Why Can’t Some People Stop Thinking Certain Thoughts? with Jon Hershfield | Inner Cosmos

Hinzugefügt: 2026-05-27

[00:00:00]Why do brains generate weird thoughts sometimes? And why do some brains refuse to let go of those thoughts but ruminate on them? Today, we're going to talk about obsessive compulsive disorder, OCD. Why do some people lock the door but go back to check it over and over and still have a feeling of uncertainty about whether it is locked? Why do some people wash their hands over and over and never feel that they reach a point when it's done? What happens when doubt becomes a full-time occupation? How for some people are intrusive thoughts like junk mail that the brain just can't help opening? Today we talk with OCD expert John Hersfield where we'll get a view from the inside and the outside. We'll see how obsessive thoughts can get caught in loops and how those loops might get broken. This is the fourth episode for mental health awareness month and you'll want to listen if you have OCD and even if you don't because it's prevalent enough in our society that you almost certainly have people in your life who suffer from these internal loops.

[00:01:14]Welcome to Inner Cosmos with me, David Eagleman. I'm a neuroscientist at Stanford and in these episodes we sail deeply into our three-pound universe to understand why and how our lives look the way they do.

[00:01:42]Let's start with Sigman Freud's proposed concept of a death drive. So he imagines you're standing at the edge of a cliff and this intrusive thought that you keep having of stepping off the cliff into the void. Now, that's part of why it's scary to stand near the cliff's edge because you have zero desire to die, but you don't totally trust your own brain because it keeps putting up this thought about stepping off of it. So, in 1920, Freud called this the death drive or Thanotose. He suggested that we have a drive for life and there's also this opposing force that pulls organisms towards stillness and dissolution. Now, his explanation of that strange feeling of standing on the cliff's edge, it was quite controversial even in his time.

[00:02:32]And I think nowadays we can take a different view on this. As you hear me say often on this podcast, the main job of the brain is to simulate possible futures. So, when you're standing on the cliff's edge, your brain unconsciously thinks, "What if I simulate moving around here? What if I simulate stepping to the left?" Okay, cool. What if I go to the right? Cool. Backwards. Cool.

[00:02:57]What if I were to step forward? Whoa.

[00:03:01]The salience of that simulation then bursts above the surface of consciousness. And now you find yourself thinking about the act of stepping forward. It's not because you're wishing for death. It's because the outcome of that particular simulation of stepping forward shoots it to the top of your conscious awareness. Now, that's an example of what we call an intrusive thought. You're standing on the cliff's edge and now you can't stop thinking about stepping forward. Now, sometimes you have intrusive thoughts that are even stranger. Every brain on earth generates strange thoughts. Sometimes you're in an important meeting and you imagine saying the worst possible thing or you're holding a baby and an image flashes into consciousness of you dropping the baby. These are all equivalents to standing on the cliff side. The brain spits up these random awful thoughts all the time. And it's just because it's generating futures and the really salient ones will sometimes intrude even though you are not the kind of person who would jump to your death off a cliff or shout out a cuss word in a meeting or drop the baby. Often a thought comes up precisely because it's the worst possible choice for you. Now, for most people, these thoughts come into our consciousness and then evaporate quickly because you're not actually going to do those things. The brain kicks these up and then they get put out with the trash. But for some people the thought sticks and the mind suddenly treats it as meaningful because it's a dangerous thought or it's morally urgent and they think what kind of person would think that why did that thought appear? Could I actually do it?

[00:04:51]And now the brain starts looking for certainty and reassurance. And paradoxically, the harder the brain searches for certainty, the less certain that it feels. This is the first step of obsessive compulsive disorder or OCD.

[00:05:07]From the outside, you might have a sense that OCD is something like someone excessively washing their hands or being super neat and organized, but it involves this much deeper issue about threat detection and uncertainty and the inability to let a thought simply pass through consciousness. A thought gets flagged with enormous emotional salience and then the brain begins constructing rituals around it. things like checking on something over and over or avoiding or seeking reassurance or mentally reviewing or excessively googling about some possible illness that you're worried about or repeating actions over and over. All of this is in an attempt to get certainty, but the certainty never fully comes. As we'll see, the behaviors become a loop and the brain gets trapped inside its own architecture of reinforcement learning. Now, people with OCD generally know intellectually that the loop doesn't really make sense.

[00:06:14]They know that the probability of whatever they're worrying about is tiny.

[00:06:19]They know that the ritual shouldn't matter. And they know that any reassurance they get from the ritual isn't going to last. But the emotional urgency overpowers the intellectual machinery. So that's what we're going to learn about today. And our guest has spent years helping people to try to untangle these loops. John Hersfield is a therapist specializing in obsessivempulsive disorder. He's the director of the Center for OCD and Anxiety at Shephard Pratt and he's the author of several books on the topic.

[00:06:52]And one of the things I appreciate most about John's work is that he approaches OCD with scientific clarity and compassion because he's been on both sides of this. Here's John Hersshfield.

[00:07:10]So John, let's start with what is an intrusive thought. So we have these objects, these mental objects that arise in our consciousness and they usually come in the in the form of words but sometimes they come in the form of images and we call it a thought. And an intrusive thought is one that is perceived as arising in consciousness against our will. We don't want it there. We immediately tag it as problematic. It shouldn't be there. Some sense of it invading our space.

[00:07:37]>> What's an example of a normal intrusive thought? You know, maybe uh on my way down here to the studio, the car went over a stick or something or a bump, but how do I know it was a bump? You know, maybe I killed somebody and they're lying, bleeding on the side of the street. And uh I'm this like terrible human being because I was like, well, I got to get to this podcast. I can't be bothered with that. So, I might start feeling like I really need to like investigate this and make sure that that's that's like something I don't have to deal with. So, another way to think about it is it's sort of like the junk mail of the brain, but it's very very good junk mail. So when we have we get you have an email account, you expect to get junk mail in your inbox.

[00:08:12]It's not surprising. But some of it can be convincing enough that you accidentally click on it and you're like, "Oh no, what have I done?" And then a lot of intrusive thoughts are like that. They're they're typically what we call egoistonic, meaning they don't line up with your sense of identity or what you would expect your brain to provide you. So they're sort of tagged with this like, well, what is that doing there kind of feeling? And then that generates a lot of distress that then starts the OCD cycle.

[00:08:35]>> Okay. So this is what I was going to ask you. What is the difference between normal intrusive thoughts which presumably everyone has once a while and obsessivecompulsive disorder?

[00:08:45]>> Right? So normal intrusive thoughts are not actually different from intrusive thoughts in OCD so much as the way people with OCD tend to respond to them is they misappraise them as urgent. And there's this sense of moral urgency. I have to fix it. It doesn't belong there.

[00:08:59]It's a contaminant. You know, people think about their hands being contaminated, but imagine your mind being contaminated by a dirty thought or an immoral or violent thought or sexual thought you're not you think you're not supposed to have. So, what happens in folks with OCD is something is going wrong in the part of the brain that is detecting error and detecting whether or not error has been resolved. And it puts all this pressure on the individual to say, I got to I got to do something about this. I have to get certain that this thought either, you know, wasn't true or isn't true or isn't going to become true. And it's usually about things that really matter to you. So like nobody wants to be sick or nobody wants their children to be unsafe. Um so if you have a thought about either of those things happening, it's normal to be like, "Huh, what's that?" Most people can be like, "Yeah, that's just my brain being silly." Someone with OCD doesn't feel like they have the moral authority to make that decision. So then they start to engage in behaviors to try to get that certainty. And we call those behaviors compulsions. And so give us some specific examples of the thoughts and the behaviors that you see in your practice.

[00:10:01]>> Yeah. So common to OCD, the the most common themes that we see are contamination, concern with harm or injury or bad luck. Sort so-called unacceptable or taboo thoughts like moral uh religious sexual violence, those types of things. existential obsessions and sort of just right obsessions, you know, feeling like something isn't lined up or organized the way that it's supposed to be. And then common compulsions would be things like excessive washing, grooming, sanitizing, avoiding, reassurance, seeking, checking, uh, repeating, and then all sorts of mental rituals like trying to figure it out, ruminating, whatever you can do in your mind to sort of lock it down and say like, "Okay, this is this is done. This is complete.

[00:10:43]I can I can walk away from this now." M and why is there such a mismatch? If somebody's looking at that person, they think that's an irrational thought that the person is having, but to them there's the moral urgency. How does that mismatch happen?

[00:10:58]>> I'm not sure we really know. I mean, you look at somebody if you if you know somebody with OCD, you can feel for them, but there's probably also a part of you that's like, "All right, enough already." You know, like why don't they just let it go? Because you're thinking, "I would be able to let it go." But if you felt the way that they felt, you wouldn't you would do whatever it took to to try to get back to that place of zero, of certainty, of balance.

[00:11:19]>> And is it about fear or uncertainty or other things?

[00:11:24]>> I think the predominant way of thinking about it is that it it is it's mostly about uncertainty or disgust. But you we used to always think of it as anxiety and then we stopped calling it anxiety disorder because people were reporting all kinds of distress beyond anxiety.

[00:11:38]you know, abject terror and and again, disgust is a very common one or sometimes just a feeling of offness, like I know that I'm not going to be the same person until I fix this thing, until I go back and check one more time or get one more answer to this question that's already been answered 10 times.

[00:11:54]And uh so there's this like intense internal to turmoil. And what makes it kind of even more painful, what increases the suffering for people is that from the outside it looks like this is a person who has no insight at all.

[00:12:08]Like can't they just see this is not a big deal? But on the inside the insight is usually pretty high. Most people with OCD know what they're doing and how they're thinking is not I don't want to call it irrational, but it's not reasonable. You know, part of what makes a compulsion a compulsion is that it's unrealistically tied to the problem it's trying to solve. It's too much. It's too excessive or it's too kind of indirect in the way that it's going about it. And so having insight to okay, something's going wrong with my brain, but also feeling like you can't do anything about it is a bit scarier than just sort of being guided on a leash by your brain and be like, well, we'll see what happens.

[00:12:45]>> So, I want to set the table here. How common is OCD in our population? The our best understanding so far is it affects about 2 to 3% of the adult population and about 1% of kids.

[00:12:55]>> So we all know somebody with OCD or more than one person. Yeah. And um Yeah. And so what age does it typically start?

[00:13:03]>> So for childhood onset, which is very common, I mean most adults that you'll meet with OCD will tell you they've had OCD since they were a kid or at least since they were an adolescent. For males, it's typically age 6 to 8. And also that that's more likely to coincide with tick disorders uh than you would see in females. Uh which I think >> tick disorders meaning movement ticks. Yeah. For females, it shows up closer to puberty, usually age 10 to 12. But uh but many people don't, you know, they might just start as being kind of perfectionist or have some anxiety and then it kind of bubbles over into OCD later in life in response to a stressor. sometimes in response to a trauma as a kind of offshoot of PTSD.

[00:13:44]There's there's so much we know about OCD because it's so common and it's been so well researched and there's so much we don't know about OCD.

[00:13:52]>> Is OCD on a spectrum or is it uh do you think of it as a binary?

[00:13:56]>> That's also open for debate because the question is whether or not you can cure such a thing. So, it's an exaggeration of a natural state of being. Like you said before, we all have intrusive thoughts and sometimes we respond to them and like okay, I'm being silly and then we stop. Um but sometimes they spiral out of control. So people without OCD might even have episodes of OCD.

[00:14:16]>> Um when we measure these things, we usually measure them in terms of mild, moderate, severe or extreme. And then the question is when someone goes through treatment and they're no longer extreme, they're no longer severe.

[00:14:26]They're no longer moderate and they're just sort of mild and they're living unburdened by this condition. Then do they have it or do they not have it? If you tested them, you said, "Well, you know, their number of like how often they're thinking these things or how how much they feel they have to do compulsions or how distressed they are.

[00:14:43]It's it's subclinical, so it's, you know, they don't need to go on meds.

[00:14:46]They don't need to see a therapist." But then there's something about knowing you have OCD that also protects you from having OCD symptoms because you might be minding your own business. You get an intrusive thought, knocks you off your feet, you're like, "Oh, I know what this is. This is my OCD. Okay, I know what to do."

[00:15:03]>> Oh, great. Okay. And we're going to come back to that point. But the first thing I want to ask you is you are a therapist who specializes in OCD, but that's not accidental. You found that you had OCD.

[00:15:15]Tell us about that.

[00:15:16]>> Yeah, I guess I'm lucky in some regards, many regards that I always knew I had OCD. It wasn't a huge secret. And sometime around adolescence when I started complaining about it that uh you know, various forms of if XYZ then something bad will happen. And this was on my mind all the time and I was made so unhappy by it. And at the time and this was in the 90s it was like oh you have OCD well here are the medications for OCD and uh you know there were things that were helpful and things that weren't helpful but nothing really uh fundamentally changed the way I understood myself. So I kind of adopted this sort of self-stigma of I am a crazy person with a crazy person problem. I have OCD. It's genetic. There's nothing I could do about it. It runs in the family. And it wasn't until my late 20s when I had an OCD episode that was so bad that I started thinking, I cannot live this way. I cannot picture the next several decades of my life being characterized by waking up every morning and this being the first thought in my head and this being the first feeling that I have in my chest, my stomach. I got to do something about this. So, I went into treatment and and then it was, you know, hardcore cognitive behavioral therapy and exposure and response prevention. the the the gold standard of OCD treatment. And wow, it was hard. A lot of tears were involved, a lot of like a lot of homework, a lot of, you know, working with a therapist basically looking at me like, "Listen, you you got to do something about this. This is really bad. You have really bad OCD." In the process of going through this hard work, I I reached out to the internet.

[00:16:49]And so, you got to picture this. It's like 2005 or so. And so, reaching out to the internet, there was no chat GBT, there was there was no nothing like that. It was Yahoo discussion board of all things, right? So, I'm writing an email out to the ether on some like OCD support group and you know the moderator is an OCD expert and it's got a couple thousand people in it all with OCD and I'm reading all these stories and they're all different from mine but they're exactly the same if you know what I mean. Like it's different content, it's different, you know, >> demographics, but it's like, yep, I think that way too. And I was mostly just writing to blow off steam and complain. I was like, this therapy is hard. I my therapist thinks I should be able to just tolerate this uncertainty.

[00:17:30]What does she know? Like why should somebody have to tolerate this? It's terrible pain. And people started writing to me and telling me their stories. And I started giving them feedback based on what I was learning in therapy. And then they started giving me feedback like, "Oh, I hadn't thought of it that way. That's actually really helpful. I'm going to try to apply that." So I became this like, you know, keyboard warrior of fake therapists in my like in front of my computer. I'm not ashamed. I mean for hours a day. I mean it was kind of compulsive. I was like I I got to check the discussion board, see how things are going. But I built this alter ego of online therapist as a way of processing what I was going through in therapy. And then it started to occur to me not so bad at this. It's actually like people seem to be like resonating with it and it's helping me. And so now fast forward several, you know, uh, you know, well over a decade later, I'm realizing that part of what has kept me in the shape that I'm in mentally is that I'm constantly teaching the thing that is that has been, you know, haunting me. So I'm not haunted by it as much anymore because I'm I'm constantly giving people information. I'm I'm training people to do the very things that also remind me of like I need to remember I need to keep doing these things.

[00:18:45]>> Oh, wonderful. I want to hit one tangential point and then come back to what you actually do in therapy. But the tangential point is I've been interested in across cultures OCD. People have obsessions about different things and you mentioned on the Yahoo board people had all kinds of different content to their obsessions and yet it was you know you recognize the same thing. So what do you see across cultures?

[00:19:11]>> All the research shows that the prevalence stays the same. So different cultures have different relationships with seeking help. And so you might see certain kind of more neurotic conditions more prevalent in certain cultures, but that's not actually true. It's just that they're more likely to ask for help and more likely to talk about it. People like me, other cultures might view some of these mental health challenges in um spiritual terms, religious terms, or something like that. Or they might um >> like what? Like I'm going to go to hell if >> Oh, sure. I've had people email me like, you know, that not just like that they have religious obsessions, but to try to convince me that the intrusive thoughts are actually the voice of a demon and that you should listen to it because your mortal soul is, you know, etc., etc. So, I think there's different ways of understanding how this works. If you do the research and you and you just look at, you know, asking people the right questions, you you find that 2 to 3% of the adult population across the board have OCD. Now the content might differ from person to person and and also from culture to culture and also from period of time to period of time.

[00:20:14]So people are more sensitive to kind of what's going on around them. If you think about what our ultimate fears are, it's usually something like being alone and being rejected from the tribe.

[00:20:24]>> So think about the things that happen in culture that make us feel that way. In the '9s, in the in the ' 80s and the '90s, there were a lot more people with OCD around fear of contracting HIV than there than there are now. People didn't know what it was. It was in the news all the time. Can I get it from a doororknob? You know that those types of OCD thoughts were much more prevalent than they are now. And then we went through the phase the me too for example. And then I was seeing in my practice there's a lot more people coming to me saying, you know, I woke up 2:00 in the morning and I had this thought that when I kissed my girlfriend in college, you know, maybe she didn't consent and like I don't remember I can remember her name. I I went to look her up on Facebook and try to see if there was any evidence that ruined her life and just going, you know, down the rabbit hole. So taking like you know things that are real and that are serious but then having the OCD sort of commandeer them and saying you know this is your life now you have to figure this out now and I assume in 2020 with co you must have seen a flavor of that >> co was interesting to watch from a therapist perspective because first it was it was the first sort of major trauma that I had to go through with everybody else right so it wasn't like I'm sorry this is happening to you it's like I'm also in the guest room of my house like trying to keep my practice together online, you know, u and worrying about the future and my kids and the rest of it. But I found some of my patients at the beginning anyway of the co epidemic got better because they were like, "Okay, this is bigger than me. Like I'm if they didn't if they didn't have contamination OCD, they were, you know, they were obsessing with some other thing and then they're like, "Oh, the world is ending. All right.

[00:21:51]Well, then I guess it doesn't really matter so much if I if I figure out this one thought from 17 years ago or what if I step on a crack or who cares?" and they got a little bit better, you know, briefly. And and if you if you talk to people with OCD, they'll they'll often report feeling calm in in states of crisis, you know, calmst during turbulence on an airplane because they're just like, "Okay, now uncertainty is not my problem."

[00:22:17]>> Wow. Is it because the other thing is breaking them out of this loop, this ruminative loop that they're stuck in?

[00:22:24]>> It's breaking them out of the loop. And I think it's also reframing the loop as like so personal and and not broader like you know like we're going to war or something like that.

[00:22:34]>> Uh that that that said I also saw a lot of patients get demonstrabably worse during CO because you know did I wash my not just did I wash my hands enough and am I going to get CO but a lot of moral obsessions.

[00:22:45]>> Did I accidentally move my mask a little bit to the right when I went to scratch an itch? And does that mean that I then expose somebody else to something and I'm gonna get them sick and they're going to die of COVID and it's gonna be my fault and am I now a murderer because I wasn't vigilant enough to pay attention to when I touched my mask would be an example of the kind of thing I would hear.

[00:23:04]>> I was going to ask you about this. So with obsessivecompulsive disorder, there are some people that are pure O the the obsessive part. So it's not, you know, we often think about OCD as washing hands obsessively or checking a lock and thinking, hey, did I did I actually lock the door and going back and checking and so on, but but one can be all the way on the side of oh without the compulsions.

[00:23:27]Is that right?

[00:23:28]>> So it's sort of commonly understood that there are these folks who if you were, you know, filming them, you you wouldn't be able to tell they have OCD because they're not doing the thing with the locks over and over and they're not going up and down the stairs and they're not washing their hands all the time, but they're doing something, right? So actually it turns out that the people we thought fell under this category and it's a little bit tricky because the diagnostic and statistical manual does say you know you have these different kinds of OCD and there's the O with the C and then there's the C without the O and the O with the most people who do what I do uh actually don't subscribe to that theory. If you have an obsession essentially what you're saying is you have an unwanted intrusive thought and you're responding to it in a way that maintains it as an unwanted intrusive thought. Like I said before about junk mail, we usually ignore our junk mail.

[00:24:14]We know not to click on it, open it, and certainly not to reply to it. And so these unwanted intrusive thoughts, if they're persisting, it's probably because you're responding to it in some behavioral way. And so where things got a little bit confusing for some folks was that people were responding with these sort of mental behaviors. They might be, let's say your fear, uh, your obsessive fear was being sick and every time you had a thought about being sick, you might repeat the word healthy, healthy, healthy, you know, three times and you got to do it three times and you got to do it in your head. You got to make sure you said it the right way and with the right intention or let's say you had a triggering thought about uh your your your faith and you had to um say a specific prayer or something like that over and over in your head. So these are these are behaviors. These are attempts to wash your mind of a contaminant, but they're unseen. So the obsessions are obsessional and the compulsions are obsessional. So they're pure in that sense and that they're not escaping the head, but they're not pure in the sense of I've yet to meet in my career somebody who just has these unwanted intrusive thoughts and that's just because that they're unlucky in that way. Got it. So it means that you can't always see behaviorally from the outside. Do you suppose that religious figures and icons and leaders sometimes have OCD and and they develop a flock of people who follow them because they think, "Wow, this guy's really >> I think people who rise to positions of having a lot to say about something tend to be obsessive, right? And they tend to keep going back to it and they tend to be rule followers >> uh in certain ways uh and they tend to be perverative, right? So, I think that sure you could look at a lot of famous historical people or religious figures and say, you know, maybe they were just responding to intrusive thoughts and and they kind of came up with a spiritual explanation for it and then that's how they got their followers. I think you could say a lot about the same thing about autism. I think you could say >> why wait double click on that? Well, uh, when you when you think about what it would mean to from a neurode divergent perspective to really feel like your functioning is going to be at its best when you have an exact script for how to live.

[00:26:21]>> Ah, yes.

[00:26:22]>> And we have the script and it's called our holy book and and all the words are in the book. And if you're not doing what it says in the book, then you might be doing something wrong. There's a there's a fair amount of crossover. um there's a much higher incidence of OCD in the autistic population than a non-aututistic population. But they're not the same thing. Think about some of our world leaders and you think, well, you know, why do they keep getting in trouble for things, you know, like uh affairs and things like that. I like to think if I was a world leader, I'd be very very careful to behave very very well. Well, part of the reason I'm not a world leader is I'm not impulsive enough and and I don't take the kind of risks that a impulsive narcissist would take that would get them to the top.

[00:26:57]>> Oh, fascinating. So, I want to make sure I understand this issue about why the compulsions seem to temporarily relieve the anxiety going on where somebody feels like, okay, I've just saved this situation because I've done this thing.

[00:27:12]Does this end up making a reinforcement loop?

[00:27:16]>> Yeah, we we call it the OC cycle or the obsessivecompulsive cycle. So, the model is you have these unwanted intrusive thoughts which are normal events. You know, you have however many thoughts you would know what the exact number of thoughts are that you have in a given day. And you know, they're not all going to be gems and some of them are going to be disturbing. And maybe they're disturbing because they're just objectively disturbing. You know, they're violent or perverse or something like that. Or maybe they're disturbing because they're just so not you. Why would you think that thought? You know, you never been in a fight. Why are you having a violent thought? Uh you you love your faith. Why are you having a blasphemous thought?

[00:27:49]>> So you notice this thought's a bit off.

[00:27:52]It's egoistonic. It's disturbing to you.

[00:27:54]So you start to feel distress. I don't like it. Makes me uncomfortable. So in a completely rational way, you're just like, I need to get away from this discomfort. The discomfort is there. You know, your body is trying to tell you like, you know, something is not the way it's supposed to be and it's trying to motivate you to do something about it.

[00:28:09]So that's why you start to get tense muscles and your brain starts to rev up a little bit. I mean, it's it's all there to help you. It's just it's a false alarm. You know, your brain can't always get it right. So now you're in this situation where your brain, your body are telling you, you're in trouble.

[00:28:23]get out of trouble. You, okay, how do I get out of trouble? So, you start engaging in compulsions, right? So, if it's a contamination thing, you're busting out the hand sanitizer again.

[00:28:30]You're washing your hands even though you just washed them, but you know, you might have bumped into something. So, now you got to go wash them again. Uh, or you're doing the mental ritual over and over again. And then it works, you know, works just a little bit, just enough to make you feel like, I am now certain that the content of this intrusive thought is false and it's not going to hurt me or the people I care about. And it feels so good to get that relief. And that triggers this thing in the brain called negative reinforcement.

[00:28:54]So as complicated as brains are, they kind of only have two settings. It's keep doing this or don't keep doing this, right? And a lot of what a person's personality comes down to is like how often do they do this and how often are they inhibited from doing this? And so we repeat things that are reinforced. Positive reinforcement. I want you to do something, you do it. Um you know, I pay you. And the next time I ask you to do it, you're like, "Oh, that sounds a great idea. We called a job."

[00:29:18]Right? Um, uh, punishment is another kind of reinforcement. And negative reinforcement is essentially you're already in an in a distressed or unpleasant state and then something you do makes that distress go away and your brain goes, "That was great. Do it again." Then what happens is the intrusive thought, the initial invader comes back because it's a normal event.

[00:29:39]You're going to have these thoughts sometimes and it comes back, but now it's tagged with additional information.

[00:29:44]We know this thought's important cuz last time you had it, you had to do something about it. We know what you have to do about it because last time you couldn't tolerate how it felt and and you did that thing and it felt better and we know there's no way you could just say like, "Okay, this is my OCD and let it go because last time you had a chance you didn't take it." So, you kind of end up bullying yourself into repeating these behaviors desperately trying to get that relief.

[00:30:03]So, it's it's it it shares some territory with addiction, but it's different from addiction in that it doesn't really have the positive reinforcement side of it. You don't get the high, you just get the relief. And the relief, you know, like I said before, it's, you know, could be disgust, could be anxiety. Oftentimes, it's guilt. It's a sense of like, if I decide that this is OCD and let it go, if I'm willing to risk my soul, my children, whatever it is that my OCD is going on about, I must be a terrible narcissist or a bad person, like it's so guilty, right? But if I know I've done everything in my power to keep this bad thing from happening, okay, then at least I know I'm like baseline. Okay, so now you bold yourself into doing it again. Now there's more negative reinforcement and around and around we go because the thoughts are going to do what they're going to do. They they're not consulting with you whether or not to show up. The question isn't whether or not they show up. It's how they show up and how easily you can see them as just like noise or signal.

[00:31:06]Why do rituals expand over time? Why doesn't the brain say, "Okay, we're safe now." So again, there's probably a great cerebral neurological explanation for it, but essentially what's happening is the good enough mechanism in the brain is not fully doing its job. Right? So, so think about what it's like to lock a door, walk away, know that you locked it, have an image in your head of having locked it, but not have the feeling of task completion. Something's missing.

[00:31:35]Something hasn't been done. It can't be that I didn't really lock the door. But could it be that I didn't lock the door?

[00:31:42]And is that why I'm now having all these intrusive images of people breaking into my house and murdering my family? Okay, maybe I should go back and lock the door again just in case. Right. And now you're you're unlocking it. And you're locking in. You know what? Just so I remember it this time. Let me unlock it and lock it in a very specific number exchange while saying out loud, it is locked. It is locked. It is locked. And actually, let me also take a picture of it and take that with me so I can refer to it later. All these things are inhibiting you from being able to accept the uncertainty which is expanding the uncertainty. It's basically you're you're training yourself to think of yourself as incompetent at not just of locking a door but of but of tolerating the unknown. So the natural trajectory of most OCD is to get worse. It's not a phase doesn't go away on its own. We used to you know people used to say this to kids like you know they're just going to get grow out of it. You don't grow out of it. You have to actually change it because it's it it has its own internal learning mechanism. So you're learning how to be more obsessivecompulsive the more compulsive you are.

[00:32:40]>> And what do people with OCD? So the fact that it's 2 or 3% of the population, what kind of jobs do people typically go into?

[00:32:49]>> H that's an interesting question. A lot of us are therapists >> for each other. That's nice.

[00:32:55]>> Yeah. I mean it's true. If you go to a conference like uh the international OCD Foundation conference I go to every year, there's a sizable percentage of the people there with lived experience.

[00:33:04]You know, I'm speaking in a non-scientific way though uh when I say, you know, people with OCD tend to be very compassionate, very sensitive, very thoughtful, you know, much to their chagrin. I mean, they would they would try to sometimes rather be less thoughtful, but >> there's an upside and a downside to it.

[00:33:21]I never like to say there's an upside to having a psychiatric condition that's causing you to suffer. But the way I think about people with OCD and myself included is that they have a like a broader brighter spotlight on the available thought content at any given time. And so what that looks like on the positive side is a person with OCD might notice a very subtle detail about a painting or a scene in a movie or or the way their their romantic partner smiles or something like that and they'll catch it and they'll be like I see that and that's awesome and they might even speak to it and they'll think oh this person's creative this person's so romantic. This person's so thoughtful. And so people with OCD tend to have a great sense of humor and tend to be very attentive to each other's needs when they're not in the hole, you know, trying to get out of out of the hole. Now, that's that's the upside, right? But if you think of it as a spotlight, if you think of it as a sort of wide spectrum on all the available things a person could be thinking about, the downside is thoughts that most people throw away, see as drunk male, you kind of perceive as muffled or underground or not worth attention. for the person with OCD have a bright light shining on them, >> right? So, it's so it's I'm having this thought of like what's what if this terrible thing happens and it feels as significant as having a thought like what day is it or like uh you know what am I going to have for lunch like a thought that belongs there that you know and but it's this like terrible terrible content. If you ask someone to think something terrible, you know, like what's worse, fire or electrocution, you know, for for death, most people will think about it and be like, I don't know, I guess this or that, right? But a person with OCD be like fire like immediately because and I've I've run this experiment in front of people.

[00:35:07]Everybody's like raising their hand, you know?

[00:35:08]>> You mean because they've thought through it before?

[00:35:10]>> Because it's just obvious to them. It's just it's it's it's not something that needs to be thought about. It's so available. So, when you think about the kinds of things people obsess about, I I'll give you an an example. When my kids were little, you know, we get them ready to get on the school bus and there's all this process involved. Do they have the right clothes? And then, you know, is their lunch packed? And you put in all this effort to make sure that they're safe and ready to go off to school. And then you you you take them to the end of the driveway and you like hold their hand and you're like, I'm like the best parent. I'm like taking such good care of them, right? And then and then you put them on a giant vehicle with no seat belts driven by a person you don't know. You have no idea if they're sober, if they're like whatever, and you're like, "See you, I got to go to work." There's a point at which you say, "Enough. This is the most I can do, right?" But a person with OCD is much more likely to be aware of how awful that story I just told really is and how what what level of risk is involved. and they might have to like pull themselves away to go to work because they know that the consequences of like driving behind the school bus and spying through the window are also problematic.

[00:36:21]>> So wait, let me just understand the thing about saying fire is the worst way to die. Is that so if you asked me that question, I've never really thought about I don't have OCD. I've never thought about being on fire or being electrocuted. So I would have to sort of walk through it. But is the point that someone has already gone down that path and thought about >> I think I think the point is that it's more readily available to them. It's it's part of what makes people with OCD tend towards creativity and and a sense of humor is they can think the exact wrong thing at the exact wrong moment.

[00:36:50]And and so where the misfire is happening is a confusion between the brightness or loudness or availability of the thought and its importance.

[00:36:57]>> I see.

[00:36:58]>> So if I say uh uh if I whisper to you that there's a bomb in the building or if I yell at you that there's a bomb in the building, it actually doesn't matter. What matters is if there's a bomb in the building, right? Right. But if you're having this internal process, the tendency is to go with the loudest thought at any given time.

[00:37:13]>> Ah, okay. Now, what I'd really like to get into then is your therapeutic approach. So, tell us about that. What do you do? Someone with OCD comes in, sits in front of you, what do you do?

[00:37:23]>> So, the very first thing you do is you you get to know them. I mean, I think sometimes when people get into specialty areas, they're like, "All right, we're going to just like uh surgically remove the the problem that I specialize in."

[00:37:33]So, you have to do all the same things you do as a regular therapist, which is establish rapport. Uh, establish that you're invested in reducing this person's suffering and and there are reasons that they should trust you or or learn to trust you to do that. So, by the time someone's come in for OCD therapy, they're already halfway up some fear hierarchy because they're telling you things that that they think are going to make them sound crazy and and that's a very vulnerable thing to do to a with a stranger, right? So you go through the the the initial part of the therapeutic process. Then you go into psycho education. Look, based on what you've told me, based on, you know, these scales that we've used and things like that, I'm I'm fairly confident you have this thing called obsessivempulsive disorder and that's why you're having trouble letting go of this thought and and letting go of these behaviors and here's how we're going to treat it. And and you run them through that OC cycle that I described before. And what I like to do after kind of running them through it in a lot of detail is ask them, "How do you treat OCD?" I'll be like, I'm new here. Just tell me how to do this.

[00:38:31]Because if you explain it well enough that the problem of the intensity of the thoughts is that they're being fed with the negative reinforcement and that the negative reinforcement is coming from this fake limited temporary relief system called the compulsions. Then this then the solution becomes kind of obvious like I need to identify all of my compulsions because I might not be aware of all of them, right? Right. I might I might I might be aware of the ones where I'm like tapping in prime numbers but not aware of the 5 hours I spent in the middle of the night on on uh you know googling how to tell if I have this disease. Right.

[00:39:06]>> Okay. So that's compulsion too. So identifying what's compulsive. What's feeding that negative reinforcement? And then learning to resist it. And the point of resisting it is both to learn that you can tolerate the discomfort and the uncertainty and that it'll go down on its own like like most fears over time, but also to just uh unpair it, right? So there's this this pairing of thought terror, right? Okay, what if I could unpair it? What if I got to have this is this is a concept called inhibitory learning. What what if I could repeatedly put myself in situations where I want to do compulsions? So now that's called exposure. Okay, now I want to do the compulsion, but I'm not going to do the compulsion. So now I know I can feel dirty or I can feel triggered and I can survive not doing the compulsion. And either that's going to get easier because I'll be less distressed or it'll still be distressing but I'll be able to tolerate that distress or know that like I don't have to take it seriously because nothing terrible happened. And >> so it's breaking the loop.

[00:40:02]>> It's breaking the loop. Exactly. So it's ERP, exposure and response prevention.

[00:40:08]And one way to think about the inhibitory learning side of things is how a lot of people relate to scary movies. I'm a huge horror movie enthusiast myself. And and one of the reasons people like it is that they go they go to the movie theater and they're like, I'm I'm going to get disregulated.

[00:40:21]This is my plan. I'm going to spend money and I hope something happens up there that makes me feel bad because that's exciting. It's exciting to feel that way and know that you're safe at the same time, right? It's the same reason people go on roller coasters. And what happens is, you know, the monster jumps out and you're like, "Ah." And if you do an analysis of what's going on in the brain, the body, it's like, it's not good. You know, you're in danger. But then what happens? Then you're like, "Ah." You turn to your friend like, "That was crazy." You get some popcorn, you're right back into the movie. At no point do you think, "I got to get out of this movie theater, right? I'm in danger." So, you've learned that it's okay to be triggered because you're pairing the trigger with something that's not threatening. And the best way to do that is to practice it. Go see a lot of these movies. And don't just see them in the theater. You know, rent them at home, too. like and make sure you generalize and do it in different settings, different context. So, it's the same thing with other forms of OCD.

[00:41:08]Maybe you have contamination OCD and all the excessive washing and avoiding that comes with that. Yes, we want you to build a hierarchy gradually, you know, don't jump in the deep end of learning to touch that door knob or that toilet handle or whatever the triggering thing is. Then resist washing and sit with that feeling of like, am I dirty? Am I spreading something? And don't just sit there with your hands up. Make sure you don't touch anything. you know, spread the wealth, you know, get it on your face, you know, shake hands with people, do do whatever it is your OCD is telling you you're not allowed to do. And then let's see what happens over time. And and the the results are really impressive for for most people.

[00:41:44]>> Wow. Because they're building up new reinforcement loops on this stuff.

[00:41:48]>> They're getting feedback telling them that their prediction was not accurate.

[00:41:52]>> Yes.

[00:41:52]>> Wow.

[00:41:53]>> And but without the certainty, right?

[00:41:55]They're not proving that they can't get sick. if they're proving anything is that they don't need to know if they're going to get sick.

[00:42:01]>> Can you just double click on that? I want to understand this difference between addressing the uncertainty part of it.

[00:42:07]>> Right? So, if I tell you if I touch this and don't wash my hands, I'm going to die and then I touch this and I don't wash my hands and I don't die, it doesn't prove that touching that, not washing my hands guarantees I won't die.

[00:42:18]I might die tomorrow.

[00:42:19]>> Right? What I'm trying to overcome when I'm trying to overcome OCD is this false message in my brain that says I'm not allowed to move forward with my life unless I'm certain.

[00:42:29]>> And so what we're ultimately training people how to do regardless of the content is change the process by which people relate to that sense of I don't know and I need to know.

[00:42:42]So one of the ways I explain this to to my patients is we have knowing skills and we have not knowing skills. And part of the problem with OCD is a deficit in the not knowing part, right? To fly a plane, you have to know what all the buttons and knobs and stuff do and how to fly the plane. But if you can't tolerate not knowing if a goose is going to get in the engine and you're going to have to do an emergency landing or something like that, you're going to be too anxious and distracted to efficiently and competently fly that plane. You have to also be good at not knowing.

[00:43:13]>> Excellent. Right. And that reminds me, there's a quotation that I think is yours. thoughts are just thoughts.

[00:43:18]They're not threats. What is that distinction there?

[00:43:22]>> So, it goes back to what I was saying before about this idea that something is happening where a person is is having a thought. They're perceiving the thought as very loud and very obvious and they're misappraising it as particularly important or super relevant to what's going on in their life and and not just the junk mail that it is. So they're saying like this thought is a threat and I have to remove the threat to keep myself or my family or my loved ones or somebody safe. But I think when I'm thinking about just like this the expression of thoughts are thoughts not threats I mean it even more globally than that right I mean that I mean to say that a thought cannot be a threat unless you make it a threat. Unless you relate to it like it's a threat. I can't hold a thought in my hand no matter how many thoughts I throw at you David none of them are going to bruise you. And I would go on to say feelings are feelings, not facts, which is a whole other mess. But still, we have these internal things and these stories about these internal things. And well, this means, you know, I'm anxious. This means something bad's going to happen or I feel guilty. It means I did the wrong thing. And then you say, well, like, are your feelings reliable? No, they're terribly unreliable. Like, okay, so there's a mismatch here. What I'm touching on there, um, is the C of CBT.

[00:44:34]So exposure and response prevention is the behavioral part of CBT. I think all good exposure therapists do some C in their CBT as well.

[00:44:42]>> And the C is cognitive.

[00:44:43]>> Exactly.

[00:44:44]>> Yeah. Okay.

[00:44:45]>> So the cognitive part being like um you know all things being the same, there are better or worse ways to think about your experience. And some ways of thinking about your experience. Again, I'm not saying there are good and bad thoughts. I'm saying there are effective and ineffective ways of thinking about your thoughts. And the most ineffective ways of thinking about your thoughts are the ones that convince you that compulsions are not a choice. That compulsions are an inevitability. How did you get to I have to do this thing?

[00:45:10]Well, I had this thought and then it was like, oh, and if I don't wash my hands, you know, it's uh something terrible is going to happen. Or if if I don't reassure myself, you know, I'm going to be a terrible human being. Okay, well, that's called catastrophizing. You you can't predict the future. Like, I get it. That's a scary idea. But if you're going to go along with that, you're just training your mind to just run off with you, you know, and you need to get a little bit of control over how you think about things. Not what you think about, but how you think about them, which then opens us up to this whole other thing called mindfulness, which I'm a big fan of.

[00:45:42]>> Great. Tell us about that and how you think about mindfulness in your practice.

[00:45:46]>> So, you asked me before about saying thoughts are thoughts, not threats.

[00:45:50]That's really at the heart of mindfulness. It's basically saying you can be an observer of your experience in the present moment and you can do it without judgment and you could even do it without thinking and I need to change this immediately. So it's learning how to show up. The experience of someone with OCD is very often one of being uh having your your mind commandeered by almost like an external force. I was doing fine and then this thing triggered me and now I just I'm not in control of my life. All I do is think about this thing all day every day. I can't sleep.

[00:46:22]It's in my dreams and I'm constantly trying to make it go away. So, it's it's really like having your mind stolen. And mindfulness is is stepping back from all that and saying like, "Okay, so you're observing what's happening. You're observing the thoughts floating by.

[00:46:37]There's a thought. There's a thought.

[00:46:38]You're observing there's some emotions.

[00:46:40]Uh maybe there's some aversion to that thought, some resistance. Okay, that's another thing that's floating by. This thing called resistance." So, a lot of, you know, sometimes when people hear mindfulness, they go, "Oh, goodness."

[00:46:49]you know, he's here with the mindfulness again. You know, the mindfulness this mindfulness that. I mean, it does get overused a little bit, but essentially learning how to say, "Hey, look at that." before everything that happens.

[00:46:59]Oh, hey, look at that. I had a thought.

[00:47:01]Oh, now you're in relation to a thought as opposed to the thought happens and you're immediately scrambling to get rid of it.

[00:47:06]>> Right. You don't have to be the thought and you're watching it.

[00:47:09]>> Exactly. So, it's it's understanding yourself as an observer of what's going on in your mind, which gives you some agency over, okay, all right, um, this is how this feels. What are we going to do about it?

[00:47:19]>> Yeah. And this is what allows you to separate feeling from fact because you look at the feeling. Oh, I'm feeling anxious. I'm feeling angry. I'm feeling guilty. And you get to just observe that as opposed to it is true that that feeling has meaning.

[00:47:34]>> Yeah. 100%. And when people get caught up in some of these, you know, cognitive distortions, you know, all or nothing thinking, magnifying, discounting, positive, all that stuff, what's really happening there is they're not maintaining an awareness that thinking is happening. They're just they're in the stream. They're not on the bank watching the leaves go by on the stream.

[00:47:52]And so the the goal is to really help people see like, "Oh, wait a second. I'm thinking. There's a way that I'm thinking. This way of thinking doesn't serve me in this moment, you know, and this actually sounds a little bit like my OCD. I'm going to make a choice not to do this compulsion, and I'm going to, you know, give myself some credit for doing the hard work of my exposure therapy."

[00:48:10]>> Yeah. You know, this has been one of the most fascinating things to me about neuroscience. There was a French writer in the 1800s, I'm totally blanking on his name, who said, "A brain bears thoughts the way that an apple tree bears apples. It's just, you know, this is what it does. You're going to get thoughts popping up all the time, >> and you just have to live with that."

[00:48:31]Yeah.

[00:48:32]>> Yeah. The the imagery that's just popped in my head is someone like biting through an apple is full of maggots and they're like, "Oh no, what happened?"

[00:48:38]Right. That's I think how many people with OCD feel is that they are um there's a part of their brain that's out to get them that's victimizing them.

[00:48:46]>> And so one of the things that's super helpful in the OCD treatment is self-compassion. Just like a part of mindfulness. It's basically just acknowledging like this is hard. A lot of people think of self-compassion, you know, give yourself a hug, be nice to yourself. That's a part of it, but it's not the most important part of it. The most >> acknowledging the struggle. It's telling the truth. It's telling the truth. It's saying, "I need help. This is hard. I'm a human being who's vulnerable.

[00:49:14]>> I I can't do this on my own right now."

[00:49:17]And then when you can apply that to other things like, "Oh, I'm having an intrusive thought. I don't like the way that it makes me feel. I'm going to stand up to it. You know that, you know, I'm doing the best I can with what I got." Right? All of that is super helpful. But it's it it really kind of lends itself to what I think is the most logical conclusion, which is if you have a thought that is tearing you down like a bully, learn how to stand up to it in a way that's effective, >> right? And and the different ways of responding to a bully, right? So if you're fighting fire with fire, try to fight OCD logic with with better logic.

[00:49:51]That doesn't really work actually, but it doesn't work with bullies either, right? A bully wants to rile you up. So, if you're willing to go into that fist fight with them, they've already kind of won.

[00:50:01]>> But there are different ways you could respond to bullies that make them say, "Uh, yeah, I don't want a piece of this, so I'm walking away."

[00:50:06]>> Like, what? How would you respond?

[00:50:08]>> Well, think about exposure therapy. What about agreeing with it?

[00:50:12]>> Am I saying, "Oh, yeah, that's great. I hope that bus goes right off a cliff, right? You don't have to mean it. You can just say, you know, the bully's like, "Do this, or I'm going to make something bad happen." Great. I love it when bad happen bad things happen. It's my favorite thing. And the bully's like, "Uh, okay, you're weird. I'm going to go pick up pick on somebody else, right?

[00:50:28]It's much more effective than always playing defense.

[00:50:32]>> Oh, fascinating. Okay, so a couple of closing questions. So, you know, I asked you before about culturally what's going on with OCD, how it differs across cultures, but it also differs across time. So, what are you seeing now, right now in 2026 with with patients with OCD?

[00:50:47]>> I'm observing a spike in existential obsessions. This is something that kind of always existed. So existential obsessions being these sort of unwanted intrusive thoughts about what's real? Am I a simulation? What if I'm the only consciousness? What happens after I die?

[00:51:03]And like how am I going to tolerate not having answers to these questions? It's too overwhelming. And I think we're going through a cultural moment now where, you know, everybody's talking about AI is coming for all of your jobs and all of your human experience is going to be replaced by robots. Um, politics is an absolute disaster. No matter, you know, who you are, what your bent is, no one's like, "Yeah, everything's going great politically."

[00:51:27]No, it isn't. And and I think, you know, it it's just sort of everybody's anxiety is, I think, a little bit raised. And when that happens, everybody with OCD has it raised times 10. And so, I'm just hearing a lot more of obsessions about like what is real? Like what matters?

[00:51:44]And, you know, what if what if none of this matters? and um you know what if in the future AI does this and does that and and all of my love for my family is just like a bunch of numbers and doesn't matter and you know people can you know I don't think it's so strange to go down a philosophical rabbit hole and then think I wish I hadn't done that I kind of want out you know I don't think that's a strange thing it's just that when it happens to someone with OCD and they have that predisposition they can't just get out they can't just be like well that's that I'm going to go watch TV now there's the OCD says like, "No, we need more. We need to figure it out. There's unfinished business." And you match that with with other symptoms like anxiety and depression.

[00:52:25]>> Does it help somebody with OCD to just physically move out of the situation they're in and go do something, some task? Does that help?

[00:52:34]>> Yeah, I I think so. I think you can use distraction compulsively, right? If you're running from your thoughts, you're sending the signal to your brain that your thoughts are dangerous. But if you're saying, um, yeah, I just think I'm just not going to deal with this right now. I'm going to go do something else instead. Then you're sending the signal to your brain that even though that thought's really terrible, and you don't really know what's going to happen, you're much more interested in your video game right now than anything else. And I think that can also be a kind of exposure. It It's another thing I tell my patients a lot, which is your brain doesn't know you have OCD. It doesn't have an opinion about any of this. It thinks everything you're doing is great. It's just like totally rational and totally reasonable. So if you avoid something, your brain's going to be like, "Good. it was probably bad.

[00:53:14]If you wash your hands, your brain's going to be, "Yeah, they were probably dirty." Right? So, when you do exposure therapy over time, it's going to say, "Oh, I guess there's new rules, right?"

[00:53:22]Like, "Oh, this person can have this thought and then they can override it and do this other behavior, so I guess that thought probably is junk mail. I'm going to start tagging it as junk mail."

[00:53:30]Starts to reverse engineer the OCD cycle. The challenge is is the reason why exposure therapy is so hard.

[00:53:36]Sometimes a brain should be quick to learn danger and slower to learn safety and really slow to learn safety after you've established danger.

[00:53:46]>> Yeah.

[00:53:47]>> So, if you've convinced yourself that it's dangerous to have a certain thought or to touch something or to do something the wrong number or something like that because of your OCD and then you're like, I'm not going to live this way anymore. I'm standing up to my OCD. I can do exposure therapy. A healthy brain is going to say, what are you doing?

[00:54:03]Don't don't do that. That's incredibly dangerous. And so you're going to get these really intense emotions. And then what's beautiful about ERP is when you get through that, when you're a witness to the other side of it, you realize, I'm stronger than I thought I was. I'm more capable than I thought I was.

[00:54:18]Feelings can't destroy me. Thoughts are thoughts, not threats. You get all that prize at the end of it as long as you're willing to go through that scary part.

[00:54:26]And I think people often forget that the scary part is actually normal and healthy. You want a brain that's a little bit slow to change its mind once something's been established as dangerous, but you can change it and you you know you're gonna want to change it if you have OCD.

[00:54:42]>> And so for listeners who have OCD, and I also want to ask you about listeners who know or love somebody with OCD, what would you recommend they do?

[00:54:52]>> I think, you know, first things first, any part of you that's saying this is because you're weak or you're crazy or something is like terribly wrong with you. I know we're using the word disorder, but we have to use words to label things. Try to step back from that and try to open up to the idea that look, this is a common treatable psychiatric condition. Everybody's got issues. This is your issue. This has nothing to do with the content. If the content is you're a bad person, this has nothing to do with you being a bad person. The content has to do with contamination or locking or whatever.

[00:55:26]It's not about that. That's just how it's manifesting behaviorally. What this has to do with is you've got OCD. It's created this deficit in your ability to tolerate certain types of uncertainty and doubt and and your strategies, your instinctive strategies are just a little misguided because nobody's perfect. And and you can train that out of yourself with the right therapies. So ask for help, right? Asking for help is never a weakness position. It's always a strength position. You're always saying like, "Hey, I'm smart enough to know I deserve better than this. So, I'm going to go find some nerd out there who thinks about this stuff all the time and doesn't and and and you know, isn't isn't sort of predisposed to helping me for no reason. I'm going to actually employ them to to to care about this part of my life." Yeah.

[00:56:13]And then and then you'll see the results. So, start with self-compassion and then then go for help. And there's lots of great resources out there now that we didn't have before. Uh, and and since we're talking about the OCD, the first one I would go to is iocdf.org.

[00:56:27]That's the International OCD Foundation.

[00:56:29]And that's just full of information, everything you could possibly want to know about OCD, including uh where to find help.

[00:56:36]>> Great. And I'm going to link that to the show notes. And what about people who have a loved one in their life with OCD?

[00:56:42]What would you recommend they do besides have them listen to this podcast?

[00:56:45]>> Yeah. And buy my book. So, I wrote a book called When a Family Member Has OCD, and it it covers all those issues.

[00:56:52]It's really an amazing and powerful thing to love somebody with OCD. Uh, ask my wife. Um, you know, she had to learn when I was going through that process how to make sense of my behavior because it affected her and and she had to learn how to respond or more often how not to respond to some of the things that I was doing to mine her for reassurance to rope her into my OCD process.

[00:57:18]>> Example, >> so I would like bring up a subject of the content of my obsession and just I'd be talking about it for, you know, no reason. You know, you ever think about this? you know, I would kind of like or or I would ask her a question that I've asked her a thousand times. Or I would come to her and say, "I know you're not supposed to answer this question, but but let me just ask it one one more time." And she'd have to make a decision about like, you know, essentially the equivalent of am I going to give him the soap to wash his hands or I'm going to tell him, "No, this is your OCD." And those are hard decisions for family members to make. So, what happens in in family systems, romantic relationships or parents and kids, um, is people get roped into accommodating the rituals.

[00:57:55]You don't like to see your loved ones suffer. you see that your loved one suffering and there are things that you can do that are part of the OCD cycle to make their suffering or at least their short-term pain go away immediately. Oh, let me just check that for you, right?

[00:58:07]Let me just answer that question for you one more time. So, part of the the treatment process is if you have a family member who's roped into the OCD, they also need to be trained and educated that the compassionate thing to do is not always just do whatever makes them feel better. The compassionate thing to do is sometimes say like, I know you can't see that this is your OCD right now, but I'm telling you this is your OCD right now. I'm not gonna answer that question. And then you collaborate with each other on like, okay, what's the best way to team up against the OCD?

[00:58:34]Uh, and and those situations, I mean, when you see them take shape, they it's just so beautiful when you see a whole family decide like this isn't about my kid misbehaving and this isn't about my irritation with with, you know, having all these uh OCD problems in my house.

[00:58:48]This is actually about us as a family getting together and declaring war on the OCD. It's not about my kid. It's about the OCD. And then you see everybody get better.

[00:59:05]That's John Hersshfield. By the way, I found the quotation I couldn't quite recall during our interview. It's by the French writer Antoine Fabra de Oliv. And in 1824 he wrote, quote, Man is a plant which bears thoughts just as a rose tree bears roses and an apple tree bears apples. So in other words, you're blossoming thoughts every moment of your life. And if you pay attention, you can detect some really wild thoughts buried in there. Some thoughts that might be violent or sexual or blasphemous. Our minds are noisier than we generally appreciate. As John and I discussed, the problem in OCD isn't the original thought because thoughts emerge from billions of neurons interacting under the surface of awareness. And this generates junk mail constantly. The problem is taking the thought too seriously. For a person suffering from OCD, the thought becomes visceral and urgent and existential. As in, if I had this thought, what does that say about me? Can I trust my own mind? So the brain starts interrogating itself. And this is one reason OCD is so exhausting.

[01:00:23]People think, did I lock the door? What if I secretly want this terrible thing?

[01:00:29]Did I contaminate somebody? Am I absolutely certain about this? And the problem is that the feeling of certainty becomes like a mirage in the distance.

[01:00:39]And as you try to move toward it, it's always receding away from you. So, a person with OCD looks for relief. I'm just going to check this one more time.

[01:00:48]I'm just going to ask one more question.

[01:00:51]I'm just going to review the memory one more time. And just for a moment, they get relief. And then the doubt returns.

[01:00:58]And so, the loop strengthens. The ritual has to keep going. So the bottom line is that for a person with OCD, mental health depends less on eliminating uncertainty than on changing your relationship to it. And this is one of the reasons exposure therapy seems to work. It teaches coexistence with uncertainty. You gradually learn that you can survive the feeling of uncertainty without resolving it completely. You learn that thoughts are events of the brain and they don't always have to be taken so seriously.

[01:01:34]Thoughts can be observed with a little bit of a distance, allowing them to pass through your awareness like a cloud moving across the sky. If you know anyone who needs to hear this week's podcast, please pass it forward to them.

[01:01:53]Go to eagleman.com/mpodcast for more information and to find further reading. Join the weekly discussions on my Substack and check out and subscribe to Inner Cosmos on YouTube for videos of each episode and to leave comments.

[01:02:06]Until next time, I'm David Eagleman and this is Inner Cosmos.