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Recovery is possible and necessary

This week is OCD Awareness Week, and each day we will be publishing a different account of Obsessive-Compulsive Disorder.

As we conclude OCD Awareness Week, we promote the international flavour of the week, with this fascinating story from Audrey in Canada.

I am writing this article in the hopes that someone will read it and feel hopeful that they will be able to gain the upper hand in their battle with OCD.   

I am a 59 year old College teacher, happily married for 35 years, with 2 young adult kids.  I have battled OCD in one form or another for the past 34 years, with intermittent episodes during my childhood and adolescence. I would like people to know that there isn't a single approach to winning this war (and yes sometimes it has felt like a war). I believe that the answer lies in consistent, near-daily challenges to the behaviours and thoughts that underlie this condition.  In my case, medication has proven an invaluable help.  I have been fortunate to benefit from the expertise of excellent psychologists.  An extremely supportive husband has been at the foundation of my near-recovery. 

As a young child, I was obsessed with the need to be honest.  I remember having to keep track all day of things which I needed to confess to my Mom. The theme of honesty revisited me during my adolescence, though it was an intermittent struggle. The tenacious onset of OCD really occurred in my mid 20s, about one year after our marriage.

Looking back, I realise that the stage was set for mental health trouble.  Grad school was tough.  There was more information than I felt I could handle, and I was having trouble sorting out the important information from the less necessary.  I decided that I would read everything about my field. I sat down to read the most up-to-date text I could find. The book was hundreds of pages long, meant to serve as a reference, not to be read cover to cover. As I was reading, it occurred to me that I might molest a child, and within seconds I convinced myself that there was a possibility that I had done so. I recall the sheer terror, the panic and the uncertainty about my identity.  I became terrorised by the thoughts, and this lead to a frantic cycle of confessing my fears to my husband.  A visit to a psychologist proved unhelpful.  Of course, I realize now that there were two themes which contributed to the onset of these intrusions. I was convinced that I was less than capable, so that I needed to work harder than others to reach competence. In addition, I was invested in the idea of completeness. At this point in my life, this meant that I felt the need to understand all of the background information in my field.  

My husband bore the brunt of my requests for reassurance.

Under the cloud of increasingly noisy intrusive thoughts of ways in which I could be dangerous, I continued my graduate studies. I was doing medical research and became consumed with fear that I was handling radioactivity, laboratory chemicals or cells in a dangerous fashion.  I don't know how I developed the idea that I am more dangerous than other people, but I know that it took me more than thirty years to realise that I was no more dangerous than any of the other grad students in the department. I also continued to be concerned with honesty and so I spent hours checking my data.  By the time I graduated with a Ph.D., my mental health had deteriorated and each day involved hours of looping worries.  My husband bore the brunt of my requests for reassurance, although I occasionally looked to a friend for confirmation that I had not inadvertently poisoned anyone.  

I also experienced the common OCD fear that I had unknowingly run someone over.  As a very experienced psychiatrist told me, avoidance is a poor choice because it works so well. As I spent years avoiding driving, I became convinced, once again, that I was significantly more dangerous than the myriad of other people on the road.  The rare times I did drive (never often enough to build confidence), I would sometimes need to double back to ensure that I had not left victims on the street.

After grad school, my husband and I left our hometown and were both pursuing post-doctoral studies.  My life was very difficult. My concerns about causing harm were greater than ever, and I was lonely and stressed after moving to a new city.  My daily work in the lab became torturous because I was convinced that I was very dangerous and that the environment was hazardous as well.  I spent hours repeating details of my lab activities to my husband, seeking reassurance that I had been careful enough. The endless reassurance-seeking took its toll on our marriage, and my husband moved out of our apartment.  Of course I was very frightened, because I believed that I needed my husband to reassure me. However, and I hope others will take courage from this, the one year break actually helped me enormously. I learned that I could stop my ritual confessing and checking, and I regained a great deal of confidence.  My husband moved back home after one year, and shortly thereafter, he heard the author of "The Boy Who Couldn't Stop Washing" speaking on the radio.   He walked into our apartment and announced that he had figured out what was happening to me. The relief of the diagnosis of OCD was incredible.  

Avoidance is a poor choice because it works so well. Once again, I proved to myself that avoidance helps the OCD persist.

During the past 27 years, I have worked with 4 different therapists on the various manifestations of OCD.  One therapist did in vivo exposure with me, in the lab. The tasks were arduous, encouraging me to tolerate exposure to the radioactivity I feared. The in vivo exposure work improved my life, to a degree.  However, I was told to expect that habituation would cause any remaining fears about danger to attenuate. In my case, habituation was not complete, almost certainly because we moved back to our hometown, and I was able to avoid the lab environment and even some of the objects in our home which had become contaminated.  Once again, I proved to myself that avoidance helps the OCD persist. There is still a box in our home which "feels" contaminated. 

Another therapist provided a more cognitive approach. He helped me to identify my intrusive thoughts as OCD.  As anyone with OCD can attest, the thoughts loom large, and they feel true even though they are egodystonic. When in doubt (and there is plenty of doubt in OCD) I was encouraged to "act as if its OCD". This meant that I was learning to attach less importance to the intrusive thoughts.  This therapist also helped me to identify a very strongly held belief that if something is important it must be repeated.  This helped decrease the amount of time I spent confessing and analysing. In therapy I learned to accept the idea that I may have done things that were dangerous in the past.  A series of loop tapes, describing the events I feared, were effective. These particular years of therapy were the hardest of my life, since I needed to speak about events where I believed I had been dangerous. I had to challenge my obsessions with honesty and completeness, and learn to trust that I was truthful in my re-telling of painful events. This work was truly life-changing because I began to see myself as separate from the OCD. Although the intrusive thoughts were frequent, knowing that I was doing cognitive work helped me to believe that there was another part of my brain which could be functional once again.

At the heart of many of these painful ideas that I could be dangerous was another very powerful theme which persists. I simply feel too lucky. Whenever someone close to me suffers misfortune, I feel guilty that I am not similarly afflicted. This idea often morphs into the concern that some dangerous part of me has caused the other-person's problem. 

I have also been told (and I still struggle with believing this) that I feel overly responsible.  Because of this I find it hard to see people in pain or in difficulty, without feeling that I have contributed to their problem, either directly through being dangerous, or by negligence. The combination of the ideas that I am too lucky, and that I am responsible for other people's problems have often left me feeling very weighed down and unable to accept happiness easily.

The next therapist provided help with OCD symptoms and was supportive through many of life's other stressors as well. Parenting one's kids through the teenage years and dealing with aging parents and their difficulties are problems common to most middle-aged people. However, feeling responsible for other people's choices has complicated this part of my life.  These challenges brought forth my over-inflated sense of responsibility.

Another aspect of my OCD moved to the forefront during my work with this therapist.  It took me years to reveal the extent of my fears about contamination from food. My obsession is that grease or other substances will transfer from food onto my belongings. Our house, for years, was highly regulated in terms of what object could be placed where. Pens from the kitchen were never allowed to be used in our master bedroom. Purses which may have touched a trolley at the grocery store were forbidden from the living room.  I pestered my kids during meals, worrying that their clothes would become contaminated with food that would then transfer into their bedrooms. Sitting on public transit was very very hard. If someone entered the bus while carrying a fast food bag, I believed that grease from the bag would transfer onto me. I routinely washed my coat, my purse and even my shoes.  Hours of in vivo exposure has dampened the severity of this aspect of the OCD, though I still struggle.  Despite working with my therapist to try to name the fear behind this obsession, I have no answer.  It is possible that my concerns about laboratory safety have migrated to food.  The obsession about food transfer has had a large impact on my life.  Lunches with colleagues, family dinners and parties are often painful, not pleasant.  I continue to chip away at this problem, and I have seen some success.

I love reading and for a while I abandoned this hobby because it was just too difficult. Now I read as often as I can, and I try to just move forward and enjoy the process...

Like most people with OCD, I am, at times, plagued with uncertainty. This manifests itself in checking behaviour, during which I must repeat my actions in order to receive some magic feeling that quenches the doubt.  Over all these years I have checked that locks were locked, data graphed correctly and that I had, in fact, absorbed each paragraph of whatever novel I was currently reading. This last problem hurt a lot. I love reading and for a while I abandoned this hobby because it was just too difficult. Now I read as often as I can, and I try to just move forward and enjoy the process. It is not easy, though, and I still frequently spend more time re-reading than actually moving through a book.   

My current therapist focusses mostly on the cognitive aspects of treatment.  It is through this work that I have come to truly focus on the themes in my thinking which have fuelled the behaviours associated with OCD.   I have come to observe that I have made unreasonable demands of myself.  For example, there have been many instances when I have spent hours worrying about what I said during a social interaction, concerned that I was somehow unkind or not appropriate.  It is only lately that I have truly understood that I have a different set of standards for myself than for others. While I tend to be forgiving of others' errors, I struggle with my own.  During this therapy, I have also thought about the role of intention in behaviour.  I am observing myself, and find that I mostly try my best. However, I have a deep-seated belief that I need to be extra good, to try extra hard and be especially careful and kind and so I continue to struggle.

This latest stretch of therapy is helping me to recognise the need for self-compassion.

In addition, this latest stretch of therapy is helping me to recognise the need for self-compassion.  Years of struggling against the OCD, in addition to a mix of life's other challenges, have led me to episodes of depression and chronic pain.  I'm not sure why I have finally accepted that its okay to show myself some kindness.  Many of the themes I have written about in this article were suggested to me nearly twenty years ago.  I always felt that it would be too dangerous to accept them, since doing so might let me off the hook regarding what I worried was my dangerous behaviour. As I approach 60, the intensity of the struggle has waned.  

To continue to live under the yolk of OCD is just not a good enough life.

I have never felt that a diagnosis of OCD was disheartening.  I have found that it was liberating to consider the OCD as separate from myself.  I am aware that there are those who consider OCD to be a biological illness and others who consider it psychological. I would counsel people suffering from OCD to not get caught up in the debate. Instead, search for good people to help you reach towards recovery.  For me, medication has been very helpful.  Without the medication, my ability to separate myself from the OCD and to be insightful was very limited.   In my experience, recovery takes an open mind.  It has been necessary for me to talk about situations that are painful, to listen to therapists' ideas that may seem foreign and to attempt to stop the behaviours that were false comforts.  Most importantly I feel it is important to believe that recovery is necessary, and that to continue to live under the yolk of OCD is just not a good enough life. 

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