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

The Dishwasher, Marriage, and Obsessive Compulsive Disorder

Caveat:

Before we begin, please do not consider the following post an exhaustive treatment on how to treat Obsessive Compulsive Disorder. The intervention I discuss is only one strategy, and treating OCD can be quite long-term, begs different methods. It is never a simple behavioral therapy. I'm only suggesting that without a behavioral approach, the therapy is remiss.

Nor am I making fun of people who have the disorder or dismissing them as silly. That's the farthest thing in my mind. It's a very serious, painful disorder.

The Post

Many couples argue about the right and the wrong way to stack a dishwasher. There is, apparently, a right and a wrong way, depending upon the direction of the jets. You knew about the jets, right? So couples argue about this one quite a bit, and it's not an Obsessive-Compulsive Disorder thing, not even a control thing, so much as an

Are the dishes getting clean?

thing.

So we could talk about that, for sure, but let's talk about me.

I’ve become one of those people who washes the dishes 100% before stacking them in the dishwasher. I never thought it would happen. There's no need to do this. This particular Whirlpool sounds like an airplane, but the dishes come out clean when the war is over.

So FD comes home and eats breakfast, wants to stack his plate of crusted bagel crumbs and butter in the dishwasher. He sees the clean dishes and asks me, “Are these clean? I just emptied this thing.” His tone is upset, confused.

“Yes, they’re clean. I’m using the rack to let them air dry.”

“Well, how am I supposed to know what’s clean and what isn’t?”

He has a point.

You're all thinking, I know you are, this is so obsessive-compulsive, washing before a wash. But the difference is that there is no second wash.

Another example of mythological OCD:

My mother, 84.5, lives independently but won’t cook for herself anymore. Or bake. She is a fabulous cook, a wonderful baker, and although I’ve tried to fill in, I’m too impatient for real baking; you know what I mean. She won’t cook because it’s too messy. Does she have Obsessive Compulsive Disorder?

She might, is the truth, but in this case, her behavior isn’t a function of her OCD; it’s a vestige of self-esteem. Why should she have to clean up for herself at her age? She's done enough of that, cleaning up for herself, for others. It's time to call it quits.

So we don’t have to treat Mom. But when should we treat compulsions? (Obsessions are the thoughts, compulsions the behavior). And when should we leave symptomatic behavior alone?

We might suggest that if a younger person refuses to cook for herself because a splat of omelet on the range causes her too much distress, then that might be something to treat, depending upon a host of other variables.

And how would we do that, treat it?

It’s not necessary to talk about toilet training as a child, although a therapist could make decent money off this approach. And it’s fun to talk about early childhood, for we do establish much of our irrational tendencies as children just coping with life stress. Life, if you're a kid, has inherent stressors, mainly having to do with weird rules and the behaviors of large people.

But far more elegant than talking about childhood is a behavioral approach. You start (I do) with something that’s upsetting to the patient, like a spill. A therapist like me might pour grape juice into a pitcher and leave it close to the edge of my desk for an entire visit to see how long it takes for the patient to say,

“Could you please move it? It’s going to fall.”

Ridiculous, right? It’s not going to fall. It is a full pitcher. It isn't going anywhere. I move it an inch away from the edge.

“Good enough?”

Of course not.

“Does this make sense?” I ask.

Well yes, it does. We could have an earthquake. Anything could happen. We talk about the concept of stressing the mental set, making the brain grapple with the thought that it could fall, all kind of bad things can happen. But it won't. I won't let it. The thought is irrational and dysfunctional.

Dysfunctional because while under the influence of an obsessive thought, or a compulsive behavior, whatever else is going on in our lives, whatever else is important, is taking a second to something as small as a pitcher of grape juice. And we make other people miserable, waiting for us.

Sure, caution is a good thing, and most of us avoid precarious situations like spills, but when the caution is obligatory, rigid, symbolic for everything, somehow, then we have to tickle many sources, not only a difficult childhood. Pick a trigger, any cause for anxiety, then another, and play with it, talk about it, test it.

Try syrup, working with a spill phobe. No one with this set of compulsions (the cleaning set) is comfortable with spilled syrup.

Hold a spoonful of syrup over the floor, make like you’re going to spill it, but don’t. Get very close to spilling it, but definitely don't. This requires some coordination, but repeat the near accident over and over, each time measuring the length of time the patient is holding his or her breath. (Not literally, just look for any change in expression).

A little anxiety is what we’re shooting for, not too much, and a gradual magnification of the stimulus. This teaches the patient to manage his or her anxiety some other way, and hopefully you're familiar with relaxation techniques and have passed them on, or cognitive strategies, like the rational thinking we discussed above.

The technique of gradually increasing the stress of a feared stimulus is called desensitization. Gradual is key. No need to give anyone a heart attack with spilled grape juice of syrup. Not until you're sure that spilling won't cause a heart attack.

The therapy really can take years. There's always another trigger to desensitize the patient who has this disorder. Medication is helpful, and surely a couple's therapy is always in order, psycho-education for the spouse, and coaching, even shadowing.

So what about me and FD? With the dishwasher. We could dedicate one side of the dishwasher to clean dishes, another to dirty. But I feel this contaminates the clean ones that are minding their own business, just resting across from the dirty ones.

Maybe someone can think of a better idea. I’m not sure I want to quit washing the dishes 100%. It feels good, hot soapy water on skin (I never thought of it this way until a friend mentioned it to me). And it seems like something that should become a permanent bit of the home’s personality, saving counter space, like we're heading in a new direction.

And FD could actually look at a dish to see if the dish is clean. Would that be so bad?

therapydoc

The Courageous Heart of Irena Sendler

What a terrific role, wonderful actress.


Heroic. One of the more sung heroes now, thanks to CBS and Hallmark.


And these are the Desperate Housewives, who really don't belong on the same page as Irena Sendler, but well, you'll see. Nicolette Sheridan, far right, plays Edie Britt.

I know I promised you something on exposure therapies, but something came up and I had to tell you about it. And it’s ironic, of course, because it’s about the Holocaust, and if ever a population suffered from post traumatic stress, one of the disorders we use exposure therapies to ameliorate, survivors of the Holocaust qualify.

And yet, exposure therapies, I believe, might be over the top for Holocaust survivors, cruel and maladaptive. But I'll explain all that another day. I could be wrong though, I really could. I'm not the expert here, not on Holocaust survivors.

Tomorrow, April 21, 2009 is Holocaust Remembrance Day.

So let’s use this time to remember, just a little.

FIRST A STORY

This one has nothing to do with the Holocaust. If you’ve been watching my sidebar then you see me Twitter every once in a while. I don’t do it much, like I don’t blog all that much lately, but every now and again I get the urge to tweet.

My tweets have been about preparing for a Jewish holiday, mainly about how labor intensive it is, Passover. We change over all of the kitchen utensils and appliances in the house, use different dishes, different silverware, different everything, old sets of things that feel new because they are set aside year after year, not used at all, save this one holiday.

We clean the whole house from top to bottom and the work part, if you're not familiar with it, the preparation, is spring cleaning with an attitude, reminds us of slavery in Egypt, for sure, and is all about leavening, and getting it out of the system, mental, mainly, although most of us bread lovers complain about the matzah substitute. But complaining is in our nature, and for eight days, we can and should live without something, something like leavening.

The more observant among us take off as much time as we can from our jobs to celebrate when the holiday finally arrives, definitely the first and last two days and the Sabbath in the middle. But it is laudable to take off all eight of those days, because, you know, let's talk, it's a waste not to celebrate a perfectly good festival.

So in my house, this year, like every year usually, Passover passed uneventfully. Passover comes, it goes, and life goes on. But as we’re getting our lives back to normal, changing back from the Passover dishes to the every day dishes, putting things away, FD can’t help but notice that one of our sets of silverware is looking a little yellow.

The silver plate's looking a little yellow, he tells me.

It’s not pretty, yellowing silver plate. I can assure you.

Silver plate flatware isn’t all that expensive, not much more than stainless steel, if at all, but when you shine it up, it looks like real silver. And I happen to be a real sucker for shiny things, shine things up as a general rule. Like I don't mind doing dishes, or washing glassware, or silverware. And you know my world view tends to get a little glossy at times.

If you read this blog regularly then you also know that a lot of us find it therapeutic to shine things up. You don’t have to be OCD to like things clean, we're talking literally now. On the other hand, you might be.

Anyway, I told FD that indeed I had noticed that the silverware needed polishing, but didn’t want to do it just then. There would be a good time, there always is. Story End.

Then tonight, wouldn't you know, ready to polish up the post on exposure therapies, CBS features a Hallmark presentation, a present, really, The Courageous Heart of Irena Sendler. Irena Sendler, who just passed away at 98 in May, 2008, was a Christian social worker in Germany during the second world war.

There haven’t been all that many TV shows or made for TV movies about social workers. When I was a kid George C. Scott played one on East Side West Side, and more recently, Tyne Daly played a tough cookie, a social worker with chutzpah and heart on Judging Amy. I loved the show, but most people probably didn’t.

There’s a nice treatment of social workers in the media by Robert DeLauro, MSW in Social Work Today. Not terribly flattering, to tell you the truth, pre Judging Amy, for sure.

But never in a million years would I have known about social worker Irena Sendler were it not for this teledrama. Sure, it’s Hollywood--gorgeous movie stars play regular, probably not so gorgeous people, but the sets seemed real to me, and that scene where the kid punches a hole through the floor of a moving rail car and drops to the tracks to face life alone (or so he thinks) in the wintry woods of Poland, now THAT’S good television.

But basically it's a made for TV production that serves its purpose, sucks the tears right out of you, unless you have no heart.

But we should cry for such things.

I’ll admit it was a tough choice. A really key new episode of Desperate Housewives, serious competition, especially since I wasn’t sure I had the stomach for a Holocaust movie this evening. Who ever does?

And yet how could I not watch it? I feel the survivor guilt of any decent liberal. If I’m not suffering, then why not?

I like to think that having been born in the fifties, those years following the destruction of six to ten million or more innocents by monsters, for there is no other word, I’m sorry, to describe the Nazis, that after the war the soul of an innocent Jew, one who suffered and didn’t make it out of Europe in the early 40's, who didn’t survive, somehow got recycled into my zygote, ultimately this ol' bod. That may sound crazy, but the timing is just right.

And timing, as you know, is everything.

And this being two days prior to Holocaust Remembrance Day, having to choose between Irena’s courageous heart and Edie Britt’s electrocution in an automobile accident on Desperate, well, really, it wasn't a contest. The electrocution might have upset me too, come to think of it.

Ms. Sendler, it turns out, is more than your basic do-gooder social worker. In 1939 she's the director of Polish Social Services in Warsaw but considers the children in the Warsaw ghetto, rationed down to 300 calories a day by the Germans, her cause.

Her own mother worries about her safety, begs Irena to pick another cause.

Irena: I have to save these children.

Mom: You are a social worker a good social worker. Why go risking everything for something you know nothing about?

Irena: If you see a man drowning, you have to try to rescue him even if you don’t know how to swim.

Convincing her mother isn’t all that tough, but convincing Jewish parents to let their children go, well, that's quite another matter.

Irena: The new camp the Germans are building for deportation. . . Treblinka. . .they. . .

Jewish mother in the Warsaw ghetto: It is a concentration camp, a work camp.

Irena: They’re not building any barracks for this camp.

Jewish father in the ghetto: Why wouldn’t they build barracks? I don't understand.

Irena: Treblinka is a place for killing. It is a death camp. There won’t be a need for beds.

Ultimately these protective parents get the idea that it is better to take your chance on the kindness of strangers than to trust the Nazis.

So Tuesday is Holocaust Remembrance Day. We’ll observe a moment of silence, remember things like when we hear words like genocide, that we should wake up, pay attention. DO something. Give money to our local Simon Wiesanthal Center my Uncle Max would like that, or the Holocaust Museum in D.C., something that gives memory its due.

We should be a little more like Ms. Sendler, irrepressible, righteous, brave. Contemplate, at least, what it must be like to be someone like her. Wonder about that.

FD and my son talk a little, after the show, about what they have just seen, the dramatization, their thoughts about that nomination Irena Sendler received for a Nobel Peace Prize in 2007, having lost the prize to Al Gore. How must he feel?

I saunter out of the family room to the kitchen, get up on a chair and find the silver polish. Not that I'm anything like Golda Meir, the first female Prime Minister of Israel, but it's what she would do, I'm pretty sure, under the circumstances. They say she polished silverware when she got depressed.*

Makes sense to me.

therapydoc

*I'm not depressed, I'm really not. But one day, long ago, having heard that story about Ms. Meir, it changed my whole way of thinking about silver and polishing. Not that I don't farm out the job to an available man now and again. Technically, it is a guy job. For the record.

More facts about Ms. Sendler from the Internet. I understand Snopes argues a few of them.

These are from Life in A Jar, the Irena Sendler Project. http://www.irenasendler.org/facts.asp ,

As early as 1939, when the Germans invaded Warsaw, Irena began helping Jews by offering them food and shelter.

The Warsaw Ghetto, built in 1940, was the size of New York’s Central Park. Four hundred fifty thousand Jews were forced to live there.

When the Warsaw Ghetto was erected in 1940, Irena could no longer help isolated Jews. The Ghetto was an area the size of New York's Central Park and 450,000 Jewish people were forced into this area.

Irena and the ten who went with her into the ghetto, used many, many methods to smuggle children out. There were five main means of escape: 1- using an ambulance a child could be taken out hidden under the stretcher. 2 - escape through the courthouse. 3 - a child could be taken out using the sewer pipes or other secret underground passages. 4- A trolley could carry out children hiding in a sack, in a trunk, a suitcase or something similar. 5 - if a child could pretend to be sick or was actually very ill, it could be legally removed using the ambulance. The number of babies saved was small in relation to the total number of children rescued.

There was a church next to the ghetto, but the entrance leading to it was "sealed" by the Germans. If a child could speak good Polish and rattle off some Christian prayers it could be smuggled in through the "sealed" entrance and later taken to the Aryan side. This was very dangerous since Germans often used a rouse to trick the Poles and then arrest Jolanta/Irena documented on the strips of paper she had buried, as well as where the child was taken in the first phase of its escape.

Irena (code name Jolanta) was arrested on October 20, 1943. She was placed in the notorious Piawiak prison, where she was constantly questioned and tortured. During the questioning she had her legs and feet fractured.

The German who interrogated her was young, very stylish and spoke perfect Polish. He wanted the names of the Zegota leaders, their addresses and the names of others involved. Irena fed him the version that she and her collaborators had prepared in the event they were captured. The German held up a folder with information of places, times and persons who had informed on her. She received a death sentence. She was to be shot. Unbeknown to her, Zegota had bribed the German executioner who helped her escape. On the following day the Germans loudly proclaimed her execution. Posters were put up all over the city with the news that she was shot. Irena read the posters herself.

During the remaining years of the war, she lived hidden, just like the children she rescued. Irena was the only one who knew where the children were to be found. When the war was finally over, she dug up the bottles and began the job of finding the children and trying to find a living parent.

Almost all the parents of the children Irena saved, died at the Treblinka death camp.

Natalie and Monk

You probably know that care-takers get a bad rap. It's bad to be one, you tend to focus on others, put yourself last, burn out, lose self. You deny other people the joy of taking care of you. I could go on and on.

If you're familiar with the show then you know that Monk is a famous detective with Obsessive Compulsive Disorder, and Natalie is his assistant. Monk's disorder is so severe that much of Natalie's job is watching out for him, making sure he is safe. His concentration on cleanliness (germ phobic) and order (symmetry) make Monk something of an absent-minded professor. He bumps into things. He gets hurt because he's more worried about the order of nature than his own safety.

But Natalie saves him, usually, from things like walking in front of a bus.

I tape the show and always have to hear the song, It's a Jungle Out There, will sing along with Randy Newman. What can I tell you.

Anyway, because I tape much more than I watch as a rule, I have a huge assortment of shows to choose from. One night I choose Monk and the Magician. I try to get FD to watch it with me, but as soon as he realizes who the murderer is (first ten minutes) he sees no point in watching anymore. Guys are like this unless they're watching recaps of sports.

So he goes out to do some guy thing or another and I have the remote to myself. I buzz through to where I've left off, and it becomes very obvious that the magician is a very, very bad guy. Monk figures it out right away, not as fast as FD but fast.

FD returns as it's just about to end and I rewind, make him join me. "Watch this!" I command. This is a good part so he can't complain. Monk is in very serious danger, I'm getting very worried. Pazowie! Abracadabra! Natalie shows up with the police and saves him. She throws her arms around him and gives him an emotional hug. I would have, too. This was a really close call.

My pulse eventually returns to normal and FD says to me, "She seems to really have feelings for him. That's not exactly appropriate for an assistant, is it?"

"She's his care-taker," I say. "Her job is making sure he's okay."

"He really needs that much care-taking? It's just OCD."

Just OCD.

"Honey, it's never just OCD. And no matter what the disabling disorder, we tell people to find someone, if at all possible, to check in on them, maybe even coach or take care of them, pay for it if necessary.

Some people really need shadows. In tribal societies this has always been understood. In our industrialized, independence-is-valued-to-a-fault society, too few of us have people to watch out for us, to make sure we' don't kill ourselves, don't drink or stick needles in our arms, who will brush the crumbs off our chins, tuck in or cut off our tags, make sure we've eaten, know where we've dropped our keys. It would be nice if we could always have it together, but most of us can't. And is it all that necessary, anyway? Always having it together?"

I can't help it, I'm on a roll.

"And this doesn't apply just to people who are a little less than functional due to some disorder or another. A person can be perfectly independent and still need a little help now and then. It's ridiculous that we blow off our parents so early, now that I think about it, so dramatically, find it necessary to bark things at people who are just trying to help, like that woman on a television commercial from the seventies, the one who said, Mother please, I'd rather do it myself."

This is the end of the rant.

And you know it's true, we can't help but do this when we're teenagers, even as children or young adults. It is very normal and very good to blow off the caretakers, to glory in our independent choices, our autonomy, at any age, really. Then, we're not sure when it happens, all of sudden it's not so bad to let someone else lend us a hand.

I tell FD, "You'll take care of me, I imagine, one day. When I get old and can't find my glasses."

"Uh, why would I do that?"

therapydoc

Never Write When

My son nonchalantly asks me, "Uh, can I ask? Is your post today long? Or short?"

I know he's not in the mood to read much. "Depends on your perspective. On a second read, not having looked at it since publishing late last night, I thought every word of it too long. Maybe it's better now." A sensitive man, he caught my regret.

"Everyone's entitled to a bad post occasionally, ya' know."

Nah. And not a long bad post, for sure not.

So it's a lesson, don't write when you're sick. Not if you care what people will think about your post. It's probably no big deal for most of us, and we let the words tumble out into the blogsphere. But some of us should watch this compulsion, resist the need to blog, certainly shouldn't do it NPO, (Latin: nil per os ) nothing by mouth. Fasting affects the brain, not in a good way, necessarily. It's so embarrassing.

Seems to me I learned somewhere that master Japanese fine artists, the ones who use ink so beautifully, deliberately, purposefully-- they only work about an hour a day, the best hour of the day.

A lot of us do the opposite. We write while at home sick with something or when we're exhausted, anything but at our best. We love to write about our aches and pains, too. After all, we're sharing our feelings with friends. And we want to be honest with one another, to be real.

But let's talk.

Probably we're going to kvetch about every day stuff, a typical virus, maybe a bruise. The bruise sounds interesting, actually. But the everyday malady is usually the kind of ailment that FD, under pressure will designate as follows:

Question: "WHAT IS THIS, DOC?"
FD: You have an SDV.

Huh?

FD: Yes, an SDV. Some D___ Virus.

They are too numerous to name, to count, and why bother? The treatment is usually the same, basically, and usually isn't about gobbling antibiotics.

Wait, isn't this a mental health blog? What can I say? I live with a doctor. Years and years of listening to phone calls, all day, all night.

don't eat much when you're sick, maybe nothing if it's in the gut or heading that direction;

drink fluids if your nose is running;

don't drink, ANYTHING;

suck on a Popsicle if your throat hurts, maybe,

call me tomorrow and come in.

no, don't go to work. see ME.
subtext: at MY convenience, not yours.

Otherwise you're the one neglecting you.

We're supposed to check in with the doc when in doubt, mainly because no one else wants to hear about it. No one else really cares. Except maybe the tissue and drug companies.

Wait a minute! That's not true, not fair, either. Some people care, probably not as many as we'd like to think, but some people care. It is about you when you're sick.

As the joke goes, and I'm sure I'm butchering it. A lawyer asks his friend the doctor how work is going *and the doctor says,

'Tanks G-d for the flu.'

No, it's not funny, but it is, in its way. Depends on your perspective.

Maybe it's just that while we're in it, while in the center of it, our sniffles, our cough, our stomach flu, what else, it is so consuming, such a mark on our humanity. It can feel life threatening it's so intense, and we don't understand it, the physiology, so we write about it, our own little way of working through the disease. But bottom line, to everyone else, it's not so interesting.

Some of us who write about our everyday kvetches , who come to our senses later, will yank posts right off the blog. The truth is that I really like the bloggers who write about disorder and disease, generally I like all bloggers unless their content makes me sick. Our average community writer is so lovable is the truth.

It's funny that to me, some of the the really interesting ones are about disorder and disease that I'm not likely to catch, the safe ones. Maybe this makes me a wimp or a neurotic or both. But I would bet I'm not alone not wanting to hear about allergies and backs so much, nagging reminders of the human condition. Not that I don't worry about everyone who has allergies and bad backs. It's no fun.

In the winter (seems like spring, summer and fall, too, these days) with all the junk floating around in the air, a person just wants to stay home, honestly. We used to be confused about the OCD types, (you can read about OCD here, Obsessive Compulsive Disorder), people like Howard Hughes, who wouldn't touch a doorknob for fear of germs, who got agorophobic like this. Now we know Howard was ahead of his time.

When you're truly sick, the only trips to the grocery worth making are for tissues, jello and meds. And you can't carry out Chinese, you know, not if the doc says you're NPO, nothing by mouth. That's you, your new identity, those first four hours at the very least, with most things that affect the gut.

This is the long way of saying that you'll be glad to know (still about me, here, still spreading the joy) that the only way you'll get me to write about nausea or a common virus, from now on, no promises, is if Puffs sponsors this blog.

In which case. . .well, what can I say. . .seriously. TELL ME ABOUT IT! LET'S TALK ABOUT YOUR COLD! BRING IT ON! I care, I really do! And so does everyone else! We're going to talk about this, blog about this until we have cured the common cold, and we'll buy stock while we're at it, in tissues, only certain ones, obviously.

All joking aside, to be honest, maybe it's not the worst thing in the world, to kvetch about the little aches and pains. We keep saying that blogging is therapeutic.

The best we can do is do what our doctors tells us to do, not take aspirin (hard on the stomach), do call them when they're working, not sleeping, for non-emergencies, try not to spread it around, and read about the latest home remedies on the web. But ask your doctor, maybe, before you try them.

FD recommends chicken soup for just about everything, you should know.**

To your health,

therapydoc

*You know times are tough, have been for medical docs for twenty years, you have to have compassion, here.

**Vegetarians have to take it slow, if at all with chicken soup. You've lost those digestive enzymes, probably, depending upon how long it's been since you had a good steak.