Transcription
Foreign, let's go to Sarah in Joshua, Texas. What's up, Sarah?
Hi, Dr. John Deloney. What a pleasure.
What a pleasure it is. My favorite podcast, and also mortifying.
Yeah, it's all good. What's up? Uh, so I, since I was six years old, I have, what I didn't know was a disorder until I was 15. Uh, a skin picking disorder. So my, my fingertips are just always kind of cut and bloody. And then it, you know, when I was 15, I started pulling my hair out. And there's names for these things.
Oh my gosh. You know the name? Hey, uh, do you, okay, we're gonna, we're already here, so we're gonna keep going. Do you, um, when you pull out like eyelashes or hair, do you eat it?
No, I don't. And I have heard of that, but no, that's not me.
Okay. All right. All right. Um, wow. So why six? That is just a memory. That's me remembering the first time I was ever bothering with my hands. And I remember being scolded for it too. My, my dad, he, he would always tell me, you know, quit doing that. That's a habit.
It's not a habit. It is a compulsion. That's very, very different. And people, people don't understand that. They think it's just something that you do because you do it. It's, it's no. It is, it's very purposeful. It's not mindless. And it's excruciating. It's, it's exhausting.
Yes. And, you know, I'm 31 now. It's been my whole life.
Yes. Um, how would you define a compulsion?
When you cannot refrain.
Okay. Does that make sense?
Yes. That's so strange. It's strange because I am a very controlled person. I don't have, I don't have any vices. I don't have addictions. I've never gotten caught up with things that all of my friends did, you know, I never got caught up in alcohol, cigarettes, drugs, like nothing. Literally nothing.
Maybe if you'd had a few drinks. I'm just kidding. Um, so that actually doesn't surprise me at all. Okay. The, so do you promise that that you like that, you know, I'm not, I'm, I'm, uh, I'm on your side. I can believe that. Okay.
Okay. So let's do this first. So you can take, uh, we'll geek out for just eight seconds. You can take like a past digging approach, like a cycling, a little psychoanalytic approach, like what happened in your past? What, what things are being repressed? What things happened that led to this behavior? You can do that. And you can also take a very strict behavioral approach, okay?
Uh, that this is, this is, um, it's, it's a, it's a, it's a learned habit. Just a habit. And then it just ingrained itself. And the habit ultimately becomes a compulsion. There's been some recent studies, um, that suggest that it could also be very biological in nature. Like this is a brain on a loop trying to solve some things for itself. Or there's a serotonogenic issues. Or there's all kinds of of neurotransmitter, neuromodulator issues. Here's what I'm telling you that I don't want you spending so much energy, one, asking what's wrong with you, why are you broken? Two, you've probably spent a fair amount of time playing Indiana Jones with your past trying to figure this out. Is that fair?
Um, I wrote it down last week. Literally trying to find a trigger or a pattern or something. I'm, and what you said, you said loop. I'm, I wouldn't say that I'm a, a person of high anxiety, but I'm very cyclic. I, I will just run around in circles in my brain until I find, correct the root of the issue. And I don't know. I don't know. Maybe that does define me as high anxiety, but I don't. I don't know.
I was recently having a conversation with a good buddy of mine who's a psychologist at Brown University, uh, at the, in the, in the research hospital. And I have a theory that I'm just working through. And I asked him, like, I was like, hey, I need to talk through this with you because as I read more nerd literature, um, the scientific studies, I, I'm coming to believe, and I have nothing to back this up, okay? So this is me just spitballing with my buddy. Uh, but he did say, man, I think you are dead on to something. And in fact, he told me a bunch of other studies I didn't know existed, um, some out of Kansas, some out of a couple of other places that, would would suggest that I, the way we are trained is that OCD, that basically life happens to you. And based off of your genetics, some people get dragged down into depression, other people get spun up into anxiety. But that it's a body reacting to stimulus. It, it can't, it's exceeding its capacity to to deal with it. And a derivative of anxiety is OCD. I have been really, um, blown away by some of the the neuroimaging around OCD to the point that I am beginning to wonder. And Alan Short did some great work here. I think the root is OCD and depression and anxiety and all of these other downstream things that we try to do is our bodies trying to stop the loop. And you are a person of high control who has been told since you were a little girl that the way you control things is gross and disgusting. Quit. And they may have loved you and been incredible and wonderful. But sometimes, depending on what kind of brain you were born with and genetics you were born with and experiences you had, it may just take a splinter, a crack in the way you respond is wrong. And who you are is wrong. And your body says, we've got to solve for that. And it gets anxious about it. And then it becomes a loop that gets etched into concrete. So I would, my challenge to you is a compulsion is a habit on steroids. I think trying to differentiate between the two of them, uh, is, uh, is a waste of time and energy. Your body has tried to figure out a way to make you feel better. And this is the way it's chosen. Do you wish it was something else? For sure. Um, but this is what you got. And so here's why I tell you all visible or obvious because I think I can hide. I can't. I can't. I can't hide this.
That's right. That's right. But here's the thing. You can't hate your body into healing. And you have been at war with Sarah since you were six years old, right?
Yes. Absolutely.
You've got to make peace with Sarah. And the moment you can, and literally it's a moment, the moment you can begin to, I mean, you've probably heard of, uh, ACT therapy, act like acceptance and commitment. You have to switch from war to curiosity. That's your only path forward. Because every time you pull your hair out, you get pissed. And you think you screwed up something. Or you think, what are you doing? Why are you doing? Oh my gosh, it's the worst. It's the worst. And people who struggle with binge eating, people who struggle, I mean, it's these compulsions. People who smoke, who grab cigarettes, who just sit in their bathroom and have imaginary wars with other people. And it's like, I can't stop fighting somebody in my head. And then I see them at work, and my body's like, there they are, kill them. And they're so kind. They're offering me a drink, right? Like it's like it's these habits, these loops that become compulsions that we lose control of. And the key back to control is curiosity. Huh? What's my body trying to protect me from? And I'm saying it with a smile on my face. What is my body trying to solve right now? Because it is pulling hair out of itself. And I'm also, you see, I'm, I'm putting some gaps between you and what's happening. You are not your trichotillomania. You're not a lunatic. You're not crazy. You're not disgusting. You're not gross. Your body's figured out a way to solve a thing. And it's just the solution isn't very helpful. Or actually, I would bet you, it's really, really, really helpful, or it wouldn't keep doing it. But it's helpful. That also doesn't make sense. It doesn't. It makes me feel worse. But does it shift your focus away from what you can't control?
Oh, absolutely.
Does it shift your focus away from the battles that are you are raging on a daily basis that you can't fix or change?
Well, sometimes it's just, I'm just trying to work. Like I can't even be at work. I, you know, I work, I work at a desk. And I actually work remote at work at home. So I'm just trying to be productive. And it's the only way I can describe it is like someone's tapping on the back of your head.
Oh, yeah.
And you, and you are, you know, twiddling away. And you try to make it stop. And they're still tapping on the back of your head until you give your attention to that. And then the whole day goes by. I haven't been as productive as I want to. And that's only one example. I have children. Like sometimes I, I can't be present in anywhere else in my life because my fingertips are bothering me. That's so absurd. My eyelashes are bothering me. Who feels their eyelashes? Like I'm not even supposed to notice those things.
Says who?
Oh, I, I guess just general sane people.
You've constructed a whole planet about how terrible Sarah is. And she's not. She's not. I will admit the things that you struggle with are hard because they're, they're, they are outside the norm. They don't happen to a lot of people. Although I think the number I saw was 10 million or 8 million people. I mean, so it's not an insignificant number of people who struggle with this. But it is weird. If you're sitting there and you're picking at your finger until it's bleeding, and you're pulling a piece of hair out the back of your head, and you're doing it mindlessly while you're watching TV, and you look over and your little son is or daughter staring at you like, what is that? Yeah, that's unnerving. That's weird, right?
It is. But you have create a constructed a character around this of a lunatic, unfit to be a parent, shouldn't be even in an office with people. And you've created a whole person. And you hate that person.
I see that. Let's try this. And at the root of that, I think this is, and again, so some of the neurological stuff can be grooming habits that are wired into us that are just a little bit off the rails, okay? And so it might be something as simple as, man, I, I need to take an SSRI. And have you tried that before?
No, I'm, I'm actually not even familiar. I, I, um, I went to a therapist one time when I was 15. I was prescribed antidepressants, tried that for about a week, then I refused them and never went back to a professional ever again.
There is some, um, there is some evidence that suggests, um, SSRIs. It's, it's not, um, benzodiazepines, but it's, it's SSRIs that help with anxiety. They're anti-anxiety things. But what, here's what, here's the way I characterize them. They just turn the alarms down so that I can go do the work that I gotta do. For instance, when I was, sorry, go ahead.
Buried in anxiety, I was sat at my table. I met with my buddy who's a medical doctor. Again, I'm super privileged to have a close friend who I love and trust that's a medical doctor. I get that. But, um, I sat with him for a long time. And he said, hey man, I don't see a path out of this for you without some really good counseling and some behavior modification. And you can't, you're not in a place to do that. I sat at my table with a low-level SSRI that I cut in half, okay? So the lowest dose. And I cut that in half. And I wept because I thought I was a failure. I thought I was a total loser. I had a new baby, my son was like one years old. And I thought I was a such a failure. And I wouldn't put a pill in my mouth until I had a plan off of it. My doctor was like, super helpful in making that plan. That plan was not even close to reality, but he humored me on it. And, um, here's all it did. It did not solve my anxiety. It didn't solve my control issues. It didn't solve my loneliness. It didn't solve all these things. It didn't make me less, uh, um, addiction prone. It didn't make any of that stuff go away. What it did was it turned the alarm systems way down so that when I felt a compulsion to do something, I could be curious about it. That tapping you feel, it would make it more like a, like a, like a whisper or a breath instead of a, a banging in the back of your head. This is just me. This is me hypothesis. Like I'm just, I'm not saying you need to go get meds. I'm saying here's what it did for me. And what I want, what I'm trying to get you to do is to open up. It may be time to sit down and say, okay, what I've done to this far, it hasn't worked. Cool. My body's still getting what it needs from me by doing this. Um, I want to stop this behavior. So let's try another avenue. That may be medication. That may be hypnosis. That may be EMDR. That may be several other avenues. But let's give this a shot. Does that make sense?
Yes.
What I don't want you to do is to give in to despair and quit and think you're screwed up and broken. Because here's why you start to turn from your kids. Fair?
Yeah.
And you create space between your kids. Are you married?
No.
Okay. You create space between romantic partners. And they think it's their fault. Is that fair?
Yeah. I could see that. Oh, actually, I could definitely see that. I'm, I'm, so I'm so afraid of, yeah, medicated.
Yeah, I get that. I get that. I'm afraid if I, if I take something that numbs the alarms, what else is it going to numb? This process.
That's absolutely fair. And there's certain drugs that, um, I wouldn't, I have written into my, um, psychiatric power of attorney that I won't have in my body because they turn joy and pain off at the same switch, right? And so that's terrifying.
Yeah. It is. It is. And also, um, I can just tell you my experience. Um, I am somebody who does not advocate for medication. And it was a powerful, um, tool in my toolkit when I was getting well. And I haven't been on it in years, years and years and years. But for a season, man, it was powerful. And again, that might not be your journey. What you need to do is figure out ways you can make peace with Sarah. Because you can't overcontrol Sarah. Because this whole thing is a control response. Or maybe a biological thing, which then you're going to need medication as though you have a heart. Like, and just be grateful that you live in this one with a weird sliver of time. And we have all of this, you know, incredible technology. All right. But all of this, here's all this is making peace with Sarah. Will you do me just, of all the favors I'm asking, one, I think you should go talk to somebody. Not because you're broken, but but because like you have tried to fix the plumbing under your house and you're like, I don't know how to do what's next. That's it. You just got a professional. They're gonna have different skills. You're not screwed up. You're not broken. You're not, ah, you just don't have the skill set there. That's great. That's awesome. You have tried. And you'd be like, all right, I need someone with different skills. Luckily, there's people who went to college for a long time to learn how those skills that can help. Okay? That's number one. Underneath that, number two is I want you to keep a journal. And I want you to begin to write five things a day that you are, that you love about Sarah.
Okay.
You actually never, I, I could have, I would have bet my car on that. My car is not nice. That would have been a great big bet. But, um, you, you strike me as such a loving, caring person. And that love and care is wrapped over like, like, um, wrapping paper over a nuclear bomb's worth of energy grasping for control. And at some point, we have to release the tension that is held underneath that thing. And for most people in that situation, that feels like the end of their life. Because if I let this thing unwind, this thing I'm controlling and compressing and holding onto, it's all of my mind. If I let it go, everything spins into chaos. And the most terrifying thing is chaos. And so when I start to feel chaos, and I start to feel something I can't control, like my kids' behavior, like my husband walking out on me, like climate change, like whatever else you think is coming, the economy is all coming down, or they're gonna elect a Democrat. No. Or whatever your body then has some built-in mechanisms to divert your attention from that stuff that we can't control to this. And it's cool, man. Body's just trying to take care of you. Trying to love you. That's assuming, again, this isn't biological in nature, right? But sitting with somebody that can help you slowly peel the thing apart, let that thing, some of the tension of the energy release. That's the path to healing, my friend. I'm so, so grateful for you, sir. You're a brave, brave woman. And you're an incredible mom. Starting today, we're gonna start making friends with Sarah. We're gonna come to love Sarah. And Sarah's gonna become somebody worth taking care of and loving. They're gonna be curious, man, why is my body doing that? And that's going to be where we start getting well.