Order-Cravers: Being O-C

OCD, OCPD, or just neat

Order Cravers.  Sounds like something out of Harry Potter. Unbeknownst to Harry, the Order-Cravers waited patiently for him to step out of his room.

Indeed, order-cravers can make you sick.  You want them to stop ranting about disorder, the shape of a room, the clutter.  And some of them really are sick.  But probably, most are not.

Those who are  impervious to hygiene, to dirt, in contrast to order-cravers, might suffer a severe mental illness.  Sick with depression, there's less energy to shower, and a dirty glass, a smudged coffee table, feels irrelevant.  Depression is like that, breeds apathy, zaps our energy.  The nemesis of an order-craver.

This is National Suicide Prevention Week.  (Tagline: You can make a difference.  Check out the link). So I have to stress that there's nothing pretty about mental illness, and nothing funny about it, certainly nothing funny about that Death-Eater-- depression-- that won't let up.  All that works is love, attention, time, and compliance with those impertinent doctors who make you exercise, eat right, smell the proverbial roses, take your medicine, and occasionally check into the hospital.  Day programs are great, and always, always, therapy is recommended.  These things make the difference between life and death.  As does lots of sleep.

And reading.  For those who can still open their eyes to read, reading is helpful.  (This is the best I can do to link over to a site that gave this blog a recent shout-out, an "award" on 25 Depression Information Sites without totally selling out.)

We elaborated on suicide prevention in 2009, that Fray song, How to Save a Life.  That might be worth a revisit.  But let's move along now, address order-craving, and how some people need so much order, but not everybody cares.  Should they?

Caring about physical space, the chaos that surrounds us, the never-ending mail, newspapers, dust, dirty dishes, dirty floors; wanting cleanliness and order, predictability, is the psychological equivalent of environmental hygiene. Unconvinced of the importance of picking up, some of us have other priorities, sleep among them.  Video games another.  And poor environmental hygiene.

We can take it when a three-year old throws a candy-wrapper out of a car window.  When we explain why he should not, he'll listen carefully, then vociferously disagree and toss something else out of the window.  It is normal to be oppositional at this age.  Funny.

Over the age of three, less so.

We assume that those who simply leave a mess for others were either indulged as children, or not introduced to the beauty of empty space.  Someone probably picked up, didn't insist upon better habits. (Parents can insist). Or nobody did anything at home in that family of origin, ever, not even the ones in charge.  Disorder becomes the norm.

This is discussed quite a bit in relationship and family therapies. It can become a goal of therapy, inspiring a partner to care about housework.  Young therapists will go over this same problem week after week in a couples therapy.

Label the problem:  One partner needs order, the other a rest from the insults.

It is the therapist's duty to elevate the discussion beyond wet towels on the floor.  The towels will be picked up when emotional needs, face-time, genuine eye-contact, replace them as a priority.  (Domestic abuse, child abuse excepted.  Abuse gets results, too, but not the ones we're looking for, see OCPD below).

Treat the lack of emotional intimacy, and suddenly attending to the chaos magically improves, assuming mental or physical illness doesn't incapacitate. And even then, laziness is forgiven with only a tad of lip service.  I wish I could get out of bed to help out around here.  But I also wish I had never met a pair of skis.  I'll help more as soon as I am able.

Those who don't notice the clutter and dirt, who don't care if a cup of milk has been sitting for days, or an entire carton of milk, for that matter, start to notice a bit more when they are noticed, addressed without insults and criticism.  Addressed intimately.

Order in the home can become a matter of power and control, which is why it tends to be such an emotional trigger.  An order-craver not only insults but threatens: "You're such a slob!  If you don't shape up, I'm out of here.  I can't live like this."  Interestingly,the less-than-ordered partner doesn't threaten divorce (it is nice to have a maid), and will even go so far as to suggest an hour after dinner, "Must you clean up now?  Come watch TV.  You are so O-C!"

The implication is that the neat freak is the one with the problem, the one who has a disorder. Obviously, O-C.

But we have to clarify, we really do.  Being an order-craver is not the same as having OCD, Obsessive Compulsive Disorder, not on its own, nor does it qualify a person as OCPD, having Obsessive Compulsive Personality Disorder.

Obsessive Compulsive Disorder (OCD) is defined by obsessions (intrusive thoughts), and compulsions, being compelled to do things, even illogically. It is not illogical to put things away.  Someone has to know where to find the scissors.

And Obsessive Compulsive Personality Disorder OCPD is defined by a need to control life to the max, no matter how it inconveniences others has nothing to do with clean dishes, either.  Hoarders have a corner on OCPD.  The idea of de-cluttering, getting rid of those precious piles of National Geographic magazines from the sixties, is not on the agenda of a person with OCPD.

A quick review.  Recognizing any disorder is relatively easy.  How to fix it,  generally less clear.

OCD, 300.3 (the anxiety disorder)

A) Either obsessions or compulsions:

           Obsessions include:

1) recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety and distress
2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
3) the person attempts to ignore, suppress, or neutralize them with some other thought or action
4) the person recognizes that they are a product of his or her own mind (not imposed from without as in thought insertion*)

          Compulsions include:

1) repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2) the behaviors or mental acts are aimed at preventing or reducing the distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point the individual recognizes that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (1 hour or more a day) or significantly interfere with normal routine, work, academics, social life or relationships.
D. If another Axis I disorder, the content of the obsessions or compulsions is not limited to that (i.e., preoccupation with drugs in the presence of substances, food for anorexics)E. The disturbance is not due to the physiological effects of a substance or general medical condition.

versus 

OCPD, 301.4 (the personality disorder)

A pervasive (doesn't go away) pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by FOUR or more of the following: 
1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2) shows perfectionism that interferes with task completion (unable to complete a project because his or her own overly strict standards are not met)
3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
5) is unable to discard worn-out or worthless objects even when they have no sentimental value 
6) is reluctant to delegate tasks or to work with others unless they submit toexactly his or her way of doing things
7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
8) shows rigidity and stubbornness

The ordering feature of OCD, the anxiety disorder in pink, above is ritualistic ordering, with no real purpose.  It isn't to straighten a room, not really.  The object is to create order in the brain, activity driven by intense anxiety.  People with OCD are the ones who straighten cans at the grocery store.  They count, for nothing, for the sake of counting.  They skip over cracks, can't help it.  They know what they do is irrational.

The ordering feature of OCPD, the personality disorder in orange above, refers to a need for control.  Saving, thumping about morality, working too hard and getting nowhere, an unusual adherence to rules as a response to having had history of acting out, unnecessary financial restraint-- it seems a penance.  Ebenezer Scrooge had OCPD.  It can seem very normal on the surface, but when there's no path to the kitchen, no room for a car in the garage, and refusal to spend money for a new pair of shoes more than once a decade, we call it sick.

Thus merely wanting a clean floor is not dysfunctional.  It is not a disorder, it isn't even O-C.

Yet it is lonely, being the only one at a sparkling, clean table.  So it is worthy of intervention.

STRATEGIES FOR COUPLES WITH ORDER-CRAVING ISSUES.  (These can be used in any type of relationship.)

(1) When couples have the problem, cranking up the emotional intimacy, talking rationally about feelings and needs, as opposed to clutter, is a good beginning.  The psychodynamics-- seeking out the roots, the history of a lackadaisical attitude toward environmental hygiene, can be surprisingly intimate.

Similarly, exploring why one needs things to sparkle is worth examining, too.  It could be as simple as finding that making things spotless is symbolic; it is how we wish others would see us.  The praise from others reinforces the behavior.  Most perfectionists suffer this need for praise, and their partners, their families, suffer them.  Not that we mind borrowing their keys when ours are lost.

(2) Quid pro quo agreements, you do this, and I'll do that, work when they work. The one who needs order agrees to  relinquish some of the control, to stop insulting and nagging.  The one who doesn't mind chaos picks up the pace, brings a dish to the sink, even washes dishes on a regular basis, throws out trash.

 (3) The give-in to it intervention, a paradox, is fun.  Rather than fight the need for order, or being critical of those who do not care, the order-craver accepts the role of the identified patient. He is told to freely criticize himself and everyone else.  Go ahead and criticize!  Say what is in your heart.  Feel free, express all of the criticism that you are thinking, do it all week.  Make that two weeks.  Let's see how that works for you.

Angered by an unwashed dish, "You left out a dish!"

The ostensibly errant, more relaxed partner should shout back.  "OMG!  You are so right!  I did!  Do you think I'm going to lose my afterlife for this?  Are the ants marching in as we speak?  Come, let's go see!"

(4) The diagnosis of the relationship, an over-adequate/under-adequate relationship, lends itself to the idea that the partner who is doing too much should stop working so hard. Give up on all that work, find your own corner and keep it clean.  Theoretically the under-functioning partner will get lonely, pick up the slack.  The problem, obviously, is that if that doesn't happen, it bodes poorly for relationship longevity.

(5) The middle ground.  Finding a middle ground is a real test for a true order-craver.  The room has to be picked up, the bed made, before this person will come to bed.  The therapist suggests that she try to go to bed anyway, knowing there is s still dust lurking somewhere.  The more relaxed partner meets her in the middle by making sure the bed is made.

The last intervention accomplishes so much more, in so many ways, than flowers or candy.

therapydoc

Please Don't Leave Me

He's Just Not That Into You--It's not a new movie, and a lot of people said they were Just Not Into It.

But the topic had me at hello.

The cast is stunning, for one.  I watch chick flicks for many reasons (they're sedating, primarily), but a pleasant looking cast is at the top of the list. You can't talk about deep subjects all the time and not have a really shallow side somewhere deep down inside.

FD didn't bother with it for 30 seconds. He went to bed. But he was tired, is the truth.

Gigi Haim, (Ginnifer Goodwin, above, bottom right below) desperately seeks a boyfriend. It's the desperate part we don't like.  A woman (or a man, this movie could easily have been about a desperate man) should strive for a little more pride, more independence. Hanging on for dear life when someone is pushing you away, stalking restaurants and bars to catch the prey unannounced, feels like high school.  I know it's hard not to do it, and that for many of us, it's hard to have the kind of self-control necessary to go it alone.  But we've got to try.  That said, we can work on this for years in therapy, and we do.

Gigi anxiously waits for telephone calls, checks voicemail a hundred times a day, even when her first dates don't go well, which is always. What she wants, what she needs, is beyond her social intelligence. The social IQ should tell her that a little mystery, a little challenge, is attractive in relationships. And if the attraction isn't mutual, let it go.  But we're made up of much more than social intelligence.  Our emotional lives tend to rule.

She's rejected often, but nothing ventured, nothing gained. And Gigi's obsessive thinking, her compulsive man-chasing, doesn't hurt anyone. She's obsessed, but she would not be diagnosed with OCD, Obsessive Compulsive Disorder. She doesn't want to be alone, and although we might suggest she feels empty, she doesn't have Borderline Personality Disorder, either.  That's the one we think of when we associate fears of abandonment with mental illness.

She's just not getting it, can't read the signs when it's so obvious that it's never going to happen. Men read the neediness in her face instantly. They politely suggest, “Call me," a nice way of saying, "I’m not interested enough to call you, so I won't be calling you, but knock yourself out."

The film is full of examples of these types of metacommunications, communications about communications. It is worth seeing for that alone. But remember, the epiphanies of a chick flick aren't usually rocket science.

Gigi's social disconnect, her persistence in knocking when the doors are all closed, is a remez (rhymes with them-pez, Hebrew for hint, but hint just doesn't quite say it as well) to the drive that makes some people successful in this world. They know what they want and get it, don't take no for an answer.

When it comes to relationships and love, unfortunately, that kind of persistence and drive doesn't usually pay off. Forcing ourselves upon others only makes us less attractive, less likable. Gigi's manhunt turns out to be the exception to the rule. It's romantic comedy, after all.

Contrast this to Pink, and her violent music video, Please Don't Leave Me. I can't even link to it for you, it's so violent. Pink bloodies her boyfriend, beats him senseless so that he can't get out of the apartment. She's a sociopath, clearly, a violent, antisocial individual. I mean, rock star.  Not that rock stars are violent.

When I first heard the song, the lyrics isolated from the video screamed Borderline Personality Disorder. So I checked out the video at YouTube to see if it would work as a teaching tool for high school kids learning about abandonment anxiety. (They teach kids about that, right, in your high schools?)

Here are the lyrics:

Da da da da, da da da da
Da da da, da da
Da da da, da da

I don't know if I can yell any louder
How many time I've kicked you outta here?
Or said something insulting?
Da da da, da da

I can be so mean when I wanna be
I am capable of really anything
I can cut you into pieces
But my heart is broken
Da da da, da da

Please don't leave me
Please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me

How did I become so obnoxious?
What is it with you that makes me act like this?
I've never been this nasty
Da da da, da da

Can't you tell that this is all just a contest?
The one that wins will be the one that hits the hardest
But baby I don't mean it
I mean it, I promise
Da da da, da da

Please don't leave me
Oh please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me

I forgot to say out loud how beautiful you really are to me
I cannot be without, you're my perfect little punching bag
And I need you, I'm sorry
Da da da, da da

You say I don't need you
But it's always gonna come right back
It's gonna come right back to this
Please, don't leave me

Please don't leave me, oh no no no.

What's interesting to me is that both women, Gigi and Pink, are desperately in need of a relationship, both concentrate all of their energy to keep a relationship, even go to extreme measures. But they are such different women.

Engaging Gigi in therapy would be a snap. Teaching her rubberband theory, exploring her insecurities about being alone, she'd grow leaps and bounds in a single visit. Well, not a single visit, but a few for sure.  It's hard to let go, and managing neediness in relationships can take a lot of therapy, it's true.  Yet Gigi's not that dysfunctional. She hurts only herself.

Whereas someone like Pink would be self-mutilating in my office and throwing rocks at home.  I'd call in a team to work with her.

The differences in the two women, both so needy, underscores the importance of not diagnosing based upon a single symptom, not even an extreme symptom, although the no sleep thing in Bi-polar Disorder, and the hallucinations or delusions in Schizophrenia are fairly robust indicators of disease.  But even then, there are things to rule out before making a diagnosis. Like speed, acid, other physical disease, brain tumors. Things.

I looked already. Nothing's on tonight.

therapydoc

It's Not You, It's Your Bedbugs

It’s hard for me to relax, you know, sit and watch teev, read the newspapers. But Saturday mornings I catch up with many of these, newspapers, a week’s worth of WSJ, even if it’s just to scan the headlines. When you skim it all on a Saturday morning before shul (rhymes with bull, Yiddish for synagogue), you reduce the odds that whatever you read will upset you.  There's just not enough time.

Today, however, by the time FD and I catch up after our respective jaunts into the community, I'm still upset from what I have read, and greet the poor guy with

Did you read that incredibly insensitive piece in the Wall Street Journal about bedbug phobias?

He has not.

And it is likely that you have not either. It seems that my favorite newspaper is reaching to satisfy the populist psychological appetite, which is fine, the more the merrier; the reviews of academic findings can be captivating.  A new regular, Jonah Lehrer, for example, specializes in decision making, reminds us that if decision making is hard for you, it is because you are actually mature.  You see all kinds of alternatives, lots of gray.  Gray is something we like, the people of my cloth.  Lots of gray, lots of leeway, as much as we can live with.

And I like that he recommends (this week, Kant on a Kindle) that we read things that make us think.  He differentiates between processing with the ventral route versus the dorsal stream. Chick lit readers go the ventral route, it is correct to assume, don't like to have to reread many sentences.  Those who prefer Kant, however, flex the dorsal muscles, mixed metaphor not mine, don't spleen me.

Anyway, Amy Bonnaffons passed her editors with a tongue-in-cheek dig at variants of both Obsessive Compulsive Disorder and other serious anxiety disorders, phobias.  She writes a Dear John letter to her ex, Mark, technically a Dear Mark letter, page 13, section A.

The piece, I'm sorry, doesn't belong in a newspaper that professes serious journalism and a mission, apparently, of psychological edification of its readership. Tongue and cheek is fine*, but when it comes to being cheeky about disabilities, not.

Ms. Bonnaffons writes:

Dear Mark,

This is really hard for me. My hand is shaking as I write. . . Mark, I don't think we should be together anymore. It's not you—it's your bedbugs.

I know they've been gone for six years, but since you told me about your 2004 infestation I can't get it out of my mind. . .

You have to be patient with me. Yes, it was perhaps excessive to require your grandmother to wrap her sofa in plastic before our visit and to put on that hooded poncho and face mask before I hugged her. . .She has so many health problems already that she might not notice a little itch here or there. . .

I won't even ride the subway anymore. Who knows who might have sat there before me? It's exhausting to commute on foot every day. . . especially when I need to sidestep constantly in the more crowded areas to avoid accidentally brushing up against a stranger's clothing. . .

You get the idea.  Is this funny?  It isn't for those of us who have treated people who suffer with these thoughts, behaviors.  Can you imagine having a germ phobia and reading this?  It could be that Ms. Bonnaffons really does suffer from obsessive thoughts, and that she has compulsive behaviors that are dysfunctional, so dysfunctional that they distance her from others, obliterate her potential for intimate relationships.

I doubt it, somehow.  But it's my job to tell you, Amy, it happens, and funny, it isn't.

therapydoc
 
*For an example of fine, in the same paper, on page 11, section C, by Joe Queenan suggesting that bloggers deserve stimulus money. If the government forks a few bucks our way, we’ll surely buy “more IPads and Droids, netbooks, and tickets to see Pavement.”

Up in the Air

Seriously, it's not that I don't have any original stuff. There's a deeper essay inside me, all about food being the thing we all obsess about most-- weight, to be more specific-- and how money takes the #2 spot.  Or was it the other way around?

But let's just settle for a movie. It's summertime.

Have you seen Up in the Air? If you haven't, think twice before reading this post, there will be spoilers and you're going to see it. Not that it's a must-see, but maybe it should be.  We hear what must be be real stories, told by actors who appear to be real people, stories about the torment of unemployment: the initial impact of losing a job; the mental anguish of facing foreclosure, the loss of status and purpose, bankruptcy and shame; suicide. Required reading? Walter Kirn wrote the book.  There's gossip about him not being invited to the Academy Awards.

Anyway.  If you're me and you travel a lot, the opening sequence is captivating-- aerial photographs like the ones I'm always snapping with my phone. Some of us really, really like flying, despite the hassle, the aggravation in line, the paranoia of security, the wait. The cancellations. I'm taking off for a couple of days this week, that's the plan, and my excitement is palpable. Some of the twitter in my belly has to do with being up in the air again.

Ryan Bingham (George Clooney) loves flying, too, the feeling of living out of a carry-on, paring down his possessions to what he can pack into a light-weight vessel on wheels. He is a motivational speaker, talks ad nauseum about the backpack, how if you filled one of these with all of your possessions, all that you have, all the things you own, packed in all of your friends, your family, your people-- you would find that you are mightily burdened.

All of this, he implies, the weight of living as a social animal, the choice to be grounded, is a burden.

Live like Ryan Bingham and set yourself free.

Has he got OCD, Obsessive Compulsive Disorder? Sure, maybe. Or is he disordered with Schizoid or Avoidant Personality Disorder, fearful of people to the degree of self-imposed isolation? Nah. He speaks to people for a living, empowers them to be good with a solitary independence, tells us to look forward, unafraid. And he has relationships with women, he's George Clooney, for crying out loud, handsome and socially fluid.  He even falls in love. (The female supportive actors, Anna Kendrick and Vera Farmiga made the movie for me, not George, particularly)

Ryan has an agenda with that backpack metaphor, even if he believes in it. What he is really doing, when he tells people that life as a social animal is a burden is a verbal equivalent of slight of hand, a con.

He works for an outsourcing company. You may be familiar with these. They take the pinch out of unemployment, present you with the package, the severance, and point the finger to other sources of employment. But Ryan has the ugly job of having to tell people,

"You're fired."

He doesn't say it like that, he says it nicely. He relabels the experience:

"All great people have been let go."

Or,

"Now you have the opportunity to do what you've always wanted to do."

Or,

"Now you can be great, meet your aspirations."

If you've ever treated anyone who has lost a job, the same words, maybe, have come from your mouth. They can be soothing, they can be true. They are a Bandaid, you both know this, but you're not applying the Bandaid unless the patient has opened with the concept first, alluded to relief and desire to pursue a dream, can see the possibilities inherent in the dream. You both know that being let go means there's a likelihood you may lose everything, certainly much of the life you're accustomed to living, the one you have grown to know, maybe even love.

You don't lose your family, however. You don't lose your soul. You don't lose your goodness, all that is you, or you shouldn't, when you lose your job. We hear this from the actors who have lost their jobs in the denouement, at the conclusion of the film.

They speak into the camera to tell us the rest of the story, as Paul Harvey used to say. This air of documentary makes the film a little grim, is the truth, but it's appeal is that is is so real. Some of us don't mind a little reality in our escapism, find it therapeutic.

In therapy, real people tell real stories, and when the story is about job loss, we talk primarily about how job loss can change one's role in life, identity. But it is changing all the time, identity, anyway. Change can be thrilling, but it can be painful, too, and in this case, the change of role, the challenge is gut-wrenching, a true test of one's mettle. We shrinks subtly suggest:

Don't let the test destroy you. Stay alive, stay well for your family, if not yourself, but do it for you, too. They can't take that away from you, who you really are, your essential goodness

This is a crossroads. Things will change. You will survive. What was that Spock line?

Oh yes. And prosper.

Perhaps.

And yet, to minimize what has been lost? Unfathomable, unconscionable, very bad technique. Platitudes are a condescension on the part of the therapist, or the employer, the hatchetman. Don't give people snake oil, don't hope they will fall for your politics. Now you can be great.

Now you will be broke. How is that great? How at all is that great?

When it comes down to money, everyone obsesses. Thus the job of therapy, when money is the crisis, is to increase denial, distraction, help a person draw upon old resources and find new ones, problem solve. We advise you to stay clear of self-pity, for this eats a person up from the inside out. Spirituality helps here, spiritual resolve to be a better person, not a bitter one, a force for good in the universe. Somehow.*

Attention to anything outside oneself, can be stabilizing. (But be careful here, pick your charities wisely). We don't say it, but we tiptoe around it, but we're hoping you'll get, that even if it is you who has lost the position,

It's still not all about you. Get out of bed. Do something. Anything. You'll be more tolerable to live with if you do.

Job loss is stress, in no uncertain terms, and managing it an art of good problem solving, varied coping strategies, and surely, supportive relationships.

So nurture these especially, the relationships. And while you're nurturing, grab some dinner with friends. Maybe share a salad.

therapydoc


*Spiritual stuff-  I originally put up some of the cognitive therapy that goes into this, but took it down, sorry.