OCD Isn't Adorable. And Other Truths.

People, my people, this is so worth the read. 

If you want to learn about chemistry, about science, about brains, about ME JOHANNA, please read this and try to absorb it. It is such a Long but worthwhile Time.com article about "When Worry Hijacks the Brain."

Even the most stable brain operates just a millimeter from madness. In such a finely tuned cognitive engine, only a small part must start to sputter before the whole machine comes crashing down. When that happens, reason and function come undone, rarely as dramatically as in the neurochemical storm that is obsessive-compulsive disorder.

Say you leave work at 6 p.m. for what should be a 12-minute drive home. Say just as you're pulling onto the street, a child on a bicycle crosses in front of you. A few feet later, you feel the thump of a pothole. But what if it wasn't a pothole? Suppose you hit the child.

You look in your rearview mirror, and all is clear, but can you be sure? So you circle back around the block. Still clear--except for a lumpy bag of leaves on the curb. But is it a bag or a child? So you circle once more. Four hours later, you finally arrive home, mutter something to your spouse about a late meeting and go to bed spent and ashamed. Tomorrow you'll do it all over again.

Devoting an entire evening to a 12-minute drive is not the only way to know you've got obsessive-compulsive disorder (OCD). You know it when you shrink from the sight of a kitchen knife, worried that you'll inexplicably snatch it up and hurt yourself or a family member. You know it when leaving the house consumes hours of your day because the pillows on your bed must be placed just right. You know it when you can't leave the house at all for fear of a vast and vague contamination that you can't even name.

We all think we know what OCD is, and most of the time we're all wrong. It's the nervous guy from Monk; it's cranky Jack Nicholson in As Good As It Gets. In the end, though, things usually work out for them. They even get the girl, who sees them as a kind of adorable emotional fixer-upper.

But OCD isn't adorable. [Ed. Note: In the words of one Billy E. Crystal, "It's not funny, it's not fun."] 

About 7 million adults, teens and children in the U.S. are now thought to have it in one form or another, and their pain is far worse than you probably know. What's more, since one family member disabled by the disorder can destabilize an entire household, a single diagnosed case can mean several collateral victims. Worse, OCD is a condition that often masquerades as other things. It is routinely labeled depression, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), autism, even schizophrenia. Victims often conceal their problem for years, ensuring that no diagnosis--right or wrong--can begin to be made.

With the twin obstacles of secrecy and mislabeling, the average lag time between the onset of the disorder and a proper diagnosis is now a shocking nine years, according to surveys of doctors conducted by the Obsessive Compulsive Foundation, a 21-year-old organization with headquarters in New Haven, Conn. It takes an average of eight additional years before effective treatment is prescribed.

If the disorder strikes a young person, as it often does, that can mean an entire childhood lost to illness. "OCD has had a slow research start," says Gerald Nestadt, co-director of the OCD clinic at Johns Hopkins University. "It's behind schizophrenia, bipolar disorder, autism and ADHD."

But all that is changing. A burst of new genetics studies is turning up insights into the causes of the disorder. Scanning technologies are pinpointing the parts of the brain that trigger the symptoms. New treatments are being developed. And refinements of old treatments, like talk and behavioral therapy, are proving more effective than ever.

"Everyone has intrusive thoughts, but most people consider them meaningless and can move on with their lives," says psychologist Sabine Wilhelm, associate professor at the Harvard Medical School and director of the OCD clinic at Massachusetts General Hospital. "For people with OCD, the thoughts become their lives. We can give those lives back to them."

THE ROOTS OF OBSESSION, on the whole, a little anxiety is a good thing. It was not enough for humans in the state of nature to know there was no lion near the family cave; they also had to be able to imagine all the other places a lion could lurk. The same is true for other eccentricities of human behavior. Our anxiety about all the ways harm may befall someone else keeps us mindful of the safety of family and community. "There's a creative, what-if quality to this thinking," says clinical psychologist Jonathan Grayson of the Anxiety and Agoraphobia Treatment Center in Bala Cynwyd, Pa. "It's evolutionarily valuable."Something woven so tightly into the genome is not likely to be shaken loose by a few thousand years of modern living. But that doesn't mean every person with eccentric traits--the woman in the office next to yours who keeps her desk impeccably neat and gets edgy if something is moved out of place, for example--has OCD. "Having these OCD-like traits is a universal experience," says Judith Rapoport, author of the landmark book The Boy Who Couldn't Stop Washing and chief of child psychiatry at the National Institute of Mental Health. "I sometimes count on my fingers when I have nothing to count." The key to diagnosing whether such behavior is authentic OCD is how great an impact the behavior has on your life. "You have to show longstanding interference with function, and that eliminates most people," Rapoport explains.

What causes some people to suffer that interference and most not? Why does their internal alarm keep shouting "Lion!" long after they've checked every place a lion could plausibly be? The answer has always been thought to lie principally in a small, almond-shaped structure in the brain called the amygdala--

--the place where danger is processed and evaluated. It stands to reason that if this risk center is overactive, it would keep on alerting you to peril even after you've attended to the problem.

As it turns out, the amygdala is indeed a big player in the pathological process of OCD but only one of several players. Functional magnetic resonance imaging (fMRI) and other scanning technologies have allowed researchers to peer deeper than ever into the OCD-tossed brain. In addition to the amygdala, there are three other anatomical hot spots involved in the disorder: the orbital frontal cortex, the caudate nucleus and the thalamus--the first two seated high in the brain, the third lying deeper within.

"Those areas are linked along a circuit," says Dr. Sanjaya Saxena, director of the OCD program at the University of California at San Diego. It's the job of that wiring to regulate your response to the stimuli around you, including how anxious you are in the face of threatening or frustrating things. "That circuit," says Saxena, "is abnormally active in people with OCD."

Saxena, who has conducted extensive scanning research, has even come to recognize the neural fingerprint that distinguishes one less common type of OCD behavior--hoarding--from better-known ones. Hoarders who live alone have been known to crowd themselves into small areas of their home, with clear paths left from sofa to kitchen to bathroom, and the rest piled high with debris. When Saxena scanned the brains of these highly particular people, he found that they had equally particular abnormalities. Instead of hyperactivity in any area, they had reduced activity in the anterior cingulate gyrus, the part of the brain that helps you focus your attention and make decisions. "Those are things that compulsive hoarders have a lot of trouble with," he says.

GENES AND GERMS

Although scans can tell you the landscape of the obsessive-compulsive brain, they can't tell you how it got to be that way. As with many other psychological disorders, research is revealing that OCD has a powerful genetic component. Having any blood relative with OCD puts your risk of the disorder at 12%, and while that seems low, it's still more than four times as high as that of the U.S. population as a whole.

If the disorder comes to you through the genes, the next job is to determine which ones. A team of investigators at Johns Hopkins University last summer discovered half a dozen areas in the human genome that appear to be linked to the development of OCD. Analyzing 1,008 blood samples from 219 families in which at least two siblings had the disorder, they discovered gene markers at six sites on five chromosomes that appear more frequently in those kids than in family members and other people without OCD. That study did not tease out how those genes do their damage, but another group has identified a seventh gene whose mechanism is clearer.

Located on the ninth chromosome, that gene--discovered in two studies by researchers at several universities including the University of Michigan and the University of Toronto--appears to regulate a brain chemical known as glutamate. One of a number of substances that stimulate signaling among neurons, glutamate works fine unless you've got too much on hand. Then the signals just keep coming. In the case of the alarm centers in the brain, that means the warning bell just keeps on ringing.

"Glutamate has to be taken up quickly because otherwise it becomes toxic to the brain cells," says Vladimir Coric, director of OCD research at Yale University and a leader in studies of the chemical.

What makes the glutamate-related gene especially suspect is the particular people it affects the most. OCD strikes males and females about evenly, but early-onset forms tend to target boys more than girls. This is particularly true in cases in which the boys also exhibit the involuntary tics or vocalizations often associated with Tourette's syndrome. Interacting with the glutamate gene are three genes related to androgens, or masculinizing hormones. Interacting with those is another gene that has been implicated in Tourette's. Gather all these together in the same chromosomal neighborhood, and they can make trouble. "Kids who start early tend to be boys, tend to have tic disorders and, in genetic analyses, tend to have parents with tic disorders too," says John March, chief of child psychiatry at Duke University.

Other compelling, if controversial, research has long pursued an entirely different cause of OCD: streptococcal infection [Ed. Note: I have been repeatedly diagnosed with this]. As long ago as the 17th century, British physician Thomas Sydenham first noticed a link between childhood strep and the later onset of a tic condition that became known as Sydenham's chorea. Modern researchers who saw a link between tics and OCD began wondering if, in some cases, strep might be involved with both.

Last year investigators from the University of Chicago and the University of Washington studied a group of 144 children-- 71% of whom were boys--who had tics or OCD. All the kids, it turned out, were more than twice as likely as others to have had a strep infection in the previous three months. For those with Tourette's symptoms, the strep incidence was a whopping 13 times as great.
The tics and OCD are probably the result of an autoimmune response, in which the body begins attacking its own healthy tissue. Blood tests of kids with strep-related tics and OCD have turned up antibodies hostile to neural tissue, particularly in the brain's caudate nucleus and putamen, regions associated with reinforcement learning. "There certainly seems to be an epidemiological relationship there," says Dr. Cathy Budman, associate professor of psychiatry and neurology at New York University, "but what it means needs to be further investigated."

HOW TO FIX IT

No matter how or when the disorder hits, the first step in striking back is usually comparatively short-term behavioral therapy, using a technique known as exposure and response prevention (ERP), in which OCD sufferers don't try to avoid their particular source of anxiety but actually seek it out. Eventually, emotional nerve endings grow desensitized to the stimulus. The point is to tough it out until that happens. [ED. NOTE: FUCK THAT SHIT I'M NOT EATING NO TACOS OFF A PUBLIC TOILET I DON'T CARE ABOUT YOUR MOTHERFUCKING ERP]

At the Obsessive Compulsive Foundation convention in Atlanta last summer, Grayson, the Pennsylvania-based clinical psychologist, gave those in attendance who had OCD a quick taste of ERP. Inviting the ones in the audience with dirt and germ anxieties to come forward, he instructed them to sit beside him on the ballroom carpet. Then he told them to touch the carpet and bring their fingers to their lips. Left to themselves, most would have refused or, if they went along, would have then found the nearest bathroom and spent long minutes--perhaps long hours--scrubbing. Instead, they sat with Grayson and the anxiety, learning a very early lesson that the pain does subside. Extended ERP treatment involves a graduated series of such exposures, each a bit more challenging than the one before it.

Such tactical jujitsu works for all manner of OCD, though it's not always easy to find a doctor skilled at administering it. Patients obsessed about their sexual orientation, who become intolerably anxious if they so much as notice an attractive member of the same sex, are assigned to do just that: flip through magazines for scantily clad same-sex models. People plagued by what's known as relationship substantiation, who become consumed by inconsequential defects in a partner, are encouraged to seek out those flaws and even exaggerate them in their mind.
Medication helps too. Antidepressants such as Prozac and other selective serotonin reuptake inhibitors (SSRIs) can help dial down the anxiety enough that patients can get started with ERP and, significantly, stay with it. When patients are children, practitioners are more reluctant to prescribe medication, but they are careful not to stay too long with ERP alone if it's not producing results. "The longer a child struggles with an illness, the more impact it's going to have," says Dr. John Piacentini, director of UCLA's child OCD clinic. 

Still, there are some people--kids and adults--whose OCD is so acute that more extreme methods are needed, such as hospitalization, more intensive exposure therapy and other medications.

Coric, of Yale, is among the growing group of investigators experimenting with drugs targeting the glutamate problem. The best medication so far, riluzole, was originally developed for Lou Gehrig's disease and works simply by turning down the glutamate spigot, reducing the amount that's available in the brain. In Coric's admittedly small studies and clinical observations, half of about 50 subjects experienced at least a 35% remission, and almost all the rest improved at least a little.

Much more invasively, investigators are looking into deep-brain stimulation (DBS), in which electrodes are implanted in the brain and connected by wires embedded in the skin to a pacemaker-like device in the chest.

Low doses of current can then be applied as needed to calm the turmoil in the regions of the brain that cause OCD. The procedure sounds extreme--and it is--but it's already been used in about 35,000 people worldwide to treat Parkinson's disease, and FDA approval to use DBS for OCD as well is pending. "Many of our OCD patients are able to re-engage in life rather than being stuck at home," says neurosurgeon Ali Rezai of the Cleveland Clinic, who performs DBS surgery for Parkinson's and has researched it for OCD.

For the vast majority of people, the treatment never needs to go so far. OCD, for all the suffering it inflicts, is nothing more than the brain doing something it's supposed to do--warning you of danger--but doing it very badly. Living in the world means living with risks: real ones, imagined ones, exaggerated ones. That's not an easy lesson, but it's a powerful lesson--one that, once learned, can offer a paradoxical state of peace.

Even the most stable brain operates just a millimeter from madness. In such a finely tuned cognitive engine, only a small part must start to sputter before the whole machine comes crashing down. When that happens, reason and function come undone, rarely as dramatically as in the neurochemical storm that is obsessive-compulsive disorder. 

---

I hope you read this. I think that, even if you didn't, you need to understand that this is what it boils down to:

OCD, for all the suffering it inflicts, is nothing more than the brain doing something it's supposed to do--warning you of danger--but doing it very badly.  

Very badly indeed.

I Fucking Sit in My Tower. And Fucking Nap.

"Oh my God. Oh my God I've done it.

[Kage come here I want you!!]

Oh my God I did it.

I've done it.

I fuckin' did it."

---

Sorry to say that I didn't invent inward-singing, as per Tenacious Mother Fucking D. But. But you guys. Here's what I did do:


I hired a housecleaner.



Marcus was his name. He came today at 3:15 pm and left at 6:15 pm. And it went as well as could be expected.

But you guys. You don't understand. This is huge.

First, because, even though I have OCD coming out of my proverbial asshole and I vomit germ phobias and I shit Clorox bleach and I scrub my face with Comet, my house is a cluttered mess. My BFF chesea can vouch for this. (After she visited my house for the first time, in her words....well, no, here I must admit I'm paraphrasing, but basically she said, "I expected more of you." lol just kidding my love. I LOVE YOU CHESEA) :-) But she was surprised at the lack of absolute sterility. My house is full of bullcrap. See, everything you actually touch in my house is clean. Disinfected. Cleaner than the driven snow. Even though that makes no sense because snow what has been driven through is brown and dog-pissy and mud-tracky and gross. Either way, if you lick my sink faucet, you will end up healthier than when you started. If you lie prostrate on my kitchen floor, your clothes may end up with bleach stains, but no big deal right. If you place your MRSA-infected ass-boil on my toilet (and please do not do this), it will magically heal. All because I disinfect. I disinfect, see. Things are cluttered but clean. CLEAN.

Do I dust? Fuck to the No. Do I wipe down my crown molding and baseboards and the top of the shelves? In your wildest dreams. Do I organize my pantry cupboards?

HAHAHHAHAHAHHAHHAHA

HAHAHAHAH

HAHAHA

Oh and plus I'm a hoarder. Not quite like my mother, Jesus bless her sweet soul--

But, I do have, ummm, issues with letting things go. Things like old craft paper and rubber stamps. Things like music boxes that I will never open again to hear their sweet tinkly sounds of "The Wind Beneath My Wings." Things like clothes: I have shirts I wore in LITERALLY 9th grade (I am currently 34 motherfucking years old, should you wonder how many years have elapsed since I was 15). Things like shoes, no matter how dusty, nasty, and cobwebby, no matter how long they've gone un-worn in the garage. Things like stupid fugly Pippsywoggin fairy dolls that my darling grandma gave me, God bless her sweet kind heart--

And yes this is the exact model I own

Things like my old nametag that used to be on my office door before I was married and became Johanna [Last Name Redacted].

In fact, here's an actual snap of it, rearranged and copy/pasted MS Paint-Stylee, and if you're clever, you'll be able to deduce my maiden name BUT WHATEVER YOU FUCKING STALKER:

I think this anagram is mad approp.

What the fuck was I SAYING before I started dicking around with Photoshop and talking about the shit I hoard??

Oh yes. I hired a house cleaner. So, yes, I hired a house cleaner. After I made email contact with him, all I could think was,

Because here's a man, a DANGEROUS OMG MALE MAN WHO COULD DO ME HARM WHILST I'M TOTALLY ALONE AND HELPLESS IN THE HOUSE WITH TWO TINY BABIES. And then I was like, "A housecleaning rapist? Really Johanna? Really?"

And then I thought, plus, he's coming to touch my things and wipe my things and walk on my things and breathe on my things and I was like, "Fuck this, not in my sterile bubble!! How I'mona let someone into my Cloroxed haven?? How I'mona let some stranger clean and manhandle my shizz??" Because I'm all about my sterile bubble. My home is my sanctuary. Let someone in my bubble? Fuck that.

OH THE HORROR!!

At first I thought I was going to be all

...but then after I researched him and realized he not only had stellar reviews but that he is FULL-ON AMISH (somehow this made me feel better), I hired him.

So he came today. He knew a bit about my phobias (in my email, I had mentioned fears about cross-contamination and our policy about no shoes in the house and shit like that), and I had heard that he was a generally respectful man anyway, so I did it. I did it, I've done it, I fuckin' did it.

So he came over at 3:15 pm, and whilst my beloved mother took my eldest to the park, I played outside with the baby for two got-damn hours to give Marcus his space and to hopefully make him feel comfortable didding what he needed to did. After two hours outside (playing on the swing, playing in the wading pool, playing with bubbles), we went inside to watch Sesame Street. Marcus was conversational and pleasant and kept about his busy-work.

He did a lot of good stuff, and although there are a few nooks and crannies that he missed (that anyone in the world would miss, I imagine, which I later touched up, like Windexing down the brushed-steel garbage can and dusting the Kinect and wiping off our living room lamp table), I am pleased.

Of course, I don't have to tell you that after he left, I took Lysol wipes and cleaned off the doorknobs, light switches, faucet handles, etc., but that is my failing, not Marcus's. Because I am Johanna, and I am an OCDer.

Anyway. What I'm trying to say, and which you may have gathered, is that I DID IT, I FUCKING DID IT.

YESSSSSSSSS

You guys. I hired a house cleaner.

Now, this is not to say I still feel like a total failure for not being able to deep-clean my own fucking house because I'm nothing but a simple fucking housewife and mother of two small childrens, but still, major step here. Major step.

I feel good. I feel refreshed. Now that I've Cloroxed the handles of everything, I feel safe. Marcus was a gem. I made progress today. This feels good.

If I Don't Die of Anxiety, I will Die in a Fiery Plane Crash.

This blog is too long for you to even read. I highly recommend you skip it. Love, Johanna.


However. Should you choose to embark on this epic journey....let me just say a few hundred things.

My anxiety has been through the roof lately. Which is obnoxious, because I'm on a whole shitload of meds that are supposed to counteract my anxiety. But of course, my motherfucker of a superliver processes shit out before I can even swallow it and nothing affects me, nothing. Fuck you liver and the horse you rode in on and a curse on your children and your children's children. I hate you in the face. Liver, metabolism, toleraance to drugs, I want to ream you in the goat ass.

So this is approx how many meds I take a day. Give or take. And nothing's helping. Fuck it all.

The anxiety is killing me. I lay awake at night worrying so much that I cry while my husband sleeps soundly. What kinds of things am I worried about, you ask? I am so very deeply glad you asked. Let's see. Oh, and bear in mind that not many of my worries actually make sense. Some do, and some are so off the wall I can't even. I can't.

• There's choking, which you know I obsess about constantly. Every minute of every day. And night. That goes without saying. I will cut blueberries in 8ths before I serve them to my children. Grapes? Forget it, I dice those fuckers until they are unrecognizable mush. Hot dogs are chopped into morsels the size of sunflower seeds. I will dice cheese into wafer-thin slivers. I will still mash banana rather than let her take big bits of a full banana. I can't get over the what-ifs. Right this minute I had a moment of insanity and I am ACTUALLY letting my child take bites of a whole apple and I want to snatch it from her hands and shout "YOU ARE GOING TO DIE TO DEATH OF APPLE."

This is about how finely I chop all foods:

If not smaller.

• I worry that my daughter has some terrible illness like leukemia, because I spotted a bruise on her spine. Well, and bruises on her legs and arm. I can't stop imagining terrible scenarios in which I find out that something is truly wrong with her. And I bawl my eyes out. All because of some bruises. On a clumsy, klutzy four-year-old. On one hand, she's four. and wild. And did I mention accident-prone. On the other hand, bruises on her spine and other random places? Mama's radar is on high a-fucking-lert. It all goes back to the "It happens to someone" mentality. Why not me, why not my child? What is wrong with her that she bruises so easily? My mind races with the possibilities. I. Am. Neurotic.

• This one a doozy of whatthefuckery. I'm embarrassed to talk about it. I worry about taking the kids on an airplane. Do you want to know the exceptionally hilarious part? We have no vacation or flights planned. We aren't going anywhere. But I lay there at night, unable to sleep, panicking over the potential dangers of a POTENTIAL FLIGHT THAT WE MIGHT POTENTIALLY SOMEDAY TAKE POTENTIALLY. My stomach knots up, my muscles tense, I play out terrible scenarios in my head, I just know, I KNOW, that we will all die a horrible death if we fly anywhere. I think to myself, "It happens to someone. Someone dies in a plane wreck. Why not us? How do we know it won't be us?" But I must emphasize: We have no vacation or flights planned. Yet I lie awake fretting over this completely hypothetical flight that we do not have planned. I don't care about statistics. My newest therapist Dr. C keeps telling me how it is outrageously unike that we all perish in a terrible, unspeakable demise on an airplane. But it happens to motherfucking someone. Mr. Sr. Dr. Joe John Abernathy McSampson-Bronhild boards a plane, maybe his usual 45-minute quick jaunt from SEA TO PDX, but today wasn't his lucky day. He expected to make it there fine and in one piece, maybe the worst that could happen was that his luggage was diverted to Texas. But instead he died a gruesome death, plummeting for his few last minutes on earth thinking, "This is how I die. Today I die. Right now I die. And how bad is this fucker gonna hurt? This shit's gonna hurt. I'm going to smash to smithereens, all because I took a business trip to Portland, OR. I die now. I'm dead." Why him, but not me? Yes I'm away of statistics and "You're more likely to die in a car wreck than a plane crash. But (1) that doesn't reassure me any about taking motherfucking car rides; and (2) I must go back to the fact that Someone Dies On A Plane Though They Least Expect it. Someone dies. And that, to me is an almost intolerable risk. Do I want to go to Hawaii again? Would I like to visit Fiji? Scotland? The Bahamas? Yes. I do. I want a vacation. But can I ever bring my beautiful tiny children on a horrifying dangerous airplane ever again? I do not know.

• I worry that I somehow blinded the kids. The other day, I filled up a kiddie swimming pool with water and, thinking I was being hygienically smart, I tossed in some chlorine (which naturally we have on hand, doesn't everyone?). Turns out after talking to my husband that I used approximately 40 times too much chlorine. Seriously. I threw that shit in like it was no big thang. Like, let me just give you a for-example: When it comes to cooking? I am a whiz kid. I know just how much salt & pepper, just how much cilantro, just how much honey mustard, just how much flour, just how much cayenne, just how much basil, ad especially just how much garlic to add. I toss it in, without measuring, and it comes out spot-on. It's intuitive, it's instinctual, it's innate, it's a skill. And my meals ROCK. So I looked at that wading pool and, thinking I knew what the fuck I was doing, decided to add yay-much  powdered chlorine, 

Er, make that, yay-much:

And like I said, turns out that I added a fuck-ton too much. At one point, before I knew this, my daughter got some water in her eyes and started shrieking. I had her dry her eyes on a towel and after a bit she eventually said was OK, and she has had no apparent complications since, but now that I know that the water was basically straight mothershitting bleach, I'm freaking the fuck out that I caused lasting damage. Oh, and Maya splashed the baby in her eyes, too. So I lay there crying at night thinking I blinded both my children or that they will go blind at age 11 because I used a fuck-ton too much chlorine in the wading pool. Seriously. a FUCK-TON TOO MUCH. You have no idea how much I used. I am riddled with guilt.

• I worry about putting my daughter back in school (she's been on, er, um, "hiatus" since Christmas). I worry about all the germs she'll encounter, how every kid is sick every day at all times with something horrendous, how sick Maya will get, and how sick she'll then make the baby. The baby will then get super congested and phlegmy and chokey, and will get double ear infections, as is the pattern. And then I will have to take her to the doctor. Where she will surely catch some other dreaded infectious disease. All of which makes me panic. 

• And I worry about something happening to Maya at school, or someone kidnapping her. I worry about her escaping out the back yard gate at the playgound, which because of fire codes has to remain unlocked. So anyone could get in, anyone could get out. There are so many things to worry about when my child is under my supervision, but when she's not? When I have to trust strangers with my most beloved creatures on earth for 5 or 6 hours a day? My anxiety skyrockets.

• I worry that the back door is unlocked (you know this) and I check it up to ten times a night. Several times at once, too--I yank it like five times in a row to make sure it's locked, or I will it once and keep pulling for like 20 seconds to make sure it's closed. But I also lay in bed worrying that the garage door is wide open. I'm afraid someone left it opened up and that an intruder will enter and steal my children. This is absurd because about 98% of the time, no one opens the garage door all day or at night, and my husband comes home from work and would notice if it was left open, and he often goes out to the garage fridge for a Coke and would also notice if it were left open. See, it's never left open. But I lie awake at night worrying that it is. I ask my husband, "But how do you know it's not open?" because I am unfamiliar with this thing called "knowing something's already been done." For me, I never know. OCD means never knowing something has been completed to satisfaction or peace of mind. I always worry.

• I worry that our giant treadmill, when left in its full upright and locked position:

...will come loose and fall on the fragile skulls of my children playing innocently in its vicinity. It's kind of jury-rigged with a bolt to stay locked, so maybe this fear is more "founded" than my other fears, but still. How likely is it that it will spontaneously fall down just as the baby is 'neath it? V. unlikely. Yet I toss and turn and sweat, thinking of the what-ifs. I finally had to get up one night at 3:30 am and unbolt the fucker and lay it down in its, well, its "down" position just so I could go back to sleep knowing that it wouldn't crush my kids.

• I worry that I leave the tub filled with water after the kids' bath. I imagine my dearest husband having a momentary lapse in sanity and letting the kids go unsupervised (an unfounded fear? I'll let you decide), and then my top-heavy baby topples into the full tub that I accidentally forgot to drain, and she and meets her demise without anyone noticing. Again, I wonder, "Did I really drain the tub after I bathed them?" You people without OCD or intrusive thoughts will not understand. You will think, "If you drained the tub, you fucking drained the tub. And you know it." But I don't know it. I wonder, and I worry. Did I drain it? Did I really? WHAT IF I DIDN'T? Did I? Can I be sure? How? How can I be sure? How many times should I check, and can I go to be really knowig?? Because what if?

It's such a sickness.

• I worry that I'm an absolute failure as a mother. I lie there thinking about how little I did with my kids today. How maybe I shoved some Play-Doh in Maya's direction and said "Have at it" while I watched Snooki & JWoww or the Bachelorette on TiVo. How maybe I set Naomi up in front of Sesame Street while I played shitty games on Facebook. How we stayed indoors even though it's beautiful out. How I can't remember the last time my kids SAW OTHER KIDS. How we don't go to parks or kids' museums. How I fed them toast, crackers, and cheese all day and nothing good for them. How I never got down on the floor and played with them, all day. Every night I think back on the day and call it a total failure. Every night I think to myself, "Did I succeed or fail today?" And every single night of my life, my answer is, "Fail." Every night it's Fail. Every night I vow to be better the next day. But I never am.

• I worry about potentially getting my deviated septum fixed. I lie there and get sick to my stomach over the fact that they'd have to surgically take a chisel and re-break my nose (which I first broke back in 2004) and then I'd have to deal with all the swelling and black eyes and the intense pain (and as you know I am completely immune to painkillers so I would have no relief). Then there's the fact that my child head-butts me in the face on the regular and would probably smash it right back up. And that I'm not supposed to bend over or pick anything heavy up for ages. How do I keep my house clean and pick up my daughter?? I lay there agonizing over the decision to fix my nose or not. My fucked-up schnoz has caused me endless pain and distress in the past, breathing problems, swollen nasal passages, I can only sleep on one side because I can't breathe if I sleep on the other side. Not to mention, if I'm going in to have my septum straightened, I'd like then to do a little summat-summat with this gigantic crooked long ugly nose of mine, cosmetically speaking. I mean, while they're in there, they could at least straighten it and shorten my ugly hooknose. But while insurance would cover the entire cost of a medically necessary septoplasty, any rhinoplasty cosmetic work would not be covered and would be like $10,000 more. What do I do? What do I do? I agonize over the thought of going through another broken nose, the horrible pain, the healing time, the absolute gross-out factor (I want to barf when I think of nose jobs), possible complications like a messed up ugly botched surgery leaving my nose uglier than before:

 ...and oh yeah, the prohibitive cost. But I also agonize over having an ugly, long, crooked, troublesome, fucked-up nose for the rest of my life. And I only have a couple of months to decide because our super outstanding insurance runs out this year.

Yours truly, in great pain, after the first surgery to re-set my broken bones, which did not end up healing well at all.

• I worry about the state of my marriage. Enough said.

• I worry about the End of Times. I worry about 12/21/2012. I worry about super-flu and plagues and famine and the pale horse and stock market crashes and EMPs and asteroids and aliens and the antichrist because I am a super religious Jesus Freak.

• I lie there and thing of the gruesome ways I could die. Chances seem one in a trillion that I will die peacefully old of age in my sleep without even knowing it. Go to sleep, wake up in heaven, win-win-win. But in all likelihood something far more gruesome will happen. Odds are good I won't die peacefully in my sleep at age 101. I will choke to death while I am home alone with me helpless children; I will run out for a quick Starbucks and cocoa for the tots and we will be smashed to smithereens on the two-minute drive home by a drunk semi-truck driver. I will die of a suden brain aneurysm. I will get a rear, incurable, and painful cancer. I will get Alzheimers at age 45 and die a slow miserable death. I take a shitload of my prescription medication and I get worried every night that somehow I will overdose or that it will be too much for my body to handle. Every day I wake up thinking, "Well I survived another night and did not fall into a coma from my Prozac, Lamictal, Buspar, Klonopin, and so on and so forth. But how long until I fall too deeply asleep and don't wake up?"

Sick in the head? Why yes, yes I am. I am exhausted. I am a constantly high-strung ball of intense nerves and I just feel ready to explode all the time. I've said it a thousand time, I cannot live like this. I cannot live like this. But what else can I do? I take enough medication to kill a horse. I see two or three different therapists. I just feel like there's no hope for me. Every day it's get worse. Every I have something else to worry about on top of all the other things that already consume me. It all started off with anxiety and OCD. Now it's full-blown depression to where I can barely function or want to live. If only something would work for me. If only medication could help ease my symptoms. If only I didn't have so many problems that I bring upon myself (so much is my own bullshit fault). If only I weren't such a waste of a person who does nothing with her life and never will. If only, only, only I were a better mother. But it's not so simple as wanting it or deciding to do it or just bucking up and getting my butt in gear. It's a fucking sickness and I'm consumed by it. I feel lost. I feel worthless. I feel a failure.

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This post has been pure depressing. Here, have a motherfucking baby squirrel. Goddammit all.

My Life in Four Pictures.

Doooon't Think About Beerd.

How much would someone have to pay you to drink Beard Beer?

"It reads like a headline from The Onion, but this bit of news isn't fiction: Craft brewery Rogue Ales is working on a new beer made with a strain of wild yeast produced from the follicles of brewmaster John Maier's beard."