OCD – The Opportunistic Troll

So, it’s been a while since the last entry in this OCD story of mine, and for those who have been following the blog, it feels like I need to open up with an American drama series style ‘last-time on Sketches by Baz’ sequence of key points from the last few episodes.  Basically those key points were:

  • In OCD, despite all appearances, the intrusive thoughts are not the problem – it is the process of attributing an alarming significance to these thoughts, and the subsequent defensive reaction
  • By disengaging from that defensive reaction – be it washing hands, checking things, making lists, generating counter-thoughts and seeking validating arguments – and letting the thoughts be, they lose their power
  • This is all good news – but unfortunately the reaction is compulsive, deeply unpleasant and doing all this is, while achievable, bloody difficult

I’ve actually just looked back through the last few articles from late December and early January.  Largely because I need to tell myself all this – because in the last few weeks I’ve had a bit of a crash in my recovery and am currently feeling really bloody awful.

What I want to explain is that this could be a crucial period in my battle, and it could actually be a positive thing, no matter how difficult that is to believe this very minute.  Recently I have made a lot of achievements in overcoming my illness.  Part of my current problem may have come about by giving the OCD a window of opportunity by the very act of reviewing my achievements and checking that they are stable.  While the OCD has indeed taken this opportunity, it has made clear a characteristic about itself that my therapists say I can use to my own advantage.

Ok, first let me give you an example of a gain I have achieved over the OCD.

I had discussed in CBT this helpful analogy.   When I first fell in love with a couple of my favourite Pink Floyd albums, my copies were tapes (kids – use Wikipedia to look up audio tapes), copied from fairly old LP’s (vinyl records kids – you’re not bloody cool if you don’t know what they are!)  So as well as the music, there were a lot of crackles, pops, a couple of places where the needle on the record jumped a little.  Does this mean that it ruined the experience of listening to the albums?  No.  Because I focused on the music.  I could still process the beauty of the music in and of itself.  I was long at the stage where by I did not process the crackles and pops at all.

The crackles and pops, are not part of the music.  Just as my horrible intrusive thoughts are not part of the things in life that I have been struggling to enjoy.  Whatever the thoughts tell me, what I enjoy, what I am, life – it is still beautiful and enjoyable if I focus on it, and not on the interference.  And if I don’t focus on that inference, I’ll stop being aware of it.

Understanding the truth of this analogy makes me feel really good.  Then, a day after talking about this in CBT recently, I had a wobble.  I thought, does this analogy work in my particular case?  Is it different because…?  Does that mean what I thought I had achieved is wrong?  If so then…?  What if…?  But… but… but…  Before you knew it the intrusive thoughts were using my gain against me.

So what had happened?  It’s not actually that complicated.  You could say that because I had achieved something, the OCD threw a noisy strop.  I stopped responding to it, so it shouted louder.  You can demonstrate this basic kind of mechanism in behaviourist psychology.  If you have a mouse (Gerald) who lives in a cage where there is a lever and he presses the lever, only to have a pellet of food delivered, he’s going to press the lever again.  By delivering the food each time Gerald presses the lever, you have conditioned a behaviour in him.  My intrusive thoughts, while not as cute as Gerald, have been behaving the same way.  They pop into my head, I react to them.  In reacting to them I have reinforced their occurrence, so like Gerald with his lever they keep coming back into my head demanding attention.  Now, if you stop delivering the pellet of food to Gerald, what does he do?  Does he think ‘oh, stuff it then’, and wander off, taking no further interest in the lever.  Does he buggery!  He presses it, presses it again – sooner than he normally would, and goes briefly berserk, pressing it with heightened regular intensity.  Where is the food he’s conditioned to expect!?  Where, where!?  Press, press press!  Eventually, of course, he gives up.  And that’s what the OCD does.  Shouts, jumps up and down, causes a ruckus: ‘where is my reaction!?’

Having achieved something over the OCD, unfortunately, I gave it an opportunity, an opening, by kind of safety-checking my thoughts and feelings.  ‘I’ve made an achievement, is it ok now?  Is my achievement stable?’  Doing that was just enough of an opportunity for the OCD to get its foot in the door, and shout desperately ‘no Baz, your achievement is shite!  You’re shite!  And you’ve got stupid hair!’

What is important to recognise however, is not just that the OCD is opportunistic, not just that it is reacting against achievements I’ve made.  It is the manner in which it is reacting.  It is a wind-up.  It is acting just like an internet troll: its message (the content of the thoughts) don’t matter, it has no actual argument of its own, all that matters is its intention: to upset met.  Trying to provoke a reaction from me.  It just wants its pellet of food.

So if you say something good, something that you have achieved, something you deserve to be happy about on twitter, and a troll starts sending through messages that amount to saying your achievement is crap, that you are crap, what do you do?  Argue with them?  Does that make them go away?  No.  Just because they say you should worry about the validity of your achievement, should you worry?  Should you try to explain to them?  No.

Understanding this character of the OCD will help me win.  I’ve had a bad few weeks, and have received excellent help in some pretty intensive therapy sessions, where it already has helped me, just I’ve then slipped a bit again.  These troll like thoughts… pouncing on my own safety checking like unscrupulous salesmen, con men, tricksters employing suggestion and implication to get to me to doubt myself, tempt me back in to engaging with them…  It’s difficult.  But knowing that that’s all they are, trolls – that I can’t win by engaging with them and justifying myself, that there is no onus on me do so, it will help me win.  They have no argument to present, and my achievements are real.

Be back soon with an article about how valuable the friends in my corner supporting me through my illness are.

 

And by pouncing on my own safety checking like an unscrupulous salesman, a con-man or a trickster, to use suggestion and implication, getting me to doubt myself, it is currently getting that reaction.

Finding the ‘D’ in the ‘OCD’

It’s not about the content, it’s about the process.

This is something my CBT therapist discusses with me a lot.  He’s pleased that recently I’ve been attending OCD support groups and Bryony Gordon’s excellent Mental Health Mates meet-ups; things I’d have previously shied away from.  We’ve discussed the therapeutic benefits, amongst which is finding the similarities with others who overtly, at least, seem to experience something very different to me.  Realising that the similarities lie in the process of how the illness works, not the content of thoughts and scenarios experienced, is a very valuable thing indeed.   For the more that you realise that the content of intrusive thoughts does not matter, the closer to recovery you come.

Let’s strip OCD down to the basics.  Meet the stars of today’s two made up examples: Buffy and Davros (what?!  That’s their names, ok?).  Buffy loves going jogging, but has been terrorised by this intrusive thought: that when she runs along the street and encounters a little girl playing on her scooter, she’s going to violently shove that little girl out of the way, into the road, under the path of a speeding van.  She is horrified by this image, appalled that she has thought it, and terrified about why she has thought it.  Is there something bad in her?  Is she actually going to do that?  She can’t get rid of the image, and  she stops going running, or even walking in the street.

Davros doesn’t understand Buffy’s problem at all, and wishes that was all he had to worry about.  His anxiety has gotten out of control since he nearly left the house with the kitchen tap running.  He turned it off, but then turned it on and off again to be sure.  He finished getting ready to go out, but then checked the tap again, turning it on and off again twice more.  Getting to the front door, he thought, what if he left the bathroom tap on as well?  So he went back, turned that on and off again three times to be sure of that too.  Feeling better he finally left, but now he keeps thinking about the incident.  Before he knows it, he is struggling to ever leave the house or any room without turning taps, light switches, all sorts, on and off three times; and his anxiety about it and how weird it is, is making him feel sick.  Buffy hears about this and thinks it’s stupid.  Why worry about that?  It’s not like he’s being terrorised by images of pushing little girls in the road all day long, which might mean she has evil impulses!

The scenarios differ in content, but the process of Buffy and Davros’ problems are the same.  There is a thought that invades their minds (‘push girl in front of van’, and ‘left tap running’).  This thought glares the spotlight of each ones attention, gets trapped in their minds, like a song you can’t stop replaying in your head.

To try to neutralise this obsessive thought, both carry out a reactive behaviour.  Even though she loves running, Buffy stops going.  When this doesn’t work she even stops walking in busy streets.  Davros checks all the taps.  He checks excessively by turning them on and off three times each.  When this doesn’t work, he starts checking all manner of things, turning them off multiple more times.  This is a compulsive behaviour.

Ok, but last time I talked about mental images that upset me, and about abstract misery regarding the concept of humour.  They were obsessive thoughts, sure, but where was the compulsive element?  These type of OCD experiences are sometimes referred to under the umbrella term ‘pure O’, meaning pure obsession.  It is a term that I dislike for a couple of reasons.  Firstly it sounds to me like the title of a porn video!  Secondly, it is misleading, as there is a very strong compulsive element in terms of my reactions to the obsessive thoughts.  For a start, I do carry out overt behaviours, such as avoidance.  Also, the behaviours don’t have to be overt – they can be internal, mental.  In my case I try to transform the images to make them more acceptable or manageable.  Or I try to justify reassuring arguments that I construct to deal with the obsessive abstract terrors; try to ‘solve’ or ‘clean’ the thoughts.  Inn Buffy’s case she tries to stop the image, or questions the reason for it.

However, the real compulsive element in all cases, is not just found in the action carried out to manage the situation, but also the initial reaction to the thought.  This is a very important point in understanding and fighting the illness.  Because this negative reaction involves an interpretation of the original thought.  Buffy thinks ‘that’s horrible – but why did I think it; what if I actually do it;I must not do that; does it mean there is something bad in me; what if I can never walk in a street again?’.  Davros thinks ’how do I know I turned off the tap if I forgot before; why am I still worried about it; I must not let this happen; why did it feel better after three times; what if I can never just do things first time again’.  These are thoughts-about-thoughts – meta-cognitions.  They tell you that you need to do something about the thought.  Now.  NOW!!  They tell you the thought is dangerous, frightening, disgusting – do something about it, neutralise it, NOW, and don’t stop until it is gone.

And how do you make the thought gone?  Do you try to ignore it?  No, no, no.  Ok, you need to keep acting out sets of behaviours or counter thoughts until you find the right one to stop it, right?  Do you arse! (if you are reading outside the UK, this translates as ‘most certainly not’).  Look at Buffy and Davros’ examples.  The more they do, the worse it gets.  Oh, ok, shit.  So what do you do to stop them?

Well – you don’t.

What?!  But… surely…. What?!

What I mean, is that you don’t try to stop them.  And also, you can’t stop them.  But don’t worry, you don’t need to stop them.

You see, the thoughts themselves are not the problem.  They are just thoughts.  No matter how weird or unpleasant.  Everyone has thousands of thoughts passing through their minds every minute, and some of them are, well, weird and unpleasant.  Having the thoughts is not the disordered component in OCD.  How could it be, when the thoughts themselves can be about anything at all?  What is disordered is the reaction to the thoughts.  The severity of that compulsive reaction, that alarmed interpretation, keeps the thought in the spotlight of attention.  The meta-cognition which demands corrective behaviour, a mental solving of a problem, that doesn’t actually exist, maintains the obsessive problem in a vicious cycle.

This is the reason that, in cognitive-neuropsychology terminology, OCD is such a total, utter, bastard.  But while it is a long, long way from easy, once you fully get to grips with where the disorder truly lies – in the process, not the content – then you can start working towards dealing with it effectively.

Why I never wanted to write a blog about my mental health… and Why I think it’s important to write a blog about my mental health!

1 -Why I never wanted to write a blog about my mental health

So during the normal baseline, ‘clean’, periods between major OCD episodes, you know what?  I want nothing to do with OCD.  Rather, I want no acknowledged relationship between it and me.

I’m an empathetic person, and as having a psychology degree suggests, I’m interested in the functioning of the mind.  I care about the welfare of people and mental health – but I like all this at a distance.  It’s a bit like I’ve been deeply involved with the activities of this fiend – yeah, I’m Holmes and it is Moriarty – but when our battles are not actively taking place my interest changes to: ‘yes, everyone should learn about Moriarty, learn how deal with the bounder – it’s a very important matter!  Me?  Oh no, I’ not cut out for that kind of thing… There are better deerstalker-wearing mavericks out there for that task.  I support them!  Jolly good on them!  But me, no.  I’m off to play snooker’.

So, when my current OCD episode – the worst and longest lasting I’ve endured since the year leading up to first being diagnosed – and it was suggested to me that I write a blog… I kind of nodded vaguely, while thinking to myself ‘no bloody way!’

The suggestion had been made by my friend (all names here are changed to protect the innocent, so let’s call her…) Zsa Zsa.  The conversation was taking place, because I had changed my typical behaviour.  Usually when experiencing such an episode, I would tell people that I was unwell, that I sometimes suffered a strange neurological complaint that made my head feel gooey and sticky, made me feel a bit down in the dumps.  This time, I knew it was a really tricky one.  I felt isolated, alone, scared – and I suddenly opened up, told people.  Friends, work colleagues, my boss.  I am lucky in some ways – there was overwhelming support.

So, I was talking to Zsa Zsa about it, about going to CBT (Cognitive Behavioural Therapy), about being afraid that I’ll never go back to normal (I think this every time), but that I was fighting hard.  Zsa Zsa was giving me a good supportive pep talk, saying I would come through this, and when I did I’d be different this time – I could share my experiences, champion awareness and hope, helping myself and others in the process.

I nodded along, while thinking: ‘Hmm, or , screw that.  When I get better I don’t want to touch this experience again with a shitty stick!  I want to embrace my normality and dismiss this whole episode as a sticky nastiness that happened, matters not to me now, and is best left well alone!

And there’s a thing about OCD – avoidance.  I want to avoid thinking about it, engaging with it when I’m feeling ok, so that it doesn’t contaminate me, trigger associative thoughts, get my head all yucky and infected with it.  I want t get better asap.  I do not want to start my writing career with a blog about having OCD.

2 – Why I think it’s important to write a blog about my mental health

And what do they tell you in CBT about avoiding anxiety-tagged objects or situations?  Do they tell you to leave them well alone?  Do you go into CBT, explain that every time, oh I don’t know, you see or think of a bottle of pepsi max (other anxiety-inducing stimulants are available) it triggers a series of obsessive, disgusting mental images of your teeth and tongue melting, and the only way to neutralise these thoughts is to scrub your tongue until you are sick… does the therapist recommend that you never enter any shops selling pepsi max, and force yourself to ignore any mental images of pepsi max?

For those who have never done CBT, I’ll give you a clue:  No.

Doing that maintains the problem.  It makes the problem worse.  It doesn’t mean that you have to drink pepsi max for the rest of your life, but do get used to discomfort when entering shops where it lines the shelves, and if you don’t try to hide from it, over time it will become less important and harmful to you.

So hiding from having OCD when I am feeling more well… it sounds almost like developing OCD about OCD!  And while the problem with OCD really is the thoughts about thoughts, that situation is in danger of becoming so meta only Charlie Kaufman could make a film about it!

But that is not why I’ve now decided that writing a blog about having OCD is a good thing to do.  While I don’t want to spend my life running away from the monster, as I start feeling better there is also no need to go chasing after it all the time either.  I don’t want to hide from OCD, but I don’t want to make my life all about it either.

Zsa Zsa made an important point about helping myself and helping others.  Over the course of this year I have made progress.  Bumpy, stop-stat progress and I’m not there yet.  But progress there has been, and at least a part of it is down to new approaches and openness.  Engaging with wider and different types of help.  Addressing wider emotional issues as well as the OCD symptoms.  Reading accounts of the condition (e.g. Lily Bailey’s ‘Because We Are Bad – OCD and a Girl Lost in Thought’).  Joining Bryony Gordon’s Mental Health Mates Facebook and meet-up group.  ‘Coming out’ – telling everyone.  Not only has this made dealing with the situation less lonely, the support I’ve received has improved as my friends learn what support does help and what doesn’t.

There’s the big thing there – learning.  A huge issue with mental health illness is a lack of awareness and knowledge.  This is particularly pronounced with OCD.  ‘I’m a bit OCD’ says someone lining up the blinds just so, aping the merits of a quirky American sit-com character.  The public ‘know’ what OCD is – it’s people being really fussy about being clean or organised, right?  And when they’re too fussy, it’s a bit silly, right?  That dirt isn’t really going to hurt them…

No.  If they have OCD, their thoughts are harming them.  If they have OCD they probably won’t be telling you – they’ll be hiding it.  Worse still, if they have OCD they may not know it – be suffering alone in silence, while that relief of knowing what is happening in their heads ‘is a thing’, when real treatment is out there to help them.

You see, it’s not just the trivialisation, making a joke, of OCD that is harmful.  A public perpetuation of the myth that OCD is about cleanliness, neatness, symmetry, organisation means that a huge amount of sufferers where it is expressed in it’s many, weird, different forms (such as mine – come to that another time) may not realise what’s happening to them.  Not know it is ‘a thing’.  Not get help.  Suffer.  Die.

Sounds dramatic.  Well, that’s because it is.  And real.

So while I’ve been opening up, sharing, and realising that getting some of this crap out through talking and writing can help me, I have encountered a wonderful community of people who want to help.  And a wonderful community of people who need the help.  I’ve realised that I want to be part of these communities.  I want to share in the process of helping me and helping others.  Add my voice to those who can educate and support through experience.  I’m going to get involved beat this beast, destroy OCD and save the world…  Oh incidentally, my therapist is working with me on how I set my expectation levels at the moment.

So here we go: I never wanted to write a blog about my mental health.  Welcome to my blog about my mental health!