Self-Fulfilling Prophecy: The OCD Tyrant!

Here’s a helpful cautionary tale from the modern folklore that is Star Wars.  It doesn’t matter if you’re not a fan of Star Wars, you’ll pick up the idea.  (Although it does matter if you’re not a fan of Star Wars – what on Earth is the matter with you!?!)

Anakin Skywalker is an heroic Jedi Knight who, for all his powers with the Force, harbours two personal struggles: one is a self-perceived guilt over the abandonment, and later death, of his mother; the other is that he is plagued by nightmares that the love of his life, centre of his universe, Natalie Portman (or Padme, as he likes to call her) is going to die in childbirth.  Influenced by the guilt he feels over his mother, and the fact that his marriage to Padme is secret (so he is even afflicted by guilt over his own feelings of love) he does not only fear that these nightmares shall come true, but that this, too, shall be his fault.

Right, now you’re probably thinking ‘wow, that’s a great story Baz, but (either) a) I already know it, I’ve seen the films, b) I couldn’t give a toss, (plus) c) what the hell has this got to do with a blog allegedly about the mental health condition Obsessive Compulsive Disorder, which was all very helpful and informative until you stopped bothering your arse even writing it at least a year ago?

Well, please – allow me to continue and to clarify.  Back to the story, and enter Chancellor Palpatine, a.k.a. the evil Sith Lord in disguise who is soon to become the tyrannical Emperor, oppressor of all liberty and hope.  A.k.a. the intrusive thoughts at the heart of OCD.  ‘Ahh,’ you all say, ‘he’s using it as a metaphor!’

Yeah, yeah, thanks for keeping up – let me get on with it.

The Chancellor / Emperor has befriended young Anakin for some time now, and has been subtly manipulating him to believe that he understands the troubled hero whereas no one else does, making him the only one that can truly be trusted.  So of course Anakin confides his fears to the Emperor, who then makes clear to him that not only are his irrational fears definitely going to come true! (cleverly reinforcing Anakin’s guilty feelings that what might go wrong is all his own fault), but that the only way he can stop this happening is to side with the Emperor and embark on an increasingly destructive set of actions which then actually result not only in the very things he has been fearing taking place, but also in the loss of everything else he loves, and the loss, effectively, of his own identity (replaced by something dark, corrupted, and destructive – Darth Vader).

Now, I’m not just telling you all this as an example of literary criticism, and presenting Star Wars: Revenge of the Sith as cinematic metaphorical depiction of how OCD can work (though it seems to work that way quite well, now that I’ve written it).  Rather my intention was to use it as an example of something that is key to the perpetuation of intrusive thoughts and their impact in OCD, or indeed other experiences of anxiety and worry: the self-fulfilling prophecy.

The only reason, ultimately, that everything goes so very badly wrong for Anakin, was because he was persuaded that he had to do something about his worry: and those very things that he did were the actual cause of his fears coming true.  I’ve spoken in blog articles before that the issue, when it comes to OCD, is not the thought (the ‘O’ – Obsession – component of OCD), but the response or reaction to this thought that we feel compelled (the ‘C’ component) to do about it.  The thought becomes the central problem in your conscious existence when you follow it, believe that it will be this problem, and so you try to stop it.  Things only go so badly wrong for you due to the measures that you carry out to prevent, change or nullify it: checking again and again that the door is locked; washing your hands if you touch a certain thing; avoiding seeing a certain food product in the shop; finding reassurance that the strange thing you just thought about is not the case, constructing arguments in your head about why it must not be the case.  It’s not the problem to have the nightmare: the problem is to listen to what the Emperor says you must do about.

This Star Wars example, this metaphor, cropped up in a therapy session of mine a year ago.  I had made certain progress at the time, but a small something occurred while I was watching a film (an activity that I enjoy a lot, but had been unable to consistently do for a couple of years at that point due to my OCD) and something I saw made me think of something, that linked to intrusive thoughts that I had been suffering.  I actually did pretty well – I was discomforted for a few days, but recognised that I could accept that and that there was no need to follow the thought and demonstrate why it was not a problem; no need to avoid watching another film until I had managed to demonstrate this to myself – because it was only going to become more than a temporary discomfort and become a mentally crippling problem if I tried to demonstrate this to myself, to challenge the thought through internal arguments which would escalate, and get out of control, if I believed that any of this was necessary.  My therapist was pleased with my response, with the insight, and laid bare the role of self-fulfilling prophecy in OCD, of recognising that is what it would become.

So, why am I writing about all this today, a year after that conversation, and about the same length of time since I last contributed to this blog?

In terms of recovery from OCD, I have been doing very well.  A month after that session last year I had a bad, bad downturn and was in what cognitive scientists call a ‘right fucking state’ for a few months.  But then in November / December I made a massive break-through, and a couple of brief slip-ups aside that I have sailed through well, this year I am pleased to say that I am doing much, much better – the best I have felt in four or five years.

In recent weeks however, I have noticed some warning signs.  Not so much of OCD – but of becoming overwhelmed by my own feelings, of ruminating on this, worrying about it.  I have experienced depression in the past as well as OCD and I have noticed that I am projecting the way things may pan out based upon those experiences: I have started applying certain negative interpretations to things happening around me, applying self-judgement as a result, ruminating over how I need to adjust my behaviour in order to avoid the path of depressive episodes before; to make sure that the faint whispers of OCD symptoms I’ve been hearing for a couple of weeks at the edges of my mind don’t grow into a problem…  Then, it struck me, as I opened the laptop today, to work on the book that I’m writing (hence, so little blog activity), and weave in the Anakin Skywalker self-fulfilling prophecy metaphor into the self-realisation of one of my characters, that the very way I am approaching my feelings is same thing.  It’s the Emperor, wearing a different outfit, and warning me what to do about a different nightmare.  I am feeling a bit down at the moment, but the way it shall become the disaster I fear, is by my trying to work out what to do about it.  There is only one thing I need to do: recognise the thought-distortions involved in my current thinking, take a step back, don’t judge and to be aware.

Very much advice Yoda would give, rather than the Emperor.

So I wrote this, to remind myself.  But also, because I hope that it is useful and helpful.  As I have said before, OCD is a disordered version of normal human cognitive processes: understanding what goes wrong, how it escalates and what can be done about it is useful for all of us.  Recognising the role of self-fulfilling prophecies, of thought distortions in our thinking when feeling anxious or down, is helpful, because they can be countered.

That’s great, you all say.  What are these thought-distortion thingys again?  Are they like Jedi mind tricks?

Ah, no.  They are something else.  And because this is getting long, and I’ve got a book to write, I shall leave it there, on that cliff-hanger.  But I shall be back very soon to explain their part in my current worries, and the part they play in all of our worries.  Best still, I’ll suggest what you can do about them.

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.

How OCD first invaded my mind, and other stories

As I explained last time, the experience of OCD is massively varied.  Not only does it vary from person to person, but within one person’s experience it changes too.  This is an important point to emphasise – as next time I’ll discuss how it is not the content of the thoughts that is important, but the process.  Today, to provide that discussion with some context and to demonstrate OCDs variable nature, I’m going to take you on a tour of the earliest years of my illness.  Believe me – this is deeply uncomfortable.

14 -16 years old: Contamination

It began with a problem at school.  Bullying?  Girls?  Long division?  No.  Acid.

I don’t mean acid as in LSD or late 80s dance music (‘this is aciiieed!’).  I mean hydrochloric, sulfuric… whatever acid as used in chemistry class.  Although I believe that acid tends to announce is presence on skin quite proudly, I felt deeply uncomfortable after science class.  What if the chemicals were on my hands?  On my clothes?  On my school bag?  Within no time at all, just going to school resulted in a feeling of entering a contaminated environment.  And I mean feeling: I experienced a highly sensitive physical discomfort, like walking in to lukewarm, dirty, water.  My home life and school life were wrenched apart – I had to keep them separate.  Anything associated with school took on this irradiated quality, humming with a stale warm glow, like the halo around people who had eaten porridge in the old Ready Break adverts (showing your age Baz – tell them to look it up on YouTube).  When I got home I would remove my uniform, store it, my school bag and books in an isolated location which could not be touched, then go straight into the bathroom to thoroughly wash.  While my school work went to shit (I didn’t do any homework) and social life was affected, I managed the situation up quite well, I thought.  When I went into the sixth form, which was safely separate to the rest of the school, the problem faded away.  It was not until years later, that I told anyone about all this, or associated it at all with what was to come.

16-22 years old: mental imagery

Gradually over these years OCD properly took hold, and took the form of bizarre mental images that intruded upon my minds eye like a waking nightmare.  Polluting and infecting all other mental imagery, they’d twist and distort my imagination.  This is still the most common form of the illness I experience to this day, when I have relapses.

The problem would come and go, be more manageable sometimes or worse others, and last varying lengths of time.  The frequency, duration and severity gradually increased over a few years, until by the age of 21 it was near constant and having a severely distressing impact.  I responded to the images with compulsive feelings of disgust, repulsion and severe upset.  Their presence was feared and delivered an extreme sense of discomfort and wrongness, accompanied by apparent physical sensations: similar to the irradiated contamination I described above, and a warm sickly sensation in my head like a lumpy ooze bubbling under my skull, or rock jammed in my brain.

I was also stricken by a guilt – a responsibility, a need to seek reassurance from myself that I could fix this this.  Try to restructure the mental images, arrange them all as if solving a puzzle to get back to normal.  To have a ‘clear’ or ‘clean’ head again.  I tried to avoid physical or topical stimuli that may trigger the images.  My reaction to encountering such stimuli was as if to an electric shock, or an alarming, explosive sound.  They commanded my attention, demanded reassurance and resolution.

The form that the images themselves took changed every couple of years after they started.  First it was cigarette butts.  I’d be reading a book, picturing a scene – and there was a mound of cigarette butts.  Thinking of nothing in particular – there was a rotting cigarette butt floating in my head.  That changed as the problem intensified, both in frequency and severity.  The first change came when I’d poked my hand down the side of the armchair to retrieve a dropped pen, and recoiled in disgust at feeling food crumbs that had escaped and gathered there over time.  Now thoughts and images invaded my head with a force I’d not experienced before – ‘imagine that mess mixed with cigarette butts; imagine all little things in the world dropped and mixing with that mess; imagine that mess is the rubbish everywhere, all around us choking the world; imagine all chairs, all homes, all safe places you snuggle into… you are snuggling into that disgusting mess!’  Comfort, safety – they felt stripped away.  I felt exposed to a terrifying mass, surrounding me, closing in.

In turn this too changed.  For a long time the images were of a specific food stuff – a gooey, horrible dessert, which, I’m sorry, I’d rather not describe.  But really it doesn’t matter.  As each image changed, what used to upset me no longer did.  I could often deliberately think of previous images and they didn’t bother me, or if they did, the thought passed out of my head.  But the distress remained, and worsened.

 

22 years old: Conceptual crisis

In 1993 I was in an utter mess.  To this day I have a difficult, anxious, OCD relationship with the number 93.  Some weeks I couldn’t operate at all, and was bedridden, wishing I could just not think at all.  The images had gone after one day the foodstuff image took the place of something else as a punchline in a joke.  My response was devastatingly strange.  My compulsive, defensive instinct was to try to stop the image being associated with the joke, so as not to ‘contaminate’ it.  But then this other thought smashed everything away.  What was funny about the joke anyway?  How does it work?  How does any joke work?  What is humour?  Why is humour?  How is humour?  I scrabbled mentally to explain, and with every explanation opened up a trap door – what did I mean by this?  What did I mean by that?  What is enjoyment?  What is beauty?  Why do you like things?  Explain and justify these things!!

Within a week, all the unpleasant, upsetting mental images had gone.  But they were replaced by this non stop, howling, abstract storm in my head, which carried with it all the feelings of physical discomfort and exposed wrongness that used to accompany the images, and which I knew could not go until I lived up to my responsibility, and solved these unsolvable abstract riddles.  Consciousness was exhausting.  All I wanted was this crap out of head, or just to be dead.

And then help at last

The diagnosis of Obsessive Compulsive Disorder and subsequent psychiatric help late that year saved me (see earlier posts),  and until a little over a year ago, management of my illness has been pretty successful.

But see how varied it can be: an irrational fear of the contamination by chemicals.  Upsetting, stubborn mental imagery.  A compelling need to justify my own thoughts at the cost of despair.  All parts of the same illness, and none of them as funny as arranging my pens by colour.  What is it about these thoughts that makes them so disordered?

Well, the answer is – nothing.  They are, no matter how weird, just thoughts.  It isn’t the content of these thoughts that is the problem in OCD.  It is the mental interpretation of them.  It is in this, and the response, that we find the disorder.  As I shall discuss next time.