Monday, March 09, 2009

Dear Charlie:

I work in the mental health field. True, I am nowhere near a provider -- not a psychologist or psychiatrist, not a therapist/counselor, not even a case manager. No, I'm a lowly records clerk.

However, I have this peculiar ideology as regards those records. I treat them as I would treat the people described in them -- with respect. The pages I process and sort and file away are filled with people's hopes, fears, dreams, despairs, nightmares, obsessions, fantasies...their most private, personal thoughts. I get angry when a provider carelessly slaps a chart closed, thus folding up the topmost pages. I get even more irritated when I find rips, tears, bad hole-punching, and staples (which lead to all three).

Yeah, it's a weird ideation, but I can't help it. It's the mental health field. I suppose I am allowed my own foibles to survive in it.

Anyway, while I don't routinely read any of the paperwork I endlessly shuffle, I do occasionally catch a glimpse of a word that snags my attention. Usually words that deal with OCD -- obsessive-compulsive disorder. I find that particular brand of hell endlessly fascinating in a horrifying kind of way.

Probably why I've read Stephen King's short story, N. from his Just After Sunset compilation, four times already, while the only other story to get even half so much love is The Gingerbread Girl, which is as opposite from it as can be.

And not that the other stories aren't equally good. Don't get that idea. Some just grab me more than others.

Anyway, N. is a patient, you see. It's a HIPAA thing, see. Providers in the medical, mental, and legal fields (probably others, but these I know of personally) never refer to their patients by their full names anymore. It's to protect the patient's privacy, and I can't imagine a more important privacy to keep than a person's own questions of sanity.

In specific, N. is a patient who has recently developed one of the more severe cases of OCD ever seen. Without giving you a book report (or a case report, if you like that better), N.'s core delusion -- the rock upon which his obsessions and compulsions are footed -- is that if he doesn't perform these certain behaviors, a thin spot in the skin of the world will split open like that of a noxious, rotted wound and spew forth abominations from another dimension.

Funny thing is, while such core delusions are surprisingly common among sufferers of OCD -- though usually less specific or strongly expressed -- Mr. King...makes it seem not only possible and plausible but...necessary. It's no wonder everyone who heard the tale was compelled to visit the scene from which sprung the core delusion.

If I hadn't already pitied (in the best sense of the word) people plagued by OCD, I would do so after reading. The typical diagnosee is firmly (if falsely) convinced that "something bad" will happen if they don't perform their rituals.

So...what if..."something bad"...did happen? What if you witnessed the very bulging of the woefully thin skin of the world and saw your counting, your touching, your placing of objects (or balancing, if you prefer the term) positively affect that bulge? Seal it away? Make that thin place stronger, even if only for a while? Would you still be a mere diagnosis in the ICD-9? Or would you be the bearer of such an onerous burden that it had broken many a strong man before you and will break a legion more when you're gone?

Does proof of the bad that would happen make the obsession, the compulsion less a disorder? Or does it just make it that much more terrible?

God, I love that story. It does what any story should do and what any horror story should especially do. It...I dunno...connects.

And creeps you right the hell out. Geez, man.


At 8:01 AM, Blogger writtenwyrdd said...

This is fascinating, but I must say that your understanding of OCD misses a huge population of sufferers who are not suffering delusions at all. Many (if not most) OCD people have issues with things like having to count things, or wash their hands or pull out their hair or similar behaviors. They do these things not out of a belief that they must or the world will end (or whatever); but because they hust HAVE TO DO IT.

And I can say this because I have an OCD. And so do several members of my family. And the compulsions are all different and named, without any psychoses or delusional problems present.

At 10:02 PM, Blogger GutterBall said...

Bless your heart, WW, but I didn't mean anything by it. I did say such delusions were surprisingly common, not that they're the only issue or that a core delusion is the only way to manifest OCD behaviors.

In fact, like phobias, the very reason OCD is a diagnosis is because there is no rational reason for the behavior. You're right: you just have to do it. Sometimes, there is no why.

I was just commenting on my horrible fascination with those who have formed the why.


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