Interesting article about OCD that might spark many thoughts about comparable phenomena.
The story had started when, aged 15, I was suddenly bombarded by relentless, maddening doubts about core aspects of my identity: my capacity for violence and abuse, my physical appearance, my sexuality, whether I could trust my bones not to break. Graphic, unbearable thoughts and images started looping in my mind, thousands of times a day. I had no language for my devastating anxiety, or for my shame, so I kept it all a secret for 12 years.
The scene we were filming that day was based on the euphoric moment in my 20s when I first discovered that my thoughts were typical symptoms of obsessive-compulsive disorder (OCD), and that there were others out there battling this common enemy. “Oh my God. Oh my God. Oh my God. Fuck. It’s OCD. I’ve got OCD!” said actor Charly Clive as she read a list of symptoms from the medical textbook in her hands, giving voice to the astonishing clarity and relief that diagnosis can bring in a bewildering mental-health landscape.
Regardless of the labels I’d been given over the years (I’d previously been diagnosed with depression and anxiety), doctors had always framed it in the same way: illness. This was due to the received wisdom that mental disorders are diseases of the brain with organic, biological root causes; and to the medical language that infused charity campaigns and the media. It was also due to the ideas explicitly promoted by professionals who treated me. One of my CBT (cognitive behavioural therapy) therapists said that OCD is primarily caused by a misfiring amygdala, a structure in the temporal lobe of the brain. Another said that their trademarked therapy could “rewire my brain” in six weeks.
The turning point came a few months before filming, when I visited Trinity College Dublin to interview neuroscientist Prof Claire Gillan for a mental health charity podcast. Gillan was studying feelings and behaviours across a variety of psychiatric diagnoses. I was accustomed to softball media engagements about fighting stigma, and expected more of the same. I asked what she had discovered.
“OCD is not a biological reality,” Gillan said, very matter of factly. “That’s what the data increasingly shows.”
A lump rose in my throat. I fumbled for a response. Hadn’t researchers proved that OCD brains are different biologically? (Some neuroimaging studies show increased activity in various cortices.) “Abnormalities in these regions are by no means exclusive to OCD,” Gillan said. “A great many disorders show the same kinds of brain changes.”
I didn’t know this. I thought my brain shared the same abnormalities as everyone else with OCD and that these were the root causes of our obsessions; that we had brains that were measurably different from the brains of people with, say, ADHD or anorexia. I thought this was the definition of “official” diagnosis. Gillan explained that, on the contrary, psychiatric diagnoses are not based on biomarkers, they are subjective constructs.
I felt torn with nerves for the rest of the interview. I wanted to dismiss what I’d heard, and yet felt compelled to learn more. Afterwards, I started reading, and was incredulous to discover innumerable similar assessments. Apparently, Prof Allen Frances, who literally wrote the book on diagnosis as the lead editor of the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (the handbook widely used by doctors), had said psychiatric diagnosis was “bullshit”. As he told Wired magazine in 2010, “These concepts are virtually impossible to define precisely with bright lines at the boundaries.”
https://www.theguardian.com/society/2024/apr/13/i-was-the-poster-girl-for-ocd-then-i-began-to-question-everything-id-been-told-about-mental-illness