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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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."
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.
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.
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.
> 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. :)
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.
> 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.
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.
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".
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?
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.
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.
"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).
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.
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.
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.
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.
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
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.
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?
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!
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.”
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, 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".
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.
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.
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?
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.
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.
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.
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"
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.
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").
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.
> 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.
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).
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.
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 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?
> 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.
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.
> 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.
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".
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.
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.
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.
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
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.
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.
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
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.
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.
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[ 3.8 ms ] story [ 157 ms ] threadIf 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.
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.
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 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").
[0] https://www.scientificamerican.com/article/fact-or-fiction-n...
[1] https://littlegreenviper.com/miscellany/the-road-most-travel...
[2] https://www.studynovels.com/Page/Story?bookId=27327&pageNo=6...
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.
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.
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.
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.
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 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..."
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.
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.
What do they call a person who goes to med school and graduates at the bottom of their class? "Doctor".
We dont let electrical engineers build bridges so why do we give doctors so much freedom in their practice?
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.
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.
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.
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.
Haven't worried since
Wouldn't necessarily work for OCD, as the obsession can easily morph into "Did the sensor fail?" I can see it being helpful though.
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. :)
He didn't, as it turns out. https://lorienpsych.com/
Found the story: https://www.madinamerica.com/2013/11/living-one-r-d-laings-p...
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".
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.
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?
Pictures is a cheaper way of accomplishing that, not a bad idea.
"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 ..."
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).
Is the Amazon home drone a real product, or was that just a CGI demo?
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.
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.
1. https://en.wikipedia.org/wiki/Slate_Star_Codex
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.
It's so interesting how many weird states our brains can get into like that.
Congrats on kicking the habit though!
It's even better when the sorted letters turn out to make any sort of repetitive pattern.
And I count stairs, unless I specifically override the internal voice and say "1", "1", "1", "1,".... to myself.
‘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
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.
“Then one day it just went away completely. It's a strange thing to try and explain it to someone.”
Fixed that in my mind as usual.
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.
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."
Wouldn't this just tell us that these categories are completely meaningless?
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 just shorthand for "this is something we'd like to fix".
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 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.
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?
[1] https://slatestarcodex.com/2014/11/21/the-categories-were-ma...
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.
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:
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?
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.’
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.
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.
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.
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"
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.
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.
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.
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.
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").
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.
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.
Regardless, this idea that one needs to "keep up", as if work were a competitive footrace, is something you have invented.
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.
(I'm not a doctor, this is not medical advice)
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.
I was euphoric off the first 15.
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.
ADHD meds for non-ADHD students don't really help those students perform better academically. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/
They make you feel better, but not actually perform notably better.
> 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.
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.
are all acronyms, right?
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.
> 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.
From: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
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.
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.
Those same doctors are probably perfectly fine with handing out methadone prescriptions to addicts.
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.
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.
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.
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.
"Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence."
Source: https://www.psychiatry.org/patients-families/addiction/what-...
Most organizations that deal with addiction now operate using a similar definition.
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.
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.
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.
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
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.
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.