B (2:35)

Yes.

A (2:36)

And that there's nothing wrong with that. And that it doesn't mean that you're. You're gonna jump. Right. That's a really important insight for me because I didn't know that until I was in treatment. My intrusive thoughts. I'll give you, like, one example of an earlyish intrusive thought. I mean, this is pretty horrible what happened. I was in a motel. I was staying in a motel, and I just stepped outside to get something at the vending machine, and I was barefoot, and I stepped in someone else's spit. That's really gross. It was really gross. It was really gross when it happened. But my reaction to that was not. Like, my first thought was, oh, like, you're probably gonna get an STD from stepping on someone's spit. Like, there's probably a little bit of a cut on the bottom of your foot. And then you're probably gonna get an std, and then your girlfriend is gonna be like, why did you get an std? You know, and it's gonna ruin your life. And that was the chain of thoughts for me. And it became very quickly impossible to manage these thoughts. Like, it went from 0 to 100 very quickly. There's this great Edna St. Vincent Millay poem that I think is more about depression than ocd, but I like it for ocd, too, where she writes, night falls fast. Today is in the past three flakes, then four arrive, then many more. And that feeling of, like, there's like, three snowflakes of these thoughts that are just, like, percolating down. And then there are many more. And then it is a whiteout. It is a blizzard. It is a blinding white light. And there is no thought, except for this thought that you have given yourself a STD by stepping on this spit. And your life is over. Like, your life is over on every level. And that's what a really bad, intrusive thought is like for me. And I. I had. I dealt with that thought. I dealt with that obsession for months and months and months.

B (4:44)

And people will do so many different things with. This is why it's interesting with ocd, how unique it is to the person. Some people will go to the STD clinic every other day to get tested again, just to see has it finally manifested itself?

A (4:57)

I Did that one.

B (4:57)

You did that one?

A (4:58)

Yeah. So not every other day, but I did, I did pretty regularly. And you know, I have a friend who has OCD who has an obsessive fear of radon and he would call the radon hotline, well, once a day, every day at the same time. And they were like, I just don't think that your problem is radon.

B (5:17)

Yeah.

A (5:18)

Because it isn't. Of course. Like his problem is ocd. And similarly, I wasn't going to get an std. Like, no matter how many times I tested myself, I wasn't going to get an std. But I also dealt with it by like, like really scraping away at that part of my foot, trying to like find a way to deal with it through that. Like really trying to clean out my. For like weeks afterwards, long after it made sense to clean out my foot, I was still doing it. And all of these, for me, you're right, it's a very personal, very personal disease and it finds whatever your own unique ways into it are. But yeah, I, I did have that one. What are some of the other ones I might have had?

B (6:00)

Well, maybe you would have gone over it a bunch of times to think, did it, was it the heel where it was harder versus the softer part of the inner soul and would it have a better chance of getting in there versus here? And, and then that, that real event, almost experience. Right. Or did I forget how I did it? Did I.

A (6:19)

You know, so mental. Mental.

B (6:22)

Yeah, checking, mental repetition, tons of that could be there. Plus then there's the research. And as we've talked a little bit, as things become more and more available to us through our phone, all we need to do is could I get an STD by stepping on spit? And you could probably find some anecdotal story of someone in some off the beat world country who says that it happened to them and you're like, oh, well then it's happened and now.

A (6:46)

And then you just feel the dread descend. You feel that like overwhelming dread in your. But then the only way to manage the dread is by more, more checking, more googling, more searching, more looking, rereading that to make sure that this person's life isn't exactly like your own. And maybe their story's a little bit different, but maybe it's not different enough. And you know, yeah, it's, it sucks.

B (7:08)

There's your eight hours a day right there.

A (7:09)

There's your eight hours a day of checking and, and managing these fears. And that's a full time job.

B (7:18)

I, I Like what you said earlier, the last thing was, and then my life will be ruined. I mean, I wonder if you could put that in parentheses for the definition. And then my life will be ruined.

A (7:27)

Then my life will be ruined. Yeah, it is like that, though. Like. And then my life will be over, and then my life will be ruined. And then this will happen, and that will happen. And, like. And it's just so.

B (7:37)

It's.

A (7:38)

We're almost talking about it a little casually now because it's over. But, like, when it's happening, it's so overwhelming. Like, I can't talk to you about the intrusive thoughts I have now because I don't feel comfortable talking about them because, like, that's between me and my therapist. But, like, it's so overwhelming. It's so difficult to manage. It's so. It's just so hard when you're in the thick of it, because it's so real.

B (8:03)

Yeah. And it doesn't matter what you know rationally, because it's really what you're feeling emotionally. Correct.

A (8:11)

Yeah. That's an interesting observation. And what you're feeling emotionally is intense. Intense fear and dread and then a mix of shame with that. I mean, it's. It's. It's a cocktail of really difficult emotions to manage. And I think that's part of the reason why we use compulsive behaviors to try to manage them. Yeah.

B (8:31)

What would you say is your relationship and how you approach an obsession, these thoughts, images, and urges now with medication and treatment versus before you had the appropriate diagnosis and treatment going?

A (8:45)

Well, for me, medication just, like, gives me a little bit of distance from the thing. It makes it a little less severe so that I can say, like, hold on a second. I think I know what's happening here.

B (8:54)

Okay.

A (8:55)

I think what's happening is that you're having ocd, not an std.

B (9:01)

Yeah.

A (9:01)

I don't think you're. I don't think you're about to get herpes. I think you're having an OCD experience. And not for the first time.

B (9:10)

Right.

A (9:10)

And the other times that it happened, you worked through it. And here's how you're going to work through it this time. You're going to go to your therapist and you're going to say, listen, it's happening again. Here's what happened. It was really gross, and I'm not dealing. I'm not dealing well with it at all. And so we need to probably do some erp.

B (9:26)

Isn't that the kick in the teeth in a Way, though, that you could have gone through this a thousand times and nothing bad happened. But your OCD will say, but this time might be the time.

A (9:33)

Oh, yeah. I mean, my OCD is incredibly compelling at convincing me that this time it's different. Every. Yeah. I mean, every time it's different. And I remember saying to Sarah once, my wife, who I also really trust with this stuff and like, can bring. Thank God, I can like bring stuff to her. And. And I was like, I, like, couldn't raise my arm because I had over exercised. And I was like, I can't raise my arm. I'm pretty sure that it's like, you know, musculoskeletal degenerative disorder. And Sarah was like, well, I think that's unlikely. I mean, we're laughing now, but like, to the point, like, it was not funny.

B (10:12)

Yeah.

A (10:13)

And even. And to her credit, she didn't take as funny. Right. Like, she took it as, like, she didn't take it as. Here we go again. She didn't take it as like, Christ almighty, I can't believe I married this guy. She took it as like, well, you know, here. Here we are again. And like, I think it's unlikely, but it felt as real to me as every other time. And that's eventually what I told her was like, you know, I appreciated you taking it seriously because to me, it's serious. Like, it's as serious every time as every other time. And it's just, you know, it's a hard thing to live with. It really is. But the. But it is possible to live with it. I think that's the thing that I needed to hear when I was really, really sick, is that it's possible to live with it. In fact, it's possible to get better. It's possible to even laugh about it eventually.

B (10:58)

That's what I loved in Turtles all the Way Down. Especially that montage at the end where you show, you know, a life being lived with ocd.

A (11:05)

Yeah, right. Yeah, that, like, she's not separate from it. She doesn't get cured of it. Right. Like, I'd love to be cured of ocd. I'd love to snap my fingers and not have this as part of my life anymore. And like, whenever people are like, oh, I. I see all these secret upsides to having ocd. Not me, buddy. I don't see any upsides. It just sucks. And my life is a lot better when it's managed. And it would be better still if I didn't have it, but. But I. I do have A really good life. And I also have a serious mental illness. Like, they're both real at the same time. And I wanted to show that. That for Aza, this character in Turtles all the Way down, that's. That's true for her as well.

B (11:45)

Yeah. I'm glad you brought up that idea that OCD can be a superpower.

A (11:51)

No, yeah, it really. It's. It's very compelling. And I. I understand why some people, like, I want to tell a story about illness that is triumphalist, but to me, it's something that you live with, you live alongside, rather than something that, like, fuels your creative output or whatever. Like, when I'm. People often say, like, do you think that, you know, it's because you have OCD that you're a writer or because you have lived with depression that you're able to write these, you know, sad stories or whatever? And I'm like, no, I really don't, because when I'm sick, I can't read a menu, let alone write a novel.

B (12:25)

There you go.

A (12:26)

I can't do anything. I can't function. And so, you know, we sometimes, like, we often stigmatize things that we also romanticize.

B (12:35)

Sure.

A (12:36)

And so I think that's often the case with ocd. We hugely stigmatize it. We stigmatize people living with ocd, and then we also romanticize the illness, like, in TV shows and stuff, and say, like, look at all these secret superpowers. It brings you. And of course, that's just not true. Like, it doesn't turn you into Sherlock Holmes, unfortunately.

B (12:53)

No. And one of the things that I think has been difficult and where I like doing this for educational purposes also, is to really inform people that there are mental compulsions. Because that looks really boring on television. Because it would look like this.

A (13:10)

Right, right.

B (13:12)

That's not very exciting tv.

A (13:13)

Right. Not all compulsions are hand washing. Not all compulsions are picking at skin or whatever. I mean, those are compulsive behaviors, and those happen. But, yeah, mental compulsions are really, really compelling. And, like, you know, I thought about that in Turtles all the Way Down. Like, how do you visualize or make dramatic Googling, you know, because that's her main compulsive behavior is, like, Googling. And then eventually she starts using hand sanitizer to try to manage it a little bit. But, like, Googling is not a very visually compelling thing, but it's something that a lot of us do to try to manage our fear.

B (13:48)

And that was what I really loved in the movie, because we heard her thoughts.

A (13:52)

Right.

B (13:53)

You visualized it in a way that is like. Oh, that's also ocd, too.

A (13:58)

Yeah. You need to be able to, like, hear those thoughts because those thoughts are what. Those sort of like, cyclical, repetitive thoughts are part of what makes it so difficult.

B (14:07)

Yeah. As you've gone through treatment, how do you approach now when those. A new thought or image or urge comes up? Is it the same as when you were a teenager or do you have some barriers or boxing gloves on, ready to take. Take on?

A (14:25)

It's usually easier. It usually. I usually am able to catch it a little faster and deal with it a little faster than I. Than I could when I was in my teens or twenties. But, man, when it. When it hits, it's still as real as anything. Sure. When it hits, it's still really hard. And so I sometimes really struggle, you know, like, we can have this conversation and we can talk about how much better my life is, and my life is so much better. I'm so grateful. But it's still work. It's still a struggle. And, like, I still have to go back to, you know, doing that. Doing that therapy stuff that works and working with therapists who really understand OCD and making sure that I'm taking care of myself.

B (15:09)

And that takes time and effort. To take care of yourself.

A (15:12)

Right.

B (15:12)

That's not just a natural thing.

A (15:14)

No, it is. It takes time. It takes effort. And, you know, like I said, I would rather not have this disease because then I would have even more time. But I. I'm pretty. I'm pretty happy with where I'm at right now, and my ability to manage it is just so much better than it was even 10 years ago. And that's really. That's the gift that therapy can bring you. The right therapy, you're correct.

B (15:39)

With the right treatment. And that is beyond what many people think of as therapy. It's. It's not just talking about it. It's doing things. It's exposure and response prevention. It's facing your fears and not doing your safety behaviors, and also can be combined with medication as well as. And you've. You've done both.

A (15:59)

Yeah. And I think it's important to note that, like, talk therapy can be really helpful for people. It isn't necessarily helpful for people with ocd.

B (16:10)

Right. Absolutely.

A (16:11)

And so you need not just therapy, but the right kind of treatment.

B (16:17)

And it doesn't just affect you. I mean, you. You then get more time with your children, with your wife. You can.

A (16:23)

The hardest. The hardest thing about this whole thing for me, is the way that it took away time from my kids.

B (16:29)

Sure.

A (16:29)

You know, like, I remember I was really sick in 2017, and I had, like six months where I was just not doing well, and I was just really struggling with OCD symptoms. And my kids would talk to me, and I would be trying desperately to hear what they were saying, desperately trying to listen, and I just couldn't. I just couldn't because the thoughts were so loud. They were so much louder than anything else.

B (16:55)

Yeah. And there's. There's no amount of distraction. No matter. Even if it's the people you love the most in your life, it's still not enough to pull you away from ocd.

A (17:07)

Exactly. Even if it's the people you love the most, it's still. But still there.

B (17:10)

Yeah. It's an ass of a disorder, if I may.

A (17:14)

Yeah, it is. It really sucks. It is really. It's really insidious as well. Like, it's. I think of it sometimes as sort of tentacled, many tentacles, and you. You cut off one tentacle and it regrows. And it's just, you know, I expect to live with OCD for the rest of my life. I really do, and I'm okay with that. And I think. I think maybe 10 years ago I would have found that really difficult thing to say, but now I think, well, I know how to do this. I can do this. I can live with this thing.

B (17:44)

Sometimes I'll hear if I could have any other kind of OCD but this one.

A (17:49)

Oh, yeah, yeah, yeah, yeah. I mean, I'd love to have a clean house. Right?

B (17:55)

Yeah, right, right.

A (17:57)

That's the. That's the stereotype of ocd. It's like, you know, I'd love to have my Pepsis ordered just so. But so often, of course, like, that. That masks something that's much deeper and more profound. And then if you had that kind of ocd, it would suck just as much as the kind you have.

B (18:14)

Yeah. I always chuckled with the people that were in group who were there already. We'd. We'd be doing an OCD group at the hospital I used to work at, and the new person would come in and inevitably somebody be talking and they'd. That new person would lean over the person next to them and say, I wish I had that kind of.

A (18:30)

I want that. That. Yeah, that I could handle.

B (18:33)

Yeah.

A (18:33)

So. Because the thing is, like, if you had that kind, you wouldn't have it because you'd be like, well, that's not real.

B (18:40)

Exactly.

A (18:40)

No big deal. I can put that aside. But of course, that's why your OCD targets you in this particular way. It finds the thing that you. Or the things that you are vulnerable to.

B (18:54)

And so many people associate these obsessions, those thoughts, those images, those urges, with bringing about anxiety. But I wonder if you could touch a little bit more on some of the other emotions, because there's guilt and shame and disgust and discomfort. All those other things, too. So it's. It's not just that I'm anxious and I do these things because of that. There's some other really profound emotions that come in this.

A (19:15)

Yeah, I mean, for me, anxiety is the biggest one, But I know for a lot of people, guilt and shame are really, really intense, you know, especially around, like, sexual OCD or other forms of OCD that, you know, engage with. With the shame spots inside of us. I. I have felt a lot of shame and then just a lot of dread, A lot of, like, acute. Acute fear and guilt. I'm often made. I'm often made by my OCD to feel guilty. And even talking about that thing, like, not being able to listen to my kids, like, I've felt a little bit of, like, yeah, that spike of shame. And I was like, is that okay to talk about? But I think we have to talk about this stuff. Otherwise it kind of lives in the darkness, Right?

B (20:08)

Yeah. And if people don't know that and they have this notion. A guy I used to work with, he coined this phrase that I loved, or maybe he heard it, but he talked about terminal uniqueness.

A (20:22)

Yes.

B (20:22)

I'm the only one who's ever had this thought or this feeling in the world.

A (20:27)

And that's part of what brings up the guilt and the shame is that you feel uniquely horrific. Yeah. You told me once that if somebody brings up an intrusive thought that you've never heard before, you'll give them a dollar.

B (20:39)

I did, yes.

A (20:41)

And I quote that a lot because I find that helpful that, you know, I quote it to friends or when I meet people with ocd, especially if they aren't doing well or, you know, haven't. Haven't been through therapy yet or whatever. I often bring that up to them that say, like, you know, you think that this thing is uniquely you and, like, uniquely horrific and horrible. But in fact, it's probably pretty common.

B (21:06)

Yeah.

A (21:06)

I remember once I told my therapist, my psychiatrist, I was like, I have this obsessive fear that I'm going to, like, rip off my own arms. And he was like, that's not uncommon. And I was like, well, for God's sakes. Like, how do I think of something that is uncommon if that's not uncommon?

B (21:24)

You want to be unique.

A (21:25)

Yeah, exactly.

B (21:26)

I'm a writer.

A (21:27)

I want to be special. Special, Patrick.

B (21:30)

But even that, I've sometimes said with people, there's this concept that I call specialness. The rules of the world apply to me differently than they do to everybody else.

A (21:37)

Right.

B (21:38)

And that can be so part of ocd, too.

A (21:41)

Yeah. The scrupulousness, the. Yeah, absolutely.

B (21:45)

Yeah. And in the end, I don't find a lot of uniqueness in ocd. I find a very common core fear of. Yeah, but what if. And once that puts its hooks in you, you will go down rabbit holes after rabbit holes.

A (22:07)

Yes. And they will be endlessly deep. And they're. They're. You know, I. In. In turtles all the way down. I write about how when you're in a spiral, it can tighten forever because it can become infinitely tight. You know, there is no limit to. To the. To the. To the ending. There is no limit to how long or how intense a thought spiral can become. It can become infinite. But that is also true when you're walking out of a spiral. Right. That is also infinite. There's also space to walk out of the spiral. And so I don't know. Yeah, I. It's a hard thing to live with.

B (22:43)

Yeah. But thank you for being an example of somebody who has learned how to live with it and who struggles to learn with it and talks about that and is open to the fact that this is not an easy road.

A (22:55)

Yeah. Well, thanks for saying that. That's kind to you.

B (22:57)

Yeah. Because I always want to set the right expectations for treatment, which is, it's not that you're never going to have this thought, image, or urge ever again for the rest of your life. Hopefully, it's that you'll be able to handle them.

A (23:13)

Yeah. And being able to handle it better over time is success. Even if you can't handle it the way a normal person might or the way someone without OCD might. I shouldn't say normal person.

B (23:25)

I've never met a normal. Have you met a normal person?

A (23:28)

That's a great point. No such thing.

B (23:30)

I'm still waiting.

A (23:32)

But someone without OCD might be able to, you know, like my wife, who doesn't have ocd, like, has intrusive thoughts, and they just pass.

B (23:40)

Sure.

A (23:40)

You know, the three flakes and then four arrive, but not the many more. And that's great for her, but that's just never going to be the case for me, I'm always going to be struggling against it. And so I. What I have now that I didn't have in the past is the tools for the fight. I have the tools now. I know what to do when it happens, and that makes a huge difference.

B (24:09)

Awesome. I'm really thankful for your examples of walking through intrusive thoughts, images and urges and how, yes, like your wife, everyone has them, but for people with ocd, they go to that next level. Right. They really get to that obsession because they're hitting that fight flight or freeze response, which feels so real to so many people. Right. And I think that having that example is just so great for people who are struggling out there, who do think they're the only person in the world who's had this thought, who do think they're alone.

A (24:45)

Yeah. Yeah. It's a really isolating illness in a lot of ways. And the hardest thing can be to come in from the cold, if you will, and acknowledge to someone you love or trust that you have a problem, that you're really struggling, and then find the right tools to move forward. And we're fortunate that we do have those tools. Right. I mean, this is a treatable condition. You don't have to be losing like, I was eight or ten hours a day to this.

B (25:17)

Yeah. Thanks for your time today, John. I appreciate it.

A (25:21)

Thank you. So if you think you might have OCD, head to nocd.com to get started with effective treatment. You can book a free call with their team and get matched with the right OCD specialist for you. That's nocd.com.