I obsess, therefore I am
By Simon Lewsen, The McGill Daily (McGill University)
Last year I would call Donna every Thursday at a quarter past five. There’d usually be a couple of rings, then I’d say a brief hello to the receptionist, and then Donna would pick up.
“Hello Simon.”
“Hi there, Donna.”
She really has one of the brightest voices I’ve ever heard. She also has a vintage New York accent, and she talks a bit like Stephanie from Saturday Night Fever. I picture her looking like Stephanie as well. But then I wouldn’t know. I’ve never met her.
Usually we’d start out with some chit-chat. Donna likes a lot of the same music as me, and she’s into movies and literature as well. And then there are the inevitable comparisons of weather in Montreal and Manhattan. We have a lot to talk about. But sooner or later, one of us has to get down to business. She’s the therapist, so she usually initiates this.
“So tell me Simon, how many people did you kill today?” Donna laughs out loud when she asks this.
“I don’t know. I’ve been slacking a bit. I was going to kill a few people in my cultural studies lecture, but I got distracted.”
“Simon, you know you have to keep on top of these things.”
“Yeah, I know,” I say, “I’m really sorry.”
At this point, both of us laugh. I never thought I’d be having this kind of conversation. And this is therapy. It’s pretty funny really. But obsessive-compulsive disorder (OCD) is a funny thing. I understand that now.
People don’t really understand OCD. My only knowledge of the disorder came from Jack Nicholson’s character in As Good as it Gets. I do not see any similarities between him and me, which explains how I managed to live with the disorder for almost five years without knowing what it was.
The first long night
When I was younger, I always had trouble with images of violence. I would watch slasher flicks, and then stay up all night, sometimes for two or three nights straight. Always, one image from the movie would linger in my mind, more vivid and haunting than it had been on the screen. Sometimes it would linger for weeks. The more I wanted to get rid of it, the more tenaciously it would remain. I always thought this was normal, and I suppose, to a degree, it was. But then, in January, during my first year at McGill University, things got a little worse.
It was the first Saturday of January, and it was a really cold night. That night was my first encounter with a real Montreal winter, among other things.
I was with one other friend, and we were perched at a corner table at a local brewpub. We were chatting about this and that: politics, sex, you know, student banter. Somehow we got onto the topic of death. I think it started as a discussion of assisted suicide, but pretty soon we were just talking about death.
And then I had the worst kind of thought. The kind that comes at you from left field with unprecedented intensity.
I thought: What would she look like if she were dead?
And that was it. I tried to push the thought away. I tried to ease it aside and replace it with something pleasant. That night I lay in bed and the same macabre image flipped through my mind. Then I started thinking in the same way of other people, people I knew and loved. I didn’t want these thoughts, but I couldn’t help them. I wished I’d never started thinking them in the first place. But you can’t retract a thought any more than you can prevent one.
A technical interlude
The technical name for my disorder is pure obsessionalism, which is a form of obsessive-compulsive disorder. Doctors have pet-named it “pure-O.” It’s hard-hitting and much more widespread than you’d think. There have probably been countless pure-O related suicides in Canada. But there’s no way of knowing. It’s not something people talk about.
Basically, all types of OCD centre on an unwanted thought, which, in medical jargon, is referred to as a “spike.” Usually, people take some kind of action to dispel this thought, or at least alleviate some of its intensity. Doctors refer to this as a “ritual.”
For example, consider a compulsive hand-washer. The unwanted thought, or spike, might be “my hands are filthy and bacteria infested, and pretty soon I’m going to get sick.” This might be accompanied with some kind of gross-out mental image.
So the hand-washer goes to the sink and performs a ritual washing of her hands. For a short while, she feels better. The problem is, while the ritual alleviates the spike in the short-run, it actually re-enforces it in the long run. Our hand-washer might feel all right for a minute or two, but then the spike reappears and she’s off to the sink again, and again, and again. She might wash her hands thousands of times in a day. Her skin might start to bleed from excessive contact with soap and water.
This seems a little counterintuitive because, after all, washing one’s hands until the skin breaks can’t possibly be hygienic. But here’s the tricky part: it isn’t really about hygiene. She isn’t really washing her hands to get them clean; she’s washing them to get rid of the persistent thought that they’re dirty. In effect, she’s trying to cleanse her mind.
Unlike hand-washers, checkers, and hoarders, pure-O sufferers don’t have any outward rituals. The rituals are usually mental (such as trying to replace bad images with pleasant ones) and sometimes non-existent.
Apart from this, the same principles apply: an unwanted thought arises, and the more you try to dispel it from your consciousness, the more persistently it re-appears. For me, it got to a point where I couldn’t go more than 10 seconds without confronting a gruesome image of one kind or another.
I had trouble when I was alone, but things were always worse around people. I found myself transplanting the images in my mind onto the faces of those around me. I couldn’t look at another person without picturing them dead . . . and dead not in the nicest kinds of ways.
This caused tremendous anxiety. In my case, I tried to think deeply, looking for meaning. I felt horrendous guilt every time I looked at a friend, or passed a stranger on the street, and unintentionally thought something untoward.
During the worst period, these thoughts would render gripping, daylong bouts of anxiety — the kind that constricts your chest, and interferes with your breathing. Sometimes, I’d wake up in the morning and my muscles would ache all over from panicking the day before. And always there was this pervasive feeling of being haunted, of carrying this harrowing secret that would shock everyone if they knew. And of course, the more I wanted out, the more entrenched I became.
The invisible disorder
As I said before, people don’t talk about pure-O. Doctors only really established its existence about 20 years ago. Even writing about it is pretty tough. But I believe that talking about the disorder will make life much easier for its sufferers.
Usually, in the case of pure-O, the unwanted thought is laden with bothersome implications about the person’s character. A young man might have an off-the-cuff image of one of his male friends naked and start to question his sexuality. A loving parent might start having horrific thoughts about killing his or her child, and begin to wonder if this indicates some kind of deep-seeded homicidal tendency.
I believe that the thoughts are meaningless, at least in the sense that they aren’t indicative of any real desires. They usually indicate tremendous aversion — the thoughts wouldn’t create so much anxiety if they weren’t so unsettling.
I never talked about my thoughts because I was afraid of their implications. What would my friends say if I exposed them to the brutal substance of my consciousness?
I also had tremendous trouble expressing my experiences in words. When I confided in someone, I would just say that I was suffering from anxiety. This wasn’t a lie, but it certainly omitted a lot of critical details. I didn’t know what else to say. I couldn’t reconcile my experiences with any known disorder. I had no basis to offer any kind of comparison.
So I went on in silence, and I did quite well. The disorder would ebb and flow, and after my first Montreal winter, things dissipated. I put the experience in the past, and went on pretty happily. Nobody knew. But of course, two years later, it all returned. But this time it was more intense, more unsettling, like the inevitable gory sequel to some shitty, B-rated horror flick. And once again, I kept silent.
You don’t look anxious to me
When I finally did try to talk about my experiences, it was in an office in Dawson Hall, in front of an academic advisor who I’d never met before. I was having a really hard time, and I’d decided that dropping a course might make things easier. At the very least it would give me space to think. However, I didn’t know how to explain things to her, so I simply said that I was suffering from extreme anxiety.
Her response was so idiotic that it bears repeating: “You don’t look anxious to me.”
Why didn’t I look anxious? Was it because I hadn’t come in with cuts on my wrists and burns on my arms? Because I wasn’t weeping, or tearing out my hair? Because I’d had the decency to compose myself in public?
If there’s one thing I’ve learned, it’s that there’s no one way to look or act anxious. People go through all manner of inner traumas, and some people simply don’t visibly express them. Even at my worst, I was still amiable and composed, I kept up appearances and turned my papers in on time. The reality is, mental illness is not necessarily a public performance. People should know this.
My bloody valentine
I finally confessed, in full, to my girlfriend the day after Valentine’s Day (romantic, huh?). Believe me, I hadn’t planned it this way. We were at an Indian restaurant. Things were so rough that night that I could hardly concentrate on our conversation. My thoughts were permeated with a continual, brutal bombardment. I had to tell somebody.
Her response was so insightful that it bears repeating: “It’s okay. They’re just thoughts. You’re welcome to think anything you want about me, you know that, right?” Then she stared straight at me. She grabbed my face, and forced me to look back at her.
“Go ahead, think your worst.”
We figured things out together. I’d been looking on the Net about a week before, and I’d finally gotten the idea that I might be dealing with OCD. The two of us went online again that same night. By the end of the night, we’d jotted down a list of mental health clinics, and I was resolved to start calling them the next Monday.
I chose the first clinic that called me back: Dr. Stevenson’s Centre for Cognitive Therapy in New York. I didn’t really want to opt for private therapy, but then again Stevenson is a specialist in pure-O, which makes him a bit of an anomaly in the psychiatric world. That Thursday I had my first phone session with his intern, Donna Phair, and I knew that I’d found something golden.
Winning the game of wits
Medical specialists say that therapy, with the right techniques, can work for pretty much any OCD sufferer. Luckily, I’ve never had the experience of dealing with a lousy therapist. But I’ve read enough online personal retrospectives to know that a lot of OCD sufferers have.
I guess I don’t really know enough to come out unequivocally against Freudian thought. However, I’ve read enough testimonies from patients whose therapists attributed their OCD to deep-seated hostilities, unresolved Oedipal complexes and the like, and I can’t help my skepticism. These freshman clichés are ineffectual at best, and seriously destructive at worst.
The problem with the psychoanalytic approach is that it implicates the patient’s personality in what I believe is a purely biological disorder. It implies that on some level OCD sufferers relish their unwanted thoughts.
Simply put, this insults my intelligence. I know enough about myself to distinguish the thoughts I enjoy, from the thoughts that bother me, from the thoughts that induce 12-hour fits of unrelenting anxiety.
The cognitive therapeutic approach, on the other hand, accepts OCD for what it is — an inexplicable, albeit legitimate, disorder. Nobody really understands why people have OCD, but, as far as my sanity is concerned, the reasons don’t matter. What matters is that one can learn to manage.
The cornerstone to effective OCD treatment is acknowledging one’s unwanted thoughts, and allowing them to exist. After all, thoughts are just thoughts.
Therapy consultations are basically strategy sessions. Donna and I would spend our phone time planning out new, inventive ways for me to confront my thoughts.
She encouraged me to go out in public, pass people on the street or sit beside people in lectures, and deliberately induce the worst kind of images. Then I had to hold on to those thoughts, meditate on them, and demonstrate that I was tough enough to endure their existence.
This is a hard thing to do, because it runs completely contrary to a person’s natural instincts. If you don’t like what’s on TV, you should change the channel, right? Apparently not, in this case.
Naturally, the first few weeks of therapy were almost worse than the disorder itself. The thoughts increased in intensity and frequency. But then, after a few weeks, I experienced something magical — in a word: boredom. I had meditated on these thoughts so long, and so hard, that they’d become a little tired. I never knew boredom could be exhilarating.
I obsess, therefore I am
Okay, in all seriousness things aren’t quite so easy.
Sure, I might be able to conquer my thoughts and forget them temporarily, but they’re always lingering. Some days they’re ambient noise, other days they strike with a vengeance. I’ve been working on cognitive therapy for half a year, and I’ve been using anti-anxiety medication for the past two months. It’s an effective combination, but it doesn’t prevent me from having occasional bad days. But this is all right. OCD and I aren’t pals, but, for the most part, we maintain a relatively civil co-existence.
Also, the beauty of acknowledging the disorder is that I’m able to enlist the much-needed support of those around me. At the risk of sounding corny, I have to say that the experience has brought me closer to a lot of people — parents, siblings, friends.
I obsess, therefore I am — for better or worse, my OCD is with me. It’s an edifying reminder of my own vulnerability. I’m writing this because I want people to know. I want to unmask dated, puritanical perceptions that thinking can be sinful. Up until now, I haven’t talked much about my OCD. In the future, however, I plan to talk a lot. I’ll talk to pretty much anybody who’s interested, and I’ll keep on talking until other people start talking too.
Canadian University Press