#910 Michael Alcee PhD on The Upside of OCD

Shrinkwrap Radio, number 910.

Michael Alce, Ph.D. on the upside of OCD.

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Just enough to make it dangerous.

It's all in your head.

And now here's your host, Dr. Dave.

My return guest is Michael Alce, Ph.D.,

discussing his latest book, The Upside of OCD.

He asserts that OCD is a misunderstood existential

and emotional problem.

It's an empathic sensitivity that has served the life

and work of many notable OCD sufferers.

Now, here's the interview.

Dr. Michael Alce, welcome back to Shrinkwrap Radio.

Yeah, it's great to be with you, David.

Well, it's been about two years since you've been on the show

discussing your book on therapeutic improvisation.

And today we're going to discuss your subsequent book

on the upside of OCD.

How did you come to write this book?

OCD has always been a little hobby horse of mine

since my grad school days.

But I've always felt that there was more to OCD

than clinicians and even sufferers talked about.

And while I was doing it in practice,

I was like, why should I hoard all this information to myself?

I should write about it.

Yeah, yeah.

So what made you feel suspicious about, you know,

that this book is a good book?

Well, I think it's a good book.

I think it's a good book.

Some of it was being hoarded and not put out to the world.

Well, you know, right now, as you probably know,

and many therapists know,

like the most, the mainstay dominant model

is a cognitive behavioral model

for treating OCD, exposure response prevention,

medication, maybe a little acceptance, commitment therapy.

But there's not much that looks at feelings

and relationship and meaning within OCD.

I think because there's a little bit of the field

has a trauma response because, you know,

psychoanalysis made it feel like it was very ineffective for OCD.

So therefore, anything that gets close to that

seems sort of dubious.

And I really felt like, wait a minute,

what if we could blend these things together?

Yeah, and your book is written directly to OCD sufferers.

And I wonder if you yourself were ever diagnosed with OCD.

Yeah, yeah.

I really wanted it to be written directly to sufferers

because I wanted it to echo the kind of lived experience

that they have, which was mine as well.

I write about in the book,

my mom had severe OCD, contamination kind of OCD

and the kind of reassurance seeking and doubting

and things like that.

And I too, when I was young,

one of my earliest OCD symptoms was these intrusive thoughts

that if I didn't do my prayers correctly,

or if I was immoral in some way,

that my mom would die.

And out of the blue, just, you know,

all of a sudden, and I remember coming home from school

and hugging her for dear life, thinking,

gosh, I might have lost her today.

And, you know, the OCD would morph into other forms

throughout my life, right?

Making sure that I took notes impeccably

in high school and college, you know,

as if I was a teacher was spreading gospel, right?

You know, reassurance seeking,

in every which way, doubting my own kind of ideas

and things like that.

And, you know, what I really wanted to get at the book

is that despite all these seeming downsides of OCD,

there's a lot of hidden upsides

that we don't really talk about.

And that when we connect,

that actually help with the downsides.

Well, as you learned about OCD

and the general attitudes towards it,

I wonder, did you feel,

did you feel a need

to defend it, to defend yourself?

Yeah, that's great.

I mean, totally.

I mean, I think some of the great, great,

you know, psychological writers

kind of find something in themselves,

hopefully to share with the world

and hopefully speak to something larger.

Yeah, I felt that there was missing poetry

in the literature and research and treatment on OCD.

I felt like having OCD was a lot more nuanced

and also being a person with,

I call it a sensibility of sensitivity.

I think people with OCD

have a profound empathic sensitivity

that when not understood and validated and supported

can go haywire.

And I also think that people with OCD

have an extremely imaginative mind

and without, again, proper understanding of how that,

they're like border collies, you know?

If you don't give a border collie good enough exercise,

it's going to tear apart the place.

Right.

People with OCD,

I'm actually stealing that from Elizabeth Gilbert, the writer,

and people with OCD have very active minds

and very generous hearts.

And when they're not given proper exercise and support,

they start to take it out on themselves.

And so I really did have a personal,

a personal stake in changing the dialogue

on what OCD is,

what people are who struggle with it.

And that's one of the reasons

why I highlighted so many people

who have had OCD,

who are famous with OCD,

like Charles Darwin or Nikola Tesla

or author John Green or Greta Thunberg,

you know, Jack Antonoff, the musician.

I really wanted to showcase

that there's a lot more richness

and texture to what is the OCD experience.

Well, I'm glad you did.

And I'm glad that you're sharing this with us now.

And I hope we have lots of OCD listeners

who, you know,

the people who are privileged

to have that sensitivity

that you're talking about and experience.

And, you know, and like other things,

I imagine it's probably

on some kind of a distribution

from lots to little.

And probably all of us can relate to it

in one way or another.

And, you know, you said something funny too

that I wanted to point out.

I think there's a high proportion of therapists

who have OCD,

who have either OCD or OCD tendencies.

And when you look at one of the earliest cases,

Freud did a wonderful case.

Paul L. was the rat man case,

and he was the classic OCD case.

And when Paul was a young man,

he was intrigued by Freud's writing

because he said,

you actually write the way my mind thinks.

In other words,

the way that we question

and are curious as psychologists

in its best days is creatively obsessional.

And so I think there's a high correlation

between those of us in this field

who have, if not a touch, a good portion of it.

And my hope is to figure out how we could use that

not just for our patients, but for ourselves.

Yeah, yeah.

Well, my feeling is if you don't have OCD

when you start graduate school,

particularly in psychology,

you're gonna have it by the time you're done.

You're gonna have to learn how to develop it a little bit.

Yeah, yeah.

Because, you know, you sort of,

for one thing in psychology,

you're taught to question everything

and to kind of doubt everything

and hold it up to an analytic light.

And that's kind of how you described

your own experience as a kid, you know,

that you found yourself questioning aspects

of reality and so on.

And that makes sense.

And we talk about obsessive compulsive

and,

graduate school, particularly psychology,

I think really trains you to,

to be obsessive and compulsive.

You have to be, if you're gonna get through it.

You do.

Just like being a doctor, right?

Like a medical doctor, you have to be really,

you know, I think that's a really important point.

This is part of the human condition.

And when I think of people with OCD,

is that they have also a big range.

And that's one of the things that I set out

to write this book to talk about,

the range of thought and range of feeling, the scope, the fuller scope of it.

Yeah, yeah.

Now, actually, you didn't start out in psychology or psychotherapy.

You started out in music.

And so one of the things I wanted to ask you about,

and I'm sure you've probably given some thought to that,

but I'd like you to think about it right now,

is in what ways music has informed your sensibilities about OCD,

your understanding of it.

For example, I seem to recall research that suggests that musicians

turn out to be particularly good as programmers,

I guess because of the patterns and so on.

Yeah.

So how do you feel?

How has music gifted you in this pursuit?

That's a really beautiful connection,

because I hadn't thought about it in this way, David.

But in a way, if you think about it,

music does two things that are so apropos to OCD.

One, music is about learning how to read the changes we talked about, right?

In therapy, we're learning how to read the changes of emotions and thoughts

that are constantly moving.

But we're trying to detect patterns

to see where there are places that we can get some constants within the change.

And music is about having change and variation within form.

And so music really showcases the best of being emotionally connected to something,

but analytically very, very precise.

And that's the other thing about music, is that it's the best of both worlds.

You have to be very, very analytically sharp to be a good musician,

but you also have to be very emotionally available and expressive.

Very generous.

And so I think music is a great example of how our minds work.

When I think of OCD, I don't just think of the mind, I think of the heart.

I think they have as roving and open a heart as they do a mind.

And when you see that, that's what music is.

Music touches your heart, but it also sometimes speaks to that something bigger, right?

Yeah.

And I do think there's some real connection.

And that's why I think, you know, watching people who kind of...

Like Charles Darwin is a great example.

Here's a guy who struggled throughout his life with asking for reassurance,

worrying about the potential death of his children.

His mother died when he was fairly young, so he also was semi-traumatized by that.

But he also had this roving mind that was always looking at new angles on things, right?

What was the name? Who was it?

It was Charles Darwin.

Charles Darwin. Okay.

Yeah. And most people think of him because of Spencer's, you know, idea of him being survival of the fittest.

But I think it was... I forget who said it. I'm looking at my books here.

The gentleman who writes about awe. What's his name? Dacher.

You know who I'm talking about.

I do. I do.

So he had this beautiful quote that Darwin really was about survival of the kindest.

Because he felt that the most...

...involved in us were morally generous and caring for each other.

And it's one of the things that I think people forget about when they think about OCD.

They often think about this worrying mind, but they forget about this really, really open heart.

And I think one of the things about music that connects it back is that I think music always connects the heart.

Yeah.

Now, music, of course, is very broad.

And, you know, there's music theory.

There's music performance.

There's music performance, et cetera.

So what...

Are you a performing musician?

What's your instrument?

Or are you more into the music theory?

Or is it all?

So I'm really an amateur.

I work at Manhattan School of Music with all these professional jazz musicians, classical musicians.

And growing up, I studied classical and jazz.

But for me, it really...

I think music was another way to put the kind of depth of what you're thinking and feeling into form.

And I think, you know, we've talked about this when I talked about the first book, Therapeutic Improvisation.

I think therapy is such an artful process.

And that when we're deeply connecting with people, we are allowing new forms to come and also allowing new forms to be seen.

And I think music does that in its exquisite way.

And yes, I'm a pianist by training.

So when you think of the piano, what I love about the piano is, like, the piano has, like, the greatest range of all the instruments.

And so, you know, the piano is where all the greats used to practice playing the orchestra parts for their concerti, you know.

So the thing that I love about the piano, I think it kind of really evokes the emotional range of being human.

Wow.

Yeah, I'm so jealous of you in that regard.

Because I actually tried to, you know, my grandmother wanted me to learn to play piano when I was a kid.

And I didn't want to practice.

And plus, she didn't play piano.

She didn't know how to play piano.

But she was trying to, you know, teach me some of the basics from books and would try to get me to practice.

And the thing that really hooked me later was I was really drawn to...

I was really drawn to folk music during the whole folk boom and took up the guitar.

And then later, I really wanted to learn to play the piano.

And I tried to...

I tried it from different perspectives.

And particularly, some of the teachers that I worked with wanted to teach me improvisation.

And I was really drawn to improvisational piano.

And I discovered to my...

And I realize now, in retrospect, what my big problem was.

Partly due to aging, but I think just partly due to whatever kind of brain I have.

Memory is not...

Isn't my strong suit.

It's funny.

I remember...

I think, for example...

I think you were probably referring to Dacher Keltner.

That's right.

It was the name that you were reaching for.

Yes, that's what I was reaching for.

Yep.

You know, and it's funny how I'll have that.

I can pull that out of my head.

But I'm playing the piano.

I learned the chords and the notes and all.

But at one point, my teacher, who had emphasized...

Look at your hands like baby hands, without judgment.

So that's where he was coming from.

And so I did that.

But then I felt really rebuffed at a later point when he said,

This is not music.

You're just wandering around on the keyboard.

And it's because I couldn't remember the pattern.

I couldn't establish a pattern that I could repeat.

Because I was just wandering, and I didn't know where I'd been.

Yeah.

And that was very frustrating, and still is.

Finally, I had to give up.

But, you know, I want to give you some consolation on this, David.

And also to other therapists out there.

You know, I'm really a hack at improvising.

I'm really bad at it.

I wish that I was as good at improvising as I always dreamed to be.

But what I found is, as a therapist, I'm a really good improviser.

And I can, just like you, I can remember people's stories.

And I can remember the metaphors or the different pieces.

And I think, you know, Jung said something, right?

The mind plays with that which it loves, right?

And that's where the creative act comes.

And I think it's really important to see that musicality

is something that we do every day in our sessions.

And that's sort of the reason that I wanted to write about this,

to look at more of the musicality of what is it like to improvise

with a very overactive mind and very overactive heart.

Yeah.

Right?

And just like you, I took piano lessons.

And at first, I took them and I hated them.

And I gave them up.

And it was only when my mom, I said, I want to play like Billy Joel.

And my mom said, I'm going to get you a teacher who will teach you Billy Joel.

And I'm like, I'm in.

Okay.

Right?

So there had to be an in.

And I think really it's so important that there's something about connecting to that place,

which is...

One of the reasons why I wanted to write this book

was to connect to that heart and soul of this particular thing.

Yeah, yeah.

I was really drawn to the blues and the country blues

and boogie-woogie and sort of the African-American experience,

partly because I grew up in a racially mixed family.

And so I was exposed a lot to the black side.

And I was exposed to the black side of life as a result of that.

And that's somewhere, you know, they talk about soul, food, et cetera.

And I have to acknowledge that even though I feel like I've been overeducated

in a way that creates a lot of distance between me and the world of blackness,

that it does speak to my soul.

Yeah, I can't find the quote here,

but Quincy Jones has a great book.

It's a book called 12 Notes.

And he writes about his...

It's a memoir slash sort of inspirational guy.

And he says there's the science of music

and there's the science of life

and then there's the poetry and the soul of it.

And the soul of it is sort of what you're talking about.

And that's, again, that was the reason why I wanted to write this book,

to talk a little bit more about the soul of this particular condition

that is very, very human and very, very intriguing and very rich.

So, you know, it's exciting to be able to share it with therapists

because...

Yeah.

The other thing is I looked at all the books out there, you know,

and I was like, wait, there's not as much new angles on this particular...

I wanted to mix up the blues.

Yeah.

I wanted to play some new changes here.

Yeah.

And I wanted to say like, hey, this is a great standard.

I love this tune.

Let's see what else we can do with it.

Yeah, yeah.

So in your book, you know, as I've mentioned,

you write directly to...

You write directly to people who are,

and it's not right to call them sufferers.

Yeah.

If they're sufferers, it's only because our judgment says a society

and as a professional have put it in a, given it a negative cast.

Yeah, maybe people who live with OCD, right?

Who live with it.

Yeah.

Many people who, Bart, what's the right word?

The rest of that sentence.

People who live with OCD, right?

They're not just sufferers.

They live with it.

And there's life within it as well.

Yeah, yeah, yeah.

And so maybe you can take us through,

and you're doing therapy with people.

So what are the steps that you take people through?

Yeah, you know, a big part is recognizing how sensitive

they are emotionally

and how quick they are to be sensitive to others,

but how much less sensitive they are to themselves.

People with OCD are extremely thoughtful and worried about others,

but they're extremely critical and hostile to themselves.

And they also have, they get really cagey around disagreeing,

being angry, setting a boundary.

It's almost like those sides are not allowed.

Right.

It makes sense.

If you feel so much, like if you feel the feelings of others,

it's almost like you're hearing everybody else's music

and you lose track of your own music.

And in a lot of ways, I think people with OCD also then start to feel like,

what's my music?

Everybody else has all this stuff going on.

Yeah, yeah.

They must feel really, really heard when you say these things to them.

I would think they would feel very,

very seen and heard and valued at a deep level,

which is healing.

Yeah, I mean, I think that's the thing that I think

are one of the most important things.

I want people with OCD to feel more seen

and more seen in this particular area,

which is how deeply feeling they are,

but how difficult it is for them to stay in touch with their own feelings.

And I think that's another reason why they go into their worried minds

to control all this stuff.

Right.

And so one piece is just recognizing that,

I call it, like I said, it's a sensibility of sensitivity.

That's the nature part of it.

I feel like people with OCD have a nature,

a temperament that is really tuned, highly tuned.

Yeah.

But then, of course, if you're highly tuned,

then you start to think about all this stuff that you're feeling.

And then you start to worry and wonder,

hmm, what if that happens?

Or what if I did that?

Or what if I thought that?

And all the what ifs.

And that could be really,

really interesting if it's balanced, right?

And so the second part of what I like to do

is to look at the imaginative mind of the OCD person

and say, hey, wait a minute.

Yeah, yeah, yeah, you're right.

There are a lot of what ifs.

How do we make them into why nots?

Meaning, why not?

Let's see what's possible here.

And also, let's see,

like I talk later in the book about

how to balance out this self-criticism

with a little bit more of the muse.

I've been really intrigued,

Maggie Jackson wrote this beautiful book

about the power of uncertainty.

It's called The Wisdom and Wonder of Being Unsure.

She wrote a lovely endorsement for the book.

I was really grateful for it.

And in this book, she talks about

how much more powerful trusting uncertainty is.

There's a lot of creative possibility there.

And I think people with OCD can bring that power.

They can transform this malignant doubt

into creative possibility.

Yeah.

And so-

You know, as a podcaster,

I've struggled with the fact that,

well, I think more generally,

I've struggled with accepting myself

as somebody who's not really specialized

and gone super deep.

I think people have gone super deep in a certain area.

Like quotes, you're supposed to do.

Yes.

You know, you're supposed to become an expert

and be really committed to something.

And then the picture of science

as it's portrayed generally is that,

you know, is that you become really committed

to a theory or a perspective.

And of course, and in science,

and we're talking about,

We're taught that scientists are open to changing their ideas and their theories,

but in fact, it doesn't appear to be that way at all.

Somehow, they are so convinced that they know how it is

that they just will keep trying experiment after experiment after experiment

until finally they can reveal, see, this is how it is.

I sort of sensed it, which I think is interesting.

There's this intuitive aspect, I think, to science.

Yeah, that's right, and that's exactly what I'm getting at.

So people with OCD have an intuitive sixth sense.

They have a sixth sense, and I think the reason I wanted to write this book

was to talk more about that, because I don't think there's enough press on it,

both for people who live with OCD, but also for therapists to tap into that,

the power of that.

There's a lot of wealth there, and there's something that you just said

about that scientific stance.

There's something really beautiful about being able to be creative,

to open to these different possibilities,

and that is something that I think is difficult in this culture, right?

It's a lot more difficult with polarization, and actually, that's what I thought.

Yeah.

It's so powerful about people with OCD.

One of the things that both Sigmund Freud and Anna Freud said about people with OCD

is that they are wracked by tremendous ambivalences,

both tremendous love and connection,

and at times, hate that they feel like they can't control.

And to me, it gets at the full Shakespearean range of what it's like to feel.

So...

So broadly, which is what it is to be fully human.

And the thing that I think is the saving grace for people with OCD,

just as it is for our culture, is to lean into nuance.

That I can be this and that and something in between.

And to paraphrase Walt Whitman, whatever contradictions, that's okay.

I am large.

I contain multitudes, right, as he would say.

Yeah.

And nuance is an interesting word, as I write about in the book.

It comes from the French word for nuage,

which means cloud.

You know, because when you look at clouds, you see all this dimension and shape.

But yet, when we think of something that's cloudy, we think of something that's obscured.

What a beautiful paradox to have something that's obscured that also has more dimension.

And I think people with OCD struggle with noticing that constant conflict between these things.

Yeah.

I'm thinking of Joni Mitchell's song.

Both Sides Now.

Yeah.

Right?

One of my favorite songs.

And so profound.

And my condemnation of my condemning voice has said, I'm a dilettante.

Because, you know, and some years ago, I met with a graduate committee in which I was supposed

to, it was actually, I already had a PhD and so on.

It was a faculty committee.

It was a faculty committee in which we were supposed to look at ourselves and get feedback

from our peers.

And, you know, and I, somehow that it came out that I had this condemning sense of, you

know, having failed for being, quotes, a dilettante.

But then, you know, but they were able to get me to see that I'm not a dilettante, I'm

a generalist.

Or a renaissance man.

Okay.

I like that.

Even better.

Yeah.

Da Vinci wasn't just a dilettante, right?

But one could make the argument, oh, I think you're right, too.

I think that's the beauty of this.

I think it's also hard, because sometimes we live in a culture that says, wait, wait,

you should have things really sharply specialized.

Even, here's my funny take on OCD.

I think it's wonderful.

It's wonderful what CBT and ERP and ACT have brought to the OCD world.

And yet, at the same time, sometimes I think they get a little obsessional, right?

That it's okay to do the Joni Mitchell thing and see both sides.

Yeah.

In fact, when I wrote the book, I was really inspired by these two business writers, Marianne

Lewis and Wendy Smith, who wrote a wonderful book called Both and Thinking.

And it's about how finding these really interesting solutions in business.

And in politics, by kind of blending things that seem to really not fit and working the

paradox.

Yes.

And I really think, as you know, in my first book, I felt that way, too, as being a really

good therapist is a paradox.

You're an uber listener as a therapist, and you should also be an uber talker.

Yeah, yeah.

You should be giving much back as you're taking in.

It really should be back.

Yeah.

And so I think you're right, David.

I mean, I think it's a wonderful sign of having that range again, that scope.

Yeah, yeah, yeah.

You've got some interesting chapter titles in your book.

One is Masterminding OCD.

What does that mean?

Masterminding it?

Yeah.

Yeah, I was trying to find a good metaphor.

So the first part of that is all this good inside.

Because most people with OCD think that all this stuff is just terrible, right?

OCD throws like the worst stuff at you.

All of the, you know, DEFCON 5 fears get thrown at you.

But masterminding it in a way, from my sense, is realizing, wait, you're just in touch with

the full range of things.

And as long as you...

Again, like you said, David.

Don't think, oh, my gosh, I have to have it all figured out immediately.

Yeah.

Let me see what I can notice and work with this stuff.

And that's both emotional as well as thought wise.

Because one of the things I write about in the book is how OCD is tricky.

It both throws you off the trail and distracts you from what's important, and it's trying

to focus you.

In other words, if a client, like I said in the book, had an obsession that she was going

to get brain damage.

If anybody touched her, she was very worried about this.

Yeah.

And when I looked at the context of when this obsession came out, she was at work

and somebody, a friend, playfully hit her, playfully.

But she was not assertive enough to say that she didn't like it or she, you know, was bothered

by it.

And all of a sudden, the obsession cropped up.

Now, the obsession, she's not really going to get brain damage.

But was she feeling uncomfortable around it?

Yeah.

Taking the aggression of taking up space and saying no completely.

And so masterminding OCD is learning how to see the richness of how it's trying to give

you a message, but it's an exaggerated form.

It's a messenger of sorts if you learn how to do it.

Yeah.

I'm remembering a patient that I worked with when I was pretty young as a therapist.

who had an obsession that maybe he had run over people on his bicycle.

And somehow it didn't seem to yield to reason.

You could say, well, if you ran over somebody on your bicycle,

you would really feel it, like it would throw you probably off your bicycle.

Yes.

But that didn't seem to be a terribly helpful intervention, as I recall.

You know, and some of the part, too, is that the feeling is so big, right?

The feeling of the potential for doing something so awful.

Sometimes I think one of the exposure exercises should be being with the feeling,

not necessarily the situation, right?

No.

It feels like the most horrible thing in the world, right?

And then I'd wonder, like, what were you feeling before?

Like, were you feeling like you were rushing home?

Like, what was going on, you know?

In other words, there's a fuller context.

I know that people with OCD therapists don't like to focus on the content of obsession so much

because they feel like that's providing reassurance and going down the rabbit hole.

But I think looking at the context is helpful, right?

Like, why now, right?

And you're right, though.

And I think that's part of the reason, too, is that, guys, I think sometimes you can't

always work these things through the mind.

Now, I think it's interesting about CBT is they try to work through going through the

behavior, which is very useful.

I think what I wish they would do a little bit more as well is to say, wait, let's go

into the feeling place a little bit more.

Yeah, yeah.

What does it feel like all of a sudden to feel like you could be a terrible person?

Did you have people who tried to work with you using CBT?

Key techniques and what was that like for you?

Yeah, you know, they have.

I've had people who wanted to do some of that stuff.

I've also had people who did the CBT and felt like there was more that they felt they were

missing or that the CBT worked to a certain extent.

One person that I can distinctly remember recently said, you know, Mike, I did the exposure

exercises and they helped.

But every time I wanted to talk about more about, let's say, my relationship and what

it feels like, they would say, well, I don't want to give you reassurance because, you

know, you doubt about relationships.

And it felt like there was it inhibited the person from being able to really get into

more of the full story.

And as we unpack the story, there was a lot of not so many reasons about the relationship,

but about the person's backstory that were coming up through some of these questions

and doubts that, yes, they were like I had a mentor who once said that obsessions are

bad.

They're bad.

They're like magnets.

They take a lot of material and they kind of focus them in one area.

And what's strange about it is, is that it makes it feel like that's it.

But ironically, it's not just it.

And so I think one of the things with OCD treatment is I would like us more as therapists

to zoom in and to pan out and to pan out to see, wait, what's the fuller context of what's

happening emotionally?

What just happened relationally, right?

Or what happened emotionally?

What happened in the person's story?

So this person who had a relationship concern, she grew up in a family which was very emotionally

unreliable and less, not very sensitive.

Yeah.

And so she was very concerned about getting involved with anybody who could be emotionally

unreliable.

This wasn't just a random obsession.

This had some meaningful connection.

Yeah.

You've got a chapter called Making Meaning in the Face of Death.

And tell us about that.

Big one, right?

Yeah.

You know, it's a big one.

And the reason I thought it deserved a special chapter is because when you look at every

form of OCD, whether it's harm OCD or contamination OCD or relationship OCD, what unifies them,

and Freud said this too, is the ultimate fear of death.

The fear of something could happen to someone that I love and need and care about.

Something could happen to myself, including I could lose relationships, which is a psychological

death.

So I joke there's an old game called Six Degrees of Kevin Bacon.

You know, like you could find the movie which relates.

And I think the Kevin Bacon is death.

In OCD, everything comes back to death, which is the Kevin Bacon.

Yeah.

Right now treatment leans toward not looking at too much meaning because you're afraid

like Jonathan Grayson, an OCD expert, says something really brilliant.

He says people with OCD are extremely philosophical.

They think about all the important questions.

The only difference is unlike people without OCD, they want the answer.

Right.

And he's right.

They do want the answer.

But I also think it's important for us to look at where we are.

Right.

maybe that's okay to look at through an existential lens that this is a very intensified

being tuned in in a very intensified way and existential sensitivity i said before i think

people with ocd have a sixth sense for empathy i also think they have a heightened existential

sensitivity and i think if we looked at it through that lens we could help understand that

there's a lot of good stuff out of that right darwin you know the funny thing is for someone

who was so worried about death he figured out how life goes on right greta thunberg who was

you know horrified when she was a child seeing environmental devastation has taken that as a

call to action to try and you know advocate you know for climate change or you know working on

climate change yeah and and and so i think what i wanted to get at with the

you know the the the the the the the the the the the the the the the the the the the the the

you know, making meaning is that there's such a taboo about meaning in OCD. And I don't, I think,

like I said, OCD has its meaningless distracting elements, and it has its meaningful ones. And I

think when we bring those things together, we have a much more powerful treatment for OCD. And I

think actually, you get more buy in from people with OCD. Because as much as you know, ERP is

successful, there's a good proportion of people that don't even want to touch it with a 10 and a

half foot pole. Right? Yeah, right. You know, theoretically, the thing that's drawn me in

psychology has been the existential approach, which is all about death and doubt. And, you know,

and... But doesn't Yalom say if we can, if we can face death and look it in the eye,

we can actually live life. Yeah. And so I, the upside for me of OCD is seeing,

it's not just that they're tormented by death, they're so aware of the beauty and preciousness

of life. That to me is the upside. Yeah. So your book, is your book out yet?

It's coming out November. It's out for pre-order on, you know, Amazon and Roman and Littlefield,

where it's published and all that stuff. Yeah. So that's, that's very exciting. And have you got,

you must have given presentations.

At conferences and so on, maybe where you're putting these ideas out there. And I wonder

what, you know, how they've been received. I gave my first this week, actually, I went to

the International, yeah, the International OCD Foundation, which is a wonderful organization.

And I led this support group about the upside. And I was so struck at how people were

sort of delighted to be able to talk about this stuff.

Yeah.

You know, it's like this, it's like this open secret, I think, within the community that there's

these interesting upsides. And without saying, I was very clear, we're not glamorizing or glorifying

this at all. We're saying this has lots of downsides, but this is also a part of one's

identity. It's sort of like a part of your sensibility. If you're an introvert,

that's part of your sensibility, right? I do, I do think that this is a really important thing

that people with OCD have not put words to. And it was really exciting to see people be like,

oh, I never thought of it like that. Yeah. I am really empathic to a fault. I am really hard on

myself. I am really uncomfortable with being a little bit more of a contrarian. Hmm.

Yeah, yeah.

So yeah, I'm really, I'm really excited to see when clinicians read it too, if they get excited about,

wait, there's more we can do.

With this, there's even more that we can add to our package of treatment.

Yeah. That's funny that you say contrarian, because one of the questions that I had formulated to,

to ask you about, but then I thought, no, I'm not going to go there,

involves, you know, well, are you generally a contrarian?

It's funny. I'm not. That's the, that's I think the reason why it took me so long to even put

this out there. So I did my dissertation on OCD with Dean McKay, who's a big researcher in the

OCD world. And he was very, very, you know, you know, very much up to date on all the empirically

backed stuff. And when I learned everything from him, but I was taking all these other classes on

existentialism and psychoanalysis at the same time, and I was doing a training in ERP. And I

said to him, Hey, would you be willing to sponsor me on a dissertation where I bring together

cognitive behavioral therapy and psychodynamic and attachment theory to look at OCD? And he's

like, sure.

And, you know, I did that thinking, okay, that was fun. And that was interesting. And I thought,

I'm not a contrarian. I'm not going to try and change the dialogue on this. And,

you know, I wrote my first book and I thought, well, maybe I should put this out there.

Yeah. Right. Right. Well, Michael, it's been such a delight to speak with you. And

I, I, I think these ideas are going to really catch fire among the,

the people who can benefit from them most and will in fact be a breath of fresh air or maybe a,

a torrent of fresh air in the field.

I love it.

Which we're ready for. So, and so I want to thank you too, for gracing me to come back and,

and be one of the people that would interview you as this, as it was still tender.

And, and just coming out.

Thank you so much, David. I always have such a good time talking and riffing together.

See you're a musician at heart.

Yes. Thank you. Thank you.

Okay. Well, I want to thank you for being my guest today on Shrinkwrap Radio and

I look forward to maybe other, other adventures that we'll have together.

It was thrilling to have the opportunity to work with Michael Alsay again. I'd forgotten

just how lively a personality he has. On the one hand, he is an advocate for a contrarian view of

OCD while he speaks out with great excitement for the positive aspects and potentials of the OCD

mind. And I think it's a great opportunity to work with Michael Alsay again. I think it's a great

opportunity to work with Michael Alsay again. And I think it's a great opportunity to work with

Michael Alsay again. And I think it's a great opportunity to work with Michael Alsay again.

He is not in denial about the limitations and the pain that often accompanies OCD. Whatever its

blessings he knows from personal experience, that there's no getting around the stigma that others

place on people suffering from OCD, as well as the way those external judgments tend to become

internalized into a kind of self-hatred. In addition, there are the real life inefficiencies

of having to take time to engage in one's compulsions and or obsessions. Also, I have

the impression that OCD, like other disabilities, probably exists along a spectrum from highly

disruptive to mildly disruptive. I had the opportunity to experience what a healing presence

Michael presents. As I confessed to some of my own limitations, he was so very

reassuring. For example, I have at times labeled myself as a dilettante rather than celebrating

the breadth I express and enjoy as a generalist. I have a wide-ranging curiosity and openness to

others that I bring to this work. As you will have heard in our interview, Michael's PhD

is in music rather than psychotherapy. Although he's done much to develop

expertise as a therapist, I was moved to share with him my own frustrations as a wannabe musician,

having taken many stabs in that direction as an adult. As I tried to learn improvisational piano,

I found I was limited by memory handicaps that prevented me from remembering the phrases

I had just played, such that the end result,

was a aimless wandering on the keyboard. Michael was so affirming and actually healing in his

reactions to my struggles as a musician. I really appreciate that about him, and it's easy for me to

see what a healing presence he brings to the clients that he works with. For me, our conversation

flowed as a kind of jazz. As time has gone by, I've been able to see that I've been able to

recognize many OCD-type characteristics in my own personality. To what extent those were created

by graduate study, and to what extent they were already present, I'm not sure. Michael has addressed

his book on the upside of OCD to the OCD-afflicted readers in his audience, and I can enthusiastically

endorse this book. I've been able to see that I've been able to recognize many OCD-type characteristics

in my own personality. To what extent those were created by graduate study, and to what extent they

were already present, I'm not sure. Michael has addressed his book on the upside of OCD-afflicted

readers in his audience, and I can enthusiastically endorse this book and his work to anyone who is

dealing with these issues themselves. I also think that he has an important message for the

psychotherapeutic community to widen their views about those who are similarly afflicted.

Caroline, a passionate and avid listener from Zurich, Switzerland. I love Shrinkwrap Radio

because the shows are very inspiring, motivational, and educational. They cover a wide range of

diverse topics presented in an entertaining and articulate way. In particular, what brought me to

the show is Dr. Dave himself as a person. He's an incredibly erudite professor in both worlds of

psychology, in the academic slash mainstream and, quote, more alternative fields. And he's an

excellent and empathetic listener. This makes him as a unique host, and maybe this is the

hidden secret of getting Shrinkwrap Radio addicted. There is no other podcast show that I

could think of that offers this combination. Thank you so much, and I hope you will continue the show

for a while, Dr. Dave. Thank you, Caroline, there in Zurich, Switzerland. I really appreciate your

appreciation for the way that I conduct the show and for the personal characteristics I bring

to it. Thank you.

Also, thank you for encouraging others to follow your fine example.

Time once again to shrinkwrap it up. Big thanks to Michael Alce for his revisioning of OCD

and for sharing so openly with us. At this point, I'm not sure who our next guest will be,

but I can guarantee you that it will be someone really good. So I hope you'll join us then.

And until then, this is Dr. Dave reminding you to be kind to yourselves, others, and our precious Earth.

All the psychology you need to know, and just enough to make you dangerous.