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Girls and OCD

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We are moved to discuss the last three episodes of last year's Season 2 of Girls, the hit HBO television series a year after it first aired because of its realistic and sensitive portrayal of a challenging mental health issue known as Obsessive Compulsive Disorder (OCD). Chances are you've heard of OCD. Most everyone has a touch of it, but you may not know much about it in its extreme form.

Sufferers are no mere perfectionists or procrastinators who work best under pressure. According to the OCD Foundation, it affects about 1 in 100 -- or between 2 to 3 million adults -- and about half a million children in the United States. It affects men, women and children of all races and backgrounds equally. A terrible disorder, it's characterized by intrusive thoughts that can create unrealistic fears, pervasive obsessions such as hoarding, and certain repetitive behaviors such as excessive hand washing, as well as other nervous rituals.

OCD afflicts Girls main character Hannah, who has been in remission for the better part of a decade. When it returns, we see a full blown relapse in all its eerie "glory." Hannah's first bout officially appeared in high school. We imagine her as a neurotic over-achiever with dreams of being a writer, who went overboard, as she became out of control with her desire to be in control.

With the hard work and discipline of individual therapy, family therapy and medication, Hannah, like Girls creator Lena Dunham, was one of the lucky ones. With treatment her OCD was manageable and had gone dormant. Fast forward to Hannah's early 20s and on the brink of a game-changing career opportunity. Faced with a looming deadline to deliver the final manuscript on her first major book deal, at the same time she's dealing with a break up of her boyfriend.

Hannah is highly triggered and very anxious which is to be expected under the circumstances. Rather than honoring where she is with it, she lives in the denial that got her into trouble to begin with as a teenager. We don't see her reach out to a therapist or a psychiatrist.

Instead, she becomes a victim of her own success, and forgets that treatment and relapse prevention requires management over a lifetime. Basically, when she stops maintaining a rigorous regime of self-care her OCD returns.

Attempting to bring order to her chaotic experience, Hannah reacts irrationally and does everything by numbers and counting. Initially, she attempts to hide this from her parents but they're onto her, confront her, and even attempt to get her help. Initially their good intentions are not a source of support of comfort for her.

Worse, they are in turn overwhelmed by her and unwittingly collude with her. Out of loving concern, Hannah's parents nonetheless are frozen in how to assist and her symptoms, which along with the worry about her, worsen. The parents' anxious coping skills seem rather weak so why shouldn't hers be?

They begin to feed off each other as Hannah engages in increasingly maladaptive coping behaviors such as emotional eating. One night she gives herself a bizarre haircut. They wring their hands and offer encouragement that she rejects. Coming home, doesn't work. This is the good news and the hard news.

Actor Robert DeNiro recently described a writer's life best in jest, addressing this year's Academy Awards, "The mind of a writer can be a truly terrifying thing. Isolated, neurotic, caffeine-addled, crippled by procrastination, consumed by feelings of panic, self-loathing, and soul-crushing inadequacy. And that's on a good day."

Hannah's editor begins to doubt her and along with extreme insomnia, she develops writer's block. Instead of being patient and sitting quietly with her muse, she makes odd and impulsive decisions, becoming somatic with tension head and stomach aches. Finally, by cleaning her ears so compulsively, she ends up in the hospital emergency room.

That's when she finally bottoms out and begins to repair. Hannah reaches out to her ex boyfriend and he too, confronts her behavior. In true retro-Hollywood style, she knows whom to turn to for the safety of support and they resume a torrid love affair.

These episodes are a reminder that good or bad, stress is stress, and by definition hard to live with. There will be triggers in people's lives in the best of times and in the worse. How one manages triggers and can learn from what is stirred up, yes can unsettle, but also instruct us. Learning from these low moments is almost more important than the origin of the stress. A set-back can also be a re-set in life when properly handled.

When stress isn't managed the triggers that lurk in everyone, run amok and takes us down. If someone has a prior diagnosis he or she is at particular risk for relapse. Everyone is susceptible to stress. Although there will be struggles, the message is how stress is handled determines our existence.

Season 2 ends not knowing if Hannah can respond to the pressures, pull her life together once again, and deliver the manuscript. Spoiler alert: Season 3 opens with the huge critical acclaim and widespread reader acceptance of the book that nearly sent her over the edge writing it. As the consuming public, rarely do we get an accurate behind the scenes view inside the creative process. Bringing to fruition any work of art is often the result of a highly arduous and unflattering process, it's true.