I was a happy little baby until it was time for first grade. I woke up everyday with a knot in my stomach that was only relieved by vomiting. I was scared of the teacher, of my fellow students, and of doing poorly. My first obsessive incident soon followed, and although I don't remember, my father tells me that I used to throw fits every morning because I could not decide what to wear. Dad took away all of my outfits except two and the problem was solved. Unfortunately, there was more to come, as I began to develop physical habits; I breathed strangely, I did things with my feet as I walked, I crossed my eyes and I made noises in my throat. I did these things because I wondered "should I make a noise?" Or maybe I shouldn't make a noise. Do I need to make a noise? I would make one and feel fulfilled for about three seconds. Then the voices would return, and the process would continue every second of every day. My parents and I began therapy but only discussed my nervousness and my daily separation from my mother.
I had many different physical obsessions until the fifth grade. Then my obsessions traveled from my body into my mind, where they have been ever since. Almost all of these mental obsessions were so strange and detail oriented that I can not remember them, but I do remember some. I saw words in my mind next to actual printed words. For example, I had a Yankee garbage pail (my favorite team 12 years ago) that had the word "Yankees" printed on it, and my mind would insert the word "sucks" next to the word Yankees. This was very bad, partly because it was bad to think that the Yankees suck, but mostly because I felt that the word "suck" should not arise in my mind. This word, or any other obsession, was a form of mental pollution. By pollution, I mean that I see shapes and colors in my mind; gray triangles, heavy fog, or objects that look like mushy car engines, or racquet balls. These visions represent something amiss in my life, like the word "suck" popping into my head when I feel it should not. The visions haunted me, they were my enemy because they blocked my ability to see the world clearly. They acted as a gray screen in front of my eyes preventing perfect paintings, classic times with my buddies, or tender moments with a girl.
In the other aspect of my life, despite these visions and my suffering, I was successful. I always did well in school, I always had friends, and I was a talented artist. I had praise heaped on me concerning my art since I was a baby and was extremely successful artistically in high school having won some prestigious awards. The "sucks" example is one of many. When I was in the Bahamas many years ago, I looked out of the hotel window and saw someone para-sailing in the sunshine. This scene was so beautiful and idyllic that it became perfect OCD material. From that moment on, I had to remember this scene exactly as it occurred, and I created a set of rules which determined whether or not I was successful in remembering. The main rule was that I had to mentally re-create the scene until I felt a knot form in my stomach. Somehow, this anxious knot meant that I had re-created the scene perfectly. But perfect wasn't good enough and could not satisfy what had become an all encompassing mission. Somehow, I still was not truly remembering the scene. Was this vision in my mind really what I had seen? How can I be sure? What defines a memory exactly? It was essential that I remember, that I not lose this memory to any degree, because it was so beautiful and so perfect. I problem solved on this topic non-stop for about six months, and as always happened with my OCD after a given period of time, I dropped the current topic and moved on to another. My purely obsessional thinking grew as time went on. Every second of every day was spent either solving the mental dilemmas I had created, or, while temporarily focusing on something else, put on hold and grinded my insides. The number of different subjects is uncountable. Yet despite the process, I continued to function and do well in school and in art. I also had some very close friends. Nobody could tell. Nobody knew what was going on within my mind. But I was a very angry and unhappy person because I felt there was always an unresolved issue within me of critical importance which I needed to solve. I had been in therapy since the age of about seven at this point, and talked to my therapists about my anxiety and about letting go. For the fifteen minutes following each session, I felt free. But beyond that, the steel bars of my mental prison grew thicker.
One night while flipping around the channels, I came across Larry King. His guest was the kid from the book The Boy Who Couldn't Stop Washing. Even though I never had any hand washing issues (I probably don't wash enough, according to my mother), I thought "This sounds a lot like me." It was then that I knew what OCD was. But knowing what it is doesn't make you better, as I found out in the next few years. It wasn't that I didn't try to improve, or didn't want to get better, but I just didn't know how. The last half of my senior year of high school was terrible. I continued to grow worse day by day as my obsessions and my need to solve them became more enormous than I could have ever imagined. I remember the most vicious cycle in which I was ever caught. I was aware that throughout the duration of the time with my doctor at the time, I continued to worsen. Yet I felt that I could not survive without him because my health and my inner peace was at stake and my doctor was the only person who could give it to me. But I could not stay with him, because I would continue to worsen. But I could not leave him, because I would continue to worsen. My eternal suffering, growing larger every second, had now been verified and was inevitable. I had been taking Prozac for some months at this point, and I survived this dilemma because I took some Klonopin, a powerful anti-anxiety pill. The reduction of the anxiety made me drunk with pleasure. The only thing I lived for was the Klonopin, because with it I might be able to fall asleep, and in sleep, I would not suffer. I soon after began to snap a rubber-band against my wrist anytime I became aware of having a thought related to any obsessions. It began to help me, even though I was its slave. My first semester at college was pretty good. I had a ton of fun, and gained twenty pounds (not from Prozac, but from eating.) I suffered a lot, but was in an eternal bliss compared to what I had been through just months before. But this bliss began to fade. Semester after semester passed, and I slowly worsened as my mental obsessions returned with the strength they once had. I had just broken up with a girlfriend and was being bombed with a vicious circular obsession similar to the one about my doctor. After a month of my fifth semester at college, I was unable to function. Getting to class was a challenge of indescribable proportions. My hair was long, I had a beard and I was thin and taking an enormous amount of anti-OCD and anxiety drugs. I dropped out of school. I came home to nothing. No job, no therapist, no school, no idea of what to do. I remember lying on the couch watching "Welcome Back Kotter." One of the characters said "When the going gets tough, the tough get going." Although I had heard that phrase a million times, I was inspired, and through months of hard work and courage, I found Dr. Phillipson and began behavior therapy combined with medicine. Steve introduced me to the idea that what my brain told me and how I responded to it were different entities. (I believe that this notion is the foundation of OCD management). These thoughts Steve calls spikes; a thought that pops into your head and creates anxiety, like "I have AIDS," or "I need to wash my hands," or for me, simply a picture of mental pollution. Many spikes contain certain words which help an OCD sufferer label them. "Need," "must," "have to," "should," and "can't" are common spike words -- "I need to get an AIDS test or I can't go out until I wash my hands," as opposed to a non-OCD thought like "I loved that movie." After establishing that certain thoughts are spikes, it is learned that they are confronted directly and fully. So if I have a spike like "I need to figure out if I am gay right now," my response might be "O.K., that is a spike. I don't need to do anything. If I want to explore my sexuality, I will do so when I choose, and not when you tell me, brain." Separating yourself, your desires, and your goals from the OCD is the most fundamental concept of OCD behavior therapy. Pretend you have two parts -- you and your OCD. The OCD can do whatever it wants whenever it wants, but your life and the choices made within it are determined by you. Think of OCD as the undisputed king who sits on his throne all day and night, but just as a figurehead with no authority. You are the president who makes all the decisions and who runs the self. I find that in addition to such spike responses, something else the OCD hates is confrontation. OCD is a playground bully, and bullies (or kings for that matter) don't like to have their authority questioned. There are particular tools that can be implemented to help confront the bully, one of which is called flooding. Flooding works around the basic concept of habituation -- the more familiar you are to a particular thought, the less afraid you are of it. So in a flood, I purposely bring up the exact spikes which have been pounding me all day. That way, I not only become habituated to the spikes, I am also messing around with the OCD's agenda-I am chasing the bully instead of fleeing from it.
Another tool is the capsule. A capsule is a pre-designated period of time, say five minutes, in which someone with OCD can reassure themselves, flood, or "overdose" on particular thoughts or actions. So when I wake up every day, I know that at 8 AM, 2 PM, and 8 PM I will solve every problem in the world and make my life perfect in five minutes, but aside from those three capsules, I can't do any problem solving of any kind related to my OCD. The benefits of capsules are twofold: Firstly, by containing my problem solving or flooding to those three time periods only, I can let my mind do whatever it pleases for the remainder of the day. Secondly, an OCD sufferer mocks and belittles the OCD with capsules by essentially saying to it that the issues it presents are only good enough to be resolved at the pre-destined time, and only for five minutes, no matter how critical they appear to be when they first pop up. The tools presented above are a few examples of what to do in managing the OCD and stand in stark contrast to what not to do -- problem solve. Problem solving, or ruminating, is the opposite of flooding. Instead of confronting your fears and the ambiguity that goes with them, you seek reassurance and relief when you ruminate, telling your spikes that they are the master, and whenever they knock, you will run to the door and do their bidding. Unfortunately, OCD feeds off of itself, so whenever you ruminate, the OCD gets stronger. It's no wonder, then, why OCD is such a powerful force and how it can take over someone's life if left untreated.
It is difficult to stay positive and energetic while confronting the OCD. It pounds on you ruthlessly, trying with all of its might to envelop you in its world. But discipline and determination are very important. Everybody has ups and downs with all aspects of life, and OCD is no exception, so consistent exposure and a general check on your attitude towards the spikes are important. And sometimes if you do ruminate, or the OCD really beats you up, its O.K. You're human, and you wouldn't expect less from the king. My father once said something to me about fear that I will never forget. He recalled the image from Rocky when late in the fight, exhausted and battered, Rocky motioned for Apollo Creed to come and get him. This is the spirit of the therapy, and when the spirit is united with some tools, OCD becomes manageable. I have always grown the most in my life when I have been the most challenged and simply stayed the course. Don't limit yourself. If you choose to face your fears and continue to go about your business, you do so.
My life is different now. It is a challenge instead of a nightmare.
Originally printed in the Obsessive-Compulsive Newsletter, 5 (4), 1991, published by the OCF
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