always try to correct people that it's. No, it's exposure and response prevention therapy. Because OCD is always exposing you to things. And if just exposure to things was curative, I don't have a job. Right, because you don't need me if that's the case. But when people are exposed to the obsessions, they have two choices. They could do the compulsion, which is what keeps you in ocd, or you could go down the road of response prevention, which is the elimination of that compulsion. What was it like to really apply response prevention to your lives? Because that really is the curative piece of the work.

[Stephen Smith]

So for me, like I, when, when I was going through therapy, I was told, you have to do response prevention.

[Dr. Patrick McGrath]

Yeah.

[Stephen Smith]

The question that I always would ask is, how do you do response prevention? Right. And what would happen is people say, well, look, if you're, if you have a contamination fear and there's a doorknob right in front of you, you know, you might have the fear, what if I get sick if I touch the doorknob? Well, in this case, you know, you may accept the uncertainty and touch the doorknob. Right, Versus avoiding the doorknob. Well, my, my compulsions were mainly mental in nature. They'd almost happen automatically. So I'd have an intrusive thought, and then almost automatically I would go into the rumination or into the, you know, reviewing past events in my head, the kind of the back and forth in my head. And so I never really knew how to actually tactically apply response prevention. So. So I had to, I had to work on specifically one, identifying when I had. When I would have an obsession and then when I had that fear, I would have to consciously then accept uncertainty in that moment with really specific statements like, maybe that could happen, I'll accept the uncertainty, move on, or sir, that could happen, but I'm gonna live my life anyways, or so what? I'll just keep on going. Right? And that was a profound moment in my treatment journey. Because when I learned how to actually respond to the intrusive thoughts, that gave me the leverage to then apply response prevention. Not just when I was with my therapist, but when I was, you know, at the gym between sessions or if I was at school or if I was on the football field, playing football with, with, with when I was in college. Right. That was, that's how I was able to get better. Right. And it was learning specifically how to apply response prevention.

[John Green]

Yeah. And for me, it was a little easier because I'm closer to being able to touch the doorknob than you are. But I do still have mental compulsions, and it's very similar. I have to be able to live in the doubt. I have to be able to say, yes, that could happen, and that could happen.

[Dr. Patrick McGrath]

And from those, there's really four things that we're looking at in response prevention. Can we get someone to delay the compulsion, put some time in between? Can we get someone to reduce the amount of time they do the compulsion so that it gets smaller and smaller over time? Can we undo the compulsion? So even if it's mental and it's almost automatic, can you add a phrase at the end, like you said, Stephen, that puts some doubt back into it so that you're having people live with doubt? And ultimately, can we get people to resist doing the compulsion? So those are my four areas I really look at in response prevention about how we're going to start to implement that so that OCD takes up less and less space in the lives of people who are afflicted with.

[Stephen Smith]

Yeah. I also say, like, giving yourself some grace when you accidentally do a compulsion, like, that's also very important. Like, there'll be days where you'll, you'll be doing great and all of a sudden, like, you'll catch yourself ruminating.

[Dr. Patrick McGrath]

Right.

[Stephen Smith]

And just knowing that that's part of the journey, but you can correct that action. And instead of, you know, taking the approach of, oh, I just did a compulsion, you can just in that moment start to then practice response prevention. Like, that's, that's what I would do. And that was really helpful.

[Dr. Patrick McGrath]

Yeah. So ultimately, doing good exposure and response prevention has led the two of you to living the lives you live now and learning to live with OCD instead of being controlled by ocd? And so to both of you, I'm wondering if you could just, as we kind of close here, what has the influence of that been and what have you tried to do with it to make sure that this concept of evidence based care is available for ocd?

[Stephen Smith]

So just thinking back on one of the previous questions about, well, how do we know progress is being made? Like, when I was making progress and it became clear that progress was being made, I was reflecting on, like, well, I started Reflecting on the full journey, right? How did I go from, you know, point A to point B now to point C? Like, it felt like a roller coaster in many ways. And through that journey, I realized that, you know, there's really effective treatment for ocd. You can't cure ocd, but you can manage it and you can actually get better. So why aren't more people getting better? If you have 1 in 40 people globally suffering with this issue, why are so many people suffering in silence and sadly developing severe comorbidities like depression, you know, like substance use disorders, eating disorders and whatnot? And that led me to just like honestly asking the question, well, is it a clinical issue or is it an OPS issue? And when I thought about it that way, I realized it's actually an operational issue because the clinical treatment is there available for people to get better. We just don't have enough people getting identified and then enough providers who are specialized in disseminating it. And so when I realized that was the problem, I realized, okay, we have to do something about this. We have to find a way to use technology and to ultimately, one, better identify people with OCD who are suffering in silence before they develop, you know, severe comorbidities, before they lose decades on their life. Then two, we need to find a way to build the networks of specialty therapists who are, who are trained in the evidence based treatment for OCD exposure and response prevention and can help people then get better and then stay healthy long term. And so that was to me, like a calling in many ways, just because I realized, like, you know, I, we, you know, I could help with some of the operational effort to do this. And it just, we started the company in college. It was just brick by brick went day after day just trying to find ways to just make this better and better. And here we are 11 years later.

[Dr. Patrick McGrath]

I love the story of you getting your football teammates in a room together to make calls to people and providing them pizza to do it.

[Stephen Smith]

That was our internship. We had Friday nights at 6 o'. Clock. We had people on our team who wanted an internship. We would contact therapists who potentially wanted to learn more about ocd. And the reward was I didn't have any money, so I was like, we can get some Domino's pizzas and get like a keg of beer and make this an experience. And that was, it was an alternative to a lot of, you know, kind of. It was a better time spent because it was fun too. Like, we had a good time, you know, doing a lot of the Outreach, and it led to many people learning about OCD resources that we were providing at the time. For an ocd. We had self help app. We didn't have therapists at the time. It was just a self help app between sessions. Help people do ERP homework more easily, help people get support in the moment of an episode, track their progress, you know, set up their hierarchy and whatnot. And so people started using it between sessions and we learn a lot and then we would just kind of iterate and then day after day just kind of made more progress.

[Dr. Patrick McGrath]

And for you, similar kinds of things. You come out on the other side of treatment still in the journey of it forever. But has it changed your writing, your outlook on your podcast and the work that you do and what you look forward to?

[John Green]

Well, it's completely changed my life because I feel like I have my life back and I feel like I'm, you know, like I said, I still have ocd, but it's not the, not, not the mainstay of my life that it once was. And, you know, I think that's why it's so important not just to get treatment, but to get the right treatment, to get the right kind of therapy, because this is treatable. And that's the one thing that I would want to communicate. I felt so helpless and hopeless at the worst of it, and I wish that I had been able to hear those words, that this is treatable. There is another side to this. There is a way through.

[Dr. Patrick McGrath]

I really want to thank both of you for being here because what great examples of living with OCD the two of you are, and what you can do with a life that has OCD in it, you can be partners, you can be fathers, you can be entrepreneurs, and you can have ocd.

[John Green]

Right?

[Dr. Patrick McGrath]

And for those out there who might be wondering, oh, can, can I? Can I have the life that I want to live? Yes. You see amazing examples of these two fine gents here with me today, and I thank both of you for sharing your stories and being open about that very much.

[John Green]

No, thank you.

[Stephen Smith]

Thanks, Patrick.

[Dr. Patrick McGrath]

And thank all of you for watching and hopefully learning and we hope, being inspired to reach out for amazing treatment. If you're looking for that help, you can go to nocd.com and we would be happy to chat with you and provide you a therapist who has been trained to personally work with you and whatever kind of OCD you have to develop those very specific treatments for you so that you will have personalized care. And if we could do that for you, it would be just icing on the cake of the work we've done already. So check us [e-mail] and we look forward to making sure that you live your life and not the life that OCD wants you to live. We hope to see you soon.