OCD – is it a bit weird or are we all ‘a bit OCD’?

In the article ‘Finding the D in the OCD’, I spoke of how the disordered component in OCD is the compulsive interpretation and reaction to intrusive thoughts.  This is what keeps the illness going, and although if feels as if the intrusive thought is what is wrong and what is hurting, it is actually this reaction.  It is this reaction that CBT targets, but it’s not an easy thing to challenge.  Do not underestimate how strong the disordered compulsion is.  Just think about the word: compulsion.  Something that you are compelled to do, that you have to do.  In her book ‘Am I Normal Yet?’ Holly Bourne equates it to the physical urge to urinate.  It is a deep and irresistible urge, which takes over and can’t just be ignored.  It is not something that you choose to do, mistakenly, for the best.  It is not a habitual peculiarity that becomes irritating and difficult to break.  It was no irritating peculiarity which influenced a couple of (admittedly half-arsed, but nonetheless despairingly intentioned) suicide attempts in my early twenties.

It is not easy to explain how much these disordered interpretations and reactions feel a part of you; how undeniable the unsettled, distorted state of mind and self-perception feels, as most people have probably never experienced anything like it.  Hmm, apart from… most people probably have experienced something like it.

As I also mentioned before, everybody has thousands of thoughts passing through their minds a day, and some of those thoughts will be weird or unpleasant, incongruent and unwanted.  Let’s just pluck a few examples out the air:

You’re waiting for a train and among myriad thoughts passing through the background scenery of your mind, this one pops up: ‘what if I jump in front of the train?’

You’re eating your tea/dinner/supper (all regional interpretations catered for here) and for no good reason as you stab your fork into some carrots you have the mental image of a rabbit, doing a poo, on your plate.  Eurgh!

You are walking past a playground when you find a dropped hat.  You pick it up, thinking maybe to hand it in somewhere, then out of nowhere think – ‘what if the child who dropped this has been kidnapped and murdered?!  What if everyone thinks I’ve done that?   I’ve got the hat!!’

Think, just for a moment.  These are just a few examples I’ve made up, out of near infinite possibilities of potential thoughts.  Just think – you’ll find your own examples that all of you will have at some time experienced.  Many of which, you shall have forgotten.

Likewise, everybody experiences unpleasant emotional reactions to thoughts or external events.  Everybody gets trapped in worry-loops about something in particular, sometimes rational, but unaided by the worry, sometimes thoroughly irrational.  In relation to thee examples of unwanted thoughts above, consider these reactions:

While you may think a surprised ‘blimey’ on the train station platform, and take a step back, you may also inspect the thought – ‘why did I think that?  Can I control urges to jump?  I’m not suicidal – am I?’

Where one person may well laugh at the idea of a rabbit doing a poo (each to their own), another may feel sickened, disgusted.  Put off their tea, or even for a while put off carrots.

You may shrug at the thought of being accused of kidnap and murder (unlikely), and carry on; or you may drop the hat, then worry for the next twenty minutes that your DNA is on it.  Or that if you told someone about the thought, they’d wonder why you were hanging around playgrounds.

Also everybody sometimes employs some personal set of rules to manage how comfortable they feel about something.  You knock one had as you walking through the shop, you feel like knocking the other one, to balance it out.  You have in your kitchen a hand towel (for drying hands only), a tea-towel (for drying dishes only) and a dish cloth (for wiping down the work surface only).  And you do not mix them up!!  You get fidgety and irritated when someone visits and uses the wrong one for the wrong thing.

Again, look through your own life, and you’ll find some of your own examples, at some point, somewhere.

So… does this mean that OCD actually affects everybody?  Aha, thanks for asking: No!  Absolutely not.  The often casually banded phrases of ‘I’m a little bit OCD’, and ‘everybody’s a bit OCD aren’t they?’ are part of the harmful myths to which I’ve referred before, which perpetuate a misunderstanding and belittling of a very serious illness, that affects between 1%-2% of the population of the UK and USA (OCDUK.org figures).

You may be thinking ‘OK Baz, fair enough mate, but, um, you do appear to have just slightly contradicted yourself by saying everyone experiences these thoughts and reactions, but it’s wrong to say everyone is a bit OCD…’  Yeah, don’t worry, there’s no contradiction.

What I’ve intended to demonstrate here is that these odd, unwanted thoughts, these anxious interpretations of things, weirdly disproportionate emotional reactions, ways of maintaining our own mental comfort or order are totally normal.  It is all part of normal human cognition, emotion and behaviour, and very valuable it is too, even when sometimes confusing or worrying.  But just as everybody sneezes and coughs, it doesn’t mean that they have a cold.  Just as when people have colds, it doesn’t mean they have pneumonia; or it doesn’t mean they have a serious, chronic and potentially terminal health condition.

What I am getting at here is that OCD, however it may appear, is not weird.  There is a disordered severity to what otherwise could be a normal reaction, to a thought, resulting in attention assigning wrongly significant interpretations to thoughts and behaviours.  In themselves, the processes involved are normal.  Not everyone has it, but as with all mental illness, OCD is normal human thoughts and behaviours becoming unhealthily detrimental.

Realising this is very important to understanding, accepting, and dealing with mental health.  And it is important for everyone.  Because, just as with physical health, while not everyone has a mental illness, everyone has mental health.  This health is on a spectrum, not fixed in one place.  Mental health can move up and down this spectrum, changing to more or less well, for everybody.  So understanding it, is important for us all.

Thanks for reading.  The next article shall be about an important feminist issue in film and culture – and a social campaign that I am going to attempt to start!  I shall return to the continuing narrative regarding OCD and mental health in the article after that.

 

 

 

 

 

 

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.