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Daily inspection of teeth and finger nails. Older pupils make the inspection under the direction of teacher who records results. This has been done every day this year. School #49, Comanche County. Location: Lawton, Oklahoma. (1917). Photo by Lewis W. Hine. From the Library of Congress Prints and Photographs Division."

This month we have been discussing obsessive-compulsive disorder and its relationship to compulsions regarding organization and cleaning. As I indicated at the beginning of the month, I chose this subject because it was something I have not experienced personally and have trouble comprehending. This month’s discussion has corrected a lot of my misconceptions about this condition.

First, in the overview of OCD symptoms, it was a surprise to me to learn that cleaning and organization compulsions are not pleasant to the person who suffers from them. While they may help the person accomplish a lot of work in a short period of time, the person is not doing them out of a sense of pride but rather to alleviate extreme anxiety the person feels. However, I think we can all sympathize with Sal’s comment on this post:

“I wouldn’t mind being OCD about keeping my house clean and organized . . . “

In order to relate to this month’s discussion, I had to think long and hard about myself to find something I do that could be considered a compulsion. Even my husband could not come up with something. Finally, I realized that recycling must be my compulsion. I take extra time to wash out glass bottles, carefully check each plastic bottle for its recycling code, collect and sort white office paper, and junk mail and feel guilty if I accidentally throw something away that could be recycled. It is an automatic reflex for me. For many people, recycling is just a burden and they feel no qualms about tossing stuff in the trash. In part, I am recycling to help the planet but I realized that I am also recycling to alleviate my own anxieties about throwing things away.

I appreciated this great anonymous comment:

“From personal experience, I think we all could be diagnosed with mental illness of one kind or another. . . .”

I also found a wonderful quote somewhere on the web (that alas, I cannot now locate) that indicated that perfectionism is often a sign of OCD. Ultimately, perfectionism is the fear of failure and the perfectionist fears that if they don’t do everything absolutely correctly, something horrible will happen. The same anxiety/compulsion that occurs with OCD often occurs with perfectionism.

I also realized that when you are dealing with someone who has a cleaning or organizing compulsion, it helps to think of the compulsion as a sort of disability rather than assuming the person is judgmental and intolerant. How you decide to react to the person depends on your circumstances. If the individual is your boss or someone else who you need to stay in the good graces of, you probably need to try to accommodate the compulsion to the best of your ability. If the individual is someone you live with on a day-to-day basis, you probably need to consult the person’s therapist to determine whether you should be accommodating the compulsion or working with the person to get over the compulsion.

It was also an interesting coincidence that of the 3 personal stories of OCD we discussed, Howie Mandel, Sammy, and Jared Douglas Kant, all of the affected persons had above-average intelligence. This leads to two possible interpretations to me. Is there a price for genius? i.e. in exchange for the brain specializing in a particular area is the brain less effective in other basic functions? Or is it simply the case that more intelligent people have a natural advantage in coping with mental illness in general? Perhaps we tend to hear more of their stories because the illness does not incapacitate them as it does people with fewer intellectual advantages.

We saw from the profile of Howie Mandel that an OCD diagnosis does not have to limit your potential in life. You can have OCD and still be highly successful. There are at least a few prominent examples in the business world of OCD behavior. We discussed them as well as the trend toward fist bumping as a replacement for the traditional handshake.

We saw in Ruly Ruth’s post that disputes between spouses about cleanliness and organization are relatively common. Perhaps this is the maxim, “Opposites attract” at work.

Finally, as a parent, it was very helpful to know that we shouldn’t consider our children fully developed psychologically until they are approximately 21 years old. During the tumultuous teenage and young adult years, parents should keep in mind that this is also the period when most mental illness appears. If something seems wrong with your child, don’t hesitate to get them evaluated. We know from the stories of Jared Douglas Kant and Sammy that it can take years of treatment to arrive at an effective treatment strategy. The sooner your child begins treatment the sooner your child will understand what is happening and figure out how to cope. Ignoring the problem or hoping the child will grow out of it could be a recipe for years of heartbreak.

On the lighter side this month, in celebration of Valentine’s Day this month, there were also two posts related to friendship and romance. I shared with you my daughter’s valentine project and Andrew Huang shared a great Ruly Mix honoring his wedding anniversary.

I hope this month’s discussion has been enlightening to you. Perhaps you recognized yourself or someone you are close to. If you did recognize yourself, I hope that you keep in mind that while OCD can be beneficial in certain, limited contexts, like cleaning and organizing, it can also go too far. The most damaging aspect of OCD, I believe, is its spreading effect on others. Just because you are personally bothered by something doesn’t mean that others are too and it certainly does not mean that you can expect everyone else to conform to your expectations and make them feel terrible if they don’t. At some point, you have to recognize that occasionally it is someone else’s problem or defect that bothers you but sometimes you are the problem. Likewise, if you identified someone else in your life as being affected by OCD, it is helpful to acknowledge what the problem is and understand that their compulsions can impact you, positively and negatively, as well. There is no perfect solution for OCD and sometimes you are going to have to compromise to meet their compulsions.

Has this month’s discussion changed your thinking in any way? Would you like to revisit this topic in the future? Please share in the comments.

P.S. When I found the above photo from the Library of Congress, I at least breathed a little sigh of relief that we are no longer this obsessive-compulsive in the public school system!

"Jim and Marsha bump fists." Photo by Jeff Hart. From the Flickr Creative Commons.

You may feel that this month’s discussion of obsessive-compulsive disorder (OCD) has little to do with the business world. Yet we all know that we bring our personalities with us to the workplace, including our best and worst attributes.

It shouldn’t be a huge surprise to any of us to know that success in business does not necessarily require perfect mental health. Recall for a moment all the “Crazy Boss Sale” advertising you have seen over the years. Sometimes that “craziness” is due to OCD. We have already profiled Howie Mandel, a successful comedian, actor and businessman and there is one more example I have uncovered…..Donald Trump!

Now, Donald Trump does not admit to having full-blown OCD but he certainly has some views that are consistent with the OCD spectrum. Take for example this quote from his 1997 book The Art of the Comeback that I reviewed last year:

“I am a clean-hands freak. . . [T]here is no way, after shaking someone’s hand, that I would eat bread. . . . [I]f any of you folks reading this book really like me, please approach me a any time, in a restaurant or elsewhere, and don’t stick out your hand but simply bow. I will bow back and greatly appreciate the thought.”

–Donald Trump, The Art of the Comeback

Donald Trump’s clean hands compulsion made me reflect for a moment on the importance of shaking hands in the business world. Traditionally, shaking hands was the way to formally present yourself to a new colleague or business associate and begin the trust-building process.

In MBA school, our class received lessons from a career coach about the importance of a good handshake to signal your competence. For women in particular, it was emphasized that you should never offer just a few fingers like a dainty Victorian maid, but rather present your whole hand and give a firm handshake. In the business world, you always shake hands with an interview candidate, an existing or potential business partner and any new acquaintance within your own company.

But the rules change every now and again. Most recently, the fist bump or knuckle knock is making its way into the workplace. What is the fist bump? If you don’t know, here is a brief, humorous video to explain:

While fist bumping entered the mainstream when Barack and Michele Obama demonstrated it at the Democratic National Convention in 2008, Howie Mandel was using it long before on the Deal or No Deal gameshow and it probably was around before that in professional sports, the African American community and other settings.

But does anyone really fist bump at the office? I never have had occasion to use it in my professional career. The greeting situation I am more often confronted with is reading whether someone wants to shake my hand, hug me or kiss me on the cheek (once or twice)! While a simple handshake is by far the most common, with so many different cultures represented here in the Washington area, a hug and kiss in the Washington business setting is a relatively frequent occurrence.

I asked my husband if he ever fist bumps at the office. He works in a male-dominated field. “Yes,” he said. I was surprised. “When do you use a fist bump?” He explained that it comes up occasionally around colleagues at the office—particularly if they are celebrating a big win. He indicated that he has never used a fist bump with any clients or at serious business meetings, though and it would seem inappropriate to do so.

Might we see more fist bumping in the future? Some signs point to yes. A recent survey from the Purell hand sanitizer company indicated that 41% of Americans have hesitated to shake hands with someone because of a fear of germs. The survey also found that people on the East Coast of the United States were more germophobic with about 50% of people fearing germs through handshakes compared to 35% of West Coast residents. Women and younger people in the survey expressed a greater fear of germs that other populations. The survey also claimed that “roughly half of Americans (49 percent) have chosen the fist bump over a classic handshake.”

It is hard for me to wrap my head around the concept of a fist bump. As a person with relatively small hands and bony knuckles, the thought of crashing my knuckles into someone else’s isn’t exactly pleasant, particularly if the other person hits hard. Offering a wimpy fist bump looks a little pathetic. You would also miss out on some of the information you can gain from a person’s handshake. Are their hands warm or cold? Sweaty or dry? Soft or rough? Do they give a firm or a soft handshake. You get quite a few subtle clues to the person’s personality. With a fist bump, all that information is gone.

Yet, every businessperson today probably needs to know how to fist bump in case it is ever needed. For example, here is the Dalai Lama getting a little fist bump instruction from the Mayor of Memphis, Tennessee in 2009.

Do you fist bump in your office or social setting? Please share in the comments.

"Turlock, California. Husband and wife get ready for dinner in their backyard," (1942). Photo by Russell Lee for the Farm Security Administration. From the Library of Congress Prints and Photographs Division.

My darling husband of 12.5 years, the father of my two precious children, the King of our castle, is also the one who demands we live in a neat home. He literally cannot function with any level of clutter around–it makes him crazy! (I have a few girlfriends who feel the exact same way.) And this feeling of craziness is not imagined or exaggerated; when, for example, the dining table is covered in magazines or scraps of fabric or papers–he feels tense and almost nauseous. He cannot function–he’s irritated and agitated to a state where he can’t concentrate on anything but that surface. The rest of the house could be immaculate, but if the table’s cluttered or there are toys everywhere on the living room floor, it’s almost like having an anxiety attack.

I, on the other hand, have no problem with clutter. The table surface is clean, the items on the table/floor is/are clean, but it can be covered a pile high and I don’t know if I’d notice. I do love it when it’s empty, but it doesn’t bother me. It definitely doesn’t stop the progress of my day. And granted, it’s usually me that makes the mess to top it off.

How to cope with two completely different idyllic levels of stuff management? A marriage therapist would probably recommend a level of compromise (although I’m not positive on that since we didn’t go that route). In our house, it came down to the fact that I’m home all day, and I can deal in a clean or messy environment, and DH (Darling Husband) can’t–so I’m responsible to TRY to keep things as neat and organized as possible. Which I have come a really long way, baby!

My husband describes counter- and tabletops as “Horizontal Surfaces”. Horizontal Surfaces, prior to our marriage, to me would be a descriptive term from 3D algebra or geometry. Not the countertops in my home! These Horizontal Surfaces are to be kept clean so at any time you can set something down. Once something is set down, it must be put away/dealt with/filed relatively soon after setting it down so that the surface can be clear once more. It has taken me almost 12.5 years to figure this out, LOL! (That’s how much this concept never really bothered me.)

In exchange for a renewed vigilance on Horizontal Surfaces on my part, I am allowed TWO areas where my papers/clutter do NOT have to be completely organized. And it’s not to stash them away in a drawer! I have a few friends who have immaculate countertops, but God Forbid you open a kitchen drawer!! The stuff is there–it has to go somewhere. Now as much as I don’t mind a cluttered table, my kitchen has to be relatively neat and tidy–I love to cook and have to have instant access to any of my gadgets. So it’s one smallish area of a countertop with my calendar and extra papers in the far end of the kitchen, and one area near the old Maid’s Quarters (I live in a 1943-ish built home on China Lake military base–and yes–they used to come with maids!) where no one really goes except me most of the time.

So yes–our office area and the majority of the house are very neat-looking and organized. This is what keeps our home and really our marriage functioning. Those two areas of mine could almost be called an eyesore at times–but it’s actually what it takes for ME to function! I love to have all of my necessary papers and documentation that I feel like I need to make sure no missed events, school project due dates, etc. occur.

The huge advantage of this level of neatness is that my house is ready to have people over at a moment’s notice and there are places to sit down, eat, walk, etc. that are completely free of clutter/stuff. And that I love! I love that friends can come over any time–and when we’ve had show our home to sell or rent, it’s no big deal for people to pop over.

I’d love to hear your reactions and your experiences with neatness. And especially coping mechanisms!

"Husband and wife sitting on settee encamped by the roadside, Wagoner County, Oklahoma" (1939). Photo by Russell Lee for the Farm Security Administration. From the Library of Congress Prints and Photographs Division.

Andrew Huang - Website: http://www.songstowearpantsto.com/, Twitter: @andrewismusic

It’s the day after the most romantic day of the year and I thought we could all use a little reminder to cherish our loved ones every day of the year.  This month’s Ruly Mix artist, Andrew Huang, has provided a great song inspired by the day he married his wife.  It is also a great, sunny upbeat track that reminds those of us in winter climates right now that warmer days are coming soon.

Read on for more about Andrew and his music.

What is your musical background? When did you begin playing/writing music? What instruments do you play?

From almost as early as I can remember, I was playing and listening to classical music. Radio pop started to creep in as I approached the age of 10, and soon after discovering the bass guitar at 12 my mind was opened to the worlds of rock, jazz and hip-hop.

I have a bit of formal training in piano, guitar, bass and theory, but am completely self-taught in terms of writing and recording and all of the other instruments I play. “What instruments do you play” is a difficult question for me to answer because while I’m comfortable in my own way on many instruments – for instance, banjo, ukulele, mandolin, drums, glockenspiel, melodica – for all I know I could be doing everything all wrong!

At 15 I decided that writing and recording songs was going to be the most important thing in my life, and since then have dedicated most of my free time to honing those crafts.

What inspires you generally when you are writing music?

Inspiration can come from anywhere. A major theme in my songs is love, but many also touch on political, religious or societal issues that I’ve heard about through the news or that have affected my life in some way. I like to write songs about both the real people in my life and fictional characters and stories I dream up; about large and loft ideas as well as the mundane things we all experience.

An extra tap into inspiration that is uniquely mine is a hilarious website I’ve been running for several years, where visitors are daily suggesting song ideas to me. The majority of them are not that inspiring, but some have induced me to write songs – that I end up liking a fair bit – about the strangest things, from robots in love to energy drinks to sea anemones to brushing your teeth. It’s worth a visit: http://songstowearpantsto.com

Tell us about September 6th. What were you thinking about when you composed this?

September 6th is my anniversary. I started writing the song a few months before getting married and finished it a few months after. It’s the sappiest thing ever, but simply put the song is a celebration of the life and love I have with my wife. I actually wrote the whole song just about our wedding day, but realized later that it will apply to every September 6th that ever comes around for us – particularly the line “I always knew we’d make it this far.” The first half of the song is kind of cute and talks about how much we enjoy being together, and the second half is a rejoicing explosion of singing, latin percussion, bouncy guitar and two drum kits.

This month’s theme is about obsessive compulsive disorder and its relationship to excessive tidiness. Do you classify yourself as a neat-freak? How much chaos and disorder can you/do you tolerate in your own life?

I’m pretty on top of keeping things in my environment clean and neat, though I don’t think anyone would call it excessive. When I get immersed in my work, my studio degrades into more and more disarray, but I always get everything tidied and organized again before beginning another project. I might be a compulsive hand-washer though…

Click the picture below to play or right-click to download Andrew’s track, “September 6.” (If the picture is not working for you, you can also download by clicking here.)

To respect the rights of the musician, please comply with the simple Ruly License terms below.

Ruly License: You may download and play any Ruly Mix song for your own personal use so long as you keep the voiceover tags intact indicating the name of the artist and that the song came from beruly.com. Businesses may also download this song to play as background music in their establishments so long as the voiceover tags remain intact. Any other uses of the song (such as in videos, etc.) must be pre-approved by the musician. Questions about license permissions can be addressed to info@beruly.com.

If you enjoy this mix, please comment, give a “like” on Facebook and share this link with others!

Previous Ruly Mix artists: Ben Harris, George Vlad, Samuel Pushpak, Danny Stewart-Smith (“Maintain Focus”), Danny Stewart-Smith (“The Flow”), Danny Stewart-Smith (“Insights”), Danny Stewart-Smith feat. Evin Gibson, Joe Hanley, Jamie Smith, Rajiv Agarwal

With a houseful of girls, Valentine’s Day is a big deal at our house.  It is the most frilly, girly holiday there is.  Making crafts with hearts, lace, glue, glitter and markers is right up our alley.   Last year, I took a homemade approach and shared my recycled crayon valentine project.  This year we went with a prepackaged approach.

We happened to be in Michael’s in early January for some errand when the Valentine’s Day craft supplies had just arrived.  My 5-year old zeroed right in on the foam sticker selection.  We found some really cute make-your-own Valentine teddy bears where all the foam pieces were pre-cut and self-adhesive.  They came in a pack of 12  bears for about $5.

When we got home from the store, my young art enthusiast wanted to get started on them right away.  She sat for an hour dutifully making all the valentines all by herself.  This was a fantastic craft for this age group because it was entirely self-created.  I did not need to help with anything at all.

The downside of a prepackaged craft is that it doesn’t allow for much creativity.  Well, you might think that (as I did) but that underestimates the creative powers of children.

“Mom, now I am going to make a Valentine’s rabbit.”

“Ok, great!” I said, not looking up from what I was doing but curious as to how she was going to make a rabbit out of a teddy bear shape.

“Look, mom!  It’s done!”

She proudly showed me her work, in which she discovered that if you turned the teddy bear shape upside down and used the bear’s legs as “ears” it did make a convincing rabbit shape!  It was a moment that would make Martha Stewart proud.

We found some Dove heart-shaped chocolates that were the perfect fit for the heart on the bears (and rabbits) and taped them on.  She wrote her name in Sharpie on the animals’ arms and added some small drawings too for a personalized touch.

After weeks of asking when Valentine’s Day would ever come, she took great pride in delivering the valentines she made herself to her preschool class this morning.

Yesterday, Michael’s offered a free Valentine making session for children that we attended and had great fun using punches, glitter glue and markers to create unique valentine art.  We also wanted to take advantage of Michael’s 60% off foam valentine craft kits to stock up for next year.  Sadly, the store was almost completely denuded of anything valentine-related.  All the valentine shelves were bare.  There was hardly a heart-shaped anything to be found. An elementary school teacher was lamenting what craft she would do with her class the next day and the Michael’s staff was helping her come up with alternatives.

So, if you love Valentine’s Day like we do, next year, put it on your calendar to check out Michael’s Valentine’s Day supplies in mid-January!    Also, if you intend to do any crafting for St. Patrick’s Day (March 17) or Easter (April 24), you might be interested to know that Michael’s has its stock in now for these holidays!

Happy Valentine’s Day to all my readers!  Wishing you lots of love and happiness throughout the year!

Today we discuss one more personal story of OCD. Like Sammy in the previous profile, Jared Douglas Kant first experienced debilitating OCD symptoms as a young pre-teen. Also, like Sammy, Jared was a bright kid with lots of creative ideas. Where Sammy was strong in math (to the point of having a mild reading and language disability), Jared was strong in language (to the point of having a mild math disability).

“[M]ost of my memories from being younger seem to center around a knowledge that I was somehow special. . . .

I loved to read; I was reading at a twelfth-grade level in the first grade. . . . I was computer literate in kindergarten. . . . I grew up in an affluent community with a loving, hard-working family.

I realize now that I had some peculiarities, but they didn’t seem to cause much of a problem. I was useless at team sports, but I could hold my own in any discussion. . . .

Essentially, aside from being a horribly picky eater, overly shy, and constantly mindful of a desire to remain clean at all times, I was a normal kid. I suppose they really mean it when they say puberty changes everything.

–Jared Douglas Kant, The Thought That Counts

Jared’s first recognizable symptoms appeared at the age of 11. He begins to worry that merely touching books he is reading about the Ebola virus will cause him to get the disease. He begins washing his hands more often. He has a precise route by which he has to enter and leave the junior high school building. He begins to express vocal “tics,” unusual noises that he feels compelled to produce, much like a person feels a need to sneeze.

Jared’s journey is a tough one. He is institutionalized twice. His parents force him to attend a therapeutic boarding school. He contemplates suicide. Eventually, by embracing cognitive behavioral therapy (CBT) as well as a love of martial arts, he gains control over his condition and graduates high school and college with honors. He now is a research fellow at the International OCD Foundation and is pursuing a graduate degree in social work.

Jared wrote a memoir of his experiences with OCD, a condition he continues to struggle with today, in The Thought That Counts: A Firsthand Account of One Teenager’s Experience with Obsessive-Compulsive Disorder. The book is co-written by Martin Franklin, Ph.D., a professor of psychiatry and writer Linda Wasmer Andrews. Throughout the book, Jared’s personal anecdotes are woven together with OCD reference information. It’s a fact-based sourcebook for teenagers and young adults on OCD with a personal touch.

Jared’s story adds a couple of key details to our OCD discussion.

The most touching aspects of this book are the numerous descriptions of people who were Jared’s supporters during some very difficult and embarrassing times.

“OCD was unpredictable, awkward and embarrassing. It would crop up in the most inconvenient places—although I think it’s safe to say there’s really no such thing as a good place for an OCD attack.”

–Jared Douglas Kant, The Thought That Counts

In junior high, when Jared suddenly finds himself in the mortifying position of having an episode of vocal tics while standing in the junior high school lobby filled with students, a surprising thing happens:

“Then my friend Jessica came over and saved my dying social life. Jessica had a gorgeous smile with a personality and body to match. The whole school loved her. What most people didn’t know was that Jessica had OCD with a side order of Tourette’s syndrome . . . . Jessica was a master at camouflaging her symptoms. At school, she clapped her hands under the desk but by using only one hand like a clamshell snapping shut, she minimized the noise. She also licked her lips frequently but by applying fresh lip gloss afterward, she simply seemed like a connoisseur of lip care products.

We moved down the hall, away from the other students. Then I collapsed, crying softly, and Jessica cradled me. My friend Brad, who was the size of a house but all muscle and heart, stood guard as my personal bouncer. I was safe and saved.”

–Jared Douglas Kant, The Thought That Counts

. . . “[T]he locker became my personal refuge. I went there to hide, to count, to cry alone –in short to do whatever it was that other people didn’t need to see. Before long, hiding in my locker had become a compulsive ritual. . . .

As you can probably guess, the day finally came when I was observed by a group of people as I emerged from my hiding spot . . . To my surprise, a popular kid in the class thought this was the coolest thing he had ever seen. Most people just skipped class by travelling the halls. I actually had a place to hang out and listen to music. I gained a reputation as something of a contortionist and I ran with it. It was a whole lot better than being an outcast.”

–Jared Douglas Kant, The Thought That Counts

“I wasn’t comfortable changing into my gym clothes. . . . I also had to dress according to very specific rules. If I put on my socks before my shorts, which I was prone to do because I was so repulsed by the dirty floor, then I would have to undress completely and start the process all over again. Needless to say, I was almost always late to gym class.

One day it went too far, even by OCD standards . . . . When I finally snapped out of it, I realized, much to my confusion and distress, that I wasn’t wearing any clothes except for my socks and shoes. . . . Finally, I collapsed onto the floor crying. . . .

At that moment, the coach happened to go into his office, and he heard me cry out. He came into the locker room, concerned and confused. . . .He came over, knelt beside me, and wiped my tears until I looked up in choking sobs. . . .

Another student—a good-hearted friend who cared about my condition and wanted to help—wandered into the locker room. . . . The coach told my friend to contact the other gym teachers and explain that the boys’ locker room was temporarily closed . . . The coach sat with me and coached me through getting dressed. He assured me that no harm would befall me or anyone else if I opened my locker and finished putting on my clothes. . . . I thanked God for this man who had wandered through by sheer providence and helped me overcome the immobilizing effects of anxiety.”

–Jared Douglas Kant, The Thought That Counts

One eye-opening anecdote he shares has to do with “harming obsessions.”

“It was during my junior year of high school that I experienced my most horrific and terrifying obsessions. . . . For instance, in the middle of a conversation with my best friend Corinne, I would suddenly see myself burying a hatchet in her chest. . . . I also developed a fear that if I didn’t tell my therapist every single thing I had done the entire day, it would turn out that I had omitted the part where I killed someone and left the body in the woods. . . Sometimes in the middle of a therapy session, I would tell my therapist that I was afraid I was going to hit him or do him bodily harm. . . . “

–Jared Douglas Kant, The Thought That Counts

Wow! If you knew that your child’s classmate, a co-worker or someone else you closely associate with was having these kinds of thoughts, it would be extremely scary to most of us. “He’s mentally unstable and violent too!,” we might think. It turns out in the case of OCD, we would most likely be wrong! Apparently these types of harming obsessions are relatively common among OCD individuals. The people are not violent but rather are deathly afraid that they could be violent and they obsess about it and have these very unusual and graphic thoughts. Should you ever experience this unique situation in a school or work setting, it is still appropriate to act with caution and request clarification on the individual from a mental health expert but it is also important to know that not every violent thought is indeed a real risk.

Another interesting detail revealed by this book is that it is not uncommon for OCD individuals to refuse to participate in the very therapies that would help them the most. A form of cognitive-behavioral therapy called exposure and response prevention is one of the most effective treatments for OCD. The problem is that this therapy requires the OCD individual to experience the things that they fear the most—a hard sell indeed.

“These days, parents of young people diagnosed with OCD ask me what they can do to get their kids to participate fully in therapy. I tell these parents that they have to accept their powerlessness over the situation. . . . No one—not even your parents—can force recovery onto you.”

–Jared Douglas Kant, The Thought That Counts

You can hear more about Jared’s story from the man himself in the video below. Fast forward to the 43:07 mark for his recent presentation for OCD Awareness Week.

OCD Awareness Week – OCD Stories part 1 from International OCD Foundation on Vimeo.

I think we can all appreciate how much courage it took to write such an honest memoir.  It is sure to be an empowering read for many newly diagnosed OCD patients.  Please share your thoughts in the comments.

This month we are looking at an organizing extreme, obsessive-compulsive disorder (OCD), both to better understand our own organizing motivations and the motivations of OCD-affected individuals, which ultimately impact all of us.

While the pre-teen and teenage years are challenging for most people, they are especially tough for children experiencing OCD for the first time and those children’s families. The majority of OCD affected adults seem to experience a sudden onset of symptoms in the early teen to early adult years (approximately ages 12-21). For both the child, the parent and the family, this is an extremely scary and frustrating time. One moment you have a normally progressing child just about to enter the teenage years and the next moment you have a preteen suffering so severely from vague fears and strange movements that you begin to wonder whether your child will ever get better and is lost to you forever.

Saving Sammy: Curing the Boy Who Caught OCD tells this experience from the mother’s perspective. Beth Alison Maloney was raising three boys as a single, working mom after a recent divorce. She moved the boys to Maine while their father remained in the Los Angeles area. Her eldest son Josh showed great proficiency in math and science and was accepted to a Maine boarding school for math and sciences. Her second son, Sammy, is also extremely gifted in math and seems to be recognized as a borderline genius/savant by his teachers. Not much is said about the talents of her third and youngest son, James, who was only 8 at the time, but he seems normal and well-adjusted in the story.

After Sammy turns 12 and the family moves to a new home, Sammy begins behaving very strangely. The changes are subtle at first and progressively become more severe.

“He now had verbal tics that peppered his speech like hiccups. . .. As time went on . . . there were more and more tics . . . Within a few weeks, they had completely changed his speech pattern.

He stopped flushing the toilet . . . and resumed permanent residence on the couch in the den. When he occasionally changed his clothes, it took him forty-five minutes to do so.

He told me the house was full of invisible walls. They sprouted like lasers in every direction, from electrical outlets television sets, portable telephones, and DVD players. . . . He had to step over or duck under each one, depending on their location. . . .

Each morning he had to have a series of different drinks . . . milk, orange juice, apple juice, pink lemonade and grape juice. . . .

He stopped walking entirely. He jumped and hopped instead. The pounding, pounding was relentless. Lamps fell off tables. Smoke detectors fell off the walls. . .”

–Beth Alison Maloney, Saving Sammy

Sammy’s behavior becomes all consuming. He can’t eat, he can’t go to school because of fears about entering the school building. Any time he or the family goes anywhere, they literally have to wait for hours for Sammy to complete the physical rituals needed to enter the car, exit a restroom, walk through the front door of a building, etc. Sammy spends hours locked in his room at home. He is awake often all night long wandering the halls of the home. Ms. Maloney is spending as much time monitoring Sammy as she would a fussy newborn. It’s utterly exhausting.

Desperate for answers, Ms. Maloney begins consulting doctors, psychologists and psychiatrists. They diagnose Sammy with OCD and then later with Tourette’s syndrome. They prescribe various medications and Sammy begins counseling sessions. All of this effort is having very little effect and Sammy’s condition seems to be getting no better and sometimes worse.

Ultimately, Ms. Maloney is inspired by a friend to get her son tested for strep infection. The medical information here gets a little fuzzy for me to understand but it appears that in some cases children have been known to develop severe OCD-like symptoms after exposure to strep bacteria (a syndrome called PANDAS). Generally these children are quite young and they are either treated with antibiotics or a procedure that cleans their blood to remove strep antibodies.

Sammy’s story gets complicated here. Ms. Maloney makes the case that once her son was diagnosed with strep it was the answer to all their prayers and, once on a regimen of strong antibiotics, Sammy began to get better. He was eventually completely healed of all his symptoms and the symptoms only seem to recur when he is exposed to the strep virus.

Below you can watch an interview with the author and her son on the Today show in 2009.

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It is an incredible story and very well-written. It gives you the day-by-day experience of living with someone with severe OCD and the impact it has not only on the affected person but the family and friends as well. It is also a bit of a love letter to the state of Maine. Ms. Maloney describes the scenery and events of Maine living so beautifully I now have put Kennebunkport as one of the vacation destinations we hope to visit soon.

Sammy’s story is inspiring but also controversial. Some of the medical issues include: 1) not all doctors seem to accept PANDAS as a diagnosis, 2) “strep infection” is surprisingly hard to define even with medical tests and 3) even the doctors who do accept PANDAS don’t agree that Sammy has it. Some prestigious doctors Sammy consults in neurology and other fields tell his mother outright that he does not have PANDAS and instead has a permanent mental illness.

Dr. Roger Kurlan, is one of the leading PANDAS “nonbelievers” as Ms. Maloney calls them in the book. In this recent webcast from 2010, Dr. Kurlan reviews some of his most recent research on PANDAS.  Dr. Kurlan claims that his study comparing PANDAS-identified patients with non-PANDAS children with OCD and Tourette’s syndrome showed that strep-infection made OCD and Tourette’s symptoms worse in PANDAS children only 7-25% of the time. In other words, 75-93% of the time, exposure to strep had no correlation to their symptoms. Dr. Kurlan indicates that it is the natural course of Tourette’s syndrome to have symptoms wax and wane over time and children often get better and worse even with no medical intervention. Also, about 2 out of 3 children outgrow Tourette’s syndrome. Dr. Kurlan also indicates that exposure to any type of physical or emotional stress, from viruses and bacteria, to seasonal allergies, problems with family and friends and final exams can worsen the symptoms in patients with mental illnesses. Dr. Kurlan acknowledges that a PANDAS diagnosis might be useful in identifying a rare subset of children who are more susceptible to strep, but that ultimately, antibiotics are not a “cure” and traditional mental health therapies are still needed for PANDAS children.

So that leaves us with a lot of questions about Sammy. Does he have a new infection-related OCD condition that has not been discovered yet? Or could it be possible that his treatment and recovery was a bit of a coincidence? Could his recovery also be explained by his maturing into an older teen who was better able to implement cognitive behavioral therapy and better adapt to stressful situation such as coping with the divorce and visitation schedule and his brother leaving for boarding school. Toward the end of Sammy’s worst period he suddenly announces to his doctor:

“I found a loophole . . . I don’t need to do compulsions anymore. . . . So instead I do a substitute compulsion. . . Like I count to six on my fingers instead of going over an invisible wall.”

–Beth Alison Maloney, Saving Sammy

Sammy is so intelligent that it is not impossible to believe that he is able to construct a sort of giant chess match in his head for daily living. His internal conversation might read: “If I am thinking X, I need to do Y to avoid this thought and focus on Z a real thought.” His system generally works except perhaps when he is overly stressed or tired and his brain can’t keep up with it. Once the stress is removed, he can go back to normal functioning.

There are some very interesting social questions raised by this book as well. The first comes to communicating with your child about mental illness. Below is Ms. Maloney’s view:

“I still had not told Sammy the name of his disorder. There are two theories when it comes to children and mental illness. One is to treat the behaviors and keep the diagnosis confidential. The other is to share the diagnosis. Even some grown-ups never fully recover from some truths, so when it comes to children, I feel it is best to err on the side of caution.

Another reason to be cautious is that a mental illness diagnosis is never certain, and once a child is labeled, it tends to stick.”

–Beth Alison Maloney, Saving Sammy

Another issue comes up as to how close family and friends should treat someone with severe mental illness. Ms. Maloney was often isolated from friends and normal social interactions when dealing with the worst of Sammy’s illness. But there were still very good friends who stood by her and Sammy through thick and thin. I was especially moved by the description of Sammy’s friend Devers who wanted to come visit Sammy at his home. Devers had to comply with a myriad of requirements, including wearing socks with his sandals so that Sammy wouldn’t have to look at Devers’ toes. I imagine the compassion of friends like this is extremely important to the recovery process. In the average junior high or high school, Devers would take a lot of heat from his peers for visiting the “crazy kid,” but he stuck by his friend. I imagine that kindness will never be forgotten.

The story also gives the real picture of the stress experienced by families of the mentally ill. For many families struggling with OCD, Sammy’s story is the dream they have been hoping for. I imagine families affected by autism want to find similar “cures” to reclaim the children they once knew. As Ms. Maloney says to her eldest son, Josh, at a low point during Sammy’s treatment:

“Sammy’s doing better, don’t you think?” I asked, sliding the scrambled eggs from the pan to his plate.

“No, Mom, he’s not,” Josh answered impatiently. “And why do you keep saying he’s getting better when he’s not?” . . .

“Because if I thought this was it, that he’d never get better, and that for the rest of our lives it would be like this, I’m not sure I could get up in the morning and keep going,” I shoved the plate at him. “Got it?”

Josh nodded yes.

–Beth Alison Maloney, Saving Sammy

One thing that is never in doubt during this book is Ms. Maloney’s love for her son. She never gives up on Sammy. She waits patiently through years of treatment. She contemplates institutionalizing Sammy at various points but ultimately bears the responsibility for his care herself at home. She also demonstrates incredible organizational skills when it comes to researching and documenting her son’s illness, including daily diaries of his symptoms, videotapes of his compulsions and records of his medications and doctor’s visits.

This book and Sammy’s story gives us all a lot to think about. What does it mean to be “mentally ill”? What do you do when your heart and personal experience tells you one thing and medical science tells you another? If your child was affected like Sammy, would you try anything possible in your search for an effective therapy? How can we as a society better support the treatment of people affected by mental illnesses? Please share your thoughts in the comments.

Howie Mandel on the set of Deal or No Deal. Photo by The National Guard. From the Flickr Creative Commons.

Of all the obsessive-compulsive disorder (OCD) profiles, the “germophobe” is the one we probably think of the most often. This person’s greatest fear is that things are unclean, contaminated or may cause illness. While we all may wonder how someone gets to this extreme, we have to admit that there are certain situations where being a germophobe has its advantages. Take, for example, this tuberculosis poster I found while browsing the Library of Congress pictures database.

Tuberculosis poster from Hempstead, New York (~1941). WPA Federal Art Project. From the Library of Congress Prints and Photographs Division.

Before advances in modern medicine when child and infant death rates were high, the best preventative medicine a mom had was germophobia. In some cases it probably was a matter of life and death. We sometimes still see these situations today. For example, the recent anthrax scare in the mail system, some flu strains, and terrible but rare diseases like ebola virus.

For the OCD individual, though, germophobe is a mild description of how concerns about germs actually affect the person. Not only does the person have a fear of germs but that fear is not alleviated even when measures are taken to sterilize everything. Washing hands for hours or taking shower upon shower are common reactions to germ contact in an OCD individual.

Howie Mandel may be the biggest celebrity to publicly acknowledge he struggles with OCD.  In his memoir, Here’s the Deal: Don’t Touch Me, he provides a very humorous and engaging autobiography, which, in part, addresses how OCD has affected him throughout the years.

Mr. Mandel is part of the 1/3 of adults with OCD who had diagnosable symptoms as a child.  Yet, it does not appear that Mr. Mandel ever saw a mental health counselor until he was a young adult.  Why not sooner?  As he describes his childhood, it may be that since a number of adults in his family had cleaning compulsions, no one saw anything wrong with his behavior.  It also could be that his symptoms were relatively mild and the family just saw them as quirky and manageable.

“If somebody sniffled and touched my crib, my mother would mark the spot in her mind.  She would remember that it was two inches to the left of the headboard, and again, as soon as that person left the room, she would hit that spot with the Lysol, putting me back in my sterile environment.

You might think this was over the top, but the apple didn’t fall far from the tree.  The first and all recollections I have of visiting my grandparents on my mother’s side were of approaching the house and seeing my “bubbie” outside the front door on her hands and knees, waxing the concrete veranda.  . . . There was no way she was going to allow anyone to track filth into her home. . . . I don’t think I ever touched any of the furniture or carpets in her house because it was all covered with plastic. . . .

By first grade, I had other issues. . . When my [shoe]laces touched the ground, I could not bring myself to touch them. . . . My young brother, Stevie, had a sense of the things that horrified me.  . . . [I]f I was chasing him, his last bastion of defense was running to the laundry hamper, removing the lid and waving it in my direction. . . I don’t know what I thought would happen if it touched me, but I was horrified and the fight would come to an end.”

–Howie Mandel, Here’s the Deal: Don’t Touch Me

As Mr. Mandel grew older the symptoms seemed to intensify and even change.  To this day he requires professional mental health treatment for his condition.

“Fear is probably the most powerful driving force in my life.  I’m always afraid of losing control.  I’m afraid of how I feel.  I’m afraid of hurting someone else.  I’m afraid I’m going to die in the next minute and a half.  This is my life.”

–Howie Mandel, Here’s the Deal: Don’t Touch Me

One of the most interesting things I have learned from reading OCD memoirs is that one of the most terrifying aspects of this mental illness is that the affected person has to ultimately realize that their own thoughts are not 100% reliable.

“It’s debilitating to know I’m not in control of my own mind.  It goes places, and I cannot bring it back.  People close to me will tell you that during these times I seem agitated or intolerant.  The best description is that I feel incredibly busy in my own mind, and that’s why I need distraction.”

–Howie Mandel, Here’s the Deal: Don’t Touch Me

For the average person this situation is hard to even comprehend.  Can you imagine your mind telling you something, something that feels incredibly real and perhaps even rational, yet you have to somehow learn to say, “I can’t trust that thought.  It must be the OCD talking.”  I imagine you would start to doubt almost everything you thought or felt and it would take a long time to learn (with professional help) which thoughts to trust.

The most amazing part of Howie Mandel’s story, however, is how in spite of his condition which we would all expect to limit his life choices, he becomes a successful stage performer, he has a strong marriage to a very understanding wife and raises three children.  It would be hard to come up with a better OCD success story.

How does Mr. Mandel compensate for his OCD shortcomings?  Comedy requires a keen intelligence, including the ability to think quickly on your feet and to make rapid connections between ideas, people, emotions, physical actions, modes of expression  and objects.  High intelligence seems to be tremendously helpful in successfully coping with OCD.

The other factor in Mr. Mandel’s case seems to be his competing drive for attention.

“I now believe that my brother, Steve, is the reason I have become a performer today.  From the moment ‘the baby’ appeared, I spent every waking moment trying to get all the attention.  Regardless of whether that attention was positive or negative, it was attention just the same.  I didn’t make the connection at the time, but child experts say that a good part of your personality and who you are going to be is formed in the first years of your life  If that is true, then the sick need that I have to be accepted and appreciated by people I don’t know stemmed from spending my entire childhood trying to get 100 percent of the attention.  Obviously, you can’t get all of the attention, but I promise you I’m still trying.”

–Howie Mandel, Here’s the Deal: Don’t Touch Me

For more information on Howie Mandel and his OCD, you can watch the 20/20 profile on him at his website howiemandel.com, which gives details that aren’t discussed in the book.

How does knowing about Howie Mandel’s OCD affect your perception of him?  Please share in the comments.

The closest you may ever get to shaking Howie Mandel's hand. Howie's handprints preserved in cement. Photo by _rockinfree (Claire Schmitt). From the Flickr Creative Commons.

Rehabilitation client worrying over his accounts, Jackson County, Ohio (1936). Photo by Theodor Jung. From the Library of Congress Prints and Photographs Division.

It is the start of a new month and time to introduce a new discussion topic.  This month we will explore an extreme perspective of organization….obsessive-compulsive disorder.

This month’s topic comes out of my own curiosity and desire to better understand certain extreme points of view about cleaning and organization.  How many times have you read a news article such as this one about the hazards of sleeping with your dog or this one about exactly how many germs are on kitchen sponges, door handles and other household items.

I see these articles all the time and I keep wondering, “Who cares about this stuff? Does it really help anyone to know all of this?  After all, we have been doing these germy-dirty activities forever and no one we know has been sick or died from them yet!”   I just scratch my head and find it amazing how many people are truly interested in this information.  Some other viewpoints that confuse me:

• People who can’t eat foods where the chef has to touch and arrange a lot of the ingredients.
• People who fret excessively about using public restrooms.
• The common refrain, “I can’t go to bed if there are dirty dishes in the sink.”

What is behind all of this?  I decided this month to try to find out.

My objective is not to cure people or provide any sort of therapy.  That is clearly not in my job description.  Rather, my goals are to share stories from people who have suffered from obsessive-compulsive disorder, to better understand and recognize the condition and to learn how obsessive-compulsive disorder affects all of us and our organizing habits.

Below is my continuum of the human condition when it comes to organization. (Click the picture for a larger view.)

There are two basic organizing styles.  On one side is a structured, controlled style with the extreme end at obsessive-compulsive disorder and on the other side is a loose, adaptive style with the extreme end at chronic disorganization.  In the middle of the continuum is the fictional “normal” (which no one really is).  Neither style is “correct” and each style has its advantages and disadvantages.  Most of us generally lean one direction in most cases but we most likely employ a mix of styles in different circumstances.  For example, many people have one approach to managing their physical environment and the opposite approach to managing their money.

Taking a few steps in either direction on the continuum doesn’t cause most of us any serious problems coping with daily life.  Everyone goes a little too far once in a while but most of us can recognize when we have reached that point and make adjustments to come back closer to center.  When a person either can’t recognize that they are far from the center or has no idea how to dial things back, this is often where professional mental help is needed.

Starting our journey along the continuum toward obsessive-compulsive disorder (“OCD”), first I thought it would be helpful to have a brief OCD Q&A.

What are the characteristics of OCD?

As the name suggests, there are two essential characteristics of OCD.

1)   Obsessions. These are excessive fears the person has about one or more situations.  While everyone may worry about these things from time to time, a person affected with OCD worries about their obsession all the time.  It’s like a giant tape loop in their head constantly repeating the worry.  What are the common OCD obsessions?

• Contamination and germs (the most common)
• Causing harm to others
• Being harmed or embarrassed by others
• Not being prepared when circumstances change
• Offending God or doing something immoral

2)   Compulsions.  Compulsions are activities the person does to relieve the anxiety caused by the obsession.  Sometimes the compulsion has a connection to the obsession, for example, washing and cleaning as a response to contamination fear.  Other times, the compulsion is something unusual like pacing a specific path or counting to a certain number.  The compulsion is generally something the person does not enjoy doing but feels is the only way to make the obsessive thoughts stop.  When the compulsions begin to take an hour or more per day or begins to otherwise interfere with normal life functioning, OCD is formally diagnosed.  Other disorders with an OCD connection include Tourette’s syndrome, certain aspects of hoarding, eating disorders like anorexia and bulimia and hypochondriasis (fear of having a serious illness).

What causes OCD?

The exact cause of OCD is unknown but OCD is generally thought to have a genetic connection related the structure of the brain.  Certain parts of the brain are hyperactive in OCD individuals.  Environmental stressors can influence the severity and frequency of the disease, however.  Some studies have also linked bacterial infection to OCD symptoms, particularly in children.

How common is OCD?

The International OCD Foundation estimates that approximately 1% of the population suffers from OCD.  A survey in the 1980’s by the National Institutes of Mental Health suggests the number may be higher, at around 2% of the population.

Many people with OCD are deeply ashamed of their disturbing thoughts and rituals and don’t want to disclose them to anyone–even a professional mental health counselor.  The condition causes them so much distress that often OCD sufferers also have anxiety and depression.  It can take an OCD sufferer a while to develop enough trust with a mental health professional to be willing to disclose the obsessions and compulsions.  It is possible, therefore, that the number of OCD sufferers is under-reported and that some people seeking help for anxiety and depression could also have OCD.

When is OCD diagnosed?

Approximately 1/3 of adult OCD sufferers are diagnosed as children. In most other cases, OCD appears in the teenage and young adult years and can come on suddenly.

How is OCD treated?

OCD is a challenging disorder to treat.  Generally a combination of various mood-stabilizing medications and cognitive-behavioral therapy is used to treat OCD.  The goal of most cognitive-behavioral therapy is to get the person to think about their obsession (or sometimes experience the actual fear itself) and to retrain the person to stop doing the compulsions and instead learn how to address the obsession in a more productive manner.  OCD is never fully cured but a person can learn to be effective and productive and handle their obsessions appropriately with proper treatment.

How does OCD impact family and friends?

OCD has a dramatic impact on close friends and family.  Often an OCD-affected individual will insist that family and friends adopt their compulsions.  Many family members will comply with such a request feeling that it must bring the OCD sufferer relief.  Surprisingly, it turns out that this harms the OCD sufferer more than it helps.

“Family members who participate in rituals are unintentionally reinforcing and strengthening OCD symptoms.  Recognizing the problem is easier than doing something about it.  Just stopping participation abruptly is likely to be met with anger, resentment and increased anxiety.  A better approach is to collaborate with the person who has OCD in a plan to lessen involvement with the symptoms.  This is most likely to occur in the context of cognitive-behavioral therapy with an experienced therapist directing the effort.”

–Bruce M. Hyman, Ph.D. and Cherry Pedrick, R.N., Obsessive-Compulsive Disorder

What should I do if I think I have OCD?

OCD is a very complex condition that requires accurate diagnosis. Often it is best to look for a therapist with an expertise in OCD.  You can find a searchable list of therapists here at the Obsessive-Compulsive Foundation website.

I hope this month’s discussion will give you a new angle on organization and motivation issues and may help you think more about your own psychology.

Where do you fall on the continuum?  What are your experiences with OCD?  Please share in the comments.