[HN Gopher] The Hair Dryer Incident (2014) ___________________________________________________________________ The Hair Dryer Incident (2014) Author : bschne Score : 230 points Date : 2021-06-17 17:37 UTC (5 hours ago) (HTM) web link (quotulatiousness.ca) (TXT) w3m dump (quotulatiousness.ca) | quwert95 wrote: | A friend told me a story similar to this where a psychologist | helped a patient with their taxes and credit card debt, the | patient was immediately more functional as a result. | | The crux of it being that academically this is the "wrong" | solution because the textbook and journals don't cite it as a | valid one. But a medical professional's job is to not only treat | symptoms, but to treat the underlying problems as a person. This | was the right solution for this particular person. Yes, it | doesn't scale, but neither does perfect medical care in general. | There is a difference between "triage" and "care". | bullen wrote: | I actually have a triple buffered solution for this on my stove | and water pump in the summer house (which has dodgy electric | wiring and home made plumbing): | | 1) Manual switch with a light when on. | | 2) Timer (runs max 60 minutes, makes some clicking noise when on) | | 3) Remote switch that I can turn off with my mobile phone from | anywhere. | | That way if I forget to manually switch things off, I can turn | the remote switch off and if that fails the stove and pump are | powered maximum 60 minutes = wont burn the house down or flood it | too much hopefully. | | In a future without insurance this is the only way to have a | modern life without bringing the pump and stove with you! Xo | | By the way I don't think she had OCD, I think everyone else is | reckless. | legitster wrote: | This story is cute, but my concern for calling it a treatment | method is.. what is stopping the OCD from transferring to a new | concern? | | Surely, it's not about the actual hair dryer. If they suddenly | get concerned about leaving the heat on or the lamp plugged in | they will quickly run out of room in the car. | tonyarkles wrote: | You're right, but it could be enough of a workaround to help | this person in the short-term to be able to spend the time | long-term to better address the problem. For example, if | they're completely distracted 10 minutes into therapy because | the hair dryer might be on, it's going to be pretty difficult | to actually engage. | kayodelycaon wrote: | Seems like a good solution to me if that was the only major | issue. | | If the underlying cause becomes an issue again, then maybe look | at longer term solutions. | | I've always had an issue with leaving light switches on. So I | installed a bunch of home automation stuff. Now my light bulbs | turn themselves off when I leave the house and a few turn on when | I return. It's a lot easier than trying to fix the problem of | forgetting to flip switches before leaving. | silvestrov wrote: | Bringing the hair dryer along can be the best road to treating | the OCD, because you can then do the treatment in small steps. | | If people can't go swimming because they are afraid of | drowning, you don't give them medication and then throw them | out in the deep end. Instead you let them take as small steps | into water as possible in a way where they feel in control all | the time. | Ensorceled wrote: | I remember a panel on a news program years ago where the one | guest was a psychologist who was treating "untreatable" drug | addicts by getting them "hooked" on running or weightlifting or | martial arts. They would stop drugs but would instead be doing | martial arts for hours a day or running 20 miles every morning. | Then he would start treating the addiction personality and | causes, but in many cases the patients would just stop coming and | live three or more hours of every day in the gym. | | The other guests were various degrees of horrified. | | His patients went from literally living on the street as heroin | addicts to doing 3 hour gym sessions and holding down a job; and | his peers thought he shouldn't be allowed to practice. | | Recently I was reading a book on ADHD and the author was quite | adamant that you could only be diagnosed with ADHD if your life | was worse than "the norm". In this view, if you have symptoms of | ADHD but can, for instance, hold down a good job then _by | definition_ you don 't have ADHD. I deleted the book from my | Audible account. | fpgaminer wrote: | > Recently I was reading a book on ADHD and the author was | quite adamant that you could only be diagnosed with ADHD if | your life was worse than "the norm". In this view, if you have | symptoms of ADHD but can, for instance, hold down a good job | then by definition you don't have ADHD. I deleted the book from | my Audible account. | | IANAP, but that sounds correct to me. I recall the DSM | requiring negative impact on one's lifestyle as one of the | criteria for diagnosis of any mental disorder. And even if I'm | misremembering that, that's what psychiatrists look for in | practice. They not only query what symptoms you're feeling, but | also the impact they have on your day to day life. | | Which makes total sense. Treatment of any disorder, especially | mental ones, carries a (sometimes significant) risk. It would | be unethical to subject someone to that risk for no possible | benefit. | handoflixue wrote: | > It would be unethical to subject someone to that risk for | no possible benefit. | | Let's take two people, say me and Einstein. Let's say | Einstein has super-severe ADHD and thus performs so poorly | that he can fairly be compared to me. | | Is there really "no possible benefit" to curing that ADHD? | Keep in mind that the real Einstein discovered relativity, | and uh... I'm just going to say my contributions to science | have been a bit less dramatic. | | I don't think it's at all unreasonable to posit that there | are plenty of people who are gifted enough to compensate for | their mental issues, but they'd still benefit if they could | fully apply themselves instead of wasting half their talent | mitigating such issues. | Baeocystin wrote: | I agree with your statement. I did not get diagnosed with | ADD until well in to adulthood, and one of the reasons is | that I'm intelligent enough to have come up with a crapton | of workarounds on my own. | | I didn't even know they were workarounds that other people | didn't need. It's just, well, I'm good at problem solving. | | But workarounds they were nonetheless. Life was very | stressful and unsatisfying for a long time, because I | completely used up everything I had trying to compensate | for an inherent, undiagnosed deficit. That I was otherwise | capable enough to (with great difficulty) pull it off | doesn't make the loss any better. | | Within a month of getting a proper diagnosis and | appropriate treatment, I was getting things done in days | that I had put off for months or years. If someone were to | come along and judge that I didn't really have ADD because | I'd found a way to scrape by, they'd be lucky not to be met | with a smack upside the head. | michaelkeenan wrote: | The same psychiatrist from the hair dryer incident in the | link has written about this. He's skeptical about ADHD being | a discrete condition, and generally thinks that if ADHD drugs | will help you focus, taking them is reasonable whether you're | diagnosed with ADHD or not: | | > Psychiatric guidelines are very clear on this point: only | give Adderall to people who "genuinely" "have" "ADHD". | | > But "ability to concentrate" is a normally distributed | trait, like IQ. We draw a line at some point on the far left | of the bell curve and tell the people on the far side that | they've "got" "the disease" of "ADHD". This isn't just me | saying this. It's the neurostructural literature, the the | genetics literature, a bunch of other studies, and the the | Consensus Conference On ADHD. This doesn't mean ADHD is "just | laziness" or "isn't biological" - of course it's biological! | Height is biological! But that doesn't mean the world is | divided into two natural categories of "healthy people" and | "people who have Height Deficiency Syndrome". Attention is | the same way. Some people really do have poor concentration, | they suffer a lot from it, and it's not their fault. They | just don't form a discrete population. | | > Meanwhile, Adderall works for people whether they "have" | "ADHD" or not. It may work better for people with ADHD - a | lot of them report an almost "magical" effect - but it works | at least a little for most people. There is a vast literature | trying to disprove this. Its main strategy is to show | Adderall doesn't enhance cognition in healthy people. Fine. | But mostly it doesn't enhance cognition in people with ADHD | either. People aren't using Adderall to get smart, they're | using it to focus. | | From: https://slatestarcodex.com/2017/12/28/adderall-risks- | much-mo... | sp332 wrote: | Sure, and that wouldn't change who gets a diagnosis. | mlyle wrote: | > In this view, if you have symptoms of ADHD but can, for | instance, hold down a good job then by definition you don't | have ADHD. I deleted the book from my Audible account. | | This may overstate the point a little bit. But there's a kernel | of truth here: if you don't require some degree of significant | impairment of functioning, a whole lot of criteria for mental | illness would apply to huge swaths of the population. E.g. this | is why the diagnostic criteria for ADHD include: "There is | clear evidence that the symptoms interfere with or reduce the | quality of social, academic, or occupational functioning." | thaumasiotes wrote: | > if you don't require some degree of significant impairment | of functioning, a whole lot of criteria for mental illness | would apply to huge swaths of the population. E.g. this is | why the diagnostic criteria for ADHD include: "There is clear | evidence that the symptoms interfere with or reduce the | quality of social, academic, or occupational functioning." | | Wouldn't this just tell us that these categories are | completely meaningless? | kdmccormick wrote: | No. It's a misconception that mental disorders are meant to | categorize folks by sets of character/personality traits, | whether or not they negatively impact someone. No, you do | not have "a bit of OCD" if disorganization simply stresses | you out. | | On the contrary, mental disorders are labels expressely | intended to inform and enable treatment of distress. | Disorder and treatment are inextricably linked. | | This is all according to how the DSM defines things, of | course. Others may have opinions on how mental disorders | _should_ be defined. | thaumasiotes wrote: | You're elaborating on how the categories are intended to | be meaningless, but you're not doing much to claim that | they are in fact not meaningless. | | If someone has low occupational functioning, you could | call that a disorder. But why would you call it "ADHD"? | Why would you call it ADHD for some people and OCD for | other people? Suppose you have two lists of symptoms: | Attention Deficit Hyperactivity Disorder - Patient | has an active mind. - Patient has a crummy job. | Borderline Personality Disorder - Patient rubs me | the wrong way. - Patient has a crummy job. | | And you have several people who display every combination | of mental activity, mental lethargy, likeability, | unlikeability, good jobs, and bad jobs. You say everyone | with a good job has no mental disorder, unlikeable people | with mental lethargy and a bad job have borderline | personality disorder, likeable people with mental | activity and a bad job have ADHD, and unlikeable people | with mental activity and a bad job have borderline | personalities _and_ ADHD. Likeable people with mental | lethargy and a bad job have a disorder as yet unnamed. | | What did you learn about the reasons why people with bad | jobs (your primary diagnostic criterion, after all!) have | bad jobs? | lazide wrote: | That is definitely not how it is defined through - it | seems to be a straw man? | | The criteria is essentially 'you meet these criteria AND | it causes clear problems with your ability to live your | life'. | | It doesn't mean you have a bad job and X, therefore you | have ADHD. Rather, you show ADHD traits and they get in | the way (and cause you distress) in doing a job you | otherwise would be entirely capable of doing. Or | consistently fail (and have distress) on social | environments you'd otherwise be perfectly fine in, etc. | | If you don't have a criteria like that, there is no | useful criteria at all, since practically all medicine is | oriented towards fixing things that aren't working | correctly/causing problems. | | It's the same type of criteria used for evaluating | everything from heart disease to stroke to a broken bone. | Or in other words 'if it ain't broken, then it isn't | broken.' | thaumasiotes wrote: | That is absolutely not how strokes and broken bones are | diagnosed. If one of your bones breaks, you have a broken | bone. Whether it hurts, or stops you from doing things | you'd like to do, is an unrelated question. | kdmccormick wrote: | I think you're missing the point. Let me be concrete. | | I'm diagnosed with bipolar disorder. Sometimes I feel | axnious and euphoric, other times depressed and | lethargic, both at extremes noticably deviant from the | average person. This has caused all sorts of turbulence | and distress in my personal and academic life. Being | diagnosed allowed me access to therapy and prescriptions. | | There exist plenty of people who oscillate between | distinctively high and low moods, but have never found | themselves in serious distress because of it. Thus, they | have not been diagnosed with bipolar _disorder_. Whether | or not they "are bipolar" is a subjective question that | mainstream psychiatry doesn't seem to have an opinion on. | thaumasiotes wrote: | So when you find a person whose highs are higher than | yours, and whose lows are lower than yours, and whose | life is better than yours, that person doesn't have | bipolar disorder, because they're not experiencing | problems. | | Which makes the idea of "bipolar disorder" meaningless. | That person demonstrates that your problems are not | caused by bipolar disorder. But the disorder is defined | by you having problems, even though the problems come | from somewhere else. | kdmccormick wrote: | > whose life is better than yours, that person doesn't | have bipolar disorder, because they're not experiencing | problems | | Your argument seems to hinge on this idea that a good | life => no distress, which, if you've interacted with | anyone diagnosed with a mental disorder, is obviously not | true. | | My life is great. If I didn't take a mood stabilizer, | it'd probably still be good, but not as good. Regardless, | my mood swings can negatively affect me and those around | me. | | If one day I reach a point where I can live without meds | or therapy and reap no negative consequences, then yes, | it would be fair at that point to say that I no longer | had bipolar disorder. | | > That person demonstrates that your problems are not | caused by bipolar disorder. But the disorder is defined | by you having problems, even though the problems come | from somewhere else. | | Bingo. My symptoms (mood swings) + my problems ARE the | cause my bipolar disorder diagnosis. Until I had | problems, I had no disorder. | | What causes the mood swings, then? Genetics, upbringing, | life experiences, diet, idk. Nobody knows for sure. It's | an active area of research, but there is no one known | cause. For all we know, there may be five independent and | unrelated risk factors that lead to someone developing | bipolar disorder. | | It's like you get it, but you're still dismissing it for | some reason. I'm curious what ulterior point you're | trying to make. | underwater wrote: | Someone close to me broke their arm, and had to have it | pinned. As it healed the bone rotated and shifted | slightly. | | In discussing whether they'd need to try to correct this | movement via surgery, the doctor very much said "it's a | problem if it's a problem". When it fully healed the | person had full use of their arm, so the doctor was | satisfied with the outcome. | | The doctor did also say that different countries had | different philosophies on what they expected a healed | bone to look like. In their experience Canadians were | more likely to be OK with an imperfect solution, but | Australians were more likely to want the break healed in | a "like new" condition. | StavrosK wrote: | No, why? "Illness" sometimes is about the quantity, not the | quality. If you enjoy the odd glass of wine once a week, | you're fine, if you drink every hour of the day, not so | fine. | thaumasiotes wrote: | But that's an orthogonal concern. Two people can easily | display exactly the same quantity of, shall we say, ADHD- | like tendencies. If one of them is a success for separate | reasons, and the other one is a failure for separate | reasons, why do we want to say that the failure, in | addition to his other problems, also has ADHD? What do we | learn from that? | | If the success has _a lot more_ ADHD-tendency than the | failure, how do we defend the idea that the failure has | ADHD, and the success doesn 't? | StavrosK wrote: | It's not about whether the person is "a success" or "a | failure", it's about whether the person feels that their | condition is materially impacting their daily life. If I | feel that my gaming habit is impacting my job because I | can't resist playing games during work hours, that can be | classified as a disorder. | | It's just shorthand for "this is something we'd like to | fix". | adambard wrote: | The essay [1] from which the hairdryer anecdote is quoted | has the thesis that categories (in general) are | instrumental, and don't have much value separated from | their context. | | ADHD is a category of psychiatric diagnosis; psychiatric | diagnoses exist to address deficiencies in function. | Separating the one from the other, as you perceive, renders | it meaningless -- or perhaps, useless. If one happens to | have some of the traits of ADHD but it doesn't affect their | life negatively, so what? | | [1] https://slatestarcodex.com/2014/11/21/the-categories- | were-ma... | pmichaud wrote: | Do you remember the name of the psychologist or any info I | might use to look him up? | thequux wrote: | Scott Alexander. He used to post on slatestarcodex.com, but | has since moved to astralcodexten.substack.com . | gwbas1c wrote: | > could only be diagnosed with ADHD if your life was worse than | "the norm" | | Because ADHD is a real situation for some people, and for | others it's a way to legally take class-B stimulants. | | Yes, people really do try their friends' ADHD medication, enjoy | it, and then shop around doctors to find someone who will | prescribe it. It's called "drug seeking," and doctors do flag | patients who do it. | | This, BTW, is what happens with medical marijuana. There are | people who really need it, there are people who think they need | it, and then there are people who who tell everyone but their | doctor that it's recreational. | neutronicus wrote: | I'm ADHD-diagnosed, and god _damn_ do I wish I could just go | to the store and get Adderall when I feel like I need it | | The fact that I have to call someone and get a prescription | every month just makes it so that I go untreated for months | at a time (kind of a cruel irony that ADHD treatment is gated | behind the wherewithal to make a monthly phone call). And | honestly I think modern life is probably such that most | people could benefit from 10-20 mg of Adderall. | TimTheTinker wrote: | Have you tried a nicotine patch? | | Taken for a short period each morning at a low dose (cut an | 8mg patch into sections) it offers similar stimulant | effects, but with fewer side-effects. Nicotine patches are | reportedly less agitating, less addictive, less expensive, | and more available than Adderall. It also measurably | improves cognitive ability according to some studies I've | read online. | | I'm almost 40 years old, and I have ADHD-inattentive. For | two weeks I've been using sections of nicotine patches - | about 1/4 of an 8mg patch for an hour each morning, and I | have never found it more easy to be focused and productive. | | Just be careful to not use too much, especially if you've | never been a recreational nicotine user. I've had several | nights when it's been difficult to sleep -- which has been | a signal that I need to decrease the morning dose. | | (I'm not a doctor, this is not medical advice) | Zababa wrote: | > Because ADHD is a real situation for some people, and for | others it's a way to legally take class-B stimulants. | | In some cases it's really clear, in some others it isn't. A | few of my friends did better than me in school, and they had | access to Ritalin. They were pretty good student while I was | a problem child. I never really explored the option during | school as I didn't really know how it worked and what ADHD | was. I tried it later in life and it helped with work. | Ritalin probably would have helped me during school. But was | it because of some "real" ADHD? Was it because it's a | stimulant and it helps anyone? Was my ADHD more or less real | than them? I know that for them Rilatin and ADHD was a part | of their identity, so maybe they convinced themselves they | couldn't work without it? I don't think there's any good and | objective way to measure that. Should I feel guilt when I | take Ritalin now? I can function without it, but they can | too. It's just far from optimal. | dantheman wrote: | Let people take whatever medicine they want. | kaibee wrote: | So like, in theory, yes, but in practice, now everyone has | to take Adderall just to be able to keep up with their | coworkers. | dantheman wrote: | Not at all, there's more work than can possibly be done. | It's not a sports competition - everyone can win. | sneak wrote: | It's straightforward/trivial to excel over coworkers | (even those on stimulants) at most jobs. | | Regardless, this idea that one needs to "keep up", as if | work were a competitive footrace, is something you have | invented. | caslon wrote: | Seems like the free market at work to me. | Zababa wrote: | Would you apply the same reasoning to caffeine and | nicotine? Should we ban both? You're also seeing the | world as a competition between people ("keep up with | their coworkers") but I believe most people are actually | trying to make a living (no need to take adderall if you | are already satisfied with what you have). | hinkley wrote: | Doctors are really good at cognitive dissonance. I think it's a | professional hazard of having to compartmentalize. | | Those same doctors are probably perfectly fine with handing out | methadone prescriptions to addicts. | frickenhamster wrote: | Crabs in the bucket | spicybright wrote: | This is very much paralleled with non-techies solving techie | problems eloquently. | | A few weeks ago there was a story in a company where the | financial department used pretty old computers that didn't run | anyone else's software. They were the only ones that could use | it. | | When asked, they said they were tired of the programmers mucking | around with their machines so they just didn't use anything they | knew. | | A knee jerk techie solution would probably be password login | systems with someone holding the "keys" to it. Maybe some kind of | other procedures. Or just do the above! | superjan wrote: | While reading, I was thinking about telling her to get rid of the | hairdryer, but bringing it with you is way smarter. If there was | no hairdryer to worry about the mind would likely search for | something new to obsess over. | lainga wrote: | A bit like a lightning rod. The OCD is going to fixate on | something... give it a target you can control | tyleo wrote: | This is a great story. I know its not related but I can't help | but feel a sort of analogy to engineering work: the tension | between idealism and pragmatism. | | At a previous company our build times for a game client were | around 5 minutes or so. Our tools team had planned some work to | get this down but it kept getting pushed out. The tools weren't | part of the client so I'm not sure they know how bad this was. | Anyways, one of the tools engineers rigged up a solution in a day | or so that got this down to a minute. Unfortunately it wasn't the | nice, perfect, planned solution that kept getting pushed out so | they were reprimanded by some manager. Fortunately, more were on | the side of the engineer than the manager. To my knowledge they | never did end up implementing the planned solution. | Ma8ee wrote: | Imagine if the nice perfectly planned solution would have | gotten the build time down to 5 seconds and been done next | month, but it now never would be implemented because 1 minute | was considered good enough. | phkahler wrote: | >> but it now never would be implemented because 1 minute was | considered good enough. | | By definition it's good enough. The only thing being lost is | the stroking of some ego. Our whole world seems to be built | with "good enough" and I do find that frustrating at times. | People are imperfect and have finite time, so I understand. | Evolution seems to think we're good enough for now. | milesvp wrote: | I'm a big fan of these kinds of improvements. They can be a bit | dangerous politically though. 5 minutes might be something the | manager can get traction to implement a fix to get it below 1 | minute build times. At 1 minute the manager may never be able | to make a political argument to improve. | | This may also be why the manager chastised the person fixing | this. Such a drastic improvement can completely undermine any | efforts to make even bigger fixes, as well as make the manager | look foolish that they couldn't make these improvements | already. | | I tend to believe the perfect is the enemy of good, but I've | certainly worked in some orgs where I might take an improvement | like this to the main champion of the problem first and ask if | it's a useful solution. I might even be willing to shelf the | solution if I can be convinced it's not in the long term best | interest of the org. If I'm not, though, I'd likely become a | champion of this short term pain relief knowing that things may | not ever have much chance to get much better. | ChrisMarshallNY wrote: | It's totally related. There's the old urban myth about the | "NASA Pen,"[0] which is a favorite of tech people (It isn't | actually true, but it's a great story). | | I have a similar apocryphal story that I use in design. I write | about it here[1]. | | _> For many years, I have heard stories about some architect - | they never say who - that once designed an office park | /university campus/government center, etc., and deliberately | did not add any paved walkways. Instead, it is said he had the | buildings completely surrounded by lawns. After a year, he came | back, and paved the areas of these lawns worn thin by people | taking the most effective routes around the buildings. He did | this because he decided at the start of the project, he'd never | be able to account for human nature, and it was his goal to | serve the folks using the campus as best as he could. The users | of his system would let him know, organically, how to "tune" it | so it can best serve them._ | | Also, anyone that is familiar with the Granny Weatherwax | character, by Sir Terry Pratchett, may remember that she | practiced what was termed "Headology." That was sort of | "practical" psychology, and it involved things like giving | headless ghosts pumpkins, so they would stop moaning (actually, | it was another character that did that -from _I Shall Wear | Midnight_ [2], but it was definitely Granny's "Headology"). | | [0] https://www.scientificamerican.com/article/fact-or- | fiction-n... | | [1] https://littlegreenviper.com/miscellany/the-road-most- | travel... | | [2] | https://www.studynovels.com/Page/Story?bookId=27327&pageNo=6... | ortusdux wrote: | I believe it was the podcast 99% invisible that had an | episode about urban planners driving around after a heavy | snow and documenting unofficial paths for later development. | nexuist wrote: | There's a subreddit for this: /r/DesirePath | ChrisMarshallNY wrote: | Cool! Thanks for that! | gricardo99 wrote: | Engineering is filled with "hacks" and workarounds, where the | root cause isn't fully understood, if at all. I feel that if, as | a profession, there was immense pressure to instead find only | root causes to address issues, we'd still be working out the | kinks with punch-card systems. | tonyarkles wrote: | Yeah, it's a really tough balance to strike. I've worked with | teams and systems where they were fully happy to apply a hack | and move on and it worked great for them. I've also worked with | teams who had a terribly bad culture of throwing shit at the | wall to see what sticks for fixing weird errors and in the | process making problems worse without actually fixing the | problem. | | Using good judgment to figure out when a hard RCA is necessary | and when it's not is _key_ to making forward progress without | constantly shooting yourself (or your teammates) in the foot. | ElViajero wrote: | Many are missing the point, this is a story about transgender | rights, not about psychologist knowledge. | | The original article, linked in the post, starts with: | | "I've made this argument before and gotten a reply something like | this: | | Transgender is a psychiatric disorder. When people have | psychiatric disorders, certainly it's right to sympathize and | feel sorry for them and want to help them. But the way we try to | help them is by treating their disorder, not by indulging them in | their delusion." | | And then goes to explain the "Hair Dryer Incident" as a counter | point. | nexuist wrote: | Oh wow, this is very cool added context. Unfortunate that the | linked article doesn't include it, although the story works out | of context as well. | dahart wrote: | I saw you were downvoted, and went and read the rest of the | post to read the transgender argument. It's a great read, the | longer article is well worth perusing. I upvoted you for that. | | The article's thesis, though, is about how humans get stuck | categorizing things, in ways that get canonized, and then have | a hard time understanding that there are different legitimate | ways to categorize. Transgender was just one example, the Hair | Dryer incident another, and among them the whale-fish, and | Israel vs Palestine. I love the way he framed transgender | rights, and the Napoleon example is hilarious, but I wouldn't | say the story is primarily about trans rights rather than | psychologist knowledge. If anything, it's specifically showing | some of the reasons why DSM 5 is so dramatically different from | DSM 4, right? | cowboysauce wrote: | I've read most of Scott's blog posts and he rarely mentions OCD | and when he does it tends to be "this is what I think people with | OCD experience" and not "this is what my patients have told me" | which leads me to believe that he is not an expert in OCD. | | I have OCD and it's ruined my life in ways that are hard to | articulate. Which is why I can point out two good reasons why | what's being described might not be a good idea. First, giving | into compulsions just legitimizes them and reinforces the | patterns that are central to OCD and can ultimately make things | worse. Secondly, OCD has a habit of changing how it manifests. | Sure, maybe the woman is no longer bothered by the hairdryer, but | what happens when it becomes changes to worrying if the oven is | on? She'll be right back where she started. | | I doubt that the anecdote actually happened as described. It's | way too contrived, simplistic and borders on "Psychiatrists hate | her! Cure your OCD with this one simple trick!". Realistically, | OCD is incredibly insidious and if it were that simple to cure | then nobody would have OCD. What's described is, at best, a | short-term fix and half the psychiatrists likely knew that such | things rarely stick. | | I've had the same thing happen to me more times than I can count. | I think I found the silver bullet, a way to permanently defeat my | obsessive thoughts. If I'm lucky then it'll last a week before my | OCD comes back in full force. But the truth is that you cannot | directly fight OCD, it's like squeezing dough. When you clamp | down in one spot, it just squirts out somewhere else. There's a | quote that I think describes it perfectly "To hate me is to give | me breath, to fight me is to give me strength". Fighting OCD or | giving into its demands is just falling into its traps. You only | truly win when you reach a point where you don't respond to it. | meowface wrote: | I've suffered from symptoms of OCD on and off, and, personally, | I totally believe this anecdote and think it's a great parable. | | I think the world is probably split into pro- and anti-hair | dryerism, both among people who do and don't have OCD. | | >First, giving into compulsions just legitimizes them and | reinforces the patterns that are central to OCD and can | ultimately make things worse. | | Of course, but that's the whole crux of this story: "She'd seen | countless psychiatrists, psychologists, and counselors, she'd | done all sorts of therapy, she'd taken every medication in the | book, and none of them had helped." It's paved over for | conciseness, but I think it's implied that what you said is | definitely not news to the patient. | | _Of course_ the first, second, third, and fifteenth thing you | should and must try is what you say. I 'm sure Scott would | agree. This was a Hail Mary when every attempt to do that so | far failed. | | To give another example: I think ECT is terrible. But if | nothing else has remotely helped someone with severe depression | over a very long period of time and they hate every waking | moment and are close to suicide? Throw that brain in a Tesla | coil, I say. Another facet of hair dryerism would be stances on | body identity integrity disorder. I won't write at length, but | I think anyone can guess my position on it. | | >Secondly, OCD has a habit of changing how it manifests. | | Yes, this was my first thought, but I think that's also part of | this parable, too. It likely will manifest in other ways for | the patient, but this is a simple hack that actually helped | resolve one immediate issue that was causing her a lot of | difficulties at that time. | | Some of the other issues will probably cause less severe of a | life impact. There's a decent chance some won't, since it could | be something thing like an oven, but the point is that this was | one method to immediately address one pressing problem that was | heavily affecting her life. Obviously you wouldn't just say | "okay, you're fine now" and tell her to never come back; this | would just be a stopgap while the patient is further treated. | | On the topic of OCD, one thing that surprisingly helped me a | lot and continues to help me came from what I believe was a | random reddit or perhaps HN comment I happened to stumble | across a few years ago. It was a short sentence from someone | quoting their psychiatrist - essentially a suggestion of a | different way of mentally framing things. It actually was "one | weird trick" that really did immediately work in my case. | | I think it was the precise phrasing of it that helped me, so I | don't want to try to roughly paraphrase it from memory, but it | definitely made it clear that while OCD is certainly a | neurological problem, psychological techniques can help guide | your neurology, like the proverbial elephant rider prodding the | elephant a bit in one direction or another. Hopefully something | like that, or perhaps something entirely different, will help | this patient so they don't need to take their hairdryer with | them anymore. | cowboysauce wrote: | Despite my initial comment, I'm pro-hairdryer. If it works | when nothing else does, then do it. I'm even pro-hairdryer in | the sense that it could be used as a stop gap until the | patient learns more effective ways to manage their OCD. | | I think what bothers me about is that Scott doesn't mention | that there are legitimate drawbacks to the solution in the | story. It's a nice "thinking outside of the box" story but to | use it as an excuse to be smug and very much "I'm better than | the rest of these psychiatrists who don't actually want to | help you" is distasteful. | meowface wrote: | I didn't see it as a way to be smug or seem better. It | seemed like his colleagues were split in half, as he said, | and he happened to be on one side, and both sides felt like | the other side was being ridiculous. | fpgaminer wrote: | I think what you wrote perfectly describes the correct approach | to mental health _in general_. Not just OCD, but also many | other mental disorders like anxiety, and just emotions in | general. Trying to ignore or repress our thoughts and emotions | just serve to "give [them] strength". It's a life lesson I wish | a lot more people knew. | | [NOTE: This thought got me going on a random train of thought | below, not really directed at the person or comment I'm | replying to above. Sorry for the slight tangent...] | | I've recently started taking on a unique viewpoint of my own | psychology. It's more of an interesting way to think of one's | mind than an actual theory on the mechanisms of the brain. But | basically I started thinking of my mind in terms of the classic | conscious/subconscious split, but thinking of the subconscious | as less like a ... primitive/instinctive part of myself and | more like a separate system with its own thoughts and desires. | Kind of like how we imagine the body to be conceptually a | separate entity from our minds. Though they're quite | intertwined, its easy to imagine that we could transplant our | mind into a different body and still be ourselves. I imagine | that I could transplant my consciousness into a different brain | and still be _me_, but with a different subconscious. That | sounds strange, because we're so used to the idea of the | subconscious being a part of our us, but hopefully it makes | more sense momentarily. | | The point of viewing the subconscious like this is then one can | say that, like the body, if you don't take care of your | subconscious's needs and desires, if you don't give it space to | be heard, it will lash out. Trying to repress one's emotions, | anxieties, OCDness, etc, you're making your subconscious | unhealthy in the same way that you can make your body unhealthy | by not eating healthy, not working out, or ignoring pain. | Emotions are the way our subconscious tells us its in pain or | in need. | | More importantly, this allows a subjective _detachment_ from | one's emotions and anxieties. To view them objectively. Whereas | it's really easy to feel anxious and then believe that that | anxiety is _part_ of yourself. That you, yourself, are anxious. | But viewing the subconscious as a separate system that must be | managed like the body allows one to feel anxiety and | acknowledge that it isn't _you_, yourself, that are anxious. | It's your brain that's anxious. And it's a signal that you need | to do X, Y, and Z to take care of your brain. Much like one | would rest when your body is telling you it's hurt. | | Again, this is more of a way of viewing the brain, rather than | a psychological theory with any basis in reality. It's | definitely very derivative of archaic psychology theories like | Freud's theories and bicameralism. But I find it helpful none | the less. The most important component, and something I think a | lot of people with mental disorders have trouble grasping, is | that this idea that one's identity is not tied to their | disorder. I'm lucky in that I've experienced what my brain is | like without anxiety and found out that I'm still the exact | same person, just minus anxiety. I know prior to that | experience I probably would have said that _I'm_ an anxious | person, as if it were some fundamental part of my personality. | So that experience has better enabled me to make clearer | divisions between self and the flaws of the substrate my | conscious mind is running on. | | N.B. I'm just sharing a (hopefully) interesting viewpoint. This | isn't "do this one weird trick and you won't have a mental | disorder anymore!" kind of thing. Anyone who suspects a mental | disorder, no matter how small, should seek guidance from a | medical professional. Seriously. There's no shame in any of it, | and treatments are better today than they've ever been. My | little pet theory above is, again, just something I found | interesting in the way I view my own psychology. | cosmojg wrote: | What you're describing lines up well with recent research[1] | on multi-agent models of mind. You might be interested in | internal double crux[2] and internal family systems[3] more | generally. These are techniques for managing mental health | very similar that which you describe, and they build | primarily upon the idea that the mind is best treated as a | collaboration among multiple subagents. | | [1] https://www.lesswrong.com/posts/i9xyZBS3qzA8nFXNQ/book- | summa... | | [2] https://www.lesswrong.com/posts/mQmx4kQQtHeBip9ZC/interna | l-d... | | [3] https://www.lesswrong.com/posts/5gfqG3Xcopscta3st/buildin | g-u... | caethan wrote: | Scott _has_ OCD. Search for "obsessive compulsive disorder" | here: https://slatestarcodex.com/2014/04/11/going-loopy/ | cowboysauce wrote: | That's strange. My impression came from his article about the | Chamber of Guf where he talks about pure OCD, but it sounds | like he's only read about it and never actually met someone | with it. | | I wonder if the disconnect is in taking the story in an | idealistic way vs a practical way. Like sure, if you had | someone for whom that works utterly when nothing else works | then yeah, do that. But I don't think that's a realistic | scenario. | fleekonpoint wrote: | "To hate me is to give me breath, to fight me is to give me | strength" | | I've been listening to the self-esteem meditations on headspace | and this is the same thing that they are recommending. I am | amazed at how effective it has been. | sunshineforever wrote: | The idea that the entire psychiatric community wouldn't be | completely on the side of the author is one of the reasons that I | have such little faith in their field. | | The reason being is that the underlying condition could always be | worked on after first taking the small, practical steps to | dramatically reduce the impact of the problem. | | I have personally experienced situations like this and it was so | frustrating until I realised that I had to take personal | responsibility, because help wasn't coming from within the | system. | kayodelycaon wrote: | I've had the same problems with regular doctors and medical | issues. A lot of my problems turned out to be a milk allergy. | hallway_monitor wrote: | In my experience most doctors are pretty useless trying to | solve a difficult problem. I had my daughter's colon biopsied | before someone suggested using a hypoallergenic formula. | dr_orpheus wrote: | Variation from doctor to doctor is also wild the reactions | you get out of people. Our daughter had a dairy allergy and | we had observed after cutting it out her getting better. | Our original pediatrician basically had the attitude of | "well since you self-diagnosed this and it wasn't | officially by me I'm going to largely ignore it and proceed | as normal." | | We switched pediatricians and the difference was amazing. | The response was "I have listed to all that you have said | and I agree with your assessment that she has an issue with | dairy. Here are some options for her diet going forward". | The difference between fighting a battle to feel heard | versus feeling like someone is on your team solving a | problem is incredible. | rebuilder wrote: | Doctor 1: "Kids have all kinds of stomach problems all | the time. The parents always say it's dairy or gluten. | The parents don't know anything, so I'm going to ignore | them." | | Doctor 2: "Kids have all kinds of stomach problems all | the time. The parents always say it's dairy or gluten. | This is probably going to go away on its own, but the | parents will keep insisting I do some thing until it | does. I will tell them they are on the right track and | send them off. " | | Doctors have to play a whole metagame beyond just trying | to figure out what might be causing the symptoms their | patients are presenting with. | nitrogen wrote: | _Doctors have to play a whole metagame_ | | I _really_ detest this idea that blatant manipulation is | necessary from people we are supposed to be able trust. | How about this instead, where the doctor provides | information and a plan of action instead of manipulation: | | Doctor 3: "Stomach problems are common, they may or may | not be caused by the most popular triggers, and they | might go away on their own by coincidence. Here's the | decision tree we can follow, which will let us know if we | need to do more..." | verall wrote: | Plenty of doctors do explain all of this, but people hear | what they want: did the doc affirm or contest my theory? | Did they "do anything"? (recommend surgery, prescription, | diet, etc) | paulcole wrote: | > In my experience most doctors are pretty useless trying | to solve a difficult problem | | This applies to nearly every profession. Most people are | average at their jobs and most people aren't that great at | consistently solving the harder (or hardest) problems their | job presents. | | It's as true for doctors as it is software developers or | truck drivers or teachers. | phkahler wrote: | That's why they should do triage. If they can't figure | out the problem, at least be able to refer a person to | someone they think can. If they're not willing to do that | then they're probably more interested in their own | practice (can make more money by fumbling around) than | helping patients. | | I have a great deal of respect for someone who says "I | can't help you, but that person over there can" and turns | out to be right. I'd gladly try them again with a | different problem. | [deleted] | ineptech wrote: | Doctors are just tech support for the human body. They listen | to your complaint and offer up their best guess diagnosis | based on what's helped previous customers with the same | symptoms, but they have limited information on the system | they support, the documentation is spotty and sometimes | contradictory, there's a ton of bugs, and they have no | escalation path because the engineer who designed the system | quit ages ago and left no contact info. | __turbobrew__ wrote: | I have been misdiagnosed so many times for health issues, I | feel like doctors need to specialize within domains and | they are only allowed to practice within that domain. So | much advice given out by general practitioners is useless | and only treats symptoms of health conditions. It literally | took me 4 years to figure out a health issue as a bounced | from doctor to doctor as they all scratched their head. | Some doctors even made incorrect diagnoses which lead to | treatment which was actively harmful to my condition, it | would have been better to not see those doctors at all | since they set back my recovery by months. | | We dont let electrical engineers build bridges so why do we | give doctors so much freedom in their practice? | kyleee wrote: | Hilarious and often quite truthful | teucris wrote: | Except that the small steps that seem innocuous actually turn | into dramatic problems in the case of OCD. | TuringTest wrote: | But if you dramatically improve the patient's life _right | now_ , it will probably be a lot easier to treat the | underlying problem, without the added worries of stress and a | failing career. | rootusrootus wrote: | The impact isn't the same, but I've been guilty of doing | exactly the same thing with software bugs. "Sure, we could just | do this little workaround and get you back up and running, but | there's a _reason_ for this and we would be better off in the | long run investing in a real fix. " | | I do have a limit, at least, after which I'll go for the quick | fix and then try to follow up with a broader investigation. | Depends on how severe the issue is, too. | loloquwowndueo wrote: | People are not software :) | hawkesnest wrote: | I heard/read a similar mental "hack" about folks who fear leaving | things "on" when travelling. Take pictures with your phone of all | the things just before you leave. They'd be easily available, | verifiable evidence that the stove is off, all the doors are | closed/locked, furnace set, water shut off, and so on. | op00to wrote: | The pictures don't work with all ocd. Often times I would worry | that I did the thing that couldn't happen (open door, whatever) | AFTER the picture. So I'd videotape the situation and myself | walking away. It got silly. I really hate this condition. | teucris wrote: | Just recently went through my phone and spent an hour | deleting all the photos I took of appliances, etc. I had | taken during the height of my OCD. It must have been hundreds | of pictures. | op00to wrote: | I had to upgrade to a bigger cloud tier. lol. So insane! | csteubs wrote: | FWIW, this is also great advice from an insurance point of | view. I went on a 3 month trip and took pictures of all the | appliances before leaving--mostly for peace of mind, but also | because the building was fairly old and had a history of | leaking pipes, faulty outlets, etc. | | Sure enough, a month into the trip and my downstairs neighbor | has his bathroom ceiling fall in due to a leaky drain pipe in | my shower. I had photo proof that the water wasn't on or | leaking and the building's insurance policy ended up renovating | both of our bathrooms. Came back to a brand new rainfall shower | and granite countertops. | rootusrootus wrote: | That's cheaper than my solution, which was to make the status | of the door locks, garage doors, furnace, etc, all verifiable | via home automation. And with backups for some of them, like | auto-closing garage doors. I used to have a problem where I'd | get a half mile from home and have to turn around and verify | the garage doors were in fact closed. Never once did I return | to find them open. But now I can just pull it up on the phone. | | Pictures is a cheaper way of accomplishing that, not a bad | idea. | PaulDavisThe1st wrote: | level 2 of that game, tho': | | "Is the list I made to know what to take pictures of complete? | Did I really take pictures of everything? What about that thing | I'm not remembering right now and wasn't on the list but I'm | pretty sure I didn't turn it off, either ..." | bigmattystyles wrote: | I have, at times, pretty bad OCD - If this works and it keeps | working, I'm happy for the person. In my experience though, OCD | will find something else. The point about the other psychiatrist | saying it's absurd is probably because they know, it will about | having left her garage door open next. OCD is horrible, and | nothing like what most people think; if you want to see the | horrors many with the affliction deal with, head over to | reddit.com/r/ocd | CalChris wrote: | The Gordian Knot theory of psychiatry. | dr_orpheus wrote: | I agree that its a great solution and in a way it is consistent | with any other long term medical condition so I don't understand | the outrage. | | You can try and try and try to treat the underlying medical | condition. But at some point if it doesn't work you stop trying | to treat the underlying medical condition and instead treat | symptoms to make the patients quality of life as good as you can | while living with the issue. | mindvirus wrote: | Hah, my first instinct was "just set up a baby monitor". I can | totally see not thinking of the even more obvious solution. | tempestn wrote: | Similarly my thought was, "Just sell the hairdryer and deal | with damp hair - it's not worth it!" | Hamuko wrote: | I think a similar case I read somewhere was a case where someone | was having trouble showering because they had body image issues | and they didn't want to see their naked body in the shower. | Therapist had a simple solution: "Try showering without lights | on." | jmkd wrote: | A brilliant little story with a lovely glimpse as to where | scrappy solutions might come from to many kinds of problem. | teucris wrote: | Having lived through OCD and come out the other side, I | completely understand why the solution was considered bad. | | Sure, this solves the particular obsession. But the issue is that | OCD is never satisfied. You develop rituals like this and they | work for a while, giving your brain that little dopamine boost | every time you look at the hairdryer in your car. But that dose | diminishes over time, and soon taking the hairdryer with you | isn't enough. You need to do something more to feel okay about | the obsession. This is why OCD sufferers find themselves doing | something over and over. | | Sustainable solutions address the anxiety (most often meds) or | build up the person's tolerance for uncertainty (exposure | response prevention). It was only a combination of these | approaches that helped me overcome my illness. | spaetzleesser wrote: | Don't let the perfect be the enemy of the good. It may not be | the final solution but it improves the life of the person. | | I would have more sympathy with the other doctors if they | actually had a solution for OCD but they don't. So somebody who | has no fix for the problem is criticizing someone who fixes a | part of the problem. | choeger wrote: | Did you consider that the OCD could get worse due to the | negative effects of the OCD, e.g., bad performance in the job | or problems with the patient's relationships to friends and | family? If such a feedback loop exists, breaking it _can_ be | part of the cure, no? | teucris wrote: | Breaking the cycle is important, no doubt. The issue I take | is the quote makes it seem like all they had to do was carry | the hair dryer with them. There's so much more that needs to | be done. | phkahler wrote: | It's critical to find any intervention that works for a | debilitating problem. If the hairdryer person lost their job | because of it, they may not be able to continue ANY treatment | and that might be the end of them. | | The first goals in DBT therapy are to stop behaviors that may | interfere with therapy or kill the patient. Seems like a good | approach to me. | | On a related note, I knew someone who had some very self- | destructive ways of dealing with her stressful life and | associated problems. She held down a good professional job at | <big company> and most people didn't know about her issues. She | found a psychologist that she liked (and I didn't) and after | somewhere between 1 and 2 years she ended up dead. You've got | to stop self-destructive life-interfering problems any way you | can. | | When a person might be bleeding to death, the first step is to | stop the bleeding even if by tourniquet. You can do surgery to | fix things later, but not if the patient is dead. Priorities | are a thing. | teucris wrote: | No argument here. I just don't think the other medical | professionals are given a fair shake in the original quote. | tnorthcutt wrote: | _She'd seen countless psychiatrists, psychologists, and | counselors, she'd done all sorts of therapy, she'd taken | every medication in the book, and none of them had helped._ | | Sounds like everything else had been given a fair shake to | me. | teucris wrote: | This is the part that irked me: | | > And approximately half the psychiatrists at my hospital | thought this was absolutely scandalous, and This Is Not | How One Treats Obsessive Compulsive Disorder | stordoff wrote: | Also having OCD, I can see how this would be helpful though. | You can fall into a stable position where you're doing enough | to keep the OCD at bay (taking the hairdryer with you) without | it being something that interferes with your life. I don't | think it's an _ideal_ long-term solution, as the OCD can latch | onto something else, but as a starting point for ERP (leaving | the hairdryer at home on shorter trips) or if other solutions | have been tried and failed, I can see it being useful. | teucris wrote: | Sure, but the quote seems to deride the other medical | professionals involved. They were likely not idiots: they | were likely thinking longer term. | phkahler wrote: | They are idiots. And also probably very smart people. | Sounds like they have their own issues to work on :-O | betwixthewires wrote: | Well, you can call it a stopgap. As long as they're not saying | "cured! It's over for you now." I think it is great. Why does | the patient have to live through the debilitating symptom while | the causes are worked on? Perhaps a part of the treatment then | is getting the patient to leave the dryer at home on weekends, | maybe initially curled up on the coffee table, then in the | bathroom, etc. while they go to the grocery store or for a jog. | It could be a very good first step. | | I have a compulsive problem that developed due to an anxious | situation I was in. I was taking a nap on the couch, I smelled | burning and assumed it was someone in my neighborhood grilling, | which was common. I woke up to an apartment filled with smoke, | my place was on fire. It was small, I was able to get out the | front door (which is where the fire was) and call the fire | department, they came and put it out, minimal damage, no loss | of life. But still, since then, if I smelled wood burning, even | though I know it's probably someone grilling or with a fire in | the fireplace I go outside and look around just to be sure. It | is irrational and I know while I'm doing it. What helped me was | living in a place where some neighbor or other burns wood | almost daily. I still get a tinge of "but what if that's not | what it is this time" every time I smell it, but I don't | compulsively check anymore. | | Also for a lot of people these mental illnesses cannot be | cured, only managed. I'd think finding simple solutions to | reduce compulsive anxiety are more sustainable than long term | drug use. | teucris wrote: | When monitored, sure. The approach I would guess an OCD | specialist would use (I'm not one, so this is only a guess) | is to have the patient dry their hair, leave the bathroom, | and wait as long as they can bear without checking to make | sure they turned it off. Then, some time later, have them do | it again, and try to wait longer. Repeat until they can go to | work without worrying. Letting them take the hairdryer with | them until they can do without it seems like a good addition | to ensure they can get through the rest of the day. | aspyct wrote: | I personally have problems with doors, and stuff that should be | locked. I can never be sure I locked properly. | | Totally did backtrack unreasonable distances just to check if I | had closed the door. | | It's all fine when it's my door. Worst case scenario, I get | robbed. | | However it's more of a problem when it's someone else's door. | Worst case scenario, they get robbed, and that's a different | story. Or pets get out... | | Obviously I can't take the door on my front seat... So my | solution is to take a picture of me trying to open the door, a | kind of proof that it's closed. | | And, would you know it, it works! When I get anxious, I pull out | my phone and look at the pictures. | | It's getting better, actually. I believe I'm fixing it slowly. | Good riddance! | robotresearcher wrote: | There's a very helpful method for being confident that you did | something right, and while it may not be enough for people with | compulsive disorders, it's great for many situations: | | https://en.wikipedia.org/wiki/Pointing_and_calling | | I think it works by recruiting more of your body & brain to the | task of attending to something. | | Maybe the anxious could video themselves doing it, and watch it | back later. | dasyatidprime wrote: | I've had a lot of success with this for things like closing | doors and taking medication, as my memory gradually wanders | off into the misty lagoon. Especially the "as needed but at | most once every 24 hours" kinds of medication that can't be | handled with a pill organizer--with the timing information | included in the call. Point to the bottle (or if out of | range, hold the pill up, or otherwise physically emphasize | the object), say "Taking a symptomstoppidine on Thursday | morning" or such. | [deleted] | bentcorner wrote: | I kind of hit a similar problem: My parents let me stay at | their house while they were on vacation and I was traveling | through their city, as long as I locked up and set their alarm | when I left. | | Me, being unused to how their alarm worked, was unsure if I set | it. | | I set the alarm, locked the door, hear it beep, waited outside | until it stopped beeping, then I thought to myself "was the | alarm _really_ on? ". I unlocked the door, opened it, setting | off the alarm, which I turned off with my code. | | Goto 10 | | This repeated a few times until some larger alarm somewhere | else in the house started blaring loudly that could probably be | heard across the neighborhood. So I disabled it one more time, | and just left it well enough alone since I couldn't get out of | the loop without some other way of verifying things. | Johnny555 wrote: | I used to work with someone who had that same problem with door | locks, he'd sometimes leave work to make sure he locked his | door. This was well before the days of ubiquitous web based | home security cameras, but he rigged up a video camera and a | video capture card on his PC to take a picture of the door (and | door lock) and post it on a web page every minute. So he could | easily check to verify that the door was closed and locked. | | Nowadays, maybe an electronic lock would be an easier solution, | though I'm not sure that would satisfy the urge to be sure it | was locked, would he trust it? | underwater wrote: | I don't see why he wouldn't trust it. The OCD seems to be an | anxiety triggered by the uncertainty of his memory, rather | than paranoia. | spaetzleesser wrote: | That's correct. My girlfriend has issues with locks and | stoves. She doesn't trust herself but if I tell her it's | all good she has peace. | rootusrootus wrote: | Can't speak for anyone else, but for me the electronic lock | was enough. At least after I'd used it a few times and got a | feel for how reliable the indication was. | DanHulton wrote: | Similarly, I used to get anxious about if I'd turned off the | lights, locked the door, made sure the oven was off, etc at | night. So now I count one number for each "thing" I do, and I | know that I need to count up to 5 to "prove" I did it. Then, | later in bed, I know I checked the front door because I know I | counted to 5. | | You'd expect this would transfer to the "well, are you sure you | counted", but I'm never actually anxious about that. I think it | works similarly to mnemonics, where the simple act of making a | mnemonic for something makes it memorable, and it doesn't | matter if it's a good mnemonic or not. In this case, I have | "proof" I have done the things that make me anxious, and it | doesn't matter if it's "good" proof or not, I just don't feel | the anxiety. | function_seven wrote: | This is kinda funny, because I've had the opposite outcome. | Well, "ish", because my situation isn't directly comparable. | | When I'd leave the house in the morning, there were always | five things I needed to have with me: Wallet, phone, badge, | glasses, and smokes. | | Once a month or so I'd get to work and realize I had left one | of these at home. It was a tragedy to be caught an hour from | home without my phone or glasses. It was annoying to be | without my wallet, cigarettes, or badge. | | So I decided to regiment this. Wallet always in the front | right pocket, badge always clipped to belt, phone in left | back pocket, cigs in front left pocket, and glasses in my | backpack. I would pat each location and say out loud, | "wallet, badge, phone, smokes, ... glasses". | | It didn't work. I quickly just went through the motion of | patting and saying without _actually verifying_ the fucking | things were there. The first time I forgot an item was a mini | existential crisis. ( "If I can't account for these simple | EDC items when I'm trying to, what hope is there?") | | WFH has solved the badge issue. ApplePay mitigates the wallet | issue. Glasses are still forgotten sometimes, but my eyesight | isn't _that_ bad when I 'm out and about (it was only | terrible to be without glasses when I worked at a computer in | an office). So I guess the situation just solved itself. | | I only need to confirm my e-cig is with me. Everything else | is either I remembered it or "oh well". And if I quit that, | then I'm free :) | alliao wrote: | I do this counting thing subconsciously with the stuff I'm | carrying from "scene" to "scene" of my life. And it show. If | you suddenly throw me an extra thing to carry, I'll forget | something I should've had with me. It's hilarious really for | everyone else. | malka wrote: | I am totally gonna use your solution. Thanks. This has been a | huge problem for me as well. | aspyct wrote: | Good luck :) | Pick-A-Hill2019 wrote: | I make a mark on the back of my hand in ball-point and _ONLY_ | rub it off when the job is done. Eq (using your example) if I | knew I had to lock a door on the way out I would write either | an 'L'(ocked) or a D(oor) on the back of my hand. | | Because I stick to the 'mental rules' of only rubbing it off | once the task is completed, if I'm uncertain if I've done the | thing / task I can look down to my hand to see if that mark is | still there or not. If it is - U-Turn time! | | It Works pretty well (as always, mileage may vary) even for | multiple things if needed although the random letters/marks on | the back of your hand can make people curious but if it does I | simply say - It's a list of stuff I need to do. | dragontamer wrote: | I keep a pocket notebook. | | Field Notes has been my favorite, though I'm experimenting | with different brands. Pentel Kerry is my pencil. | | https://fieldnotesbrand.com/products/original-kraft | | https://www.jetpens.com/blog/pentel-sharp-kerry-a-cool- | mecha... | | Field Notes 3.5" x 5.5" notebooks are the size of a folded | index card with only a few pages in them. So they comfortably | fit in my pocket. Staple bound is relatively weak, but their | relatively cheap price means that you can just keep buying | them as they wear out (moving your legs / walking / etc. etc. | slowly weakens the paper and tears it apart). | | Realistically speaking, a Field Notes 3.5 x 5.5 is well | balanced: I seem to run out of space roughly as the staple | binding wears out. (I know people don't want to "waste paper" | but.... I haven't found a good strategy for that. The small | size and "disposable" nature of these Field Note books are | superior in my experience) | | Pentel Kerry is a "shrinking" pencil. It has a small size | when its stored, but when you pull the cap off and put it on | the back, it "grows" slightly and has a better balance for | writing. Its a very slight effect, but the "smaller stored | size" makes for a nifty pocket-pencil. | | --------- | | > I make a mark on the back of my hand in ball-point and ONLY | rub it off when the job is done. Eq (using your example) if I | knew I had to lock a door on the way out I would write either | an 'L'(ocked) or a D(oor) on the back of my hand. | | Never erase in your pocket notebook (despite using a pencil). | Just add more information later: cross out old information | with new dates, if you're out of space write down a page- | number where you can see more information on a particular | subject. | aspyct wrote: | Oh that's pretty cool! | larsiusprime wrote: | I have a weirder version of this problem that's less | debilitating but annoys people who live with me -- if I pass by | a door I will automatically lock it with no memory of having | done so, even seconds after. Like kleptomania but for locking | doors. If I'm within five feet of a door it's as if a magic | force emanates from my body to lock it as far as my own | awareness is concerned. | | One of my roommates in college was carrying in groceries, put | his keys down on the counter, and went out to get a second | load. I was reading a book, passed the door, locked it, and | walked upstairs, completely oblivious, stranding my roommate | outside. | | They referred to this as "getting Larsed out" from then on. | cperciva wrote: | My version of this is turning lights on. I enter a room and | immediately turn the lights on, but I'm neither aware of | turning them on nor aware of them _being_ on, so I don 't | turn them off when I leave. | | Drives me wife crazy. | Baeocystin wrote: | I had a family member who had the same drive, and after one | too many times of me getting locked out while I'm bringing in | things from the car, the New Rule(tm) was that if I'm | actively using the door, it is stopped fully open, and the | Habitual Locker is not allowed to touch it without coming | outside to help carry things in, no exceptions. | | It actually worked out quite well! | JadeNB wrote: | I started reading and thought "why not just ..."--and you did! | | Since this _is_ Hacker News, I 'm surprised that you haven't | come up with some more elaborate system, e.g., properly locking | the door closes a circuit, and you can check the status of the | circuit remotely. | SamBam wrote: | I don't worry too much about whether I left the door locked | or unlocked, but suck a system would _produce_ anxiety in me, | because I could never be sure if there wasn 't some circuit | malfunction and it wasn't showing me a false positive or | negative. | | My wife and I had the exact same response to the baby | wearables or gadgets that promised to tell us if our baby was | still breathing up in her crib. We _weren 't_ worried about | that, so the notion of _adding_ something that would almost- | certainly be a flaky indicator seemed guaranteed to increase | anxiety. | aspyct wrote: | Spot on, mate! | aspyct wrote: | Ahah, I absolutely did! And sibling commenter SamBam got it | exactly right :D | betwixthewires wrote: | Is I was reading the first few sentences, my thought was "why | don't they just take the hair dryer with them?" And then I start | thinking "well, maybe that's just an outward indicator of the | illness and that it would manifest in other ways, maybe they have | to treat the underlying whatever, these guys are experts after | all if the solution was so simple..." | | Then that's exactly what happened. Maybe there are underlying | problems. But maybe, and this is a stretch, medicine treats | symptoms and not causes. And maybe those problems don't really | matter to the people who suffer when something simple can make | their lives work for them. | acuozzo wrote: | Hacks like this often work wonders. | | Reducing the burden of OCD is necessary to get in the frame of | mind required to make breaking cycles a habit. | | Taking a daily photo of the stove dials with my iPhone helped | break the cycle for me and was the first step I took on my long | road of (successful!) recovery. | teucris wrote: | That's awesome! It's funny because taking pictures was one of | the major compulsions I had to break. | swayvil wrote: | If she suffered from an obsessive compulsion to review her case- | notes in her head all waking hours, which made her into a better | lawyer, we'd never even hear of this. | | Other useful forms of this "insanity" may be seen in engineers, | scientists, writers... | | So UTILITY is definitely already the basis for any further | judgment or antidote. We can say that. | | So taking the hairdryer with you is already entirely appropriate. | | An ideal of sanity is not our aim here. Never was. Never should | be (unless that's your own personal thing). | [deleted] | [deleted] | Fleetfantasy wrote: | As an OCD haver of over 20 years, I find these suggestions to be | pretty wonderful. In some of cases, these conditions can't be | fixed by therapy, and/or the drugs don't work. Therapy is | fantastic, but sometimes these things can be the difference | between getting out of bed in the morning & not. | | Finding these solutions can be absolute bliss - technology for | 'hands-off' switching off things is one for me. As with | everything it's a balance, but if something small helps in a big | way, that's a win for me! | insickness wrote: | This story sounds like it should be posted in the subreddit "and | everyone clapped." Any therapist worth their salt would consider | both practical solutions as well as treatment of the underlying | cause. If your depression were triggered by job loss, they'd urge | you to look for another job as well as figure out how to | prevent/treat the depression itself. I'm skeptical that the other | psychiatrists thought the practical portion of this treatment was | scandalous. | | The only reason the other psychiatrists may have objected to his | 'treatment' is if the psychiatrist who recommended this solution | considered the problem solved after just applying the practical | solution. The OCD is likely to find another way into this | person's life, whether it's checking lights or the stove or | something else. It's a pathology and pathologies don't typically | resolve themselves by making a minor life change. | jetrink wrote: | The writer is a well-known and well-liked psychiatrist/blogger | who does not have a reputation for lying. | | 1. https://en.wikipedia.org/wiki/Slate_Star_Codex | MarkusWandel wrote: | Seriously, I wasn't even through the second paragraph before I | thought the same thing - just take the thing with you. It doesn't | try to solve the OCD, but it solves the problem. | | Nobody in my household has OCD, but we had a garage door that | sometimes, unpredictably, would decide that there was an | obstruction at the very bottom, and go back up. Did you really, | really watch it go all the way down before driving off? Did you? | | Engineer's solution rather than psychiatrist's - simply rig | something that lets you check over the internet _and_ close the | door (but not open it!) if necessary. I 've since debugged the | garage door too. | ortusdux wrote: | I've been looking at circuit breaker level power monitors, and | one of uses that seems interesting is the ability to see if | your oven is drawing power. Some systems allow you to enable | geofencing and trigger a push notification if your phone leaves | the home wifi range wile the oven is on. | stordoff wrote: | > Engineer's solution rather than psychiatrist's - simply rig | something that lets you check over the internet and close the | door (but not open it!) if necessary. | | Wouldn't necessarily work for OCD, as the obsession can easily | morph into "Did the sensor fail?" I can see it being helpful | though. | lstamour wrote: | Live feed camera with a timestamp turned on then? :) Could | double as a security cam for the car when it's in the | garage... | | The real fun one is if you need to stare at the latch as | well, just in case it looked closed, but wasn't... | | That said, this particular story has been repeated a bunch, | or at least I've heard it before but I can't quite remember | where. I'd be interested if anyone's found a proper source | for it, but not quite interested enough to go hunting myself. | :) | zestyping wrote: | Same here. The solution was immediately obvious. I'm amazed | that she actually got as far as talking to a psychiatrist, | unless I suppose she was so ashamed of the problem that she had | never told anyone about it before. | kleinsch wrote: | I think a lot of smart home gadgets are stupid, but we had to | get a new garage door opener and all the decent ones are smart. | It's amazing. My opener sends me a notif on my phone if it's | been open for 10 mins and I can close it remotely. | Forge36 wrote: | I had a gather like that, for like half an hour the sun would | shine on the sensor and it wouldn't close. Fixed with a toilet | paper role over the sensor to avoid the glare. In my current | house I have homeassistant and a sensor so I can check if it's | closed/auto close after ~10 minutes (I'd set it to 5 but that | was too aggressive). | | Haven't worried since | MarkusWandel wrote: | In my case the rails were misadjusted so the door would | contact the frame before it was all the way down. The | friction would sometimes, just sometimes, trigger the | overtorque sensor, but only when the door was about an inch | or two from the bottom. Fixed by adjusting the rails. | tibbydudeza wrote: | In my case it is my remote garage doors. | | Sometimes worry that I did not press the button on the remote to | close them when I left home so I would drive pass my home again | after dropping off the kids at school. | | Fortunately distance to school/home/freeway to work is within a | few minutes of each other. | | Later installed an IP camera - told the wife it was for home | security and not monitoring the garage doors. | [deleted] | P4u1 wrote: | That's amazing. Before I finished reading the article I thought | one solution could be to throw the hair dryer away, and just use | a towel or something(not ideal but beats being miserable I | guess). But taking the hair dryer with her was way better. | ngvrnd wrote: | SSC FTW | OscarCunningham wrote: | > If one day I open up my own psychiatric practice, I am half- | seriously considering using a picture of a hair dryer as the | logo, just to let everyone know where I stand on this issue. | | He didn't, as it turns out. https://lorienpsych.com/ | frereubu wrote: | This reminds me of the British Psychiatrist R.D. Laing who had a | kind of "open house" for people with mental health issues in the | late 60s / early 70s, where they could go and live untreatead | except as they wished. (There were obvious limits to this, such | as violent people not being admitted). One person came to stay | and wouldn't talk to anyone, spending the vast majority of his | time in his room, and becoming very irritated if anyone spoke to | him. He became more and more withdrawn and stopped eating, and | the psychiatric team were very concerned about his wellbeing as | his weight dropped. One morning he came down from his room, | smiling, and asked for a large breakfast. It turned out that he | had been trying to count up to one million and back to zero and | every time someone spoke to him he'd lose count. Once he'd | managed to do it the spell was broken and he was essentially | "cured". There are obvious ethical concerns about his treatment, | and I often wonder whether he just lapsed back into some other | compulsion, but it does make me wonder a great deal about the | lack of individual attention and creative thinking about | treatments for for patients with mental health issues that the | hairdryer incident points to. | | Found the story: https://www.madinamerica.com/2013/11/living-one- | r-d-laings-p... | willcipriano wrote: | I had a weird tick as a kid where anytime someone said something | to me I had to mentally adjust the length of the statement so the | number of words was divisible by 5. | | So for example if you said "Are you going to school today?" I'd | add "my good friend, Will" in my mind. | | It drove me nuts, but I was unable to stop. Then one day it just | went away. Still have no idea what that was but it plagued most | of my childhood. I remember when I noticed that I didn't have to | do that anymore and it was probably the happiest I felt prior to | my daughters birth. | | Never told anyone about it before this comment. It's a strange | thing to try and explain to someone. | spicybright wrote: | Have you considered writing children's books? :) /s | | It's so interesting how many weird states our brains can get | into like that. | | Congrats on kicking the habit though! | robocat wrote: | Have you had any benefits? For example, has it made you much | more accepting of the mental quirks of other people? | | I really appreciate your disclosure of something so intimate, | because it brings a sense of wonder into my world, and it | reminds me we never really know what is going on in the minds | of our friends (let alone my own mind!). Thank you. | anonymousDan wrote: | Wow, it's actually amazing to me that this is the first time | you have articulated this to anyone - thanks for sharing! | zentiggr wrote: | I've had a habit for my entire adult life, of sorting the | letters of words alphabetically in my head. The longer the word | the better. | | It's even better when the sorted letters turn out to make any | sort of repetitive pattern. | | And I count stairs, unless I specifically override the internal | voice and say "1", "1", "1", "1,".... to myself. | Zababa wrote: | I used to count stairs when I was younger too, and remember | that most of them had between 16 and 18 steps for a floor. ___________________________________________________________________ (page generated 2021-06-17 23:00 UTC)