'Triggered': anxiety and the doubting disorder

From a young age, Fletcher Wortmann spent countless hours absorbed by his obsessions. In third grade, he became consumed with the idea that every non-water substance on the planet would soon freeze. He spent hours laying plans for how he and his family would survive. Over and over, he replayed an imagined apocalypse. Though he wouldn't be diagnosed until many years later, in retrospect Wortmann realized the episode marked his "first full-blown bout" with obsessive-compulsive disorder. Wortmann was diagnosed with a form of obsessive-compulsive disorder after his sophomore year in college. In his memoir Triggered, Wortmann examines the origins of his anxieties, and how he came to be overwhelmed by intrusive thoughts. He talks with NPR's Neal Conan about how he gradually learned to cope with what some call the "doubting disorder." NEAL CONAN, HOST: This is TALK OF THE NATION. I'm Neal Conan in Washington. From a young age, Fletcher Wortmann spent countless hours absorbed by dinosaurs, video games, Transformers, comic books, and over and over he replayed Apocalypse in his imagination. He would plan how he and his family would survive if, say, the sun overheated and exploded tomorrow. After his sophomore year in college, Wortmann was diagnosed with a form of obsessive-compulsive disorder. In a new book, he examines the origins of his anxieties and how he came to be overwhelmed by intrusive thoughts. We want to hear from those of you who live with OCD: When did it first show up? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. Later in the program, Kentucky and Louisville take their rivalry to another level Saturday in the men's final four. But first, Fletcher Wortmann joins us from member station WBUR in Boston. His book is called "Triggered: A Memoir of Obsessive-Compulsive Disorder." Nice to have you with us today. FLETCHER WORTMANN: Thank you, great to be here, Neal. CONAN: And write that in retrospect, your first go-around came courtesy of Kurt Vonnegut back in third grade. WORTMANN: Yes, what happened was that one of my instructors decided it would be fun to tell her charges about the plot of Vonnegut's "Cat's Cradle," which of course has the climactic release of the chemical Ice-9, which freezes the entire world. I imagine my teacher and most of the other students in the class just sort of thought of that and let it go. Unfortunately, due to my OCD, I was unable to do so. The possibility of that scenario occurring consumed me, and because of my obsessive-compulsive disorder, I ritualistically repeated escape scenarios, survival scenarios, over and over again in my mind, trying to find a way to prove to(ph) myself that this kind of end-of-the-world nightmare could never happen. CONAN: And that ritual repetition, that's the characteristic of OCD. WORTMANN: Yes, one of the most understood - misunderstood aspects of OCD is that many people believe that it has to involve visible physical compulsion, such as hand-washing or counting or organizing things. The truth of the matter is there's another variant, referred to as Pure-O, purely obsessional, where the compulsive behaviors are entirely internal. CONAN: Intrusive thoughts. WORTMANN: Yes, yes, this was a symptom that I developed more as I grew older. CONAN: But wasn't there a kid in your class when you were in grade school who had the other type, the more common type? WORTMANN: Yes, yeah, I'm a little jealous of him, honestly. He got to go on Oprah, and he wrote a little children's book about it. (SOUNDBITE OF LAUGHTER) CONAN: You said he stole your thunder before you were out of fourth grade or fifth grade. WORTMANN: Yeah, you know, so it goes. CONAN: So it goes, another phrase from Vonnegut. As you were getting older, this did start to manifest more and more, through high school. But, you know, it was hard to tell sometimes, reading your book, the difference between an unhappy, lonely, forgive me, kind of geeky kid and somebody with a mental disorder. WORTMANN: Yeah, I think a lot of the loneliness and the unhappiness was caused as a result of the mental disorder. Again, the fundamental mechanism of OCD is an intolerance of uncertainty and then the repetition of certain thoughts or behaviors to try to let go of that uncertainty. So not only the intrusive thoughts but also low self-esteem, social isolation, trying to come up with different ways to protect myself that ultimately wound up backfiring and hurting me more than taking very simple social risks, the way most people do in high school. CONAN: And it is that reaction to fear, protecting yourself - that's what the mechanism seems to be. WORTMANN: Yes. Again, one of the most stereotyped forms of OCD is contamination. So I like to use that because people tend to understand it. The fear is that I might die of a bacterial infection. So the response to that is to wash hands, and then because of the disorder's predilection for repetition and its inability to tolerate uncertainty, the sufferer will continue to wash his hands over and over and over again until it consumes his life. CONAN: So if washing your hands once is good, washing your hands 20 times is better. WORTMANN: Yeah, precisely. CONAN: And the same thing with the intrusive thoughts. The cycles, as this goes through your head over and over again, and these are not cycles of, gee, I need to touch these things or wash my hands, these were horrible, horrible thoughts. WORTMANN: Yeah, absolutely. I think everyone experiences these kind of things. Your mind will just sort of settle on something really distressing and upsetting, and you know, most people are able to shake it off. Unfortunately, with obsessive-compulsive disorder, the thoughts take on kind of a life of your own, and you begin to wonder what do these mean, how can I make them go away. And again, the context of these is often deeply personal and deeply upsetting. People can be consumed by images of terrible violence, of religious blasphemy, of sexual perversion, bestiality, pedophilia. And again, because of the OCD and because of the repetitious nature of it, the more you try to make these thoughts go away, the worse and worse they become. CONAN: And you also encountered, even after you'd had a psychotic breakdown, mental health professionals who were skeptical that what you had was OCD. WORTMANN: Yeah, I was really disappointed, in retrospect. I'd had a number of therapists growing up. I eventually had a breakdown and was brought to McLean Hospital, and up to the point of that hospitalization people misunderstood, misdiagnosed. They would try to reassure me, oh no, that could never happen, or no, no, those thoughts don't mean anything, which ironically is the worst thing you can do for someone with OCD because trying to reassure them and tell them that they are safe, it doesn't help with the fundamental issue of uncertainty and just sort of serves as another ritual, another metaphorical hand-washing that can't really give them the absolute certainty they would desire. CONAN: And even after you were correctly diagnosed and started getting therapy that started to be effective, your obsessions mutated. You found yourself obsessing about obsession. WORTMANN: Yes, yeah, the final cruel irony of it. I would notice myself starting to obsess, and I would think: Oh my God, I'm obsessing. I have OCD. The OCD is coming back. I have to stop it. I have to make sure it doesn't come back again and run through that kind of circular thinking. And we actually - my therapist in Philadelphia and I, we think we ran through like four or five levels of obsessing about obsessing about obsessing, before we were able to finally address that. (SOUNDBITE OF LAUGHTER) CONAN: I'm sorry, I don't mean to laugh, but... WORTMANN: Oh no, no, there is an element of absurdity to it. I think and do things that no reasonable person would ever choose to do. And you have to learn to laugh at it. CONAN: And you have to learn to laugh at it and stop taking - that's, I guess, part of the – part of coming out. WORTMANN: Yes. CONAN: Interesting. We want to get some callers on the line, people who have some experience with OCD, 800-989-8255. Email us, talk@npr.org. In fact, we're asking particularly how, in retrospect, it manifested for the first time. We do have this email from Marie(ph): Almost overnight our happy, easygoing 11-year-old son became a slave to baffling repetitive habits and complicated routines that none of us understood. His primary care doctor recommended we get a psychiatric consultation for OCD. We're also awaiting the tests for PANDAS, immunity - immune reaction to strep that makes OCD come on suddenly. This disease has turned our family upside-down. I know it's too soon to lose hope, but I feel so helpless. I worry for my son. Important to remember in that context that when a child has this, as you did growing up, it's not just you that has it, it's everybody, your family in particular, but everybody else you're around. WORTMANN: Yeah, absolutely, and one of the most troubling aspects of OCD is the initial reaction to try to comfort the sufferer and to try to make their worries go away. As I mentioned before, it is often counterproductive. There's a terrible irrationality to the disease. CONAN: Let's get Andrew on the line. Andrew's calling us from Sacramento. ANDREW: Hi, hello. WORTMANN: Hey. ANDREW: Good morning. You know, a lot of your story really, you know, echoes a lot of the things I went through growing up. But I was diagnosed with OCD and then later OCPD, obsessive-compulsive personality disorder. And as a kid I often had checking habits, but when I go to - you know, still today when I go to public places, like I get uncomfortable if I don't think I can get an escape route. Or mostly, you know, the projects just pile up, and I don't get to anything because I'm afraid it won't get done properly, you know. WORTMANN: Uh-huh. Yeah, I've had terrible... ANDREW: And then I finally got one of my motorcycles rebuilt, and everyone, you know, shows up and tells me what a good job I did, and I just think they're lying to me because I only see the stuff I messed up. It's minor stuff. CONAN: And you think, going back in retrospect, it was that checking, the first time it manifested when you were a kid? ANDREW: Yeah, you know, that and I think the only movie I watched for about six years was Disney's "The Rocketeer." I only liked one movie. CONAN: And watched it over and over again. ANDREW: Over and over again. CONAN: Yeah. ANDREW: And also, and today I can't - I actually can't go anywhere without NPR on in the background. I keep a headset with me. I turn it on in every car I'm in. If I see a radio, like on a display in a store, 90.9 everywhere I go. I can't not listen to NPR. CONAN: Well, I'm not going to comment on that as an aspect of mental disorder. I think you can understand that, Andrew, but thank you very much for the call. Fletcher Wortmann, you were saying at one point when he was talking, that reaction of thinking everybody is being critical of you. We don't necessarily associate that with OCD. WORTMANN: Absolutely, yeah, and I think that's one of the problems with our understanding of the disorder. We conceptualize it primarily as cleaning, counting, hand-washing. Really what defines it is this mechanism of I'm not sure about something so I'm going to try to do something to fix it, and I'm going to do that fixing behavior over and over again, as often as I need to, until I feel certain that things are better for me. CONAN: We're talking with Fletcher Wortmann about his memoir of obsessive-compulsive disorder, "Triggered." If you've been diagnosed with OCD, call and tell us: When did it first show up? 800-989-8255. Email us, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News. (SOUNDBITE OF MUSIC) CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. Most of us have very little experience with obsessive-compulsive disorder. So Fletcher Wortmann opens his memoir with a brief introduction to OCD. He describes the end-of-the-world anxieties, the obsessions and the many rituals that might, just maybe, hold off the looming apocalypse. You can read what he calls the interactive portion of the text in an excerpt at our website. Go to npr.org. Click on TALK OF THE NATION. Fletcher Wortmann is our guest. We want to hear from those of you who live with OCD. When did it first show up? 800-989-8255. Email talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. And I wanted to go back to something else our first caller said, and that was the feeling that you can't start a project for fear that it won't get done right. You also affirmed him on that. Given what he said, and given what you said, how difficult was it to write this book? WORTMANN: Oh, goodness. It's funny, procrastination can be a symptom of OCD in the sense that because you know a project will require so much of your effort, and you're so frightened of screwing up, it's easy to just keep putting it off and putting it off and putting it off. That wasn't a problem for me. I was really excited about writing "Triggered." I think my primary issue was in editing and revising it and trying to make the text absolutely perfect. And of course there are any number of changes that have to be made as part of the publication process. So you know, they'd come to me, and they'd say oh, you can't use those song lyrics for legal reasons. And I'd be like, ah, you've plunged a knife into my chest. (SOUNDBITE OF LAUGHTER) CONAN: Did they say that to Tolstoy? So it is a difficult process in any case. You are now a Master's candidate in creative writing. And boy, staring at a blank screen, that can - that can trigger some postponement problems. WORTMANN: Absolutely, and in a funny way I think that my treatment has helped me tremendously with my writing and particularly in dealing with writer's block. For me, writer's block always came from this idea that, OK, I need to write something, and I need to write it perfectly. I need to just create beauty on this screen. What I do now is I just putting words, you know, start typing and trust that eventually something worthwhile will show up. CONAN: Let's get another caller in. This is Mary, Mary with us from Laramie in Wyoming. MARY: Hi, thanks for taking my call. I was diagnosed - well, no I wasn't diagnosed, but I have memories of very, very early catatonic fear. I could not let my mother take a nap because I was very frightened that the house would burn down. And I had fears - they would change. It wasn't always the house burning down, but growing up - and then when I was actually being treated for post-partum depression after my sixth pregnancy, for the first time in my life I was able to clear my thoughts. I had never had that experience in my life where I was able to actually clear my head and think of nothing. CONAN: And when you had those fears of the house burning down, I wonder, how did it start, do you think? MARY: Well, I think probably just the basic safety lessons that parents teach their kids, you know, don't play with the stove or the house is going to burn down, things that you wouldn't - it's not like I had any terrible experiences with fire or anything like that, but just the thought that something like that terrible could happen, I really, I just couldn't... CONAN: And the threat was to your mother more than it was to you. MARY: Well, I just felt like if she was awake, if she was around, we were safe. If I let her take a nap, and if I ever saw her sleeping, I would just wake her up. And I didn't have any reason. I was just, like, that was my security, to have her awake. It drove her crazy. CONAN: This can make you unpopular in certain circles. MARY: Yes, actually, yeah. CONAN: Mary, thanks very much for the call. I'm glad things have worked out for you. MARY: Yeah, thank you. CONAN: It's interesting, going back to the Ice-9 obsession that you had back in third grade, Fletcher Wortmann, it was actually - came to a sudden stop when your father told you that, in fact, your teacher had gotten the plot of "Cat's Cradle" wrong. WORTMANN: Yeah, she'd had it backwards. She said Ice-9 freezes everything but water. The Vonnegut book, originally the text says that it freezes only water, which is a completely ridiculous, arbitrary, inconsequential thing, you know, this imagined... CONAN: What difference fundamentally does it make? WORTMANN: Yeah, this imaginary molecule made up by some writer. But it's just sort of the - it demonstrates, I think, the arbitrary, cruel nature of the disorder. And it demonstrates, I think, how it really sinks its claws into you. You know, I had repeated these rituals and this obsessive thinking over and over and over again, and then finally something clicked, and it all went away. And the OCD was able to say to me then, ah, see, see, you know, I did that for you. That was me. I was the one - because you did all that good work, I'm the one who was able to finally make the anxiety go away. CONAN: You continually third-personalize the OCD. It is a character. WORTMANN: Yeah, it's funny. There's an almost - there's an almost schizophrenic aspect to it sometimes. There's a sense of being taunted by someone, the way it continually hones in on your worst fears and traumas and anxieties. There's a very adversarial aspect to it. And ironically, I think overcoming that has been part of my successful treatment because eventually you have to learn, you know, OCD is, it's like diabetes. It's a condition. It's not something I'll ever be able to completely exorcise or cure. So accepting it just as a psychological mechanism rather than as my evil doppelganger has been very helpful. CONAN: Let's go next to Steve, Steve with us from Jackson, California. STEVE: Hey, how are you? CONAN: Good, thanks. WORTMANN: Good, thank you, Steve. STEVE: Good. Well, my story is I'm a correctional officer, and I just went through a recent (unintelligible) at work, and I've had OCD during different stressful points in my life, but you know, I've had issues, but now they've diagnosed me with PTSD anxiety disorder from the assaults that I went through. So they seem to be one and the same, but this seems like OCD on steroids right now. CONAN: And it can be pretty terrifying, can't it? STEVE: Oh, absolutely, yeah. I'm going through a lot of tough situations right now. So I was curious if you guys had anything to say about that or if you've heard of anything like that happening to somebody before. WORTMANN: Yeah, well, Steve, I can tell you - OCD is co-morbid, as I understand it, with a number of psychological conditions. I've dealt with depression in the past, largely because I felt so lonely and isolated and terrified because of my OCD. It just has happened as a consequence. But PTSD as a response to anxiety and as a way to try to protect yourself from something that's really frightened and upset you, I think there's - yeah, I absolutely think there's a connection there. CONAN: And it's interesting - go ahead, Steve, I'm sorry. STEVE: No, no, go ahead. I want to hear what you have to say. CONAN: I was just going to say, we had an email from Julia in Phoenix, who said: The author's story really resonated with me. I have the purely obsessional type of OCD that was initially diagnosed as generalized anxiety disorder. I spent weeks obsessing over whether I had OCD or GAD before the irony of that dawned on me. WORTMANN: Steve, I don't know if you've gotten any kind of treatment yet, and I don't know if what's been helpful for me will necessarily apply to your situation, but what really helped me get over my OCD was something called exposure response therapy. So we've talked extensively about how OCD comes from fear and anxiety and fear of a specific something. STEVE: Absolutely. WORTMANN: Yeah. What I had to do in McLean Hospital at the OCDI was sit down and face directly whatever it was I was afraid of without performing the ritual to try to protect myself. So mine was tricky and kind of weird to describe because of the purely obsessional thoughts, but you know, I had friends who had contamination issues who would have to sit there with their hands in a toilet for two hours without washing or with their hands in a bucket of biohazard junk. And it's a terrible, challenging, traumatizing process. It's really tough. But I found through ERP I was able to really confront the things I was frightened of without obsession and eventually managed my disorder much better. I don't know if you've attempted anything like that yet, but it may be worth looking into. STEVE: No, no, not at all, but I'm open to anything. CONAN: Well, you should - it sounds like you should try to talk to somebody and get some help. STEVE: Yeah, absolutely. Yeah, actually, I have been, but, you know, I'm still having some issues, so - but thanks for your input. CONAN: All right, thanks very much for the call, Steve. WORTMANN: Best of luck to you. CONAN: And it's interesting, that caller - it's not easy to talk about these things, and in fact even as you are being diagnosed in your book, you write how difficult it was for you to try to tell these successive batteries of doctors and therapists what your symptoms were. WORTMANN: Yeah. It stuns me how much this disorder is misunderstood. I originally received my diagnosis not after months and months of speaking to a therapist at Swarthmore College, where I was studying, but by Googling it myself, saying, OK, it seems like I'm obsessed about something. And yet, you know, it is - it's - again, because of the cruel, specific nature of it, it becomes very difficult to talk about, you know? If you're having obsessions related to I'm worried I'm going to stab someone, then you don't want to tell that to friends or family or therapists because, you know, they may get you locked up. CONAN: It is also that, through ignorance, we trivialize OCD. Gee, I guess your house is neat. WORTMANN: Yeah, yeah. Oh, I've heard a ton of that. Yeah, I - in retrospect, this is probably a little bit of a digression in the memoir that I regret, but I go off on the TV show "Monk" pretty badly because I watched that, and it just seems like a complete representation of the... CONAN: You call it a minstrel show. WORTMANN: Yeah. I think there's an element of that. It exaggerates and stereotypes OCD for comic effect without getting into the just terror and the loneliness of it, and it turns this sufferer into a clown. It's - yeah. My parents were in the other room first time I saw it, and they ran in because they just heard me screaming at the television, swearing at the top of my lungs. CONAN: You also go off on those who would characterize the psychiatric profession as one that is trying to control its patients through drug use because you said fundamentally you came to believe that. WORTMANN: Yeah. I was very hesitant to take medication, and I think because of this cultural myth we have that medication turns you into a zombie or a robot, or it changes who you are. That hasn't been my experience. I found it's been useful in helping me get into a place where the exposure response therapy I mentioned was more acceptable and doable and less painful. And that myth of psychiatric medication as a kind of, you know, giving up or selling out, that really disturbs me because I think that's part of what prevented me from really seeking out this kind of help I needed for so long. And I wonder how many other people out there are resisting therapy when they could really benefit from it. CONAN: One more rant - the sort of, I guess, Byronic myth that this mental disorder makes you creative. WORTMANN: Mm-hmm. Yes. OCD has - it kills therapy. It kills creativity in a lot of ways. It really locks you down because this drive that everything you create must be perfect, in a lot of ways it works against the kind of spontaneity and freewheeling mindset that, I think, really helps me in my writing personally. That's not to say I haven't benefitted from these myths. I remember with some embarrassment being in the hospital, thinking about my situation and thinking, you know, I bet girls would be really into this... (SOUNDBITE OF LAUGHTER) WORTMANN: ...like if I wrote about this, like the whole tortured artist thing, like, yeah. CONAN: Yeah. Yeah, right. Fletcher Wortmann's book is "Triggered: A Memoir of Obsessive-Compulsive Disorder." You're listening to TALK OF THE NATION from NPR News. Here's an email from Kelly(ph) in Carmichael, California: My son is 14, was diagnosed with OCD and Tourette's syndrome in third grade. Question for the author: Does increased anxiety increase your OCD behavior? If so, can you recommend anything for a 14-year-old boy to learn to calm himself daily and lower anxiety? WORTMANN: Yeah. Absolutely. I'm so sorry that your child is struggling with that, although you should take some comfort in the fact that the earlier OCD is diagnosed, the easier it is to turn against and cope with. In terms of anxiety and OCD, yeah, absolutely. Stress makes it worse. There's a certain amount of mental energy I have to expend as a sufferer in order to manage my symptoms and keep myself functioning. And if other responsibilities start cropping up, then it becomes very difficult to take the time and to spend the energy I need to keep my OCD in check. I actually had to drop a class this semester at Temple University just because it was too much on top of the publication of the book, the other classes I was taking and the OCD. In terms of managing anxiety, I can recommend two things, I think, other than the exposure response prevention I mentioned before, which I'm really convinced is the best treatment for OCD. But in a day-to-day context to help control OCD, I found things that are really consuming and interesting and engaging. You know, I've loved video games and comic books and - ever since I was little, you know, going back to when I was obsessed with dinosaurs when I was a little kid. And I found(ph) having these interests and getting really engaged with them and learning about the minutia of them could sometimes quiet the OCD just because I would be so consumed by them. Going in the opposite direction, I found mindfulness practice and meditation to be very useful. I know we had a listener before who spoke about postpartum depression and anxiety and being able to have a quiet mind and just stop thinking for the first time in her life. And that can be so useful with OCD, just being able to relax and turn off this kind of cognition machine that keeps running the obsession. CONAN: Email from Chris: I can't tell you how your guest's experience resonates with me. I spent all college obsessively checking doors, wall sockets. Occasionally, I'd have to leave class to go home just to check the front door, a two-hour round-trip from the university. What was striking to me was that all these symptoms disappeared overnight when I left home for graduate school. Hearing your guest today, though, I realize the things I now simply put down to extreme procrastination may be another manifestation of the disorder. And it's important to remember also, there are all kinds of - there's a spectrum. It's not everybody deteriorates all the way to have the kind of problems you have. WORTMANN: Mm-hmm. Yeah. I think Chris is right. I think it's so important to understand the underlying mechanism of OCD, this I'm uncertain so I'm going to repeat this thing over and over again until I feel, better because I think that's something everyone does. You know, obsession is not just a clinical thing. It's something that everyone struggles with. We all get things stuck in our minds. You know, it can be as simple as having a song stuck in your head. And I think learning to recognize that can lead us all to healthier, more productive lives. CONAN: Fletcher Wortmann, thank you so much for your time today, and good luck with your Master's program. WORTMANN: Oh, thank you so much. Thank you for giving me this opportunity. CONAN: The book is called is called "Triggered: A Memoir of Obsessive-Compulsive Disorder." Fletcher Wortmann joined us from our member station WBUR in Boston.