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Key points
- While self-awareness may be helpful, so are some more mundane strategies for reducing distress.
- People with OCD tend to have thought spirals that don't necessarily improve when challenged.
- Patients may look for "better" strategies less because ours don't work well and more so due to shame.
The "answer," if we can call it that, is sometimes simpler than you think.
Most therapists love the intellectual tussle of therapy. We love grafting our interpretations onto our patients' problems, linking upbringing to schemas (or expectations of others) to specific interpretations of the world. We love being able to tell people what they're really doing and why.
As helpful as this aspect of treatment can be, there's another that can sometimes be even more effective (at least at times). And that is to follow a patient's natural inclinations—that is, doing the things they just want to do.
For example, obsessive compulsive disorder (OCD) is an extraordinarily obstinate illness, against which reason often can't seem to penetrate. Despite therapists' pleas to attempt to live life with uncertainty and to try to work out conclusions while reminding themselves of the illusion of infallible truths, patients, nonetheless, cycle between relief and fixation.
So, we ask: What is it that seems to work, if anything does? The answers are, in a way, remarkable. And their theme: thinking less, rather than more.
So much of my writing and therapeutic work is wrapped up in theory because many of us believe that deep self-awareness is the foundation of increased maturity. Yet we often miss the mark. After years of therapy, too many patients find themselves feeling ashamed of being unable to apply any of their insights to their lives; some even become fixated on the acquisition of them. A common refrain is: "I know myself a lot better, but nothing's really changed."
While many of us scoff at some of the more temporary and mundane resolutions available, they appear, at least anecdotally, effective. With regard to OCD, cognitive restructuring (i.e., examining the evidence for one's beliefs and then adjusting them to fit it) can foster endless thought-spirals, a never-ending stream of "what-ifs."
But showers, walks, video games, time spent with friends, and even naps, when used as short-term strategies over the long run, alleviate some distress. The problem is the shame patients feel when they engage in those activities.
People with obsessive and compulsive tendencies are often driven by a high motor, which in part is associated with pride and shame, feeling the sense of having something to prove in order to manage the shame. Unfortunately, therapy can easily become a breeding ground for more of it, particularly if the patient feels pressured to work really, really hard to resolve a really, really difficult problem, even if the pressure felt is mainly internal.
As they try harder, their thought patterns may worsen. Yet the strategies they tend to resort to are abandoned for fear of humiliation. Feeling childish, lazy, and even privileged, some patients forego what they know works—like taking a nap—for more "mature" defenses. Therapy, in this respect, may aid in freeing them to turn to their more primal, internal resources, those that stood the test of time.
This isn't to say that someone should just take a walk if they're feeling depressed, but I strongly encourage people to ask themselves what's worked in the past and why they have abandoned it. Many of our coping mechanisms may appear childish, and thus many of us have spent our lives being talked out of them.
Yet we fail to consider how few options we actually have and how limited even intensive therapy, that thing that adults do, can be. So, as someone told me: If you need to take four showers a day or multiple naps, and it's feasible, then do your thing. In the end, your mental health is the foundation of all of the other things that matter.
An ancient proverb reads: Enlightenment is the feeling of lightness. The implication for treatment is that doing less, at times, is doing more. It seems the happiest among us are those who aren’t necessarily worried about fixing their sadness, especially in a manner that makes them feel useful, special, or good. Enlightenment is not acquiring more, even wisdom; it’s a letting go. Of concepts, ideals, and visions, and the methods used to extract them from inner space.
