Triggered

Exploring the psychological landscape of OCD

Obsessing About Obsessing: When OCD Goes Meta

You have no idea how deep the OCD rabbit hole goes.

You’d be surprised at how long, even after I’d finished my treatment at the OCD Institute at McLean Hospital, my disorder continued to bother me. 

For years leading up to my OCD diagnosis, I’d been tormented by uncontrollable intrusive thoughts, forced to picture the least appropriate thing I could imagine at any given moment. Violent, sexual, sacrilegious, obscene—whatever horrible thing you can think of—OCD used it to torment me. And cruelest of all: the harder I tried to stop thinking about my OCD, the harder the thoughts came.

But with the help of the professionals at the OCDI, I started to manage these thoughts. I was taught to fight my OCD with Exposure and Response Prevention (ERP), a process that requires confronting and accepting disturbing thoughts instead of resisting them. ERP is painful and difficult, but it reduces the anxiety associated with OCD, and over time can allow the sufferer to return to a normal life.

Even after I left the hospital, there was still work to be done. I returned to Philadelphia for college and began work with a new therapist. He continued my ERP exercises, listening for upwards of a quarter of an hour as I would rattle off an id-driven, stream-of-conscious litany of curses and atrocities. It was like telling him my version of “The Aristocrats,” or freestyling an Odd Future track, acting out a Lars Von Trier movie, reading aloud the Marquis de Sade's 120 Days of Sodom, or copying a painting by Hieronymus Bosch. At the start we’d both be disturbed; five minutes in, my therapist would start covertly checking his watch as he nodded and listened; ten minutes in, we were both bored. By now, this stuff seemed almost mundane. 

Yet for some reason my anxiety endured. Whenever the thoughts popped up, even though they weren’t as viscerally disturbing as they’d once been, I still panicked. 

At first, my therapist told me to use my ERP exercises whenever my thoughts returned: to deliberately think of perverse and disturbing imagery until my symptoms went away. So I developed a protective chant, a rosary of cursing and wickedness, that I repeated again and again to banish the disorder from my mind—not that different from washing your hands over and over to disinfect them. Compulsions masquerading as ERP. Rituals pretending to be therapy.

OCD methodically exploits its host’s deepest and most personal fears. That spring, perversely, the thing that frightened me more than anything else in the world was my own Obsessive-Compulsive Disorder. I knew every intrusive thought could be a sign of the disorder’s return, an overture to a reprisal of the past twenty years of misery. My therapist and I eventually realized I was being terrorized not by the intrusive thoughts, but by the exasperating persistence of the disorder itself. 

Somehow, unbelievably, maddeningly—I had started obsessing about obsessing.

This is not an entirely unknown phenomenon in the study of anxiety disorders. But I found its implications somewhat baffling. It seemed like an insane crossover of my undergraduate English studies with my mental illness: postmodern OCD, OCD derived from my study of OCD. 

And as I unraveled each layer of obsession, the disorder inevitably found some new way to perplex me. When I realized I was obsessing about obsessing and tried to stop it, my OCD asked me if I was now obsessing about obsessing about obsessing. Obsession and obsession and obsession, layers of thought enveloping one another, like an inverse onion. Was I obsessing now? What about now? The questions never stopped and could never really be answered. Like the Red Queen’s race in Lewis Carroll—it took me running all of my mind, only to keep in the same place.

My therapist and I fought these symptoms for months. Every Friday that spring I would travel over to his office, by car-share or public bus, and we would spend a long hour trying to disentangle my thinking. We tried endless, circular exposures, we confronted the thoughts that reinforced the obsession that drew their momentum from being thought. But every time I attacked it with another form of preventative exposure, the OCD drew its grip tighter.

Does it sound confusing? Frustrating? Trust me—living through it was worse.

There was no sudden moment of revelation during this stage of my treatment, no epiphany. I stumbled along; I experienced countless relapses and committed indefensible blunders. But the answer, in the end, was stupidly obvious from the beginning, and the only obstacle had been my steadfast refusal to see it. 

I realized that I was demanding perfect treatment, perfect therapy—I wanted to be perfectly healthy. In other words, I was applying obsessive-compulsive logic to my struggle against OCD. The disorder fed on the sadness and anger I directed towards it—lean morsels, to be sure, compared to the feast of neurosis it had once gorged on, but enough to ensure a meager existence. Every time I stomped my feet and demanded it vanish, it snatched back a little bit of territory.

What I slowly, agonizingly accepted was that I would never be fully healthy.

Paradoxically, I overcame the sickness in doing so.

This is what I learned, in confronting this strange permutation of my OCD: I’m not really healed, and I never can be. I cannot eliminate my unwanted thoughts, and although I am learning to manage them, I will experience sporadic outbreaks of symptoms for the rest of my life. I will never extract myself from the sterilizing, controlling, self-annihilating tendencies that I’ve struggled with since childhood. I will have this disorder until I die.

But, I am still healing. And, I will continue healing. 

That is enough. 

It has to be.

 

Copyright, Fletcher Wortmann, 2014.

You may also be interested in my column about ERP: 

http://www.psychologytoday.com/blog/triggered/201205/full-exposur...

Author of Triggered: A Memoir of Obsessive-Compulsive Disorder (St. Martin’s Press), named one of Booklist’s “Top 10 Science & Health Books of 2012.”

Visit my website: www.fletcherwortmann.com 

Read my Psychology Today blog: www.psychologytoday.com/blog/triggered

Image: ©iStockphoto.com/SamRyleyƒ

Fletcher Wortmann is the author of Triggered: A Memoir of Obsessive-Compulsive Disorder.

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