I personally have problems with doors, and stuff that should be locked. I can never be sure I locked properly.
Totally did backtrack unreasonable distances just to check if I had closed the door.
It's all fine when it's my door. Worst case scenario, I get robbed.
However it's more of a problem when it's someone else's door. Worst case scenario, they get robbed, and that's a different story. Or pets get out...
Obviously I can't take the door on my front seat... So my solution is to take a picture of me trying to open the door, a kind of proof that it's closed.
And, would you know it, it works! When I get anxious, I pull out my phone and look at the pictures.
It's getting better, actually. I believe I'm fixing it slowly. Good riddance!
There's a very helpful method for being confident that you did something right, and while it may not be enough for people with compulsive disorders, it's great for many situations:
I have experienced a (partial) failure of this. On the takeoff roll, there’s a call out for “airspeed alive”. One day after leaving the airplane parked outside for a long weekend, I dutifully looked at a dead airspeed indicator and called out “airspeed alive” followed shortly by realizing the mistake and aborting the takeoff, but there’s a danger of looking and “seeing” what’s expected but not actually there.
This reminds me of some of my… I guess I should call them “non-conscious automated vocalisations”.
For a while I used to greet people with the greeting they’ve just given me: they say “hello”, I also say “hello”, they say “good morning”, I say “good morning”. Fine until my sister greeted me with “happy birthday”, though I did at least notice and stop myself after one syllable.
More seriously was when I was following a different automated greeting. I was in hospital with testicular torsion and the doctor asked “how are you?” — my polite British “fine thanks how are you?” was entirely out of my lips before I realised that this answer was not there one I wished to give and I had to add “well expect for this…”
> Fine until my sister greeted me with “happy birthday”, though I did at least notice and stop myself after one syllable.
When I'm not able to stop myself I have been forced to say,
"happy birthday ... to me". Others must think this silly reply means it's more like too many birthdays.
Other comments contradict this. Also, it doesn't pass a common sense test. How can you validate the air speed meter with zero airspeed? The correct reading is the same as a common completely broken reading.
I've had a lot of success with this for things like closing doors and taking medication, as my memory gradually wanders off into the misty lagoon. Especially the “as needed but at most once every 24 hours” kinds of medication that can't be handled with a pill organizer—with the timing information included in the call. Point to the bottle (or if out of range, hold the pill up, or otherwise physically emphasize the object), say “Taking a symptomstoppidine on Thursday morning” or such.
I don't suffer with this too much, but while the "point and call" method works well for one-off activities it doesn't do much for regular ones. I end up asking myself "I remember pointing and calling... but was that today or yesterday?"
Is there a way of using point and call, or a similar method, for helping with that?
This is also a useful technique for keeping two people in sync about something situational and important. Whenever our pet bird flies down to the floor, which is often, it's vulnerable to being trodden on. So the wife and I call it out whenever we see it, and repeat until the other person also says it out loud.
Works with lots of other stuff, like hot stove tops. It can be a bit infantilizing to the other party unless they're also au fait and on-board with the technique.
I have a weirder version of this problem that's less debilitating but annoys people who live with me -- if I pass by a door I will automatically lock it with no memory of having done so, even seconds after. Like kleptomania but for locking doors. If I'm within five feet of a door it's as if a magic force emanates from my body to lock it as far as my own awareness is concerned.
One of my roommates in college was carrying in groceries, put his keys down on the counter, and went out to get a second load. I was reading a book, passed the door, locked it, and walked upstairs, completely oblivious, stranding my roommate outside.
They referred to this as "getting Lars'ed out" from then on.
I had a family member who had the same drive, and after one too many times of me getting locked out while I'm bringing in things from the car, the New Rule™ was that if I'm actively using the door, it is stopped fully open, and the Habitual Locker is not allowed to touch it without coming outside to help carry things in, no exceptions.
My version of this is turning lights on. I enter a room and immediately turn the lights on, but I'm neither aware of turning them on nor aware of them being on, so I don't turn them off when I leave.
I added motion sensors to most rooms in my house about a year ago and I’m surprised how much of a quality of life upgrade they have been, maybe give that a shot.
My wife used to turn off all the lights before we both ran to work, but she would usually start doing it when I was half naked and looking for my keys wallet and phone.
I replaced everything with LEDs and stressed that the price of leaving the lights on was less than being 2 minutes later to work and absolutely nothing compared to getting fired for being late.
Since moving into town and getting my ipod stolen from my (possibly unlocked?) car, I habitually lock my car doors every time I'm getting out. Which is fine, except when I'm just running up to someplace and not actually parking. I locked myself out a few times before I got into a routine of very deliberately putting the keys into the same pocket every time and telling myself I have them.
Which is great, except for the time I got a phone call as I was leaving the car and forgot the keys in the ignition. Gotta stick to the routine for it to work!
Similarly, I used to get anxious about if I'd turned off the lights, locked the door, made sure the oven was off, etc at night. So now I count one number for each "thing" I do, and I know that I need to count up to 5 to "prove" I did it. Then, later in bed, I know I checked the front door because I know I counted to 5.
You'd expect this would transfer to the "well, are you sure you counted", but I'm never actually anxious about that. I think it works similarly to mnemonics, where the simple act of making a mnemonic for something makes it memorable, and it doesn't matter if it's a good mnemonic or not. In this case, I have "proof" I have done the things that make me anxious, and it doesn't matter if it's "good" proof or not, I just don't feel the anxiety.
This is kinda funny, because I've had the opposite outcome. Well, "ish", because my situation isn't directly comparable.
When I'd leave the house in the morning, there were always five things I needed to have with me: Wallet, phone, badge, glasses, and smokes.
Once a month or so I'd get to work and realize I had left one of these at home. It was a tragedy to be caught an hour from home without my phone or glasses. It was annoying to be without my wallet, cigarettes, or badge.
So I decided to regiment this. Wallet always in the front right pocket, badge always clipped to belt, phone in left back pocket, cigs in front left pocket, and glasses in my backpack. I would pat each location and say out loud, "wallet, badge, phone, smokes, ... glasses".
It didn't work. I quickly just went through the motion of patting and saying without actually verifying the fucking things were there. The first time I forgot an item was a mini existential crisis. ("If I can't account for these simple EDC items when I'm trying to, what hope is there?")
WFH has solved the badge issue. ApplePay mitigates the wallet issue. Glasses are still forgotten sometimes, but my eyesight isn't that bad when I'm out and about (it was only terrible to be without glasses when I worked at a computer in an office). So I guess the situation just solved itself.
I only need to confirm my e-cig is with me. Everything else is either I remembered it or "oh well". And if I quit that, then I'm free :)
I do this counting thing subconsciously with the stuff I'm carrying from "scene" to "scene" of my life.
And it show.
If you suddenly throw me an extra thing to carry, I'll forget something I should've had with me. It's hilarious really for everyone else.
I used to work with someone who had that same problem with door locks, he'd sometimes leave work to make sure he locked his door. This was well before the days of ubiquitous web based home security cameras, but he rigged up a video camera and a video capture card on his PC to take a picture of the door (and door lock) and post it on a web page every minute. So he could easily check to verify that the door was closed and locked.
Nowadays, maybe an electronic lock would be an easier solution, though I'm not sure that would satisfy the urge to be sure it was locked, would he trust it?
I have this exact same phobia. Except it's having left the gas on the stove on or having bumped it. I bought a methane alarm and put it not too far from the stove. Now all I need to do to make sure there's not a gas leak in the house is just open up the camera and not hear the alarm.
Can't speak for anyone else, but for me the electronic lock was enough. At least after I'd used it a few times and got a feel for how reliable the indication was.
I kind of hit a similar problem: My parents let me stay at their house while they were on vacation and I was traveling through their city, as long as I locked up and set their alarm when I left.
Me, being unused to how their alarm worked, was unsure if I set it.
I set the alarm, locked the door, hear it beep, waited outside until it stopped beeping, then I thought to myself "was the alarm really on?". I unlocked the door, opened it, setting off the alarm, which I turned off with my code.
Goto 10
This repeated a few times until some larger alarm somewhere else in the house started blaring loudly that could probably be heard across the neighborhood. So I disabled it one more time, and just left it well enough alone since I couldn't get out of the loop without some other way of verifying things.
I started reading and thought "why not just …"—and you did!
Since this is Hacker News, I'm surprised that you haven't come up with some more elaborate system, e.g., properly locking the door closes a circuit, and you can check the status of the circuit remotely.
I don't worry too much about whether I left the door locked or unlocked, but suck a system would produce anxiety in me, because I could never be sure if there wasn't some circuit malfunction and it wasn't showing me a false positive or negative.
My wife and I had the exact same response to the baby wearables or gadgets that promised to tell us if our baby was still breathing up in her crib. We weren't worried about that, so the notion of adding something that would almost-certainly be a flaky indicator seemed guaranteed to increase anxiety.
I make a mark on the back of my hand in ball-point and ONLY rub it off when the job is done. Eq (using your example) if I knew I had to lock a door on the way out I would write either an 'L'(ocked) or a D(oor) on the back of my hand.
Because I stick to the 'mental rules' of only rubbing it off once the task is completed, if I'm uncertain if I've done the thing / task I can look down to my hand to see if that mark is still there or not. If it is - U-Turn time!
It Works pretty well (as always, mileage may vary) even for multiple things if needed although the random letters/marks on the back of your hand can make people curious but if it does I simply say - It's a list of stuff I need to do.
Field Notes 3.5" x 5.5" notebooks are the size of a folded index card with only a few pages in them. So they comfortably fit in my pocket. Staple bound is relatively weak, but their relatively cheap price means that you can just keep buying them as they wear out (moving your legs / walking / etc. etc. slowly weakens the paper and tears it apart).
Realistically speaking, a Field Notes 3.5 x 5.5 is well balanced: I seem to run out of space roughly as the staple binding wears out. (I know people don't want to "waste paper" but.... I haven't found a good strategy for that. The small size and "disposable" nature of these Field Note books are superior in my experience)
Pentel Kerry is a "shrinking" pencil. It has a small size when its stored, but when you pull the cap off and put it on the back, it "grows" slightly and has a better balance for writing. Its a very slight effect, but the "smaller stored size" makes for a nifty pocket-pencil.
---------
> I make a mark on the back of my hand in ball-point and ONLY rub it off when the job is done. Eq (using your example) if I knew I had to lock a door on the way out I would write either an 'L'(ocked) or a D(oor) on the back of my hand.
Never erase in your pocket notebook (despite using a pencil). Just add more information later: cross out old information with new dates, if you're out of space write down a page-number where you can see more information on a particular subject.
I really enjoy reading about folks sharing their OCD stories. This one resonated with me because it's one of my obsessions.
I will say that after going through CBT and becoming an amature expert on OCD as a sufferer, a therapist would argue that this behavior of checking your photo is a form of compulsion. It works for dam sure but you're never really going to be able to go to sleep without some form of checking when the obsessive thoughts start.
Anyone who has gone through treatment knows the ultimate goal is to weaken the reaction of the obsessive thoughts which is what exposure therapy is all about.
Just a quick story, my laddering technique for achieving peace was to eventually get to a comfort level where I can sleep with the door wide open all night. Well, I didn't get that far but I did sleep with all my doors unlocked for a couple nights.
Lastly, I can safely say that I now check all my doors once these days with the exception when I'm stressed at work. I'll check them once before going to bed and if I brush my teeth between checking the door and actually walking to bed, I might check them once more. But this is a seldom occurrence these days.
Same for me. A fix I used to have is shifting something unusual about my clothes after checking the doors are locked, like doing up a button I don't normally do up, etc. I can then check that, "yes, button is done up, I locked the door".
But what seems to have cured me for good is having children. I'm just waaaay too tired now to even consider going back to check the door. Screw it, what am I gonna do? Oh dear, baby #1 was sick on me again. Hey, baby #2, don't run off without me! Baby #1, put that hat back on again. No more snacks until it's back on. Baby #2, what did I say about running off? What is it I was worrying about? Can't remember. Goto 1
> It's getting better, actually. I believe I'm fixing it slowly.
You've illuminated the key point I think. I struggled with this as well, and finally just forced myself to abandon the door, and struggle with the feelings. If you can do it ONCE, it gets easier from there. I admit I was a light case compared to the hair dryer, but the more times you can push through the compulsion -- with the aid of whatever tricks you can come up with -- the easier it gets.
A technique I learnt as a kid from my uncle was to mindlessly use physical interaction to “feel” the state of things and learn a habit of doing it all the time. For the example of locking the door, it would be trying to open it and pull/push on the handle right after closing it. This seems to stick far longer in one’s memory.
I still remember one time when I was staying at a friends place in a different city, I took his key to get back early and the key broke in the lock so he came back to me trying to get the bit of key out of the door so someone else could open it. We were all very drunk. It was quite traumatic!
Have you tried getting locks that only release the key when locked? If you've got the key in your pocket then the door is locked. More time efficient than taking a photo every day.
How would you get back inside the house without leaving the key in the exterior lock, making you unable to lock the door from the inside with the same key?
Not to mention the potential of having someone lock you inside, taking the key, and then something bad like a fire happening while you're stuck.
They actually do make locks that only release the key when they are locked-LOTO (lock out tag out) locks. They are used to disable hazardous equipment for maintenance. The idea behind key retention is that it prevents leaving the lock in an unsafe state where someone else could unlock it. It's also supposed to make it easier to know that the machine is actually locked out, since the maintenance tech can check if they have the key. Similar idea to some of the solutions to OCD posted, the tech can check if they have their LOTO key to be sure it's disabled before entering something like a trash compactor. The key stays with the lock at all other times.
That being said, for a door all your objections are pretty reasonable, the only use for key-retaining locks I know of is fairly specialized, but interesting in how similar it is to the reminders people dealing with OCD use.
When i leave the house i count to 7 before I close the door. House keys, wallet, phone, glasses, car keys, lock the door. Anything else is item 7, prepared the night before.
I remember a panel on a news program years ago where the one guest was a psychologist who was treating "untreatable" drug addicts by getting them "hooked" on running or weightlifting or martial arts. They would stop drugs but would instead be doing martial arts for hours a day or running 20 miles every morning. Then he would start treating the addiction personality and causes, but in many cases the patients would just stop coming and live three or more hours of every day in the gym.
The other guests were various degrees of horrified.
His patients went from literally living on the street as heroin addicts to doing 3 hour gym sessions and holding down a job; and his peers thought he shouldn't be allowed to practice.
Recently I was reading a book on ADHD and the author was quite adamant that you could only be diagnosed with ADHD if your life was worse than "the norm". In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account.
> In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account.
This may overstate the point a little bit. But there's a kernel of truth here: if you don't require some degree of significant impairment of functioning, a whole lot of criteria for mental illness would apply to huge swaths of the population. E.g. this is why the diagnostic criteria for ADHD include: "There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning."
> if you don't require some degree of significant impairment of functioning, a whole lot of criteria for mental illness would apply to huge swaths of the population. E.g. this is why the diagnostic criteria for ADHD include: "There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning."
Wouldn't this just tell us that these categories are completely meaningless?
No. It's a misconception that mental disorders are meant to categorize folks by sets of character/personality traits, whether or not they negatively impact someone. No, you do not have "a bit of OCD" if disorganization simply stresses you out.
On the contrary, mental disorders are labels expressely intended to inform and enable treatment of distress. Disorder and treatment are inextricably linked.
This is all according to how the DSM defines things, of course. Others may have opinions on how mental disorders should be defined.
But basically, if you have some horrible effects from the thing, and by some herculean effort or remarkable circumstance you're able to work around it, then by definition you don't have a disorder and it's not treatable.
Heaven help you if the effort or circumstance becomes unsustainable, when you could've had years to treat the underlying problem but medicine denied it was a problem.
Such "herculean efforts" would constitute distress. If you're successfully busting ass every day to compensate for depressive symptoms, you might have a depressive disorder.
As for your point w.r.t. circumstances: yes, this seems to be by design. Someome who might be diagnosed with schizophrenia in the US could easily be considered just quirky or even revered as a sort of spiritual guru in other cultures where symptoms have fewer/no negative impacts (and thus do not present so "horribly").
You're elaborating on how the categories are intended to be meaningless, but you're not doing much to claim that they are in fact not meaningless.
If someone has low occupational functioning, you could call that a disorder. But why would you call it "ADHD"? Why would you call it ADHD for some people and OCD for other people? Suppose you have two lists of symptoms:
Attention Deficit Hyperactivity Disorder
- Patient has an active mind.
- Patient has a crummy job.
Borderline Personality Disorder
- Patient rubs me the wrong way.
- Patient has a crummy job.
And you have several people who display every combination of mental activity, mental lethargy, likeability, unlikeability, good jobs, and bad jobs. You say everyone with a good job has no mental disorder, unlikeable people with mental lethargy and a bad job have borderline personality disorder, likeable people with mental activity and a bad job have ADHD, and unlikeable people with mental activity and a bad job have borderline personalities _and_ ADHD. Likeable people with mental lethargy and a bad job have a disorder as yet unnamed.
What did you learn about the reasons why people with bad jobs (your primary diagnostic criterion, after all!) have bad jobs?
That is definitely not how it is defined through - it seems to be a straw man?
The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’.
It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc.
If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems.
It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’
That is absolutely not how strokes and broken bones are diagnosed. If one of your bones breaks, you have a broken bone. Whether it hurts, or stops you from doing things you'd like to do, is an unrelated question.
I think you're missing the point. Let me be concrete.
I'm diagnosed with bipolar disorder. Sometimes I feel axnious and euphoric, other times depressed and lethargic, both at extremes noticably deviant from the average person. This has caused all sorts of turbulence and distress in my personal and academic life. Being diagnosed allowed me access to therapy and prescriptions.
There exist plenty of people who oscillate between distinctively high and low moods, but have never found themselves in serious distress because of it. Thus, they have not been diagnosed with bipolar disorder. Whether or not they "are bipolar" is a subjective question that mainstream psychiatry doesn't seem to have an opinion on.
But also if you have schizophrenia, but all the people around you -for some reason- have chosen you at random to aggressively reward your schizophrenia and lavish you while also threatening that if the illusions stop, they will kill you, then schizophrenia really isn't a problem, in fact it's the best thing that ever happened to you. Saves your life every day.
But it's still a thing. Maybe you can't refer to it as a disorder, but you are hallucinating stuff. It's a set of material facts about your mental state.
Some of Donald Trump's various disorders have objectively rewarded him, generously. But he has those conditions. He doesn't not have narcissism just because his narcissism is good for his bottom line.
I think the issue is that medical criteria are functional- what should doctors do about this. If it's not even bad, they shouldn't do anything! And this gets translated as "nothing is there to treat" but shouldn't be translated as "nothing is there to notice"
So when you find a person whose highs are higher than yours, and whose lows are lower than yours, and whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems.
Which makes the idea of "bipolar disorder" meaningless. That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.
> whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems
Your argument seems to hinge on this idea that a good life => no distress, which, if you've interacted with anyone diagnosed with a mental disorder, is obviously not true.
My life is great. If I didn't take a mood stabilizer, it'd probably still be good, but not as good. Regardless, my mood swings can negatively affect me and those around me.
If one day I reach a point where I can live without meds or therapy and reap no negative consequences, then yes, it would be fair at that point to say that I no longer had bipolar disorder.
> That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.
Bingo. My symptoms (mood swings) + my problems ARE the cause my bipolar disorder diagnosis. Until I had problems, I had no disorder.
What causes the mood swings, then? Genetics, upbringing, life experiences, diet, idk. Nobody knows for sure. It's an active area of research, but there is no one known cause. For all we know, there may be five independent and unrelated risk factors that lead to someone developing bipolar disorder.
It's like you get it, but you're still dismissing it for some reason. I'm curious what ulterior point you're trying to make.
Someone close to me broke their arm, and had to have it pinned. As it healed the bone rotated and shifted slightly.
In discussing whether they'd need to try to correct this movement via surgery, the doctor very much said "it's a problem if it's a problem". When it fully healed the person had full use of their arm, so the doctor was satisfied with the outcome.
The doctor did also say that different countries had different philosophies on what they expected a healed bone to look like. In their experience Canadians were more likely to be OK with an imperfect solution, but Australians were more likely to want the break healed in a "like new" condition.
This is akin to totalling out a car for cosmetic damage - are you trying to fix it back to as it were (may be impossible or exceeding costly or risky) - or is it working to get it back to good enough?
And circumstances make this different - a sports star is going to want to do everything to improve performance, whereas an office worker may just want functionality.
But it is absolutely how broken bones are diagnosed! We don’t run around randomly x-raying the population. We have ERs and similar places where those who are hurting go and there we try to answer what is the cause of their pain. If you have a bone broken but its not causing pain and not affecting you in any way how would we even know it? Now this is vanishingly unlikely with broken bones, thus not something we have to worry about much consciously.
Like I understand why you are being downvoted here, your comment is kind of confrontational and kind of strawmanny, but the concern I think is quite valid and deserves a real response.
My response is, mental illness is something more personal than a broken bone and at present diagnosis needs to be cruder, which does make the categories a bit more "meaningless" but I don't think it gets all the way there.
So, like, take depression for example. I am being slightly unfair but hopefully on-the-nose when I say that DSM defines depression essentially as "you are too sad, too often, and you are not in a situation like mourning a parent or spouse where that level of sadness would be expected." The point is, it's a symptomatic diagnosis.
Other symptomatic diagnoses include “migraine” or “hypertension” or “diabetes” being symptomatic is not necessarily something that excludes meaningfulness, I think we could agree? But it also means that there is a difficulty with treatment. This medicine might work for your migraine but not her migraine; whereas my hypertension is caused by not getting a good night's sleep due to mild apnea and can be cured by a CPAP machine, his hypertension is caused by the fact that he weighs 350 pounds and CPAP therapy will fail.
OK, so like diabetes there is not just one major depression, and maybe some day we will distinguish between "type 1 depression, type 2 depression, gestational depression, predepression" and have specific causes subsumed as different "types" of the symptoms. Maybe not. But the label still has some sort of meaning, just like we can have "migraine medicine" as a group of things worth trying if you have migraines, or like how we can use insulin to handle diabetes in general and so on.
But then combine this with another question which is, "for mental illness, what does cured or managed even look like?" and that's where this occupational functioning criterion starts to look quite reasonable. Because the deal is that if "depression" isn't going to single out a particular cause, the causes of your depression will still likely be around, just like "we have you using insulin" has technically fixed your diabetes (that is, the symptom -- the hypoglycemia) but the cause is still not addressed. That these illnesses take place in the mind makes them harder to quantify. So we need a qualitative criterion, a "how bad is the pain from 1 to 10?", so that we can measure if the intervention is improving things.
Asking questions about your occupational functioning is thus a reasonable qualitative scale to indicate the severity of the symptoms and the success of treatment, even though it says nothing about cause. The different "buckets" of symptoms still make sense as they suggest categories of things-going-wrong and clusters of treatments-for-those-things.
No, why? "Illness" sometimes is about the quantity, not the quality. If you enjoy the odd glass of wine once a week, you're fine, if you drink every hour of the day, not so fine.
But that's an orthogonal concern. Two people can easily display exactly the same quantity of, shall we say, ADHD-like tendencies. If one of them is a success for separate reasons, and the other one is a failure for separate reasons, why do we want to say that the failure, in addition to his other problems, also has ADHD? What do we learn from that?
If the success has a lot more ADHD-tendency than the failure, how do we defend the idea that the failure has ADHD, and the success doesn't?
It's not about whether the person is "a success" or "a failure", it's about whether the person feels that their condition is materially impacting their daily life. If I feel that my gaming habit is impacting my job because I can't resist playing games during work hours, that can be classified as a disorder.
It's just shorthand for "this is something we'd like to fix".
Someone could certainly be a billionaire and also have ADHD.
The criteria is more like “but for this tendency, the patient would be/feel better, all else being equal.” A software engineer making $$$ could meet the criteria if their inability to focus keeps costing them promotions, launch their own company, or whatever their goal might be. A neurotypical buggy whip maker who can’t find or hold a job doesn’t qualify, even if he is obviously worse off overall.
You have two people with ADHD-like tendencies. One person feels they have found their own ways to adapt to their ADHD-like tendencies and that they are successful. Another person feels that they have not found ways to adapt to their ADHD-like tendencies and their life could be better if they found ways to adapt.
In this case, the actual magnitude is less important than how individuals adapt.
The problem is that it's a matter of degree. Like another comment mentioned, having some wine every few months isn't being an alcoholic. Being distracted sometimes is completely normal, being distracted too much is a disorder. So it has to be a line you draw somewhere.
And it's not like you can just count them or something. It's not like you can say "5.2 distracto-particles is normal, but 5.3 distracto-particles is ADHD".
And traditionally, "too distracted to hold a job" is a common place you might draw the line between "normal" and "ADHD".
So yeah, you might have to draw the line somewhere arbitrary, but that doesn't mean that the thing it's trying to measure doesn't exist. Any line you draw between "short" and "tall" will be arbitrary, but that doesn't mean height doesn't exist.
The essay [1] from which the hairdryer anecdote is quoted has the thesis that categories (in general) are instrumental, and don't have much value separated from their context.
ADHD is a category of psychiatric diagnosis; psychiatric diagnoses exist to address deficiencies in function. Separating the one from the other, as you perceive, renders it meaningless -- or perhaps, useless. If one happens to have some of the traits of ADHD but it doesn't affect their life negatively, so what?
> could only be diagnosed with ADHD if your life was worse than "the norm"
Because ADHD is a real situation for some people, and for others it's a way to legally take class-B stimulants.
Yes, people really do try their friends' ADHD medication, enjoy it, and then shop around doctors to find someone who will prescribe it. It's called "drug seeking," and doctors do flag patients who do it.
This, BTW, is what happens with medical marijuana. There are people who really need it, there are people who think they need it, and then there are people who who tell everyone but their doctor that it's recreational.
I'm ADHD-diagnosed, and god damn do I wish I could just go to the store and get Adderall when I feel like I need it
The fact that I have to call someone and get a prescription every month just makes it so that I go untreated for months at a time (kind of a cruel irony that ADHD treatment is gated behind the wherewithal to make a monthly phone call). And honestly I think modern life is probably such that most people could benefit from 10-20 mg of Adderall.
Taken for a short period each morning at a low dose (cut an 8mg patch into sections) it offers similar stimulant effects, but with fewer side-effects. Nicotine patches are reportedly less agitating, less addictive, less expensive, and more available than Adderall. It also measurably improves cognitive ability according to some studies I've read online.
I'm almost 40 years old, and I have ADHD-inattentive. For two weeks I've been using sections of nicotine patches - about 1/4 of an 8mg patch for an hour each morning, and I have never found it more easy to be focused and productive.
Just be careful to not use too much, especially if you've never been a recreational nicotine user. I've had several nights when it's been difficult to sleep -- which has been a signal that I need to decrease the morning dose.
The couple that referred me to my primary care doctor likes our doctor because it's very quick for them to renew their ADHD prescriptions.
BTW, I once tried 30 mg of Adderall and I felt like I would go crazy if I took it every day. I took it at 6:00 a.m. and I had heart palpitations, euphoria, and crazy insomnia past midnight. It's not really something that's as safe as coffee for the average person.
> Because ADHD is a real situation for some people, and for others it's a way to legally take class-B stimulants.
In some cases it's really clear, in some others it isn't. A few of my friends did better than me in school, and they had access to Ritalin. They were pretty good student while I was a problem child. I never really explored the option during school as I didn't really know how it worked and what ADHD was. I tried it later in life and it helped with work. Ritalin probably would have helped me during school. But was it because of some "real" ADHD? Was it because it's a stimulant and it helps anyone? Was my ADHD more or less real than them? I know that for them Rilatin and ADHD was a part of their identity, so maybe they convinced themselves they couldn't work without it? I don't think there's any good and objective way to measure that. Should I feel guilt when I take Ritalin now? I can function without it, but they can too. It's just far from optimal.
> These data suggest that when people are given rote-learning tasks their performance is improved by stimulants.
Rote learning was (and still is) one of my big weaknesses. Tools like Anki help but going through them is way easier when I use stimulants. So maybe it depends on the student, but I'm wary of statements like "ADHD meds for non-ADHD students don't really help", it seems more to be pushing an agenda than telling the truth.
> This, BTW, is what happens with medical marijuana. There are people who really need it, there are people who think they need it, and then there are people who who tell everyone but their doctor that it's recreational.
Well, yes, and this is how it came to be allowed; the harm from the "preventing recreational use" system was so huge (see yesterday's war on drugs post etc) that it made sense to stop trying to make this distinction. The medical system provides a "fig leaf" which allows the remaining pure-puritans to accept it while at the same time the people who need it for medical use can get it, and nobody has to get their life ruined with jail.
(By "Pure-puritans" I mean those people who are against it because it's recreational, not because of alleged harms or externalities like smoke)
I also think there's a huge grey area of people with chronic pain or unhappiness problems that don't quite reach a diagnosis bucket - or they've not yet learned to speak the words that would get them there, or don't meed the social class critera - whose "drug seeking" behavior might most easily be addressed by just letting them have the drugs. As long as they're not opiates.
Would you apply the same reasoning to caffeine and nicotine? Should we ban both? You're also seeing the world as a competition between people ("keep up with their coworkers") but I believe most people are actually trying to make a living (no need to take adderall if you are already satisfied with what you have).
> Recently I was reading a book on ADHD and the author was quite adamant that you could only be diagnosed with ADHD if your life was worse than "the norm". In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account.
IANAP, but that sounds correct to me. I recall the DSM requiring negative impact on one's lifestyle as one of the criteria for diagnosis of any mental disorder. And even if I'm misremembering that, that's what psychiatrists look for in practice. They not only query what symptoms you're feeling, but also the impact they have on your day to day life.
Which makes total sense. Treatment of any disorder, especially mental ones, carries a (sometimes significant) risk. It would be unethical to subject someone to that risk for no possible benefit.
> It would be unethical to subject someone to that risk for no possible benefit.
Let's take two people, say me and Einstein. Let's say Einstein has super-severe ADHD and thus performs so poorly that he can fairly be compared to me.
Is there really "no possible benefit" to curing that ADHD? Keep in mind that the real Einstein discovered relativity, and uh... I'm just going to say my contributions to science have been a bit less dramatic.
I don't think it's at all unreasonable to posit that there are plenty of people who are gifted enough to compensate for their mental issues, but they'd still benefit if they could fully apply themselves instead of wasting half their talent mitigating such issues.
This is the argument I've been making for years. I used to be _way_ smarter than I am, I have concrete examples of things I used to do with ease that are now major cognitive effort, but I'm still alright in a lot of ways. Most folks meeting me would still consider me pretty smart, although I have profound struggles with memory lately.
And there doesn't seem to be a doctor in the world who considers this a problem. "Yep, it goes 0-60 in 27 seconds, just like a chevette should!" "but doc, it's a bugatti". That would be one hell of an incompetent mechanic.
The same psychiatrist from the hair dryer incident in the link has written about this. He's skeptical about ADHD being a discrete condition, and generally thinks that if ADHD drugs will help you focus, taking them is reasonable whether you're diagnosed with ADHD or not:
> Psychiatric guidelines are very clear on this point: only give Adderall to people who “genuinely” “have” “ADHD”.
> But “ability to concentrate” is a normally distributed trait, like IQ. We draw a line at some point on the far left of the bell curve and tell the people on the far side that they’ve “got” “the disease” of “ADHD”. This isn’t just me saying this. It’s the neurostructural literature, the the genetics literature, a bunch of other studies, and the the Consensus Conference On ADHD. This doesn’t mean ADHD is “just laziness” or “isn’t biological” – of course it’s biological! Height is biological! But that doesn’t mean the world is divided into two natural categories of “healthy people” and “people who have Height Deficiency Syndrome“. Attention is the same way. Some people really do have poor concentration, they suffer a lot from it, and it’s not their fault. They just don’t form a discrete population.
> Meanwhile, Adderall works for people whether they “have” “ADHD” or not. It may work better for people with ADHD – a lot of them report an almost “magical” effect – but it works at least a little for most people. There is a vast literature trying to disprove this. Its main strategy is to show Adderall doesn’t enhance cognition in healthy people. Fine. But mostly it doesn’t enhance cognition in people with ADHD either. People aren’t using Adderall to get smart, they’re using it to focus.
Psychology has the sizable problem that everything is a disorder but very little is actually known about any of them.
You can't say "ADHD is this" and point at a definitive cause, tis just a bag of related symptoms that is geared more towards consistent diagnoses (i.e. you go to five different doctors and they all diagnose the same thing) rather than attachment to a common underlying cause or consistent treatment plan and success phase.
This isn't to say psychology is useless, many people find great help in it... but when it comes down to it, it is scientists (who as a whole have some of the biggest problems in being good at being scientists) trying to describe malfunctions of the highest abstraction on the most complicated class of things known to exist... and just scratching the surface.
The last D is for Disorder... it's a value judgment and the question does need to be asked: if something isn't causing significant problems, is it a disorder? The answer isn't clear cut and people are going to draw the line in the wide grey area in different places.
The solution must be neuroscience continuing to advance to higher levels and replacing the vagueries of psychology with justifiable cause and effect explanations. It is advancing but still a far way off.
> You can't say "ADHD is this" and point at a definitive cause
There's plenty of existing and on-going research that demonstrates differences in brain structure and development in people clinically diagnosed with ADHD. In other words, ADHD is caused by parts of your brain being underdeveloped or damaged. There is on-going research applying machine learning to MRI brain scans to try to predict ADHD through brain scans rather than only clinical diagnosis.
I really don't like 'the norm' as the base point. If you have the mental abilities of someone with 140 IQ with serious untreated ADHD, but your life is 'just ok', that is wasted human potential. That 'just ok' person could do so much more for society's and their own benefit.
That's pretty much why I threw away the book. I wouldn't meet his criteria for treatment, but I look at how much better my life is this past year and half since my diagnosis and said ... "F this".
Similarly, the modern medical view of addiction is basically something like, "continued use in the face of adverse consequences." Laypeople really hate this definition, preferring to think of addiction as primarily a physio-chemical phenomenon, but the American Psychiatric Association has to say:
"Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence."
I'm in the process of doing something about my symptoms that as far as I'm aware are ADHD, and people have said that to me, but I reckon I could be at least 5x more productive with help. The number of unpushed branches on my machine is proof of that.
This goes hand in hand with many laws in california.
There's a law that governs the treatment of mental illness and basically, it's not against the law to be mentally ill, and as long as you're a not "a danger to self or others" they will have to leave you alone, even if you clearly need help.
This is particularly heartbreaking for many people with some form psychosis, because anosognosia is frequently correlated with it. This is basically an inability to have insight into your own mental illness (sort of like a powerful form of denial).
So there are lots of mentally ill people in california, and they usually end up homeless, or eventually in jail.
>Then he would start treating the addiction personality and causes, but in many cases the patients would just stop coming and live three or more hours of every day in the gym.
one can speculate why addiction hasn't been selected out - may be because it probably provides significant advantage when channeled right. Some achievements/mastery/etc. require tremendous focus and huge amount of persistent work which probably may be not doable on rational motivation alone, without the primal dopamine [over]drive.
I doubt this is right. Scott doesn't do stuff like podcasts or panels generally. He likes to write, and avoids real time stuff. Can you provide a link or something?
Probably, but Scott Alexander writes on the latter two things so realizing this is nothing but a curiosity. Dearest Claxton is also an anagram and as it so happens dearestclaxton.substack.com is not written by Scott Alexander. Or anyone really.
I've read most of Scott's blog posts and he rarely mentions OCD and when he does it tends to be "this is what I think people with OCD experience" and not "this is what my patients have told me" which leads me to believe that he is not an expert in OCD.
I have OCD and it's ruined my life in ways that are hard to articulate. Which is why I can point out two good reasons why what's being described might not be a good idea. First, giving into compulsions just legitimizes them and reinforces the patterns that are central to OCD and can ultimately make things worse. Secondly, OCD has a habit of changing how it manifests. Sure, maybe the woman is no longer bothered by the hairdryer, but what happens when it becomes changes to worrying if the oven is on? She'll be right back where she started.
I doubt that the anecdote actually happened as described. It's way too contrived, simplistic and borders on "Psychiatrists hate her! Cure your OCD with this one simple trick!". Realistically, OCD is incredibly insidious and if it were that simple to cure then nobody would have OCD. What's described is, at best, a short-term fix and half the psychiatrists likely knew that such things rarely stick.
I've had the same thing happen to me more times than I can count. I think I found the silver bullet, a way to permanently defeat my obsessive thoughts. If I'm lucky then it'll last a week before my OCD comes back in full force. But the truth is that you cannot directly fight OCD, it's like squeezing dough. When you clamp down in one spot, it just squirts out somewhere else. There's a quote that I think describes it perfectly "To hate me is to give me breath, to fight me is to give me strength". Fighting OCD or giving into its demands is just falling into its traps. You only truly win when you reach a point where you don't respond to it.
OCD is like a fire... you have trash can burning, and you have to treat the problem properly... so, water? Do I have a container to bring it? A glass is too small.. bottle to slow to empty... what about an extinguisher? Dust or CO2? Where are they? Can I use them= Damp towel? Baking soda?
If the can burning is in a garage, and you're able to move it to the middle of the asphalt (non-flammable) driveway, you still haven't put out the fire, but you've solved one half of the problem and given yourself a lot more time to think and find something that helps.
Driving back home 10 times per day, means that she might lose her job, become homeless and not be able to afford proper care... having a hair dryer in her purse (or wherever), means she can live a pretty much normal life, while slowly working on her problems (eg. start with leaving the hairdryer at the psychs receptionist, and start from there).
"To hate me is to give me breath, to fight me is to give me strength"
I've been listening to the self-esteem meditations on headspace and this is the same thing that they are recommending. I am amazed at how effective it has been.
That's strange. My impression came from his article about the Chamber of Guf where he talks about pure OCD, but it sounds like he's only read about it and never actually met someone with it.
I wonder if the disconnect is in taking the story in an idealistic way vs a practical way. Like sure, if you had someone for whom that works utterly when nothing else works then yeah, do that. But I don't think that's a realistic scenario.
I think it is clearly framed as a last resort rather than standard treatment:
> Here’s someone who was totally untreatable by the normal methods, with a debilitating condition, and a drop-dead simple intervention that nobody else had thought of gave her her life back.
I've suffered from symptoms of OCD on and off, and, personally, I totally believe this anecdote and think it's a great parable.
I think the world is probably split into pro- and anti-hair dryerism, both among people who do and don't have OCD.
>First, giving into compulsions just legitimizes them and reinforces the patterns that are central to OCD and can ultimately make things worse.
Of course, but that's the whole crux of this story: "She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped." It's paved over for conciseness, but I think it's implied that what you said is definitely not news to the patient.
Of course the first, second, third, and fifteenth thing you should and must try is what you say. I'm sure Scott would agree. This was a Hail Mary when every attempt to do that so far failed.
To give another example: I think ECT is terrible. But if nothing else has remotely helped someone with severe depression over a very long period of time and they hate every waking moment and are close to suicide? Throw that brain in a Tesla coil, I say. Another facet of hair dryerism would be stances on body identity integrity disorder. I won't write at length, but I think anyone can guess my position on it.
>Secondly, OCD has a habit of changing how it manifests.
Yes, this was my first thought, but I think that's also part of this parable, too. It likely will manifest in other ways for the patient, but this is a simple hack that actually helped resolve one immediate issue that was causing her a lot of difficulties at that time.
Some of the other issues will probably cause less severe of a life impact. There's a decent chance some won't, since it could be something thing like an oven, but the point is that this was one method to immediately address one pressing problem that was heavily affecting her life. Obviously you wouldn't just say "okay, you're fine now" and tell her to never come back; this would just be a stopgap while the patient is further treated.
On the topic of OCD, one thing that surprisingly helped me a lot and continues to help me came from what I believe was a random reddit or perhaps HN comment I happened to stumble across a few years ago. It was a short sentence from someone quoting their psychiatrist - essentially a suggestion of a different way of mentally framing things. It actually was "one weird trick" that really did immediately work in my case.
I think it was the precise phrasing of it that helped me, so I don't want to try to roughly paraphrase it from memory, but it definitely made it clear that while OCD is certainly a neurological problem, psychological techniques can help guide your neurology, like the proverbial elephant rider prodding the elephant a bit in one direction or another. Hopefully something like that, or perhaps something entirely different, will help this patient so they don't need to take their hairdryer with them anymore.
Despite my initial comment, I'm pro-hairdryer. If it works when nothing else does, then do it. I'm even pro-hairdryer in the sense that it could be used as a stop gap until the patient learns more effective ways to manage their OCD.
I think what bothers me about is that Scott doesn't mention that there are legitimate drawbacks to the solution in the story. It's a nice "thinking outside of the box" story but to use it as an excuse to be smug and very much "I'm better than the rest of these psychiatrists who don't actually want to help you" is distasteful.
I didn't see it as a way to be smug or seem better. It seemed like his colleagues were split in half, as he said, and he happened to be on one side, and both sides felt like the other side was being ridiculous.
I think what you wrote perfectly describes the correct approach to mental health _in general_. Not just OCD, but also many other mental disorders like anxiety, and just emotions in general. Trying to ignore or repress our thoughts and emotions just serve to "give [them] strength". It's a life lesson I wish a lot more people knew.
[NOTE: This thought got me going on a random train of thought below, not really directed at the person or comment I'm replying to above. Sorry for the slight tangent...]
I've recently started taking on a unique viewpoint of my own psychology. It's more of an interesting way to think of one's mind than an actual theory on the mechanisms of the brain. But basically I started thinking of my mind in terms of the classic conscious/subconscious split, but thinking of the subconscious as less like a ... primitive/instinctive part of myself and more like a separate system with its own thoughts and desires. Kind of like how we imagine the body to be conceptually a separate entity from our minds. Though they're quite intertwined, its easy to imagine that we could transplant our mind into a different body and still be ourselves. I imagine that I could transplant my consciousness into a different brain and still be _me_, but with a different subconscious. That sounds strange, because we're so used to the idea of the subconscious being a part of our us, but hopefully it makes more sense momentarily.
The point of viewing the subconscious like this is then one can say that, like the body, if you don't take care of your subconscious's needs and desires, if you don't give it space to be heard, it will lash out. Trying to repress one's emotions, anxieties, OCDness, etc, you're making your subconscious unhealthy in the same way that you can make your body unhealthy by not eating healthy, not working out, or ignoring pain. Emotions are the way our subconscious tells us its in pain or in need.
More importantly, this allows a subjective _detachment_ from one's emotions and anxieties. To view them objectively. Whereas it's really easy to feel anxious and then believe that that anxiety is _part_ of yourself. That you, yourself, are anxious. But viewing the subconscious as a separate system that must be managed like the body allows one to feel anxiety and acknowledge that it isn't _you_, yourself, that are anxious. It's your brain that's anxious. And it's a signal that you need to do X, Y, and Z to take care of your brain. Much like one would rest when your body is telling you it's hurt.
Again, this is more of a way of viewing the brain, rather than a psychological theory with any basis in reality. It's definitely very derivative of archaic psychology theories like Freud's theories and bicameralism. But I find it helpful none the less. The most important component, and something I think a lot of people with mental disorders have trouble grasping, is that this idea that one's identity is not tied to their disorder. I'm lucky in that I've experienced what my brain is like without anxiety and found out that I'm still the exact same person, just minus anxiety. I know prior to that experience I probably would have said that _I'm_ an anxious person, as if it were some fundamental part of my personality. So that experience has better enabled me to make clearer divisions between self and the flaws of the substrate my conscious mind is running on.
N.B. I'm just sharing a (hopefully) interesting viewpoint. This isn't "do this one weird trick and you won't have a mental disorder anymore!" kind of thing. Anyone who suspects a mental disorder, no matter how small, should seek guidance from a medical professional. Seriously. There's no shame in any of it, and treatments are better today than they've ever been. My little pet theory above is, again, just something I found interesting in the way I view my own psychology.
What you're describing lines up well with recent research[1] on multi-agent models of mind. You might be interested in internal double crux[2] and internal family systems[3] more generally. These are techniques for managing mental health very similar that which you describe, and they build primarily upon the idea that the mind is best treated as a collaboration among multiple subagents.
I had a weird tick as a kid where anytime someone said something to me I had to mentally adjust the length of the statement so the number of words was divisible by 5.
So for example if you said "Are you going to school today?" I'd add "my good friend, Will" in my mind.
It drove me nuts, but I was unable to stop. Then one day it just went away. Still have no idea what that was but it plagued most of my childhood. I remember when I noticed that I didn't have to do that anymore and it was probably the happiest I felt prior to my daughters birth.
Never told anyone about it before this comment. It's a strange thing to try and explain to someone.
Wow, that took me back. When I was a kid every time I would say something outloud I had to repeat it to myself, whispering, to "check" if sounds "good", and I had absolutely no control over it. It would also drive me mad and adults would give me shit for it because they thought I was just playing some dumb game. One day it was just gone. And I felt just like you felt!
I don’t mean to be glib but are you really good at Scrabble? I believe the strategy at the competitive level is similar to what you’ve described: Memorizing essentially an index of words by the alphabetized sequence of letters, then you keep your tiles in alphabetical order and “look them up”
“‘You see, but you do not observe. The distinction is clear. For example, you have frequently seen the steps which lead up from the hall to this room.’
‘Frequently.’
‘How often?’
‘Well, some hundreds of times.’
‘Then how many are there?’
‘How many! I don’t know.’
‘Quite so. You have not observed. And yet you have seen. That is just my point. Now, I know that there are seventeen steps, because I have both seen and observed.’”
Sherlock Holmes & Dr. Watson, A Scandal In Bohemia, 1891
Did that seem to have a mathematical basis... a form of counting and grouping... or did it seem to have a rhythmic basis, like you needed a 'dah dah dah dah DAH' pattern in speech?
Heh. Walking over cracks, doing balancing un-rotation, alternating first leg on ladders, skipping first over-two if a ladder is uneven, walking into pools to save an intertial momentum. (No more)
“Then one day it just went away completely. It's a strange thing to try and explain it to someone.”
Have you had any benefits? For example, has it made you much more accepting of the mental quirks of other people?
I really appreciate your disclosure of something so intimate, because it brings a sense of wonder into my world, and it reminds me we never really know what is going on in the minds of our friends (let alone my own mind!). Thank you.
This reminds me of the British Psychiatrist R.D. Laing who had a kind of "open house" for people with mental health issues in the late 60s / early 70s, where they could go and live untreatead except as they wished. (There were obvious limits to this, such as violent people not being admitted). One person came to stay and wouldn't talk to anyone, spending the vast majority of his time in his room, and becoming very irritated if anyone spoke to him. He became more and more withdrawn and stopped eating, and the psychiatric team were very concerned about his wellbeing as his weight dropped. One morning he came down from his room, smiling, and asked for a large breakfast. It turned out that he had been trying to count up to one million and back to zero and every time someone spoke to him he'd lose count. Once he'd managed to do it the spell was broken and he was essentially "cured". There are obvious ethical concerns about his treatment, and I often wonder whether he just lapsed back into some other compulsion, but it does make me wonder a great deal about the lack of individual attention and creative thinking about treatments for for patients with mental health issues that the hairdryer incident points to.
Having lived through OCD and come out the other side, I completely understand why the solution was considered bad.
Sure, this solves the particular obsession. But the issue is that OCD is never satisfied. You develop rituals like this and they work for a while, giving your brain that little dopamine boost every time you look at the hairdryer in your car. But that dose diminishes over time, and soon taking the hairdryer with you isn’t enough. You need to do something more to feel okay about the obsession. This is why OCD sufferers find themselves doing something over and over.
Sustainable solutions address the anxiety (most often meds) or build up the person’s tolerance for uncertainty (exposure response prevention). It was only a combination of these approaches that helped me overcome my illness.
It's critical to find any intervention that works for a debilitating problem. If the hairdryer person lost their job because of it, they may not be able to continue ANY treatment and that might be the end of them.
The first goals in DBT therapy are to stop behaviors that may interfere with therapy or kill the patient. Seems like a good approach to me.
On a related note, I knew someone who had some very self-destructive ways of dealing with her stressful life and associated problems. She held down a good professional job at <big company> and most people didn't know about her issues. She found a psychologist that she liked (and I didn't) and after somewhere between 1 and 2 years she ended up dead. You've got to stop self-destructive life-interfering problems any way you can.
When a person might be bleeding to death, the first step is to stop the bleeding even if by tourniquet. You can do surgery to fix things later, but not if the patient is dead. Priorities are a thing.
She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped.
Sounds like everything else had been given a fair shake to me.
> And approximately half the psychiatrists at my hospital thought this was absolutely scandalous, and This Is Not How One Treats Obsessive Compulsive Disorder
Well, you can call it a stopgap. As long as they're not saying "cured! It's over for you now." I think it is great. Why does the patient have to live through the debilitating symptom while the causes are worked on? Perhaps a part of the treatment then is getting the patient to leave the dryer at home on weekends, maybe initially curled up on the coffee table, then in the bathroom, etc. while they go to the grocery store or for a jog. It could be a very good first step.
I have a compulsive problem that developed due to an anxious situation I was in. I was taking a nap on the couch, I smelled burning and assumed it was someone in my neighborhood grilling, which was common. I woke up to an apartment filled with smoke, my place was on fire. It was small, I was able to get out the front door (which is where the fire was) and call the fire department, they came and put it out, minimal damage, no loss of life. But still, since then, if I smelled wood burning, even though I know it's probably someone grilling or with a fire in the fireplace I go outside and look around just to be sure. It is irrational and I know while I'm doing it. What helped me was living in a place where some neighbor or other burns wood almost daily. I still get a tinge of "but what if that's not what it is this time" every time I smell it, but I don't compulsively check anymore.
Also for a lot of people these mental illnesses cannot be cured, only managed. I'd think finding simple solutions to reduce compulsive anxiety are more sustainable than long term drug use.
When monitored, sure. The approach I would guess an OCD specialist would use (I’m not one, so this is only a guess) is to have the patient dry their hair, leave the bathroom, and wait as long as they can bear without checking to make sure they turned it off. Then, some time later, have them do it again, and try to wait longer. Repeat until they can go to work without worrying. Letting them take the hairdryer with them until they can do without it seems like a good addition to ensure they can get through the rest of the day.
Also having OCD, I can see how this would be helpful though. You can fall into a stable position where you're doing enough to keep the OCD at bay (taking the hairdryer with you) without it being something that interferes with your life. I don't think it's an _ideal_ long-term solution, as the OCD can latch onto something else, but as a starting point for ERP (leaving the hairdryer at home on shorter trips) or if other solutions have been tried and failed, I can see it being useful.
Did you consider that the OCD could get worse due to the negative effects of the OCD, e.g., bad performance in the job or problems with the patient's relationships to friends and family? If such a feedback loop exists, breaking it can be part of the cure, no?
Breaking the cycle is important, no doubt. The issue I take is the quote makes it seem like all they had to do was carry the hair dryer with them. There’s so much more that needs to be done.
Don’t let the perfect be the enemy of the good. It may not be the final solution but it improves the life of the person.
I would have more sympathy with the other doctors if they actually had a solution for OCD but they don’t. So somebody who has no fix for the problem is criticizing someone who fixes a part of the problem.
Many are missing the point, this is a story about transgender rights, not about psychologist knowledge.
The original article, linked in the post, starts with:
“I’ve made this argument before and gotten a reply something like this:
Transgender is a psychiatric disorder. When people have psychiatric disorders, certainly it’s right to sympathize and feel sorry for them and want to help them. But the way we try to help them is by treating their disorder, not by indulging them in their delusion.”
And then goes to explain the "Hair Dryer Incident" as a counter point.
I saw you were downvoted, and went and read the rest of the post to read the transgender argument. It’s a great read, the longer article is well worth perusing. I upvoted you for that.
The article’s thesis, though, is about how humans get stuck categorizing things, in ways that get canonized, and then have a hard time understanding that there are different legitimate ways to categorize. Transgender was just one example, the Hair Dryer incident another, and among them the whale-fish, and Israel vs Palestine. I love the way he framed transgender rights, and the Napoleon example is hilarious, but I wouldn’t say the story is primarily about trans rights rather than psychologist knowledge. If anything, it’s specifically showing some of the reasons why DSM 5 is so dramatically different from DSM 4, right?
Seriously, I wasn't even through the second paragraph before I thought the same thing - just take the thing with you. It doesn't try to solve the OCD, but it solves the problem.
Nobody in my household has OCD, but we had a garage door that sometimes, unpredictably, would decide that there was an obstruction at the very bottom, and go back up. Did you really, really watch it go all the way down before driving off? Did you?
Engineer's solution rather than psychiatrist's - simply rig something that lets you check over the internet and close the door (but not open it!) if necessary. I've since debugged the garage door too.
I had a gather like that, for like half an hour the sun would shine on the sensor and it wouldn't close. Fixed with a toilet paper role over the sensor to avoid the glare. In my current house I have homeassistant and a sensor so I can check if it's closed/auto close after ~10 minutes (I'd set it to 5 but that was too aggressive).
In my case the rails were misadjusted so the door would contact the frame before it was all the way down. The friction would sometimes, just sometimes, trigger the overtorque sensor, but only when the door was about an inch or two from the bottom. Fixed by adjusting the rails.
I had a garage door problem with the sun too. I tried the toilet paper roll trick, but it was only partially effective. Finally had to replace the sensor.
> Engineer's solution rather than psychiatrist's - simply rig something that lets you check over the internet and close the door (but not open it!) if necessary.
Wouldn't necessarily work for OCD, as the obsession can easily morph into "Did the sensor fail?" I can see it being helpful though.
Live feed camera with a timestamp turned on then? :) Could double as a security cam for the car when it's in the garage...
The real fun one is if you need to stare at the latch as well, just in case it looked closed, but wasn't...
That said, this particular story has been repeated a bunch, or at least I've heard it before but I can't quite remember where. I'd be interested if anyone's found a proper source for it, but not quite interested enough to go hunting myself. :)
I think a lot of smart home gadgets are stupid, but we had to get a new garage door opener and all the decent ones are smart. It's amazing. My opener sends me a notif on my phone if it's been open for 10 mins and I can close it remotely.
I've been looking at circuit breaker level power monitors, and one of uses that seems interesting is the ability to see if your oven is drawing power. Some systems allow you to enable geofencing and trigger a push notification if your phone leaves the home wifi range wile the oven is on.
Same here. The solution was immediately obvious. I'm amazed that she actually got as far as talking to a psychiatrist, unless I suppose she was so ashamed of the problem that she had never told anyone about it before.
The idea that the entire psychiatric community wouldn't be completely on the side of the author is one of the reasons that I have such little faith in their field.
The reason being is that the underlying condition could always be worked on after first taking the small, practical steps to dramatically reduce the impact of the problem.
I have personally experienced situations like this and it was so frustrating until I realised that I had to take personal responsibility, because help wasn't coming from within the system.
The impact isn't the same, but I've been guilty of doing exactly the same thing with software bugs. "Sure, we could just do this little workaround and get you back up and running, but there's a reason for this and we would be better off in the long run investing in a real fix."
I do have a limit, at least, after which I'll go for the quick fix and then try to follow up with a broader investigation. Depends on how severe the issue is, too.
Ah yeah, don't get me started on my things - I can't stand anything but inbox zero, I can't stand having anything in Trash (whether desktop or mailbox), luckily this is related only to computer and my smartphone and doesn't affect my daily life.
Doctors are just tech support for the human body. They listen to your complaint and offer up their best guess diagnosis based on what's helped previous customers with the same symptoms, but they have limited information on the system they support, the documentation is spotty and sometimes contradictory, there's a ton of bugs, and they have no escalation path because the engineer who designed the system quit ages ago and left no contact info.
I have been misdiagnosed so many times for health issues, I feel like doctors need to specialize within domains and they are only allowed to practice within that domain. So much advice given out by general practitioners is useless and only treats symptoms of health conditions. It literally took me 4 years to figure out a health issue as a bounced from doctor to doctor as they all scratched their head. Some doctors even made incorrect diagnoses which lead to treatment which was actively harmful to my condition, it would have been better to not see those doctors at all since they set back my recovery by months.
We dont let electrical engineers build bridges so why do we give doctors so much freedom in their practice?
In my experience most doctors are pretty useless trying to solve a difficult problem. I had my daughter's colon biopsied before someone suggested using a hypoallergenic formula.
Variation from doctor to doctor is also wild the reactions you get out of people. Our daughter had a dairy allergy and we had observed after cutting it out her getting better. Our original pediatrician basically had the attitude of "well since you self-diagnosed this and it wasn't officially by me I'm going to largely ignore it and proceed as normal."
We switched pediatricians and the difference was amazing. The response was "I have listed to all that you have said and I agree with your assessment that she has an issue with dairy. Here are some options for her diet going forward". The difference between fighting a battle to feel heard versus feeling like someone is on your team solving a problem is incredible.
Doctor 1: "Kids have all kinds of stomach problems all the time. The parents always say it's dairy or gluten. The parents don't know anything, so I'm going to ignore them."
Doctor 2: "Kids have all kinds of stomach problems all the time. The parents always say it's dairy or gluten. This is probably going to go away on its own, but the parents will keep insisting I do some thing until it does. I will tell them they are on the right track and send them off. "
Doctors have to play a whole metagame beyond just trying to figure out what might be causing the symptoms their patients are presenting with.
I really detest this idea that blatant manipulation is necessary from people we are supposed to be able trust. How about this instead, where the doctor provides information and a plan of action instead of manipulation:
Doctor 3: "Stomach problems are common, they may or may not be caused by the most popular triggers, and they might go away on their own by coincidence. Here's the decision tree we can follow, which will let us know if we need to do more..."
Plenty of doctors do explain all of this, but people hear what they want: did the doc affirm or contest my theory? Did they "do anything"? (recommend surgery, prescription, diet, etc)
> In my experience most doctors are pretty useless trying to solve a difficult problem
This applies to nearly every profession. Most people are average at their jobs and most people aren't that great at consistently solving the harder (or hardest) problems their job presents.
It's as true for doctors as it is software developers or truck drivers or teachers.
That's why they should do triage. If they can't figure out the problem, at least be able to refer a person to someone they think can. If they're not willing to do that then they're probably more interested in their own practice (can make more money by fumbling around) than helping patients.
I have a great deal of respect for someone who says "I can't help you, but that person over there can" and turns out to be right. I'd gladly try them again with a different problem.
It's hard to imagine anything that a GP can help you with if you're an adult with Google, other than giving you the prescriptions you know you need. They and anyone involved in sports medicine are about as good as WebMD if not worse. Internal medicine specialists and such are still useful though.
But if you dramatically improve the patient's life right now, it will probably be a lot easier to treat the underlying problem, without the added worries of stress and a failing career.
A friend told me a story similar to this where a psychologist helped a patient with their taxes and credit card debt, the patient was immediately more functional as a result.
The crux of it being that academically this is the "wrong" solution because the textbook and journals don't cite it as a valid one. But a medical professional's job is to not only treat symptoms, but to treat the underlying problems as a person. This was the right solution for this particular person. Yes, it doesn't scale, but neither does perfect medical care in general. There is a difference between "triage" and "care".
This is a great story. I know its not related but I can't help but feel a sort of analogy to engineering work: the tension between idealism and pragmatism.
At a previous company our build times for a game client were around 5 minutes or so. Our tools team had planned some work to get this down but it kept getting pushed out. The tools weren't part of the client so I'm not sure they know how bad this was. Anyways, one of the tools engineers rigged up a solution in a day or so that got this down to a minute. Unfortunately it wasn't the nice, perfect, planned solution that kept getting pushed out so they were reprimanded by some manager. Fortunately, more were on the side of the engineer than the manager. To my knowledge they never did end up implementing the planned solution.
I’m a big fan of these kinds of improvements. They can be a bit dangerous politically though. 5 minutes might be something the manager can get traction to implement a fix to get it below 1 minute build times. At 1 minute the manager may never be able to make a political argument to improve.
This may also be why the manager chastised the person fixing this. Such a drastic improvement can completely undermine any efforts to make even bigger fixes, as well as make the manager look foolish that they couldn’t make these improvements already.
I tend to believe the perfect is the enemy of good, but I’ve certainly worked in some orgs where I might take an improvement like this to the main champion of the problem first and ask if it’s a useful solution. I might even be willing to shelf the solution if I can be convinced it’s not in the long term best interest of the org. If I’m not, though, I’d likely become a champion of this short term pain relief knowing that things may not ever have much chance to get much better.
It's totally related. There's the old urban myth about the "NASA Pen,"[0] which is a favorite of tech people (It isn't actually true, but it's a great story).
I have a similar apocryphal story that I use in design. I write about it here[1].
> For many years, I have heard stories about some architect – they never say who – that once designed an office park/university campus/government center, etc., and deliberately did not add any paved walkways. Instead, it is said he had the buildings completely surrounded by lawns. After a year, he came back, and paved the areas of these lawns worn thin by people taking the most effective routes around the buildings. He did this because he decided at the start of the project, he’d never be able to account for human nature, and it was his goal to serve the folks using the campus as best as he could. The users of his system would let him know, organically, how to “tune” it so it can best serve them.
Also, anyone that is familiar with the Granny Weatherwax character, by Sir Terry Pratchett, may remember that she practiced what was termed "Headology." That was sort of "practical" psychology, and it involved things like giving headless ghosts pumpkins, so they would stop moaning (actually, it was another character that did that -from I Shall Wear Midnight[2], but it was definitely Granny's "Headology").
I believe it was the podcast 99% invisible that had an episode about urban planners driving around after a heavy snow and documenting unofficial paths for later development.
Imagine if the nice perfectly planned solution would have gotten the build time down to 5 seconds and been done next month, but it now never would be implemented because 1 minute was considered good enough.
>> but it now never would be implemented because 1 minute was considered good enough.
By definition it's good enough. The only thing being lost is the stroking of some ego. Our whole world seems to be built with "good enough" and I do find that frustrating at times. People are imperfect and have finite time, so I understand. Evolution seems to think we're good enough for now.
> If one day I open up my own psychiatric practice, I am half-seriously considering using a picture of a hair dryer as the logo, just to let everyone know where I stand on this issue.
I heard/read a similar mental "hack" about folks who fear leaving things "on" when travelling. Take pictures with your phone of all the things just before you leave. They'd be easily available, verifiable evidence that the stove is off, all the doors are closed/locked, furnace set, water shut off, and so on.
FWIW, this is also great advice from an insurance point of view. I went on a 3 month trip and took pictures of all the appliances before leaving--mostly for peace of mind, but also because the building was fairly old and had a history of leaking pipes, faulty outlets, etc.
Sure enough, a month into the trip and my downstairs neighbor has his bathroom ceiling fall in due to a leaky drain pipe in my shower. I had photo proof that the water wasn't on or leaking and the building's insurance policy ended up renovating both of our bathrooms. Came back to a brand new rainfall shower and granite countertops.
That's cheaper than my solution, which was to make the status of the door locks, garage doors, furnace, etc, all verifiable via home automation. And with backups for some of them, like auto-closing garage doors. I used to have a problem where I'd get a half mile from home and have to turn around and verify the garage doors were in fact closed. Never once did I return to find them open. But now I can just pull it up on the phone.
Pictures is a cheaper way of accomplishing that, not a bad idea.
The pictures don’t work with all ocd. Often times I would worry that I did the thing that couldn’t happen (open door, whatever) AFTER the picture. So I’d videotape the situation and myself walking away. It got silly. I really hate this condition.
Just recently went through my phone and spent an hour deleting all the photos I took of appliances, etc. I had taken during the height of my OCD. It must have been hundreds of pictures.
"Is the list I made to know what to take pictures of complete? Did I really take pictures of everything? What about that thing I'm not remembering right now and wasn't on the list but I'm pretty sure I didn't turn it off, either ..."
Sunflower Labs https://www.sunflower-labs.com/ and Ring will have products for you. The latter is only $250 and you can stick a drone at home you can look through.
I think you could also just stick one of the Amazon Echo Shows that has Drop-in or Auto-Answer or whatever (the Google Nests don't, disappointingly).
Reducing the burden of OCD is necessary to get in the frame of mind required to make breaking cycles a habit.
Taking a daily photo of the stove dials with my iPhone helped break the cycle for me and was the first step I took on my long road of (successful!) recovery.
Engineering is filled with "hacks" and workarounds, where the root cause isn't fully understood, if at all. I feel that if, as a profession, there was immense pressure to instead find only root causes to address issues, we'd still be working out the kinks with punch-card systems.
Yeah, it's a really tough balance to strike. I've worked with teams and systems where they were fully happy to apply a hack and move on and it worked great for them. I've also worked with teams who had a terribly bad culture of throwing shit at the wall to see what sticks for fixing weird errors and in the process making problems worse without actually fixing the problem.
Using good judgment to figure out when a hard RCA is necessary and when it's not is key to making forward progress without constantly shooting yourself (or your teammates) in the foot.
As an OCD haver of over 20 years, I find these suggestions to be pretty wonderful. In some of cases, these conditions can't be fixed by therapy, and/or the drugs don't work. Therapy is fantastic, but sometimes these things can be the difference between getting out of bed in the morning & not.
Finding these solutions can be absolute bliss - technology for 'hands-off' switching off things is one for me.
As with everything it's a balance, but if something small helps in a big way, that's a win for me!
I have, at times, pretty bad OCD - If this works and it keeps working, I'm happy for the person. In my experience though, OCD will find something else. The point about the other psychiatrist saying it's absurd is probably because they know, it will about having left her garage door open next. OCD is horrible, and nothing like what most people think; if you want to see the horrors many with the affliction deal with, head over to reddit.com/r/ocd
Seems like a good solution to me if that was the only major issue.
If the underlying cause becomes an issue again, then maybe look at longer term solutions.
I’ve always had an issue with leaving light switches on. So I installed a bunch of home automation stuff. Now my light bulbs turn themselves off when I leave the house and a few turn on when I return. It’s a lot easier than trying to fix the problem of forgetting to flip switches before leaving.
Bringing the hair dryer along can be the best road to treating the OCD, because you can then do the treatment in small steps.
If people can't go swimming because they are afraid of drowning, you don't give them medication and then throw them out in the deep end. Instead you let them take as small steps into water as possible in a way where they feel in control all the time.
Is I was reading the first few sentences, my thought was "why don't they just take the hair dryer with them?" And then I start thinking "well, maybe that's just an outward indicator of the illness and that it would manifest in other ways, maybe they have to treat the underlying whatever, these guys are experts after all if the solution was so simple..."
Then that's exactly what happened. Maybe there are underlying problems. But maybe, and this is a stretch, medicine treats symptoms and not causes. And maybe those problems don't really matter to the people who suffer when something simple can make their lives work for them.
This is a great frickin story. I have pretty severe OCD and I treat myself this way. You basically can't have mercy with your own stupid terrors about objects if you have OCD. Taking the hair drier with you is brilliant.
What the other shrinks should have noticed is that this is taking the power of agency away from the object and returning it to the owner. OCD people like me follow a certain thought process:
1. I need to do this [thing] or [something] bad will happen.
2. Nothing bad happened. I'm not wounded or dead. That was because I did [thing].
3. If I hadn't switched the blender on and off 14 times today before I walked out the house, I might have walked out 30 seconds earlier and been hit by a bus. Therefore even as irrational as it seems, the wasted time on the blender was enough to keep me in the right timeline where I'm still alive and breathing.
4. Therefore whenever I get an irrational impulse to do something that might delay me, I should do it, because that's what keeps me on the timeline where I'm not hit by a bus.
Just because none of this can be cured by someone speaking rationally to you and telling you you're insane, doesn't mean that it can or should be cured by mood-altering chemicals. The only answer for me has been demonstration to myself, i.e., I didn't slam the door six times but I didn't get cancer. etc. However, the biggest motivator was my ex-gf who used to wake up when I was folding my pants over and over, and go, WILL YOU FRIGGIN LAY DOWN?
Last thought here. Drawing connections between what happens and what happened prior is a fine art, and one that's richly rewarded in the right corners of hackerdom. There's no shortage of people who lack the ability to see the most basic cause/effect and are willing to pay you to tease those things out of the data, or out of your ass. I consider OCD to be an asset, not a fault, as long as it can be channeled properly. It may have saved my life. BUT yeah about stupid shit like hair driers, just show people the obvious. Being OCD doesn't mean you're an idiot, and if you swallow the pill that says "I won't die because X" you open more doors to other rational thoughts. OCD is just your brain stuck in an if/then pattern. Several elses may cure a big chunk of it.
Call me a "uneducated layman" but that advice was my very first impulse while reading the pain the patient is going through.
Thankfully in psychiatry there is a push for "treating what is bothering you" against the Freudian "dig for the cause" - often patients are not served at all by the tedious and painful search for cause or roots of an itch, they just need a working remedy.
This story is cute, but my concern for calling it a treatment method is.. what is stopping the OCD from transferring to a new concern?
Surely, it's not about the actual hair dryer. If they suddenly get concerned about leaving the heat on or the lamp plugged in they will quickly run out of room in the car.
The way I see it is that if a server has run out of disk space, I first find the largest file, find the processes with that file open, truncate the file and restart them, and only then do I diagnose how I even ran into disk space issues.
If I don't do that, I might lose uptime. This gives me head room.
You're right, but it could be enough of a workaround to help this person in the short-term to be able to spend the time long-term to better address the problem. For example, if they're completely distracted 10 minutes into therapy because the hair dryer might be on, it's going to be pretty difficult to actually engage.
I think a similar case I read somewhere was a case where someone was having trouble showering because they had body image issues and they didn't want to see their naked body in the shower. Therapist had a simple solution: "Try showering without lights on."
That's amazing. Before I finished reading the article I thought one solution could be to throw the hair dryer away, and just use a towel or something(not ideal but beats being miserable I guess). But taking the hair dryer with her was way better.
To be honest: It was my first thought as well to just tell her to take the hair dryer with her to give her the peace of mind after reading halfway through the text.
Anyone who has experienced some sort of compulsory disorder would understand that.
This is very much paralleled with non-techies solving techie problems eloquently.
A few weeks ago there was a story in a company where the financial department used pretty old computers that didn't run anyone else's software. They were the only ones that could use it.
When asked, they said they were tired of the programmers mucking around with their machines so they just didn't use anything they knew.
A knee jerk techie solution would probably be password login systems with someone holding the "keys" to it. Maybe some kind of other procedures. Or just do the above!
If she suffered from an obsessive compulsion to review her case-notes in her head all waking hours, which made her into a better lawyer, we'd never even hear of this.
Other useful forms of this "insanity" may be seen in engineers, scientists, writers...
So UTILITY is definitely already the basis for any further judgment or antidote. We can say that.
So taking the hairdryer with you is already entirely appropriate.
An ideal of sanity is not our aim here. Never was. Never should be (unless that's your own personal thing).
I was puzzled by the responses of therapists finding out about this. I guess as an engineer I’m always thinking of a quick practical solution. I would set up a camera where the dryer is. Taking the dryer itself is of course much better and simpler. What I find absolutely dumb is to skip these immediate remedies and instead trying to medicate someone off the bat.
It’s like prescribing a healthy exercise regime for someone who’s having a heart attack.
I agree that its a great solution and in a way it is consistent with any other long term medical condition so I don't understand the outrage.
You can try and try and try to treat the underlying medical condition. But at some point if it doesn't work you stop trying to treat the underlying medical condition and instead treat symptoms to make the patients quality of life as good as you can while living with the issue.
Sometimes worry that I did not press the button on the remote to close them when I left home so I would drive pass my home again after dropping off the kids at school.
Fortunately distance to school/home/freeway to work is within a few minutes of each other.
Later installed an IP camera - told the wife it was for home security and not monitoring the garage doors.
I think this was triggered when I came home one day and the garage door was open - suspect it was due to somebody using the same channel as me for theirs or I really forgot to close it.
Replaced it with a rolling code controller board as a precaution to eliminate one possible cause.
While reading, I was thinking about telling her to get rid of the hairdryer, but bringing it with you is way smarter. If there was no hairdryer to worry about the mind would likely search for something new to obsess over.
You're either solving problems, or you're jerking off. In this particular case, for this particular problem, the intervention solved the problem. Nothing left to discuss.
I actually have a triple buffered solution for this on my stove and water pump in the summer house (which has dodgy electric wiring and home made plumbing):
1) Manual switch with a light when on.
2) Timer (runs max 60 minutes, makes some clicking noise when on)
3) Remote switch that I can turn off with my mobile phone from anywhere.
That way if I forget to manually switch things off, I can turn the remote switch off and if that fails the stove and pump are powered maximum 60 minutes = wont burn the house down or flood it too much hopefully.
In a future without insurance this is the only way to have a modern life without bringing the pump and stove with you! Xo
By the way I don't think she had OCD, I think everyone else is reckless.
This quote is from a longer article. The specific comparison made there is how we relate to transgender people.
> Imagine if we could give depressed people a much higher quality of life merely by giving them cheap natural hormones. I don’t think there’s a psychiatrist in the world who wouldn’t celebrate that as one of the biggest mental health advances in a generation. Imagine if we could ameliorate schizophrenia with one safe simple surgery, just snip snip you’re not schizophrenic anymore. Pretty sure that would win all of the Nobel prizes. Imagine that we could make a serious dent in bipolar disorder just by calling people different pronouns. I’m pretty sure the entire mental health field would join together in bludgeoning anybody who refused to do that. We would bludgeon them over the head with big books about the side effects of lithium.
This story sounds like it should be posted in the subreddit "and everyone clapped." Any therapist worth their salt would consider both practical solutions as well as treatment of the underlying cause. If your depression were triggered by job loss, they'd urge you to look for another job as well as figure out how to prevent/treat the depression itself. I'm skeptical that the other psychiatrists thought the practical portion of this treatment was scandalous.
The only reason the other psychiatrists may have objected to his 'treatment' is if the psychiatrist who recommended this solution considered the problem solved after just applying the practical solution. The OCD is likely to find another way into this person's life, whether it's checking lights or the stove or something else. It's a pathology and pathologies don't typically resolve themselves by making a minor life change.
Totally did backtrack unreasonable distances just to check if I had closed the door.
It's all fine when it's my door. Worst case scenario, I get robbed.
However it's more of a problem when it's someone else's door. Worst case scenario, they get robbed, and that's a different story. Or pets get out...
Obviously I can't take the door on my front seat... So my solution is to take a picture of me trying to open the door, a kind of proof that it's closed.
And, would you know it, it works! When I get anxious, I pull out my phone and look at the pictures.
It's getting better, actually. I believe I'm fixing it slowly. Good riddance!