We continue our Access Astronomy spotlight on mental health in academia (part1, part2). Today's guest post is written by an anonymous contributor and carries on the anxiety disorder theme to shine a spotlight on OCD. It includes personal anecdotes and the author would prefer to not be identified. Content warning: description of panic attack onset. When not working and writing in support of destigmatizing mental health issues and identifying how to provide support for mental wellness in academia, the author works as an astronomy postdoc.
As in previous posts, this is not intended to be medical advice. Please seek the assistance of a therapist for any diagnostic or treatment purposes. If this is an emergency, call 911 or go to your local emergency room. In the U.S. you may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or click here for a listing of international numbers.
Today, I almost had a panic attack while attending a talk. It’s the first time it’s ever happened at work, and I’m considerably shaken. The speaker was delivering a very casual overview of a project in development and spent some time sharing anecdotes regarding a recent personal health scare that interrupted this work; this particular health scare happens to be the focus of fear and preoccupation whenever I experience a panic attack because the panic attack symptoms mirror those of this medical event. As pictures of the very ill astronomer in the hospital and then their scars while recovering from major surgery appeared on the screen, my stomach dropped to the floor. I began to feel nauseated, light headed; pain began to radiate down from my left shoulder and my chest and back muscles tightened as I drew my shoulders high in some futile effort to protect myself from the incoming tide of dread and sense of impending doom. I tried desperately to talk myself down: “I’m going to be ok.. just breathe, think of something else.. going to be ok.. breathe.. no, definitely not ok. I need to get out. Now.” I left the room, found and took the xanax in my bag. I then sat and waited at my desk, head between knees, for the blessed pharmaceutical to take effect and squash the spike of panic back into the quiescent level of anxiety that I generally am able to live with, taking the other alarming symptoms with it. I’m ok now, very tired and trying not to cry at my desk, but it’s over.
While this particular episode was understandable given my primary trigger was front and center in this talk, generally, panic attacks are not at all predictable. Panic attacks live in the diverse panoply of anxiety disorders, which can include generalized anxiety and specific anxiety-driven conditions like obsessive-compulsive disorder. Many of these disorders are comorbid, meaning the likelihood of having one increases if you have another; this makes sense as their root causes lie in anxiety itself, which can manifest in many different ways.
Obsessive compulsive disorder, OCD, is an anxiety disorder that centers on discomfort with uncertainty. Since our professions involve so much uncertainty, I’m not surprised to also have this in the list of my brain’s unique specializations. OCD is a distinct condition from Obsessive Compulsive Personality Disorder, OCPD, though they share many traits; I’ll focus here on OCD as it is classified as an anxiety disorder and it is my diagnosed condition. While OCD manifests in many ways, the stereotypical picture that immediately comes to mind is of repeated hand washing. The act of hand washing is referred to as a ritual, and in OCD, rituals are patterns of behavior that sufferers establish and maintain as a means to eliminate or manage the negative thoughts and emotions surrounding sources of uncertainty. Intrusive thoughts, including things like fears that you may harm yourself or someone you love, that you’re a terrible person and going to hell, doubts about important relationships, fears of uncleanliness or impending catastrophe, spur on ritualization. Rituals tend to escalate in their frequency and complexity as eventually the calm they initially brought wears off. If the sufferer does not act to mitigate the effects the intrusive thoughts suggest, it can bring about a sense of despair, panic, despondence, fear, anxiety. A person with OCD lives in a near constant state of fight-or-flight as the amygdala is convinced something bad, as suggested by the intrusive thought, will happen if you don’t act somehow, and that action is ritualization. An OCD sufferer feels they cannot stop, and simply being told to stop doing it causes pain and further anxiety because believe me, they wish they could just stop!
Sometimes the connection between the uncertainty feared and the ritual established in response are relatively clear: my fire phobia rituals include making sure small appliances are unplugged before I leave the house and being extraordinarily cautious with household fixtures that produce fire (wood stoves, candles) or that could somehow cause a fire (clothes dryer, hair dryers, toaster, oven, anything with a pilot light). This also applies to the office- I’ve been known to walk back to the building from the parking garage to ensure I unplugged things in my office. I’ve turned around mid-commute and driven home, upwards of 5 miles, to make sure my hair dryer was unplugged (even though I know I checked before I left the house, “what if..?” haunts and compels me to check yet again even as I argue with myself that I know it's fine). For me, experiencing a house fire was the clear genesis of this particular phobia and set of preventative rituals to cope. Being robbed led to my ritual of visually checking, then touching locks and deadbolts multiple times to ensure their security. For other rituals, their origins may be unclear. Fears of harm coming to you or loved ones could be calmed by tapping door frames in a pattern, left-right-right-left-left, repeatedly, upon entry and exit. The OCD sufferer is aware it doesn’t make sense in a cause-and-effect way, but is compelled to do it: the intrusive “What if?” dominates behavior patterns. As rituals escalate, they take time to perform and increasingly interfere with basic life functions; this is the hallmark of a mental illness.
There are many facets of OCD and ritualization, but a lesser known OCD behavior that can manifest in academic contexts is a cognitive distortion called scrupulosity. Scrupulosity can often refer to moral or religious contexts, with the fear and attendant intrusive thoughts that you will be punished for sinful thoughts or behaviors or that you are an inherently "bad" person. In the academic context, I want to focus on the facet of scrupulosity that is rooted in a fear that you aren’t telling the truth in the most whole, full, complete way possible. Some may dismissively call it perfectionism, but it’s a little more complicated than that- it involves compulsion to keep working on the same problem, even beyond its resolution, just so you can be *sure* that it’s really, really, resolved. What if I forgot something? What if that fit could be better? “What if...?”
For me, OCD-driven scrupulosity manifests in a few primary ways: communications with others (e-mail and giving talks) and data analysis. E-mails take a very long time to compose as I do back research to ensure what I am saying is not redundant, unclear, a waste of the reader’s time, or betraying a fundamental lack of knowledge on my part (this is where OCD and impostor syndrome can meet and amplify). Talks also take a very long time to prepare, as I feel compelled to provide the most in-depth, well-cited picture of the subject I’m presenting. These may sound like simply best practice, and indeed collaborators tend to enjoy working with me, often praising my thoroughness. But what they don’t recognize is the disruption it represents to my daily life, the delays it causes in getting other things done, and that I’m watching others in the field pass while being able to direct their efforts in more productive ways.
In data analysis, scrupulosity leads to re-doing analyses over and over- directories filled with duplication of work: version 1, version 2, 3; versions 10, 11, 12... The cycle of doing and re-doing is generally only broken when a colleague intervenes and reassures: yes, this is fine. You did a good job, I think it’s great. The external verification and validation can end the death spiral of re-re-re-doing. In the meantime, my publication rates have suffered, and if you try to explain that it’s a real, legitimate mental illness, people think you’re joking. OCD has become so trivialized, made into a meme for people who find patterns being broken distasteful (“Oh, that floor tile is in the wrong place for that design- omg I’m so OCD because that bothers me!”) that the very real suffering of people with OCD goes ignored, turned into a joke, robbed of its legitimacy and the acknowledgment of the power it has to disrupt lives and careers. Please, don’t joke about “being so OCD;” it is painful for sufferers to hear, to see the meme lists of pictures of “N things that will trigger your OCD,” and to effectively not be able to talk about it openly because it’s assumed the sufferer is using the term in jest.
One does not need to be diagnosed with OCD for it to be recognized that they manifest OCD behaviors; these behaviors may or may not be destructive to the individual’s well being or disrupt their ability to engage with life as fully as they wish to. There are a number of avenues for treating OCD, including therapy and medication. Cognitive behavioral therapy for OCD generally focuses on a technique called Exposure and Response Prevention, which aims to eliminate the response to obsession-triggering stimuli through careful, guided exposure to those triggers. Treating scrupulosity with therapy involves cognitive restructuring: the sufferer is made aware of their obsessive thoughts, identifying the distortions that drive them, and then trying to confront the distortions with more reasonable arguments or interpretations. If you are concerned about escalation of ritualization, seeing a therapist to discuss is highly recommended. There are excellent books on OCD, but I would strongly recommend reading them under the advisement of a therapist, especially if it’s a certain book that provides worksheets to be filled out as diagnostic aides- a therapist can help immensely in going through the worksheets and helping you focus your efforts on handling the issues most immediately impacting your daily life.