#tourettes die challenge please

[wheelchairtetris]

Self hitting tics are getting progressively worse despite upping my medication to the highest dose my neuro is willing to go. I hate it here.

[media-on-the-mind101]

Turtles All the Way Down: OCD and Generalized Anxiety Disorder (Book)

* May contain spoilers*

I recently finished reading Turtles All the Way Down by John Green, and it is now one of my favorite novels. The story hit me close to home because it deals with a disorder that I was diagnosed with. I thought writing an article about it would be a good way to educate you readers, while also sharing a little bit about myself.

Turtles All the Way Down is story about a teenage girl named Aza Holmes who suffers from OCD or Obsessive Compulsive Disorder. The story shows how the disorder impacts her daily life as well as her relationships. Because the author suffers from the disorder in real life, the depiction is fairly accurate. However, I spotted a few things that might suggest a whole different diagnosis whatsoever. The story also covers Aza’s treatment which I felt was missing a lot of important things.

According to the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) Obsessive Compulsive Disorder is a disorder where a person gets caught in a cycle of obsessions and compulsions. Obsessions are intrusive thoughts that trigger distressing feelings, while compulsions are repetitive behaviors that are performed to relieve anxiety or prevent something bad from happening. OCD is often confused with OCPD (Obsessive Compulsive Personality Disorder) which is characterized by extreme perfectionism, order, and neatness. OCPD is often portrayed as OCD in the media which means that stereotypical OCD is really OCPD.

While Aza does have obsessions that involve cleaning, they are more about health and less about being organized. People with OCD often have a specific thing they worry about, and for Aza it is contracting an infection from a parasite called C-diff which essentially causes food poisoning and stomach damage. While she doesn’t really do anything to neutralize or cancel her thoughts out, she repeatedly reads articles online and uses hand sanitizer to relieve her anxiety.

As you may already have figured out, people with OCD often have illogical thought patterns and they are fully aware of it. But their anxiety makes them perform their compulsion anyway “just to make sure.” This is seen in the book when Aza drinks a bottle of hand sanitizer to insure that all bad bacteria inside her body are cured. Of course we all know, that drinking hand sanitizer would actually be more harmful then helpful.

“Drinking hand sanitizer is not going to make you healthier, you crazy fuck. But they can talk to your brain. THEY can tell your brain what to think, and you can’t. So, who’s running the show? Stop it, please (pg. 210).

In this scene, Aza knows that drinking hand sanitizer is actually more harmful then helpful, but she feels as if something is controlling her brain. The “they” refers to her OCD and she tells it to stop but isn’t able to control it.

While reading the book, I noticed that some of Aza’s symptoms don’t quite fit the diagnosis of OCD, such as her feeling of not knowing if she is awake or dreaming, real or non-existent. In one chapter she says the following:

“the pressing of my thumbnail against my fingertip had started off as a way of convincing myself that I was real . . . every time I thought maybe I wasn’t real, I would dig my nail into my fingertip, and I would feel the pain, and for a second I’d think, Of course I’m real” (pg.106).

The feeling of disconnect she has from her own body and surroundings are actually symptoms of DDD (Depersonalization - Derealization Disorder). According to the DSM, the disorder is characterized by persistent feelings of being a stranger to yourself or your surroundings. According to Psychology Today, however, you have to have no signs of other mental illness that can explain your symptoms, in order to be diagnosed with DDD. This is when diagnosing a patient becomes challenging; so many disorders can have similar symptoms or be co-morbid with each other that it they can difficult to differentiate.

The other symptom I noticed that is actually its own disorder, is the fact that Aza has a habit of digging her nail into her fingertip to the point where her finger becomes scarred. While picking of the skin is often comorbid with OCD, it is actually a separate disorder called excoriation disorder or dermatillomania. According to mhanational.org, this disorder is characterized by picking of the skin that creates skin lesions and that causes disruption in everyday life. It is true that the disorder falls under the category of obsessive compulsive disorders in the DSM, but excoriation disorder is not the same as OCD.

Now we’ve defined what OCD is, but another important part of how the book portrays it is in the treatment. According to Mayoclinic.com, the most common treatments for OCD include CBT (Cognitive Behavioral Therapy), exposure therapy, and medications such as SSRIs (Selective Serotonin Reuptake Inhibitors). These are the treatments that I had during my childhood, and they have been statistically proven to be very effective. 

In the book Aza sees a therapist and takes medication, but she doesn’t get exposure therapy, one of the main treatments for OCD. Aza mainly gets CBT which is essentially talk therapy, but she is not forced to face her obsessions without performing her compulsions. An example of this would be touching a dirty substance and then forcing herself not to take out her phone or use hand sanitizer. 

The last important thing is how OCD effects a peoples relationships. Throughout the story, the characters in Aza’s life talk about how hard she is to deal with. One scene toward the end really emphasizes the importance of this issue. In this scene, Aza and her best friend Daisy get into an argument because Daisy feels that Aza is too self-centered.

She says “and you’re so, like, pathologically uncurious that you don’t even know what you don’t know.” And later she adds “I don’t mean that you’re a bad friend or anything. But you’re slightly tortured, and the way you’re tortured is sometimes also painful for, like, everyone around you”(pg. 216).

Daisy is frustrated because she feels like Aza is so caught up in her own thoughts that she never shows any interest in the lives of others. When she says Aza is “tortured” and it makes it painful for everyone around her, this shows just how much her illness impacts her relationships with other people. Basically, people find her difficult to be around because they, in a sense, have to experience everything with her and they begin to lose patience. At the end of this scene, the two girls get into a car accident because they weren’t paying attention to the road.

Aza’s other important relationship in the story is with is Davis, who is like a friend with benefits. The reason he never becomes Aza’s boyfriend is because of her social anxiety and fear of contamination that prevents her from being physically close to people. 

“I enjoyed being with him more in this nonphysical space, but I also felt the need to board up the windows of myself. Me: I feel kinda precarious in general, and I can’t really date you. Or date anyone. I’m sorry but I can’t. I like you, but I can’t date you” (pg. 162).

I this scene, Aza reveals that she communicates better online then in person and this suggests that she has some form of social anxiety.

Another scene tells us just how much her fear of germs effects her life: “billions of people kiss and don’t die just make sure his microbes aren’t going to permanently colonize you come on please stop this . . . then you’ll get C. diff and boom dead in four days please fucking stop just kiss him JUST CHECK TO MAKE SURE. I pulled away” (pg. 152).

In this scene, Aza has difficulty being physically intimate with Davis because her fear of germs prevents from enjoying it like most people would. Based on this fact, we could predict that Aza will have difficulty in her future relationships because of her mental illness and this is a great example of how it effects people in real life.

As I mentioned in the beginning of this article, the author John Green himself suffers from OCD. Compared to his own experiences, the book is pretty similar. Like the main character, Green suffers from obsessions about contamination. In an episode of the Vlogbrothers Youtube channel, Green explains that

 “I might worry out of nowhere that my food is contaminated or somehow poisoned and then somehow suddenly that will be the only thought I'm able to think . . . I can lose all control over my thoughts for an extended period of time to the extent that I can't follow what's happening in a TV show or read a book.” (Green).

*John Green, author of Turtles All the Way Down*

So like Aza, he worries about contamination to the point where he can’t focus on anything else. He also has the same kinds of thought spirals :  

“the compulsive behaviors I use to cope with these obsessive thought spirals, repeatedly checking my food for contamination, for instance, or spending hours Googling what will happen to me if I eat moldy bread.” (Green).

As you can see, the characters compulsion of checking in internet comes straight from the author’s real life experience. According to the New York Times, John Green developed the disorder at around seven years old and eventually got it under control with the right medication and CBT. It was not said weather or not he underwent exposure therapy. So the treatment that Aza receives is based on the way some treatments work in real life.

While reading Turtles All the Way Down I  often found myself feeling nostalgic because my own experience with OCD is very similar. Although I do not have an obsession with a specific thing like Aza does, I have the same types of intrusive thoughts. I also have similar compulsions to seek reassurance from the internet or other people about my health, as well as other compulsions to neutralize, or cancel out my thoughts. 

Because I had Tourette Syndrome (a neurological disorder that causes physical impulses) as a child, I developed what is called Tourettic OCD. It is pretty much exactly what it sounds like; Tourette Syndrome and OCD combined. The reason this occurs in some individuals is because the ability to filter out and thoughts and the impulse to move, take place in the same brain area, the basal ganglia. As a result of this, my compulsions tend to be more physical, such as moving my eyes excessively whenever I see negative words in a book, or someone getting sick in a movie.

Like Aza, I went through CBT but I also went through several years of exposure therapy and I take an SSRI in conjunction. I think exposure therapy is a very important part of the treatment of disorders such as OCD and PTSD and I was disappointed that the book did not include it. I think that if you are going to educate a person about disorder, then you have to educate them about the treatment as well. In conclusion, Turtles All the Way Down was a great novel that captured OCD more accurately then any movie I have seen. The fact that the author has the disorder makes it all the more realistic and personal, and I have to say as a person with OCD and a psychology major, I was quite pleased with the way the character was portrayed. The story may have been missing a few important elements but overall it provided a realistic way of educating people about the disorder.