April 6, 2015 • 50 mins
What is obsessive-compulsive disorder and why does it happen? Cristen and Caroline separate mental health facts from pop cultural fiction about this commonly misunderstood disorder that affects millions of men and women.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to stuff Mom Never told You from how Stuff
Works dot com. Hello, welcome to the podcast. I'm Kristen
and I'm Caroline, and today we're gonna talk about obsessive
compulsive disorder or o c D, which is something I
have a feeling most of us are casually familiar with.
(00:25):
We might even joke about having, say O c D
in terms of having to do the dishes in a
particular kind of way load the dishwasher. I don't know
what you would be referring to Christen Conger dishwasher mistress.
I may or may not have a very particular way
of loading the dishwasher. But the fact of the matter is,
(00:45):
within the medical community a lot still isn't known about
o c D, and O c D isn't something for
people who actually experience it that is as casual to say,
really enjoying an orderly dishwasher, right, because I was accused
in college of being o c D because I follow
(01:07):
the same morning routine so strictly. Uh, you know, like
my roommate actually said, you know, God, are you just
like totally O c D? You know, you get up
the same time every day, and then you shower and
then you do this and this and this, and it
never deviates. And it's My response was, well, that has
way more to do with the fact that I have
not switched on my brain yet in the morning. It's
not that I, you know, I feel compelled to follow
(01:28):
a certain routine, but yeah, it's it's o c D
is so much more than just loading the dishwasher certain way,
following a certain morning routine. It's certainly more than just
how adorable the character Monk is on that television show.
Because the key to o c D that separates the
media representation from the real life reality is that people
(01:52):
with obsessive compulsive disorder don't actually enjoy the things that
they feel compelled to do. Yeah, and it is rather
ironic that we collectively approach o c D and talk
about o c D in such a casual, joking way,
whereas it is this disorder that still needs a lot
more attention. So, for instance, Johns Hopkins Hospital researcher Dr
(02:16):
Gerald Nestalt, who recently identified a gene linked to o
c D, told Newsweek quote, it never had the sexy
appeal of other psychiatric disorders, So we're fine with joking
about it. But the jokes have perhaps eroded our perception
of it as a serious mental disorder that affects a
(02:37):
lot of people. Yeah. Well, and the interesting thing too,
is that o c D this is not a new disorder.
This is not something that has just cropped up in
the past ten or twenty years that scientists are thinking, oh,
maybe we should finally study this. People have been writing
about and observing o c D symptoms for centuries. Yeah.
We found a lot of information about the medical history
(03:00):
of obsessive compulsive disorder over at Stanford, and it was
first described in medical literature in the sevent century as
quote symptoms of religious melancholy, and pretty much the entire
representation of it at the time seemed to be the
struggle between the mind and carnal thoughts and God right
(03:22):
and in Bishop John Moore defined it as trouble where
the trouble is over a doubt. When doubts are resolved,
he wrote that naughty and sometimes blasphemous thoughts which start
in their minds while they are exercised in the worship
of God, despite all their endeavors to stifle and suppress them,
the more they struggle with them, the more they increase
(03:43):
so that definition, while it is very very old, is
not that unfamiliar to people who have researched the disease today.
And in the nineteenth century, the more modern concept of
o c D really begins to evolve, with differentiations between
obsessions and delusions as well as compulsions and impulsions, in
(04:05):
other words, figuring out what the line is between maybe
just naturally impulsive behavior and unnaturally compulsive behavior. Right and one,
psychiatrists described it as a form of partial insanity. And
while this idea was abandoned by the mid nineteenth century,
so it didn't have a very long lifespan, what I
(04:26):
thought was interesting about it was that it's this partial
insanity idea that is sort of how o c D
is described today, because the whole thing is that someone
with o c D recognizes that the thoughts and behaviors
that they experience day in and day out, are not normal,
they are quote unquote crazy, and that they feel that
(04:47):
these are negative things that they just have no power
to avoid or ignore. And so this idea, while it
was abandoned, was sort of on the right track. And
around the same time the Germans were positive, saying that
it was a disorder of intellect and speaking of the Germans.
O c D gets its name in the late nineteenth
(05:07):
century from differing translations of the term forgive me if
I mispronounce it zvang wost a lung, which is a
compelled presentation or idea. Yeah, so in Great Britain they
translate this when you say the German term again, please Caroline,
because I don't trust my mangled German pronunciation uh zvang
(05:28):
wost a lung, So they translate that as obsession, whereas
in the United States it becomes translated as compulsion. And
so we agree to disagree and call it obsessive compulsive
disorder and moving away from Germany and into Austria. Of course,
Freud had something to say about o c D, but
(05:49):
we won't dwell on Freud for too long. But Freud
thought that o c D was simply the mind's maladaptive
response to quote conflicts between unacceptable unconscious sexual or aggressive
i'd impulses and demands of conscience and reality. So not
too far from that seventeenth century idea about what it was,
(06:09):
although that concerned more religion than just purely sex. In
the id well, if anything, all of these definitions seem
to have in common, this idea of o c D
as a mental tug of war. Really yeah, and speaking
of that mental tug of war, let's dive into what
it is. We've given you a bit of a history,
but let's turn to the National Institutes of Mental Health,
(06:31):
who define o c D as a disorder that's characterized
by frequent, uncontrollable upsetting thoughts a k a. Obsessions that
compel people to perform ritual behavior a k a. Compulsions.
And like we said earlier, these rituals are not pleasurable.
It's not the satisfaction you get from purging and organizing
your closet, from organizing your books on your shelf. Just so,
(06:56):
this is stuff that really interferes with daily life. And
we should also note that o c D is distinct
from obsessive compulsive personality disorder, which is a mental condition
in which a person is preoccupied by rules, orderliness, and control.
So it sounds pretty similar, and they do have similar symptoms.
(07:16):
But crucially, people with o c D usually know, like
we've mentioned, that those intrusive thoughts are illogical, whereas people
with o c p D believe they're right and often
get angry when confronted, and it's closely associated with perfectionism,
which Caroline me should absolutely devote a podcast to at
(07:37):
some point totally. And one source I found looking at
O c p D said that it affects both men
and women, but occurs more often in men than in women,
and it also starts later in life than O c D,
or it could just be diagnosed later in life than
O c D is. And you know, it's just another
condition that I assume I have because I turned into
(07:57):
a hypochondriac. Anytime you and I do a thing about mental, emotional,
physical health, and you do get very angry when I
confront of Caroline about rules about missing sandwiches. Yeah, well no,
it's it's the different O c p D. While they
still might have those obsessions, in those compulsions, like you said,
they think that they're right and that the you know,
(08:19):
when they I don't know, let me just pull something
out of my hat here, Like if they get mad
in traffic that people are, you know, breaking traffic rules,
then they might feel very like self righteous and like
they are correct in assuming that everybody else is driving
like a jerk and you are driving perfectly of course,
of course, and I'm smiling now. Well, we clearly need
(08:42):
to save O c p D and perfectionism for another podcast.
Is I think there's a lot for us to explore
their Caroline. I know I'm sensing a lot of energy
behind the um, but we really wanted to devote this
episode just to looking at obsessive compulsive disorder no p
involved all, and just for a little more insight into
(09:03):
how it impacts people who experience it. Dr Judith L.
Rappaport wrote in her groundbreaking study The Boy who Couldn't
Stop Washing, The Experience and Treatment of O c D,
that for people with o c D, quote, everyday life
becomes tyrannized by doubts, leading to senseless repetition and ritual
(09:25):
because again, there are these these obsessions and the recognition
that they are very likely illogical, and yet you are
compelled to do them over and over again. So it's
a very unpleasant, to say the least process. And so
it's for that reason, um realizing that their thoughts, compulsions
and obsessions are illogical, that people with o c D
(09:47):
are very effective at hiding their behavior. They don't want
to appear crazy. They already think that the thoughts that
they're experiencing are crazy, and so they don't want to
let on to others that they might be struggling with
a real, very real issue. Yeah, they might still perform
their ritually very likely or still performing their quote unquote
rituals in private, but just away from anybody actually seeing this,
(10:08):
unlike say something like schizophrenia, where there is no recognition
that what they're experiencing is delusion and disordered. And so
for that reason, because of the ability for people with
obsessive compulsive disorder to possibly indulge the disorder while keeping
it private, that can prolonged diagnosis and effective treatment. Yeah,
(10:34):
and so some of the basic symptoms. If you know
you are a hypochondriac type of individual like I am,
you might want to listen to the symptoms because o
c D is is very specific. It's not something that
can be mistaken for something else. So symptoms of c
D include repeated thoughts and images revolving around things like
a fear of germs, dirt, or intruders, acts of violence,
(10:57):
hurting loved ones, sexual acts, conflicts with religious beliefs, or
being overly tidy. And that's followed by here. This is
where the compulsions come in performing rituals over and over again,
such is washing hands, locking and unlocking doors, counting, keeping
unneeded items, or repeating the same same steps again and again,
(11:20):
which is compounded by this uncontrollability, which makes this entire
cycle often time consuming to the point of causing distress
and getting in one's way of daily life, because once
it starts, then you have to complete the entire process,
and one one action might sort of trigger another action.
(11:42):
It's it can often be sort of a domino effect
of all these things that you have to do, and
suddenly you're two hours late even leaving the house for
work because you have to unlock or lock or tap
or whatever it might be, wash your hands until you
feel able to relinquish it, and then go yeah. One
(12:04):
source we read a guy um picked up rocks and
sticks off the street because he was obsessed with the
idea that someone could hurt themselves, and so he was
constantly bending over and picking up rocks, and so in
that behavior, it's almost like, Okay, if I'm just passing
by a guy who's like bending down and picking something
up off the street, I'm not going to think that's strange.
But he said that eventually got to the point where
because he was doing it every day, you know, kids
(12:25):
on the street, you're watching him going like, why is
that guy picking up every single rock? And he would
try to try to exercise a degree of willpower and
just say no, I'm just gonna keep walking. But he
would literally double back and walk back almost a mile
sometimes to go pick up that rock that was in
the street. And so these things, these aren't just like oh,
(12:45):
I'm just gonna go check the iron one more time
to make sure I turn it off, or just go
make sure that I unplugged the whatever thing to make
sure it doesn't burn the house down. This is stuff
that really does interfere with your daily life, and it
has a high comorbidity with things like depression, social phobias,
and eating disorders, even Tourette syndrome and other conditions like that.
(13:07):
And there's no real gender difference though in whether or
how many comorbid conditions a person with o c D has.
We also read that there was a slightly elevated risk
for body dysmorphic disorder, hypochondria, and alcohol abuse. And so
as a result of all of this, study in the
Journal Molecular Psychiatry found that sixty of people with moderate
(13:30):
O c D and eight percent of people with severe
O c D experienced severe impairment with relationships, work, home life,
and social life. So my appreciation for an orderly dishwasher
loading process is something very finite. I get my dish
washer in one particular way, and then I'm done. But
(13:52):
if say I have to arrange and rearrange those dishes
over and over and over again and move the cups
all around in a certain way, that taking up so
much time and never allowing me to ever just leave
it be, and then impacting my personal life in that way.
Just as one example that that's the difference between me
just enjoying something in a particular kind of way versus
(14:15):
an actual disordered behavior. Yeah, and it would also it
also might be tied to almost a superstitious belief that
what you're doing has an effect on something else in
the universe. I don't know if you ever watched I
think it was MTVS. True Life series. Oh yes, of course,
but there was one featuring a young woman with O
c D and her compulsion was to turn light switches
(14:38):
so that they all pointed up because her mother was
very ill, and she had sort of developed this obsessive
compulsion and this behavior because she was convinced that, Okay,
if I just do this, then that is somehow going
to control my mother's health, and that if if I
fail at my compulsion, if I leave the light switches
(14:59):
pointing down, then she's going to get sick. And I
watched that exact exact episode of Carolina. I know exactly
what you're talking about, And I mean it might seem
so ridiculous of like, well, of course a light switch
isn't going to negatively impact your mother's health. But one
day if you don't do that and then something happens,
(15:20):
of course they're unrelated, but why would you ever take
the chance. That's a kind of you know, the sort
of thinking, that tug of war again between the logical
and illogical in your brain that makes this so I'm
almost addictive in the behavioral pattern. Yeah, exactly. And so
when does o c D surface? When is it diagnosed? Well,
it usually emerges during childhood or adolescents, but the average
(15:44):
age of diagnosis isn't until nineteen And there was a
two thousand four paper in the New England Journal of
Medicine that found that there is a seventeen year average
gap between the onset of symptoms and the diagnosis. But
hopefully that gap has actually narrowed in the past eleven years.
(16:04):
But there again, I mean, there hasn't been a ton
of research pointing to whether that's true. And Dr Christopher Pittinger,
who's the director of the Yale O c D Research Clinic,
is really invested in narrowing that gap because he points
out that it affects a lot more people than we
might realize. He points to a two thousand twelve study
(16:26):
which found one point two percent of the population have
o c D in any given year, and that rises
to a two point seven percent lifetime prevalence rate, which
translates to one and forty people or eight million Americans
and around one hundred seventies six million people worldwide. And
(16:47):
the individual symptoms are even more common. Yeah, And it's
interesting when you look at country by country breakdowns of
how many people experience o c D. The percentages are different,
reports of of Europeans experiencing symptoms up to of Americans
of Swiss citizens. But the whole thing there is that
(17:12):
people are defining o c D and o c D
symptoms and the threshold for being diagnosed in different ways.
And so it would be interesting to see if everybody
had across the globe a standard definition and a standard threshold,
what those numbers would do. And he emphasizes Dr Pittinger
that o c D is far more common than schizophrenia
(17:33):
and bipolar one disorder, which effect around one percent of
the population. But that also gets back to that quote
from Dr Gerald Nostal to Newsweek magazine saying that o
c D has never had this quote unquote sexy appeal
of other psychiatric disorders. And then that also relates as
well to the ability of people with o c D
(17:56):
to mask their o c D to possibly delay getting treatment. Yeah,
and back in the World Health Organization identified o c
D a is one of the top twenty global sources
of disability, and that's that number has since dropped due
to some methodological tweaks in the research. But I mean,
that's that's a huge deal because people, like we said,
(18:18):
people with o c D have a really high unemployment rate.
These people are not unaffected. Just because they can mask
their symptoms from day to day doesn't mean it's not debilitating. Now,
what about the gender, Because of course, if we're talking
about something on stuff I've never told you, we have
to unpack the gender differences. So before I started researching
(18:40):
for this episode, I had assume that we were going
to find that O c D tends to lean more women,
possibly because a lot of the O c D jokes,
whether self inflicted or jokes about other people having O
c D, seem to be more lady directed, maybe because
we are likelier to be loading the dish washer or
(19:00):
organizing our bookshelves and closets, whatever. But it turns out
that in the real world, away from all of our
casual jokes, it seems to affect men and women equally,
although there is some nuance within there. Yeah, and we
are going to get into that nuance. And we come
right back from a quick break. In the first half
(19:28):
of the podcast, we were defining a c D, giving
a bit of a history, and we were about to
dive into the gender differences. And as Kristen was saying,
there's not a huge gender difference, but some researchers have
found that there is a slightly earlier onset among boys.
One nine study, for instance, found that it's diagnosed in
(19:51):
boys around age nine and a half versus age eleven
in girls. But the thing is depending on the study
and depending on the methodology. Other researchers have found either
that there's no significant difference between onset and boys and
girls at all, or that it actually shows up earlier
in girls and women than it does in boys and men.
(20:13):
So what is going on there? Well, I wonder when
it comes to the diagnosis, if boys might be likelier
to receive an earlier diagnosis. Do a little bit to
gender stereotyping and socialization, because perhaps some of the most
visible symptoms of o c D might stand out more
in a little boy because it doesn't seem like little
(20:36):
boyish type of behavior to perhaps be washing his hands compulsively,
because we associate cleanliness and things like that more with
little girls. So the little girl is washing her hands
a lot. For instance, one of my sisters as a child,
and still to this day, I don't want to say
obsessively at this point, now that I understand o c D,
(20:58):
she didn't obsessively wash her hands, but she was very
concerned about having clean hands. And I don't think it
ever struck my parents as strange because she was just
a you know, a clean minded little girl. But I
think if one of my brothers had done it, it
would have raised more of an eyebrow. Yeah. I have
a friend with a little boy who is three or
four now, and from the time that he was very little,
(21:21):
like very very toddler, first learning to walk, he was
already exhibiting in her mind. I haven't witnessed it, but
in her mind o c D behavior, because he was
very obsessed from the earliest age, even before he could
say a full sentence, with making sure his toys were
in a very specific place, in a very specific order,
(21:42):
making sure that there was nothing on the floor, picking
up after himself. And so whether that does develop into
actual and actual o c D diagnosis will wait and see.
But she was definitely this is her firstborn, firstborn child,
oh boy, and here he is obsessed with cleanliness in
order to the point where he's pointing at his mother
(22:05):
to like pick stuff up and and clean stuff. I
mean to me, honestly, Caroline, a child at that age
that picks up after him or herself just sounds like
a dream, sounds like a total And that's what I
said to her. I was like, I don't think I
would worry about it yet. But my niece, one of
my nieces, one of my many nieces, did a similar thing.
She was very she's very interested in order, in lining
(22:29):
her toys up, especially when she was younger, in a
similar kind of way. But my sister never batted an eyelash. Again,
though I wonder if my niece were a nephew, if
maybe she would have been a little more nervous about
that behavior. But again, all I'm saying is a self
cleaning child, like a self cleaning imperfect. Does he change
his own diapert done? Perfect? Sign me up. But where
(22:54):
gender differences have been uncovered is in the way that
some of these behaviors and compulsions manifest themselves. And there
was a twenty eleven literature review on some of the
symptomatic distinctions, with male patients experiencing more social impairment, sexual, religious,
and aggressive symptoms, and co morbidity with ticks and substance abuse,
(23:18):
while female patients they found were likelier to have cleaning
and contamination obsessions and co morbidity with eating disorders and
impulse control disorders. And one of the things that uh,
this made me stop in wonder was you know, are
are these things manifesting along very gendery norm e uh lines,
(23:39):
Because like you said when we were talking about the kids, Kristen,
you know, girls are expected to be more clean and
well behaved and neat um and when people express anger,
masculine people are expected to be more you know, out
there with their anger, more physical and violent, and so
you know, and we also hear our reports of eating disorders,
(24:01):
typically in the media and wherever we hear more eating
disorder reports among women and girls. And so it's interesting
that these obsessions and compulsive compulsions in this behavior would
sort of emerge and blossom along these what we would
kind of consider gender norm e lines. Yeah. Well, and
unpacking all of that and figuring out where perhaps the
(24:23):
neurology meets the sociology is what a lot of doctors
today are trying to figure out. Because we have these
we have these symptoms that we can see and we
can identify in terms of say a cleaning or contamination, obsession,
or social impairment. But where does that route back to
(24:46):
stripping away the gender? If we look into biology, delving
into our brains, why is this happening? And there does
appear to be a genetic link, although the jury is
still out on exactly what it is. Um Earlier in
the podcast, we quoted JOHNS. Hopkins researcher Dr Gerald the Stalt,
(25:07):
who helped identify a genetic marker called protein tyro scene
phospholk and nase that seems to be associated with O
c D. So they're thinking there is probably a hereditary link.
That makes sense, or it makes sense to me and
my completely non scientific line of work. Well, and I'm
trying to remember, Caroline, whether we ran across any twins
(25:28):
studies on O c D because a lot of times
when we're trying to figure out whether something is hereditary,
you get a bunch of twins together and say who
has what? How does this happen? But again, the research
on all of this is still in a surprisingly like
elementary phase. Yeah, you would think, but I mean we
(25:50):
run across that and so many of the health episodes
we do that you would think that by now people
would know more, but you know, there's only so much
funding out there. Well, brain scans have shown that okay,
we might have this genetic link, but there does seem
to be a brain difference in someone with O c
D versus someone without o c D, which isn't surprising
(26:13):
considering again, this like tug of war, as we've termed
it between logical and illogical, this compulsion thinking about um
our brains with impulsivity and those kinds of behaviors. So
some medical researchers have highlighted a hyper connectivity between the
orbitofrontal cortex and the caught it nucleus. Caroline, can you
(26:35):
put that in plain English? Well, the orbitofrontal cortex is
the part of the brain that's involved in decision making,
and the caught it nucleus is part of the basil ganglia,
and it's responsible for voluntary movement. So you've got that
decision making linking up with movement, and this in turn
creates this irrational fear and response cycle and other brain
(27:00):
regions to have also been implicated, but it could also
be related to a disregulation of dopamine or serotonin. But
as Christopher Pittinger, that Yale O c D Research Clinic
heads says, the fact is the vast majority of the
time a brain scan and someone with O c D
looks completely normal. What Pittinger add another wrinkle to this mystery. Yeah,
(27:25):
he says that brain imaging hasn't obviously lead to a
cure because there isn't one there. There isn't an o
c D brain essentially, is what he's saying. Yeah, but
when we were reading these sources about brain imaging and
scans of people with o c D versus people without
o c D, they did include scans that showed some
(27:47):
o c D patients do have way more brain activity
in those regions that we mentioned than someone without. And
so it's not that there's never an indication on a
brain scan. It's just that sometimes there's not. Yeah, it's
not it's not consistent across the board. But that doesn't
mean that treatments don't exist, although Pitton, Jur and others
(28:09):
point out that existing options aren't terribly effective, especially when
it comes to medication, because current medications work for only
sixty to seventy of cases. Plus, The New York Times
reported that only one third of patients with o c
D even receive any appropriate pharmacotherapy, and fewer than ten
(28:31):
per cent RESI receive any kind of evidence based psychotherapy
such as um exposure therapy and effective therapy. A lot
of times is derailed because of misdiagnosis of depression or anxiety,
which might accompany o c D. But treating depression anxiety
(28:52):
is not the same as treating o c D. So
I mean, again, this points to that average seventeen year
gap that was indicated in that two thousand four study
between the onset of symptoms and actually getting a diagnosis. Well, also,
it makes sense if you have someone who is aware
that some of the the intrusive thoughts that they're experiencing
might be quote unquote crazy. Um, maybe they will just
(29:15):
go to their doctor and say, hey, you know, I'm
feeling really anxious, or I'm feeling really depressed, or something's
off or not right. You know, I've talked about on
the podcast before talking to my doctor about anxiety I
was experiencing and how quick she was to be like, oh, well,
here's an anti anxiety prescription. It's like whoa, whoa. You know,
I didn't take it because it's like, let's figure out
what's actually going on before I just start taking anxiety medication.
(29:38):
And so I can see how that could happen very easily,
where if someone maybe doesn't tell their doctor about the
intrusive thoughts or the obsessive behavior and they just complain
about a certain aspect of what's going on with them
that they could end up misdiagnosed or taking the wrong medicine. Yeah,
if you say I have a hard time forming and
(30:00):
intaining relationships and leaving my house, well here you go,
here's some zolof like some kind of antidepressant. And in fact,
SSR EYES combined with exposure therapy is one of the
most common treatment combinations, and exposure therapy is pretty much
what it sounds like. You gradually expose the patient to
(30:23):
the compulsive trigger to sort of break down the that
that logic barrier, to let them know that Okay, if
you flip the light switch, it isn't in fact going
to set off this chain of events. So, for instance,
with that that girl in the MTV show that Caroline
and I both watched probably in our early college days. Uh,
(30:46):
an exposure therapy might be having her leave her house
with maybe one to start off with light switch flipped
down rather than up, and just seeing what happens throughout
the day and whether it in fact changes any thing.
And one controversial figure in the treatment of o c
D is Dr Jeffrey Schwartz at U c L A
(31:08):
who relies on a trick called mindfulness meditation. He wants
to harness the brains neuroplasticity to allow patients to quote
rewire their thought patterns. And this is coming from an
article and Discover magazine that I thought was fascinating. And
so he has this group of people with O c
(31:28):
D who have suffered varying levels of obsessive and compulsive
thoughts and behaviors for years, to the point of hopelessness
of my life is never going to change. This is terrible.
I can barely make it through the day. Um, A
lot of people came to him with suicidal thoughts and
tendencies as a last resort. What do I do? And
(31:48):
so what he basically has them do is sort of
what practitioners of meditation in general tell you to do,
which is recognize the thoughts as they come to hold them,
examine them except that they are quote unquote trash thoughts basically,
and then sort of throw them away. And I mean,
(32:09):
I'm greatly simplifying his whole process, but it involves, you know,
realizing that these thoughts are junk, that they don't actually
affect your life. And that you have power over them,
and that seems like, oh my god, how do I
have power over them? I can barely, you know, make
it through the day without doing whatever ritual it is
I have to do um. But once he sort of
(32:32):
informed people that you've got to tell yourself that this
is the O c D. This is the disorder making
you do this. This isn't you actually wanting to wash
your hands fifty times or flip the light switch fifty times.
This is the O c D telling you to do
something that you don't actually want to do, because again,
these are behaviors and rituals that people don't get joy
out of. It's not like telling someone who loves to
(32:54):
organize the dishwasher, you've got to stop doing it because
they won't want to. These are people who are few
absolutely overwhelmingly controlled by rituals that they do not want
to participate in anymore. And so over time he not
only watched as these people sort of took control over
their lives, but at the end of the session I
(33:15):
think it was like ten weeks, he did another brain
scan and the the areas in the brain where people
had shown a lot of activity because of their I
c D. It suddenly was just like a flicker as
opposed to a giant glow. Yeah, because the idea is
with this kind of mindfulness meditation, which is becoming more
(33:37):
and more common, I feel like I'm hearing a bit
a lot. It's something that if you've taken a yoga
class you might have heard about or have just gone
to a general therapist. UM. Trying to harness that idea
of the brain's neuroplasticity of rewiring the patterns of our
thoughts through habit and repetition, and this idea of presence
(33:58):
and staying present is really really compelling when you apply
it to something like o c D, but also quite
controversial to apply it to something as ingrained as a
disorders as O c D, because some people in the
medical community say, no, this is kind of focus focus.
You can't actually, you know, just magically, And it's not magically.
(34:22):
I'm saying that magically in quotes rewire your own brain. Um.
But he seems to have had success with it. And
side note fun fact about Dr Schwartz. His claim to
fame is training Leonardo DiCaprio for his OSCAR nominated role
as Howard Hughes who had abilitating O c D in
(34:44):
the film The Aviator. So if you're curious about what
O c D can look like and what doctor Schwartz's
understanding of it is, you can watch Leo DiCaprio and
The Aviator. And apparently, as this Discover magazine profile of
him talked about, Leonardo DiCaprio's method acting embodiment of these
(35:06):
severe O c D behaviors were so impactful on him
that even I think it was something like a year
after filming, he was still sort of having to rework
his way back into the regular normal world, sort of
de engage himself from it. So talking, I mean, that's
kind of reverse neuroplasticity or reverse mindful mindfulness meditation. Yeah,
(35:29):
and it's interesting. I I totally this whole mindfulness meditation
thing sounds a lot like basically cognitive behavioral therapy, which
is experiencing a thought, recognizing that you're having it, and
actively working to change that thought and that behavior. Um
and over time, you know, practice makes perfect all that stuff. Um.
(35:53):
But it's interesting to hear that concept applied to something
like O c D, which you know, it's not just
and inn security like I'm gonna stop telling myself that
I look bad or whatever. It's This is a deeply
ingrained uh disorder that people suffer from, and so it
is interesting and it is controversial. But again, if it
works for people, that helps people, why not well, and
(36:16):
considering too, how debilitating it is for the people who
experience it and the prevalence rate, like we mentioned, it
is more common than schizophrenia and bipolar disorder. Yet Dr
Pittinger at Yale notes how O c D quote receives
far less attention from the major funders of research like
the National Institutes of Health and the pharmaceutical industry than
(36:39):
other conditions of comparable severity. So, for instance, a pharmaceutical
company Row has been conducting trials on an O c
D targeted drug as opposed to a drug that might,
as an additional side effect effectively treat O c D.
This specific drug is thest of its kind to be
(37:01):
even tested have any direct funding to it from the
pharmaceutical industry since, so I mean, considering the commonality of it,
it is sort of surprising that big pharma hasn't left
on it because it could be a decent money maker. Well,
I mean, you know, do do you have people. Have
(37:25):
you historically had people um sort of advocating for o
c D patients and suffers the way that you have
people you know, rightfully so in Alzheimer's breast cancer. I
mean those people are very vocal as well they should be.
But does o c D have champions that are that vocal?
And and that hasn't historically been the case until sort
(37:48):
of recently, we've we've seen sort of an upsurge in
attention paid to actual clinical life altering o c D
versus just the adorable like Mom character on TV or
Jack Nicholson's character and as good as it gets, I
think people with actual o c D are starting to
get more attention. Yeah, you have to wonder how much
(38:10):
our pop cultural depictions of o c D is just
kind of this this little character cork that some people have.
It makes men want to clean. How funny is that?
And also just our casual use of it, how that
might in a very real, real way negatively impact research
funding for it, Because if we look at o c
(38:31):
D in pop culture, we have movies like The Odd
Couple where Jack Lemon's character plays this guy who cooks
and he cleans and they can't have poker night at
Walter Matthol's apartment because he's constantly wanting to clean up
and like put coasters down so that they don't get
you know, stains on the table from their whiskey tumblers. Um.
(38:55):
And then you have shows like Monk that use o
c D as a comedic device, and of course there's
that gendered angle to it, because it's funnier for a
guy to have all these ticks as opposed to a woman,
it seems like. But one show that got a lot
of praise for not using o c D as a
comedic device at all was Girls. Actually, Lena Dunham, who
(39:17):
in real life has dealt with o c D since childhood,
had her character Hannah undergo a really traumatic o c
D experience basically in the wake of, you know, a
relationship trauma. She sort of reverts back to this o
c D behavior of counting um. And she writes about
(39:37):
her real life experience in her book Not That Kind
of Girl. Yeah, and this is just an excerpt of it.
And keep in mind too, how this relates to the
early onset of symptoms in childhood and adolescence. She writes,
I'm eight and I'm afraid of everything. The list of
things that keep me up at night includes, but is
(39:57):
not limited to, appendicida, typhoid, leprosy, unclean meat, foods I
haven't seen emerge from their packaging, foods my mother hasn't
tasted first, so that if we die, we die together,
homeless people, headaches, rape, kidnapping, milk, the subway, sleep. And
she goes on to talk about the process of being
in therapy as a child for O c D and
(40:21):
growing up with it, and it's something that she still
deals with, and she's talked publicly about how much it
grates on her nerves to hear people casually say oh
my god, I'm so O c D about X y
Z and she says, no, you're not. Yeah, and you
don't want to be because it's kind of awful. Yeah, yeah,
I this is definitely I feel like you and I
(40:42):
do a lot of episodes, Kristen, where we we learned
about something, we explore topic, and at the end we say,
maybe we should just cut that out. You know. Cankles,
We're not going to say cankles anymore. They're just ankles, people.
And it's the same with O c D. I mean,
this is an excellent Listening to this episode O my
Friends is a great opportunity to finally say, Okay, we're
(41:04):
gonna stop being offensive. We're gonna stop using O c
D as an adjective, because not only is it a
really horrible condition to have to live with and deal with,
but it has very real life awful consequences. There is
a strong relationship between O c D and suicidal ideations
and attempts. UM. The name John Cleaver Kelly might sound
(41:25):
familiar to some people. He in two eleven committed suicide. UM.
It was his third suicide attempt. UM. He had been
dealing with o c D his whole life and had
been in institutions and been to therapists and psychiatrists trying
to overcome it, and um it led to tragic consequences. Yeah,
(41:47):
and that unfortunately attracted national media attention to the life
threatening potential of O c D. And that's you know,
a big reason why it isn't It isn't such a
funny joke anymore. It isn't. It isn't cute to just
play off your um propensity for organization or your enjoyment
(42:09):
of like of nice color schemes or whatever. It might
be as just this this cute little pet thing that
you have, because it is, it's debilitating to the point
of being lethal. And that was one reason too why
And I don't have his name in front of me.
There's a blogger over at Psychology Today who hates the
(42:31):
depiction of Monk and that entire TV show because for
the same reason, he was just saying, no, this is
not like making it a communic device isn't helping anybody.
And there was one particular episode where Monk gets on
some kind of trial medication for o c D and
it magically cures all of his symptoms. But with that too,
(42:56):
it takes away his ability to solve crimes as well
as he does, so it turns o c D into
the superpower of sorts and also made the blogger mad
saying no, there is no cure and and don't make
this into something good. It just twists it and twist
and twist it. Yeah. He also wrote about his closet.
He's like, yes, I do enjoy a neat closet where
(43:18):
all of my things are color coordinatee and whatever. But
ladies and gentlemen, this is not a symptom of my
O c D. I just happened to like things neat.
I don't feel like I can't leave the house if
my hangars aren't hung. Just so, I have other symptoms
of O c D that I've had to work hard
to overcome. Yeah, and you, for instance, carrying out the
same morning routine in college is not a sign probably
(43:41):
of your obsessive compulsions, but rather it just a healthy lifestyle,
you know, just keeping it together, right, just making sure
I eat breakfast and brush my teeth. So people have
suggested that instead of using the off hand oh my god,
I'm so O c D, say something like, oh, you're
really hyper focused, you're diligent, you're detail oriented, or just say, yeah,
(44:03):
I'm really into cleaning. I enjoy cleanliness. Yeah done. I
like I like having my You can't even say like
having my CDs organized in alphabetical order anymore, because that
doesn't exist and now iTunes to finals. I like having
my records alphabetically organized. We could probably say, just to
keep this even more current for the future, I like
(44:24):
having my my cassette alphabetized, because you know that's coming back.
I can't roll my eyes any harder. So we're curious
to know if this rings a bell with anybody. Does
anyone listening have obsessive compulsive disorder or have someone in
your life who deals with this and perhaps it's gone
(44:46):
through treatment for it. What has been your experience and
what do you think about eliminating this casual jokey use
of o c D Because some people get bristly when
they hear things like let's not use phrases like that,
because I think, oh, well, it's not doing any harm.
Do you think that maybe it's fine to use O
c D in a casual joking way, or yeah, maybe
(45:09):
let's watch our language be a little more diligent about that.
Let us know your thoughts. Mom Stuff at how stuffworks
dot com is our email address. You can tweet us
at mom Stuff podcast or messages on Facebook as well.
And we've got a couple of messages to share with
you about another acorn and then we've talked about on
the podcast right now. Well, I have a letter here
(45:36):
from Taylor that actually touches on to different sminty topics.
She writes, I'm a female architect who was directed to
your podcast by a coworker yesterday, and I have to
tell you just how much I think that your stories
and research and p s a s are so well
informed and interestingly presented. I've just begun to uncover the
(45:57):
archive of your podcast and was struck by the timely
us of your Fibroids one on one podcast, because it
came out in December of last year, which was near
the time that I was dealing with learning I had
a uterine fibroid, but likely more than one. All of
the areas you covered, from race to treatment to taking
time off from work were all issues I encountered in
the fall. Often. I wanted to just share an abbreviated
(46:21):
version of my story because if I had heard this
podcast in December, I would have felt so much more
prepared for what I was undertaking. From my own research,
I already knew that African American women like myself were
much more likely to get fibroids. From my doctors, I
knew that they weren't cancerous, and from three different ultrasounds,
I knew my fibroid was larger than my uterus in
diameter and on the exterior wall of my uterus. I
(46:43):
wanted to say thank you for researching this topic because
uterine fibroids are indeed, a topic that not a lot
of women know exists or no could be the cause
of symptoms affecting them and be the options for treating
them are pretty slim for pre men posel women who
have yet to have children, like myself. In fact, other
than removal of my i U D because of the
size and location of my fibroid, I didn't receive any
(47:05):
treatment except for the recommendation to take a series of
non prescription supplements to regulate hormones. I also think that
the relationship between African American women and uterine uterine fibroids
is very interesting because the factors that range from genetics
to sociate economic status. I'm actually half black, my mother
being Caucasian, and I've never used hair relaxers. I consider
(47:25):
myself a member of the educated medal class, and I
also lead and was raised with a healthy, healthy lifestyle
that does not include eating red meat and an avoidance
of inorganically grown food or gluten. So, despite doing what
seems to have been healthy for the avoidance of fibroids,
I still am in that percentage of childbearing aged women
(47:45):
that have fibroids in the US. You both are doing
an amazing job with this podcast, and I was so
touched by the truth that you relate in this particular
episode that I was compelled to tell you really covered
this one, So thank you, Taylor. I have a letter
here from Laura about our Queen's Week, and she writes,
love the podcast. I eagerly listened to every episode and
(48:08):
have even gotten my fiance addicted. Thank you, Laura. As
a huge history nerd, I had to drop a line
about your Queen's Week. First of all, Woo loved having
a podcast look at Queen's from a more feminist perspective.
So many look at women rulers as stereotypes, so it
was good to hear them explored as real people. I
wish you could have turned Queen's Week into Queen's Month.
(48:30):
I was a big fan of the hat Chips episode,
but I was a little disappointed in your second choice, Victoria.
With a long list of kick ass female rulers, Victoria
was a bit of a downer. She was strongly against
women's suffrage and very outspoken about women's place in the world,
which was not exactly a feminist stance. I would have
(48:50):
loved to have heard an episode on Isabella who encouraged
study and ruled in her own right, or Jinga of
Angola who fought European invasion, or my ever Elizabeth, who
basically one at ruling during the late Middle Ages. I'd
love to hear an episode on women and families and
indigenous cultures around the world as well. I know in
Australia the Aboriginal cultures relationship with women is really complex,
(49:13):
as is the Maudi women's place in the family. Would
love to hear something on cultures around the world. Thanks
for the awesome podcast and keep up the good work
and thanks for your suggestions. Laura. I think that Victoria
was nonetheless a compelling person to talk about, because the
thing is, when it comes to women, they are not
always everything we hope that they will be, so her
(49:34):
complexity is kind of fascinating to me in that regard.
But now, thanks to you, we have some more incredible
ladies to spotlight and be sure to to check over
at Stuff You Missed in History Class because they have
done a number of podcasts on fantastic lady rulers over
the ages as well. And thanks to everybody who's written
(49:56):
into us. Mom Stuff at how stuff works dot Com
is our email address to find links to all of
our social media as well as all of our blogs, videos,
and podcasts with this one so you can read along
and learn about your possible O c D tendencies. Head
on over to stuff mom Never Told You dot com
(50:19):
for more on this and thousands of other topics. Is
it has stuff works dot com
Welcome to stuff Mom Never told You from how Stuff
Works dot com. Hello, welcome to the podcast. I'm Kristen
and I'm Caroline, and today we're gonna talk about obsessive
compulsive disorder or o c D, which is something I
have a feeling most of us are casually familiar with.
(00:25):
We might even joke about having, say O c D
in terms of having to do the dishes in a
particular kind of way load the dishwasher. I don't know
what you would be referring to Christen Conger dishwasher mistress.
I may or may not have a very particular way
of loading the dishwasher. But the fact of the matter is,
(00:45):
within the medical community a lot still isn't known about
o c D, and O c D isn't something for
people who actually experience it that is as casual to say,
really enjoying an orderly dishwasher, right, because I was accused
in college of being o c D because I follow
(01:07):
the same morning routine so strictly. Uh, you know, like
my roommate actually said, you know, God, are you just
like totally O c D? You know, you get up
the same time every day, and then you shower and
then you do this and this and this, and it
never deviates. And it's My response was, well, that has
way more to do with the fact that I have
not switched on my brain yet in the morning. It's
not that I, you know, I feel compelled to follow
(01:28):
a certain routine, but yeah, it's it's o c D
is so much more than just loading the dishwasher certain way,
following a certain morning routine. It's certainly more than just
how adorable the character Monk is on that television show.
Because the key to o c D that separates the
media representation from the real life reality is that people
(01:52):
with obsessive compulsive disorder don't actually enjoy the things that
they feel compelled to do. Yeah, and it is rather
ironic that we collectively approach o c D and talk
about o c D in such a casual, joking way,
whereas it is this disorder that still needs a lot
more attention. So, for instance, Johns Hopkins Hospital researcher Dr
(02:16):
Gerald Nestalt, who recently identified a gene linked to o
c D, told Newsweek quote, it never had the sexy
appeal of other psychiatric disorders, So we're fine with joking
about it. But the jokes have perhaps eroded our perception
of it as a serious mental disorder that affects a
(02:37):
lot of people. Yeah. Well, and the interesting thing too,
is that o c D this is not a new disorder.
This is not something that has just cropped up in
the past ten or twenty years that scientists are thinking, oh,
maybe we should finally study this. People have been writing
about and observing o c D symptoms for centuries. Yeah.
We found a lot of information about the medical history
(03:00):
of obsessive compulsive disorder over at Stanford, and it was
first described in medical literature in the sevent century as
quote symptoms of religious melancholy, and pretty much the entire
representation of it at the time seemed to be the
struggle between the mind and carnal thoughts and God right
(03:22):
and in Bishop John Moore defined it as trouble where
the trouble is over a doubt. When doubts are resolved,
he wrote that naughty and sometimes blasphemous thoughts which start
in their minds while they are exercised in the worship
of God, despite all their endeavors to stifle and suppress them,
the more they struggle with them, the more they increase
(03:43):
so that definition, while it is very very old, is
not that unfamiliar to people who have researched the disease today.
And in the nineteenth century, the more modern concept of
o c D really begins to evolve, with differentiations between
obsessions and delusions as well as compulsions and impulsions, in
(04:05):
other words, figuring out what the line is between maybe
just naturally impulsive behavior and unnaturally compulsive behavior. Right and one,
psychiatrists described it as a form of partial insanity. And
while this idea was abandoned by the mid nineteenth century,
so it didn't have a very long lifespan, what I
(04:26):
thought was interesting about it was that it's this partial
insanity idea that is sort of how o c D
is described today, because the whole thing is that someone
with o c D recognizes that the thoughts and behaviors
that they experience day in and day out, are not normal,
they are quote unquote crazy, and that they feel that
(04:47):
these are negative things that they just have no power
to avoid or ignore. And so this idea, while it
was abandoned, was sort of on the right track. And
around the same time the Germans were positive, saying that
it was a disorder of intellect and speaking of the Germans.
O c D gets its name in the late nineteenth
(05:07):
century from differing translations of the term forgive me if
I mispronounce it zvang wost a lung, which is a
compelled presentation or idea. Yeah, so in Great Britain they
translate this when you say the German term again, please Caroline,
because I don't trust my mangled German pronunciation uh zvang
(05:28):
wost a lung, So they translate that as obsession, whereas
in the United States it becomes translated as compulsion. And
so we agree to disagree and call it obsessive compulsive
disorder and moving away from Germany and into Austria. Of course,
Freud had something to say about o c D, but
(05:49):
we won't dwell on Freud for too long. But Freud
thought that o c D was simply the mind's maladaptive
response to quote conflicts between unacceptable unconscious sexual or aggressive
i'd impulses and demands of conscience and reality. So not
too far from that seventeenth century idea about what it was,
(06:09):
although that concerned more religion than just purely sex. In
the id well, if anything, all of these definitions seem
to have in common, this idea of o c D
as a mental tug of war. Really yeah, and speaking
of that mental tug of war, let's dive into what
it is. We've given you a bit of a history,
but let's turn to the National Institutes of Mental Health,
(06:31):
who define o c D as a disorder that's characterized
by frequent, uncontrollable upsetting thoughts a k a. Obsessions that
compel people to perform ritual behavior a k a. Compulsions.
And like we said earlier, these rituals are not pleasurable.
It's not the satisfaction you get from purging and organizing
your closet, from organizing your books on your shelf. Just so,
(06:56):
this is stuff that really interferes with daily life. And
we should also note that o c D is distinct
from obsessive compulsive personality disorder, which is a mental condition
in which a person is preoccupied by rules, orderliness, and control.
So it sounds pretty similar, and they do have similar symptoms.
(07:16):
But crucially, people with o c D usually know, like
we've mentioned, that those intrusive thoughts are illogical, whereas people
with o c p D believe they're right and often
get angry when confronted, and it's closely associated with perfectionism,
which Caroline me should absolutely devote a podcast to at
(07:37):
some point totally. And one source I found looking at
O c p D said that it affects both men
and women, but occurs more often in men than in women,
and it also starts later in life than O c D,
or it could just be diagnosed later in life than
O c D is. And you know, it's just another
condition that I assume I have because I turned into
(07:57):
a hypochondriac. Anytime you and I do a thing about mental, emotional,
physical health, and you do get very angry when I
confront of Caroline about rules about missing sandwiches. Yeah, well no,
it's it's the different O c p D. While they
still might have those obsessions, in those compulsions, like you said,
they think that they're right and that the you know,
(08:19):
when they I don't know, let me just pull something
out of my hat here, Like if they get mad
in traffic that people are, you know, breaking traffic rules,
then they might feel very like self righteous and like
they are correct in assuming that everybody else is driving
like a jerk and you are driving perfectly of course,
of course, and I'm smiling now. Well, we clearly need
(08:42):
to save O c p D and perfectionism for another podcast.
Is I think there's a lot for us to explore
their Caroline. I know I'm sensing a lot of energy
behind the um, but we really wanted to devote this
episode just to looking at obsessive compulsive disorder no p
involved all, and just for a little more insight into
(09:03):
how it impacts people who experience it. Dr Judith L.
Rappaport wrote in her groundbreaking study The Boy who Couldn't
Stop Washing, The Experience and Treatment of O c D,
that for people with o c D, quote, everyday life
becomes tyrannized by doubts, leading to senseless repetition and ritual
(09:25):
because again, there are these these obsessions and the recognition
that they are very likely illogical, and yet you are
compelled to do them over and over again. So it's
a very unpleasant, to say the least process. And so
it's for that reason, um realizing that their thoughts, compulsions
and obsessions are illogical, that people with o c D
(09:47):
are very effective at hiding their behavior. They don't want
to appear crazy. They already think that the thoughts that
they're experiencing are crazy, and so they don't want to
let on to others that they might be struggling with
a real, very real issue. Yeah, they might still perform
their ritually very likely or still performing their quote unquote
rituals in private, but just away from anybody actually seeing this,
(10:08):
unlike say something like schizophrenia, where there is no recognition
that what they're experiencing is delusion and disordered. And so
for that reason, because of the ability for people with
obsessive compulsive disorder to possibly indulge the disorder while keeping
it private, that can prolonged diagnosis and effective treatment. Yeah,
(10:34):
and so some of the basic symptoms. If you know
you are a hypochondriac type of individual like I am,
you might want to listen to the symptoms because o
c D is is very specific. It's not something that
can be mistaken for something else. So symptoms of c
D include repeated thoughts and images revolving around things like
a fear of germs, dirt, or intruders, acts of violence,
(10:57):
hurting loved ones, sexual acts, conflicts with religious beliefs, or
being overly tidy. And that's followed by here. This is
where the compulsions come in performing rituals over and over again,
such is washing hands, locking and unlocking doors, counting, keeping
unneeded items, or repeating the same same steps again and again,
(11:20):
which is compounded by this uncontrollability, which makes this entire
cycle often time consuming to the point of causing distress
and getting in one's way of daily life, because once
it starts, then you have to complete the entire process,
and one one action might sort of trigger another action.
(11:42):
It's it can often be sort of a domino effect
of all these things that you have to do, and
suddenly you're two hours late even leaving the house for
work because you have to unlock or lock or tap
or whatever it might be, wash your hands until you
feel able to relinquish it, and then go yeah. One
(12:04):
source we read a guy um picked up rocks and
sticks off the street because he was obsessed with the
idea that someone could hurt themselves, and so he was
constantly bending over and picking up rocks, and so in
that behavior, it's almost like, Okay, if I'm just passing
by a guy who's like bending down and picking something
up off the street, I'm not going to think that's strange.
But he said that eventually got to the point where
because he was doing it every day, you know, kids
(12:25):
on the street, you're watching him going like, why is
that guy picking up every single rock? And he would
try to try to exercise a degree of willpower and
just say no, I'm just gonna keep walking. But he
would literally double back and walk back almost a mile
sometimes to go pick up that rock that was in
the street. And so these things, these aren't just like oh,
(12:45):
I'm just gonna go check the iron one more time
to make sure I turn it off, or just go
make sure that I unplugged the whatever thing to make
sure it doesn't burn the house down. This is stuff
that really does interfere with your daily life, and it
has a high comorbidity with things like depression, social phobias,
and eating disorders, even Tourette syndrome and other conditions like that.
(13:07):
And there's no real gender difference though in whether or
how many comorbid conditions a person with o c D has.
We also read that there was a slightly elevated risk
for body dysmorphic disorder, hypochondria, and alcohol abuse. And so
as a result of all of this, study in the
Journal Molecular Psychiatry found that sixty of people with moderate
(13:30):
O c D and eight percent of people with severe
O c D experienced severe impairment with relationships, work, home life,
and social life. So my appreciation for an orderly dishwasher
loading process is something very finite. I get my dish
washer in one particular way, and then I'm done. But
(13:52):
if say I have to arrange and rearrange those dishes
over and over and over again and move the cups
all around in a certain way, that taking up so
much time and never allowing me to ever just leave
it be, and then impacting my personal life in that way.
Just as one example that that's the difference between me
just enjoying something in a particular kind of way versus
(14:15):
an actual disordered behavior. Yeah, and it would also it
also might be tied to almost a superstitious belief that
what you're doing has an effect on something else in
the universe. I don't know if you ever watched I
think it was MTVS. True Life series. Oh yes, of course,
but there was one featuring a young woman with O
c D and her compulsion was to turn light switches
(14:38):
so that they all pointed up because her mother was
very ill, and she had sort of developed this obsessive
compulsion and this behavior because she was convinced that, Okay,
if I just do this, then that is somehow going
to control my mother's health, and that if if I
fail at my compulsion, if I leave the light switches
(14:59):
pointing down, then she's going to get sick. And I
watched that exact exact episode of Carolina. I know exactly
what you're talking about, And I mean it might seem
so ridiculous of like, well, of course a light switch
isn't going to negatively impact your mother's health. But one
day if you don't do that and then something happens,
(15:20):
of course they're unrelated, but why would you ever take
the chance. That's a kind of you know, the sort
of thinking, that tug of war again between the logical
and illogical in your brain that makes this so I'm
almost addictive in the behavioral pattern. Yeah, exactly. And so
when does o c D surface? When is it diagnosed? Well,
it usually emerges during childhood or adolescents, but the average
(15:44):
age of diagnosis isn't until nineteen And there was a
two thousand four paper in the New England Journal of
Medicine that found that there is a seventeen year average
gap between the onset of symptoms and the diagnosis. But
hopefully that gap has actually narrowed in the past eleven years.
(16:04):
But there again, I mean, there hasn't been a ton
of research pointing to whether that's true. And Dr Christopher Pittinger,
who's the director of the Yale O c D Research Clinic,
is really invested in narrowing that gap because he points
out that it affects a lot more people than we
might realize. He points to a two thousand twelve study
(16:26):
which found one point two percent of the population have
o c D in any given year, and that rises
to a two point seven percent lifetime prevalence rate, which
translates to one and forty people or eight million Americans
and around one hundred seventies six million people worldwide. And
(16:47):
the individual symptoms are even more common. Yeah, And it's
interesting when you look at country by country breakdowns of
how many people experience o c D. The percentages are different,
reports of of Europeans experiencing symptoms up to of Americans
of Swiss citizens. But the whole thing there is that
(17:12):
people are defining o c D and o c D
symptoms and the threshold for being diagnosed in different ways.
And so it would be interesting to see if everybody
had across the globe a standard definition and a standard threshold,
what those numbers would do. And he emphasizes Dr Pittinger
that o c D is far more common than schizophrenia
(17:33):
and bipolar one disorder, which effect around one percent of
the population. But that also gets back to that quote
from Dr Gerald Nostal to Newsweek magazine saying that o
c D has never had this quote unquote sexy appeal
of other psychiatric disorders. And then that also relates as
well to the ability of people with o c D
(17:56):
to mask their o c D to possibly delay getting treatment. Yeah,
and back in the World Health Organization identified o c
D a is one of the top twenty global sources
of disability, and that's that number has since dropped due
to some methodological tweaks in the research. But I mean,
that's that's a huge deal because people, like we said,
(18:18):
people with o c D have a really high unemployment rate.
These people are not unaffected. Just because they can mask
their symptoms from day to day doesn't mean it's not debilitating. Now,
what about the gender, Because of course, if we're talking
about something on stuff I've never told you, we have
to unpack the gender differences. So before I started researching
(18:40):
for this episode, I had assume that we were going
to find that O c D tends to lean more women,
possibly because a lot of the O c D jokes,
whether self inflicted or jokes about other people having O
c D, seem to be more lady directed, maybe because
we are likelier to be loading the dish washer or
(19:00):
organizing our bookshelves and closets, whatever. But it turns out
that in the real world, away from all of our
casual jokes, it seems to affect men and women equally,
although there is some nuance within there. Yeah, and we
are going to get into that nuance. And we come
right back from a quick break. In the first half
(19:28):
of the podcast, we were defining a c D, giving
a bit of a history, and we were about to
dive into the gender differences. And as Kristen was saying,
there's not a huge gender difference, but some researchers have
found that there is a slightly earlier onset among boys.
One nine study, for instance, found that it's diagnosed in
(19:51):
boys around age nine and a half versus age eleven
in girls. But the thing is depending on the study
and depending on the methodology. Other researchers have found either
that there's no significant difference between onset and boys and
girls at all, or that it actually shows up earlier
in girls and women than it does in boys and men.
(20:13):
So what is going on there? Well, I wonder when
it comes to the diagnosis, if boys might be likelier
to receive an earlier diagnosis. Do a little bit to
gender stereotyping and socialization, because perhaps some of the most
visible symptoms of o c D might stand out more
in a little boy because it doesn't seem like little
(20:36):
boyish type of behavior to perhaps be washing his hands compulsively,
because we associate cleanliness and things like that more with
little girls. So the little girl is washing her hands
a lot. For instance, one of my sisters as a child,
and still to this day, I don't want to say
obsessively at this point, now that I understand o c D,
(20:58):
she didn't obsessively wash her hands, but she was very
concerned about having clean hands. And I don't think it
ever struck my parents as strange because she was just
a you know, a clean minded little girl. But I
think if one of my brothers had done it, it
would have raised more of an eyebrow. Yeah. I have
a friend with a little boy who is three or
four now, and from the time that he was very little,
(21:21):
like very very toddler, first learning to walk, he was
already exhibiting in her mind. I haven't witnessed it, but
in her mind o c D behavior, because he was
very obsessed from the earliest age, even before he could
say a full sentence, with making sure his toys were
in a very specific place, in a very specific order,
(21:42):
making sure that there was nothing on the floor, picking
up after himself. And so whether that does develop into
actual and actual o c D diagnosis will wait and see.
But she was definitely this is her firstborn, firstborn child,
oh boy, and here he is obsessed with cleanliness in
order to the point where he's pointing at his mother
(22:05):
to like pick stuff up and and clean stuff. I
mean to me, honestly, Caroline, a child at that age
that picks up after him or herself just sounds like
a dream, sounds like a total And that's what I
said to her. I was like, I don't think I
would worry about it yet. But my niece, one of
my nieces, one of my many nieces, did a similar thing.
She was very she's very interested in order, in lining
(22:29):
her toys up, especially when she was younger, in a
similar kind of way. But my sister never batted an eyelash. Again,
though I wonder if my niece were a nephew, if
maybe she would have been a little more nervous about
that behavior. But again, all I'm saying is a self
cleaning child, like a self cleaning imperfect. Does he change
his own diapert done? Perfect? Sign me up. But where
(22:54):
gender differences have been uncovered is in the way that
some of these behaviors and compulsions manifest themselves. And there
was a twenty eleven literature review on some of the
symptomatic distinctions, with male patients experiencing more social impairment, sexual, religious,
and aggressive symptoms, and co morbidity with ticks and substance abuse,
(23:18):
while female patients they found were likelier to have cleaning
and contamination obsessions and co morbidity with eating disorders and
impulse control disorders. And one of the things that uh,
this made me stop in wonder was you know, are
are these things manifesting along very gendery norm e uh lines,
(23:39):
Because like you said when we were talking about the kids, Kristen,
you know, girls are expected to be more clean and
well behaved and neat um and when people express anger,
masculine people are expected to be more you know, out
there with their anger, more physical and violent, and so
you know, and we also hear our reports of eating disorders,
(24:01):
typically in the media and wherever we hear more eating
disorder reports among women and girls. And so it's interesting
that these obsessions and compulsive compulsions in this behavior would
sort of emerge and blossom along these what we would
kind of consider gender norm e lines. Yeah. Well, and
unpacking all of that and figuring out where perhaps the
(24:23):
neurology meets the sociology is what a lot of doctors
today are trying to figure out. Because we have these
we have these symptoms that we can see and we
can identify in terms of say a cleaning or contamination, obsession,
or social impairment. But where does that route back to
(24:46):
stripping away the gender? If we look into biology, delving
into our brains, why is this happening? And there does
appear to be a genetic link, although the jury is
still out on exactly what it is. Um Earlier in
the podcast, we quoted JOHNS. Hopkins researcher Dr Gerald the Stalt,
(25:07):
who helped identify a genetic marker called protein tyro scene
phospholk and nase that seems to be associated with O
c D. So they're thinking there is probably a hereditary link.
That makes sense, or it makes sense to me and
my completely non scientific line of work. Well, and I'm
trying to remember, Caroline, whether we ran across any twins
(25:28):
studies on O c D because a lot of times
when we're trying to figure out whether something is hereditary,
you get a bunch of twins together and say who
has what? How does this happen? But again, the research
on all of this is still in a surprisingly like
elementary phase. Yeah, you would think, but I mean we
(25:50):
run across that and so many of the health episodes
we do that you would think that by now people
would know more, but you know, there's only so much
funding out there. Well, brain scans have shown that okay,
we might have this genetic link, but there does seem
to be a brain difference in someone with O c
D versus someone without o c D, which isn't surprising
(26:13):
considering again, this like tug of war, as we've termed
it between logical and illogical, this compulsion thinking about um
our brains with impulsivity and those kinds of behaviors. So
some medical researchers have highlighted a hyper connectivity between the
orbitofrontal cortex and the caught it nucleus. Caroline, can you
(26:35):
put that in plain English? Well, the orbitofrontal cortex is
the part of the brain that's involved in decision making,
and the caught it nucleus is part of the basil ganglia,
and it's responsible for voluntary movement. So you've got that
decision making linking up with movement, and this in turn
creates this irrational fear and response cycle and other brain
(27:00):
regions to have also been implicated, but it could also
be related to a disregulation of dopamine or serotonin. But
as Christopher Pittinger, that Yale O c D Research Clinic
heads says, the fact is the vast majority of the
time a brain scan and someone with O c D
looks completely normal. What Pittinger add another wrinkle to this mystery. Yeah,
(27:25):
he says that brain imaging hasn't obviously lead to a
cure because there isn't one there. There isn't an o
c D brain essentially, is what he's saying. Yeah, but
when we were reading these sources about brain imaging and
scans of people with o c D versus people without
o c D, they did include scans that showed some
(27:47):
o c D patients do have way more brain activity
in those regions that we mentioned than someone without. And
so it's not that there's never an indication on a
brain scan. It's just that sometimes there's not. Yeah, it's
not it's not consistent across the board. But that doesn't
mean that treatments don't exist, although Pitton, Jur and others
(28:09):
point out that existing options aren't terribly effective, especially when
it comes to medication, because current medications work for only
sixty to seventy of cases. Plus, The New York Times
reported that only one third of patients with o c
D even receive any appropriate pharmacotherapy, and fewer than ten
(28:31):
per cent RESI receive any kind of evidence based psychotherapy
such as um exposure therapy and effective therapy. A lot
of times is derailed because of misdiagnosis of depression or anxiety,
which might accompany o c D. But treating depression anxiety
(28:52):
is not the same as treating o c D. So
I mean, again, this points to that average seventeen year
gap that was indicated in that two thousand four study
between the onset of symptoms and actually getting a diagnosis. Well, also,
it makes sense if you have someone who is aware
that some of the the intrusive thoughts that they're experiencing
might be quote unquote crazy. Um, maybe they will just
(29:15):
go to their doctor and say, hey, you know, I'm
feeling really anxious, or I'm feeling really depressed, or something's
off or not right. You know, I've talked about on
the podcast before talking to my doctor about anxiety I
was experiencing and how quick she was to be like, oh, well,
here's an anti anxiety prescription. It's like whoa, whoa. You know,
I didn't take it because it's like, let's figure out
what's actually going on before I just start taking anxiety medication.
(29:38):
And so I can see how that could happen very easily,
where if someone maybe doesn't tell their doctor about the
intrusive thoughts or the obsessive behavior and they just complain
about a certain aspect of what's going on with them
that they could end up misdiagnosed or taking the wrong medicine. Yeah,
if you say I have a hard time forming and
(30:00):
intaining relationships and leaving my house, well here you go,
here's some zolof like some kind of antidepressant. And in fact,
SSR EYES combined with exposure therapy is one of the
most common treatment combinations, and exposure therapy is pretty much
what it sounds like. You gradually expose the patient to
(30:23):
the compulsive trigger to sort of break down the that
that logic barrier, to let them know that Okay, if
you flip the light switch, it isn't in fact going
to set off this chain of events. So, for instance,
with that that girl in the MTV show that Caroline
and I both watched probably in our early college days. Uh,
(30:46):
an exposure therapy might be having her leave her house
with maybe one to start off with light switch flipped
down rather than up, and just seeing what happens throughout
the day and whether it in fact changes any thing.
And one controversial figure in the treatment of o c
D is Dr Jeffrey Schwartz at U c L A
(31:08):
who relies on a trick called mindfulness meditation. He wants
to harness the brains neuroplasticity to allow patients to quote
rewire their thought patterns. And this is coming from an
article and Discover magazine that I thought was fascinating. And
so he has this group of people with O c
(31:28):
D who have suffered varying levels of obsessive and compulsive
thoughts and behaviors for years, to the point of hopelessness
of my life is never going to change. This is terrible.
I can barely make it through the day. Um, A
lot of people came to him with suicidal thoughts and
tendencies as a last resort. What do I do? And
(31:48):
so what he basically has them do is sort of
what practitioners of meditation in general tell you to do,
which is recognize the thoughts as they come to hold them,
examine them except that they are quote unquote trash thoughts basically,
and then sort of throw them away. And I mean,
(32:09):
I'm greatly simplifying his whole process, but it involves, you know,
realizing that these thoughts are junk, that they don't actually
affect your life. And that you have power over them,
and that seems like, oh my god, how do I
have power over them? I can barely, you know, make
it through the day without doing whatever ritual it is
I have to do um. But once he sort of
(32:32):
informed people that you've got to tell yourself that this
is the O c D. This is the disorder making
you do this. This isn't you actually wanting to wash
your hands fifty times or flip the light switch fifty times.
This is the O c D telling you to do
something that you don't actually want to do, because again,
these are behaviors and rituals that people don't get joy
out of. It's not like telling someone who loves to
(32:54):
organize the dishwasher, you've got to stop doing it because
they won't want to. These are people who are few
absolutely overwhelmingly controlled by rituals that they do not want
to participate in anymore. And so over time he not
only watched as these people sort of took control over
their lives, but at the end of the session I
(33:15):
think it was like ten weeks, he did another brain
scan and the the areas in the brain where people
had shown a lot of activity because of their I
c D. It suddenly was just like a flicker as
opposed to a giant glow. Yeah, because the idea is
with this kind of mindfulness meditation, which is becoming more
(33:37):
and more common, I feel like I'm hearing a bit
a lot. It's something that if you've taken a yoga
class you might have heard about or have just gone
to a general therapist. UM. Trying to harness that idea
of the brain's neuroplasticity of rewiring the patterns of our
thoughts through habit and repetition, and this idea of presence
(33:58):
and staying present is really really compelling when you apply
it to something like o c D, but also quite
controversial to apply it to something as ingrained as a
disorders as O c D, because some people in the
medical community say, no, this is kind of focus focus.
You can't actually, you know, just magically, And it's not magically.
(34:22):
I'm saying that magically in quotes rewire your own brain. Um.
But he seems to have had success with it. And
side note fun fact about Dr Schwartz. His claim to
fame is training Leonardo DiCaprio for his OSCAR nominated role
as Howard Hughes who had abilitating O c D in
(34:44):
the film The Aviator. So if you're curious about what
O c D can look like and what doctor Schwartz's
understanding of it is, you can watch Leo DiCaprio and
The Aviator. And apparently, as this Discover magazine profile of
him talked about, Leonardo DiCaprio's method acting embodiment of these
(35:06):
severe O c D behaviors were so impactful on him
that even I think it was something like a year
after filming, he was still sort of having to rework
his way back into the regular normal world, sort of
de engage himself from it. So talking, I mean, that's
kind of reverse neuroplasticity or reverse mindful mindfulness meditation. Yeah,
(35:29):
and it's interesting. I I totally this whole mindfulness meditation
thing sounds a lot like basically cognitive behavioral therapy, which
is experiencing a thought, recognizing that you're having it, and
actively working to change that thought and that behavior. Um
and over time, you know, practice makes perfect all that stuff. Um.
(35:53):
But it's interesting to hear that concept applied to something
like O c D, which you know, it's not just
and inn security like I'm gonna stop telling myself that
I look bad or whatever. It's This is a deeply
ingrained uh disorder that people suffer from, and so it
is interesting and it is controversial. But again, if it
works for people, that helps people, why not well, and
(36:16):
considering too, how debilitating it is for the people who
experience it and the prevalence rate, like we mentioned, it
is more common than schizophrenia and bipolar disorder. Yet Dr
Pittinger at Yale notes how O c D quote receives
far less attention from the major funders of research like
the National Institutes of Health and the pharmaceutical industry than
(36:39):
other conditions of comparable severity. So, for instance, a pharmaceutical
company Row has been conducting trials on an O c
D targeted drug as opposed to a drug that might,
as an additional side effect effectively treat O c D.
This specific drug is thest of its kind to be
(37:01):
even tested have any direct funding to it from the
pharmaceutical industry since, so I mean, considering the commonality of it,
it is sort of surprising that big pharma hasn't left
on it because it could be a decent money maker. Well,
I mean, you know, do do you have people. Have
(37:25):
you historically had people um sort of advocating for o
c D patients and suffers the way that you have
people you know, rightfully so in Alzheimer's breast cancer. I
mean those people are very vocal as well they should be.
But does o c D have champions that are that vocal?
And and that hasn't historically been the case until sort
(37:48):
of recently, we've we've seen sort of an upsurge in
attention paid to actual clinical life altering o c D
versus just the adorable like Mom character on TV or
Jack Nicholson's character and as good as it gets, I
think people with actual o c D are starting to
get more attention. Yeah, you have to wonder how much
(38:10):
our pop cultural depictions of o c D is just
kind of this this little character cork that some people have.
It makes men want to clean. How funny is that?
And also just our casual use of it, how that
might in a very real, real way negatively impact research
funding for it, Because if we look at o c
(38:31):
D in pop culture, we have movies like The Odd
Couple where Jack Lemon's character plays this guy who cooks
and he cleans and they can't have poker night at
Walter Matthol's apartment because he's constantly wanting to clean up
and like put coasters down so that they don't get
you know, stains on the table from their whiskey tumblers. Um.
(38:55):
And then you have shows like Monk that use o
c D as a comedic device, and of course there's
that gendered angle to it, because it's funnier for a
guy to have all these ticks as opposed to a woman,
it seems like. But one show that got a lot
of praise for not using o c D as a
comedic device at all was Girls. Actually, Lena Dunham, who
(39:17):
in real life has dealt with o c D since childhood,
had her character Hannah undergo a really traumatic o c
D experience basically in the wake of, you know, a
relationship trauma. She sort of reverts back to this o
c D behavior of counting um. And she writes about
(39:37):
her real life experience in her book Not That Kind
of Girl. Yeah, and this is just an excerpt of it.
And keep in mind too, how this relates to the
early onset of symptoms in childhood and adolescence. She writes,
I'm eight and I'm afraid of everything. The list of
things that keep me up at night includes, but is
(39:57):
not limited to, appendicida, typhoid, leprosy, unclean meat, foods I
haven't seen emerge from their packaging, foods my mother hasn't
tasted first, so that if we die, we die together,
homeless people, headaches, rape, kidnapping, milk, the subway, sleep. And
she goes on to talk about the process of being
in therapy as a child for O c D and
(40:21):
growing up with it, and it's something that she still
deals with, and she's talked publicly about how much it
grates on her nerves to hear people casually say oh
my god, I'm so O c D about X y
Z and she says, no, you're not. Yeah, and you
don't want to be because it's kind of awful. Yeah, yeah,
I this is definitely I feel like you and I
(40:42):
do a lot of episodes, Kristen, where we we learned
about something, we explore topic, and at the end we say,
maybe we should just cut that out. You know. Cankles,
We're not going to say cankles anymore. They're just ankles, people.
And it's the same with O c D. I mean,
this is an excellent Listening to this episode O my
Friends is a great opportunity to finally say, Okay, we're
(41:04):
gonna stop being offensive. We're gonna stop using O c
D as an adjective, because not only is it a
really horrible condition to have to live with and deal with,
but it has very real life awful consequences. There is
a strong relationship between O c D and suicidal ideations
and attempts. UM. The name John Cleaver Kelly might sound
(41:25):
familiar to some people. He in two eleven committed suicide. UM.
It was his third suicide attempt. UM. He had been
dealing with o c D his whole life and had
been in institutions and been to therapists and psychiatrists trying
to overcome it, and um it led to tragic consequences. Yeah,
(41:47):
and that unfortunately attracted national media attention to the life
threatening potential of O c D. And that's you know,
a big reason why it isn't It isn't such a
funny joke anymore. It isn't. It isn't cute to just
play off your um propensity for organization or your enjoyment
(42:09):
of like of nice color schemes or whatever. It might
be as just this this cute little pet thing that
you have, because it is, it's debilitating to the point
of being lethal. And that was one reason too why
And I don't have his name in front of me.
There's a blogger over at Psychology Today who hates the
(42:31):
depiction of Monk and that entire TV show because for
the same reason, he was just saying, no, this is
not like making it a communic device isn't helping anybody.
And there was one particular episode where Monk gets on
some kind of trial medication for o c D and
it magically cures all of his symptoms. But with that too,
(42:56):
it takes away his ability to solve crimes as well
as he does, so it turns o c D into
the superpower of sorts and also made the blogger mad
saying no, there is no cure and and don't make
this into something good. It just twists it and twist
and twist it. Yeah. He also wrote about his closet.
He's like, yes, I do enjoy a neat closet where
(43:18):
all of my things are color coordinatee and whatever. But
ladies and gentlemen, this is not a symptom of my
O c D. I just happened to like things neat.
I don't feel like I can't leave the house if
my hangars aren't hung. Just so, I have other symptoms
of O c D that I've had to work hard
to overcome. Yeah, and you, for instance, carrying out the
same morning routine in college is not a sign probably
(43:41):
of your obsessive compulsions, but rather it just a healthy lifestyle,
you know, just keeping it together, right, just making sure
I eat breakfast and brush my teeth. So people have
suggested that instead of using the off hand oh my god,
I'm so O c D, say something like, oh, you're
really hyper focused, you're diligent, you're detail oriented, or just say, yeah,
(44:03):
I'm really into cleaning. I enjoy cleanliness. Yeah done. I
like I like having my You can't even say like
having my CDs organized in alphabetical order anymore, because that
doesn't exist and now iTunes to finals. I like having
my records alphabetically organized. We could probably say, just to
keep this even more current for the future, I like
(44:24):
having my my cassette alphabetized, because you know that's coming back.
I can't roll my eyes any harder. So we're curious
to know if this rings a bell with anybody. Does
anyone listening have obsessive compulsive disorder or have someone in
your life who deals with this and perhaps it's gone
(44:46):
through treatment for it. What has been your experience and
what do you think about eliminating this casual jokey use
of o c D Because some people get bristly when
they hear things like let's not use phrases like that,
because I think, oh, well, it's not doing any harm.
Do you think that maybe it's fine to use O
c D in a casual joking way, or yeah, maybe
(45:09):
let's watch our language be a little more diligent about that.
Let us know your thoughts. Mom Stuff at how stuffworks
dot com is our email address. You can tweet us
at mom Stuff podcast or messages on Facebook as well.
And we've got a couple of messages to share with
you about another acorn and then we've talked about on
the podcast right now. Well, I have a letter here
(45:36):
from Taylor that actually touches on to different sminty topics.
She writes, I'm a female architect who was directed to
your podcast by a coworker yesterday, and I have to
tell you just how much I think that your stories
and research and p s a s are so well
informed and interestingly presented. I've just begun to uncover the
(45:57):
archive of your podcast and was struck by the timely
us of your Fibroids one on one podcast, because it
came out in December of last year, which was near
the time that I was dealing with learning I had
a uterine fibroid, but likely more than one. All of
the areas you covered, from race to treatment to taking
time off from work were all issues I encountered in
the fall. Often. I wanted to just share an abbreviated
(46:21):
version of my story because if I had heard this
podcast in December, I would have felt so much more
prepared for what I was undertaking. From my own research,
I already knew that African American women like myself were
much more likely to get fibroids. From my doctors, I
knew that they weren't cancerous, and from three different ultrasounds,
I knew my fibroid was larger than my uterus in
diameter and on the exterior wall of my uterus. I
(46:43):
wanted to say thank you for researching this topic because
uterine fibroids are indeed, a topic that not a lot
of women know exists or no could be the cause
of symptoms affecting them and be the options for treating
them are pretty slim for pre men posel women who
have yet to have children, like myself. In fact, other
than removal of my i U D because of the
size and location of my fibroid, I didn't receive any
(47:05):
treatment except for the recommendation to take a series of
non prescription supplements to regulate hormones. I also think that
the relationship between African American women and uterine uterine fibroids
is very interesting because the factors that range from genetics
to sociate economic status. I'm actually half black, my mother
being Caucasian, and I've never used hair relaxers. I consider
(47:25):
myself a member of the educated medal class, and I
also lead and was raised with a healthy, healthy lifestyle
that does not include eating red meat and an avoidance
of inorganically grown food or gluten. So, despite doing what
seems to have been healthy for the avoidance of fibroids,
I still am in that percentage of childbearing aged women
(47:45):
that have fibroids in the US. You both are doing
an amazing job with this podcast, and I was so
touched by the truth that you relate in this particular
episode that I was compelled to tell you really covered
this one, So thank you, Taylor. I have a letter
here from Laura about our Queen's Week, and she writes,
love the podcast. I eagerly listened to every episode and
(48:08):
have even gotten my fiance addicted. Thank you, Laura. As
a huge history nerd, I had to drop a line
about your Queen's Week. First of all, Woo loved having
a podcast look at Queen's from a more feminist perspective.
So many look at women rulers as stereotypes, so it
was good to hear them explored as real people. I
wish you could have turned Queen's Week into Queen's Month.
(48:30):
I was a big fan of the hat Chips episode,
but I was a little disappointed in your second choice, Victoria.
With a long list of kick ass female rulers, Victoria
was a bit of a downer. She was strongly against
women's suffrage and very outspoken about women's place in the world,
which was not exactly a feminist stance. I would have
(48:50):
loved to have heard an episode on Isabella who encouraged
study and ruled in her own right, or Jinga of
Angola who fought European invasion, or my ever Elizabeth, who
basically one at ruling during the late Middle Ages. I'd
love to hear an episode on women and families and
indigenous cultures around the world as well. I know in
Australia the Aboriginal cultures relationship with women is really complex,
(49:13):
as is the Maudi women's place in the family. Would
love to hear something on cultures around the world. Thanks
for the awesome podcast and keep up the good work
and thanks for your suggestions. Laura. I think that Victoria
was nonetheless a compelling person to talk about, because the
thing is, when it comes to women, they are not
always everything we hope that they will be, so her
(49:34):
complexity is kind of fascinating to me in that regard.
But now, thanks to you, we have some more incredible
ladies to spotlight and be sure to to check over
at Stuff You Missed in History Class because they have
done a number of podcasts on fantastic lady rulers over
the ages as well. And thanks to everybody who's written
(49:56):
into us. Mom Stuff at how stuff works dot Com
is our email address to find links to all of
our social media as well as all of our blogs, videos,
and podcasts with this one so you can read along
and learn about your possible O c D tendencies. Head
on over to stuff mom Never Told You dot com
(50:19):
for more on this and thousands of other topics. Is
it has stuff works dot com
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