Or Else
A Look at Obsessive-Compulsive Disorder
By R.F.
If you ever did
something bizarre that you couldn’t explain, can you imagine what it might be?
If it were a task that seemed stupid or downright silly, what would it take to
motivate you to do it anyway? Conviction? Enticement? Fear?
No human is as
knowledgeable as they wish to be on other human beings. To this day, when I
look at a person switching a light switch on and off a repeated number of
times, or when I see someone excusing themselves to the restroom to wash their
hands in painful exuberance, I still don’t completely understand why they do what they do, even though
one year ago I myself was also diagnosed with obsessive-compulsive disorder
(OCD). Their trite rituals seem so senseless and unnecessary. But, if I reflect
on the way I once felt, and still feel occasionally and to some extent today, I
can sympathize. And what a horrible feeling to remember.
OCD is often
very misunderstood. At least, the term is commonly misused. Sometimes I think
it’s viewed almost as a kind of desire, or an itch that needs scratching.
People with OCD must want organization
or are inconveniently bothered by
germs. Perhaps OCD is a nagging, perfectionist quirk that can’t stand for
pencils not to be lined in a row on the desk.
I don’t know how
many people think this way about OCD. I don’t want to assume that they all
don’t know the truth, because I haven’t asked everyone. And, frankly, I used to
think the exact same way. I once saw OCD as nothing more threatening than a
bout of the common cold. I would say things like, ‘I’m a little OCD about how
my clothes are hung. I love separating them by color.’
The Diagnostic Statistical Manual of Mental
Disorders, or DSM-IV, describes OCD as follows:
“The essential
features of obsessive-compulsive disorder are recurrent obsessions or
compulsions… that are severe enough to be time consuming (i.e., they take more
than one hour per day) or cause marked distress or significant impairment.”
Obsessions are
“persistent ideas, thoughts, impulses or images that are experienced as
intrusive and inappropriate, and that cause marked anxiety or distress,” the
DSM-IV continues. Compulsions, it says, “are repetitive behaviors (e.g., hand
washing, ordering, checking) or mental acts (e.g., praying, counting, repeating
words silently), the goal of which is to prevent or reduce anxiety or distress,
not to provide pleasure or gratification.”
It can be
difficult to accurately describe what OCD feels like. OCD is not a form of
psychosis, like the disorder schizophrenia, where the sufferer is plagued by
hallucinations and unclaimed voices, Bruce M. Hyman, Ph.D. and Cherry Pedrick,
RN said in their OCD recovery guide, OCD
Workbook: Third Edition. Those with OCD understand that their problems are
internal. They can look at the world around them and grasp that no one
else spends hours counting cracks in the sidewalk to prevent something horrible
from happening; that no one else turns their car around seven times in an outing
because they thought they possibly ran over a child; that no one else needs to
sanitize their entire house daily to be free from disease. Sufferers know to some extent that what they do is strange and makes no sense, and yet it makes a harrowingly
compelling kind of sense to them. It’s not a ‘voice’ that speaks to an
OCD-suffering person; it’s an idea. A warped sense of emotion and logic, caused
by a malfunction in the communication of brain chemicals called neurotransmitters, makes it appear to a
person with OCD as if they must perform
their odd rituals – or else.
Try to imagine
it this way. You might never be caught dead in public wearing a tutu and a pair
of Mickey Mouse ears. But, if you had a completely overwhelming sense that
someone was going to hurt your family if you didn’t… would you?
Typical OCD rituals don’t include actions as
theatrical and bizarre as dressing in such a way. Some classic OCD rituals tend
to be cleansing; ordering; counting; checking; repeating; ruminating; seeking reassurance; and debatably, hoarding.
Every person,
whether suffering from OCD or not, tends to do more than one of these things on
a daily basis. Maybe you like to make sure that your hands are extra clean,
become stressed when you’re not organized, or check the locks on your house’s
doors a couple of times. OCD is characterized by much more. Hyman and Pedrick
clarified in OCD Workbook: Third Edition:
“Most people
perform some ritualistic and repetitive behavior in the normal course of daily
life… but,” they said, “when these behaviors take over, resulting in significant
impairment, distress or anxiety, or are excessively time-consuming, OCD could
be responsible. In his workshops, OCD expert Robert Ackerman, MSW, aptly
described OCD as a ‘cult of one.’”
My own account of OCD has not been so clear to the naked eye because it deals with scrupulosity in regards to my Christian faith, not a fear of germs or disorganization, where compulsions like hand-washing and arranging are more tangible and obvious. All of my obsessions had to do with sin and belief; arousing compulsions of prayer, rumination, and the seeking of reassurance; so I couldn't actually see other people not performing my rituals, though I did clearly see that no other Christians were so constantly worried and stressed about their faith or as depressed as I was.
I was raised in the most perfect spiritual biosphere imaginable. I have two very loving parents who are both strong in their faith, but not hard-handed or overbearing. Christianity was encouraged in me by watching their lives. My church, as well, was open and outgoing; very conservative, but exciting and modern; intentional, but not fire-and-brimstone. I had a very loving relationship with all the Christians in my life, and had a lot of admirable men and women of faith to look up to. In other words, psychoanalysis would reveal no browbeating of doctrine or mistreatment that would trigger some psychological reaction.Why, then, I’d wondered, was my relationship with God one of fear?
I was raised in the most perfect spiritual biosphere imaginable. I have two very loving parents who are both strong in their faith, but not hard-handed or overbearing. Christianity was encouraged in me by watching their lives. My church, as well, was open and outgoing; very conservative, but exciting and modern; intentional, but not fire-and-brimstone. I had a very loving relationship with all the Christians in my life, and had a lot of admirable men and women of faith to look up to. In other words, psychoanalysis would reveal no browbeating of doctrine or mistreatment that would trigger some psychological reaction.Why, then, I’d wondered, was my relationship with God one of fear?
I always knew
that something was different about me compared to all my friends at church and
youth group. I would never react the same way they did to anything. When a
sermon spoke of the dangers of pride, my friends could reflect on the subject
in a thoughtful discussion and then drive off after church, happy to go home
and have lunch with their families. All the while, I would be fighting thoughts
of things I needed to eradicate from my life that might possibly tempt me to be
prideful; everyday things that I loved and cherished.
When we were
called to be good disciples of Christ at an emotional revival service, my
friends would weep with joy and revelation, eagerly desiring to try and improve
their lives in the name of Christ. I would slink off to an awaiting darkness,
ruminating on how bad a Christian I felt. I wasn’t giving enough. I didn’t love
enough. I wasn’t suffering enough. No matter how much I prayed or read my Bible, I never felt like I was safe spiritually.
No one had ever confronted me about this, though. In fact, I was actually teased good-humoredly about my abnormally good moral standing and clean record. I’ve even had people say that they could just see how much I loved God. But in my heart, I felt so differently than they did about me. I didn’t understand why, but I knew something was wrong with me, and was convinced that it was my fault.
No one had ever confronted me about this, though. In fact, I was actually teased good-humoredly about my abnormally good moral standing and clean record. I’ve even had people say that they could just see how much I loved God. But in my heart, I felt so differently than they did about me. I didn’t understand why, but I knew something was wrong with me, and was convinced that it was my fault.
The thought
never occurred to me that something was medically wrong. Through adolescence I
was completely convinced that I was missing the mark spiritually, and
eventually, that I was dangerously far from the bulls eye. It’s not that I
didn’t think I was doing enough good deeds to be saved. I’ve always believed,
and continue to believe today, that faith in Christ is all that’s necessary for
salvation. I was sure, rather, that my heart was totally in the wrong place
that a Christian’s should be. I feared that I didn’t really love God, and that
I didn’t believe fully enough in Jesus. Church, which was once a place of joy
to me as a child, was becoming harder and harder to bear. God was an exposed
nerve on my body that I felt self-obligated to constantly press.
My junior year
of high school marked the beginning of the worst. I was imminently riddled with
doubt about God, though not doubts that I desired for or instigated. They came
to my attention, seemingly, from nowhere, all hours of the day, and I was
constantly attending to them. By senior year it was a full-time job.
One of my favorite authors, Anne Lamott, describes in her book Bird by Bird that trying to finish writing a book is like putting an octopus to bed. Every time you have the octopus all tucked in, one of his tentacles will pop out from under the covers. Once that tentacle is tucked in, immediately another will come out. In other words, whenever you feel that you might be finished self-editing your manuscript, another plot, character, or syntax flaw arises. I remember thinking that the octopus metaphor described my life perfectly, not necessarily in terms of writing a book, but of answering spiritual doubts.
One of my favorite authors, Anne Lamott, describes in her book Bird by Bird that trying to finish writing a book is like putting an octopus to bed. Every time you have the octopus all tucked in, one of his tentacles will pop out from under the covers. Once that tentacle is tucked in, immediately another will come out. In other words, whenever you feel that you might be finished self-editing your manuscript, another plot, character, or syntax flaw arises. I remember thinking that the octopus metaphor described my life perfectly, not necessarily in terms of writing a book, but of answering spiritual doubts.
I would doubt
about things that only the world’s bookiest of anti-Christian or anti-religion
researchers would think about; and even then maybe not. Some of my doubts
didn’t even make sense to others when I tried to explain them. I was constantly
consulting my parents, my friends, pastors, spiritual mentors, books on apologetics,
studies performed by scientists. Yet any time a doubt was put to rest and I felt
a sense of relief, immediately, even within seconds, a new one arose. I would
worry about minor details in Bible stories, hypothetical situations, and minute
moderations of belief. I was terrified that God was not real; that Jesus was
not real. These fears, however, were nothing compared to the terror of both being real and myself not having enough
faith in them.
When I was not
worried about doubting, I worried about sinning. I worried that it was sinful
for me to listen to my favorite music, to travel to my favorite places, to
write, to do art. I would spend hours ruminating over a labyrinth of illogic,
trying to convince myself that I was not sinning by doing the things that made
me happy. I couldn’t live with the thought of doing something that would upset
my relationship with God, but I also could not imagine losing all these things
that I loved.
I have spent as
long as eight hours in one sitting trying to fight thoughts such as these by
ruminating or by repetition of prayers.
There have been
times when I have looked at friends who are atheistic and wondered how great
life must be without my burden. It would be so easy to take my God-world off my
back and toss it off a cliff, watching it plummet, never to haunt me again. But
I would never give up Him whom I loved most - not for any feeling or relief in the
world. I didn’t know how I could make this decision because of how much I felt
aversion towards God, but it was a promise I constantly made of my own will.
I hit rock
bottom before I knew my demon’s name. I felt almost completely lost, nearly
hopeless, and was helplessly imprisoned in my own mind. My parents were
extremely concerned at the extent my suffering, obsession, and depression had reached. I had seen a Christian
therapist once at this point. At my second visit to her, I was in disbelief at
the answer to my spiritual problems: not more prayer, not another revival, not
monasticism, but, therapy and medicine.
Since my
diagnosis, my journey has been mostly upward. I am no longer plagued by these
horrible doubts and fears; at least not often, and not to the degree of fervor
of times passed. I have extensive periods of happiness now, and more
recognizable hope. I say ‘recognizable’ hope because I always had hope; hope that God would pull me through, though it was
often difficult to feel in the dark times. He did pull me through, and is
continuing to do so, as I am not out of the woods by any means.
“I am
responsible for bad things happening,” a woman named Sophie is quoted saying in
a May 2011 case study by Jessica Price for the journal Mental Health Practice. “If I do not stop germs from spreading, my
family may die. It would be all my fault and I would not be able to live with
myself.”
OCD places an
inhuman amount of responsibility on whomever it plagues. A sufferer feels that
they will lose what they fear losing most (in Sophie’s case, her family – in my
case, either my salvation or other things I cherished in my life). It is not the fault of the third party. A person’s
children do not force that person to clean ritualistically so that they will
not die from a potential virus. The convictions and doubts I was feeling were
coming from my OCD, not from God. It is a burden born by the conscious, forced
by a chemical.
OCD is widely
believed to be caused by a malfunction of the brain chemical (a ‘neurotransmitter’)
called serotonin, said Hyman and Pedrick.
“More recent
studies indicate that the brain chemical glutamate may play a role in OCD,” they
pointed out, also mentioning that OCD also appears to be the result of genetics
and environmental factors.
In other words,
the results are not all in about what exactly
causes OCD, but both medication and therapy have proven effective when
treating OCD.
Treatment of OCD
has changed over the past century. Before it was discovered that OCD is caused
by a chemical imbalance in the brain, OCD was treated with psychoanalysis, said
Hyman and Pedrick, as Sigmund Freud believed OCD to be caused by internal
mental conflict. However, this treatment was very unsuccessful.
Hyman and
Pedrick spoke also in their workbook of an experiment conducted in the 1960s by
psychologist Victor Meyer. Meyer used behavior therapy that included a
technique called ‘exposure’ to treat patients with OCD. He would prevent
patients with fears of germs and contamination from their ritualistic
cleansing, even shutting off the water they would use to clean their hands,
Hyman and Pedrick said. The patients were then able to see that being unable to
clean themselves did not result in the contraction of a deadly disease or whatever
it was that they feared. They would thus come closer to realizing that their fears
were unrealistic. This experiment had very positive results, with 14 out of 15
patients seeing a reduction in their OCD symptoms.
In the 1980s, Hyman and Pedrick continued,
researchers also found positive results in another kind of therapy: cognitive therapy,
which is the task of recognizing faulty and irrational beliefs and refuting
them.
Cognitive-behavioral
therapy (CBT), an exposure and response therapy combining both of the two most
successfully proven therapies, is the treatment of choice for most people
suffering with OCD, Hyman and Pedrick concluded.
Overcoming OCD
is not as simple as it may look. A sufferer can’t simply ‘stop’ doing what
they’re doing any more than a heavy smoker can toss a pack of cigarettes in the
trash and quit their addiction cold turkey. The brain must be carefully
retrained to recognize faulty thinking and beliefs.
I can’t imagine
who I’d be without OCD. OCD does not define me, but it has taught me so many
things about life, myself, and God. I’m learning the importance of leaps of
faith, as all who are treated for OCD must. I’m beginning to see a little bit
more the immenseness of Christ; that a relationship with Him is not primarily
based on emotional things like Switchfoot concerts, evangelistic revivals, and
WWJD t-shirts. God uses those things to bless some relationships, I believe,
but those things for me at this point in my life are tainted with the pain of the dark times with OCD,
as much of the typical, American, modern Christian experience is stained with bad memories
for me. I find Christ emotionally in music such as Radiohead, Christina Perri, and
Jónsi of Sigur Rós. Though the Church itself, Bible study, and fellowship with other Christians are of extreme
importance in many ways, church culture is not an obligatory factor in a
relationship with Christ. He is so much bigger than that; this I have learned
because of my struggle.
God still feels
distant and stony because of OCD, but a path is being quietly carved out for me
that holds great promise. Although I hated going through what I did, I would
not change the past or wish that I’d never had OCD. I have already seen so many
good things come out of it in my life.
I remember one
of the first things my therapist and psychiatrist told me when I was first
diagnosed with OCD was that OCD is one of the most treatable disorders out
there. This felt nearly impossible to accept at one time, but now I am seeing
that, with the my cooperation in therapy and some help from the prescribed drug
Cymbalta®, OCD isn’t as omnipotent as it would
like me to believe.
Our planet is
full of many different forms of suffering. Education on OCD will bring
awareness of another form, but hopefully can also be a gateway of treatment and
progression, producing many happy endings. I am R.F., I have OCD, and I am very
much encouraged.
‘Tornado’ by Jónsi:
“You
grow, you roar
Although
disguised
I know
you
You'll
learn to know
You grow
You grow
like tornado
You grow
from the inside
Destroy
everything through
Destroy
from the inside
Erupt
like volcano
You flow
through the inside
You kill
everything through
You kill
from the inside
You'll...
You'll
learn to know
I wonder
if I'm allowed ever to see
I wonder
if I'm allowed to ever be free
You sound
so blue
You now
are gloom
You sound
so blue
You now
are gloom
I wonder
if I'm allowed
Just ever
to be”
