Bonus Episode: The OCD Experience with Neurobiologist Uma Chatterjee

This one’s all about lived experience: What's it like to have OCD? What’s the therapy all about? How do you support people with it? And how to accept the darkest thoughts that might haunt you. As a bonus to last week’s OCD Neurobiology episode with Dr. Wayne Goodman, the wonderful neuroscientist, board-certified mental health peer specialist, and survivor Uma Chatterjee joins to share her experience living with OCD, and how it inspired a career in research and mental health advocacy. This bonus episode is wall-to-wall heart-warming compassion and real world perspective from someone who cares deeply. OCD is a bitch, but Uma’s a gem.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Alie Ward?

  Oh, hey, it's your coworker you called Dave. And he was like, David, which is good to know. Ally Ward, this is Ologies. This specific episode is a bonus. It's like a dessert for the OCD neurobiology episode that we just did with psychiatry icon, Dr. Wayne Goodman. So you can start there for a comprehensive look at what OCD is, where it starts, what to do if you or a loved one might be one of us. A person with OCD comes in all flavors, all strengths, as you may have learned in that episode. Now, between last Tuesday's OCD episode and this bonus episode, Ologies was named one of Time Magazine's Best Podcasts of All Time with our artwork

• 0:43Alie Ward?

  like smack in the middle of the lead image. This was a pure surprise. It was one I never could have dreamed of. So if you are new here from there and you're not sure where to start, you can head to ologies.com where we have a sorted list of topics. It's like a menu of things you can put in your brain with like bugs and birds and marine science and history and culture. Anyway, ologies.com. Also, I know that Time said that this is like a funny show, and here we are, just by chance, putting out two episodes on like a devastating mental health issue. So if you are not into that vibe, you can hit up one of our other 400 topics. Also, if you are looking for kid-friendly episodes, we have a spinoff show called Smologies. Those are shorter and classroom safe for all ages.

• 1:28Alie Ward?

  So you can find Smologies wherever you get podcasts. It's S-M-O-L-O-G-I-E-S. So just look for that or find the link in the show notes. Also, thank you to everyone rating and reviewing the show. I read them all, and even the ones that say that they're mad that I put a content warning in front of the cheese episodes. But I guarantee you, been doing this for eight years, I'd get more beef if I hadn't acknowledged that we talk about animal welfare in it. So that was for you and for me. Also, thank you to someone named Ally the Frog for the review saying, "I love how interesting the show makes any subject, even the ones that I normally wouldn't have found interesting or enjoyable." Ally the Frog, we do have a toad episode, Boothology. I hope you enjoy it. Thank you, everyone, for the support. Thank you to sponsors of the show who make it possible for us to donate to a cause of each ologist choosing,

• 2:13Alie Ward?

  which does require money.

• 2:15Alie Ward?

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• 2:58Alie Ward?

  Their proactive safety features help keep you more aware, connected, and engaged during every drive, which means your car does more than help protect you. It makes you a safer driver, which helps protect everyone. That's why Mazda has been named Consumer Reports' safest new car brand. To learn more, visit MazdaUSA.com. Consumer Reports does not endorse products or services. This podcast is brought to you by Aura. Your body has a lot going on. Sleep, stress, recovery. You would be surprised how connected it all is. Aura Ring tracks more than 50 metrics from your finger, and the Aura app brings that information together to help you see patterns across your sleep, and stress, activity, and more.

• 3:42Alie Ward?

  So you can start connecting the dots and figure out what works for you. Learn more at AuraRing.com. Wear your best life with Aura.

• 3:53Alie Ward?

  Okay, but let's move on to this fantastic convo. It's rich with neurobiology, psychology, with a neuroscientist and researcher, a board-certified mental health peer specialist, a mental health advocate, a science communicator, an organizer, a community builder, and a survivor with lived experience. They have a podcast called A Chat with Uma and are the president of OCD Wisconsin and join me to talk all about what it's like to have OCD, the experience of having therapy for it, how loved ones can interact with OCD to make everyone's lives better.

• 4:25Alie Ward?

  And novel therapies for it, including exposure, magnets, brain implants, and even psychedelics. So meet neuroscientist, researcher, board certified mental health peer specialist, mental health advocate, and obsessive compulsive neurobiologist Uma Chatterjee.

• 5:00Speaker 02

  Uma Chatterjee, she/her. I'm earning my PhD in neuroscience at the University of Wisconsin-Madison, studying the neurobiology of OCD and novel therapeutics like psychedelics. I'm also the president of OCD Wisconsin and on the Lived Experience Council of One Mind.

• 5:16Alie Ward?

  I'm a-

• 5:16Speaker 02

  Plus like 50 other things, but we'll stay with that. I have no hobbies.

• 5:23Alie Ward?

  I've been there.

• 5:23Speaker 03

  When there's an opportunity to do something in what you're passionate about, it's hard to take a step back. At what point did you think, I'm going to get a PhD? Or was that something that you always had your sights on? Or was that something that you were like, you know what? What if I got a PhD in something?

• 5:40Speaker 02

  Absolutely never. I never thought I, I mean, it's a joke, but it's also morbidly true. Like, I never thought I would graduate high school or college. I never internalized a single thing about science in school because I was so sick and I truly just thought I was going to die soon, and I almost did many times. So me getting a PhD has been the most wild arc of a lifetime because I dropped out of college, like at my worst, with a 1.83 GPA. I couldn't function and I, yeah, I was at the brink of death. So after going through recovery, which maybe we'll get into, I realized like, all I wanted to do was understand what was going on in my brain and other people's brains and how we can help them.

• 6:24Speaker 02

  And that led me eventually to neuroscience, but I never identified as a scientist. And it's in some ways, hard for me to still do that now because it's so out of character.

• 6:33Speaker 03

  Even though you're getting a PhD in neuroscience, you're like, me? I guess.

• 6:40Speaker 02

  Truly. I mean, it's me search. That's what it is.

• 6:43Speaker 03

  Me search. Can you tell me a little bit? I don't want you to have to go back and relive anything, but I know you're such an advocate. Where did your struggle with this sort of become really apparent to you?

• 6:54Speaker 02

  I'm really open with my story and super unfiltered. So I'll just say whatever without taking up too much time. And then you can cut out whatever you'd like to with that. My clinicians and I have come to the consensus that I was born with OCD. And what that means to us is that from the moment I can remember, this disorder has governed the way I've thought, the way I've interfaced with my life. And I had no label for these constant horrible intrusive thoughts about everything. I felt like I was responsible for everyone's life. I thought I was the worst person alive and I caused everyone harm. And I had to do all of these behaviors, physical, but mostly mental, to try to figure them out or fix them or neutralize them. And I grew up in a South Asian immigrant households that was also incredibly abusive.

• 7:39Speaker 02

  And for all those reasons, I had no awareness of mental health or mental illness. Nobody really identified anything as pathologically wrong with me. I was more so labeled as someone who was just annoying and complaining or too afraid. And especially with the immigrant perspective, I guess, because people had overcome so much to come to this country and had lived through so many problems. My problems were very trivial in comparison. So I just thought this was life and it was a reflection of myself. And I was a perfectionist, high performer for a while that sort of masked my struggles, even though it was extremely apparent that I was very unhealthily engaging with life.

• 8:19Alie Ward?

  Uma went through trauma as a child, including sexual abuse and an experience with a religious cult at 14 that instilled magical thinking compulsions for salvation. And she's a cancer survivor. And she told me kind of lightheartedly that she's such a case study, she will probably be donating her brain to science. And as a board certified peer specialist, she is the most open and the least judgmental person you can imagine when it comes to chatting about mental health. Now, we have touched on suicidality and hospitalization for severe cases of OCD in our primary episode with Dr. Wayne Goodman and about how those who have suffered chronic

• 9:00Alie Ward?

  PTSD or childhood abuse struggle more with their OCD symptoms. But in her childhood and early adulthood, then Uma wasn't diagnosed with PTSD, but says it was clear that she had OCD, experiencing intrusive thoughts about taboo themes like...

• 9:17Alie Ward?

  Unrelenting worry that she would do something sexual or pedophilic and being so ashamed of that worry that she even had been on suicide watch. And for more on a lived experience of that, we do have a suicidology episode and we'll link that for you in the show notes. But mental health treatment can sometimes overlook what's really happening.

• 9:38Speaker 02

  Up till the time I finally got a proper diagnosis and treatment at 25, I went through 22 different clinicians who got it wrong. And so I just never got the help I needed and it was devastating. It's just that what was driving that was the fact that I was convinced that I was a harmful, horrible person. I, at that point, you know, your OCD morphs and latches on to whatever is going on in your life. You know, whatever fertile ground it has, it will latch on to. And no matter what treatment they did, it wasn't at all excavating what was really going on and the fact that I was consumed by rumination and mental compulsions all the time. So yeah, looking back, I definitely, I do have the diagnoses of major depressive disorder and generalized anxiety disorder as well and PTSD.

• 10:22Speaker 02

  But those were not what were primarily manifesting as like why I was struggling in the first place. Those were almost like downstream byproducts of severe, extreme clinical OCD.

• 10:33Alie Ward?

  So we go more into depth to define intrusive thoughts and obsessions and compulsions in our interview last week with Dr. Wayne Goodman. But I wanted to hear firsthand from an advocate and Uma was like, let's go. Can you describe from a researcher's standpoint, as well as someone with lived experience, when it comes to obsessive compulsive and intrusive thoughts and mental compulsions versus physical ones? Can you break down for us? Because I think a lot of people think, I wash my hands a lot. I check the door lock a lot. I'm afraid to shake someone's hand. Can you give us?

• 11:10Speaker 03

  A bit more depth on what a mental compulsion is, what an obsession is, what a rumination is.

• 11:16Speaker 02

  Absolutely. So, an obsession, I like to say what it's not. People use obsessed all the time, like I'm obsessed with Taylor Swift or pizza or something we like, right? Clinically, in the context of OCD, it's the exact opposite. It's an intrusive, unwanted, or unrelenting thought that people without OCD, people in the world have intrusive thoughts all the time. They have random thoughts that they don't identify with that are absurd and that they hate. And they can see that thought, like, they're driving under a bridge and maybe they have the thought, what if the bridge falls on me? Or they're driving on the highway and they're like, what if I just swerve off? And people without OCD are able to see that thought and they're like, that's weird. I don't like that thought. Whatever, and let it go. People with OCD see these same thoughts. First of all, they're having way more than people without OCD.

• 12:00Speaker 02

  But two, they see these thoughts and they're like, well, what if it's true? What if this means something about me? They feel the intensity of the thought so much more, which then causes them to do behaviors, which can be mental or physical, in response to said thought, that the intent of the behavior is to try to lessen the distress of that thought. And I should also say, people often conflate OCD or obsessions with anxiety, or the feeling of anxiety, which can be one of the feelings. And oftentimes, that's what's portrayed. But there's also many other feelings or emotions that are not anxiety, like disgust, shame, guilt, so many things. And we kind of reconcile that oftentimes under the words uncertainty or doubt,

• 12:41Speaker 02

  where you're feeling this strong, horrible feeling, and then you can't resolve it. And so you're trying to do behaviors, again, compulsions that are mental or physical, to try to resolve that what if, or that horrible signal going off in your brain. And so for mental compulsions, that can be trying to figure it out. Like, if we have this intrusive thought that like, what if I want to harm children? We're thinking about that and we're ruminating, like, have we ever done that before? Does that actually resonate with us? Even if we don't believe it, what if it's actually real anyway? There's no resolve. And that's why we always say, like, logic does not permeate OCD. If logic answered OCD, nobody would have it. Logic does not override OCD.

• 13:22Speaker 02

  And that's why treatments that rely on logic and reason and using, you know, reality to... Debunk what's going on in your head just doesn't work because other parts of our brain are overriding that. And so, yeah, those behaviors temporarily might reduce the intensity of that horrible feeling we're having. But what it's really doing is telling our brain that that thought was important and that we have to do those behaviors to make that thought go away. So it's both reinforcing the obsessions and the compulsions. And then it's a cycle. OCD is a disorder at the end of a spectrum of obsessive compulsive behaviors. We all have traits that are common. We all have quirks and we all have things that make us a little more distressed and that make us do behaviors more. But when

• 14:05Speaker 02

  something becomes a disorder is when something is debilitating you, taking over your life, and is making you dysfunctional and harming you. And so certainly, most people do not have OCD, diagnosed or not. And just because you do something over and over, like you said, or you have certain things that bother you, or maybe one thought that doesn't leave your head, does not mean that you have OCD.

• 14:25Speaker 03

  It's funny, because if you think of how people feel about superstitions, right? That feeling of, uh, I don't want to walk on a ladder because you never know what's gonna, or, you know, having a big, maybe, meeting at work and a black cat crosses in front of your car and you go, uh, you know, but that feeling that it's like that dialed up as far as it could go. But that feeling of like, oh, no, something is coming and I need to do something to make sure that that's neutralized, that it's not going to happen. Like, we're grasping at safety, looking for any kind of safety and any kind of safe space away from those obsessions.

• 15:01Speaker 02

  That's exactly it. Compulsions are behaviors that we do not want to do and that we feel like we have no choice but to do. You know, our brain is primed to protect us. Unfortunately, in the case of people with OCD, like you said, we are primed for this sense of doom or fear or distress, or we're in danger, or whatever we value. Like, if we care about other people's safety, if we care about our own moral character, whatever, OCD is going to latch on to that because we care about it so much. So in a way, like, it brings out the biggest fears that people care about, which is ironic because people with OCD think they're horrible people for having those fears in the first place. And then those behaviors are that temporary relief, that safe space from the horrible torture that intrusive thoughts are. It's just that compulsions ultimately make everything worse,

• 15:46Speaker 02

  and we don't know that until we get treatment.

• 15:48Alie Ward?

  So we talked with Dr. Goodman in part one about how there are overt and covert compulsions, the former being behavioral that you can see, checking the light switches, checking the oven, reassurance seeking, or in the classic case of contamination, OCD, washing your hands, say. But there are so many less obvious and internal types of compulsions, like avoidance, or mental or covert compulsions, like having to ruminate on something over and over, or praying to yourself, repeating certain phrases in your head, or just overthinking. And the majority of people with OCD have covert compulsions. So loved ones and even clinicians may not catch on to those compulsions because the call is kind of coming from inside the

• 16:33Alie Ward?

  house and it's going to the inside of the house. Speaking of the wheres and the whys, let's hop into a brain and see what is happening mechanically under the hood, your skull.

• 16:45Speaker 02

  We can start with the frontal part of our brain. We have a structure called the orbitofrontal cortex, or the OFC, which is kind of like right behind our forehead. And it's the center of the brain that tells us what's important and it decides something called salience, the things that we pay attention to and the things that we think are important or what we worry about. For people with OCD, this region often fails to filter out different stimuli and it can overdetect or exaggerate potential threats. And that sort of explains why people who don't have OCD have intrusive thoughts and they're able to let it go and recognize that they don't matter and move on with their life. And people with OCD, it becomes a sticky thought and they're kind of consumed with it, even though they're

• 17:25Speaker 02

  just as strange or make as little sense for those who don't have OCD. So it can be like, oh, what if I'm a pedophile? I keep saying that. And I appreciate you letting me talk about taboo thieves because we need to overcorrect in that way because it's just not talked about in the world as much and it's just as common as people who don't have them. So yeah, like, what if I'm a pedophile? Or what if I killed someone? Or what if I'm contaminated? Or maybe even it's not a what if, it could be just an intrusive thought of, I am contaminated? Or you have an image of, you know, Stabbing a dog, or just anything that you don't identify with or want in your brain, it happens, you stay fixated on it. And then it sends these alarm bells. We also have another part of the frontal region called the anterior cingulate cortex,

• 18:06Speaker 02

  and it's also monitoring conflict and error and looking at what makes sense and what doesn't make sense. And when it's hyperactive in people with OCD, it can more often signal the feeling of something's off, something's wrong, something, you know, that sort of hyper vigilance we were talking about earlier at the beginning of the episode where we constantly feel like some sort of dread, or something's going to go wrong, or something's off. And the frontal regions project to this deeper part of our brain called the striatum, which has different elements of it. We also have the nucleus accumbens, that's more associated with reward, and different parts are all involved with OCD. But the part I'll focus on is the basal ganglia, the cauda epitammon, that are modulating our behaviors. And that's

• 18:50Speaker 02

  mental and physical. The striatum influences our habit formation. And you can think of two different paths that are happening at the same time and competing, where one path is telling us to do stuff, the go path, and another path that's telling us to not do stuff, the no-go path. And if our brain is telling us that something is highly salient, then the striatum is going to tell us to do the same thing over and over and over again, which then projects to an even deeper part of our brain called the thalamus, which is sort of a relay station for funneling sensory information and cognitive information back up to our OFC. Like, we talked about that cycle of obsessions, compulsions, back to more obsessions and more compulsions. That's the final stop that then talks back to the front.

• 19:31Alie Ward?

  So those are some fun brain stations in the trolley ride of what experts say is one of the most common psychiatric conditions. OCD affects up to 3% of the general population, which is a lot. Now, why does this highly misunderstood, highly inconvenient condition affect some folks, but not others?

• 19:49Speaker 02

  In terms of genes for OCD, it's estimated that the condition's about 40% genetically heritable. That's a rough estimate, and a huge limitation on everything I'm saying right now, is that OCD research is so far behind in terms of figuring out what genes those are, or like, the role of genes, because- Top down, because OCD is misunderstood by most people, they don't get the diagnosis properly, or they don't know how to get the proper treatment. They don't then participate in the research. There's also way less funding for research. But even if someone is genetically primed to have OCD, there's still so many other factors in terms of, like you talked about, stress or trauma. And it doesn't even have to be a capital T, trauma. It can be

• 20:31Speaker 02

  just a stressful life event that for most people, they would be able to withstand that and not trigger OCD because they're not genetically predisposed. But for people with it, especially at earlier ages, it can be the analogy you always hear of like, there's a loaded gun, but you're finally pulling the trigger, that it can be stress, it can be different environmental changes, it can be just change in general. There's so many things that can onset OCD. Also, there's a whole line of research for infections and viruses that can onset OCD rapidly in children called PANS or PANDAS. There's so much there.

• 21:03Alie Ward?

  And in that episode with Dr. Goodman, we go into more details on PANS, which is Pediatric Acute Onset Neuropsychiatric Syndrome, in a subset of that called PANDAS, which is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, like strep throat, and how Stanford University's Immune Behavioral Health Clinic is the first multidisciplinary PANS clinic in the world, which for families afflicted with this issue is very reassuring. Actually, on that note, but different.

• 21:36Speaker 03

  Can you explain a little bit more about the reassurance seeking? Because I find that very relatable and very hilarious. I shouldn't, I shouldn't like laugh at it, but it's so true.

• 21:45Alie Ward?

  Yeah, absolutely.

• 21:47Speaker 03

  It's so true. I've spent so much time in therapy, trying to make sure I don't have other things that we didn't even discuss, the obsessions and compulsions that are making me worry about other things I don't even have. Do you know what I mean?

• 22:04Speaker 02

  Ali, I hope you meet more people with OCD because like I, I'm not even like every single person I've met and at this point is thousands, like we all are, yeah, but maybe we don't actually have OCD. Maybe we're just actually tricking our own therapists and we're using this as an excuse for some deep dark other evil issue or whatever the case. And we're always like, do we have this disorder instead? Do we have that? And that's like classic. I mean, if we needed any more evidence that we have OCD, here you go. But it's just a running joke that like the people with OCD are like, we don't have it. But to your point of defining reassurance seeking, one of the most common behaviors and sort of a way to reconcile a lot of compulsions people do is this idea that when we have this intrusive thought, logic and reason doesn't permeate. And no matter how much

• 22:48Speaker 02

  evidence we gather, you know, whether it's, oh, did I murder someone last night? Well, let me set up cameras and let me film myself and let me have my husband and everyone in my home watch me to make sure I didn't go kill anyone. And they all tell me that it didn't happen. I have proof it didn't happen. But what if somehow my husband fell asleep and he missed it? Also, at the same time, the camera is short circuited. And also, I've just tricked everyone and I, what if I have magic powers? It sounds absurd, but like when your brain is in that amount of overdrive and you're so afraid, there is no amount of resolve that will make the obsession go away. And that's why we do compulsions. And one of those compulsions is asking for reassurance that something

• 23:29Speaker 02

  isn't true or something didn't happen. Like whatever your fear is, the natural response from your providers or from people who love you, especially when you're a parent who has a kid with OCD, all you want to do is make them feel safer and make them feel like they're okay. The problem is by you doing that, one, you're telling your loved ones OCD or your patients OCD that that thought mattered and it deserved a response by you telling them that they're going to be okay, or they didn't do a bad thing or whatever. Two, that's a compulsion and that's going to cause that thought to come back more. And so that's reassurance seeking in a nutshell.

• 24:03Speaker 03

  What do you wish that clinicians knew about the diagnosis and things to look for? If it takes so long for people to get the right kind of treatment, what do you wish they knew?

• 24:15Speaker 02

  First, there are so many layers to this. I think first and foremost, OCD is a real disorder. OCD is a real condition that has a real treatment that is not the treatments they probably think it is, like psychodynamic or traditional cognitive behavioral therapy.

• 24:28Alie Ward?

  Uma also wishes that clinicians would recognize that the disturbing intrusive thoughts some people with OCD can't shake are classic types of obsessions, even if, and sometimes especially if a patient reveals the obsessive worries are about taboo topics.

• 24:45Speaker 02

  But when they name it, therapists are so disgusted and so they react so poorly and they automatically assume that these thoughts are what the person actually wants. And it's so, so sad, the number of people that get locked up in facilities, get CPS called on them, get their kids taken away because they voiced intrusive thoughts that weren't theirs. And so the stigma alone of not being able to name your thoughts in a safe space and be met with curiosity and an understanding of what an intrusive thought is, can keep so many people from getting treatment. So I wish therapists and clinicians knew that. Also, that compulsions can be mental. That's something that the vast majority of people don't know. If they even know what compulsions are, they only think it's counting, hand washing, checking, all of which are debilitating and horrible. And I

• 25:30Speaker 02

  have experienced them, but mental compulsions can also be that reassurance seeking and rumination. And I've spent so many years just playing a reassurance seeking game in therapy and winning. And it just made me sicker and sicker because no one recognized that I'm just swirling around this drain, trying to get this answer. And I will out logic them every single time because that's how strong my OCD is. So I wish people knew that. And lastly, I wish they knew that there was one frontline specialized psychotherapeutic treatment called exposure and response prevention that is not traditional cognitive behavioral therapy, that is not psychodynamic. And not only is ERP the only current existing modality on its own that treats OCD effectively, the other treatments make it worse. It's not

• 26:15Speaker 02

  just that they're neutral and you experience them and you don't get the help you need. Like, all of those treatments serve as a form of compulsive behavior.

• 26:23Alie Ward?

  For example, Uma notes that digging deep for the root of the obsessions can be harmful because it's seeking a reason for why you're afflicted with the thoughts, which is another compulsive form of ruminating on them.

• 26:37Speaker 03

  Yeah, when it comes to those relationships, I think it's really interesting that you bring that up because a lot of these obsessions and compulsions, we can do very silently, or we can just think that this is normal for people. And people who see us more intimately, whether they're roommates, or siblings, or parents, or clinicians, or teachers, or partners, they see the struggle and they're probably more affected in their daily life by it. Can you describe a little bit how this might impact relationships and what someone who knows someone with OCD, whether they're diagnosed or not, like, how to approach it so that there's maybe some compassion, but not too much accommodation?

• 27:17Speaker 02

  Exactly. That was a word I was going to bring up. Accommodations are such a crucial part of OCD treatment. And I've heard so many people say that when you're treating OCD, you're not just treating the person, you're treating the whole system. People who love you, who are watching you, just trying to support you. And the best thing that they can think to do is to, you know, make sure that nothing is contaminated to your standards that will never work out, or to constantly tell you that they love you and that you're a good person, or whatever the case is. So to have to change that behavior can feel so cruel. And for the person with OCD who's struggling, who's going through that transition, on the one hand, I mean, presumably they're engaging in treatment consensually. And so that they're aware that these instructions are being given to the people in their life

• 28:02Speaker 02

  to stop providing that reassurance, to stop enabling their OCD, because it's the best thing they can do. But, you know, in the person going through treatment, like, they haven't gotten to the other side yet of seeing the results of that. And it can feel like just the most cruel, unloving thing. It can be interpreted as, you know, by you not telling me for the 500th time that I am not a horrible person, that you actually believe that now. And I've been down those roads so many times, where if I don't get that reassurance right in the minute, it's just building up proof on the other side that, nope, actually, this is all true. And I've watched upfront and personal, I've watched parents with their children, and just seeing the pain that parents have to go through of watching their kids

• 28:44Speaker 02

  just like, in many ways lash out and suffer because they need that help and they're not getting it in their minds. It's devastating. It's so hard to watch that transition period, and for people with OCD to... Buy into the fact that this will pay off because it's the most counterintuitive thing ever to do this treatment because you've been wired your whole life to act on these thoughts and to believe them and think that they're real. So you don't necessarily go to like the hardest exposure or the hardest elimination of a compulsion. So sometimes you're lessening it, you're delaying it. And for all these people to have to be on board to sort of find their way on that ladder too. And like, oh, should I give it now? Should I give it in five minutes? Like, it's such a toll. It's such a toll.

• 29:29Alie Ward?

  But of course, it's worth it. And we're going to hear more about ERP, Exposure Response Prevention, in a moment. But first, let's toss some money at Uma's Top Nonprofit Choice, which is OCD Wisconsin, which is dedicated to supporting Wisconsin families via comprehensive programming and valuable resources. And Uma is the president of that organization. So happy to donate some money and raise some awareness for the wonderful work she's doing. And thank you to sponsors of the show for making that donation possible. How's your ponytail looking? Maybe like a little thinner than it used to? We've talked about this in our menopause episode. At some point, it's bound to happen to all of us. So if you're ready for thicker, fuller hair, start your free online visit

• 30:11Alie Ward?

  today at forhers.com/ologies for personalized care. So that's F-O-R-H-E-R-S.com/ologies. Individual results may vary. Featured products include compounded drug products which the FDA does not approve or verify for safety, effectiveness, or quality. Prescription required. Price varies based on product and subscription plan. See website for full details, restrictions, and important safety information. This episode of Ologies with Ally Ward is brought to you by Alloy Health. As you may know, we've talked a lot about estrogen and hormones on this podcast. We have a three-part menopause episode. And there's something that nobody tells you. And this is that your skin changes that start in your 40s, they aren't just aging, they are hormonal, specifically estrogen loss. So estrogen naturally helps maintain collagen, it helps support elasticity,

• 30:53Alie Ward?

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• 31:37Alie Ward?

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• 32:18Alie Ward?

  Listen, sometimes you get out of your routine. That happened to me recently when I went out of town and I realized I forgot my Ritual Essential for Women 18+ It's a multi that I've been taking for years. And guess who landed in another country without them? Me. Didn't feel right. They contain nine key nutrients, two delayed-release capsules designed for optimal absorption. But Ritual, why do I love them so much? They have a team of scientists. They poured over thousands of studies to figure out what are common gaps that people need in their diet, but they don't actually consume. It's also designed to be gentle on the stomach. You can take it with or without food, which I love. Plus, I like that it looks like a tiny lava lamp. I tell you that every time, but it has these beads and oil, and it tastes like mint. Easy down the hatch. I usually take them in the morning.

• 33:03Alie Ward?

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• 33:25Alie Ward?

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• 34:10Alie Ward?

  So whether you're giving that to you or to someone else, you can give the gift of quality this holiday season. Download the Quince app for app-exclusive offers or you can go to quince.com. Get free shipping on your order and 365-day returns, now available in Canada and the UK, too. And when Quince asks you where you heard about them, just let them know it was Ologies. It's the best way to support the show. Okay, if you've got OCD or you know someone who does, how do you go about feeling better?

• 34:42Speaker 02

  I'll start with ERP, which I will scream off the rooftops till I die because I can't believe, like, it's absurd that most people don't know it, especially in our field. But ERP is a subset of cognitive behavioral therapy. And that's important to say because it's specialized for OCD. And if anyone is saying that they use CBT to treat OCD, don't go, like, that's a red flag because you specifically want to name the form of CBT that works for OCD. ERP is exposure and response prevention. It's a form of exposure therapy where you are exposed to your obsession, which can look many different ways. It can look like if it's a contamination fear or something more external that you are gradually exposed to facing that stimulus, whatever your fear is, like, for example,

• 35:26Speaker 02

  needles or the stove. You're constantly fixated on the fact that you haven't turned it off, then it's gradually like... Using stoves or locking doors, or whatever the case is, that makes more sense to people. But in terms of more internal themes and internal behaviors, if you have the intrusive thought that maybe you're a pedophile, it's literally facing that thought and then the response prevention of not doing compulsions in response to that thought, which sounds so simple and is the hardest thing I've ever done, all in the same breath, because we are wired to have those thoughts. And as soon as they come in, we do these behaviors instantaneously, repetitively. That's what OCD is. And the more severe it gets, the more time it takes up of your life, the less you're able to do out in the world. And so

• 36:11Speaker 02

  the most counterintuitive thing is to experience and approach actively those feared intrusive thoughts and to not do anything about it. But what happens in the time that you're not doing anything about it, when ERP is in its full glory, is that you have the thought, you can't control it coming in unless, I guess, you're facing it intentionally, which is what a directed exposure is. And then you just let it be there and it takes you to the worst places ever and you learn how to deal with it. You learn how to experience that horrific level of anxiety, shame, disgust, distress, whatever that feeling is. And you show your brain that you don't have to do behaviors in response to it and that you can tolerate that amount of distress because we don't believe that we can. Hence

• 36:55Speaker 02

  why we're doing these behaviors and we're choosing for our life to be worse by doing these behaviors and experiencing these horrible emotions. Down the line, it's really, really effective. It's obvious, it doesn't treat everyone, hence why we need to develop better treatments, but it's extremely effective for those who it works for, up to two thirds of patients. And it can be done in a number of settings. It can be done virtually, in person. At its worst, for people who are really, really suffering and are close to losing their lives, it's done in residential settings as well. Yeah, those three letters saved my life.

• 37:26Speaker 03

  Let's say that you have the thought, what if I'm a pedophile? Let's say, like, what types of compulsions mentally would come up? What kind of checking would come up for you that you have to say, nope, we're not doing that?

• 37:38Speaker 02

  Mm-hmm. For me, that primarily looks like ruminating about it and questioning the thought and trying to figure out, am I really a pedophile, going through a mental inventory of everything I've ever done? Then it comes meta and I doubt my memory about everything I've ever done and I question my character and I, in the past, when I had less insight, I would do a lot of Googling to try to understand, like, who is a pedophile and who isn't? And do people actually know that they're pedophiles? And just, those are different examples of what it can look like. But at the end of the day, a mental compulsion or compulsion in general is doing literally anything in response to that thought, instead of, okay, yeah, I have that thought and it sucks, I'm gonna eat a pizza.

• 38:17Speaker 03

  Yeah.

• 38:21Speaker 03

  So, it seems so easy for other people, but feeling like this overwhelming due diligence that you have to do. And you realize that, oh, not everything needs due diligence. Meanwhile, has my car insurance lapsed this week? It has. Did I do diligence on that? Fucking no.

• 38:41Speaker 02

  Yeah, or the irony of it all, like, people think people with OCD are clean. I'm like, oh, well, meanwhile, like, literally, my whole apartment is in chaos and like, when was the last time I cleaned the toilet? I don't know.

• 38:53Speaker 03

  So, yes, these are not the OCD thoughts you're used to hearing about from ultra tidy sitcom characters. You're not gonna see a quirky sidekick who, like, interrupts dialogue to ask loved ones if they might secretly be the devil. Or if it's possible that maybe they kicked a stranger to death but didn't know it. Worries which are, like, so OCD.

• 39:15Speaker 04

  I'm like, so OCD about this stuff.

• 39:17Speaker 02

  I've never met someone who I know actually has OCD that would ever use that term because of how harmful. Like, I'm not here to try to police people's language or be like so precise about language. But in this case, like, the baggage that comes from using it wrong, like, it, people die, like, it's so sad to say, but people die, like, at 10 times the rate by suicide because of this condition. Like, I'm the president of OCD Wisconsin, I'm an advocate, and I'm getting stories from families of their children ending their lives and being like, how can we help fix this? Like, it's devastating. So that's why I, yeah, I've never met anyone who thinks it's okay to use that word incorrectly, because they understand how harmful it is.

• 39:53Alie Ward?

  And for more on suicide and suicide prevention, again, we spoke with an amazing psychologist, Dr. Dequincy Mayfran Lazzine, and we will link that Suicidology episode in the show notes. I'm sure people ask you this a lot, but best or worst media examples of OCD? Is anyone getting it right? I know, um, what was it? Turtles All the Way Down? Or is it Turtles All the Way Down?

• 40:16Speaker 03

  A lot of my thoughts don't even feel like they're mine. Like, I'm not the real me.

• 40:21Speaker 05

  We can just take things really slow.

• 40:22Speaker 02

  You won't feel that way forever.

• 40:24Speaker 05

  But it's not forever. It's now.

• 40:27Speaker 02

  That's my only example. You took my only example. And it's because John Green has OCD and has been open about it and was diagnosed and treated many, many years ago. So he was like, the only person that I've seen. And when I watched that, I was still really vigilant and skeptical because to what you were alluding to. I personally, I know I have selection bias because I think about OCD a lot, but like, 10 times a day, I will hear on a podcast, see on TV, see on the internet, OCD being misused as like, oh, my gosh, I'm so OCD. Like, I have a running list of every single podcast episode that one day I'd like to call out, but I'm too scared to right now. But, so I watched Turtles All the Way Down, and I was so scared that he would somehow get it wrong. And I sobbed through that movie,

• 41:11Speaker 02

  especially there's this one scene where she's in the hospital and she's just like, I'm... Like, I need to die. Like, there's no hope. Like, there's nothing that's going to save me, and I'm actually the monster. No matter what theme you have of OCD, like, that just, that's how we all feel, and it's horrific. So I recommend people watching that.

• 41:32Alie Ward?

  Oh, that's so funny that I had, that it, it happens to be the only one that I feel like has any credibility. So that was called Turtles All the Way Down, which is also an excellent book by author John Green, who is Hank Green's brother. Also, we do have an episode with Hank Green about science communication on TikTok. We'll link in the show notes if you need it. So, therapy-wise, we've talked about SSRIs and SNRIs in Dr. Goodman's episode, as well as his work in deep brain stimulation. But what about getting into your brain by tripping balls?

• 42:02Speaker 02

  For OCD in particular, there's so much promise in psilocybin particularly, that's being studied at largest scale right now at different institutions. We're in the earlier phases compared to other psychedelic treatments for other conditions because, once again, I keep sounding like a broken record, a lack of funding because people don't think OCD is real, or, you know, we don't have enough researchers to do the work, period. Hence why I'm trying to join the field. But with that, psilocybin has incredible promise for many people. It's not a cure, although some people have reported that, and that's cool. But it intervenes in a very different way, like you said, in that SSRIs are modulating serotonin reuptake activity, kind of on a daily basis. And the reaction people have

• 42:44Speaker 02

  to that is like a natural lessening of the intensity of their OCD. With psilocybin and other consciousness-altering medications or compounds like that, there's the trip itself that people are experiencing a lot of insight from. For me in particular, I am very open about my own usage and how it has been hugely therapeutic for me. It's actually like the worst experience ever, and this is shared with many people in the Yale psilocybin trials as well, where we expect like, oh, we hear that psychedelics are so fun, and they're going to be so joyous. And for me, I take it. I'm stuck in my intrusive thoughts for four hours, and the loudest they've ever been, and I am convinced that, like, I need to die in my life. And that sounds extreme, but that's exactly what happened. And what I get from-

• 43:28Speaker 02

  Coming out of it, just on a psychological level, is the fact that I experience how strong and loud my thoughts are and how literally nothing about my life has changed from having those thoughts. That decoupling of thought-action fusion, that my thoughts somehow govern reality. I'm shown so clearly how literally they are just thoughts and they don't matter and they impact me so much and it allows me to have self-compassion for myself that I suffer so deeply on a daily basis with these horrific thoughts. And yet, I don't have to buy into them and they don't have to have any impact on my life if I don't do these behaviors, which I can't do compulsions when I'm tripping on mushrooms because I'm literally just laying there like, I can't move.

• 44:09Speaker 02

  So it's a really interesting experience from that way, but even irrespective of the actual trip and what people experience on that, the after-effect is what I believe and a lot of people think is really driving the therapeutic benefit and that it's creating this space for your brain to change the way it communicates with itself. People hear the word neuroplasticity all the time. I like to make it more narrow and talk about synaptic plasticity and how our brain has this more malleable, open period to be able to change the way we think and act and loosen up the rigidity of how much our brain is operating in that cycle. And for me and many other people, it allows us to engage with ERP and other treatments in a far more effective way because of that loosened, open state. And that has been profound.

• 44:54Speaker 02

  And so generally, the field of OCD psychedelic research is looking for ways that psychedelics can be an on-ramp to those psychotherapies that are really helpful because the data shows even with SSRIs, you put that against ERP, most people get better with ERP alone. A lot of people need medication as well. Almost nobody gets better with medication and not ERP because what is the point of changing the way your brain is operating and creating more malleability or plasticity, both through SSRIs or psychedelics or whatever, if you're not actually learning how to act differently or think differently or understand your thoughts? Like, that's not going to change unless you do something about it. So. That is what psilocybin and ketamine is showing great data and MDMA is being looked

• 45:35Speaker 02

  at as well to help the therapeutic relationship between a patient and the therapist to do ERP because there's so much shame, especially with the stigmatized themes. It's hard for people to even engage in treatment because they're so afraid they're going to be judged or they're going to find out their OCD is not real. So MDMA is being looked at to help with that element of it. So I'm very, very, very excited about that. There's also, I'm sure you talked about with Dr. Goodman, like deep brain stimulation surgery, which is directly like going into the brain, stimulating a part to try to interrupt that circuit. And there's non-invasive technologies being looked at, like TMS is something most people know about. There's also transcranial non-invasive ultrasound. There's a lot of stuff going on.

• 46:15Alie Ward?

  And Uma says MDMA, ketamine, psilocybin, she's kind of lumping them all together in the category of adaptive hallucinogens. And they're all being looked at as therapies for a host of disorders, she says. And we did a psychedelology episode with the stellar Dr. Charles Grob about that. And yeah, we will link it for you. But a recent 2024 paper titled psychedelics for the treatment of obsessive compulsive disorder efficacy and proposed mechanisms in the journal neuropsychopharmacology reported that since the 1960s, case studies have shown improvements to obsessive and compulsive behaviors in patients taking psychedelics recreationally. And the effects of psilocybin were then systematically assessed in these

• 46:58Alie Ward?

  small, open-label trials in 2006, which found that psilocybin significantly reduces symptoms of OCD and reduced compulsion behaviors have also been seen in rodent models of OCD after administration of psilocybin. Nevertheless, the study continues. The mechanisms underlying the effects of psychedelics for OCD are unclear, with hypotheses including their acute pharmacological effects, changes in neural plasticity, and resting state neural networks and their psychological effects. Now Uma, with this being one of her specialties, says that adaptive hallucinogens can kind of essentially like crack open the psyche to having an easier time with things

• 47:43Alie Ward?

  like exposure and response prevention therapies afterward, which again are the gold standard for OCD. Now, another tried and true resource, support groups.

• 47:54Speaker 02

  It's literally just the next level of you realize in the most amazing way how not special you are. Like every single thing that you're like, but what if? And it's like, well, they think the same thing of themselves and they'll call it out on you. And it's the funniest thing when you're around a group of people with OCD and they're like, oh yeah, she's reassurance seeking now. Like they just speak your language. This is just normal. This is everyday life. And I believe that I believe that so much for you.

• 48:17Speaker 04

  You're the best.

• 48:18Speaker 03

  Any advice you have for someone who has OCD or who suspects they do? Like what next? If you have any advice too for loved ones, then you know, that as well. But yeah, your advice from your lived experience and it's okay. It doesn't have to be perfect for everyone, but just what you wish that you knew.

• 48:37Speaker 02

  On more of the tangible level, before I get to talking to their heart, because that's equally as important. On a tangible level, if you identified with anything you heard today and you think you might have OCD, please go to a directory of therapists from the International OCD Foundation, which Dr. Goodman had co-founded, that specifically provides you therapists who provide evidence-based treatment for OCD, because you cannot control if you have OCD, but you can't control if you get proper treatment. And that can be the difference between life and death for so many people. It can save you decades of suffering and your OCD getting worse if you get treatment that actually targets OCD. If you see anyone who's advertising themselves on Psychology Today or whatever, saying that they treat OCD, first of all, people usually check off everything, especially generalists.

• 49:22Speaker 02

  So they probably don't treat it. Two, if they don't have exposure and response prevention and they don't say that that is the first thing they use, even if they add other treatment modalities to it, run. That is a red flag. That is the most tangible thing I can say, because it'll save people a lot of trouble from getting the wrong treatment. But more so to people who are suffering it right now. Your suffering is so valid. It's so real. We believe you. And I'm so sorry that you lived through this hell. I'm talking to you, Ally. I'm talking to everyone listening, that this condition is so painful. It attacks everything about you. And I'm amazed by how much we have all survived and that we're here to even have this conversation, because it can so easily take out our lives from the shame and pain that we experience. Also, I'm bracing people ahead of time for the

• 50:07Speaker 02

  fact that when you talk about your OCD to people in your life, or you read about it on the internet, or whatever, it's usually going to be wrong. People are going to trivialize it. They're going to shame you for it if you talk about. Themes that people are uncomfortable with, and please do not take that personally. That's a reflection of our ignorance as a society and the fact that we need to do better. And podcasts like this are what are going to make that difference in the world. That does not mean your OCD is not real. I know we're always looking for something to tell us we don't have it. And it's far easier for us to feel shame and self hatred than it is for us to believe that we are deserving of treatment and compassion and that our thoughts are not real. But I promise you, there is hope on the other side. Treatment is also one of the most brave things you can do for yourself.

• 50:48Speaker 02

  And it feels so wrong and counterintuitive, but just you deserve that. And it's going to be hard, but let yourself have that gift because I promise you on the other side, there is a life that you never thought possible for yourself. And yeah, we're not curing OCD yet. I hope I could contribute to that with my work in some way. But at the very least, you can live a really big, meaningful life. You might even be subclinical and there is so much hope outside of the hell you're experiencing is what I'd say. And then lastly, to, to loved ones, also I see you so deeply. I respect my husband so much for how much he has to deal with and you know, how hard it is to not give me reassurance and to, to live with watching me suffer. So thank you for being that for your friends and family.

• 51:32Speaker 02

  And people relapse all the time. People have flares and just please keep an open mind and give them compassion as they're dealing with it. They're trying their best, even if they are flaring at the moment. And yeah, that's just love to everyone is I guess what I'm saying.

• 51:48Alie Ward?

  And again, the International OCD Foundation, iocdf.org, co-founded by last week's guest, Dr. Wayne Goodman, is an excellent resource for clinicians. They have studies, they have books, so much more.

• 52:01Speaker 02

  It's not our OCD, like we are not our OCD, but when we understand it about ourselves, the lens through which we can see our experience, it's life-changing.

• 52:09Alie Ward?

  So ask empathetic experts important questions because flimflim is out there and it is best debunked with facts and compassion. Now Uma Chatterjee, thank you so, so much for being on the show and for the research and the advocacy you continue to do. You're a gift and we love you. You can listen to her podcast, A Chat with Uma, which covers so many OCD questions and mental health topics, and it's linked in the show notes. She's on Instagram, TikTok, and Blue Sky at Uma Chatterjee, and her website is UmaChatterjee.com, all of which we will link in the show notes. Very easy to remember. It's just her name on all the platforms. We also have more links and resources up at alieward.com/ologies/ocdneurobiology.

• 52:52Alie Ward?

  And if you go to ologies.com, you will find a whole menu of our 400-plus episode back catalog. It's all sorted for you. We are at ologies on Instagram and Blue Sky. I'm at @Alieward, just one L on both. We have shorter, kid-friendly episodes and our spinoff show, which is called Smologies, S-M-O-L-O-G-I-E-S, which is classroom safe. You can find that wherever you get podcasts, or at the link in the show notes. We have ologies merch at ologiesmerch.com. And you can support the show via Patreon, patreon.com/ologies, for as little as $1 a month, and you can submit questions for the ologists ahead of time. Erin Talbert admins our ologies podcast Facebook group. Aveline Malik makes our professional

• 53:35Alie Ward?

  transcripts. Kelly R. Dwyer does the website. Noel Dilworth is our scheduling producer. Susan Hale manages the whole show. And stitching it all together are Jake Chafee and lead editor Mercedes Maitland of Maitland Audio. Nick Thorburn wrote the theme music. And if you stick around until the episode ends, if this is your first time here, I tell you a secret. And this week, it's that there's someone in my neighborhood who drives a car with the bumper stickers "Science Queen." There's a raccoon one that says, "Don't honk at me. I'm having a crisis." And another one that reads MILF, "Man, I love frogs." And I want to know them. I want to know who they are, but I also never want to meet them because I want them to remain a mystery forever, because what if, for some reason, we didn't

• 54:19Alie Ward?

  get along? But by the bumper stickers, this person is a person I want to know. But I do love knowing that they're out there and they're nearby. Okay, that's it for this week. Thanks for being here. Bye-bye.

• 54:37Alie Ward?

  Meteorology. Geology. Nephology. Seriology. Seology.

• 54:49Speaker 06

  Don't you understand? It's turtles all the way down.

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