The documentary "Obsessential Disease" shows the world in the eyes of real obsessive-compulsive patients, and they use the words: fear, anxiety, despair, guilt, sadness, and even death.

Nowadays, we need to re-understand the term " obsessive-compulsive disorder ".

Perhaps no name for mental illness is used so widely in life: many people use "obsessive-compulsive disorder" to define various seemingly perfectionistic and even interesting behaviors - they feel uncomfortable when they see the wrong color of the floor tiles on the road; they insist on tucking the four corners of sheets neatly; they often clean the room; they cannot tolerate the red dots of message prompts appearing in the upper right corner of the communication software... But these occasional actions are only the slightest "compulsive" phenomenon, and strictly speaking, they do not fall into the category of obsessive-compulsive disorder.

The truth about obsessive-compulsive disorder is much crueler. The documentary "Obsessential Disease" shows the world in the eyes of real obsessive-compulsive patients, and the words they use are: fear, anxiety, despair, guilt, sadness, and even death.

People suffering from this neuropsychiatric disease are always repeatedly invaded by some meaningless thoughts or impulses. They tried various ways to offset these thoughts, but they still could not be completely relieved, which caused endless anxiety and pain, and even affected basic social functions.

In 2019, a national epidemiological survey on mental illness organized by Peking University Sixth Hospital found that the lifelong prevalence of obsessive-compulsive disorder in my country is 2.4%, which means that about one in every 40 people has obsessive-compulsive disorder. According to statistics from the Shanghai Mental Health Center, in recent years, the number of patients with obsessive-compulsive disorder has increased at a rate of 10% to 15% each year.

Shanghai Mental Health Center Deputy Director and Chief Physician of the Department of Clinical Psychology Wang Zhen and obsessive-compulsive disorder have been in battle for nearly 20 years. In his opinion, in addition to biological factors, there are also complex psychological motivations behind the onset of obsessive-compulsive disorder patients, which are closely related to the symptoms of the times. A society with doubled uncertainty may "cultivate" more patients with obsessive-compulsive disorder.

From 1:30 to 4:30 pm, is Wang Zhen’s visit time. But his outpatient clinic was the slowest, starting early at 12:30 noon and continuing until 9:00 pm. During his long communication with patients, he observed that almost every patient with obsessive-compulsive disorder has psychological trauma left in his growth. For those who are not yet involved in obsessive-compulsive disorder, this condition is not far away, it can lurk within us, being aroused after a specific event.

How to identify a true patient with obsessive-compulsive disorder? How should we coexist with obsessive-compulsive disorder? What kind of inspiration can obsessive-compulsive disorder bring to ordinary people today? Around these issues, in mid-September, "People" and Wang Zhen met in his office for a conversation. In the conversation, he reiterated the medical implications of obsessive-compulsive disorder and told the stories of patients who have been ignored for a long time. These stories are not limited to obsessive-compulsive disorder itself, they are also related to education, to understanding, to every ordinary person who desires certainty.

or below is Wang Zhen’s story.

text｜Lin Qiuming

Edit｜Huaiyang

Picture｜Visual China (except for special marks)

1

Now we say that someone is a bit "forced", most of which are entertainment interpretations, used to evaluate a person more serious, or when both A and B are available, you must choose A. Many normal people have such compulsive personality, but it is limited to one aspect of life. This is not pathological and is not the same as obsessive-compulsive disorder.

Many children will have some compulsive behaviors. The youngest child I have ever come into contact with in my life who has obsessive compulsive symptoms is only six or seven years old. The child likes to clean it, wipe it and make it up, and the toys are arranged neatly and no one is allowed to touch it. Once someone touches him, he will throw it around, go crazy, and then put it neatly again.

Parents will think that placing toys is a good habit, and will encourage them to aggravate their symptoms. If you ask him patiently, you are tidy and you are doing this, why do you do this? If he said that it would be uncomfortable if I didn't show it, there might be some problems. We should observe whether he was forced in other details.We discourage children of this age being diagnosed with obsessive-compulsive disorder because they have a higher chance of correction. It doesn't matter if the parents guide him and put it in an untidy manner. Gradually, these behaviors of the children will disappear.

A true obsessive-compulsive disorder patient has an anxiety, fear and tension in his life. Obsessive-compulsive symptoms involved all aspects of his life. Some patients cannot look at the time on their phones. They are very concerned about a certain number. If the time jumps to that number, they will collapse; some patients will wash their hands over and over again, always feeling that their hands are not washed clean. Even more serious, except for sleeping, they are in a state of compulsiveness and even lose their ability to live.

The symptoms of obsessive-compulsive disorder have certain dimensions. Some are related to pollution, some are related to numbers, some are related to sex, symmetry of things, superstition or beliefs, and hoarding of items. Its most typical manifestation is the behavior of offsetting. When a certain idea appears, the other self in the mind will try to offset the bad thoughts, but this offset will not bring real pleasure, it will only bring fleeting relaxation, but it is just an imaginary offset.

For example, if you ask a person who is obsessed with cleanliness, he said, I feel comfortable after washing my hands. Actually, this is not the case. 95% of patients with obsessive-compulsive disorder have self-knowledge. He knows that he doesn't need to wash like this, but he can't control it. After washing, he knew that there would be a short period of comfort, but he knew even more that comfort would last for a short period of time. Once he encountered something that made people feel "unclean", he would have to wash it constantly.

Most of them have a strong sense of responsibility and insecurity, and are always afraid of "what if......". Some people always worry that the door will not be closed when they go out when they are young. Every night before going to bed, they will tell their parents, "You can take a look at the gas." His parents did these counteracting behaviors for him, so for a long time, his obsessive-compulsive disorder would not be discovered. He thought his parents had checked it and felt relieved. But when he grows up and lives alone, he may have to spend half an hour checking the gas every day, and the symptoms will be exposed.

pic source documentary "Obsessential Disorder·Mystery"

2

About 2016-2020, the number of people who came to our hospital's obsessive-compulsive Disease clinic increased by between 10% and 15% each year, which is relatively fast compared with other diseases. Not only because many people are sick, but also because of popular science education, more people know about this disease. Nowadays, there are more than 50,000 people diagnosed with obsessive-compulsive disorder in our hospital every year, and the number is still rising, from six or seven to over 80s.

Most children who come to see obsessive-compulsive disorder are found at two points in time, and the third year of junior high school and senior high school are often brought by their parents. Because the high school entrance examination and college entrance examination are approaching, the grades suddenly drop, and parents notice that the child has an obsessive-compulsive disorder. For example, they always wipe off their homework repeatedly, and they know that they have done the right thing, but they still wipe and rewritten it.

There is a girl of sixteen or seventeen years old, and I remember it very deeply. She just went to high school and developed very typical obsessive-compulsive symptoms, and was always afraid that she would write something wrong. During class, she always lowered her head and did not dare to look at the blackboard; when she was touched by the opposite sex, she had to go home and clean herself constantly. She believes that she is very "dirty" person when she pays attention to the private parts of the opposite sex.

After two or three visits to the hospital, she and I established trust. One day she said that she might not be able to come next time. She used New Year's money to see a doctor. Her parents no longer asked her to come, and they thought she was not sick. She didn't come back for a long time. When she appeared again, she said, Doctor, I have money to see a doctor now. She did not tell her parents that she had to take medicine and insisted on taking medicine. The symptoms gradually improved. Instead, her parents said, "You see, you will get better if you don't let you see a doctor."

Her symptoms improved significantly, but such intermittent treatment was not conducive to her long-term recovery.

Her illness has a lot to do with the strict requirements of her parents. You can imagine that parents who don’t even allow their children to see a doctor must be very strict in their lives. They never praised her, they were all critical education.I made rules for her and wanted to do 1, 2, and 3 points, which seemed to be "for your own good". This made her feel out of control about life. In her heart, she was unwilling to obey her parents' discipline, but outside, she had to do this, and accumulated deep anger. Two selves were fighting, one asked her to listen to her parents, and the other said, "I don't want to listen anymore, I feel very uncomfortable."

The symptoms of obsessive-compulsive disorder related to sex are often related to the growing family atmosphere. A particularly conservative parent, when talking about sex, means badness, and instilled in the concept that "the opposite sex is bad" since childhood, especially in the unfortunate marriage of parents, this feeling is reinforced. When she entered puberty and had the sexual impulse, she felt that the opposite sex was attractive and hoped to contact the opposite sex, which was inconsistent with the concept conveyed by her parents. Conflict becomes a symptom.

She usually looks very happy, but in fact she is not pretending deliberately, but psychologically forming a defense mechanism. When she cannot actively express her emotions, she chooses to use that behavioral pattern to offset: If I do it well, my parents will praise me. So she doesn't allow herself to make mistakes.

I also met a patient. Whenever he was about to go to bed, all kinds of absurd and fearful thoughts popped up in his mind. At eleven or two o'clock in the middle of the night, he would shout monotonously, "Ah--". He felt that the idea would disappear only if he shouted a specific number of times, such as three times. If the three times did not work, the matter would be over after a while. As soon as he shouted, his father wrapped him and himself with the quilt. Dad thinks it’s so ugly that the neighbors know.

I asked them, how many people live in this city care about your child’s illness? There will definitely be people who gossip, but they pass by as they talk. Do you think it is important to have a neighbor when they find out, or is it important for a child's life? To truly protect a child, it is not to wrap him up, but to relieve him of the pressure from the environment. If you criticize him and tell him not to shout, he will shout harder.

Later, they took the initiative to communicate with their neighbors and said that the child had some psychological problems and the current treatment may affect you. The neighbors comforted them and said that it was no problem. This is normal during the growth stage of children, so don’t worry. The parents gradually understood that they took care of their feelings too much and did not expect their children's feelings at all.

In these children, you can see the two directions of Chinese-style parent and parent-child relationship. If the parents have high authority enough, the child will form the concept of "police" in his mind. If the police have been strong, the child will not become obsessive-compulsive disorder. He is just very docile and obedient, and becomes weak because there are no internal contradictions. But if he has a strong personality and a strong image of his parents, and two "self" fights, it may turn into obsessive-compulsive disorder.

3

Obsessive-compulsive disorder has a genetic background, and biological factors account for about 40% to 50%. The more relevant genes are carried, the greater the risk of the disease. But we do not emphasize genetic factors too much, because this cannot be changed and it is easy for patients to mistakenly transfer anger to their parents, which will put a lot of pressure on their parents and will not cooperate well in the later treatment process.

For patients, the greater influencing factors are childhood experiences and the process of their cultivation. Some things are buried in emotions and are awakened again when they enter puberty. If the external pressure is too great, they will become sick. In fact, each of us is very close to obsessive-compulsive disorder, and we may have these hidden factors, but we have not experienced the incident that caused us to get sick.

Everyone has psychological toughness , and sometimes a small thing can also be induced. More common, such as going to school, exams, getting married, having children, or the loss of relatives, events that will cause major changes in life may become inducing factors.

Just now we talked about going to school, exams, and later, such as childbirth. In recent years, society has begun to pay attention to postpartum depression , and postpartum compulsion is not uncommon.

I have seen it in the outpatient clinic. Some mothers dare not hold their children for fear of throwing them to the ground or throwing them down through the window.Some mothers can't fall asleep at night, so they look at their children every once in a while and pat their faces to see if they can wake up. Some mothers have a lot of milk and the child has a lot of milk overflow, so she will be very worried and afraid.

The family constantly strengthens her responsibilities and her mother's identity during pregnancy. These mothers bear an exaggerated sense of responsibility and believe that if any problems arise in the child, it is their fault. Once this idea comes into play, she will be very alert to any potential accidents in her life.

If you observe carefully again, the outbreak of obsessive-compulsive disorder among mothers is also related to unhappiness at home, such as dissatisfaction with your husband and suppressed anger that cannot be expressed. For example, the mother who wants to throw her child down may have a subconscious self saying, "You are not good to me, I still work so hard to take care of this child, and I don't want this child anymore." This idea accidentally jumped into consciousness and formed the idea of ​​"I'll throw him down." She began to blame herself, how could I have this idea? My mother is so bad. When two thoughts arise, forcedness may arise.

Photo source "Kim Ji-young Born in 1982"

Some individuals will also experience post-traumatic obsessive-compulsive disorder after experiencing sexual assault and harassment. Some people will repeatedly check whether the door is locked and whether there is anything you are ready to defend yourself. I have a patient who talked about a boyfriend who once tried to infringe on her. Because of this shadow, she has not fallen in love for nearly ten years. Recently, someone introduced her to a boyfriend. She knew that the boy was very nice to her, very tolerant of her, and his words and deeds were decent, but as soon as she thought of holding hands, the memory of being violated emerged. Another person in his mind tried to offset this idea and said no, this boy is so good. Two thoughts kept entangling her.

Trauma caused by car accidents, earthquakes, and vicious events will be quickly reflected in the individual. More hidden trauma related to the social environment and contemporary background will take longer to emerge.

The oldest old man I have ever treated, was 83 years old when I came and had OCD for 53 years. He remembers it very clearly that he fell ill at the age of 30. In that sensitive era, he was afraid that he would write something wrong and dared not use a pen. The symptoms were relatively mild at that time. Later, phones and mobile phones appeared, and the means of spreading information became richer. He was even more afraid that the words he wrote were flowing outside.

He called his son nearly 200 times a day and asked his son if I had anything bad to say today? At first, my son would answer, saying no, it was okay, but later he beat more and more, and his son collapsed, so he had to take him to see a doctor.

Each patient comes with his own social background and era marks, and the situation of a group of people can be seen from a patient.

4

Obsessive-compulsive disorder has a feature: this disease is a "curse" to smart people.

Most of these patients are very smart, and their average IQ before the disease is higher than that of the general population. It can be said that the more successful you are, the closer you are to obsessive-compulsive disorder, because seriousness itself is the obsessive-compulsive trait. People with obsessive traits study harder and are more likely to get a better education. Because of better education, it may be easier to succeed in career, and thus more stressed. In addition, the obsessive traits that already exist, they will be more likely to get sick in the future.

For example, it is clinically observed that many patients with obsessive-compulsive disorder are engaged in finance, scientific research, financial accounting and other fields. These professions are very sensitive to numbers and are all jobs with greater responsibility. Many of them are strict in their work and pursue perfection, and are high-risk groups.

At the same time, obsessive-compulsive disorder is also a group of people who are easily overlooked. There are four main mental illnesses that are most important: Alzheimer's , autism, schizophrenia and depression . All four diseases are distinctive. The first two are related to the elderly and children. We should care about vulnerable groups; schizophrenia has the risk of harming others; depression has the risk of suicide, and all need protection.Obsessive-compulsive disorder is just the opposite. Most patients are very self-disciplined people. Their pain is borne by themselves and the people around them. It does not seriously affect society, and society will naturally ignore them.

But the impact of obsessive-compulsive disorder is actually not small. A foreign survey shows that a patient with obsessive-compulsive disorder usually affects the lives of seven people, and parents, colleagues, relatives, and close relatives may all be affected.

If these patients are not sick, the average value they create to society is higher than that of the general population. Now they not only cannot create value, but also consume a lot of resources. If the right medicine is not given, patients with poor treatment will lose their ability to work and can only rely on their parents, and even make the whole family poor due to illness.

Sheldon in "The Big Bang Theory" is a "genius" with obsessive-compulsive disorder. Image source network

Many doctors are unwilling to see obsessive-compulsive disorder. It is too time-consuming and the efficacy is not as good as anxiety and depression. My outpatient clinic is the slowest, and it should have ended at 4:30 pm, but I have to see it after 9 pm. Even if the outpatient clinic time is only 10 minutes or 15 minutes, I will pass on some encouragement to the patient so that he can persevere, and even do family education to let the family know how to cooperate.

From a psychological point of view, the weird thoughts they appear, as long as they spend time talking to him, they can find the root of their experiences and find the explanation of psychological mechanism . However, if a person's psychological defense mechanism is changed by using psychodynamic methods and then improves symptoms, it may take several years, or even more than ten years, and these patients cannot wait.

To change symptoms in a short period of time, more psychological treatment methods are used to "cognitive behavioral therapy". The most commonly used method is called "exposure and reaction prevention", which means that you do not perform behavior after anxiety occurs. For example, if a patient who is afraid of dirt always wants to wash his hands, but insists on not washing, he will be very anxious at the beginning. After a little longer, the anxiety will gradually fade away by itself, and the symptoms will become less and less serious when practicing repeatedly. But the treatment process is indeed very painful, and many people are unwilling to persist, which leads to the failure of treatment.

has a therapy for treating obsessive-compulsive disorder, which uses the idea of ​​ Taoist , called "Morita Therapy", which emphasizes "going with the flow and doing what you should do". Many people misunderstand it, thinking that letting the flow naturally means that patients wash their hands as soon as they want. Some patients' families will also compromise. Don't you want to wash your hands? Just wash it. Don't you ask us to wash our hands too? Let's wash it too. It seems that he understands the patient very much, but in fact it will make his symptoms worse.

actually doesn't mean this. Let it go, means that when you are in a certain environment, if you experience uncomfortable experiences, such as nervousness and fear when you see dirty things, then let it go, and let the fear exist naturally, but you must also insist on "doing what you should do" and do what you should do. You will do whatever normal people will do in this environment.

I have always told the patient that no matter what thoughts appear in the mind, it is your own. Two "you" are fighting, you don't have to pay attention to it. If you allow them to fight, you just do your own thing. This is how to coexist with obsessive-compulsive disorder. All you can do at this time is to accept it, accept its existence, and don’t treat it as an enemy, it is just a small flaw in you. If you allow it to exist, you won't be struggling with it. Many times, our pain does not only come from the objective problem itself, but also from the perspective and direction of our view of this problem.

You must believe that obsessive-compulsive disorder can be cured. Even if it recurs later, you can continue to return to normal levels through treatment. At present, 15% of people have undergone psychological treatment and drug treatment and eventually develop into refractory obsessive-compulsive disorder, but the remaining 85% can still restore social functions. The "recovery" mentioned here does not mean that there are no symptoms at all. Maybe I am still used to checking the door when I went out. I couldn’t leave the door for two hours before, but now it takes 30 seconds to leave, which does not affect my work. That is to say, although he still has obsessive-compulsive symptoms, he is no longer a patient.

5

In an era of strong social control, obsessive-compulsive disorder rarely appears because the cost of doing something wrong is huge. Society is the "police". Everyone is clear about what they do step by step in the future. Social consciousness gives individuals a support and there will be no problems. However, when society develops and changes rapidly, uncertainty arises, and tomorrow's life is not known, and people's sense of uncertainty will further increase, which will lead to conflicts between two self-"fighting" and it will be more likely to occur.

In our lives, we face uncertainty every day, and we can only reduce the impact of uncertainty on ourselves. For example, when I was in the college entrance examination, I actually didn’t choose to be a doctor, and this direction I chose me. When I was taking the college entrance examination, I applied for computer majors. At that time, the admissions were not like computer allocations now. I don’t know why I was so confused about my files assigned to medical school. The major was psychiatric medicine. I collapsed and went to the university with my high school textbook and wanted to take the exam again. Three months later, I decided not to repeat the school. It’s fun to go to college!

My experience can be regarded as an example - everyone deals with the environment very differently. When an event has occurred, some people will have to fight it. Based on objective and reasonable judgment, there is no problem with persistence. However, if you are still very persistent under the premise of making a wrong judgment, it becomes stubborn and paranoid. This failure will bring him a second blow and stress, and the situation will get worse and worse.

When I encounter these real factors, I also take the same approach as follows: I can accept the current dissatisfaction and unsatisfaction, but I can see that after it, I can still get the results I want.

After the epidemic, the symptoms of obsessive-compulsive disorder related to disease, health, and pollution increased significantly. There was no epidemic period in the past, and there was no requirement to wash hands every day, so the symptoms could not be triggered. After the environment changes, the patient's concerns about COVID-19 have expanded to concerns about all diseases and then to uncertainty about the environment.

In this era we are in, there are many uncertainties lurking. Even if the COVID-19 stops in the foreseeable future, there may be new public health emergencies. There are also economic policies, global climate, changes in natural disasters, and uncertainties in international politics, which may affect individuals. I know a friend who is in the fertilizer business, and the Russian-Ukrainian war affected his livelihood. The more the global linkage is, any event may have an impact on personal life and work. In addition, new technologies are emerging one after another. For example, the elderly are not very good at using mobile phones during the epidemic, which is often inconvenient and will face new stress factors in the new environment.

One of the characteristics of obsessive-compulsive disorder is the need for a sense of control and the desire to reduce uncertainty. When he found that the uncertainty around him could not be reduced, he became ill. In addition, the bad emotions in the outside world and the strong competitive state in the social environment will also increase the incidence of obsessive-compulsive disorder, and they are afraid of making mistakes and being eliminated.

Of course, we can make continuous suggestions and improve the management model, reduce the environmental pressure and increase the certainty appropriately, but when the external environment is difficult to change, the only way ordinary people can adjust is to deal with environmental changes.

Before mental health problems occur, we should master appropriate mental health knowledge. When people who are not sick start to experience anxiety, we must first distinguish whether this is a realistic anxiety or a pathological anxiety; whether it is a reasonable anxiety or an unreasonable anxiety. If it is reasonable anxiety, it will naturally relieve it and does not need to be dealt with specifically, but when the anxiety lasts too long, or the anxiety level has exceeded your ability to cope, you should seek help from the surrounding area. It is also one of his abilities to seek help.

6

Now everyone does not understand obsessive-compulsive disorder enough, and there are some entertainment interpretations. Although there are not many negative emotions in it and will not bring too much shame to the patients, we still need to identify the difference between the two.

If someone says to a patient with obsessive-compulsive disorder, don’t you say that she is compulsive? If she is fine, why can’t you? This is the pain of not understanding him. Many people believe that the behavior of obsessive-compulsive patients is a matter of will quality, which is just a bad habit in them. Some people also think that obsessive-compulsive patients are just entangled in their personality and just pursue perfection. These common concepts have led to many patients not being able to seek medical attention on their own initiative.

all diseases are best prevented. Genetics is just a basis, and does not mean that this person will definitely get sick. As long as we adjust the way of education, adjust the environment he is in, and take some precautions in advance, he will not get sick at all. I have always believed that adolescence is the last window for treating psychological trauma in childhood. We are exploring whether children who carry genes can try to get sick as little as possible by reducing the impact of childhood trauma.

says that children nowadays have high suicide rates and are fragile, without compassion and gratitude. This cannot be simply said that it is the child’s fault. It may be that society is wrong and parents are wrong. They do not give their children the opportunity to develop these emotions at all. How can they blame their children? Children aged three or four have to learn scientific and cultural knowledge and logical reasoning. The emotionally related neural circuits may not have been fully developed. In addition, they are all taking online classes at home and cannot see real people. It makes no sense to say that they have no sympathy. When he grows up, he will not understand others' expressions. Any parent should think about himself when he blames his children.

People communicate with each other not only need to face to face, but also require physical contact. In our childhood, there were many people fighting and hugging. I have always believed that the energy of the brain is conserved. If you use 80% of your brain resources to learn cultural knowledge and over-cultivate your thinking ability, you will not have enough resources to develop emotional ability.

In fact, many parents also know that they should not let their children write like this, but when others write, can they not write it? The whole crowd pushed forward, and you wanted to walk backwards, but you couldn't walk at all, which was very difficult. The value system of the entire society will lead to emotional distortion and cognitive distortion, and a series of problems will arise.

Nowadays, whether it is society or children, it is a simplified development, and there are great hidden dangers behind it. If you have to say whether there is any powerlessness, this makes me powerless, and I really want to change it. Parents who have young children come to see a doctor. Whenever I have the chance, I will try my best to encourage and guide them to educate their children. When I really felt powerless, I thought of the little girl who had suspended treatment. As a doctor, I can only help her from a medical perspective, but at the family and social level... Sometimes, it is really difficult.

I remember that a teenage junior high school student came to my clinic and suddenly asked me, doctor, what is the value of life on earth? Has artificially created anything valuable for the earth? Are people too arrogant?

This is what teenagers told me, have you ever thought about it? They have these thoughts, it may not be that they are sick, but that they may also be that they are socially ill .

We cannot change the biological part of obsessive-compulsive disorder, and there is another part that we can do, which is to provide some correct guidance at a critical period of psychological development for children and adolescents to enhance their psychological resilience. Not only for obsessive-compulsive disorder, all stress-related mental illnesses are the same. Their appearance is a reminder to reflect on our educational model.

Obsessive-compulsive disorder expresses a vision of hope to be cured Image source documentary "Obsessive-compulsive disorder·Mystery"