Monday, May 02, 2005

Analysis paralysis

While many of you may have wondered if perhaps I was just a little bit crazy sometimes, most of you don't know that back in my junior year of high school, I was diagnosed with obsessive-compulsive disorder, or OCD. I had been experiencing stomach cramps for several months, my 'regular' doctor had run every test imaginable it seems, and found nothing physically wrong with me. He referred me to a psychiatrist (or perhaps a psychologist, I can never remember the difference), who spent a few hours poking around in my head, and promptly told me I had a mild form of OCD. My stomach was cramping up all the time because I was worrying too much.

For those of you unfamiliar with OCD, it's basically a chemical imbalance in the brain that causes obsessions (recurrent disgusting or frightening thoughts) and/or compulsions (behaviors that a person knows make no sense but feels compelled to do anyway). Obsessive thoughts are usually senseless and repugnant, such as repetitive thoughts of violence, contamination, or doubt. The more you try to control them, the more powerful they become. Compulsions are the actions a person takes to deal with obsessive thoughts, such as hand washing, counting, checking, and touching, and are usually performed according to strict rules, in a very rigid manner. Doctors estimate it affects roughly 2 to 4 million people in the United States. Comedian Howie Mandel has OCD, although I think most people figured he was crazy anyway. If you're familiar with Howard Hughes, or have seen the recent movie about him, "The Aviator", you likely know that most doctors believe he had an extreme case of OCD (it wasn't a known disorder in his time). Jack Nicholson displayed classic OCD behavior in the movie "As Good As It Gets". In some ways OCD is more of a category of disorders. People with eating disorders, road rage, and even chronic pain are sometimes told they have OCD.

Although I wasn't diagnosed until I was 16, in retrospect I believe it's been with me all my life. I can distinctly recall my 2nd grade teacher calling me a 'worry-wart'. I used to hound her about everything. And I very much remember playing mental games with myself while driving on the highway with mom and dad (back in the day when a kid could still ride in the front seat). I would try to tap my toes in between the lines on the road, and was convinced that if I didn't do it perfectly, the devil would appear and take me away. With the stomach cramps, I was absolutely certain that I had cancer. When a friend told me about his ordeal with Lyme disease, I was afraid to leave the fairway on a golf course for years, convinced that if I entered the rough, I was doomed. Untold numbers of golf balls were lost (if you've seen me golf, you might estimate in the thousands).

Obsessive thoughts are by far the worst for me, and usually focus on the fear of sickness. Essentially my OCD manifests itself as hypochondria. Of course most people have an aversion toward getting sick. It's a very rational fear. But like a hypochondriac, the problem for me is that I take the fear to an irrational level, well beyond the boundaries of normal thinking. I may not show it outwardly, but inside I'm a wreck. For the most part I can function in the outside world, but I've had many days where I simply could not leave the house (not quite in Howard Hughes style, where he was known to stay locked away alone, naked and trembling, for months at a time). I end up convinced that I'm going to get some horrible disease, but that maybe, just maybe, if I worry about it enough, somehow that will prevent it from actually happening. Oh can't you just taste the irony? With all the worrying I've done over the years, I never got hung up on ALS. Damn the luck.

The root cause for most of my obsessive thinking is that I have trouble shifting from one thought to another. My mind will be racing, but the gear-shift in my brain, the transmission, gets stuck. The same thought repeats itself over and over and over. And over. I get bogged down in negative thoughts, trying to figure out what do to, how to make it go away, but it only gets worse. Like quicksand. Many people like to call it 'analysis paralysis'. Sometimes I can't even decide what to order for lunch. Pretty soon my brain will start to redline, the transmission seizes up, and I just have to shutdown for awhile. Dump the cache. Reboot. And start over again.

I do have a few compulsive behaviors I guess. I used to constantly check myself for deer ticks after being outside. I've probably gone to the doctor to be reassured more often than most people. I wash my hands constantly. No offense to anyone, but I hate shaking hands. A horrible custom in my mind. I get convinced that I've got something on my hands, and I cannot sit still or move on until I've sanitized them. Public restrooms? A nightmare. Next time you're walking out of one, take a look behind the door. You'll most likely see a paper towel on the ground. Might just have been from me, using it to open the door. But I know I'm not the only one. A friend of mine admitted he was a closet 'dropper'. I've noticed that many places have caught on and starting putting the garbage can closer to the door.

At this point you might be saying to yourself, "should I call the loony bin on this guy or what?" Trust me, I'm already on their list. Well, not really. Instead of locking me up, they did what most doctors advise their patients to do: drugs! Yesiree, I've been doing drugs since I was a teenager. Zoloft to be exact. I tried a bit of Prozac back in the day, but it made me want to just sit around all day and eat paste. Or maybe that was the kid who sat behind me in 2nd grade, I'm not really sure anymore. The point is, the drugs help me maintain a sense of equilibrium. The scary thoughts don't go away completely, but I can control them better. Zoloft is like fresh transmission fluid, allowing my brain to shift gears more smoothly. Most of the things I've mentioned above are 90% contained with it. A few moments of panic here and there, but much more in the realm of the sane. As sane (or not?) as the average Joe anyway. Sometimes I think the drug overcompensates a bit, to the point where I have a hard time focusing. My brain shifts too quickly so I end up feeling scatterbrained. Another downside is that while the drugs keep my lows from getting too low, they also keep my highs from getting as high as they otherwise might. Sometimes I know I should be really excited or happy about something, but I'm just not. Can be very frustrating. The pills affect my sleep as well, and make me dog-tired in the afternoon.

Last summer I was talking to my doctor about weaning myself off the drug, perhaps by learning behavioral techniques to compensate. I've read a great deal about various approaches such as taking a break, distracting myself, and coming back to the thought later. My favorite is called "killing ANT's", wherein you consciously try to capture and stomp out automatic negative thoughts. But of course along came ALS, an event that was like a tidal wave, completely wiping out the defenses I had built up, drugs and all. I'm recovered for the most part, but I'll be taking Zoloft for the foreseeable future. And that's ok. I've realized that having learned how to deal with OCD has really prepared me for dealing with ALS. I can control my reactions to negative thinking much better than I likely would have without it.

In some ways, OCD is no different than what people think of as a 'normal' physical disability. It's always there with me, and I have to deal with it, but it's not who I am. Because in many ways the positive aspects of who I am are rooted in the same thought patterns involved with OCD. I'm very good at analyzing problems, looking at a million different sides to it, and coming up with solutions. And I play the role of devil's advocate very well (too well sometimes, by automatically saying 'No' to a new idea). I consistently get high marks for 'attention to detail' at work. While sometimes I tend to be a little too perfectionistic with some things (not everything of course, Kirsten would never let me get away with that one), once I get hold of a task, it's gonna get done, and done well. Sometimes I tend to avoid tasks that I know can't be completed right away, because I know I'll get too wrapped up in it and not be able to set it aside. But hey, everybody procrastinates once in awhile.

So why do I tell you all of this? To be honest, I'm not really sure. It certainly isn't to make you feel bad for me. I've had all the pity I can handle. I think perhaps it's to try and give those of you who have dealt with my goofy behavior a bit more background. To just share and be open and honest about it. I'm certainly not embarrassed about having OCD, but I very much want to apologize to those who've put up with my craziness. And to say thank you for being so patient. So if you see me just sitting around, looking thoughtful, perhaps shy, and not all too engaged in the conversation, it's possible I'm just killing a few ANT's, and trying to get my thoughts back in gear.

I used to think that even if OCD was a lifelong struggle for me, I'd be happy as pie if it was more or less the worst of my problems. But now that I have ALS, I'm thinking perhaps I need another malady to round things out a bit. Something with another TLA (three letter acronym). I've got dis-order and dis-ease. Maybe a little dis-temper to help keep my angry thoughts in check? Whatever. Just something else to keep my body so busy trying to figure out what's going on, that it can't let the ALS and OCD do any more damage. Who knows. Maybe I'm just SOL.


kent rockwell said...

Scott, I've read all your blogs but have been loathe to make a comment until now. Your writing is uplifting, candid and rather awe-inspiring for someone in your predicament. I will be offically diagnosed with sALS on July 11th, 2006--Doomsday. The symptoms have been mounting and present for about a 1.5 yrs.(if we put off the dx. does that mean our 2-5 yrs. starts that much later?). ALS is such an insidious disease one does not realize what is is happening until the monster is firmly entrenched (I understand you must loose 80% of a motor unit before weakness is detectable), but in my case I was found to have hyperreflexia (deep tendon) a year ago and then 7 months later developed the dreaded fasciculations. I was really hoping for BFS--Benign Fasciculation Syndrome, but too many other defecits existed or came to the fore later. I realize I'm not an official PALS until final pronouncement by an "expert" neurologist( the first one I saw couldn't push my arms and legs down and pronounced me ALS-free...a Phoenix University grad no doubt) a battery of obligatory tests have been performed, but since bulbar symptoms have come into the picture I realize there is no other possibility.
Anywho ...
I share another malady besides le maladie de Charcot. Could our OCD be a link to ALS? The constant stress on the immune system/CNS or the peculiar "wiring" of a brain/CNS succeptible to a condition like OCD may give rise to being more predisposed to a debilitating neurological disease. I don't know, just a lot of nervous conjecture on my part. I'm sure you've seen the study that have scientists reviewing a link between soccer players and sALS. You are a very lucky to have a wonderful wife, family(cute kid), friends to help lift you over the duldrums that are de rigeur when living with a terminal illness. Thank you so much for the work you do in raising awareness to this awfully perplexing and dispiriting disease that most others would as soon forget because of its overwhelmingly frightening, and insurmountable nature. I hope the emotional lability from bulbar hasn't tainted this blog too much. Bulbar...rhymes too easily with vulgar. Where do they find such ominous sounding terms? Are you doing a regimen of vitamins, anti-oxidants, herbs like Steve Shakel has suggested? Did Jaimie Heywood or ALSTDF recommend any one treatment over another? I'm also trying to get a copy of So Much So Fast, but it doesn't seem to be available currently. Well, stay strong and post some more good stuff soon.
Kent Rockwell/36yrs./Riverside, CA

Cat said...

Hi Scott,I have had ocd for three years,although i havent been medically diagnosed,i have all the symptoms and have a background working in mental health,so im pretty sure i have it.I have also been told i have it by an experienced therapist,who supervised me in my work as a counsellor last year.
Sorry,one of my compulsions is to explain myself in minute detail so i do tend to get carried away...
Anyway,i read your blog and i greatly admire your strength and courage.My ocd started as a result of a trauma i experienced three years ago,although looking back i did have some obsessive tendencies as a child (although they werent enough to impact my life much then).My dilemma is that yesterday i went to see a psychologist who assessed me.He said that i have ocd 'in there somewhere',along with issues of identity (?) and self esteem issues etc.I felt that he didnt really understand my ocd,as it is intrusive thoughts about men,ie 'hes attractive' etc repeatedly in my head,along with extreme anxiety and hours of ruminating on what they mean and trying to 'work them out',and compulsions such as checking my body to see what feelings i had 'down there'.
I think that because i told him about my past,which including bad relationships with men when i was 18 (im now 30 and a gay woman),he was a bit stunned by it all.He said i was 'complex',i have no idea what exactly he meant by that.By the end of the assessment he told me that he didnt believe that sexuality obsession (called in america HOCD) exists.I was quite upset as i have something called bocd which is obsessive bisexual fears,even though i know im gay and have been happy with that for the last ten years.Ive managed to help myself to mostly recover from my obsession using cbt techniques and exposure therapy ive done on myself.I now dont get much anxiety with the thoughts as ive learnt to ignore them etc.But after the meeting yesterday i was so upset as i didnt feel believed,which was why i went for the assessment,to see if a therapist could give me any guidance on my recovery.
Ive now got to go back in three weeks for the rest of my assessment,but am not looking forward to it.I dont know if its my ocd making me assume what hes thinking,i mean he didnt actually say i didnt have ocd,but he did say that people with ocd always had it from childhood.And when i told him i did have obsessive tendencies as a child,he said yes but he didnt believe they interferred with my daily functioning (which they didnt).But i am part of an internet forum for people with my type of ocd,and most of them only got it in early adulthood or teenage years.It affected my confidence seeing this man,and made me wonder why i ever went for help.Did your therapist diagnose you with ocd straight away? Im wondering if this guy i saw knew much about ocd,from what he said,although i do think he is able to refer me onto someone else.I feel so let down by these so called 'professionals'.Anyway,id love it if you could advise me on that or anything else about ocd if you have the time,but if not then i wish you all the best in your recovery,its sounds like your nearly there!! take care,Catx

Cat said...

I also have perfectionistic tendencies and have been known to forget to eat as im so absorbed in completing a task!! I do everything 110 per cent.You said you have highs and lows,do i have bipolar in any way? I also have highs and lows,although theyre under my control now.