Newsletter

Good OCD, Bad OCD2024-09-03

The most successful people at something are obsessed with it. They compulsively pursue that activity. They dissociate at times from reality to create, quasi-delusionally believe they can be the best, and change the world. That is OCD of the good kind. Steve Jobs had it. So did Michael Jordan, so did great artists.

Conversely, when people are obsessed with some potential threat, compulsively do activities to mitigate that threat, and this delusion of danger disrupts their lives, that is the clinical disorder OCD. At the extremes, suicidality is OCD.

The antidepressants we use to treat obsessions, the mood stabilizers we use to treat compulsions, the anti-psychotics we use to treat dissociation and delusions, do work. But how many Steve Jobs have we lost to over-medication, how much ambition, greatness and creativity has been stifled by the prevalent mass use of these medications, in particular SSRIs? The key is to find the sweet spot between over-treating and under-treating. Using for minimal amounts of times minimal effective doses of the right medications, until lifestyle changes and therapy pick up the slack, all take a clinician who is confident, experienced, and independent-thinking. The default mode nowadays is to (over-)prescribe. It also takes precision medicine tools, which my teams have developed, to make it easier for doctors to prescribe less with confidence.