Treatment 101: OCD-Institute & ERP | Article F18

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In preparing to write this article I had to do the one thing I’ve wanted to do for ages but never tried: reviewing some of my old journals and two red folders from my time three years ago in the OCD-Institute of McLean hospital. McLean offers one of the three major OCD facilities treating the disorder across the United States (and it’s a world-renowned program). The OCD-I is not a locked unit so I could actually leave the campus for dinner at Friendly’s with family but was expected to be back by, I’d guess 10PM, to sleep there overnight. Besides medication the most used tool for treating OCD is called Exposure and Response Prevention or ERP of which the goal is to expose the client to their distress related to OCD and refrain from using compulsions.

Because this took place three years ago, I can only describe what my experiences were like given my particular circumstance. I was first told about the OCD-I from the Counseling Center on campus as a potential treatment option for myself (at the time experiencing mostly OCD behaviors). Over the spring 2015 semester I transitioned to an OCD specialist therapist whom I saw twice a week for a year. I remember before I landed in my third hospitalization of 2015 I learned that the OCD-I had a three month wait list. The helplessness and hopelessness I felt at that moment was unbearable and led me to accruing more suicidal thoughts that I wanted to act on at the time. However, during my hospitalization I did begin to fill out the application and eventually sent it over to the OCD-I.

In fall 2015, I took a leave of absence from school as I got accepted into the OCD-I around October and stayed there for five weeks. Because it wasn’t a locked unit, we could have laptops and iPods and things to that effect (strings!). People who were dealing with OCD around cleaning or cooking were often the ones serving food and experiencing their ERPs firsthand. We had about four hours of ERPs each day and two hours of them on the weekends. We would often go out on the weekends into the Boston area to practice the skills we were learning at program to apply into the real world. The average stay for an individual was up to three months, but insurance often bottomed out before then. We would follow a set schedule–a goals oriented group in the morning while sitting in a circle, two hours of ERP and track A or track B specific groups, which for me, meant a mindfulness group on some days, intrusive thoughts group, expressive therapy, emotion regulation, and a motivation group.

I find it quite funny that I’ve found some DBT related worksheets from within these red folders that I didn’t realize would play such an important role in my treatment and recovery three years later.

My ERPs had involved exposing myself to methods that I had used in the past to harm myself, saying that I was going to use it to harm myself (which would produce distress) that I then had to shift gears completely from and “live my life. While living my life, I would have to practice mindfulness skills of defusion and practice staying in the moment. Living my life could include just about anything except sleeping and talking about suicide.”

If it sounds slightly warped and unethical, I did have to return the methods after the ERPs were over as they were keeping it behind the nurse’s station.

A few of my notable memories from this time period were some of the friendships that I made and rolling down a big hill out on the campus, “Fight Song” by Rachel Platten and “Stitches” by Shawn Mendes being songs that I danced to, practicing grounding techniques with one of the other clients, a client getting kicked out for stealing and a suicidal crisis that emerged from this consequence, my getting the chance to be my authentic self and make positive messages for the other clients, attending the OCD support group and a few notable lectures.

One of those lectures involved a client focusing on the whiteboard of their values while other clients played their intrusive thoughts. It was a harrowing and emotional experience and even though they cried, they kept their attention forwards and didn’t interact with the ‘thoughts’. Another involved what you would say if you had to give a last speech before you died and another was the memorable speech Alan Rabinowitz gave featured on The Moth titled: “Man and Beast” and the book “The Happiness Trap” which is about ACT.

And finally, there was a set of questions from the OCD-I’s surveys that always stuck with me:

“When I want to feel *more* positive emotions, I change the way I’m thinking” and “when I want to feel *less* negative emotions, I change the way I’m thinking.”

At the time, these two questions were the resounding hum of my treatment after I got released. And from there, well, the rest is history.


Article written: Nov. 21.2018

Present day A/N: I’m trying out the newer layout option and while it’s fancy and nice, I feel it’s also a little more complicated than complicated needs to be. Regardless, here I am.

I hope you guys enjoyed this post! Again, it’s from a while ago but soon I’ll be able to write my final 2 articles to share with you guys here (that I’ll be writing this month, just to clarify). Okay, I hope you’re all well!

I’m thinking I might return to the OCD support group that continues to meet every first Tues of the month as I haven’t gone in a year and I would like to reappear plus I now have a really, really good GPS to bust out. I might send them all an email, too, actually. 🙂 Interesting! ❤ ❤ ❤

I’m typing up my poem next to be uploaded tomorrow on here! 🙂

Stay safe!!! xxx

EDIT: I have no idea what happened but the new layout forced this post into the past and before my MoP one which makes no sense to me so that’s why there’s a discrepancy between the images used and the way the descriptions/A/N’s were written. Sorry about that!! Fucking WordPress.

Treatment 101: Diagnosis | Article F18

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It’s only fair to start off this new series, one I’ve wanted to do for a year, with the broad category of diagnosis. What is a mental health condition diagnosis and why does it matter? Some of these ins and outs about mental health diagnoses, how they are described, and the system used in which to understand them will be discussed below. But first, a disclaimer is in order.

 

My disclaimer for this article, and one that you will often see in each new article of the series, is that I am not a mental health professional and my opinions on these matters stems only from my own experiences, of which I am an expert in, and should not be taken as medical advice. I only wish to shed light on treatments that have been beneficial for me and inspire ideas in others that they can bring to their own treatment teams and potentially incorporate into their own recoveries where applicable. What works for me may not work for you, as we are all unique individuals, so take what I say with a grain of salt.

 

With that out of the way, we can begin addressing the issue of diagnosis–although, word choice is an important topic to briefly mention first.

 

I personally prefer the term “mental health condition” over “mental illness.” In 2016 I used the term “mental health issues” as a bridge between condition and illness and I suppose I reject the term “mental illness” as it feels too stigmatizing and I revoke the notion that I am “ill.” Even though at the same time I back the mission of Canadian Michael Landsberg’s “Sick not Weak” which is a nonprofit organization and popular hashtag on Twitter.

 

I think my logic in that is I’d prefer being thought of as “sick” or “ill” over “weak” as mental health conditions are not a sign of a character defect or purposeful fault of the one struggling with them.

 

I don’t mind thinking of the diagnoses I live with as chronic illnesses but there’s something about “mental illness” that just makes my skin crawl. Adopting person first language is also critical as a person is not inherently “anorexic” or “schizophrenic” they are instead a person “living with” or “struggling with” a condition.

 

But back to diagnoses, in the Diagnostic and Statistical Manual (DSM) 5 there are around two hundred and fifty disorders with a specific, varying amount of symptoms occurring over a detailed duration of time that can explain the behaviors, thoughts, emotions and physical symptoms a person with a mental health condition may experience. According to Grohol (2011) approximately 50% of people living in the US will meet the criteria for a diagnosable mental health condition at some point in their lifetime, as measured back in 2004 by the CDC.

It’s been discussed before whether the DSM should be approached as a medical model (as it has in the past), a categorical approach (as it is presently) or in a new direction altogether.

 

Having mental health conditions listed in a categorical approach has its limits (in fact, most approaches will). If I only fit the criteria for four out of nine symptoms of borderline personality disorder (BPD) I’ll meet the criteria for borderline tendencies (or ‘traits’ as it were) however if I have five or more symptoms I would fit the criteria for BPD as a whole.

 

The problem is people don’t fit so neatly into these classified boxes. And the truth is is that diagnoses have the ability to change over time. A person can be initially diagnosed with depression only for years later to come to the conclusion that the true disorder behind the curtains is bipolar (either type one or type two). That’s why although it can be instinctual to define one’s self in a diagnosis, becoming too attached and too dependent upon the labeling can create a host of chaos on its own.

 

When I was in one of my hospitalizations in spring 2017 one of the mental health specialists (MHS), where I was first introduced to the BPD tendencies diagnosis, described diagnosis as a fluid spectrum. At one point I was to the left of the spectrum and at that present moment I was elsewhere. And, ultimately, that’s okay because diagnoses are mainly important for insurance billing purposes and ways to direct treatment approaches.

 

The time when a set of symptoms begins to cause distress and impairs functioning is the biggest indicator of an underlying mental health condition. People who experience some symptoms of mental health conditions but aren’t impaired, distressed, a danger to themselves or others, or deviate from their society’s norms are not categorized as fulfilling the necessary quota to be diagnosed.

 

Lastly, treatment itself is an interwoven spider-web; there will be many overlaps and connections within each treatment to be discussed in this series.


I still don’t know if I should quote that statistic in here although I heard it first from program but later found an article that goes with it and yeah. My brain is a little muddled at the moment (I’ve totes supposed to have been doing homework but I’ve been writing instead :/)

Any who, I’ve covered ‘Diagnosis’ here (as you can see) and some of stigma (next article) and will begin to venture into other articles within the series in the next few months.

I hope that you enjoyed this piece. Things will definitely overlap and possibly split into multiple parts because I always just have too much to say.

Hope that you’re doing well!!

See you next time.

❤ ❤ ❤

PS A portion of this piece was handwritten 9/7/2018 with more of it edited and added 9/9/2018. 🙂