Comments on: Jake Gyllenhaal's pudendal face

Jake Gyllenhaal's pudendal face

mippy — Sat, 31 Aug 2013 04:17:36 -0800

"And so went the next seven years of my life, or my "life", I should say. Because when the pure O exploded, my life grew inverted commas and flew away. All that was left was an effigy of a young woman and a neon pink MySpace profile." What it's like to live with pure-OCD.

By: dng

dng — Sat, 31 Aug 2013 04:34:55 -0800

I'd always assumed this was just how brains worked.

By: howfar

howfar — Sat, 31 Aug 2013 04:41:20 -0800

I'd always assumed this was just how brains worked. Seems a bit like reading an account of clinical depression and saying "Oh, come on, everyone gets sad".

By: rebent

rebent — Sat, 31 Aug 2013 04:58:38 -0800

well its no surprise to me that CBT and exposure therapy are, according to wikipedia, the most effective treatments. I wonder why they call it "Primarily Obsessional OCD" instead of just "Obsessive Disorder"?

By: Ghidorah

Ghidorah — Sat, 31 Aug 2013 05:11:57 -0800

Howfar, I don't think that's what dng meant. If they're anything like me, it might have been a comment like the one I'm about to make: I had no idea other people had the same thing going through their heads. I pretty much thought it was just me, and that, since the thoughts and urges we're so antithetical to who I imagine myself to be, that deep down I was some sort of monster, and that I'd damn well better keep this stuff inside and not talk about it, unless everyone else found out how awful I am inside.

By: howfar

howfar — Sat, 31 Aug 2013 05:27:21 -0800

Ghidorah, possibly, but I think it's also possibly the opposite of your point. The reason I responded as I did is that it is, to some extent, true to say that all brains work like this, insofar as these kinds of experiences are common to all brains. We all suffer doubts raised by perverse thoughts to greater or lesser extents, and we all experience confusion about our social and moral identities, but there is still a broad gap between that range of experience and the pathological. Similarly, while we all experience sadness, malaise, anhedonia and other characteristics of depression, that doesn't mean that we all actually experience depression. Perhaps your experience is pathological. I suppose that is ultimately, a question that only you, in the context of whatever medical help you might choose, can determine. I'm just as wary of pathologising the range of human experience as I am of normalising neurological behaviours that people experience as pathological. It's a fraught area, and one where we do have to tread quite carefully, I think.

By: Mezentian

Mezentian — Sat, 31 Aug 2013 06:38:52 -0800

If a boy was suddenly seized by repetitive thoughts about shagging his sister with, say, the narrow end of an avocado, would he automatically assume he had a neurotic disorder? Before I went into the link I was on the side of "I'd always assumed this was just how brains worked", and now I suspect I am saner than I realised. I've had flashes of this and that, I assume many people so, but paedophilia? The sort of thing mentioned in the article? Anything? That regularly? I dodged a bullet there. And that was a really hard article to read.

By: LogicalDash

LogicalDash — Sat, 31 Aug 2013 06:46:32 -0800

I was vaguely disappointed that the article implied over and over that the foundational cause of OCD, of the anxieties that prompt the obsession, is the belief that True Identity is a real thing that exists; but never quite acknowledged the possibility of seeing yourself as a social fiction.

By: spitbull

spitbull — Sat, 31 Aug 2013 07:37:57 -0800

Pure O. It sounds so serious. I'm sure it requires special accommodation.

By: DirtyOldTown

DirtyOldTown — Sat, 31 Aug 2013 07:50:28 -0800

This is Saturday and a nice day and it would be cool if we didn't necessarily have to spend the bulk of this entire thread arguing about whether this condition exists or not.

By: Mezentian

Mezentian — Sat, 31 Aug 2013 07:58:10 -0800

Whilst I am pretty sure it exists (as described herein or not), is there some sort of more reliable source than the Big G? Yes, apparently. Sexuality: including recurrent doubt over one's sexual orientation (also called HOCD or "homosexual OCD"). People with this theme display a very different set of symptoms than those actually experiencing an actual crisis in sexuality. One major difference is that people who have HOCD report being attracted sexually towards the opposite sex prior to the onset of HOCD, while homosexual people whether in the closet or repressed have always had such same sex attractions for lifelong. The question "Am I gay" takes on a pathological form. Many people with this type of obsession are in healthy and fulfilling romantic relationships, either with members of the opposite sex, or the same sex (in which case their fear would be "Am I straight?") Man, and I thought life was tough before.

By: Alonzo T. Calm

Alonzo T. Calm — Sat, 31 Aug 2013 07:59:49 -0800

How come she published this under a pseudonym but then allowed three pictures of herself to be shown? Or is that an actress representing the author? I'm not being snarky or anything, just genuinely curious what the deal with the pics is. This condition sounds as if it would be quite debilitating. I've had enough unwanted thoughts and images enter my head with occasional persistence to understand that if this were to happen constantly and chronically I would have a difficult time functioning among other real people in the world.

By: DirtyOldTown

DirtyOldTown — Sat, 31 Aug 2013 08:02:47 -0800

By: Mezentian

Mezentian — Sat, 31 Aug 2013 08:03:19 -0800

I'm not being snarky or anything, just genuinely curious what the deal with the pics is. Since she can be easily linked to Lonely Planet, Melbourne, among other highly specific details, I'd guess I could out her in about 30 minutes if I cared to (I don't), but I reckon her pseudonym protects her against casual googling, and her images don't ping in TinEye or GIS. You'd need to know her to know, or care enough to remember tomorrow.

By: Mezentian

Mezentian — Sat, 31 Aug 2013 08:06:32 -0800

This is more than a bit like the intrusive thoughts my partner had during postpartum depression. I'll not enumerate them here or anything, but awful things went through her head nearly constantly for a while, there. I am sure we can guess the sorts of things. I wonder if there is a connection in the brain soup? I have to admit, I find this sort of thing fascinating. But mostly scary. I almost don't want to know, because I know (or suspect) how think the line in between sanity and not-quite-sanity.

By: Tell Me No Lies

Tell Me No Lies — Sat, 31 Aug 2013 08:30:48 -0800

I'm glad she's been able to find some peace. Mental illness sucks.

By: gadge emeritus

gadge emeritus — Sat, 31 Aug 2013 08:44:42 -0800

Reminds me a bit of Unwanted Thoughts Syndrome, which Maria Bamford talks about having on her album of the same name. She talks about some of the same sort of thing - not sexual, but things like walking past a urinal and having a strong and sudden urge to lick it, or then continually dwelling on the idea she might accidentally fall over and end up with her tongue in the urinal. However, unlike how the article's author describes her pure O, it sounds like Unwanted Thoughts Syndrome can respond to being reasoned out.

By: Mezentian

Mezentian — Sat, 31 Aug 2013 09:06:09 -0800

Maria Bamford talks about having on her album of the same name. She talks about some of the same sort of thing - not sexual, but things like walking past a urinal I just ask, why would she think she might encounter a urinal at all?

By: workerant

workerant — Sat, 31 Aug 2013 09:22:40 -0800

I just ask, why would she think she might encounter a urinal at all? I have no particular reason to be in men's rooms (I don't clean them or repair plumbing) but I've been in a room with a urinal probably a couple hundred times in my life. Women's urinals were relatively common when I was younger, plus the urinals found in porta-potties and unisex bathrooms. And, of course, the odd foray into the men's room.

By: rmhsinc

rmhsinc — Sat, 31 Aug 2013 09:26:24 -0800

Logicaldash "I was vaguely disappointed that the article implied over and over that the foundational cause of OCD, of the anxieties that prompt the obsession, is the belief that True Identity is a real thing that exists; but never quite acknowledged the possibility of seeing yourself as a social fiction". I have no idea what you mean. I did not see that in the article. I know a reasonable amount about 'Pure O" as a professional and more than I would like to know as one who has intermittently experienced it. She was bang on in terms of the treatment that is most successful--Some of older the SSRI's at a relatively high dose can also significantly lessen the intensity and duration of O. It is fundamentally a biological/neuro-chemical quirk that responds quite well to appropriate treatment.

By: rmhsinc

rmhsinc — Sat, 31 Aug 2013 09:37:24 -0800

Logicaldass--Should have said "what that means"not "what you mean". Not a comment directed at you but simply not understanding what you said.

By: leibniz

leibniz — Sat, 31 Aug 2013 10:07:28 -0800

I have been reviewing the psychological literature on OCD quite intensively recently while writing a theoretical review. Psychoanalytic approaches currently dominate, but there's good indications that there's a definite neural mechanism for signalling uncertainty/error that is over-active in OCD sufferers. Uncertainty in general gets us to pay attention to our thoughts. If you are getting constant signals of uncertainty, you will be compelled to evaluate your thoughts too much, particularly regarding issues that matter to you the most. Constant checking can understandably lead to active explorations ("what is the worst thing I could do?") that will gravitate towards the kinds of extreme and unfalsifiable worries reported by OCD sufferers. Though we all have extreme thoughts sometimes, OCD sufferers go quite a way beyond this, and checking can never eliminate a thought. There is simply no mechanism that allows us to choose to have 'good' thoughts. Anyway, if we are dealing with an uncertainty/error related neural dysfunction here, no amount of cognitive therapy or anti-anxiety medication is going to eliminate that (though it can ease the symptoms). I am not a doctor, but I recommend that anyone suffering OCD look up riluzole, as detailed in this research paper, which seems to operate on the frontostriatal pathway that is overactive in OCD sufferers. It is even more imperative that you don't take drugs used for treating ADHD- as this could exacerbate the problem (since it manages underactivity in the frontostriatal pathway). ADHD can quite easily get confused with OCD, because both disorders involve 'inappropriate' attentiveness- in the one case due to increased distractability, in the other due to distraction towards one's obsessions.

By: rmhsinc

rmhsinc — Sat, 31 Aug 2013 10:33:18 -0800

Leibniz--excellent post and useful information. And you are right about SSRIs and traditional anxiolytics --while they are useful in lessening intensity, frequency and duration of intrusive thoughts there is a way to go.

By: George_Spiggott

George_Spiggott — Sat, 31 Aug 2013 11:04:36 -0800

Roy Orbison in Clingfilm. I'm startled to discover it's still being maintained. Though perhaps that just validates its relevance.

By: hap_hazard

hap_hazard — Sat, 31 Aug 2013 12:27:34 -0800

yes everyone must play the the Roy Orbison in Clingfilm Adventure Game! It is not a derail because no matter how one tries to consider an article in for example the Guardian, or the well-being of one's pet tortoise, one's thoughts eventually return to the soothing yet strangely arousing notion of Roy Orbison, wrapped in many, many layers of clingfilm, do they not?

By: rmhsinc

rmhsinc — Sat, 31 Aug 2013 15:24:36 -0800

Yes, it is kind of a derail--sort of like posting a link about the time someone you knew drank to much and blacked out ( a legitimate and perhaps even amusing story) in response to a post about epilepsy and disorientation during fugues. And trust me--there is nothing "soothing yet strangely arousing" in having repetitive intrusive thoughts. But perhaps the post is exhausted anyway.

By: Tell Me No Lies

Tell Me No Lies — Sat, 31 Aug 2013 16:14:18 -0800

Huh, I'd never considered that the mechanisms for OCD and ADHD might be linked. Makes sense.

By: Ray Walston, Luck Dragon

Ray Walston, Luck Dragon — Sat, 31 Aug 2013 17:18:52 -0800

I have OCD, which was originally something akin to Pure O for me, and it essentially ruined my life for a long time. I'm still fighting my way back, using medication and CBT. Pure O was the worst: I would construct extremely elaborate chains of reasoning to give myself some relief, which if you know anything about OCD you know is just making it worse. It was like living two lives, one in a real world, where you fight a constant existential war of thoughts with yourself, and a fake world, with people and places and things that used to be real for you but now are a kind of sick joke. My Pure O "cleared up", weirdly, after a few years when I was about 17. Since then it's mostly been the regular old OCD, which is bad enough, but at least I know what it is now - Pure O, for me, didn't have any physical responses, like hand washing, cleaning or checking. I just assumed, from the ages of about 14 to 17, that I had gone mad.

By: jenfullmoon

jenfullmoon — Sat, 31 Aug 2013 21:29:54 -0800

WOMEN'S URINALS EXIST?!?! Man, I did not know this existed! I have only seen the usual sorts in porta-potties, the occasional unisex toilet, and peeking in the boy's room when I was five. So yes, I wondered where Maria was constantly coming across them as well.

By: fungible

fungible — Sun, 01 Sep 2013 05:37:23 -0800

Interesting. I had various little OCDs when I was a kid (a lot of us do apparently) but in my twenties I became obsessed with the idea that I was going to gouge my own eyes out. I knew it was not real and I knew it was irrational, and yet it was always there. It led to a lot of panic attacks, and once I learned to control the panic attacks with slow breathing, that seemed to help soothe a lot of the thoughts. Maybe Pure O is just our "fight or flight" response gone haywire (like panic attacks)? Just a layman's perception.

By: Maias

Maias — Sun, 01 Sep 2013 14:55:54 -0800

Psychoanalytic approaches currently dominate Um, where? Certainly not anywhere anyone uses evidence-based practice, since there is no evidence that these approaches work and as the author of the piece noted, they are likely to backfire completely. It's definitely hard to get evidence-based treatment and clinical practice is often far from it, but I've covered psychiatry for the last 20 years and have mild OCD myself and don't think anyone takes that approach seriously anymore— that is, anyone who has actually read the outcomes literature. I had a therapist in the early 90s who blamed my problems on poor toilet training, but that would practically be grounds for malpractice at this point and should have been by then. Also, SSRI's can make a huge, huge difference for many people— definitely more useful to me than anything else.

By: evil otto

evil otto — Mon, 02 Sep 2013 00:49:58 -0800

I have Pure O. The worst was before I knew what I had. I'd been seeing a psychologist who assumed I had some kind of generalized anxiety disorder, and proceeded to try and reassure me and answer all my Pure O "questions". Of course this made things worse, and in the 2-3 years I was under his care, my condition steadily worsened. Eventually he referred me to a colleague, the head of the psychology department at my school, who was AMAZINGLY helpful. I seriously owe my sanity to him. But what really helped was realizing that I had a condition others had, and that Pure O sufferers never do the Bad Scary Thing they're afraid they're going to do. This article rang true for me in a number of places. The really difficult part of Pure O is that it concerns itself with unanswerable questions. Things like, "Am I a good person? How do I know I'm a good person? Am I capable of horrible things?" No matter how much you think about these things, you don't get any closer to an answer. A personal theory I have is that OCD is sort of a way to distract yourself from the problem that's REALLY bothering you. Instead of tackling that, you obsess over questions that you do actually know the answer to -- after all, one feature of OCD is the "voice of reason" in the back of your mind that knows you're worrying needlessly. This is one of the most painful parts of OCD -- you know you're being ridiculous, but you're helpless to stop yourself. Regardless, my Pure O is pretty well under control these days, although occasionally I have small "flare ups". What's been helping me recently is the observation that all of my thoughts about the Bad Scary Thing were either fear thoughts ("I'm afraid I might be capable of this") or noise thoughts -- the kind of random static that goes through everybody's head that most people just ignore. At no point did I genuinely want to do the Bad Scary Thing. I don't have a perfect system or anything, but it's comforting to observe that in the last 11 years I've been suffering with Pure O, I haven't gotten any closer to doing the Bad Scary Thing. I think it's safe to say that I'm alright :)

By: leibniz

leibniz — Mon, 02 Sep 2013 08:50:55 -0800

@Maias I should be a bit clearer. I didn't mean to imply that psychiatrists try to cure OCD using the talking cure. Exposure and Response Prevention (ERP) is the treatment of choice at the moment (plus or minus anti-anxiety medication). However, you should understand that this is a variety of cognitive behavioural therapy, the rationale for which stems from Aaron Beck's cognitive theory of mental disorder. Although it has that 'behavioural' tag in its name, CBT is very much routed in the psychoanalytic tradition in terms of explaining the origin of mental disorder. In the case of OCD, they point to 'dysfunctional beliefs' ("I am not trustworthy", "I am responsible for my thoughts") which cause the OCD sufferer to take ordinary intrusive thoughts far too seriously, resulting in the increased frequency of such thoughts. Ultimately, accounts for the origins of these dysfunctional beliefs tend to fall back on psychoanalytic factors- i.e. parental influence, trauma or life circumstances such as pregnancy. I personally think that these are poor explanations for the origin of OCD. Though certain environmental influences may be risk factors, they seem to be neither necessary nor sufficient for the development of the disorder. You can get a sense of the current mainstream thinking on OCD from this review in the Lancet 2009. Obviously there is lots of research relating OCD to basic affective/cognitive processing disorders, and everyone is aware that some kind of synthesis of the neurological and cognitive evidence has to be found. With this in mind, @evil otto- I don't think your obsessions are likely to be distractions from what's really bothering you. It's more likely that you have free floating feelings of anxiety and uncertainty that you seek ways to make sense of- and this kind of exploration is what gravitates towards the Bad Scary Thing that you can't falsify. "Seek" or "explore" have to be put in heavy inverted commas here. I think there's likely to be low-level monitoring processes that are 'compelling' you to resolve information conflict signals. So I can hardly recommend you to 'stop trying to resolve your uncertainty' when this is one of the main things your brain is built to do. Perhaps there's some comfort in that consideration however.

By: evil otto

evil otto — Mon, 02 Sep 2013 10:58:45 -0800

So I can hardly recommend you to 'stop trying to resolve your uncertainty' when this is one of the main things your brain is built to do. Perhaps there's some comfort in that consideration however. This doesn't make a lot of sense to me, seeing as that my major coping skill is realizing that the OCD thought process is kind of meaningless and worthless, and the best I can do is try to let go and think of something else. What solutions do you have for me, besides taking medication?

By: leibniz

leibniz — Mon, 02 Sep 2013 12:44:41 -0800

my major coping skill is realizing that the OCD thought process is kind of meaningless and worthless, and the best I can do is try to let go and think of something else. if you can manage that, it sounds great.

By: Sys Rq

Sys Rq — Tue, 03 Sep 2013 11:45:01 -0800

Further reading: "Binky Brown Meets the Holy Virgin Mary."

By: Maias

Maias — Sun, 08 Sep 2013 19:05:53 -0800

CBT is hardly psychoanalysis, Leibniz— basically, the only thing it has in common is that it is a talk therapy. As far as I know, and I've written about it a lot, CBT is agnostic on the origin of the problem, merely focused on behavioral and cognitive ways to deal with it. If some claim that it has an origin in thinking rather than brain circuit dysfunction, that doesn't mean that that has anything to do with the practice because it simply doesn't matter what came first in terms of the technique. In contrast, psychoanalysis involves a search for the meaning and origins, something that is avoided in CBT— you are focusing on what to do now, not how you got there, except insofar as that has relevance (and typically, the idea is to ignore the "meaning" of the symptoms and frame them as symptoms, not meaningful thoughts since that can further the obsession). ERP is not open-ended talk, it doesn't search for the origin of the problem in childhood or focus on issues with your parents— it is a very specific set of tactics for dealing with anxiety disorders. To call that psychoanalytic is to stretch the term beyond any meaning.

By: leibniz

leibniz — Mon, 09 Sep 2013 02:44:02 -0800

I don't disagree with much that you say there Maias. I was making a point about the theoretical model, not therapy. Still, if you are using some kind of therapy, it might be nice to understand why that therapy works, or doesn't work.