Tormenting Thoughts and Secret Rituals Page 14

  • This silly thought is a result of a hiccup in my brain.

  • I’m not going to let this thought rule me.

  • I’ve tried my best, and that will have to be good enough.

  • This job doesn’t have to be perfect.

  • Other people do not need to do this.

  • I’ve done what is reasonable, and that’s all I’m going to do.

  • Treating my OCD is more important than doing this ritual.

  • If it feels like OCD, it is.

  STRATEGY NO. 3: THAT’S NOT ME! IT’S OCD

  A thirty-two-year-old mother suffered sexual obsessions so intensely guilt-provoking that she would do anything to prevent them from forming in her mind:

  KAREN: I’ll be changing my baby’s diapers when suddenly I begin to have a bad sexual thought. I don’t even know exactly what it is, because I don’t let myself think it. I stop it before it gets started. I’ll say prayers over and over. I’ll watch TV. When nothing else works, I’ll even start to imagine killing myself. It’s not that I want to hurt myself—I wouldn’t because of my baby—but if I put a strong image into my mind of chopping my own head off, it keeps the other thoughts away. Yesterday I spent all day long thinking about that. I absolutely won’t let those sexual thoughts come into my mind no matter what. No way.

  ANNA: I used to get the same kind of thoughts. I would be changing diapers, and I would worry that I was doing it in a sexual way, or maybe that, somehow, I was enjoying it sexually. Those thoughts used to really bother me. I would do all kinds of rituals to stop them. I drove my husband crazy asking him for reassurance that they weren’t true. What has been most helpful is realizing that they don’t come from me. Those thoughts are not who I really am. If I think about it deep and hard, I know I wouldn’t do anything sexual to my baby. That’s just not me. It’s OCD.

  Karen employed “That’s not me! It’s OCD” from that day on. It must be acknowledged that until recently most mental health professionals not only eschewed this strategy but contradicted it. Freud hypothesized that self-tormenting thoughts were due to unconscious conflicts caused by repressed urges, an idea that was accepted by several generations of American psychiatrists and psychologists. As a result, people like Anna were told that, yes, they did have violent, murderous urges deep down inside them and that really the only way to overcome these urges was through years of psychoanalysis. Untold numbers of OCDers were harmed by this mistaken idea.

  The leaders in the field now recognize that obsessions do not issue from one’s deepest self. They are passing thoughts that gain significance only because of the OCDer’s neurochemical inability to process fearful thoughts. Neuropsychiatrist Jeff Schwartz, author of the recent, highly successful OCD book Brainlock, emphasizes that OCDers of all ages should remind themselves, “That’s not me. It’s my brain sending me a false message.” Schwartz encourages patients to see OCD as a war. In order to fight it, OCDers must maintain “mindful awareness” of the fact that it is not they themselves but a biochemical disorder that is the cause of OCD’s symptoms. Duke’s John March, leading expert in the treatment of childhood OCD and author of How I Chased OCD off My Land, teaches children to give OCD a name, such as “butt head,” “stupid,” or “the playground bully.” Doing this, he explains, helps children get distance from OCD and motivates them to fight the disorder using behavior therapy.

  STRATEGY NO. 4: TAKE CONTROL: STAND UP TO OCD

  Heather, a junior majoring in human development and family studies, was tormented by terrible, violent images of being choked—by ropes, belts, and coat hangers. To ward these off, she put her hand to her neck and massaged it, or tried to imagine that she was magically protected by steel shields. On one occasion she reported to group that as soon as she had awakened on the previous Saturday she had been immediately overwhelmed by images of strangulation that drove her to spend all morning clinging desperately to protective rituals. She tried to distract herself by watching TV and listening to music, yet the dreadful images seemed only to increase to new levels of heart-stopping repulsiveness. All she could think was, “Oh, man, what’s next?”

  At that point, however, Heather remembered what another student had said in group: “You can’t let OCD control you; you have to keep up the fight.” She said to herself: “I’m not going to have a terrible day. I’m going to take control.” She made a list of goals to accomplish, starting with going to the library. As she got started, the obsessions “backed off.” She was able to “push through” the fearful thoughts each time they began to recur. The key for her was to boss back her OCD, to be master of the situation.

  In individual therapy I can encourage people to take control, to stand up to OCD, but the response is often minimal. Hearing those who speak out of personal experience is infinitely more powerful. A truck driver suffering obsessions that his shoes were full of fleas and mites scrubbed his feet nightly with alcohol, which left them painfully cracked and fissured. Even though it was obvious to him that his compulsive washing was irrational, he told our group that it had simply never occurred to him that he could resist it. He had just assumed that if he did so something terrible would happen. Once encouraged to take control of his rituals, he made surprisingly quick progress. After one month he was able to go a whole week without scrubbing. He reported to our group that as soon as his obsessions would begin, he just said to himself, “To hell with those obsessions; I’m not going to start that washing.”

  Some of my group members report that they have learned to recognize the “feel” of an obsession. They know it’s coming before it is fully formed because they detect a familiar, foreboding. Being able to detect an obsession in this way is extremely valuable because the quicker OCD is confronted the better. A group member said she stopped rituals in their tracks by saying firmly, “Stand up to OCD. Don’t even get started!”

  STRATEGY NO. 5: WHATEVER HAPPENS, HAPPENS

  One day a freshman, Lindsay, who had been attending group for about a month, and a senior, Linda, who had been attending off and on for two years, reviewed for a new group member what had been working for their OCD:

  LINDSAY: I’ve had obsessions since seventh grade, when I started waking up in the middle of the night afraid that I would go crazy and knife my parents. But my latest obsession is the thought of jumping out the window. I live on the fifth floor in the dorms, and the idea comes into my mind of running over to the window and throwing myself out. I absolutely do not want to do this, but a few weeks ago it got to the point where I was just breaking down and crying. I was on the phone every night with my parents. I was getting friends to tell me, “You’re all right, you’re not going to do it.” I was repeating to myself, “I won’t do it, I won’t do it,” all day long. Sometimes I even told myself: “You’re on the first floor, you’re on the first floor”—even when I was on the fifth floor! I thought I was going to have to drop out of school. But I’m doing a lot better this week.

  LEADER: What’s been working?

  LINDSAY: Like we talked about here, I’m telling myself: “It is possible that I could jump out the window. I might get a brain tumor that would affect my brain, and I’d go crazy, and I’d do it. It’s a one-in-a-billion chance, but it’s possible. It could happen to anyone. I have to accept that.” This lessens the anxiety. The thought just doesn’t seem as frightening.

  LINDA: I tell myself the same thing. That’s my number one way of coping with OCD. Like I have this obsession that I’m going to have a bad day. It makes me terribly scared. Last year before I could leave my room I had to look in the mirror with a certain expression on my face and say to myself, “I’m going to have a good day.” I had to repeat that over and over until I got it just right, and that could take a long time. It was wacky! But I fought that one and I won. Now, I say to myself: “Oh, well, I’m going to have a bad day. Bad days are part of nature. Everyone has them.”

  LEADER: You say to yourself that you might have a bad day, or you say that you will have a ba
d day?

  LINDA: I tell myself that I am definitely going to have a bad day. You have to accept that it will happen. You have to be okay with it. If you do that, you can get past the obsession. Another of my obsessions is that I’m afraid of rejection. I’m zoning out all day and thinking the weirdest things to counter these obsessions about rejection. So now I just say, “Let the worst happen. Let them say, ‘Who the hell are you? You’re a moron!’ I can deal with it.”

  LINDSAY: I can see you doing that with your obsessions, but I don’t think I can do that with mine. What works for me is to recognize that although it’s a one-in-a-million chance, it could happen to me, or to anybody, and I’d have to accept it.

  Whether viewing it as Lindsay did that the chance of a feared event’s happening is slim but real, or as Linda did that the feared event is definitely going to happen (not many people take this stance), the result is that the anxiety-producing thought, the obsession, is held in the mind and tolerated, leading to a dissipation of the terror it causes.

  This is a venerable approach. Whatever happens, happens, has been recommended by philosophers for over two thousand years. Epictetus, a famous Greek, put it this way: “We must not try to anticipate or to direct events, but merely to accept them.” Marcus Aurelius, the most celebrated of the Stoic philosophers, said, “Accept everything which happens, even if it seems disagreeable.” In the twentieth century, the famous philosopher Bertrand Russell, as well as the highly influential clinical psychologist Albert Ellis, have both emphasized the advantage of a worldview that includes whatever happens, happens.

  This strategy, however, can be difficult to pull off. Sometimes patients are loath to accept even a remote chance that a particular obsession might occur. Whatever happens, happens, is especially difficult with obsessions involving violence against loved ones, such as a mother’s thought to knife her baby, and with obsessions involving strongly held religious beliefs, such as the thought of losing salvation. On the other hand, whatever happens, happens, is especially helpful when obsessions center on uncertainty. In the case described above, Lindsay’s tormenting thoughts centered not so much on the act of jumping as on the doubt she had that she might do it. Saying, “It might actually happen and I have to accept the possibility,” cut to the heart of her uncertainty.

  Raymond, whose case was introduced in Chapter 1, caught on to this coping strategy after about a year of attending group. Encouraged by a sermon given in his church, he reasoned that since whatever happened was God’s will, he should be willing to accept anything. He imagined and “accepted” that he had hit someone with his car, that his son had contracted AIDS, and that everyone in his town had died from an epidemic that he could have prevented had he only taken notice of a spill of infected scrub water. This caused a marked decrease in the strength of his obsessions.

  Soon, Raymond became an enthusiastic advocate of this strategy. One day in group when a young woman shared her obsessive fears that the food she was serving her husband was contaminated, he offered her some rather blunt advice: “Look, you’re going to have to say to yourself: ‘I’m going to cook; and if he dies, he dies.’ ”

  STRATEGY NO. 6: REMEMBER OTHER OCDERS

  A great benefit of group therapy is receiving advice from other OCD sufferers as to what is reasonable and what is not. An undergraduate student was besieged by fears that the food she bought was tainted. She threw away loaves of bread unopened, fruits never touched, and hoagies and pizzas that never made it out of the bag. These compulsions were demoralizing, embarrassing, and expensive:

  MARIA: My roommate was really mad at me this week. We ordered a pizza from Domino’s, and when it came I got so nervous I threw the whole thing right in the garbage. “It doesn’t look very good,” I said. She about died. Then I had to run out and buy another one. I know I shouldn’t do it, but I just can’t stop. When I look at the food, it just doesn’t look right. Or else it doesn’t feel right. I know I shouldn’t throw food away … but you know, maybe some of it really is contaminated. They’re not very careful in some of these places.

  GROUP MEMBER 1: Look, if we allow ourselves to believe that, we’re all in big trouble. Everybody orders pizzas. Nobody gets sick. You need to stop going back to buy food. You need to break that compulsion.

  GROUP MEMBER 2: I used to work as a bag boy at a supermarket. For one thing, nobody got sick. For another, okay, some of the food probably has germs, but you can’t tell that from looking at it or feeling it. Anyway, you can’t see or feel germs. You just have to make yourself eat the food like everyone else.

  This feedback from group members she knew and respected allowed Maria to curtail her costly compulsions. When compulsions threatened, she was able to resist them by telling herself: “Remember what the people in group said. They wouldn’t lie to me. I just have to trust them.”

  Vince, a truck driver, found it useful when struck by a severe obsession to visualize the face of each person in his OCD group. He brought to mind exactly what had been talked about in the previous session and remembered, too, how silly it all sounded. Then he reminded himself that he would be in group next week discussing his obsessions and how ridiculous he would sound. Then he said to himself, “Why not realize right now how silly these obsessions are, and learn to live with them?”

  Another group member was strengthened by his desire to be encouraging to others. He once shared that what worked for him was remembering the despair and hopelessness of a young woman who had cried the week before in group. He said to himself, “I’m going to beat my OCD. I’m going to be able to tell that girl that we don’t need to be ruled by this disorder.”

  Group members often report that the simple act of being understood by their fellow sufferers is immensely consoling. Among other things, it helps them deal with the criticisms and bad advice offered by those who do not understand the disorder. Melissa, whose case of religious obsessions was introduced in Chapter 1, had many friends at church who were quite opposed to the idea that her prayers represented compulsions. She spent hours on the phone with her own sister explaining what she had learned about obsessions and compulsions, but to no avail. Her sister would counter, “It’s good to obsess about God. You should stick with the Bible and stop the shrink.” After much strong persuasion from group members that her sister was completely out of touch with this situation, Melissa was able to accept the reluctant conclusion of most OCD sufferers: There are some people who will never understand OCD, no matter how clearly you explain it to them.

  STRATEGY NO. 7: TRUST IN GOD

  Melissa’s case also demonstrates that although religion is a frequent topic of obsessions, religion is also one of the greatest helps for dealing with OCD. Melissa, whose faith never waivered while fighting her excessive scruples, recently told our group: “The coping method I use now always starts with: ‘God, help me to accept your grace on this matter.’ ” For Melissa, the difference between religious symptoms and religious faith was clear. Indeed, untangling the two is seldom difficult. Religious obsessions and compulsions are unpleasant, repetitive, senseless, and have an alien quality. True faith is meaningful, exciting, and issues from our deepest sense of self.

  Typical of the comments of many people in OCD group is that of a young mother tormented by knife obsessions after the birth of her first child: “This is the most helpful thing: I pray and put my trust in God every day to heal my mind and help me deal with these thoughts.”

  A born-again Christian student explained that, when walking along the street, an image would flash into her mind of the person walking in front of her stumbling and falling. She would have to “undo” the image immediately by imagining the person standing upright again. Yet even as she would attempt to do this, the person would “fall” once more. As she aptly put it, “Since I know what I don’t want to see, I keep on seeing it.” Soon more rituals would be called on to chase away the obsessive images, such as exhaling deeply and tapping her fingers together. After four months in group she began to
make progress. She reported to us: “What works is to stop and turn to God and leave the situation in his hands. My trust in God has to be stronger than the compulsions, though. If it’s not, the compulsions win.”

  A particular dilemma occurs when devoutly religious OCD sufferers are struck by blasphemous obsessions while praying. One member of our community mental health center group, when saying grace before a meal, was struck with the shocking thought that she was praying to the devil instead of to God. Another member of the same group had the heart-stopping image that she was performing a sexual act with Jesus. Yet intrusive, blasphemous thoughts such as these are no different from any other type of obsessions. They should never stop a person from praying—that would be avoidance. Like harm obsessions or contamination obsessions, these sorts of agonizing religious obsessions can be overcome by recognizing their senselessness and finding ways to tolerate them.

  A group member with violent obsessions once shared a prayer that he found very helpful. I will include it here, since it is the best prayer I have heard for OCD. It is found in the classic fourteenth-century text, The Imitation of Christ:

  My Lord and God, do not abandon me; remember my need, for many evil thoughts and horrid fears trouble my mind and terrify my soul. How shall I pass through them unhurt? How shall I break their power over me? You have said, “I will go before you. I will open the gates of the prison.” Do, O Lord, as you have said, and let Your coming put to flight all wicked thoughts.

  STRATEGY NO. 8: LIMIT OR POSTPONE A RITUAL

  A junior majoring in education suffered from severe, chronic OCD. As a freshman, she had had to take a medical withdrawal because of disabling symptoms. Now she was once more falling behind in her studies, and quite discouraged, she was again considering dropping out of school. Particularly oppressive were harm obsessions involving friends and loved ones and mental rituals that could occupy her mind all day long. One day in group, when asked how she was doing, she told us tearfully: