Sunday, December 26, 2010

Past Imperfect


It's been an interesting week.  I've been pretty busy and haven't had so much time to devote to blogging (or to think about blogging) as I usually do.  I start to feel "off" if I don't write as much - like I have something I want to say and am afraid I will forget if I don't write it down soon enough.  This is probably OCD in and of itself, but it's hard to know where the boundary lies between something you want to do and something you just feel you need to do because of OCD.  Writing probably falls a little bit into both categories.

Anyways, one of the things I have been doing a lot since arriving at my parents' house is sorting through old papers - souvenirs, old school report cards, notes and cards from friends, etc. - that I had been stashing away for about a decade before I left for college.  Now every time I go home, there is a certain amount of de-hoarding to do.  This particular trip I happen to be tackling all the papers and documents I saved.  And trust me, it's not a small task.  It's tiring to try to perfectly decide what to keep and what to save with the constant fear that I "might want this" or "might miss that" if I give it away hovering over me.  I realize that I haven't really missed any of this memorabilia in the last decade or so that it's been sitting in and under my desk.  Some of it I was completely unaware I even had.  Yet, when I uncover it again, it seems crucial that I keep it. 

The ironic thing is that when I keep SO MUCH stuff, it's hard for me to enjoy or appreciate any of it.  The really good stuff is all mixed in with the sort of good stuff which is also mixed up with the "I probably won't want this but I'm afraid I might" stuff.  The few things that I really do need to keep, or really do want to keep, are obvious at first sight.  But I keep so much that it gets diluted in the volume of all that's there.  I can't enjoy the things I like the most because the only time I ever see them is when I brave the drawers and bins full of papers to once again sort them and try to throw some of them out.  I don't think I qualify as a hoarder - I'm not quite that extreme.  But the fear of potentially tossing something I might want, combined with the desire to make decisions "perfectly," makes it hard for me to get rid of things I no longer need, use, or even really want.

Aside from my decision-making issues, going back through all these old papers has been interesting for others reasons.  It provides a snapshot of my past, a rough time line of various periods and experiences from my childhood.  Among other things, traces of my OCD are captured on paper.  There's my first grade report card where the teacher was always commenting on what a good and well-behaved student I was, how wonderful it was to have me in her class, except for one point at which her notes begin to hint at an emerging problem - the fact that I did well but "worked really slow" and had a hard time completing my work efficiently...in first grade!!  Other teachers seemed less aware of my difficulties, but I remember having a hard time keeping up later on as well, whether or not my teachers picked up on it.  In third grade, again, my teacher commented on my difficulty in completing work on time.  She urged my parents to help me learn to work faster, but apparently I was quite stubborn ;).  My mom told me that I was really insistent on doing things "my way" and that I didn't want others stopping me.  Somehow I'm not surprised...

Going through the artifacts from my middle school years was particularly difficult for me.  Perhaps it was just the time of day or maybe I was just tired, but going through pictures and papers from that time in my life really toyed with my emotions.  It made me remember thoughts and feelings from those particularly rough years that time has thankfully smoothed over in memory.  I have often said that my most recent descent into OCD mayhem has been the most debilitating, but even so, I still don't feel like it has taken the same emotional toll on me as it did back then.  I was more functional, but inside I was falling apart.  I was carrying emotional boulders with me everywhere I went and in everything I did,  and looking through the pictures, the notes from classmates, the assignments, and the awards, recreated that world for me in a very vivid way, a way that reminded me of just how hard those years were.  

There was the depression, the great black hole where my self-esteem was supposed to be, the way I HATED my body and the way I looked and the desperate desire to change it, the shyness and lack of confidence in myself that weighed upon me in just about every area of my life except for academics.  The feeling of being an outsider, of wondering if I did, or if I ever really could, "fit in," or if my nature and the nature of my family made that impossible.  The feeling of helplessness.  The feeling that there was no one I could really confide my struggles in, at least no one who would still want to be my friend afterward, no one besides my parents that is.  I was always on the brink of falling apart, of succumbing to the conviction that I really was a freak, that I really was amiss socially, lost and beyond any and all hope. 

I am SO GLAD I no longer feel that way.  I really think I was clinically depressed at that time, though I was never diagnosed.  And while it was fascinating to travel back through that period in my life through the various mementos saved from those times, it brought back the feelings of those years a little more vividly than I would have liked.  For a little while I felt as though I was on that ledge again, swaying on the edge of a downward spiral into not knowing who I was or whether I could sustain any confidence in myself.  I came out of that mood, but reliving just a fraction of what I felt back then was not exactly enjoyable.

Finally, moving onward from elementary and middle school to high school, the evolution of my OCD and perfectionism really became clear in sorting through stuff from my 9th-12th grade years.  There are not so subtle hints about my obsessive nature documented here and there - the friend who jokingly called me by the name "Perfect," or the Valentine's Day card given to me by a friend with his impression of me summed up as... "thinking really hard, with no sleep, thinking, tired, no sleep, thinking hard, thinking hard without sleep..."   There's a decorative placemat that was given to me at a banquet I attended my senior year that says, "I win at life!"  That, in and of itself, I found so intriguing, so puzzling, because, while I was very, very flattered that someone might think of me in that light, I didn't feel that way about myself.  I never felt like I had done well enough.  And I certainly didn't feel like I "won" at anything other than academics and music performance.  I was a leader, sure, but often I didn't feel like a very good or confident one as much as I tried to convince myself that I was.  And in the social realm, well, I definitely didn't feel like a "winner" in that area.  I feared that I didn't have that much of a social life NOT because of my life-consuming devotion to school, but rather because I was simply inept and too fundamentally flawed to foster such a social life.  The titles, the academic achievements, they were what bouyed me up, and I was somewhat shocked that others perceived me as a success and not just as a freak thinly veiled by a facade of accomplishments.  Because, to a certain extent, that's what I feared I was...and that everyone recognized it but me.

I don't mean to say that my entire experience of growing up, from childhood through adolescence and into adulthood, was all hard or all depressing.  There were plenty of happy times, times when I felt very successful and proud, times when I enjoyed hanging out with friends and making connections with others.  Times when I felt genuinely good about myself.  But this is a blog about my journey with OCD, and in going through much of my past as captured by the things I kept from those times, these are the impressions that stood out to me in relation to my experiences with OCD.  Some of the things I was able to achieve, some of the things I was able accomplish perhaps even because of OCD, I am really quite proud of, but at the same time, they came at a price. 

I'm at a point in my life now where I feel much more stable and resilient.  My self-esteem no longer seems to dangle precariously on a ledge, ready fall over at the slightest gust.  Nor do I feel like I am constantly teetering on the cliff of depression, holding on with all my might to keep from falling in.  I am so much more steady, and for that I am SO GRATEFUL.  Sometimes I wish I could travel into the past and tell my former self that, "It will get better.  Things will get easier.  They will.  Just hang on." 

All the therapy I've had over the last year or so has also helped strengthen my emotional stability.  Now I can sometimes see that the carrot on a string that I'm chasing after has been placed there by OCD, and I can recognize that it's OCD before I follow that carrot too far off course.  And this, in and of itself, has been immensely helpful.  Even as I became more confident in myself and less emotionally volatile, I still sometimes felt like my feelings were swinging on the tip of a pendulum, gliding from one extreme to the other.  I still felt like I constantly had to guard my emotional state, compulsively fending off any and all things that might make me feel "off" or no longer "right."  Now I know that that insistence on guarding my state of mind is what made it seem to need constant protection in the first place.  Figuring this out, and learning about OCD, has helped me feel more stable and so much less at the mercy of my mind and the world.  Don't get me wrong, I still have lots to work on.  I still have a very compulsive approach to life and a lot of OCD hurdles I'd like to overcome.  And I still have some really rough days when the OCD fueled self-hatred runs rampant.  But now I feel like I know what I'm battling and how to battle it.  It may not always be easy, but I feel that I am capable of fighting OCD and that I have the knowledge, tools, and support to help me fight it.

I'm not sure I believe that "knowing is half the battle" when fighting this disorder.  Knowing what you're fighting certainly doesn't guarantee that you'll fight it or even know how to.   But when a diagnosis, a name for all the collective mental struggles you've faced, is combined with the knowledge, tools, and support to challenge it, the odds of winning that battle seem infinitely greater.  There's still a lot of battle left, but at least you're no longer unknowingly stumbling around the battle field, wondering who's constantly shooting at you and why. 

Thursday, December 16, 2010

Update

So I haven't seen a therapist in the last two days.  That makes this officially the longest I have gone without a session since the beginning of November when I began intensive treatment.  It's weird and it's not.  I am at home visiting my family.  I am in a completely different (less definitively trigger-laden) environment, and there are a lot of distractions.  It kind of scares me how at ease I am sometimes.  But at the same time, I haven't been doing much exposure either...and that certainly makes things easier.  So the decrease in therapy comes with an increase of other things to do and things to hold my attention.  But at the same time, like I said, haven't been doing much exposure :/.

One thing that has been on my mind a lot (and a bit more than usual) is my weight.  Here at home with my family I can weigh myself (I have resisted buying a scale over the years because I know it would probably only lead to bad things, but here at my parents' house we have several), there are far more, and far larger mirrors for me to stare at myself in, and there are more regular meal times and other people against whom I can compare my eating habits.  All great fodder for turning up the volume on my perpetual desire to lose weight.

Anyways, I get SO confused.  I'm not happy with my weight, but who is?  All through college I had wanted to lose the weight I had gradually gained since the last year of high school, and a year ago, I finally did.  Because of OCD.  Because I found it hard to feel clean enough to eat.  So I just didn't eat.  At least not nearly as much and as frequently as I needed to.  I lost a whopping 20 pounds in a matter of a few months without really trying.

Now I have gained most of that back.  I think some of it is muscle, not fat.  But on the scale it's all the same.  The number doesn't differentiate "good" weight from "bad" weight.  And I hate it.  I despise the number I see with all my might.  But people tell me, "You're fine. You don't need to lose weight."  Or, in the past my therapist has said, "I don't want you dieting right now, given your history with an eating disorder and the current intensity of your OCD."  I never know where to draw the line.  Am I happy with my weight?  NO.  A resounding no.  Do I have the determination to change that?  I don't really know.  It's hard when the two sides play off each other in my head:  "Do you need to lose weight?  DEFINITELY!!!!  But do you really?  Maybe I'm fine..."

Ugh.  It seems like I am never happy with it.  Is that an eating disorder mentality or is that just the way we are, especially women?  Do I really have an excuse not to go on a diet because of my history with eating disorders?  Or is desiring to go on a diet normal for my age/gender, etc?  I go back and forth in my mind.  I go between feeling guilty for letting myself gain weight, and then trying to dull that feeling of guilt and disgust with myself with the words of others telling me not to diet, at least not right now.

I LOVE food.  It is one of very few things, and sometimes it seems, the only thing, that I can consistently enjoy no matter what.  Even when I was anorexic I was enamored with the taste of food, perhaps even more so, because every bite I took had that much more value when I took so few.  It's hard sometimes, when I feel I must slog through life, like I must just get through each day one after another for the sole sake of getting through them, to go on a diet.  Meals are the reward, the landing point of each stretch of time spent not eating.  I just have to keep going until my next meal.  I just have to keep doing and pushing forward, and then I can relax and get true enjoyment out of something - i.e. food.  Dieting takes that shining point of hope, that reason to keep moving forward and doing, away from me.  And when I have less freedom about when/what I eat (like while I am staying with my family) I can't as easily regulate when I eat and schedule all the hard things around my meals.  Life can't revolve around my eating schedule and my tendency to plan meals in a way that they become the motivation for getting things done, my reward for doing something I find so difficult to get myself to do.  So I am all confused.  How I am supposed to manage what I eat and how much when everything is so off kilter?  When I can't time my meals so that they provide the drive I need to get through the day?  I want to eat less, but when I can't sync my activities and chores with my meals in a way that maximizes the amount I do and minimizes the frequency of my eating, it's hard to regulate.

It probably doesn't help that I spend a fair amount of time denying myself the full calorie/full fat versions of all sorts of things.  I feel like I am constantly slightly denying myself which makes me feel like I am always a little bit on a diet, so that the idea of going on an actual diet sounds like complete deprivation.  It's like, ideally, I would always like myself to eat less.  And I am always thinking that I should be eating less every time I eat.  And sometimes I do eat less and sometimes I don't.  The result is something along the lines of always being slightly disappointed in myself.   And even when I am at a pretty good weight, I can't enjoy it, because I feel like I'm on a roll, like I have momentum.  The number on the scale is on my side and I just want to lose a little bit more so I will finally be thin "enough" to really like the way I look.

Furthermore,  I have no faith in my ability to go on a reasonable diet and lose weight.  I am horrible at sticking to middle of the road plans.  It's all or nothing.  I am obsessed and rigid or I'm not.  I'm not good at taking the middle road.  Or maybe my idea of a "middle road" is somewhat distorted.

What do you think?  Is it "normal" to be perpetually unhappy with your weight?  It seems like it is.  I have friends who are constantly trying to lose weight.  I just never know what to do.  I want to commit to a diet but then I start thinking about the things other people have said to me and I start using them as an excuse not to.  I never know.

Battling OCD is tough enough.  Battling OCD while on a diet - well, it's a bit tougher.  It takes away one thing I can count on appreciating and enjoying when sometimes it seems like the point of the day is to just make it through.  I know I could do it.  I think I've proven to myself many a time that I can push myself to do all sorts of things, even if in the process, they make me numb and dysfunctional.  Can I push myself to lose weight, too?  Do I want to?  Should I?  I never really know.  But what I do know is that I am not currently satisfied.

Wednesday, December 15, 2010

Taking Off...

My trip has only just begun and already exposures are presenting themselves.  I used a public bathroom at the airport because I DO NOT want to have to use the bathroom on the plane.  A public restroom v. plane bathroom.  It’s like choosing the lesser of two evils.  Neither is preferable at all, but this is what I “trained” for.  And I’m glad I did – using a public restroom was less of a hassle because I practiced being less compulsive when using public restrooms earlier this week with my therapist.  Pair this with the fact that I have done other restroom exposures without actually using the restrooms, and even though I may not be super duper excited about using them, I can at least get by.  I don’t have to sit for hours on end worrying that I will have to pee before I get to my destination.

But my mind is still reeling from this exposure all the same.  At least my version of reeling.  As usual, I’m terrible at identifying and labeling my anxiety for what it is.  Instead I just think and think and think…oh, and think some more.  Right now I am on the fence – should I retrace the events in my head?  It would be so easy.  I could figure out what touched what in the bathroom, what I was forced to touch before washing my hands, what could now be “contaminated.”  But that’s one of my biggest and most detrimental compulsions right now – the compulsion of mental review.  I’m not sure if I am willing to resist.  I feel like I did the exposure and physically did response prevention, so why do I have to resist the mental side of things, too?  I used a freaking public restroom, AND I washed my hands much less compulsively than I usually allow myself to.  The desire to mentally review the restroom experience is SO strong.  But if I engage in that compulsion, I will at least not engage in it here, on my blog.  I don’t want this to be an outlet for my compulsions but rather a place for me to establish my will to fight back and gain support from others. 

Still, the urge is strong.  We’ll see.

In other news, this is the first time I have traveled WITHOUT HAND SANITIZER since my relapse began.  That’s another reason I am dying to permit myself just a few big bad mental rituals.  There is so much exposure in so many other ways.  Anyways, I have never done this before – traveling without hand sanitizer that is – since my contamination issues rapidly took over my life nearly a year and a half ago now.  But since the beginning of my intensive treatment, I have sworn off the hand sanitizer.  My therapist and I threw out what was left of my stock at the beginning and I have committed to purchasing no more.  Hand sanitizer is my drug and if I let myself make an exception because I’m traveling, I could easily find myself again becoming dependent on it when trying to function in the public world.  In the end, it’s better that I am forced to sit out the discomfort of feeling like I “should” do something about the fact that I have touched lots of dirty things. 

So there it is.  The beginning of Day #1 of my trip.  First day off from treatment (besides Sundays) in several weeks.  Doing my best to continue moving forward (or at least maintain my gains) and to embrace the exposures inherent in the experience of traveling.

Monday, December 13, 2010

Bathrooms and Hand-Washing and Exposure, Oh My!!

Today I did a field session with my therapist at the mall where we proceeded to hit up just about every restroom in the place.  Correction, I hit up just about every restroom.  There was no therapist there to hover over my shoulder as I washed my hands.  No one to turn the water off.  No one to wipe the soap off my hands when I used too much.  No one to tell me stop.  No one to make me touch things.  But I did.  I washed my hands in, and even actually used, a public restroom.

Some background:  half the battle for me in using public restrooms is the hand-washing part.  I never know what the conditions will be like:  Will there be enough soap?  Will I have to touch sink handles to turn on the water?  Will I have to touch the paper towel dispenser to get a paper towel?  Will there even be a paper towel dispenser or just those hand dryer things I don’t like to use (partly because you often have to touch them!)?  On top of that there is the even more bothersome question:  Will there be other people there?  Will there be other eyes watching my erratic hand-washing behavior and making me even more nervous?  Will there only be one sink?  Will they be waiting for me to finish so that they too can wash?  Will their presence in line behind me shake me up and make me feel the need to hurry, making it all seem less "complete" and harder to attain that "right" feeling?  All these questions swim around in my mind before using public restrooms.

Well, today I did it.  Four times.  The last time I actually used the restroom, but the first few times I just did basic exposure – I’d go in a stall and touch some of the things I thought were most dirty:  the lock on the door, the toilet flusher, the toilet paper, etc.  Then I’d walk out and do a 30 second hand wash, one squirt of soap, no avoiding touching things after (sink handles, paper towel dispenser, door handles).  Though these are the general standards that my therapist always promotes, I rarely follow them.  I adamantly adhere to my “rules” until we have had the formal opportunity to address each and every one of them.  Then, and only, then, do I feel like it’s alright to take the next “step” and eliminate or cut back on some part of my elaborate hand-washing routine.

So the biggest exposure today was not so much using the restroom as it was choosing to adhere to the my therapist's guidelines even when I had no one there supervising me.  I could have used tons of soap and followed my washing routine to a tee.  I could have made my therapist go over each and every detail of the process with me before I’d be willing to let myself break the rules.  But the point of today was to get used to using public restrooms, because when I go home for the holidays, I will inevitably have to at some point I'm sure.  And when I do, I don’t want it to be such a cataclysmic event, an event that seems to require extensive self-penance in the form of compulsions, as it has often seemed in the past.  I feel the need to flog myself with compulsions not so much because I feel like I am always that much dirtier for using and washing my hands in a public restroom, but because I feel I shouldn’t have let myself.  I shouldn't have allowed myself to waiver from my strict OCD rules just because it was inconvenient to follow them or just because I didn't want to (or just because my therapist would advise it, for that matter...).

That’s the thing.  These days my contamination issues are so much more about doing things “right” than they are about thinking certain things are dirty and certain things are not.  I do feel dirty afterward, but in a way that doesn’t necessarily seem to require washing to fix.  Right now, for example, the perfect way to handle this situation according to OCD would be to change out of my “contaminated” clothing that I wore during the exposures, wash them before wearing them again or before putting them away, and showering before putting on “clean” clothes.  In a "perfect" world, if I were a "perfect" person in the way I did things, this is what I would do, OCD says. 

But I recognize that doing such things would probably be extremely detrimental to the benefit gained from today’s exposures.  I am no longer such a slave to the OCD that I will jump before every hoop it sets before me, jumping because it says jump even if it doesn't make any sense, even to me, to obey.  But just because I am not willing to do things the “perfect” way doesn’t mean that there isn’t still a desire to do something about the post-exposure situation.

Here are the compulsions I am struggling to resist or am still on the fence about at the moment:
  • Washing the pants that I wore today before wearing them again and not putting them back in the drawer with my other “clean" clothes.    
  • Running through, step by step, the exposures that I did today and how I did them.  This means mentally (or in writing) enumerating all the steps where I could have done something compulsive or where I flagrantly violated OCD rules.
The first may not be easy to resist, but there is a very definite distinction between doing it and not doing it.  The mental retracing, on the other hand, is more difficult to resist.  It would be so easy to do, but at the same it would be difficult to do “right.”  I know that I am already, without thinking about it, rehearsing some of the things I did in my mind.  But to do a systematic review of all the events, of each important step, as well as I can remember them, well, that definitely takes concerted effort and is a major compulsion.  To perform that complicated of a ritual, I have to make a definite choice.

Will I perform the compulsion?  I’m not sure yet.  Delay is my weapon of choice for the moment.  Delay the compulsions, and if you delay them long enough, you may no longer feel that you need to perform them, or so they say.  However, even this scares me.  I keep thinking, “but what if I don’t want myself to NOT care!?”  I’m also thinking:  “But even if I don’t care later I will still feel like I should care and will thus perform the compulsions anyway.”

The desire to be able to declare today's events “done” and “complete” in my mind, to close the book or turn the mental page and move on from these exposures, is strong.  And how do I usually make this happen?  By performing compulsions.  Then I feel free to let my mind go, free from the nagging urge to jump through the mental hoops that OCD has already set up in front of me.  Unlike the pants which, once I make my decision, I will largely be done with the matter, the urge to go back and retrace my actions in my head will still be there even if I decide NOT to.  Just because I make the decision doesn't mean I can't go back on that decision a minute later.  I have to keep renewing my determination to resist every time I think about the urge.  The desire to make things feel “right” in whatever way I can is incredibly persistent.   To put solid ground under my feet by performing compulsions, is continually tempting, because in them meantime, I feel like I am floating around in space, and I want so badly to tie myself back down to the ground by mentally reviewing my exposures.

So will I do it?  Will I resist these compulsions, especially mental retracing?  Well, I resisted doing it here.  I could have made this post a compulsive explanation of the exposures I did.  But I didn’t.  From here, we’ll see.

I keep thinking, "But why resist?  What's in it for me?"

The logical part of my brain says, "Duh, you can recover from you latest OCD downward spiral and be free to do what you want and enjoy it.  You can get better and make the choices you want to make without the oppressive rule of OCD controlling every movement."

The emotional part of my brain still says, "Yeah, I know that.  But what's in it for me??"  And the sad thing is, sometimes in the moment, it doesn't seem like there's much in it for me on the emotional front - just the hope for a better future.  And when I question whether I even really want a "better" future sans so much OCD crap, the pillars holding up even that shiny hope of a "better existence in the future" start to seem shaky.  "Do I really even want to be better?"  I question myself.  I know I do.  But the doubt still plagues me as I worry that life will be no better than it is now without so much OCD.

For now I am doing my best to commit to NOT performing the aforementioned compulsions despite the "But why now?  Why should I care?  Why should I do this? What's in it for me?" questioning that is going on in my head.  I just have to trust that living life with less OCD in the future is worth the current trouble.  I just have to trust that I will look at my resistance as something that led to positive changes when I have more distance.  I may feel unsure as to whether I really "want" this at the moment, but I know that in the long run I do want to get better.   I've been saying that for months, for over a year.  And yet I cling to this disorder and my discovery that I have it, fearing that if I get better too fast, it will all disappear - my diagnosis, the self-revelation, the desire and ability to change my life for the better that seems to have finally opened up before me.  I fear losing those possibilities, that excitement, and in response to that fear I ironically delay what I am so excited to discover:  that I finally know what I have, that it has affected many aspects of my life, and I can improve!

I have to remind myself of that sometimes, because the fear of losing my discovery of "the big secret" (as my therapist once called the fact that I have and have probably always had OCD) is insanely frightening.  I am so afraid of waking up from this dream (or nightmare) and realizing that the hope I was given doesn't really exist, the hope that has really changed my perspective on so many aspects of life.  The ironic thing is:  I can't even really embrace that hope without taking that risk.

So there it is.  I will not perform my compulsions tonight.  I will at least delay them one more day and then we'll see if I can't renew that determination tomorrow.

Friday, December 10, 2010

emptiness

This is the part of getting better that I hate.  When you start to see a noticeable difference, an improvement, and you hate yourself for it.  You hate yourself for letting it go all too easily.  Right now I am continuing to struggle with this.  I am noticing that the need to keep everything perfectly in line with my rules is getting looser.  I don't seem to care as much about them.  And I don't seem to care as much about the fact that I don't care as much!  Ahh!  I feel like I am losing the ability to make myself do things.  And I want it back.  Sure adhering to my completely arbitrary rules makes me dysfunctional.  It's not a self-sufficient way of life, but I start to long for the perfection again, and already it seems unattainable, like I couldn't make myself adhere to the rules again even if I wanted to.

That last part is really what bothers me.  The ascetic deprivation and self-denial that living the OCD life requires is hard to will your way back to once you come out on the other side.  And for some reason I hate that.  I hate it a lot.  I want to be able to turn the will power, the ability to adhere to my old rules, on at a moment's notice.  But without the same fear there providing the motivation, it is really hard to care enough to make myself do it.  Which drives me insane!  But I suppose that's one of the sacrifices of getting better.  You can't be better, more functional, and still carry that drive to adhere to OCD rules, to perform compulsions, no matter how nonsensical.  Because that drive comes from fear and when the fear goes, so does the drive to adhere to the rules and perform the compulsions.  But it makes me feel empty.

It's kind of funny to talk about things like this, considering that, to most people and my therapists, I probably still seem very symptomatic of my disorder.  But to me the boundaries seem to be dissolving faster and faster.  And I don't know what to do.  Those boundaries felt like my scaffolding, the bones that held my body up.  And now they seem to be dissolving within me, leaving me nothing to prop myself up on.

I have imagined the wonderful life I could have, all the wonderful things I could do, if I learned to overcome my OCD and keep it in check.  But will life really be any better?  Will I be happier?  Or will I find that life without the OCD isn't that great either?  Will I discover that having to perform ritual after ritual is only replaced by the monotonous repetition of things that actually have a constructive purpose, things that actually do need to be done?  As long as I am cocooned in the world of compulsions I can at least dream of something better.  But what if it is just as hard to get by without the severe limitations of OCD, just in different ways?

It all makes me feel empty.  So I just keep chugging along, putting one foot in front of the other for the sake of moving forward, hoping that one day I will really want to constantly keeping moving along.  Anyways, I realize I don't always feel this negatively about my progress as I do at the moment, but it's another form of discomfort that comes crawling up from the OCD abyss when I am left alone to my thoughts without more pressing fears to take precedence.

Thursday, December 9, 2010

When the Universe Hunts You Down: Band-Aids on a Mission and Dirty OCD Newsletters

Sometimes it seems as though everywhere I go, whatever I do, I come across things that remind me of OCD.  Then again, I think there is a lot of selective abstraction going on - I mean, I do pretty much have OCD and its treatment on my mind 24/7.  Literally.  I frequently dream about OCD predicaments, and it used to be all I would dream about!!  Every night it was another OCD nightmare, a dream that only I (and others with similar OCD fears) would find terrifying.  I recognize the absurdity of it, how silly it seems that such inconsequential things could be the central subject of a nightmare, but that's how it goes!  And I'm glad I can step back and appreciate the comedy in it after the fact.

It's funny how when you are focusing on your OCD, the universe seems to leap out and offer you exposure wherever you go.  I was talking to a friend who has contamination fears, particularly with blood, and as she told me stories of the challenges she faced, it seemed like wherever she went, band-aids were just crawling out of the woodwork, tracking her down so that she found herself coming across what seems like an absurd number of band-aids each day.  When she would go jogging on the sidewalk outside, there one would be, right in her path.  When she braved swimming in a pool, suddenly they were floating ominously in the water near her.  I don't know about you, but I never seem to come into contact with quite so many band-aids on a daily basis.

The truth of the matter is that I probably do.  I just don't notice.  And so goes the power of OCD tunnel vision.  When you are hyper-vigilant and hyper-focused on scanning your environment for triggers, you notice things that others probably wouldn't.  For me it's that stain on the therapist's couch, that smudge on the wall, or that puddle on the floor.  I even received my newsletter from the International OCD Foundation with what on it?  Dirt!  Yes, dirt.  It seemed like fate.  It seemed like the universe was trying to tell me something not so subtly:  "Give up already.  Your world of 'cleanliness' is just an illusion that causes you a lot of pain and suffering without really keeping you safe.  Just touch the newsletter and read it."  If you can't read your newsletter about OCD because it was too dirty, it just seems like a sign that it's time to move on and tackle your disorder!

I'm sure all of us OCD sufferers come across our own unique versions of this phenomenon.  When we start obsessing about something, suddenly all the world seems to be talking about it or doing it or leaving traces of it for us to come upon.  Things that other people do or say without even thinking can suddenly turn our whole day upside down.  It can be the tiniest, littlest thing that sets off a furor of OCD madness.  But I suppose this is all the more proof that tackling OCD head-on is far better for us in the long run.  As much as we sometimes wish we could avoid coming into contact with certain people and places and situations, as much as we long to compulsively undo the "damage" that has been done when we do come into contact with them, we cannot control the world around us.  We cannot dictate how others act or what comes across our path.  And the more we try, the more dysfunctional we become - the smaller our worlds get until we are reduced to focusing on one very small portion of life at the cost of being able to see and experience so many other things that life has to offer.  The band-aids will continue to hunt us down.  I will continue to come across disturbing stains and mysterious puddles, and so on, until I stop paying so much attention to them.  And how to I learn to pay less attention to such things?  By changing my behavior.  Engaging in compulsions only serves to heighten the apparent importance of whatever it is I wish to avoid.  Not engaging in compulsions, not structuring my life around my triggers, allows them to fade back into the fabric of day to day life until one day, hopefully, they will be no more attention-grabbing than most of the other mundane aspects of daily life.

The less I wash, the less dirty the world seems.  The more I wash, the more I focus on doing things "correctly" and avoiding dirtiness, the more "incorrectness" and dirty things seem to hunt me down.  I continue to notice this paradoxical phenomenon as I continue onward in therapy and recovery, and sometimes I am even tempted to use this knowledge to sabotage my progress.  Sometimes what I find more bothersome than fear is lack of fear.  Sometimes I want to "remember what it felt like" to feel paralyzed by this or that, to see if I can still make myself experience the same amount of anxiety surrounding a particular situation or object.  Funny thing is, in learning to overcome OCD, I also know how to make it worse.  I know how to re-sensitize myself to old triggers that no longer cause me anxiety because I know if I just keep performing compulsions, soon the feeling will return, that I can recapture and memory hoard the sensation of "having OCD."

Ridiculous, I know.  But it's part of the constant push and pull.  I get over something, notice that it doesn't cause me as much anxiety as it did previously, and then I get scared.  I try to relive, in my head, all the things I have done that were "wrong," all the things that "should" bother me, all that would have caught my attention instantly that I now pass by almost without noticing.  And I do it all to recreate the experience.  To make sure I haven't become "too careless" or to make sure that I am not allowing myself to get better "too fast."

That's a lot of what I am going through now.  Reaction to exposure comes in waves.  First there is the "You want me to do what?!" shock and awe phase.  Then there is the grudging but nevertheless committed decision to do the exposure.  Next, it gradually gets easier with repetition.  And then wham!  I fear that I am forgetting what it felt like before.  I fear that I am becoming careless because what would have shocked and appalled me before sometimes doesn't even register on my radar.  And that, that right there, is what scares me when I start to improve in regard to one trigger or another.  I want to somehow get better but still be just as observant of all the triggers in my environment.  But it doesn't work that way.  When the fear dissipates, so does the desperate need to scan my environment for warning signs.  I want to "remember what it felt like before" but as long as I keep running back to the safety of that feeling by re-sensitizing myself, I will never actually move forward.  I can't get better and feel the same way about things as I used to.  Those concepts are mutually exclusive.  And, though it is difficult and troubling in the meantime, slowly forgetting how I could once find some things so bothersome is probably a good thing in the end.  When I finally do make it out on the other side I will be able to actually appreciate the freedom it gives me.

In the meantime I just have to trust my therapists and the exposure and response prevention process.  I have to accept that my urge to go running back is another compulsion in and of itself and that it only hinders all the work I have already done.  Even if I find my progress distressing more than comforting, one day I might just might be able to appreciate and take advantage of that mental freedom.  Instead of seeing that smudge on the carpet or the streak of dirt on my newsletter, I could have a much broader and well-balanced perception of the world around me.  I could appreciate it, rather than constantly feel hunted down by the things I want to encounter the least.

Plus, I could read my OCD newsletter.  I probably need it :).

Tuesday, December 7, 2010

Mindfulness v. OCD

Thanks a lot, rocks.  Thanks for getting in my way all the time.  Don't you have anything better to do?  Some place better to be?  Get your own awesome life so you can stop intruding on mine.  Oh, that's right.  You're a rock.  You can't.
An idea that I have often found helpful lately is an analogy related to mindfulness.  I have to admit, often when you are in the trenches, when you are in the throes of anxiety and so on, mindfulness, the practice of just allowing yourself to have thoughts, to let them come and go without placing judgment on them, can seem like a joke.  When I am freaked out, the recommendation to just have the thought that sparked the anxiety and resist performing compulsions seems like a long shot.  Actually, it seems worse than a long shot.  The notion seems absolutely ridiculous.  It's like trying to bail yourself out of a sinking ship using a teaspoon.  Aka, it seems like a solution that is doomed to fail.

However, when I do allow myself to practice mindfulness (usually when I am not on the verge of panic) it can be very helpful.  Sometimes if I give it a chance and buy into the concept even when I am really upset about something, it can also be helpful then.  But sometimes it's hard to grasp the meaning of mindfulness, especially when my mind is consumed by the OCD "problem" in front of me.  It can seem like esoteric cosmic jargon, psychologist speak that sounds great in theory but, when in crisis mode, seems an awful lot like someone handing you that teaspoon and telling you to bail out the ship that's already well on its way to sinking.

What recently made the concept of mindfulness a little easier to wrap my mind around and buy into was an analogy one my therapists reminded me of.  This analogy, the idea that "water bears no scars," was apparently taken from a book of the same name.  The analogy goes something like this:  when a stream comes upon a rock in its path, it doesn't halt or dwell on the obstacle, nor does it turn around and head the other direction.  Instead it flows around the obstruction in its path, moving around it smoothly and gracefully.  It passes by the rock, accepting that it is there and moving on despite its presence.  The water may have been temporarily diverted but it comes together on the other side and moves onward in its course, onward as if the rock were never there.

Though I am not usually fond of embracing the rather fluffy, zen, "just love and be at peace with yourself" sort of self-talk, I have to admit that I really like this concept.  (Then again, I love extended metaphors in general so maybe I do have a soft spot for some of that stuff.)  This metaphor for dealing with your problems as they arise, flowing around them without pause or over-analysis, helps me apply and understand what can sometimes seem like a rather dry, wordy explanation of mindfulness and how to apply it.  Sometimes when I have a thought or a feeling that seems to require analysis, action, compulsion, or some other sort of halt or change of course, thinking of this idea of water flowing past a rock helps me to move on, to continue doing what it is I am doing despite OCD's attempts to disrupt my movement.  The thought, the feeling, the desire to perform a compulsion may still be nagging on me, but if I just move forward those thoughts, feelings, and desires will eventually fade as they are replaced by others further along down my path.

Anyways, I have been thinking about this trusty stream/rock analogy more lately as some of my rituals have begun to seem a bit less mandatory.  When I am on the cusp of making a decision as to whether or not I will engage in a compulsion, imagining the water flowing around its obstacle without stopping can make it easier to skip the compulsion and move on.  If I just keep going, even when an unwanted thought or feeling suddenly pops up in my path, then eventually I will come back to feeling alright on the other side.  Temporarily parted, the waters will reconnect and move forward again if I just let them.  I may not feel "right" at that moment, but I will again if I just keep moving.

Monday, December 6, 2010

The Gift of Doing Less


As the holiday season arrives, I sometimes think about how OCD affected this time of year for me in ways I never knew.  When I was struggling with scrupulosity, there was of course compulsive prayer surrounding the religious holiday of Christmas.  That was the most obvious form my compulsions took.  I felt compelled not only to pray, but to pray "right."  If I had bad thoughts while I was praying or if forgot important parts (or if I simply suspected that I might have forgotten important parts),  I had to start over.  So, secretly in hidden in my bedroom with the door closed, I prayed, hoping no one interrupted. Because, if they did, I would then have to stop, pretend like I had been doing something else, only to start over yet again as soon as they were gone.

Sometimes if I couldn't seem to get the prayer "right" I would begin reciting the words aloud, hoping to make them stick, hoping to make them somehow seem more final and sure so that I wouldn't have to repeat them all yet again.  Sometimes even after I finally got it "right," I would begin to doubt whether I had included all that I felt I needed to include.  The urge, the pull to go back and begin the ritual all over, was strong.

Had I forgot to pray for this relative or that relative?  Had I expressed enough gratitude for all that I had?  If I had forgotten a relative or if I hadn't expressed my gratitude sufficiently, would God take it all away from me?  How would I know that it wasn't my fault if something bad did happen?  How could I live with myself knowing that I could have done more?  That maybe if I had just spent a few more minutes perfecting my prayer nothing bad would have happened?

I had to get this ritual right.  Furthermore, I had to do it right and get it out of the way so I could appreciate and enjoy the rest of my day.  Or so I thought.  If I didn't, I feared I would constantly have that nagging sense of what still needed to be done, of the task that lay ahead hanging over me, constantly intruding upon my ability to enjoy myself.  Until I prayed and prayed correctly, the day would not feel "right."  I wouldn't be able to enjoy Christmas.  All would be tainted with the realization that I still had to face the Christmas day prayer of epic proportions.  And so I would pray.  I would pray until I got it right.

That was one of the most obvious ways OCD affected my holiday experiences, and once I learned about scrupulosity and read about the common obsessions and compulsions that were associated with it, my struggles all those years suddenly seemed to fall into place.  Suddenly my secret prayer rituals made sense.  It was amazing to me how my obsessions and compulsions fit the OCD mold so well.  So much of what I had done and felt seemed like a textbook version of scrupulosity.

What I didn't realize was how OCD affected the holiday season for me in other ways.  It wasn't until I learned more about OCD that I began to recognize all the less blatantly obvious ways OCD had hijacked my mind and my behaviors, dictating what I should do and how.

That said, each winter I would get out of school about a week before Christmas.  That's when the marathon started.  The clock was ticking and the countdown to make and find the "right" presents, so that I could enjoy the holiday, began.

Every Christmas I wanted so badly to feel accomplished and successful, like I had tried "hard enough" when the momentous day finally came, but to achieve that sense of accomplishment year after year, I had to be sure to put in just as much effort and work just as diligently as I had the year before.  Each Christmas I had to continue to meet the ever-increasing standards I had set previously in gift-giving and gift-making if I didn't want to feel like I had failed.

Thus, I would spend that week before the holiday searching for the perfect gift ideas, the perfect craft projects to take on, and I would pour all my energy into them, so that when December 25th arrived I felt accomplished.  It was like I feared that I couldn't enjoy the holiday if I didn't have to work hard for it, if I didn't spend hours shopping or brain-storming or creating, if I could think of a way in which I had done something "better" the year before.

I stopped buying cards - only those made by hand were acceptable.  I had to wrap presents the "hard" way if I noticed I was too tempted to take the easy route.  I had to wrap, not bag, the presents.  And I couldn't just slap a bow on top.  Instead, I had to create and make ever more elaborate ribbon designs.  I was always complimented on my artistic wrapping abilities.  I couldn't flake out on that now.  Christmas wouldn't be the same if I didn't work as hard at making even the wrapping of my presents just as good as it had been the year before.

I can't tell you how many times as a kid that the following would happen: my parents would eventually go to bed on Christmas Eve, asking when I, too, would turn in for the evening.  They would say, "Please, just go to bed.  It doesn't matter.  You don't have to do all this.  We appreciate how much effort you put into these gifts but you don't need to.  Can't you just stop now and go to bed?  Please get some sleep."

But I was stubborn.  I wanted to continue onward.  I wanted all to be done in the way I was set on having things done.  So I would stay up, often late into the early morning hours, finishing up and making and wrapping presents so that all could be "perfect" for Christmas day.  The late night race to finish it all seemed to bestow the elusive sense that I had worked hard "enough."  And when the morning came, I could celebrate not only the time spent with family and friends but also just being DONE.  Finally DONE.  Of knowing I had survived another Christmas and had once again put in all the hard work that would make that day seem worthwhile.  What I didn't realize was that always trying so hard to make things "perfect" was what often made them seem less than perfect in the first place.  All the effort put into ensuring that I could enjoy Christmas day just made it that much harder to enjoy.

Even when I was older and I moved on from the gift making stage to purchasing gifts, I felt the need to work for the presents I bought.  Even if I could just go buy them online, I felt the need to go to the store, to drive around town looking for the item I wanted.  Somehow just ordering presents seemed too easy.  Driving around from store to store to purchase the exact same items made me feel more complete, more worthy of the Christmas holiday.  It just didn't seem right if I didn't have to work for it.

Last year was different, though.  I was so wrapped up in my OCD world, so paralyzed by my disorder that simply getting out to shop seemed like it required heroic effort and advance planning.  As much as I felt like I needed to do more, it just didn't seem possible in my condition.  For once I felt like I could let myself off the hook.  I wasn't sure Christmas was going to be the same, but it didn't seem like I had much of a choice.

Besides, I had begun to realize just how compulsive my determination to feel a certain way on Christmas had become.  And it wasn't just Christmas.  It was all holidays, birthdays, and celebrations.  In learning about OCD, I was finally able to see how my disorder had impaired my ability to just remain in the present, to feel the feelings I was having on those occasions, rather than forcing and vehemently protecting some artificial sense of enjoyment.  I could finally see how my determination to enjoy these events actually made it more difficult to feel that way.  Instead of just being in the moment and enjoying the company of my family along with the food and presents on holidays like Christmas, I was constantly on guard, ready to pounce at any sign of something that might destroy my mood.  I spent my time constantly on defense, constantly afraid that something would ruin the day and my ability to appreciate it.  What I didn't realize was that I didn't have to do all that work to enjoy my time.  In fact, I would probably enjoy it more if I didn't spend so much time trying to feel the "right" way.  The more time I spent defending my state of mind, the more it seemed to need defending.

And that brings me to this year.  Though I still have a strong desire to enjoy the holiday season and to purchase presents for my family that will bring them fun and enjoyment on that day (and to put effort into finding and selecting those presents so that I can also get a sense of accomplishment out of it), I am more aware, more mindful, of my tendencies and am trying to make preparations without going overboard.  I realize now that all that shopping and present-making wasn't so much about the actual process or the result as the ability to make myself feel "right."  There were so many times that my parents would probably have appreciated the gift of less effort, less time slaving away on presents for them and others in exchange for more sleep and more time spent with them.  I wanted to give them that gift, too.  I just didn't know how to reconcile my desperate desire to make things "just right" with their preference that I actually do less.

Today, there is still a part of me that feels as if I am being lazy, as if I am not working hard enough for the holiday, but I am trying to be mindful of that, too.  Why does it matter if I have a perfect Christmas?  If I work hard enough to feel like I can "really" enjoy that day?  It doesn't.  And in realizing this, I am more free than ever to appreciate my actual feelings, to really experience the holiday season in a way that I haven't been able to in the past.  When Christmas arrives, I plan on being mindful of my emotional state as well as the things that threaten to impinge upon it.  Christmas doesn't have to be perfect.  I can enjoy it even if things do go wrong, and being aware of this fact allows me to be that much more present to enjoy the experience.  Instead of constantly being in my head trying to make sure I am feeling "right," I can be in the moment and appreciate all that is going on around me for real, both the bad and the good.

Saturday, December 4, 2010

An Equation Behind the Madness

my favorite dysfunctional brain...
I've been avoiding writing lately because I'm beginning to notice that it brings a sense of anxiety.  There's the idea that sparks the urge to write, followed by the desire to "perfectly" explain it all so that it feels "right" when I'm done, so that I feel "whole" and "complete" once I've finished spitting out all my thoughts.  Attempting to write a post with that goal in mind is starting to become more daunting than the idea of just holding all those thoughts in.  As often happens as my compulsions grow and take on a life of their own, I make myself perform them until the idea of DOING them finally becomes more onerous than the idea of NOT DOING them, at which point I just start avoiding whatever it is that I feel must be done in that compulsive way.  And I think that's what's begun to happen here.  I'm slowly starting to avoiding writing, even when I would like to, because I've begun chasing after that "right" feeling but am now growing tired of trying to attain it, time after time.

It's a tough balance to keep - doing something regularly but not compulsively, thoroughly but not ritualistically.  I love having this place to express my ideas and to share them with others, but the process of writing in general, and more specifically, writing here on this blog, is certainly not without its compulsive elements.  So tonight I'm going to try to do my best to write NOT in order to come to a perfect sense of completeness, of having captured my ideas perfectly in print, but rather to enjoy sharing my thoughts and exchanging ideas about OCD with others.

That said, I've been thinking a lot lately about the similarities between my experiences with an eating disorder and my experiences with OCD.  The new therapist that I started working with (in addition to my other one) has a lot of knowledge in this area, so I've started venturing into some of the thoughts and feelings I have from that period in my life.  I kind of yearn to talk about that time because it seems like yet another manifestation of my disorder that rose and then faded and yet was never really addressed or resolved. 

To provide some background to this:  I had an eating disorder (though I'm not sure it was ever officially diagnosed) for a period of time in high school, and probably disordered eating habits that developed long before my problem really became noticeable (I lost my period quite a while before what I was doing to myself was noticed by others).  But when my symptoms were finally recognized and my resistance to change was made clear, I was dragged to the doctor who ran lots of tests that began to make the severity of my condition sink in.  From there I was sent to a therapist, and a dietitian.  I gradually got better.  The concern of others and my parents' proactive-ness  seemed to be the permission I needed to stop starving myself.  I had worked hard enough to be thin.  Now I could try a little less hard since people were asking, indeed ordering me, to stop.

In my mind their demands and concern translated into, "Alright.  I guess you can have a break from pushing yourself so hard.  Maybe you do deserve to stop starving yourself.  Maybe..."  What was expressed as a fervent desire for me to get better by others seemed more like a reluctantly offered reprieve in my mind.  "Stop doing this!!  Stop doing this now!" was heard as, "Fine, I guess you can be allowed try not engaging in your disordered eating behaviors quite as much.  We'll see how that goes and if it doesn't get too out of hand maybe you can have the privilege of eating more again.  Maybe, just maybe..."

So my eating disorder faded, but my disordered approach to tackling fear and uncertainty was simply transferred elsewhere.  The energy devoted to starving myself was re-distributed to fuel other compulsive behaviors.  The therapist taught me nothing of OCD and not much about EDs, either.  I was set free from therapy not long after I began, and was really none the wiser for it.  With my disordered approach to life left intact without food to focus on, it seemed to look for something else to grab ahold of.  And the with that, the energy previously given to my ED was added to my already well-fueled OCD.  On the outside I may have seemed "better," but really I was just adding more fuel to a different, slowly simmering storm.  The problem may have been temporarily pushed aside, but it was far from solved.

So, as I have been thinking about this eating disorder time in my life more recently, I continue to notice how that stint of exercising and dieting to the extreme holds so many similarities to my current bout of OCD.

Sometimes my eating disorder seems better explained in the context of OCD, and sometimes my OCD seems better explained in the context of an eating disorder.  And often they seem like one in the same.  Swap out excessive washing and avoidance of dirty things for excessive exercising and avoidance of calories and you've gone from one to the other.  They seem to fit into the same sort of paradigm, a template that produces a spiral into severe disorder in which the contributing parts can be swapped in and out.  Put the components of an eating disorder in, the obsessive fear of gaining weight paired with compulsive attempts to control it, and voila!  Out comes an eating disorder.  Put the components of a more traditional form of OCD in, the obsessive fear of being dirty and washing incorrectly paired with compulsive attempts to be perfectly clean and to clean perfectly, and presto!  Contamination OCD!  The disordered machinery stays the same.  All you have to do is swap out the parts to go from one disorder to the other.  They both seem to be the products of the same disorder-producing machine.  The same monster disguised in different costumes.

So what does this mean?  Why does it matter?  Well, I feel like this is the first time in my life that I have really begun to treat the problem, the source of the symptoms, rather than just the symptoms themselves.  Because when just the symptoms were treated, they did indeed fade (like the symptoms of the eating disorder), but the disorder that produced the symptoms in the first place was left intact, ready to pounce again when the time proved right, when it found the right fodder for the next flare up.

Looking back, I can see all the ways it reared its ugly head over the years.  First it was a fear of contamination and contracting devastating illnesses as young child.  Then, as I got older, it became religious fears, scrupulosity, along with a fear of death and dying.  Soon my compulsive approach to doing homework would become apparent as the work load grew as I advanced through middle school and then high school.  This area of compulsions would act as a constant in the background, a constant that gained more momentum each year I continued to indulge it, all the way up through college.  The eating disorder period arrived in the midst of that, but I recovered from that while still in high school.  And now here I am, back at contamination fears, but for different reasons.  Now I am afraid to not clean perfectly, of feeling dirty, lazy, and unacceptable, instead of fearing illness and disease as I did when I was only six or seven.  I've come full circle with this last relapse being the most acutely debilitating of them all.  And it's this last relapse that finally led me to find (and realize that I really did need) the right help.

It's been a long journey, and I'm ready to start living a different, and hopefully better, life.  I'm ready to start re-programming the machine so that when all the ingredients for another relapse are poured in, a relapse is not what comes out.  Meanwhile I want to continue to improve upon all the little things, all the little compulsions that seem to have pervaded so many aspects of my life.  These little compulsions may not produce the sort of spectacular melt-downs of full-blown OCD relapses, but they tear away at the quality of life little by little.  I want the chance to overcome these compulsions, too.  Basically, I want and hope to have the chance to experience life in a way that I previously didn't know how to. 

My most recent relapse was devastating, yes.  However, I am so grateful that it allowed me to make such a profound and impacting discovery about myself.  I have OCD.  I have probably had OCD my entire life.  I have, for years, performed varying degrees of compulsions, sometimes not even really realizing it.  But now I have been given the wonderful gift of insight, of knowing and learning more about that monster that kept coming back in different disguises, year after year after year.  And, not only do I now I have a name for that monster, I have finally been given real tools to tame it and wonderful, knowledgeable therapists to help me do just that.  At the same time, I am finally learning to recognize what it is that I want, what I like to do, and how I like to do it.  I am slowly finding and taking these things back, little by little, as I learn to fight the OCD.  And I am slowly learning to reprogram the machine that is my somewhat dysfunctional mind so that I can choose to do what I want to do instead of what OCD dictates.

Wednesday, November 24, 2010

Doing Exposure and Not Looking Back

Reality:  there's really only one way to find my way back, and it's not by constantly retracing where I've been...
It's that time again.  I'm stuck in that post-home session funk where I try to decide what to do next - whether to dig myself out or to give up for the day.  I'm going to try to sort my thoughts out about it here so I can do what I need to do to get better!

Today I did a lot of good exposure work with one of my therapists.  The big exposure of the day was...showering!!  Woo.  My showers are now under 30 minutes but still heavily ritualized, meaning that I do everything in a very specific order, in a specific way, a specific number of times.  Deviation from this routine or lack of focus while completing it can lead to repetition until I'm sure I got it "right."  Well, today we took a nice big wrecking ball to my shower regimen.  And this is how we did it:  my therapist timed me as usual, but instead of just calling out how many minutes I had left at certain intervals, this time she called out what to wash and when.  And trust me, the order was so wrong. I didn't get to wash the "right" number of times, and I didn't get to wash everything the "right" way.  It felt very haphazard but at the same time freeing.

Oh, and then she had me put the same clothes back on (which actually happened to be the t-shirt and sweatpants that I had been sleeping in from the night before since I woke up only shortly before she arrived)!  That seemed so wrong in its own right.  I was "recontaminated" in my mind by putting those same clothes on.  Furthermore, I don't usually allow myself to do any type of housework or exposures until I have changed out of the clothes I have slept in and gotten dressed for the day.  It's not really a contamination issue, so much as a rule that I just arbitrarily keep because of OCD.  So continuing about my day in the same clothes I was wearing before showering, the same clothes I had been wearing since I went to bed the night before, was doubly wrong by my standards.  And yet here I am, wearing the same sweatpants and the same t-shirt.  I recognize that these rules are arbitrary but I still feel a sort of gravitational pull to follow them.  At least I do now.  Right after I did all this exposure, I felt disturbingly fine, which is why I ran into even more problems!

Indeed, it was the LACK of discomfort I felt that bothered me immediately afterward.  What a surprise (not).  Ironically, I am usually more at ease and find it easier when I AM bothered by an exposure than when I'm not.  When I don't feel discomfort or when something doesn't seem difficult, I'm not quite sure what to make of it.  Part of me is thinking, "Awesome.  Not so bad.  I'm getting better."  But an even more insistent part of me is thinking, "Woah, woah, woah, hold up!  Not so fast, you.  Think about how you did things wrong.  Try to remember all the ways in which you are now unacceptably contaminated.  You can't proceed unless you know all the ways in which you did things wrong.  You need to know this so you can make informed decisions about what is okay or not okay to do afterward.  To not perform this mental ritual is sheer carelessness."

Of course, the latter voice is that of OCD, luring me into the trap of performing mental compulsions to be "certain," to be "sure" I know exactly what I did "wrong."  This need to know and the retracing I want to make myself do are what I need to resist.  And it's not that it's actually that hard to keep myself from doing these rituals.  What's hard to resist is the feeling that I should make myself perform these compulsions whether or not I actually feel a need to.  Often, I don't necessarily feel any particular need to retrace, but I do feel a need to try to make myself feel like I need to.  Confused yet? 

Anyways, the point is that, when I don't feel the need to perform compulsions directly after a big exposure, I feel the need to seek that feeling out.  So after my shower today, as I sat talking to my therapist, I wasn't sure what to make of my lack of disturbance.  Sometimes I think that when I do an exposure for the first time, it takes a while for the realization of what I have done to sink in, for me to fully process what we did.  It's not until later when I try to go about my day as normal that I start to feel the urge to avoid coming on, the desire to just give up until tomorrow when I can shower again and get a fresh start.   That's what I'm feeling right now.

Problem is, wishing I could just do nothing until my shower tomorrow is incredibly soul-sucking in the meantime.  I feel the weight of the things I "should" do on my shoulders.  I want to get things done, and the lack of productivity begins to grate at my psyche.  As much as it seems "wrong" to do what I am supposed to do in my current unresolved state, I know I should.  In fact, that word is perfect - "unresolved."  That's how I feel.  To feel resolved I would need to engage in a number of compulsions first - shower again (the "right" way) and change clothes, or at least think through the steps of my earlier shower and enumerate all the things I did wrong.  Then I could figure out why it is or isn't okay to proceed with my other planned exposures for the day.

I have already given into this ritual a little bit.  In trying to determine why I feel "off" right now, I have gone back and explained to myself, in writing, why the things I did seemed wrong and what rules I broke.  And yet there is so much more I could retrace, more I could identify as being done incorrectly.  But while writing this, I've also begun to realize it's that uncertainty of not knowing exactly what I did "wrong" that I need to face.  I need to embrace the unresolved feeling that has grown throughout the day (the feeling that I wanted and didn't have earlier, funny enough) and accept that I don't know every way in which things I did things "wrong," nor do I need to know. 

And with that, I am off to do the rest of my exposures, embracing the unresolved feeling I am currently carrying!

Monday, November 22, 2010

Newsflash

Just thought I'd share my discomfort with the OCD blogging community, just in case anyone out there wasn't experiencing enough of their own...

So I just finished a home visit and was permitted a quick hand wash supervised by my therapist at the end of my session.  Yet, of course, that hand wash didn't seem like nearly enough to me to rid my hands of all the gross-ness collected on them from the things we did.  Maybe this isn't that gross. Maybe it's just me.  But we used rags and 409 to clean off a kitchen counter and stove top that have not been cleaned in oh, like forever.  My hands felt as if they were soaked in solution of 409, kitchen counter top debris, burned grease, and the collected film created by the gas that's burned by the stove.  We rinsed the rags out at the end, and thus, my hands were rinsed a little at that time.  But after that I was only allowed that one 30 second or so hand wash that I mentioned before.  With only two pumps of soap.  It didn't feel like enough.  Not enough to touch other things and eat something with my hands, which I am now doing.  Maybe it's enough.  Maybe not.  But it sure as hell didn't feel like it.  And I guess that's just how it's supposed to go... I guess I just have to trust my therapist...so I'm out here, right this very minute, typing and eating a sandwich with my not-so-clean-feeling hands...

Sunday, November 21, 2010

Intensive Treatment Update

So I realize that I haven't really kept up with summarizing my journey on through my intensive treatment program.   I am now at the close of week 3 and much of weeks 2 and 3 were like week 1.  Each week has had its ups and downs but the overall product is certainly progress, progress which at times feels like frighteningly much and at other times like far too little.  Hopefully presenting a brief snapshot of the experience and pulling out some of the highlights will help me focus on the areas where I have succeeded as well as those that still need a lot of work.

I have three home visits each week.  During these sessions, we have sort of been going room by room through my house doing exposures.  Of course, we started with my bedroom which is where I spend most of my time.  I now have an established "circuit" of exposures that I am supposed to do each day in my bedroom.  Mostly it involves touching a lot of things I consider dirty and then indiscriminately touching everything else in my room so that it all becomes "contaminated."  I have done well with this despite my initial resistance, even though it still doesn't completely address the problem of my rules...

The OCD rules I live by dictate that you can't touch this and then touch that, or you have to wash this way and under these circumstances before going on to do or touch other things.  So while completing my circuit of exposures forces me to disobey the rules and get used to the idea of everything being sort of "contaminated," I still have trouble breaking "the rules" except in these very pre-defined ways that are part of my exposures.  I am allowed to break the rules when I do my "circuit" and yet, when I am presented with a similar scenario outside my designated exposure time, I am still very reluctant to break the rules.  Here and there I am beginning to let myself off the hook because I realize that what I would like to do has already been done by means of my exposures.  But I still tend to hold myself to my fairly rigid OCD rules, even if they have already been violated in treatment, and even if the contamination aspect doesn't bother me nearly as much as it used to.  A lot of the time the challenge is simply allowing myself to break my arbitrary "rules" in the first place.  Perhaps the idea is that, with enough practice through exposures, I will gradually change my mind about the rules and be less hesitant to break them.

We have also begun to do some cleaning throughout my home.  I live with three guys (most of whom don't care or don't have time to clean) in a large house that has been inhabited by waves of college students year after year as evidenced by the strange assortment of items left behind - stuff that doesn't seem to belong to anyone who currently lives here and that nobody wants or knows what to do with.  Of course, all that stuff, according to OCD, was (and is) off-limits because I don't know where it's been, who it's been used by, or what's been done with it.  Even if the items themselves don't necessarily bother me that much, the rule still stands and I have long just maneuvered my way around it.  With the help of one of my therapists, we cleared this stuff out and sort of indiscriminately tossed most of it, which is sort of an exposure in and of itself, because, though I'm not a hoarder, I do have issues with doing things the "right" way.  When throwing old items away I feel like I have to first make sure no one still wants it, and then figure out whether it can be given away or recycled and where I could take it if it doesn't just go in the trash.  With the exception of some paint and electronics, we just threw it all out.  No double checking to make sure it's not stuff that anyone in our house might just might want.  They've had years to claim what they wanted, and if they still haven't needed it, they don't need it now.  So out all the old stuff went, and my house's living areas are now far less cluttered.

The real exposure in all of that, however, was not throwing stuff out.  Instead, it was just touching it - picking it up by the armful and subsequently touching my face, my hair, my clothes, after which I would then later touch things in my room.  The boundary between my "clean" stuff and the rest of the world has been breached in ways like this over and over and over.  And though my rules about what can be touched and when still stand strong, I think the repetitive violation of those rules in my home sessions has weakened the them some.  Hopefully as the basis of those rules seems to become less important, I will feel more inclined to let them, just as I have slowly let go of many other things in the process of getting better.

And of course, once we cleared a lot of the collective junk out of the house, things needed to be wiped down and cleaned.  And this has been another exposure, not just because it involves touching dirty furniture and such, but because I have to use chemical cleaners to clean them off.  This is where the OCD rules get really strict!!  Though I have not always been so over-attentive to this sort of thing, I have always been anxiously observant of the "rules" about using chemical cleaners, and now that I have pretty severe contamination issues on top of that, it makes using these cleaners extra-triggering.  I worry if I am using the "right" cleaner, in the "right" way, while taking the "right" precautions.  At the same time, I am worried about the ability of the cleaning chemicals to contaminate other things much in the way the way I imagine microscopic amounts of dirt and germs being spread by my negligence.  It is a mental marathon of trying to keep up with whether this touched that - whether I should have touched that door knob or that light switch or pushed back my hair or scratched my arm after wiping down this table with this chemical and so on.  Even if I logically recognize that it is highly unlikely that the average person considers all these factors when cleaning, and even if I am aware that spreading invisible particles of cleaner throughout my environment probably doesn't matter, OCD still commands that the rules be followed, that I KNOW what I am supposed to do and whether I have somehow done something wrong. 

In this area some of the exposures have been more difficult.  As part of my daily homework, I am supposed to be cleaning something with Windex and then not washing.  This is triggering for a number of reasons.  One, because I feel like I am "supposed to" wash my hands after Windex-ing something.  Two, because I feel that whatever I touch afterward is then contaminated with Windex even if I'm not certain I got any Windex on me in the first place.  And three, because I feel like, if I am breaking the "touch absolutely nothing until you have washed after using Windex" rule, I feel like I have to be vigilant of what I touch.  Each time I touch something I question - am I really willing to take this risk?  Can I touch this closet door knob so I can put the Windex bottle away?  Can I touch the sink handle before washing my hands when I do finally wash?  There are a million and one questions like this.  And to some extent, the cross-contamination issues are still about more than just rules in my mind.  Sometimes I really do feel like I might be doing something wrong and getting things dirty in a way I shouldn't.  So yeah, whether it is simply breaking the rules that bothers me or if it's the idea of contaminating things that put me on edge, either way the exposure makes me feel "off."  And that feeling is what I am doing exposure to, in addition to the exposure of not following every single OCD rule.

What else?  I don't know.  I'm sure I am leaving out key details, but I'm still so involved in the process that it's hard for me to step back and see the big picture.

One other note though:  I tend to get tired during this process.  Before I started this program, I would do exposure and then have time to make myself feel "right" about it again, usually by undoing half the work that was done and maybe, just maybe actually habituating to what was left.  Now, I have exposure day after day after day, either with one of my therapists, or on my own.  I don't really have a chance for my mind to catch up completely, for me to make things feel "right" ever.  Things are in a perpetually sort of "off" state, but I guess that's kind of what we're going for.

Some days I feel like I can't do my exposure homework on top of everything else that we have already done.  Some days I do my exposure homework and am made anxious by the fact that my homework doesn't make me that anxious.  That's when the thoughts of, "Oh know?!  Do I not have OCD anymore?  Am I getting better too quickly?  Am I allowing myself to be too careless too easily??" start messing with my mind.   But I guess those feelings are all part of it, too.  It's just more exposure to yet another type of unwanted thought.

Right now I'm just trying to do my best each day without worrying about what comes next or what I might have done wrong the day before.  I often feel like I'm not doing enough, that I should be working harder, but since I also fear that if I really just tried "for real" that I could just "snap out of this" immediately, these feelings of not working hard enough are probably to be expected.  And usually, when I start to question myself about this, wondering if I just got "mad enough" at myself or put the "right" amount of effort in at the "right" time, if I could be better NOW, I usually just get even more anxious which results in greater compulsivity.  The fear that I could "just stop" if "actually tried" is just one more that I have to face during this process.

Maybe if I did "just make myself stop already," I would suddenly be OCD free.  Maybe not.  Evidence suggests that this is probably not the case.  That gradual and repeated exposure to OCD triggers is how the disorder is best overcome, not by convincing oneself in one day to "just stop."  It might work for someone out there, but as much as I feel like I should force myself to stop all at once, past personal experience shows that it usually just exacerbates my symptoms rather than eliminating them.  It's a continual battle in my mind, but I try to remind myself that if there's anything I "should" make myself do, it's my exposure homework.  If I feel like I'm not trying hard enough, then I should try to do more exposures rather than debating whether I am a horrible person for not being able to just stop any and all compulsions cold turkey.

It's a fine line to walk.  If I let myself off the hook too much, I shy away from doing the exposures that I want to succeed at.  If I get mad at myself for "not working hard enough," I often get more anxious and am less receptive to doing ERP, which then makes me even more mad at myself, less willing to endure the discomfort of doing my homework, and even MORE frustrated with myself, and on and on and on.

In general, things work better when I'm nicer to myself, when I take notice of my continual scrutiny of my intentions and effort, but don't try to prove it right or wrong, one way or the other.  I have to remind myself that the point is to just DO, and that discomfort is to be expected, even if that discomfort doesn't come in the form I was expecting.  OCD is devious and constantly comes up with additional reasons to perform compulsions, new reasons to shy away from my homework.  I just have to do my exposures, and accept that I may not have addressed every single question with my therapist, every possible reason to NOT do each part of my homework, and that I may never address them at all.  I just have to accept this and move on anyway, not knowing whether I am doing the "right" things the "right" way at the "right" time.

Wednesday, November 17, 2010

Oh no!! I think I lost my OCD?! Can you help me find it?

Sometimes we are so focused on battling OCD on one front that we hardly notice when it sweeps in from another angle, offering deceptively sweet new reasons to engage in compulsive behavior...
Oh no!  What if I no longer have OCD???  Now those, I think, are officially the words of a crazy person.  Of course, this theme is far from new for me, but it's finding fun new ways to try to integrate itself into my recovery.

Earlier this evening, as I did some of my exposure homework, I noticed something:  Windex doesn't seem to cause me as much discomfort as it did in the not-so-distant past.  I feel like the appropriate response would be:  "Woo hoo!  Hooray!  I must be getting better!  I can do this without it bothering me so much!  Things are getting easier!  Take that OCD!"

Hah.  Wouldn't that be nice.  It's more like: "Wait, hold on.  Does this not bother me so much?  I don't think it does.  Oh no!  I feel differently than I did before...which means...I might not be able to remember how I used to feel.  Quick, this must be fixed!  I have to make sure I can still experience the same amount of fear from this trigger.  Do something compulsive to make yourself worse again!  Go wash your hands for a long time.  Engage in some really bad compulsive avoidance so that you can recapture the feeling you had before, the same level of discomfort you experienced in the past.  You need to remember what that was like!  Because, wait, if you can't remember, maybe you really are really better.  What will you do now?  Who are you?  Your life revolves around OCD.  How will you know who you are anymore? What will you think about?  How will you know what to do?  What to feel? Oh no!"

Lovely, right?  It's just more proof that OCD will use whatever insidious means necessary to keep itself alive.  It resists any and all change, at least in the direction of recovery.  And if the initial reason to perform a compulsion fades, it tries to find new reasons to keep those same compulsions alive.  There could be ten million reasons NOT to engage in rituals, but if OCD can find just one it its favor, it latches onto that one reason with all its might, parading that reason around in my head like its existence depended on it - because, frankly, it does.  The odds are not in OCD's favor when it comes to logic, but it makes an appeal to the emotional part of my mind, and suddenly, against all the odds, OCD has the advantage.  It may not have a lot of ammunition, but when it finds it, it knows how to use it well, and it goes in for the kill.  And suddenly, I find myself tempted to undo my progress, if only to remember what it felt like "before."

It's sort of like the "back door spike" - the kind of spike that occurs when an OCD sufferer realizes that some trigger that formerly caused a lot of distress no longer produces so much anxiety.  Again, at first glance, a reduction in anxiety seems like it could only be a good thing.  But sometimes OCD latches onto that lack of anxiety and uses it as evidence that the one thing or idea that the sufferer fears most really is true.

Take for instance, someone who has OCD harm obsessions.  They do exposure to their harm-related fears, and as a result no longer feel so distraught in response to the unwanted thoughts.  This is what we hope for, this is why we do all these difficult exposures, so that we can learn to manage, and hopefully, reduce some of the anxiety we experience.  But that reduction in anxiety can become the trigger in and of itself and can lead to more obsessing and more ritualizing.  The person with harm obsessions might fear that the lack of anxiety caused by his unwanted thoughts is actually proof that he really does want to hurt others.  The lack of terror he now feels seems to support his original fear - that he really is a killer.

My "oh no I can't remember what it feels like to have OCD" response is similar to the back door spike in that it is caused by an initial decrease in symptoms.  I notice, for example, that the Windex is no longer as alarming as it once was, and that decrease in anxiety is the source of my distress.  However, at the same time, it seems slightly different.  While my improvement is the source of my distress, my feared consequence isn't that what I originally feared is now true - that I really am a bad and careless person for not being as concerned about Windex (though, now that I think about it, this sometimes bothers me, too).  Rather, it's the fear that I won't feel "right" until I can remember just how it felt to experience as much anxiety as I used to.  It's my "memory hoarding" tendency in full swing.  It's the desire to feel like I can remember something solely for the sake of remembering, because my ability feel "right" in the present seems dependent upon whether or not I can actually capture and recreate how I once felt.  Is this compulsion pointless?  Usually.  But it's powerful all the same.  Again, logic doesn't have much power if OCD can find that one convoluted, but emotionally-triggering, reason to give in to its demands.  The argument can be as simple as "you won't feel 'right' if you don't," and soon I find myself struggling to resist the urge to do whatever OCD says I must do feel "right" again.  Even if it means intentionally unraveling my progress.

So, even though Windex and I are still far from becoming bff's anytime soon, the slight reduction in anxiety it triggers has become a trigger in and of itself.  I want to be able to remember what it felt like to fear it, even if that feeling was only marginally different.  Because, to me, that difference is really quite noticeable, and it seems to be the sign of more change to come, which scares me.  Who will I be?  What will I become, if I no longer have these fears?  I'm not exactly sure at the moment, but as long as I am constantly trying to hold on to the past at all costs, I won't have a chance to find out.


That said, I'm going to try to embrace my desire to memory hoard my former feelings as just one more challenge on the road to recovery.  I have to keep reminding myself while I am in this intensive phase of treatment, that the point is not to feel "right."  That's not what I am going for.  Instead, the goal is to be mindful of those thoughts and feelings I am experiencing, and to do my best to continue onward non-compulsively despite them.  Because if you give OCD a cookie...things quickly get out of hand...

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