Dec 16

Lena Dunham, “Hannah” on “Girls,” and Obsessive Compulsive Disorder

In real life, 27-year-old Lena Dunham, the Golden Globe-winning and again-nominated-for-2014 star of Girls, admits that she’s had a diagnosis of OCD since about age nine. Reportedly she is treated with medication, and she’s had the same therapist since she was 16.

In addition, ever since that initial discovery of having OCD, she’s been practicing Transcendental Meditation. According to Lindy West, Jezebel, Dunham told an audience at a charity event that her mother and grandmother also do it, as did her great-grandmother.

I feel forever grateful that instead of assaulting me with a barrage of medications my mother decided it was time for me to learn to meditate…Although when you’re nine you have trouble articulating the sort of internal shifts you feel, I know that it made an incredible difference. It made it possible for me to understand what I was going through, and to process what I was going through and to calm down.

Last March Lena Dunham’s character Hannah also had her OCD exposed. One of her symptoms, for example: Hannah has to do things in eights.

But something harder for viewers to watch, says Kent Sepkowitz, The Daily Beast, is when Hannah then “inserts a Q-tip into one ear and traumatizes it, causing a bloody mess…Then comes the requisite sitcom schlemiel-like ER visit with a doctor and some drops and some close-ups. But in the episode’s last scene, she grabs the difficult third rail of mental illness once again, showing us Hannah placing a new Q-tip into the other ear. And counting.”

Jeff Szymanski, Ph.D., Executive Director of the International OCD Foundation and author of The Perfectionist’s Handbook, explains OCD and Dunham’s portrayal further on Psychology Today:

The why with OCD is unrelenting anxiety…Not just ‘Oh I feel anxious today.’ Paralyzing, all-consuming, pervasive anxiety…With OCD, individuals recognize that the intense anxiety they are feeling doesn’t exactly make sense. Lena’s character demonstrates this well in the episode. Her anger covers up — barely — a sense that she realizes this has gotten the better of her. That she doesn’t want to be doing these things. These aren’t quirks and being eccentric. These behaviors are done as desperate attempts to quell unending anxiety. And now she is being found out.

Szymanski approves of how this was handled on Girls, including the family dynamics. Her parents worry about her—the OCD affects them too.

How does the series handle Hannah entering therapy?

In the therapist’s waiting room, Hannah again struggles with what it is like to have a mental illness. The stigma associated with it. She has to see a therapist who successfully treated ‘an arsonist who strapped frogs to rockets and was deeply disturbed.’ If I have a mental illness, what category do I belong to?…

…The therapist’s nonplussed response to a description of the characters’ symptoms was perfect: he calls it ‘classical presentation.’ While it may not be a comfort to hear, it is an important distinction to make, since most people assume OCD is about hand-washing. In fact, hand washing is not the ‘classic’ OCD presentation: intense anxiety, intrusive thoughts, and compulsive behaviors are the hallmark of the disorder. While many people with OCD have hand-washing and contamination concerns, to only focus on this group misses an even larger part of the OCD community. Counting, repeating, intrusive violent and sexual obsessions all fall within the realm of OCD.

The next season of HBO’s Girls starts January 12th. A newly released brief promo includes a tiny bit of Hannah’s session with her therapist, played by Bob Balaban.

Update, Jan. 2nd, 2016: The clip, however, is no longer available on YouTube.

Oct 16

Obsessive-Compulsive Disorder: Turning Off the Thoughts

I actually had anxiety for so long I went to a psychiatrist. And I said to the guy, ‘I’m constantly anxious. What do I do?’ He told me I had obsessive-compulsive disorder. I was shocked. I had to call him nine times to make sure he was certain. Judy Gold, comedian

The following essay about obsessive-compulsive disorder (OCD) and a successful self-help technique was contributed to Minding Therapy by a respected acquaintance who wishes to remain anonymous.

WHAT IF I STOPPED THINKING?!

For most of my life I had never heard of OCD, and if I had, I would
have probably thought that it was one of those exotic conditions
somebody had invented in order to come up with something “new.” So
when my son started displaying “habits” at about age eleven, we had no
idea what was happening. We just thought that his worrying and
ritualistic little “tics” might be some pre-adolescent offshoot of
being highly-strung/sensitive. After all he had had a very normal,
healthy childhood thus far, displaying very little neuroses. It was
hard to imagine that all of a sudden he was becoming “crazed.”

Long story short, we explored all the possibilities and found nothing
that we could put our finger on, but after telling an old friend about
these “habits”, this kind chap did some research and came up with the
possibility of OCD . Although this information came out of left field,
it somehow made sense to us since the symptoms pretty much matched the
info about it, as did the insight that OCD is a physical disease that
has psychological-like symptoms. So he received some therapy and
medication but never grew out of it. Instead, he slowly learned how to
deal as best he could with this aspect of his life.

It never occurred to me (until years later) that I might also have
this same malady. During my life I had had such a long history of
neuroses, childhood trauma, codependency and addiction, how could I
have possibly cherry-picked out of this grim potpourri that my need to
try to somehow make things better via obsessive thinking could
possibly be something new and different from the usual fare?
Moreover, I had spent many years working on my neuroses and addictions
with great success. So I thought that this ever so busy and punishing
head of mine were simply stubborn neuroses continuing to hang around,
(unlike those that so deliciously ended up falling by the wayside).
But the “committee” in my head could truly drive me nuts. So I soothed
it so nobly with affirmations and the like, which gave me some relief,
but not enough, because this ritual always came back, and often in
spades. What a pain to have this dramatically irritating bogeyman
alive and well with no apparent plan to vacate the premises.  .

One day I had an interesting experience on a treadmill that I thought
was in some way connected to this entire syndrome. It seemed that if I
could see the tag on my sweat rag that hung on the side of the
machine, I would become powerfully aggravated, and so I felt the need
to conceal it from myself in order to feel okay. But one morning,
after becoming sick of this routine, I opted to avoid this ritual no
matter what! (It annoyed me that I felt I “had” to do it or else).
What a challenge!! Nevertheless I put my plan into action, and after
experiencing some pretty darn insane feelings for a couple of dramatic
minutes, I somehow forgot about it and…it went away. What a victory!

Unfortunately I still had not figured out what I needed to figure out.

So I continued suffering from worry, the need to soothe myself, and
then the inevitable rerun after rerun of same, usually escalating
mercilessly.

But an article on the OCD Foundation website further opened my eyes.
It had to do with just what I’m writing about, namely obsessive
thinking and ways to deal with it. This gentleman had written a brave
piece stating that the soothing aspect of OCD, namely the compulsive
side, could be worse than the obsessions themselves as it created an
endless loop of feel bad, feel good, so feel bad again in order to
feel good again, etc.

A precious seed was planted.

One bright sunny day, with my addictions way under the radar screen
and my general behavior, (which underwrites my emotional sobriety),
pretty much intact, I wondered, as I stood in my bathroom why my head
would not stop! It could be vicious and that’s how it was that
morning. I thought about how I had spent so much time worrying during
my life, and then trying to deflect the worries by telling myself
sweet things.

Suddenly a miraculous notion flew into my consciousness—it was
this– “WHAT IF I STOPPED THINKING??”—because I surmised, if I didn’t
think, how could I possibly be in my head obsessing? Made sense to
me—you simply cannot obsess if you’re not thinking!

The grand experiment began at that very moment. I blanked my mind from
thinking—bigtime!! No thought was allowed to develop. And how they
wanted to!! But as with the experience on the treadmill, I was totally
determined to see this through. “Juicy” thoughts that wanted soothing
and TLC would come at me like machine gun bullets but I would cut them
off.  I pressed HARD to maintain this difficult exercise.

And then I realized something very sweet–I had forgotten to think
about what I had been thinking about. Ten minutes into the battle, my
mind was CLEAR. Like with the sweat rag, I had forgotten the issues
and thus the need to cure the issues. I was feeling amazingly clear
and even a little…serene.

Now, I had had enough experience with recovery- type experiences to
recognize a real discovery when I saw one. I instinctively knew that I
had found something big, equivalent to getting sober, equivalent to
successful dealings with my codependency; a God-given ticket “out of
the ghetto!”

In time I would discover that my new skill needed to be fine-tuned.
The basic notion continued to work pretty well but I soon found that
the need for perfection in this area led to another kind of
obsessive-ness, and so over the year I worked out a kind of credo on
how to deal IMPERFECTLY with my OCD. This dogma is as follows:

I indulge the bugger a little. Too hard to eliminate it completely and anyway
it’s part of my existential deal.

I keep lightly abreast of it and if I notice thinking/soothing-need
coming around too much, I take imposed breaks from it — purposely
skipping around just to show it that I can. If I remember later that I
was about to indulge and  instead had cut it off and forgotten about
it even for 10 minutes or so, I’d declare victory as my solution has
shown a mite of its gorgeous being-ness.

If I see the tidal wave coming from too much “flirtatious” indulgence,
I cut it off like I would leprosy. I go to the mattresses! The big
weapon is NO thinking; pushing thoughts away even in the middle of the
thought. This is warlike, steely enforcement. I’m aware as I do this,
that it would be very tempting to go just one more round, as it
continuously wants to seduce me.  I arrive at a point where I have
nothing but determination and blind faith and the fear of the
horribleness of it all. I can just about remember that this works, but
only barely. But action trumps belief at this juncture. It doesn’t pay
off immediately. “It” wants to make sure that you mean it!

If nothing wants to work (rarely happens) I remember that it is more
vulnerable to exiting after a night’s sleep. So I give it the juice
the next day.

It’s always amazes me how easy it is now to coexist with “it” when
it’s in remission now residing mostly in its cave. I love that it can
be so neatly handled but getting there each time there can be a
terrible act of faith.

Let me state that OCD can be an elusive and mercurial bitch. It wants
to keep you in its clutches and will test you ferociously. But I have
discovered that if I am willing to take the actions mentioned above,
particularly in blanking my mind when it so passionately wants to
prevent me from doing so, that when it knows that I mean business, it
exits dramatically! As it cowers way under the horizon I then get to
enjoy all of the good things that I have derived via my life ambition
of being happy and normal. Indeed, the abatement of OCD was the cherry
on the cake that I had been searching for, for so long.

One other thing, do this long enough and you can sense that the need
to obsess actually and fundamentally abates. It’s as if your brain
changes! What a thrill!!

I have participated in recovery-type programs for so long, and I have
seen so many good folks who have had trouble with the “committee.” I
don’t know if they have OCD or not, but I do know that the things that
I have learned in order to deal with it (as stated above) have
probably put me in a position where I not only get to beat up the OCD,
but also to deal with what seems to be a ubiquitous aspect of the
human condition consisting of worries, fear based being-ness, being
stuck in your head etc., etc.

In twelve-step programs, folks eventually tend to be grateful for
their horrible disease because, when they’re lucky and they work hard
in recovery, it ever so ironically propels them into a life that is
second to none. I feel the same way about my tyrannical OCD career.
Dealing with it successfully (but not perfectly) has helped me to find
a goodness in my life that I could only imagine and for this reason
I’m ever so grateful!

Oct 15

Ruby Wax: A Comedian Now Waxing Mindful On Mental Illness

“People who say … they’re perfectly fine [are] more insane than the rest of us.”

The above quote is taken from a recent TED talk, “What’s So Funny About Mental Illness?,” by Ruby Wax, an American comedian who started a successful career in the U.K. in the 1980’s.

In more recent years her career stalled a bit, however. And, as explained in The Telegraph, “Her rise and fall took place against the backdrop of her depression; every five years or so a creeping sense of paralysis would sneak up on her.” Following the birth of her third child in 1993, she had her first major breakdown. About five years ago, another major episode landed her in the hospital.

But Wax has let neither her condition nor the lack of available work keep her down, so to speak. She and friend Judith Owen, a singer/songwriter who’s also battled depression, created their own show, one they inaugurated at various mental health facilities. Along the way, Wax unexpectedly became a celebrity “poster child” for depression. From the TED blog:

Comic Relief put my face on a poster. I was in the Tube, and there was a poster of my face with the word DEPRESSED stamped across it. When I saw it, I almost lost my organs out of my nose. I tried to stand in front of the first poster and block the view. And then, down the escalator, there was another poster, and another. You know how they do that? And by the time I got down to the platform I thought, OK, well, I’ll write a show and pretend this was my publicity. I’ve always said to myself, if you’ve got a disability, use it.

So they branched out even further. Their newly beefed-up show Losing It expanded to other venues, including an extended run last year at a theater in London’s West End. The Guardian describes it:

The first half of the show was pretty much what you might have expected: a funny (mental illness is a much-underused comedy resource) and informative tour of depression, with a little Obsessive Compulsive Disorder (OCD) thrown in for good measure. The second half, a question-and-answer session with the audience, was anything but.

‘We wanted to give people a chance to share their experiences and ask questions,’ says Wax, ‘but we only imagined one or two people at most speaking out before it petered out with everyone making for the exit. Rather than finding it hard to get people to talk, our real problem was getting them to shut up.’

Another recent accomplishment of Wax’s is the establishing of website Black Dog Tribe to help those with mental illness find help and support.

On a more personal level, she’s been working on her Master’s in mindfulness-based cognitive therapy. Mindfulness is what she uses to decrease her own ruminating—though as she says (in the TED post):

…not in a guru Buddha let’s-eat-a-cauliflower way. I throw my attention to a physical sensation, to a sound, focus on my feet on the ground, as opposed to this … endless mental loop tape … because the mind can’t be in two modes at once. It can’t think and also sense something at the same time. It’s a trick you’re playing on yourself, on your thinking. If I throw focus from my rumination to one of my senses, it brings the cortisol down. Other people might say, ‘I’m going to focus my attention on my cat or put Vivaldi on.’ I don’t care how you learn to flip your dial when you need to.

…We need better words. ‘Mindfulness’ sounds like something Martha Stewart says: ‘Be mindful when you serve the chicken at a dinner party.’

…And the bitch of it is, you have to do it every day. Feel your breathing, feel your feet on the ground. It’s attention on attention. When you do it regularly, your neurons are rewiring…

Notably, she says she actually got into mindfulness because she’d become fed up with shrinks who weren’t so helpful.

The TED talk: “What’s So Funny About Mental Illness?”

Aug 23

The World Capital of Psychotherapy May Be Argentina

Is Argentina the world capital of psychotherapy? According to the New York Times:

The number of practicing psychologists in Argentina has been surging, to 196 per 100,000 people last year, according to a study by Modesto Alonso, a psychologist and researcher, from 145 per 100,000 in 2008.

That compares with about 27 psychologists per 100,000 people in the United States, according to the American Psychological Association.

And that’s just the psychologists, only one of several disciplines in which psychotherapists practice. In other words, what about clinical social workers, psychiatrists, mental health counselors, etc.?

Another source—the news video below—gives a broader breakdown. Stating that “Argentines are officially the most analyzed people in the world,” the report says there are 15 therapists for every 1000 residents.

Psychoanalysis has apparently found much popularity ever since Freud’s ideas emigrated there in the early 20th century. However, the other end of the spectrum—cognitive-behavioral therapy and other of the shorter-term approaches—is also represented in Argentina.

Apparently high fees don’t necessarily pose a big issue. From the NY Times article: “Andrés Raskovsky, president of the Argentine Psychoanalytic Association, recently asserted that psychoanalysis had little risk of extinction in Argentina since seeing a psychologist twice a week is still viewed as being affordable for much of the population.” When people can’t afford it, sliding scale fees and other types of arrangements are often offered; also, public insurance covers it for some.

One analyst interviewed about the wide acceptance and use of therapy in Argentina says that it’s basically about their people liking to talk—as well as liking having someone to listen.

Could it really be that simple? Probably not.

Maybe Argentinians are more in need of therapy than other folks? Unlikely. In one article last year, two therapists who were both originally from the U.S. but now practice in Argentina observe that people have essentially the same types of problems there as anywhere. As stated by one, Steven Nissenbaum: “It doesn’t make a difference what the culture is – people are people. Problems include life transitions, relationships, family, health or addictions.”

Therapy is also big in their popular culture, with the TV show In Treatment, starring Gabriel Byrne as a shrink, currently being quite popular. In addition, on the “Broadway of Buenos Aires” you can now find a staging of “Freud’s Last Session,” last year’s winner of New York’s Off Broadway Alliance award. It’s about the conversations that take place when the seriously ailing Freud invites writer C.S. Lewis to his home in London.

Michael Tanenbaum describes the play for The Argentina Independent:

As the two men carry on their debate – Lewis equating psychoanalysis with intellectual religion and Freud swatting away God as an infantile fantasy – the conversation and circumstances take multiple turns in subject, intensity, and competitive edge, bringing the men together at a historically fateful moment…

God, love, sex, and the meaning of life may be suitable tag words for this play, but overwhelmingly it is a display of the walls we build up and break down in dialogue with ourselves and others.

Another hit play “Toc Toc,” about six characters with obsessive-compulsive disorder who meet in their psychiatrist’s waiting room, is also currently playing.

If you’re interested in a more visual news report on this post’s topic, please see the clip below:

Jun 08

Bud Clayman: His Mental Health Challenges Depicted in “OC87”

OC87: The Obsessive Compulsive, Major Depression, Bipolar, Asperger’s Movie

(A New Film)

OC: obsessive-compulsive disorder

87: the year the obsessive-compulsive disorder of Bud Clayman led to a total retreat from others

The Rest: his other diagnoses

“OC87” became the nickname for the “altered state of mind” Bud Clayman experienced during that particularly challenging year—Clayman and his therapist came up with that. The specific disorder in question is known as “harm OCD“—when the intrusive thoughts have to do with causing harm. 

Clayman further explains some of his issues to Robert Siegel, NPR:

OC87 stands for the year 1987, when I decided to literally control the whole universe – or at least, attempt to try and control the whole universe. I wouldn’t allow any spontaneity with people. I wouldn’t small-talk with people. Basically, it was just something that totally existed inside of my head, that I created.

Because of his mental health struggles, Bud Clayman’s dream of becoming a filmmaker was deferred for 30 years. But now he’s been able to make this documentary about his own life. Here’s the trailer:

States psychiatrist Larry Real, M.D, about the film.:

An engaging strength of this entertaining documentary is that we see how a person with severe mental illness needn’t be a genius or a virtuoso to be worthy of our respect, admiration, and love. Instead, the person can be a teacher, a waiter, a student, or Bud Clayman – a late-blooming filmmaker with a great sense of humor who’s doing his best to get by. OC87 reminds us that when people with mental illness invest in what gives their lives meaning, they enrich and dignify our communities with their embodiment of courage, hope, and resilience.

Kalvin Henely, writing for Slant:

As Clayman lets us in on the obtrusive and uncontrollable thoughts that stifle his efforts toward functioning normally, we witness the degree to which the quality of his life—his job, the film’s financing, his emotional support—is owed to others, especially his father. Because of this, it’s obvious that, while Clayman’s life has been stymied, he’s luckier than most people, a fact of privilege that’s never acknowledged in the film, but would probably be healthy to realize.

At one point, Clayman’s psychologist mentions to him that if he actually looked as anxious as he felt on the inside, everyone would be freaked out. That seems obvious to us, but to Clayman it’s news he needs to be reminded of…(I)t’s in this rather dry and ordinary portrait of Clayman that it’s possible to realize how internalized real mental illness is; it can seem almost unnoticeable to others, silently isolating the sufferer from those who might be able to help.

Joe NeumaierNew York Daily News: “Clayman, who co-directed with filmmaker friends, is fascinating company. The camera allows a necessary distance for him, as evidenced by the ladies who sit with him at a speed-dating session. They don’t get him, but he’s not the one missing out.”

Kam Williams, AALBC.com: “A warts-and-all biopic about a cautious, creative genius burdened by a vivid imagination apt to take superstitions like ‘Step on a crack and you break your mother’s back’ very seriously.”

As it’s in limited release, please check here to see if it’s coming to your area.